Philip A.M. Rogers MRCVS

AP in Pain and Painful Conditions


Axelsson_A; Andersson S; Gu LD (1994) AP in the management of tinnitus: a placebo-controlled study. Audiology Nov-Dec 33(6):351-360. Dept of Audiology, Sahlgrenska Univ Hospital, Gothenburg, Sweden. 20 patients, randomly selected from a large group with noise-induced tinnitus, were studied in order to assess the effect of AP on their tinnitus. A single-blind cross-over design was used. The patients were assigned to two groups: 1=classical Chinese needle AP for 5 wk and; 2=Placebo. The procedures were reversed after a 2-wk interval. AP was given by a Chinese otolaryngologist at points near the ear, and at distal points on the extremities. Placebo consisted of mock electrostimulation via surface electrodes connected to a stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no electric current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. Differences between AP and placebo in annoyance, awareness or loudness of the tinnitus were not significant. Many patients preferred AP due to nonspecific effects (improved sleep, decreased muscle tension and improved blood circulation etc). AP had no specific alleviating effect on noise-induced tinnitus in this short study.

Baischer_W1 (1993) [Psychological aspects as predicting factors for the indication of AP in migraine patients]. Wien Klin Wochenschr 105(7):200-203. Ludwig-Boltzmann-Inst für Akupunktur, Kaiserin-Elisabeth-Spital, Wein. 30 patients with chronic migraine received needle AP after investigation of personality traits, cognitive and social factors. Treatment response was evaluated in 2 different ways (documentation of attacks in a migraine diary and subjective judgment of outcome). From their diaries, the frequency of attacks was halved, with no essential relation to psychological factors. Short duration of illness was the best predictor of a good response to therapy. Patients' subjective judgement showed a mean improvement of 60%. Unlike diary documentation, the subjective response rates were closely related to personality traits. In particular, patients with high scores for extroversion and low scores for neuroticism reported a better response. Age, sex, social status, and expectations of benefit did not show any relation to treatment efficacy.

Baischer_W2 (1995) AP in migraine: long-term outcome and predicting factors. Headache Sep; 35(8):472-474. Ludwig Boltzmann-Inst fur AP, Vienna, Austria. 26 patients (19 women, 7 men), who suffered from chronic migraine according to IHS criteria, underwent AP. In order to evaluate the long-term stability of treatment effects, patients documented frequency, duration, and intensity of attacks as well as analgesic intake in a migraine diary, which was kept for 5-wk periods before treatment, immediately after treatment, and 3 yr later. Posttreatment, 18 patients (69%) had improved >33% and 15 (58%) were improved at 3-yr follow-up. Drug intake was reduced to 50% and did not re-increase until follow-up. Treatment outcome was associated with personality traits, but not depending on demographic data or severity of migraine.

Ballegaard_S; Meyer CN; Trojaborg W (1994) Effects of dry needling of myofascial TPs in the neck region to metoprolol in migraine prophylaxis. J Intern Med May 235(5):451-456. Dept of Int Med P, Rigshospitalet, Univ Hospital of Copenhagen, Denmark. Pain Clinic and Med Dept, Skodsborg Sanatorium, Denmark. This was a randomized, group comparative study; patients, investigator and statistician were blinded as to treatment; the therapist was blinded as to results. Patients were referred by general practitioners or newspaper advertisements to the outpatient pain clinic in N Copenhagen. Included were patients with a history of migraine with or without aura for >2 yr. Excluded were those with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with AP or beta-blocking agents. A total of 85 patients were included; 77 completed the study. After a 4-wk run-in period, patients were allocated to a 17-wk regimen either with AP and placebo tablets or to placebo stimulation and metoprolol 100 mg daily. Results: Both groups exhibited significant reduction in attack frequency (p <.01). No difference was found between the groups regarding frequency (p >0.20) or duration (p >0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (p <.05). ConclusionS. Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.

Beppu_S; Sato Y; Amemiya Y; Tode I (1992) Practical application of Channel AP treatment for trigeminal neuralgia. Anaesthesia and Pain Control in Dentistry Spring 1(2):103-108. Tsurumi Univ Sch of Dental Med. This report evaluates the effect of Channel AP treatment on trigeminal neuralgia. 10 patients aged 26-67 yr (mean 55 yr) were studied at the Dental Anaesthesiology outpatient Clinic of Tsurumi Univ Dental Hospital from 1985-1990. 5 had idiopathic and 5 had symptomatic trigeminal neuralgia. The patients had Channel treatment by AP alone or AP combined with moxibustion. The AP method used was mainly by simple needling. Channel AP treatments were repeated from 2-4 times/mo. 5 patients were restored to a pain-free state. The other 5 patients reported less pain, but with some level of pain remaining (significant pain in one patient). Channel AP treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia.

Biondi_M; Portuesi G (1994) Tension-type headache: psychosomatic clinical assessment and treatment. Psychother Psychosom 61(1-2):41-64. Terza Clinica Psichiatrica, Universita La Sapienza, Roma, Italy. Tension-type headache (TTH) is an ill-defined nosographic entity. The classification of headaches according to the Headache Classification Committee of the International Headache Society is closer to clinical reality with respect to the past classification. From an aetiopathological standpoint, unified hypotheses to explain primary headaches are interesting. Treatment requires a thorough diagnostic framing, which should include its psychosomatic aspects, focusing on the individual patient and the history. Many studies tried to characterise headache from a psychological viewpoint, but they were unable to provide useful generalisations. None of the currently available treatments (drugs, biofeedback, psychotherapy etc) were clearly superior to the others; the choice should involve an intervention targeted on the most important factors in individual cases. Though interesting results are reported, the efficacy of AP and other physical therapies are difficult to assess and should be reserved for particular cases.

Carlsson_J1; Rosenhall U (1990) Oculomotor disturbances in patients with tension headache treated with AP or physiotherapy [see comments]. Cephalalgia Jun 10(3):123-129. Dept of Neurology, Univ of Göteborg, Sweden. 48 female patients with chronic tension headache were randomized into 2 treatment groups: physiotherapy and AP. The patients were examined using oculomotor tests. Intensity of the headache and tenderness of the trapezius muscles were assessed in accordance with graded scales. The mean velocity gain for smooth pursuit eye movements improved for all target velocities both in the physiotherapy group and in the AP group. The latency was reduced for all 3 gaze angles in the physiotherapy group while no improvement occurred in the AP group. There was a reduction of headache intensity in both groups while tenderness of the trapezius muscles was reduced in the physiotherapy group but unchanged in the AP group. A significant correlation was found between the mean velocity gain and tenderness of the trapezius muscles.

Carlsson_J2; Fahlcrantz A; Augustinsson LE (1990) Muscle tenderness in tension headache treated with AP or physiotherapy. Cephalalgia Jun 10(3):131-141. Dept of Neurology, Univ of Göteborg, Sweden. 62 female patients with chronic tension headache were randomized into 2 treatment groups, AP and physiotherapy. The intensity of headache, muscle tenderness and neck mobility was assessed before and after treatment. 30 healthy women were used for comparison. Before treatment it was found that muscle tenderness was increased and neck rotation was reduced in the patient group compared with controls. There was a significant correlation between the intensity of headache and muscle tenderness. After treatment, the intensity of headache and muscle tenderness were reduced in both treatment groups. The headache was more improved in the physiotherapy group, and there was a marked reduction in the intake of analgesics. The tenderness was reduced in all muscles tested in the physiotherapy group but only in some of the muscles after AP. The limitation of neck rotation was not influenced by either treatment.

Carlsson_J3; Augustinsson LE; Blomstrand C; Sullivan M (1990) Health status in patients with tension headache treated with AP or physiotherapy. Headache Sep 30(9):593-599. Dept of Neurology, Sahlgrenska Hospital, Göteborg, Sweden. 62 female patients with chronic tension headache were assigned at random to 2 treatment groups: 1=AP; 2=Physiotherapy. Their overall function (Sickness Impact Profile), and mental well-being (Mood Adjective Check List) and the intensity and frequency of headache were assessed before and after treatment. Before treatment the patients showed significantly more dysfunction and less positive mental well-being than a general population sample. Both treatment groups improved in overall function, the physiotherapy group somewhat more. The mental well-being increased only in the physiotherapy group. The intensity and frequency of headache was significantly reduced in both the physiotherapy group and the AP group. The intensity of headache was significantly more improved in the physiotherapy group. The improvement of headache intensity persisted unchanged 7-12 mo after treatment.

Chen_P (1991) AP at Yangsheng point to treat voice ailments in 110 cases. JTCM Dec 11(4):261-262. Art phoniatrics Laboratory of Shanghai Conservatory of Music, Shanghai College of Music, PRC.

Costantini_D; Tomasello C; Buonopane CE; Sances D; Marandola M; Delogu G (1995) Treatment of trigeminal neuralgia with EAP: Experience with 104 cases. Ann Ital Chir May-Jun 66(3):373-378. Inst di Anestesiologia e Rianimazione, Univ degli Studi di Roma La Sapienza. Essential or secondary trigeminal neuralgia is a very common incapacitating disease. Med or surgical conventional therapies are often inadequate. In this study we evaluated the effects of the AP therapy on 104 patients (mean age 52+13 yr) with idiopathic or secondary trigeminal neuralgia. EAP was used on local and distant points, or on tender points in the secondary form. Each course was 12 sessions. Three parameters (reappearance of the symptomatology, absence of pain in months and preceding treatments) were evaluated on a 4-point scale (very well, well, fair and null). EAP was an effective treatment in all kinds of secondary trigeminal neuralgia; success in the idiopathic form depended on previous medical treatments and the origins of the disease.

Di_Concetto_G; Sotte L (1991) Treatment of headaches by AP and Chinese herbal therapy: conclusive data concerning 1000 patients. JTCM Sep 11(3):174-176. Italian School of Chinese Med, Gruppo di Studio Societa e Salute.

Ge_S; Xu-B; Zhang-Y (1991) Treatment of primary trigeminal neuralgia with AP in 1500 cases. JTCM Mar 11(1):3-6. Dept of AP, Shenyang Hospital, PLA Air Force, PRC.

Halevi_S01 (1996) AP and snail shell moxibustion to treat eye diseases: Part 1. Originally published in the CMJ (UK). [Dr Shmuel Halevi is a practitioner of TCM, practising in Israel: WebMaster]. The 40-yr old man who came to my office at the beginning of June 1994 was desperate. He was a police captain with no previous health problems. His job was very demanding, and for many years he had spent most of his time at work. 2 wk before our appointment, Mr A (the patient) had a terrible quarrel with his superiors, after which he immediately felt intense heat rushing up to his head. Right after this he experienced a flash-like sensation in his left eye, followed by a stabbing pain inside the eye and loss of vision.

Alarmed and in pain he went to see the police physician who referred him to an eye specialist at a nearby hospital. Pictures of the fundus of the eye were taken, and the diagnosis was severe rupture of blood capillaries, causing Internal haemorrhage and Xue-Stasis which prevented vision. The specialist suggested a laser operation in order to repair the ruptured capillaries. This could only be performed after the blood had been reabsorbed, which would probably take at least 6 mo. Thus, seeing only blurs with his left eye, and with such a depressing prognosis, Mr A fell into a state of severe depression, fear and anxiety.

When I examined him on his first visit his pulse was slightly fast (around 6 beats/respiration), the left Inch/Cun position (HT) was slightly elevated, hard and tense, his left Gate/Guan position (LV) was strong and wiry, and the Foot/Chi (KI) position on both wrists was deep and barely palpable. His tongue was pale, lifeless and had a blue-purplish hue. Both inner eyelids had red-purple stains of Xue-Stasis.

Suspecting a tendency to sudden flaring up of LV-Yang based on KI-Yin Xu, I questioned Mr A; he admitted that sometimes, especially when he became irritated, he felt that his entire head heated up and began to perspire. Thus, a fast and wiry pulse in the positions of HT (left Cun-Inch) and LV (left Guan-Gate) indicated LV-Qi-Stasis, resulting in ascending Yang which speeded up HT rate and pushed Xue towards the head. The trauma to his eye happened due to a sudden and intense rage which had set the mechanism described above into motion. This was presumably the "last straw" for already weakened capillaries. This picture is supported by the observation of Xue-Stasis within the inner lid. Most cases of Xue-Stasis have KI-Xu as the basic cause; in this case (KI-Xu), KI was weakened by many strained working hours over many years. Other signs, such as lower back pain, tenderness at left GB25, and a distended lower abdomen all confirmed this observation. If combined with very strenuous working conditions and anger (he was a police-officer), this may put into motion LV-Yang activity that further exhausts KI-Yin, making a vicious circle that is bound to end in a crisis. The reason why this accident had happened in the left eye, rather than in the right, was because in most acute crises, where Yangqi-Shi (excessive Yang movement) is the cause, the left side is more likely to be affected. The classics say: "All the Yangqi goes to the left, while the Yinqi goes to the right". My first treatment aimed to calm the patient, relieve anxiety and relax tension. I assured him that his prognosis in TCM was very good, and that he should refrain from Heating foods (spices, coffee, alcohol, etc), take a 1 mo vacation and come for treatment daily. I then needled the following points: HT07, PC06, left Z 09, GV20, LV03, left GB37, SP06. HT07, PC06 and SP06. This is a fast acting, efficient formula to reduce HT-Fire, calm the Shen-Spirit and relax the nervous system. LV03, GV20 and SP06 is also a renowned formula to sedate LV, subdue LV-Yang, and assist in calming HT. Z 09 and GB37 were chosen to treat the left eye. The combination of those two points, one local and one distal, can reduce Heat, circulate Qi in the eye and brighten the eye. Z 09 + LV03 + GB37 together can resolve Qi-Stasis via LV. The combination of LV03 and GB37 is based on the principle of combining the Yuan point on the main affected Channel with the Luo point of its Phase-Mate (Yin-Yang Paired) Channel. All points were manipulated by the Xie (reducing) method e.g. counter-clockwise rotation, forceful lifting and slow thrusting the needles on the extremities were directed against the direction of flow of Qi in the Channels.

In <10 min Mr A reported that he felt very sleepy and that he had a comfortable feeling in his left eye. The needles were removed after 30 min and he was asked to come back the next day when his pulse rate was only 5 beats/respiratory cycle, and his left cun and guan positions had lost their hard and wiry quality. He reported that he had slept heavily for 10 h that night, and that his mood and overall feeling had radically improved.

Mr A's second treatment began with left GB20, manipulated first by Xie (Dispersing) technique, then immediately followed by the "Dragon Wags its Tail" technique which is effective to move Qi rather forcefully. The handle of the needle is wagged to and fro with one hand while the other hand massages the Channel in the direction chosen to Propagate the Channel Sensation (PCS). Thus, Mr A felt the needle sensation climbing up his skull and ending deep in his left eye. In subsequent treatments, however, there was no need to massage the Channel route. Manipulating the needle at GB20 was enough to cause the same effect. As soon as the needle sensation reached the left eye (usually after 10-15 sec), the patient was asked to lie supine with the GB20 needle in-situ (and with a pillow to support the head). The other points were then punctured in the following order (all on the left side): LI04, LI11, Z 09, Qiuhou (Extra) to be alternated every other treatment with ST01, ST36, LV03 bilaterally. GB37, LI04, LI11, ST01 and ST36 form a chain of points situated on the left Hand and Leg Yangming Channel. This Channel has much Qi-Xue, and is therefore usually used to resolve Qi-Xue Stasis. Also, all of these points have a strong effect on disorders of the head region. Qiuhou (Extra) and/or ST01 brighten and benefit the eye, Dispel Wind and Clear Heat. This point prescription was aimed at forcefully moving Qi-Xue via the Yangming Channel in the left portion of the hand in general, and in the left eye in particular. Also, as the main cause of the disorder, LV-Shi had to be further sedated, utilising points that have an effect both on LV and the eye. After obtaining Deqi, all the points on Yangming Channel were manipulated in the same fashion as GB20. LI04, LI11 and ST36 were very responsive, and always gave rise to a distinct sensation, travelling proximally and terminating around or inside the left eye. While ST36 was manipulated, Mr A could track the flow of sensation across his thigh, abdomen and chest, and usually pointed with his right finger to ST08 as the last station of the travelling sensation. GB37 was manipulated by the same technique. Z 09 was manipulated by simple lifting-thrusting with small amplitude movements, and initially gave a sensation of a deep stabbing sensation inside the eye, which subsequently changed to round waves encircling the inside of the eye. For ST01 and Qiuhou (Extra), the patient was asked to roll his eyeballs upwards and the needles were quickly inserted to a depth of circa 1 cun, until a pressure was felt behind the eye. All points were left in-situ for 30 min each time.

At the end of a course of 10 treatments (12 d), Mr A could read freely, except for very small letters, and could drive his car. He regained his confidence, slept well and enjoyed his enforced vacation.

Halevi_S02 (1996) AP and snail shell moxibustion to treat eye diseases: Part 2. Nevertheless, he could not differentiate colours at this stage. Even though he experienced remarkable Deqi with needling, I decided at this point to apply moxa to his eye in order to disperse Xue and Fluid within the eye more vigorously. I had read of a renowned Chinese physician who used an empty walnut shell, soaked in herbal tea, as a heating device (with moxa) to treat eye I disorders. I devised my own version by using an empty and sterilized snail shell of about the size of a human eye. A snail shell has some unique qualities, which make it superior, in my opinion, to a walnut shell. It conveys heat in a very moderate and tolerable way, is quite resistant to intense heat and does not crack easily. Its conch-like shape allows the heat, stemming from its top, to concentrate and conduct itself through the inner tunnel, until it reaches and penetrates the eye. Another feature of this shell may be an ability to soothe and descend LV-Yang. Even though, as far as I know, snail shell is not a substance used in the Chinese materia medica, it resembles in shape and quality other substances which are. Substances such as Shi Jue Ming (Concha Haliotidis), Zhen Zhu (Margarita) and Mu Li (Concha Ostreae) can subdue LV-Yang, and many of them are used specifically for eye diseases associated with disturbance of LV-Yang. Assuming that substances similar in shape and construction usually bear parallel energetic qualities, it was reasonable to expect promising results. Thus, 10 min after needles were inserted at Z 09 and ST01, I withdrew the needles, and laid the snail shell over the left eye, covering the whole eye region, and pressing gently against the skin. Over the top of the shell I ignited a moxa cone the size of 1 ml, and let it burn to the end. This procedure was repeated 3 times in each session. The outcome of this technique was quite remarkable. Mr A reported an extraordinary feeling and movement engulfing his eye, giving him a relaxed and pleasant sensation that he had never experienced before. Right after the first session his colour differentiation improved, and his eyesight brightened even more. After 2 more sessions with the snail moxibustion he was able to distinguish colours normally. This treatment was continued twice/wk, substituting BL01 for ST01. This was done in order to reduce oedema (enhance fluid absorption) in the eye fundus. BL01, the last point of Yinqiao Mai, can absorb Yin-Shi from around the eye. Thus, it is often used to treat somnolence, excessive lacrimation, glaucoma, etc. Also, and in order to affect this goal even more radically, KI06, being the master and first point of the Yinqiao Mai, was occasionally punctured bilaterally. Mr A was discharged after 20 treatments, and had regained his eyesight almost as it was before the accident.

Other case histories.
In the past year I have treated 5 more patients suffering from the same eye disease, in various degrees of severity. These patients were referred to me either by a "chain reaction" from patient to patient or by eye specialists who had heard of the previous case. The clinical success was excellent in all these 5 cases, ranging from marked improvement to complete cure. Convinced that this snail shell technique is promising, and considering the interest this case has raised, I decided to write a few more lines and elaborate as much as possible on this technique.

It is not in the scope of this article to give a full account of the other patients who were treated in the past year for this illness. Nevertheless here is some general information which has direct link to the understanding of the possible diversities of this disease. The patients, all male were aged from 40-64. The duration of the problem was 3 wk-2 yr. The severity was from a complete blur and undeciphered picture to a broken or twisted image, mostly described as looking through half a glass of water. Number of sessions: 7-24. WM diagnosis: Internal haemorrhage and/or thrombosis. TCM diagnosis: all patients had a primary diagnosis of internal eye haemorrhage. The aetiologies were as follows: 3 patients due to Shi of LV-Yang-Fire causing rupture to the eye capillaries; 1 patient had an underlying KI-Qi-Xu and SP-Yang-Xu as the main cause, and LV-Xue-Xu as a secondary cause; 1 patient had a Damp-Stasis (an obese person), with subsequent watery and puffy eyes.

Clinical considerations: The main objective of the treatment, regardless of the underlying Syndrome (whether Xu or Shi), was to disperse and recirculate the extravasculated blood inside the eye.

Xie (Dispersing) techniques usually are used in Shi Syndromes. This internal eye haemorrhage was absolutely Shi, although it may occur in a basic Xu Syndrome, for example, SP-Yang-Xu making SP unable to hold the Xue in the blood vessels. Xie techniques must be applied mostly to points near the eye, using also secondary points with a strong general ability to move Xue.

The underlying cause (Shi of LV-Yang or Xu of KI-Qi and SP-Qi) must also be addressed, but with less emphasis. This aspect of treatment is given to support the main course which is (as said before) the dispersion of Xue Stasis. If an underlying Xu Syndrome predominates, and the patient is generally very weak, strengthening methods should be applied in the first place and only then the main problem should be addressed.

After an improvement has occurred and the patient can see better, a gradual shifting of the treatment focus towards the underlying imbalance must take place. After the eyesight has been restored to the maximum degree possible, the remains of the underlying imbalance should be eliminated by all means possible (herbs, AP, diet management, etc).

Regardless of the basic imbalance, snail shell moxa can be used in all cases except one, an underlying state of either LV-Fire or HT-Fire. This manifests as symptoms of flushed face, very red inner eye lids, hypertension and unambiguous dislike of Heat. In such cases, snail shell therapy is contraindicated until this inner imbalance is resolved.

Point-selection: Main points: BL01, possibly the most potent point to treat any eye disease. It is suitable for any possible imbalance, whether Yin or Yang Xu in the eye, or Stasis of Wind, Heat, Damp, Xue or Cold. It is the cross point of the Yinqqiao Mai and Yangqiao Mai which greatly influence the eye. ST01 is a very potent point for eye disease. It is situated in the intersection of the CV, ST and Yangqiao Mai. Being a ST point makes it even superior to BL01 to Xue and/or Heat Stasis. Qiuhou is a wonder point in all afflictions of the optic nerve. It is therefore used whenever a marked deterioration of eyesight is a main symptom. Secondary points: GB20, which intersects the Channels of the GB, TH and the Yangwei Mai. All these Channels either begin or end near the eye. GB20 is indicated for all eye diseases, and is especially appropriate for dispersal purposes of Qi, Xue, Wind, Heat etc. LI04 is the best distant point to use for eye afflictions whenever a strong Qi moving effect is desired. This point is used in the contra lateral side of the diseased eye. SP06 has a strong effect on either the quality and/or the state of the Xue in general.