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9th Annual NKY TBI Conference 3/27/2015
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Carole Paine, MS, L.Ac.
Acupuncture History, Theory and Treatment
of Injury and Trauma
welcomeAncient medicine for a modern world
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
5,000 Years of Wisdom, Knowledge & Healing
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
An ancient system of healthcare
I - A different paradigm of health
IV - Treats more than symptoms & signs
VII - Acupuncture in a nutshell
II - Specific theories & principles
VI - Acupuncturists view of health
III - A unique diagnostic evaluation
V - Time-tested techniques
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
I - A different paradigm of health
• Supports the whole person
• Everything is interconnected
• Innate capacity for healing
Chinese Medicine
• The gardener within
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
• Yin & Yang
• Qi
• Weather reports
• A unique medical language
• Jing & Shen
• Body as a garden
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & PrinciplesYin & Yang
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
• Is the energy that enlivens & animates
Qi
• Supports our daily activities
• Provides nourishment for every cell,
tissue, muscle, organ & gland
• Activates & Animates
• Transforms & Transports
• Warms the body
• Protects & Defends
• Contains & Retains
• A sufficient, balanced & continuous flow
of Qi = good health
To have Life, is to have Qi.
No Qi equals no life.
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
The Elemental Associations
WOOD FIRE EARTH METAL WATER
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
The Elemental Cycle
Fire = Heart, Small Intestine,
Pericardium, Triple Heater
Earth = Spleen, Stomach
Metal = Lungs,Large Intestine
Water = Kidneys, Bladder
Wood = Liver, Gall Bladder
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
The Elemental Clock
Stomach 7-9 am
Spleen 9-11 am
Heart 11-1 pm
Small Intestine 1-3 pm
Bladder 3-5 pm
Kidney 5-7 pm
Pericardium 7-9 pm
Triple Heater 9-11 pm
Gall Bladder 11-1 am
Liver 1-3 am
Lung 3-5 am
Large Intestine 5-7 am
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
How Qi travels through the body.
Qi
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
Meridian & Organ Connections
Qi
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
What happens when Qi becomes blocked?
Qi
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
Blockage of Qi = imbalance
Qi
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
Environment
Diet
Trauma
OccupationHabits
Lifestyle
Inherited Constitution
What affects Qi flow & our health?
Qi
Environment
Diet
OccupationHabits
Lifestyle
Emotions
Inherited Constitution
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
II - Specific Theories & Principles
Wind Heat Dry Cold Damp
• Quick
• Rapid
• Changes
• Moves
• Hot
• Red & swollen
• Cracked
• Withered
• Frail
• Chills
• Stiff
• Aches
• Cold
• Heavy
• Sluggish
• Soft
Weather
Why does diagnosis according to acupuncture &
Chinese medicine sound like a weather report?
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
III - A Unique Diagnostic Evaluation
Quality Quantity Balance
looking Physical exam
An acupuncturist views each individual as a dynamic,
integrated whole, observing how signs and symptoms
weave together in order to understand the underlying,
energetic profile of a person’s health.
pulseasking
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
III - A Unique Diagnostic Evaluation
• Diagnosis is based upon patterns of disharmony
• Symptoms and signs appear when there is an imbalance or
disharmony:
• Yin & Yang
• Interior & Exterior
• Cold & Hot
• Deficient & Excess
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
IV - Treats More Than Symptoms & Signs
• Relieve pain & discomfort
• Eliminate obvious signs & symptoms
• Support immune health
• Balance & maintain organ systems
• Maintain & optimize health
Objective of care
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
V - Time-tested techniques
• Acupuncture
• Herbs
• Moxibustion
• Oriental nutrition
• Qi Gong/Tai Chi
• Electro-acupuncture
• Acupressure/Tuina
• Heat therapy
• Laser therapy
• Self-care
• Meridian exercises
• Gwa Sha
Acupuncturists employ various treatment methods
to restore and maintain health
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
VI - An Acupuncturist’s View of Health
• An inner resiliency
“Health is a state of complete physical, mental, and social well being
and not merely the absence of disease or infirmity.”
– World Health Organization (WHO)
• The ability to thrive when confronted with stressors:
• environmental
• physical
• emotional
• mental
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
What is your body telling you?
VI - An Acupuncturist’s View of Health
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
Adopting a healthy lifestyle
Meditation
Balanced healthy diet
Herbs
Smiles
Exercise
Nature
Yoga
Fresh air
Tai Chi &Qi Gong
VI - An Acupuncturist’s View of Health
Meditation
Balanced healthy diet
Herbs
Smiles
Exercise
Nature
Yoga
Fresh air
Tai Chi &Qi Gong
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
VII - Acupuncture in a Nutshell
• Treated billions of people over thousands of years
• Virtually no side-effects
• Out of 55,291 acupuncture treatments (5 years)
• 64 = minor adverse events
• 99.8% without any event
• Safe, effective and drug-free
Acupuncture is Extremely Safe
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
VII - Acupuncture in a Nutshell
• Tiny
• Cat’s whisker
• Flexible
• Single-use
• Disposable
• Stainless steel
Let’s Get to the Point
©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
VII - Acupuncture in a Nutshell
According to the National Institute of Health (NIH) and the World Health
Organization (WHO), acupuncture has proven effective in the treatment of many
common problems.
• Facial palsy/tics
• Fatigue
• Fertility
• Fibromyalgia
• Gingivitis
• Headache
• Hiccup
• Incontinence
• Indigestion
• Irritable bowel syndrome
• Low back pain
• Menopause
• Menstrual irregularities
• Migraine
• Morning sickness
• Nausea
• Osteoarthritis
• Pain
• PMS
• Pneumonia
• Reproductive problems
• Rhinitis
• Sciatica
• Seasonal affective disorder (SAD)
• Shoulder pain
• Sinusitis
• Sleep disturbances
• Smoking cessation
• Sore throat
• Stress
• Tennis elbow
• Tonsillitis
• Trigeminal neuralgia
• Urinary tract infections
• Vomiting
• Addictions
• Anxiety
• Arthritis
• Asthma
• Carpal tunnel syndrome
• Chronic fatigue
• Colitis
• Common cold
• Constipation
• Dental pain
• Depression
• Diarrhea
• Digestive trouble
• Dizziness
• Dysentery
• Emotional problems
• Eye problems
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
VII - Acupuncture in a Nutshell
1 Wang, R., Integration of Chinese medicine into supportive cancer care: a modern role for an ancient tradition, Cancer Treatment Review, (4): 235-46.
2 Coan, R., Wong, G., et. al., The acupuncture treatment of low back pain: a randomized controlled study, American Journal of Chinese Medicine, (8): 181-189.
3 Loh, L., Nathan, P., et. al., Acupuncture versus medical treatment for migraine & muscle tension headaches, Journal of Neurology, Neurosurgery, and Psychiatry, (47): 333-337.
4 Yang, X., Luo, H., and Jia, Y., Clinical observation on needling extra channel points in treating mental depression, Journal of Traditional Chinese Medicine, (14): 14-18.
5 Fung, KP., et. al., Attenuation of exercise-induced asthma by acupuncture, Lancet, (2): 1419-1422.
6 Hyde, E., Acupressure therapy for morning sickness: A controlled clinical trial, Journal of Nurse-Midwifery, (34): 171-178.
7 Berman, BM, et. al., effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine, DEC 21, 2004; 141(12)901-910.
cancer
pain
headaches
depression
asthmanausea
• Evidence suggests that the holistic approach of Traditional Chinese Medicine
is effective in the supportive care of cancer patients.1
• Acupuncture can provide significant benefits and relief from pain.2
• Acupuncture produces better relief from migraines and muscle tension
headaches than standard drug therapies.3
• Acupuncture is an effective alternative to drugs for treatment of depression.4
• Acupuncture provides a natural approach for asthma.5
• Acupuncture can reduce psychological and behavioral problems that
accompany morning sickness at the same time as it suppresses nausea
and vomiting.6
• Acupuncture produces significant pain relief and improved function in
patients with osteoarthritis of the knee. 7arthritis
Traumatic Brain Injury (TBI): Overview of Diagnosis and Treatment Chung, et al
TBI is currently defined as an ‘alteration in brain function, or other
evidence of brain pathology, caused by external force’.
There is insufficient evidence for acupuncture, hyperventilation;
hypothermia therapy; and speech therapy for improving dysarthria in
TBI (Table 3). Robust trials in these areas is urgently required to
build evidence-based practices in rehabilitation.
TBI is currently defined as an ‘alteration in brain function, or other evidence of brain
pathology, caused by external force’.
• In the sports setting this is basically a significant enough head trauma
that leads to brain injury.
• These injuries will vary in intensity and accordingly vary in level of
dysfunction.
• As the brain is the hub of the nervous system, injury here leads to
whole body affects.
• There is growing concern and focus on treatment of TBI.
• Due to this concern alternative therapies are being considered.
• Many studies have found compelling benefits from use of acupuncture
as a modality.
• Often these studies will say that there is insufficient evidence to fully
support acupuncture.
• However, there is enough interesting data and results to also say
robust study or trials of acupuncture is warranted.
9th Annual NKY TBI Conference 3/27/2015
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Trauma Spectrum Response
TRAUMA SPECTRUM RESPONSE
Cognitive Function
Memory, Attention,
Concentration, Problem Solving
Somatic Function
(fatigue, sleep disturbance,
sexual function)
Chronic Pain
Substance Abuse
Headache
Emotional Function
Anxiety
Depression,PTSD
The effectiveness of acupuncture research across components of the trauma
spectrum response (tsr): a systematic review of reviews Lee, et al
Acupuncture may be a promising whole-person treatment option for TSR as dynamic,
‘multi-mechanism’ responses are elicited by the insertion of thin needles at specific body
points which influence several interacting pathways in trauma response and recovery.
Because acupuncture has been found to be effective in treating several individual
conditions that form TSR (that is, insomnia, depression, chronic pain, headaches) and
other multiple co-morbidities, it could be potentially advantageous for treating the multi-
symptom complex of TSR.
Chronic pain may be better treated with a biopsychosocial approach that considers the
complex interplay of physiological, psychosocial, environmental, cognitive, behavioral,
and affective factors that influence an individual’s pain experience. This whole person
approach can assess the ‘full spectrum of trauma-related morbidities (rather than
individual components)’, in order to enhance the patient’s inherent healing mechanisms
and capacities.
The Elephant in the Room
9th Annual NKY TBI Conference 3/27/2015
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Acupuncture for chronic headache in primary care: large, pragmatic,
randomised trial Vickers, et al
Acupuncture is known to have physiologic effects relevant to analgesia,
but there is no accepted mechanism by which it could have persisting
effects on chronic pain. This lack of biological plausibility, and its
provenance in theories lying outside of biomedicine, makes acupuncture
a highly controversial therapy.
The total effects of acupuncture, as experienced by the patient in routine
practice, include both the specific effects associated with correct needle
insertion according to acupuncture theory, non-specific physiologic
effects of needling, and non-specific psychological (placebo) effects
related to the patient’s belief that treatment will be effective.
Acupuncture for chronic headache in primary care: large, pragmatic,
randomised trial Vickers, et al
Acupuncture for Treatment of Insomnia in Patients With Traumatic Brain
Injury: A Pilot Intervention Study Zollman, et al
Nthe central nervous system depressant effects of these medications may have long-term deleterious
consequences for neural plasticity, and therefore on the ultimate degree of recovery post-TBI.
“Acupuncture using auricular meridian points is equivalent to the use of tranquilizers and sedation.” Further,
“there are no associated adverse effects, drug dependence, or habit formation.”
Of the 8 studies included in this meta-analysis, which specifically addressed outcomes, there was an aggregate
greater than 80% efficacy.
N5 weeks of acupuncture treatment, provided twice weekly resulted in a statistically significant increase I
nocturnal endogenous melatonin secretion and improved sleep onset latency, arousal index, total sleep time, and
sleep efficiency. Anxiety and depression were also significantly reducedN
This pilot intervention study, although not conclusive, supports the contention that acupuncture has a beneficial
effect on perception of sleep or sleep quality and on cognition in patients with TBI.
N recent fMRI studies, suggesting a broad effect (seen with stimulation of a variety of acupuncture points) on
limbic, prefrontal and basal ganglia function.
9th Annual NKY TBI Conference 3/27/2015
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©2011 Acupuncture Media Works, LLC. All rights reserved. No duplication is allowed unless approved, written consent.
“The doctor of the future will give no medicine, but will interest
patients in the care of the human frame, in diet, and in the cause and
prevention of disease.”– Thomas Edison
“Health is like money, we never have a true idea of its
value until we lose it.”– Josh Billings
“Health is a large word. It embraces not the body only, but the mind
and spirit as well…and not today’s pleasure or pain alone, but the
whole being and outlook of a person.”– James H. West
VI - An Acupuncturist’s View of Health
What is Health?
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