Carpal tunnel syndrome (CTS) is one of the most common job-related injuries and is responsible for the highest number of days lost among all work related injuries. It is the reason for over two million visits to physicians’ offices and approximately 465,000 carpal tunnel release operations each year, making it the most frequent surgery of the hand and wrist.
Acupuncture is extremely effective at treating carpal tunnel syndrome; eliminating the need for surgery or the use of anti-inflammatory drugs or corticosteroids. In fact, one of the most common reasons that people get acupuncture is for repetitive stress injuries, including carpal tunnel syndrome. Recent studies even suggest that acupuncture may be more effective than corticosteroids when it comes to treating CTS.
What is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passageway in the wrist made up of ligaments and bones. The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through this tightly spaced tunnel.
Carpal tunnel syndrome, also known as median nerve entrapment, occurs when swelling or irritation of the nerve or tendons in the carpal tunnel results in pressure on the median nerve. The median nerve controls sensations to the palm side of the thumb and fingers, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.
Symptoms usually start gradually, with frequent burning, tingling, or numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers. The symptoms often first appear during the night. As symptoms worsen, people might feel pain, weakness, or numbness in the hand and wrist, radiating up the arm during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. If not properly treated, CTS can cause irreversible nerve damage and permanent deterioration of muscle tissue.
Diagnosis and Treatment of Carpal Tunnel Syndrome with Acupuncture
From an Oriental medicine perspective, CTS is seen as a disruption of the flow of Qi and Blood within the area and associated with Cold, Dampness or Wind penetrating the muscles and sinews of the wrist. Acupuncture points, stretching exercises, herbal remedies and nutritional supplements are chosen to treat accordingly.
From the perspective of Acupuncture Orthopedics, I find that it is important to reduce myofascial constrictions in the muscles: flexors carpi radialis and ulnaris, digitorum superficialis and profundus, flexor pollicis longus, and pronator teres. I also find that there tend to be a lot of fascial constrictions in the laminar groove between the flexor carpi radialis and the palmaris longus (i.e. the groove felt between these muscles). Interestingly, this laminar groove corresponds well to the main acupuncture meridian used to treat CTS.
In my experience, I find that it is crucial to examine the soft tissue (i.e. the myofascial) component prior to going for the more invasive surgery. I have seen many patients who have had the surgery only to keep on having pain problems. It is also important to have more than one opinion; see more than one doctor about this. In fact, if seeing an orthopedist, I would highly recommend seeing a physiatrist (an MD that specializes in physical medicine). A physiatrist will see things overlooked by a surgeon. I have seen many patients diagnoses with CTS only to continue to have problems after surgery. Later we find that they had de Quervain’s Syndrome (commonly misdiagnosed as CTS). I have even seen cases of lateral epicondylitis (i.e. Tennis Elbow) and medial epicondylitis (Golfer’s Elbow) amazingly misdiagnosed as CTS.
As well as reducing the swelling, inflammation and pain in the wrist, acupuncture addresses any headaches, neck pain, shoulder stiffness and sleeping problems that often accompany this condition.
Your treatment may also take into account any underlying conditions that contribute to the development of CTS including obesity, rheumatoid arthritis, thyroid problems, diabetes, hormonal changes of pregnancy and menopause.
If you or someone you love suffers carpal tunnel syndrome, please call to find out more about how acupuncture and Oriental medicine can help you.
It had been Jane’s dream to go to Paris for as long as she could remember. She dreamed of seeing the Eiffel Tower, the Arc de Triomphe, and visiting the Louvre. She fantasized about eating in the fine restaurants and taking in the city vibe at a sidewalk café. However, since arriving in Paris, Jane has not felt well at all. She has had difficulty falling asleep. Once asleep, she has difficulty maintaining her sleep. During the day she has had difficulty staying awake and even focusing on regular tasks. To top it off, her appetite is gone; and she has been constipated. Clearly, Jane is suffering from jet lag.
Jet lag, also called Rapid Time Zone Change Syndrome, is one of a number of Circadian Rhythm Disorders . Circadian Rhythm refers to the “internal clock” through which our biological processes are regulated. There are patterns of brain wave activity, hormone production, cell regeneration, and other biological activities linked to this 24-hour cycle. Many things can disrupt our circadian rhythms such as: shift work, pregnancy, medications, changes in routine, and time zone changes.
Jet lag happens when one flies across one or more time zones. Most people need to fly across about 3 time zones before noticing symptoms. Jet lag does not occur on long trips by car or rail because the body is able to adjust in the length of time it takes to cross each time zone. Also jet lag does not occur when flying north to south because one is not crossing time zones. Jet leg can happen to anyone, and although one may feel terrible, it isn’t serious, usually resolving in about 3 to 4 days.
Symptoms of jet lag may include: difficulty falling asleep and maintaining sleep, difficulty staying awake and maintaining focus, loss of appetite, and even changes in bowel function (constipation or diarrhea). Although jet lag is not something that was discussed in ancient Chinese medical texts for obvious reasons, acupuncture can be a very helpful in helping to manage the symptoms of jet lag. By examining the symptoms of jet leg according to an understanding of acupuncture energetic, we can see that the disruption of the circadian rhythm seems to be related to a disharmony in the Yin Qiao and Yang Qiao meridian systems. Energetically, the Yin Qiao and Yang Qiao meridians regulate our basic sleep-wake cycles. When Yin Qiao is disturbed, there is a tendency towards somnolence; and when the Yang Qiao is disturbed, there is the tendency towards insomnia. In the case of jet lag, it seems clear that both are disturbed. Considering that the Yin Qiao meridian also crosses over the abdominal region, changes in appetite and bowel function are not that surprising.
I have found that acupuncture is very helpful in treating jet lag; and I use a combination of auricular acupuncture and body points. The basic points I use in the ear are: Pineal Gland (T 5), Sleep Disorders 1 (SF 3), Sleep Disorders 2 (I 15) , Point Zero, and Shen Men. For the body points, I typically open both the Yin Qiao (KD 6, LU 7) and Yang Qiao (BL 62, SI 3). If there are disturbances in appetite and bowel function, I may use P6, ST 25, ST 36. I find herbal supplementation unnecessary. However, many of my patients have used melatonin with great success.
Although fertility treatments rely on cutting edge medical science, the difference between success and failure often lies in the application of the ancient art of acupuncture. In a 2002 peer-reviewed study, acupuncture performed 25 minutes before and after IVF pregnancy success by nearly 50%. Considering that the average IVF cycle costs between $10,000-$12,000, acupuncture has an even greater appeal. In addition, not every IVF cycle is successful. According the New England Journal of Medicine, many need repeated cycles, and that 6 cycles seems to be the magic number for success. Couple that with often having to pay high out-of-pocket costs, and acupuncture begins to look more like a God-send.
When considering acupuncture for the treatment of infertility, the first step is with your reproductive endocrinologist—not your acupuncturist. While acupuncture is very helpful, there are many things it cannot do. For example, if there is a structural reason for the infertility, acupuncture will not address tubal adhesions due to pelvic inflammatory disease or endometriosis. While acupuncture is a good alternative therapy in some cases, in the case of fertility medicine, I do not recommend it as an alternative. Rather my recommendation is that acupuncture be done as a complement to conventional treatment. This integrative approach is what has been shown to yield the best results.
Acupuncture can improve ovarian and follicular function. It also can reduce uterine artery impedance, and increase the blood flow to the uterus helping to facilitate a thick, rich endometrium, thus allowing for optimal conditions for pregnancy to occur. Unlike the fertility drugs, however, acupuncture cannot cause there to be multiple eggs during ovulation (only one at a time). This is another reason for an integrative approach.
It should also be noted that acupuncture is process-oriented. The more treatments one can get, the better the chances. I usually recommend a minimum of one treatment a week while undergoing fertility treatment. And when undergoing IVF or IUI, I recommend treating immediately before and after the procedure. I also recommend once weekly treatments during the first trimester once pregnancy has been achieved. This is to prevent any possible miscarriage by helping to facilitate a healthy endometrium. Over the past several years in practice, I have played a role in assisting many women achieve pregnancy. It remains one of the most satisfying aspects of my work.
© Copyright 2009 Thomas E. Turpen, DOM, R.Ac.
Arlington Acupuncture Clinic
3360 Tremont Rd.
Columbus, OH 43221
614-451-7246
When someone comes to see me for a particular condition, they have usually seen a gazillion of other practitioners. They usually have seen their primary care physician, and at least one or two specialists. And many will have even seen other CAM (Complimentary and Alternative Medicine) providers, including other acupuncturists. I don’t mean to imply that any of these other practitioners were less than qualified or weren’t any good. Sometimes, the diagnosis was correct in the conventional sense, but the therapy was inadequate or non-existent such as in the case of tinnitus. And occasionally they do miss something. Sometimes it just helps getting a fresh perspective or someone who can just step out of the box a bit. When a patient comes to see me, their condition can be likened to a mystery; and I am the detective that must search for the clues that will help me put the pieces of the puzzle together. One of the most important clues in Oriental Medicine (OM) is the pulse.
In OM, we are looking at several things when we palpate the pulse. I feel not only the rate and the rhythm, but I am also looking at its force (i.e. how strong is the pulse). I will look at its depth (i.e. is the pulse felt at the superficial or deep levels). When I feel the pulse, I will feel with the index, middle, and ring fingers at the same time, and individually. I will feel the pulse on the right and the left side; and I will feel the pulse at different positions both in depth and along the artery.
It is more than just simply placing my fingers on the artery and feeling. It is a subtle art that takes years to master. I do all of this to begin to classify what kind of pulse the patient has (most textbooks of Traditional Chinese Medicine have standardized the pulse to 28 or 29 qualities). Identifying this quality can often be what helps me clinch the diagnosis. According to the prominent scholar and physician of TCM, Giovanni Maciocia, there are a number of clinical applications of pulse diagnosis such as:
- The pulse is often crucial to clinching the diagnosis
- It is essential to distinguish between Deficiency and Excess (syndromes)
- It is essential to determine the TCM treatment principle
- It is an indicator of an (zang fu) organ problem
- The pulse indicates disharmonies beyond the presenting patters
- The pulse can indicate an underlying Deficiency syndrome in the absence of symptoms1.
Although pulse diagnosis in OM is difficult to learn and master, it is an important skill to develop and can be the difference in what gives me the final piece of the puzzle that helps me assess and therefore properly treat my patient.
© Copyright 2009
Thomas E. Turpen, DOM, R.Ac.
Arlington Acupuncture Clinic
3360 Tremont Rd.
Columbus, OH 43221
614-451-7246
1. Diagnosis in Chinese Medicine: A Comprehensive Guide by Giovanni Maciocia. Churchill Livingston, London, 2004. pp. 457-463.
A lot of patients are puzzled when going to an acupuncturist and are asked, “Would you please show me your tongue?” In our experience as patients in the conventional medical scene, this doesn’t seem to make a lot of sense. Of course, most of my patients who show me their tongues are usually curious to see what it means. A lot of them will ask things like “Why do you look at my tongue?” Or, “What can you see in my tongue that is related to my insomnia?”
The answer to these questions goes right to the heart of one of the key concepts of Oriental Medicine (OM)—the concept of wholeness/integrity. In OM, the body is viewed as an integrated whole. Any disorder in one area will have an effect globally (i.e. throughout the body). For example, a person may complain of insomnia, and we find that their tongue has a dark red color with no coating. We may feel their pulse and find that it is thin and rapid. Upon further inquiry, we may find that their urine is dark yellow and scanty in volume. Each of these little pieces fit together to complete the puzzle of assessing their syndrome or pattern of imbalance that manifests with the “symptom” of insomnia.
When we look at the tongue, we are looking at a number of things such as the color, shape, moisture, coating, and any other distinguishing features on the tongue body such as teeth-marks, inflamed/raised taste buds, and cracks in the body of the tongue. Also we look at the spirit of the tongue overall. Is it quivery? Or does it deviate?
We also look at the areas of the tongue that are affected. The ancient Chinese mapped out areas on the tongue that were related to each of the zang fu* organs. For example if a tongue were red on the sides, we might inquire into possible Liver or Gall Bladder** syndromes (patterns of disharmony). Each feature that we notice becomes yet another clue—another piece of the puzzle—to be able to determine what is the nature of a person’s disease or dis-ease.
Now in my practice, I do not take what is called the tongue picture as sufficient to make any diagnosis. I will look at the overall presentation of symptoms (what the patient presents to me as a complaint) and signs (what I find upon examination). Based on this overall presentation, I then make my assessment.
© Copyright 2009 Thomas E. Turpen, DOM, R.Ac.
Arlington Acupuncture Clinic
3360 Tremont Rd.
Columbus, OH 43221
614-451-7246
*zang fu—to be discussed in another post
**not necessarily the liver or gallbladder in conventional medicine
Occasionally a patient will go on the internet to look up more information about their particular syndrome only to be terrified that they might have something seriously wrong with them. And this once again relates to another aspect of what a syndrome is. It is important to know that a syndrome (i.e. a pattern of disharmony) can manifest as any number of different diseases; or it may not have yet reached the morbid stage where there is any disease at all. The syndrome may only be one’s constitutional tendency towards certain health problems. For example, let’s take the syndrome “Kidney Yang Deficiency.” Kidney Yang Deficiency may show up as the pattern of disharmony for any number of diseases from erectile dysfunction, lower back pain that is unassociated with an injury, fibromyalgia, or even something simply as chronic diarrhea. Just because someone has Kidney Yang Deficiency does not mean that they will have any these diseases or even that there may be a tendency towards any of the problems. Kidney Yang Deficiency may simply be someone’s constitutional tendency and they only really seem to have a tendency towards cold hands and feet with occasional lumbago.
Not only can one syndrome manifest as any number of different dis-eases, but one disease can be differentiated into a number of different syndromes. Let’s take the common cold for example. Let’s say that three people come into my office, each with the common cold. Cooper has a slight fever, aversion to cold, runny nose with yellow discharge, sore throat with swollen tonsils. Upon further inquiry, we find out that his urine has been darker lately; and that he has been particularly thirsty. We look at his tongue and find it to be slightly red on the sides and the front; and we take his pulse and find it to have a floating, rapid quality. Sarah comes into my office later that morning, and she has a cold as well. However, her symptoms are a slight fever, aversion to cold, runny nose with a white discharge, stiff neck, body aches, and sneezing. While her tongue doesn’t show any different changes from any previous visit, her pulse has a floating and tight quality. After lunch Jimmy comes into my office. Wouldn’t you know it? He has a cold as well. But, Jimmy’s symptoms are different. While he also has an aversion to cold and a slight fever, he also complains of a dryness of the nose, mouth, and throat. He is sweating slightly and has a dry cough. His tongue is slightly red in the front and a bit dry while his pulse has a floating quality.
Each of these patients has the same disease—the common cold. However each also has a different syndrome. Cooper’s syndrome is called a Wind-Heat, Sarah’s is called Wind-Cold, and Jimmy’s is called Wind-Dryness. Because each of these syndromes is different, each patient would be treated with different acupuncture points, and, if used, different herbal formulas. In this case, the syndrome differentiation serves to further refine the treatment to better suit the patient. If I were to use the acupuncture points for Sarah that were indicated for Cooper, I would not get good results.
© Copyright 2009 Thomas E. Turpen, DOM, R.Ac.
Arlington Acupuncture Clinic
3360 Tremont Rd.
Columbus, OH 43221
614-451-7246
Over the years, I have had a number of patients come in who have seen other acupuncturists before coming to see me. Many times I will hear something like, “My acupuncturist said that there’s something wrong with my kidneys.” After taking a history, and doing a physical exam, I will sit down and discuss their diagnosis. Most of the time, it turns out that there was never anything wrong with their kidneys, but rather they had a syndrome such as Kidney Yang Deficiency or Kidney Yin Deficiency.
In Oriental Medicine (OM), a syndrome is not a disease, but rather it represents an overall pattern of imbalance in the body’s physiology. A syndrome refers to a summary of the “…pathological changes at that stage [of the disease or dis-ease]. 1” I reiterate: It’s important to understand that a syndrome is not a disease. A person may not have any morbid disease at all, but may still be diagnosed with a syndrome. These syndromes will have names such as Liver Qi Stagnation, Kidney Yang Deficiency, or Damp Bi Syndrome. Once again these names do not refer to diseases, but rather they are simply names for the patterns of energetic and physiological disharmony in the body.
1. Advanced Textbook of Traditional Chinese Medicine and Pharmacology, Volume 1. Cai Jingfeng, editor. New World Press, Bejing, 1995 p. 160.
© Copyright 2009 Thomas E. Turpen, DOM, R.Ac.
Arlington Acupuncture Clinic
3360 Tremont Rd.
Columbus, OH 43221
614-451-7246
Over the years, I have had a number of patients come in who have seen other acupuncturists before coming to see me. Many times I will hear something like, “My acupuncturist said that there’s something wrong with my kidneys.” After taking a history, and doing a physical exam, I will sit down and discuss their diagnosis. Most of the time, it turns out that there was never anything wrong with their kidneys, but rather they had a syndrome such as Kidney Yang Deficiency or Kidney Yin Deficiency.
In Oriental Medicine (OM), a syndrome is not a disease, but rather it represents an overall pattern of imbalance in the body’s physiology. A syndrome refers to a summary of the “…pathological changes at that stage [of the disease or dis-ease]. 1” It’s important to understand that a syndrome is not a disease. A person may not have any morbid disease at all, but may still be diagnosed with a syndrome. These syndromes will have names such as Liver Qi Stagnation, Kidney Yang Deficiency, or Damp Bi Syndrome. Once again these names do not refer to diseases, but rather they are simply names for the patterns of energetic and physiological disharmony in the body.
In the field of acupuncture and Oriental medicine (AOM), there is some debate on the words used to describe our medicine. The most common terms are “Oriental Medicine” (OM), “Traditional Chinese Medicine” (TCM); and some have even begun to use the terms “Asian Medicine” and “East Asian Medicine.”
In my own practice, I fairly consistently use the term “Oriental Medicine.” Although my foundational training was in Traditional Chinese Medicine (TCM), I was also trained in Japanese, Korean, and even Vietnamese forms of acupuncture. I have studied the Ayurvedic systems of India and Tibet; and I have studied the manual therapies of Tibet, China, and Japan. So, even though the most common term is “TCM,” what I (and many other acupuncturists) practice is more accurately called “Oriental Medicine” (OM). Occasionally, I may use TCM diagnostics, but then apply Korean Hand Acupuncture as a main therapeutic. Or I may use the Manaka protocols from a famous Japanese acupuncturist. Although (with the exception of the Indian and Tibetan Ayurvedic systems) these medical systems all have their root in Chinese Medicine, there are significant differences with each.
I was quite fortunate that my training was focused on TCM, which is the root of all the east Asian medical systems. However, I was blessed to have teachers who practiced different styles, such as Japanese acupuncture. It gave me a more well-rounded education; and it gives me more tools to offer my patients.
Welcome to The Acupuncture Guru. The purpose of the blog is to inform both the lay public and practitioners of various topics in the practice of Acupuncture and Oriental Medicine. Many posts will address frequently asked questions that I receive from my patients about acupuncture in general, others will address the treatment of specific health conditions in particular.
I am a Doctor of Oriental Medicine; and have been in professional practice for over 10 years. I have studied in both the US and in China; and I have been trained in all the branches of Oriental Medicine, i.e. acupuncture, herbal medicine, nutrition, qigong (energy cultivation practices), and manual medicine.
I provide acupuncture services to the greater Columbus, Ohio area where I integrate traditional acupuncture techniques with modern acupuncture procedures. Having performed thousands of procedures, my patients include physicians, surgeons, dentists, chiropractors, nurses, professional and amatuer athletes, and people from all walks of life.
It is my sincere hope that you enjoy the blog and benefit from the information in this blog. Feel free to email me with questions and comments. I will look forward to hearing from you.
——- Tom.
