Self-reflection and Learning Goals 3: Level 2

        On the first day of my last term as a level 2 intern, I arrived to find a first term level 1 intern, Jordan, had accidentally been put in a treatment room alone and without a resident. She was clearly nervous and upset to be alone in the room, so I asked my partner, who was also a last term level 2 intern, if it would be alright if I treated with her. Once I moved into the room we quickly fell into an easy rapport and I ended up acting as a sort of resident to her. When the next week came around our supervisor said she had talked with Lesley and she was planning to set up a resident for Jordan. To my surprise and delight, Jordan asked if it was alright if she simply stayed partnered with me and if I wouldn't mind continuing to help her as I had the first week. That first week I had truly enjoyed helping Jordan, so I quickly agreed.
      We spent the rest of the term as partners and, aside from enjoying the work we did together, we quickly became friends. I loved assisting her, asking her questions and giving her advice. So much of my TCM clinical knowledge was solidified during those twelve weeks. I've always been the type of person that needs to talk through ideas. I gain so much from just saying thoughts out loud and hearing other's opinions. Sometimes even saying something out loud to myself provides enough inspiration to make an important decision or accomplish a task. The experience also gave me a great deal of confidence. Having to articulate one's thought process and defend one's ideas can be challenging. Doing that with Jordan every week showed me I understood TCM much better than I gave myself credit for.
      I remember when I first came to AOMA, before there were residents, talking to interns and they would say the best thing to do was find a more advanced intern who was willing to mentor you. The idea of that sounded great but also stressed me out. It was not something the school helped put together for you and it made me nervous to think I wouldn't find an advanced intern to be my mentor. When I found out they were doing the resident program I was so relieved and thankful. Having a resident when I was a new intern made that experience vastly more secure. As a new intern the main benefit of having a resident really ends up being to calm your nerves so your brain will work through a treatment. While the main benefit of being in a resident position is you learn a great deal about yourself as a leader and teacher as well as solidifying your TCM knowledge and proving to yourself just how much you know.

Herbal Intern Reflection 3: J.F. 6/15/16

J.F. is a female in her mid-30s. She reports a "tearing" pain in her LLQ that began 3 weeks prior during intercourse. She visited an ER 10 days prior and they found she had a ruptured cyst. Pain has remained around a 4/10 but can get to 8/10 when she moves in specific ways. No pain during or after BMs, nor any change in BMs. Patient has a history of uterine fibroid surgery.
     After prolonged questioning Dr. Shen, myself and the other herbalist came to the conclusion that her pain is most likely caused by old scar tissue adhesion that was torn or pulled. We informed the patient of our thoughts on the case, but encouraged her to visit a gynecologist as soon as was convenient.
     The patient was open to using powdered herbs but stated she only wanted herbs to support her underlying deficiencies and not to treat the pain or the "tear." We discussed this with Dr. Shen and came to the conclusion that treating the pain was of primary concern. Despite this Dr. Shen reminded us that J.F. was our client and we could not simply disregard her wishes. Our resolution was a base formula for dispelling blood stasis in the abdomen, especially when related to the female anatomy and modifying it with herbs that tonify KD, LV while also working with blood and yin.
    Before we filled the script we realized we had to convince the patient that what we were doing was the best course of action, without discounting her own desires. Luckily, she was amenable and we were able to explain to her the benefits of our formula choice. The final addition to our prescription that we would call her in one weeks time to see how things were going.

Herbal Intern Reflection 2: P.W. 5/31/16

P.W. is a mid-40s female coming in for neck and shoulder pain. This is her first time receiving treatment at the AOMA clinic. Her treating intern did an excellent and through intake but because of how many physical and mental issues the patient had became a bit lost. P.W. is a single mom, has anxiety, and has unspecified alcohol dependency. She is also on a long list of western prescriptions ranging from muscle relaxants to blood pressure diuretics to Cymbalta and proton-pump inhibitors. The treating intern wanted me to prescribe something for her underlying symptoms. After reviewing her long medication list I had to inform him that I didn't feel comfortable doing that at this time. I felt this to be the best course of action for three reasons, one: Cymbalta, specifically, has many drug interactions and precautions including a higher risk of bleeding especially in the stomach. The second reason being that in order to treat her blood stasis, ST Qi rebellion and high blood pressure the herbs we would want to use could harmfully enhance the effects or side effects of the drugs she's already taking. The third reason was due to her alcohol dependency. Without knowing the full effect alcohol has had on her body it would be dangerous to put her on herbs. Once I explained these reasons to the treating intern he agreed with my assessment and went ahead with his acupuncture treatment. Treating someone who is or was an alcoholic or has abused alcohol is not something I'm opposed to or wouldn't want to do in my future treatments but I think it's vital to know the full history before prescribing anything. Finding out this information can take time and require trust before the patient may want to tell you all the information.

Intern Reflection 1: J.G. 3/11/14

Self-reflection and Learning Goals 1: Level 1 Term 2

Set of 3 Intern Reflection 1: K.C. 3/27/14, 5/1/14, 5/15/14

Pre-Internship Reflection 5: M.F. 5/1/13

Pre-Internship Reflection 4: E.C. 2/14/13

Pre-Internship Reflection 3: S.S. 1/22/13

Pre-Internship Reflection 2: N.L. 11/15/12

Pre-Internship Reflection 1: M.D. 8/28/12

Coursework: A Personal Reflection on the Five Elements and their Emotions

A Personal Reflection on the Five Elements and their Emotions

 Clinic Communications II

AOMA Summer 2015

Water

Nature of the Qi/A place before structure and conception.

Something that has been of interest to me for a long time is the connection and relationship between our “heart and mind.” How do they communicate? How do they trust each other? I find it interesting that perhaps what I have been referring to as the “heart” is more akin to water, to the kidney Qi. It is the deepest mind, or what I also call “the lizard brain,” that instinctual part of ourselves that only feels, it cannot see or hear, it cannot rationalize. It lays deep inside our bodies and connects us to our deepest desires, the inmost request. (more on this later)

Wood

Ability to say"No"

I find great power and protection in saying "no". In fact, I often have said "no" to things before they were even asked of me. I remember being in elementary school and when all the other girls would be sitting together at lunch I would choose to sit apart from them. I would reject them before they could reject me. I found power and control in that choice.

Spontaneity

Now I find myself surrounded by spontaneous “yes” people. Sometimes they can say it to a fault which can anger and frustrate me. I find it hard to watch them be unable to say no when they really need to or want to. But I think as much as I love being able to say no, to defy others, I surround myself with those “yes” people in order not to isolate myself too much. I know I’m good at planning and decision making, so surrounding myself with more flexible people has taught me how to be more bendable myself.

Fire

Spirit

As I mentioned before, I’ve always had an interest in the relationship between the “heart and mind.” What I’ve realized thru this class is that what I’ve been calling the heart is more akin to the kidney Qi and what I was calling the mind was really the heart Qi: the higher mind, or the rational mind, how we perceive each other and ourselves. As we have heart/kidney imbalance so too we can have heart/mind imbalance. How often we have all experienced knowing something in our higher mind/heart Qi to be true but feeling with our deeper emotion the very opposite. I had an experience many years ago where I followed that deeper instinct/kidney Qi and I shut out my higher mind/heart Qi. It was the wrong choice and caused me many years of pain and sorrow. After it was over my heart Qi took over and I built a great wall around my kidney qi. My heart Qi was angry at my kidney Qi for leading me so far astray and it took many years before I was able to help rebuild the trust between the two. Now I always try and sit in peace and listen to the voices of each in the hopes of keeping that balance safe.

Earth

Part of a group/Connection

Growing up in LA I never felt like I belonged. I always felt like an outsider and wondered if I would ever truly feel comfortable in my own skin. When I went to Bennington college in Vermont it was like this huge weight had been lifted. I felt like myself, among my own spiritual tribe. I felt beautiful, accepted and understood. Living in Austin has definitely made me feel the same, perhaps even more so. While I still am very connected to the northeast, there is some part of it that I find old and stuck in certain traditions, especially when it comes to creativity. In Austin, I love the unabashed love of the weird and different. It’s so inspiring and makes me feel like anything is possible in my future.

Metal

Nature of Qi/Rhythmic order.

In the tarot the death card is one of my favorites. Death, a skeleton strolling peacefully through the world is smiling because he knows what follows him: new growth. Without death, life would lose it’s preciousness. Without pain there would be no pleasure and maybe more importantly, there would be no understanding of the worth of that pleasure. I hate how in movies and shows when they show the death tarot card it always represents a bad omen. Just another example of how American's view death, with fear and misunderstanding. Death is not evil or cruel, it just is.

Coursework: Research Study on Radix Bupleuri (Chai Hu)

Research Study on Radix Bupleuri (Chai Hu)

 Herbology I 

                                                                   AOMA Fall 2013        

           

            The Chinese herb known as Chai Hu is the root of Bupleurum Root Radix Bupleuri. It is part of the Umbelliferae family and is collected in the spring and autumn. Its preparation is to dry it in the sun, slice and use raw. It can also be bake-fried with wine or vinegar to produce different effects. It has aromatic qualities which disperse and lift, it is bitter for purgation and pungent for dispersion. These qualities release half-interior half-exterior pathogenetic heat, regulate the circulation of Qi, sooth the liver and elevate Yang to treat Qi sinking in the middle Jiao (Zhixian & Xingdong, 2004).

            Chai Hu is considered the key herb for treatment of a Shaoyang syndrome. When the pathogenic factor is halfway between interior and exterior the condition is rather complex since the patient can exhibit both interior related and exterior related symptoms (Zhixian & Xingdong, 2004). Of all the symptoms exhibited the most essential one for diagnosis of Shaoyang Syndrome is “alternating chills and fever.” In TCM diagnosis, Malaria is sometimes considered a shaoyang disorder due to patients often exhibiting alternating chills and fever. Chai Hu guides the trapped pathogenic factor outwards and harmonizes the interior and exterior (Chen & Chen, 2004).

            Chai Hu’s ascending and dispersing characteristics are also commonly used to spread Liver Qi and unblock Liver Qi stagnation. It can be combined with many different herbs to treat specific manifestations of Liver Qi stagnation such as emotional distress, hypochondriac fullness and pain, cold extremities, migraine, eye pain and swelling, irregular menstruation with cramps and jaundice (Chen & Chen, 2004).

            It’s ascending nature is also excellent for lifting Yang Qi. If there is a Qi or Yang deficiency causing prolapse of internal organs Chai Hu can be used to raise and tonify Qi, especially if paired with Sheng Ma and Huang Qi. Chai Hu treats prolapse of the rectum and uterus, hypermenorrhea, lingering diarrhea and polyuria caused by deficiency and sinking Qi in the middle Jiao (Chen & Chen, 2004).

            Chai Hu is part of a formula called Long Dan Xie Gan Tang which clears and drains damp-heat from the lower Jiao and drains excess fire from the liver and gallbladder. Due to Chai Hu’s dispersing quality it is added to the formula to dissipate the excess heat being retained. Having this function qualifies it to be the second deputy of the formula. Together Huang Qin and Zhi zi make up the first deputy because they not only clear heat but also drain damp, a quality Chai Hu doesn’t possess. Chai Hu is especially vital to the formula because it plays a second role as an envoy. One of the jobs of an envoy is to guide the effects of the other herbs to specific channels. Chai Hu enters the liver and gallbladder channels, so as an envoy in this formula it leads the other herbs to those channels (Kim, 2008).

            Chai Hu has been used in Chinese medicine to treat Liver Qi stagnation for thousands of years but in 2005 it’s chemical effects relating to Liver Qi stagnation were tested by doctors at the Beijing University of TCM (Chen, Ji, Lu, Hu, 2005). The study examined the effects of Xiao Yao San containing Chai Hu on patients with Liver Stagnation and Spleen Deficiency Syndrome (LSSDS). The study looked at 58 patients suffering from depression, hypochondriac pain, listlessness, flatulence and loose stools. They assessed changes in the plasma indices of norepinephrine(NE), epinephrine(E), dopamine(DA), beta-endorphin(beta-EP), adrenocorticotropin hormone(ACTH), estradiol(E2), testosterone(T), immunoglobulin A (Ig A) and G (Ig G) (Chen, Ji, Lu, Hu, 2005). After subjects in the experimental group had been taking Xiao Tao San containing Chai Hu for one month there was a significant decrease in their self-rated anxiety scale (Chen, Ji, Lu, Hu, 2005).  Blood samples of the experimental group showed their plasma beta-EP was enhanced and their E and DA were decreased. These finding suggests that Xiao Yao San containing Chai Hu treats patients with LSSDS by it’s regulation of beta-EP, E and DA (Chen, Ji, Lu, Hu, 2005). Beta-EP has a close relationship with emotional disorders and imbalance. One of Chai Hu’s actions in the Long Dan Xie Gan Tang formula has to do with it’s relationship to the liver and gallbladder. This study supports Chai Hu in this formula because all the studied plasma hormones have important biological connections to the liver and specifically deal with emotions which could be linked to Liver Stagnation.

            In 2012, two studies were published in which the effects of Chai Hu was investigated. The first one looked at how Vinegar-Baked Chai Hu (VBCH) treats obesity and hyperlipidemia. In previous studies it was shown that VBCH had a much stronger effect on migrating pain and bile secretion than with raw Chai Hu, but little was known about it’s effect on lipid regulation (Tzeng, Lu, Liou, Chang & Liu, 2012).  The 2012 study found that VBCH suppressed the growth of adipose tissue mass as well as bodyweight gain. These finding suggest that it may inhibit lipid accumulation in adipose tissues, most notably in the liver (Tzeng, Lu, Liou, Chang & Liu, 2012). This is an important finding because ectopic accumulation of lipids in the liver is associated with many diseases including metabolic syndrome and type 2 diabetes (Tzeng, Lu, Liou, Chang & Liu, 2012). Though Long Dan Xie Gan Tang wouldn’t specifically be used to treat obesity, type 2 diabetes and hyperlipidemia, many symptoms it treats could be secondary indications for those disorders; such as, glaucoma, uveitis, pyelonephritis, eczema, headaches, etc. (Kim, 2008).

            The second 2012 research paper is directly related to Long Dan Xie Gan Tang as it has to do with the treatment of hyperthyroidism. Hyperactivity of the thyroid promotes an accumulation of oxidatively damaging molecules and since the liver is a major target organ for thyroid hormone, this directly leads to liver damage (Kim, Kim, Chung, Cheon, Ku, 2012). Researchers induced hyperthyroidism in rats and administered Chai Hu to the experimental group. Chai Hu significantly inhibited histopathological changes in the thyroid by reducing the thickness of the follicular lining of the epithelium (Kim, Kim, Chung, Cheon, Ku, 2012). This shows that Chai Hu has direct control on hyperthyroid states. By decreasing epididymal fat, liver damage was inhibited and liver antioxidant defense were enhanced (Kim, Kim, Chung, Cheon, Ku, 2012). Long Dan Xie Gan Tang can be prescribed for hyperthyroidism already, so these findings further enforce its effectiveness in this pursuit. Chai Hu’s actions of dispersing heat and focusing the other herbs towards the liver and gallbladder are now even more significant.

            There are currently no herb-drug interactions for single Chai Hu, though their are a few for the formula which Chai Hu is a part,  Xiao Chai Hu Tang (Minor Bupleurum Decoction). It was shown that after administering Xiao Chai Hu Tang the bioavailability of Tolbutamide, a type 2 diabetes treatment, was reduced. It was also reported that Xiao Chai Hu Tang may cause an increased risk of acute pneumonitis. The formula did not directly produce any lung tissue damage but may be over stimulating the neutrophils which cause damage which is then repaired by fibroblasts leading to an increase in pulmonary fibrosis (Chen & Chen, 2004).

            Chai Hu’s functions are useful for overall health as well as treating more specific syndromes. The liver is an important organ for detoxing the body, so Chai Hu’s actions of both expelling pathogens and treating imbalance in the liver and spleen makes it an extremely functional herb.

Chen, J. K., & Chen, T. T. (2004). Chinese medical herbology and pharmacology. City of Industry, CA: Art of Medicine Press, Inc.

Chen, J., Ji, B., Lu, Z., Hu, L. (2005). Effects of Chai Hu (Radix Burpleuri) Containing Formulation on Plasma β-endorphin, Epinephrine and Dopamine in Patients. American Journal Of Chinese Medicine, 33(5), 737-745.

Kim, H. (2008). Handbook of Oriental Medicine. (4th ed). Anaheim, CA: QPuncture.

Kim, S., Kim, S., Chung, I., Cheon, W., Ku, S. (2012). Antioxidant and Protective Effects of Bupleurum falcatum on the l-Thyroxine-Induced Hyperthyroidism in Rats. Evidence-Based Complementary & Alternative Medicine (Ecam), 1-12.     

Tzeng, T., Lu, H., Liou, S., Chang, C., Liu, I. (2012). Vinegar-Baked Radix Bupleuri Regulates Lipid Disorders via a Pathway Dependent on Peroxisome-Proliferator-Activated Receptor-α in High-Fat-Diet-Induced Obese Rats. Evidence-Based Complementary & Alternative Medicine (Ecam), 1-12.         

  

Zhixian, L., & Xingdong, H. (2004). The chinese materia medica. (2nd ed.). Beijing: Academy Press (Xue Yuan).

Case Study: The Use of Auricular Acupuncture for Low Back Pain

                                   The Use of Auricular Acupuncture for Low Back Pain

                          Advanced Needling Techniques 1: Auricular Acupuncture Module

                                                            AOMA Spring 2014

 

       Patient, G.G. first came into the clinic for a flare up of her chronic low back pain

in January 2014. G.G. is a 69-year- old female who has worked as a massage therapist 5

days a week for the past 20 years. She’s returned for continuing treatment approximately

3 times a month since her first visit. Though her lumbago has improved by at least 50%,

due to the physical stress of her work it seems that her treatments have reached a plato.

She has received needling, tuina, cupping, guasha and e.stem, which all work temporarily

until her next shift at work. She has yet to have been offered any auricular treatment,

which according to multiple articles, can be very effective for this type of pain.

         According to an article published in 2013 titled, A Randomized Clinical Trial of

Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study, pain

was statistically reduced in patients who were administered auricular ear seeds in the

correct locations versus those that were given sham points. The correct points used were

shen men, sympathetic and ashi in the low back area. The sham points selected were

simply located away from areas where the patient was experiencing pain (Yeh et al.

2013). In another article published in 2003, the effectiveness of e.stem on ear points for

chronic low back was investigated. In this study they used both shen men and low back

with or without e.stem. Patients who received e.stem were able to return to work full-time

earlier than patients treated with manual auricular acupuncture. The frequency of low

back pain decreased in 82% of patients who received e.stem while it decreased by 54% in

patients without it, which is still a significant amount (Sator-Katzenschlager et al. 2004).

           While these two studies found shen men and the low back points to have clear

analgesic effects there remain other auricular points which could be used as well. It’s

important to understand what underlying factors are involved in the low back pain. For

example, it could be more stress related, caused by muscle tension, bone spurs,

subluxation, or nerve impingement. In the case of G.G., she had undergone

decompression surgery 30 years previously and had lots of scar tissue in the L3-L4 area.

She also suffered from sciatic and some thoracic pain aggravated by overuse. For G.G. it

would be beneficial to start off with points such as, lumbo-scaral, sciatic and thoracic. It

could also be useful to use shen men for general pain, tension, inflammation and to assist

with auxiliary symptoms caused by the chronic pain such as insomnia and depression.

The Thalamus point could also be used for it’s ability in reducing chronic pain (Shores).

It will be interesting to see how including these auricular points will effect the length of

analgesia provided by acupuncture for G.G..

 

Chao Hsing YehLung Chang ChienBalaban, D. (2013). A Randomized Clinical Trial of

Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study. Evidence-

Based Complementary & Alternative Medicine (Ecam), 1-9.

 

Sator-Katzenschlager, S., Scharbert, G., Kozek-Langenecker, S., Szeles, J., Finster, G.,

Schiesser, A., et al. The Short- and Long-Term Benifits in Chronic Low Back Pain

Through Adjuvant Electrical Versus Manual Auricular Acupuncture. Anesthesia &

Analgesia, 98, 1359-1364. Retrieved June 28, 2014, from

http://journals.lww.com/anesthesia-analgesia/Fulltext/2004/05000/The_Short__and_Long_Term_Benefit_in_Chronic_Low.3

 

Shores, J. Auriculotherapy: Evaluation Survey : Protocols : the Ultimate for Pain

Management. Tulsa, OK: Electro Therapy Association.

Coursework: Biomedical and TCM Study of Osterarthritis

Biomedical and TCM Study of Osterarthritis

                                                                            ATD I

AOMA Fall 2013

    One out of every three Americans suffer from some type of joint pain (J. Wu & F. Yip, 2004). According to The Global Burden of Disease: 2004, Osteoarthritis (OA) causes moderate to severe disability for 43.4 million people globally (WHO, 2004). In 2011 the US saw close to a million hospitalizations for OA (A. Pfuntner et al, 2011). Currently there are no measures being taken to control OA prevalence, lifestyle modifications are shown to provide some slowing in degeneration, but there are no known cures.

    There are many different types and causes for arthritis ranging from auto-immune to overwork. Osteoarthritis is one of the most common types of arthritis, it is also known as degenerative arthritis or wear-and-tear arthritis. OA differers from other types of arthritis because it is affects specific joints that are repetitively damaged from mechanical stress with insufficient self repair (J. Wu & F. Yip, 2004 ). Primary OA is found to have a genetic component, though a single factor has not be shown to be a sufficient cause. Primary OA is also correlated to a history of joint injury, obesity and change in the sex-hormones of post-menopausal women. Secondary OA is caused by other factors but the resulting pathology remains the same as primary (WHO, 2004).

    In TCM Osteoarthritis and Rheumatoid arthritis are both categorized as simply arthritis. The etiology of arthritis in TCM involves the invasion of the external pathogens: wind, cold and dampness. The combination of all three external pathogenetic factors is what makes arthritis more complex to treat. It can also be caused by irregular diet, specifically food allergies leading to damp-heat. Lastly, it can be caused by repetitive physical work and strain throughout life. The TCM mechanism of arthritis is local Qi and blood stagnation with general weakness. In the case of OA, it is considered to be in the Qi stage because it has a more functional etiology (J. WU & F. Yip, 2004).

    The signs and symptoms of osteoarthritis are mainly pain, loss of ability and often stiffness. Pain is usually described as sharp, aching and burning (J. Wu & F. Yip, 2004). OA usually affects the hands, feet, spine and large weight bearing joints like the knees and hips (J. Ezzo et al, 2001). Sometimes crackling noises called crepitus can be heard when the affected joint is touched or moved. Hard boney enlargements may form on the smaller joints, called Heberden’s nodes when on the distal interphalangeal joints and/or Bouchard’s nodes when on the proximal interphalangeal joints. The biomedical method for diagnosis involves clinical examinations and can be made with reasonable certainty based on patient history. X-rays can confirms the diagnosis if needed. The X-ray will show joint space narrowing, osteophytes, increased bone formation around the joint and subchondral cyst formation.

    In TCM the etiology of OA is the combination of wind, cold and dampness, so in order to diagnosis and treat the patients their other symptoms must be looked at to learn if there is more cold, damp or wind involved. If it is more due to a wind invasion the pain will be wandering and will be located more of the upper part of the body. There will be other common wind invasion symptoms like aversion to wind and a slight fever. If the OA is more due to a cold invasion the pain will be more sever and stabbing and can be alleviated by warmth. There will also be general cold symptoms like cold extremities, aversion to cold, profuse clear urine and a superficial & tight or deep & slow pulse. If there is more dampness involved the arthritis will mainly be on the lower limbs due to damp sinking. The pain will be dull with a sensation of heaviness. In the local area there will be swelling and there may be edema and numbness. There will also be general damp symptoms including general heaviness, nausea, decreased appetite, vomiting, profuse vaginal discharge, loose stools with sticky pieces, gas and bloating. The tongue will show dampness with swelling and teeth marks (J. Wu & F. Yip, 2004).

    Biomedical treatments are limited and more about management. Weight lose is important for obese patients, and a prescription for acetaminophen is very common (J. Flood, 2004). Moderate exercise is recommended for reduction of pain and increase in function (J. Wu & F.Yip, 2004). If these management options are ineffective and disability is significant, joint replacement surgery can be performed. For TCM treatments, a combination of acupuncture and Tui-na is considered the most effective (J. Wu & F. Yip, 2004). Though research has shown that acupuncture can provide pain relief, because OA is a disorder of the tendo-muscular meridians, massage and Tui-na address the type of pain much better (J. Ezzo et al, 2001). Warming therapies and exercise are also recommended (J. Wu & F. Yip, 2004).

    Acupuncture points should be chosen based on the differentiation: if more wind, use common wind points like BL12 and 13, GB20 and SJ17, if more cold, use common cold points like GB20, LU7, LI4 with moxa. If there is more dampness, use common damp points like SJ5, Sp9, St40, Sp6. It is important to pair cold, wind and/or damp points with local points according to the location of the arthritis (J. Wu & F. Yip, 2004). There are some herbal formulas which can be used in conjunction with Tui-na and acupuncture. If cold is prominent use Chuan Wu Tang (J. Wu & F. Yip, 2004). In a 2004 study on the effectiveness of Duhuo Jisheng Wan compared to the commonly used Diclofenac it was found that they have clinically comparable effects after four weeks of treatment (S. Teekachunhatean et al, 2004).

    Osteoarthritis is a complex, multi-layered disease and it’s management can be difficult whether it’s being treated by biomedical or TCM techniques.

Arthritis/bi syndrome (guan jie yan). In (2004). J. Wu & F. Yip (Eds.), Acupuncture treatment of disease: Student study guide

Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M., & Berman, B. (2001). Acupuncture for osteoarthritis of the knee: A systematic review.Arthritis & Rheumatism, 44(4), 819-825. doi: 10.1002/1529-0131(200104)44:4<819::AID-ANR138>3.0.CO;2-P

Flood, J. (2010). The role of acetaminophen in the treatment of osteoarthritis. The American journal of managed care, 48-54. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20297877

Pfuntner A., Wier L.M., Stocks C. Most Frequent Conditions in U.S. Hospitals, 2011. HCUP Statistical Brief #162. September 2013. Agency for Healthcare Research and Quality, Rockville, MD.

Teekachunhatean, S., Kunanusorn, P., Rojanasthien, N., Sananpanich, K., Pojchamarnwiputh, S., Lhieochaiphunt, S., & Pruksakorn, S. (2004). Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial . BMC Complementary and Alternative Medicine, 4(19), doi: 10.1186/1472-6882-4-19

World Health Organization. (2004). The global burden of disease:2004 update . Geneva, Switzerland: World Health Organization Press. Retrieved from http://books.google.com/books?id=xrYYZ6Jcfv0C&pg=PA35