East-West Medicine - Acoustic Neuroma Association

Transcription

Acoustic Neuroma:
The Potential Benefits of
Integrative East-West Medicine
Malcolm B. Taw, M.D., F.A.C.P
Assistant Clinical Professor
UCLA Center for East West Medicine
Department of Medicine
David Geffen School of Medicine, UCLA
Outline
- Introduction to Integrative Medicine &
Complementary/Alternative Medicine (CAM)
- Compare/contrast modern Western medicine &
traditional Chinese medicine (TCM)
- Discuss our East-West treatment approach
- Brief overview about acupuncture
- Discuss various symptoms that can be treated
UCLA Center for East-West Medicine
Integrative Medicine
“Integrative medicine encompasses the whole
spectrum of health care interventions from
prevention to treatment to rehabilitation and
recovery.”
Harvey Fineberg, MD, PhD
President
Institute of Medicine
Health Paradigm Shift
19th-20th Century
21st Century
Reductionism 
Single fxn
Miasma vs Germ theory
Chemistry
Physics
Physiology
Pathology
Emergent Properties 
Multiple fxns
Systems Biology
Genomics
Proteomics
Metabolomics
Bioinformatics
Institute of Medicine: Summit on Integrative Medicine & The
Health of The Public, February, 2009
Federoff HJ, Gostin LO. JAMA. 2009 Sep 2;302(9):994-6.
Origin of Reductionism
Limbic Music – (Massachusetts General Hospital: Handbook
of General Hospital Psychiatry, 4th ed, p. 12)
“In reductionism what one reduces and gets rid of is,
in fact, mind …The culprit for this great, supposed split
between brain and mind is usually thought to be Descartes
… One often hears the phrase ‘Cartesian dualism’.”
George B. Murray, MD
Director of Psychosomatic Program
Harvard Medical School
Philosophy
Modern
Western Medicine
(MWM)
Traditional
Chinese Medicine
(TCM)
Reductionistic
Microscopic
Structure
Quantitative
Separation of
Mind-Body
Holistic
Macroscopic
Function
Qualitative
Preservation of
Mind-Body
Language
Western
Eastern
Alphabet
Several words
Phonetic
Complex grammar
Pictures
Few characters
Not phonetic
Minimal grammar
Example of a Chinese Character
Natural image
Ancient depiction
Modern character
Mountain
Moon
Sun
Morning
Integrative East West Medicine
Traditional Chinese Medicine
Wide-Angle Lens = Holistic
Western Medicine
Telephoto Lens = Reductionistic
Spectrum of Health & Disease
Feeling
Great
Wellness/
Absence of
disease
Minor health
complaints
Multiple/ chronic Acute/
health complaints Advanced
disease
Acute crisis/
terminal stage
Death
Traditional Chinese Medicine Modern Western Medicine
Integrative East-West Medicine
Patient Evaluation
MWM
History/ Physical Exam
Disease
TCM
Zheng (pattern
diagnosis)
Heat Condition
Feverish, preference for
coolness, thirst with
preference for cold
drinks, red face or eyes,
irritability, restlessness,
constipation, deep and
dark urine, red tongue
and yellow coating
Cold Condition
Aversion to cold, preference
for warmth, tastelessness in
the mouth, absence of thirst
or preference of warm or hot
drinks, pale face, cold limbs,
sleepy, loose stool, clear and
profuse urine, pale tongue,
white and moist coating
Therapeutic Modalities
Acupuncture
Trigger point
injections
Therapeutic
acupressure/massa
ge
Dietary and herbal
counseling
Mind-body exercises
Patient education


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Lifestyle
Nutrition
Self-acupressure
Stress management
Acupuncture
What is Acupuncture?
What is Acupuncture?
“Acupuncture restores the homeostatic balance by
a differential effect of suppressing
hyperfunction, stimulating hypofunction, and
regulating disturbed function.”
Li, Y. et.al. The effect of acupuncture on gastrointestinal function and disorders. Am J
Gastroenterol. 87(10): 1372-1381, 1992.
Acupuncture
Physiologic Cascades
Health
Disease
(Balance)
(Imbalance)
Autonomic nervous system
Sympathetic
Parasympathetic
Hypothalamic-Pituitary axis
Adrenal, Thyroid, Gonadal
Pain pathways
Immune system
Coagulation cascade
Dysregulation
Different Methods of Acupoint
Stimulation











Manual needling
Acupressure
Massage
Moxibustion
TENS (Transcutaneous Electrical Nerve Stimulation)
Acupoint injection (TPIs-Trigger Point Injections)
Topical application of medicated patch
Cupping
Ultrasound
Laser
Magnetic beads
Acupuncture Styles



There are many different styles of acupuncture
Chinese, Japanese and Korean styles are examples
There are also the “so-called” microsystems of
acupuncture (auricular, hand, scalp, etc) – similar
to concept of “homunculus” in Western medicine
Auricular Diagnosis
Acupuncture
(Meridians)
• Extensive network of channels
in the human body (meridians)
• There are specific points found
along these meridians called
acupoints
• Qi is said to concentrate and
flow through these meridians
• Acupuncture maintains a free and
adequate flow of Qi and restores
balance to achieve optimal health
Acupuncture
NIH Consensus Conference
(JAMA, 1998; 280: 1518-24)
• Shown to be effective in post-operative pain, dental pain
nausea/vomiting (especially post chemotherapy/radiation)
• Recommended as an adjunct treatment in addiction, asthma,
headaches, fibromyalgia, myofascial pain, osteoarthritis,
low back pain, carpal tunnel syndrome, tennis elbow, menstrual
cramps
A combined treatment with D-amino acids and
electroacupuncture produces a greater analgesia than either
treatment alone; naloxone reverses these effects. (Pain 1980
Apr;8(2):231-6)
Cheng RS, Pomeranz B.
The D-amino acids (DAA), D-phenylalanine and D-leucine, produce
naloxone reversible analgesia; electroacupuncture (EA) also produces
analgesia which is blocked by naloxone. Combining the two treatments
produces an additive effect with a larger analgesia than that produced by
either treatment given alone; this combined effect is also blocked by
naloxone. Moreover only 62% of the mice show EA analgesia and 53%
show D-amino acid (DAA) analgesia; 80% of the animals show marked
analgesia with both EA plus DAA treatment. Perhaps the combination of
EA with DAA will provide a potent method for the treatment of clinical
pain.
What can be treated?
- Pain
- Headaches
- Tinnitus
- Balance/dizziness issues
- Emotional impact of AN - anxiety/dysthymia
- Sleep disturbance
- Stress management
Goals: 1) Reduce symptoms
2) Improve QoL
3) Enhance Wellness
Headaches &
Facial/Neck Pain
Large Intestine 4 (LI-4)
Location: Found at the highest spot of the muscle
when the thumb and index fingers are brought together
Indications: stress, headaches, toothaches, facial
pain, sinus congestion, neck pain
Caution: can induce labor in pregnant women.
Large Intestine Meridian
Acupoints for Facial Pain
Other indications:
ST 8: migraine/tension HAs,
facial motor tics, dizziness
ST 7: TMJ, otalgia, tinnitus
ST 4/5/6: Bell’s palsy,
lockjaw/trismus
ST 3: maxillary sinus
congestion
Trigger Point Injections
President JFK & White House
Physician, Janet Travell, M.D.
Tinnitus
Balance/Dizziness Issues
TCM Pattern Diagnoses
“various types of wind disease [such as] dizziness
belong to the Liver.”
- Huang Di Nei Jing
(Yellow’s Emperor Classic of Internal Medicine)
Excess:
- Liver Fire
- Liver Yang rising
- Turbid phlegm
Deficiency:
- Kidney Yin deficiency
- Liver Yin deficiency
- Kidney Essence deficiency
- Qi/Blood deficiency
Nguyen CT, Taw MB, Wang MB. Complementary and integrative treatments: balance disorders.
Otolaryngol Clin North Am. 2013 Jun;46(3):409-22.
Pericardium 6 (P-6)
Location: Three finger breadths proximal to the wrist
crease, in between the two tendons.
Indications: nausea, motion sickness, vertigo/dizziness,
anxiety, carpal tunnel syndrome, upset stomach,
regulation of heart palpitations.
Insomnia
Acupuncture & Sleep
Liver-3 (Liv-3)
Location: on the dorsum of the foot, about two
finger breadths distal to the junction of the 1st and
2nd metatarsal bones
Indications: stress, insomnia, high blood pressure
low back pain, emotional upset, limb pain.
Spleen 6 (Sp-6)
Location: Four finger breadths
proximal to the medial malleolus,
posterior to the tibia.
Indications: menstrual cramps,
pelvic pain, irregular menses,
urologic disorders, fatigue,
insomnia.
Caution: can induce labor in
pregnant women.
Anxiety
Stress
The Doctor’s Office
Hum Brain Mapping. 2000:9(1):13-25.
Mind-Body Connection:
The Limbic system
Limbic Music – (Massachusetts General Hospital: Handbook
of General Hospital Psychiatry, 4th ed, p. 13-14)
“Persons interested in psychosomatic medicine have an
interest in how the body may influence the mind and how
the mind may influence the body … I submit here that a
partial key to the understanding of the … mind-body meld
is the limbic system, [which] subserves the emotions.”
George B. Murray, MD
Director of Psychosomatic Program
Harvard Medical School
Mission:
Improve health & quality of
life by bringing together the
best of Western and
Chinese healing traditions
to provide healthcare that is
safe, effective, affordable,
and accessible for all.
1250 La Venta Drive, Suite 101A
Westlake Village, CA 91361
(855) Go2-UCLA

East-West Medicine - Acoustic Neuroma Association

Transcription

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