Ask the Acupuncturist

Dear John,
I have a 65 year old male patient who is experiencing right side jaw numbness – down from the ear to the middle of the chin (constant). There is some pain, but the main complaint is numbness. He has had this problem 4.5 months. He has seen his local doctor who has ruled out a stroke; otherwise, the western medical profession can see no problems with him physically. I have tried several different techniques – the first was Dr. Tan – and I needled the LI area contralaterally. Unfortunately, this didn’t work. I then tried local points with electrostem.  We saw no benefits. I have tried Dr. Jiao’s head points – the sensory area, lower 2/5th with electrostem – both laterally and contralaterally.  Today is the first day that he might have noticed any difference and he’s not sure if the numbness has been diminished at all.
Do you have any suggestions regarding points or perhaps an herbal formula?

Thank you again so much for your help.

Beverly K. Cowan
DAOM, Dipl.OM (NCCAOM), L.Ac.
Doctor of Acupuncture and Oriental Medicine

Dear Bev,

I would need to know a lot more about his TCM patterns and diagnosis.
How are the pulses and tongue?  Is there yin xu and/or phlegm damp? Has he done viral testing?

I will give some very general thoughts for consideration.

Herbally:
May need something fairly powerful to warm and open the channels.  The basic formula for this could be Xiao Huo Luo Dan.  Because of the age of the patient this is likely too strong and would need to be combined with some other formulae that treat the underlying patterns and diagnoses. As you know, Xiao Huo Luo Dan is to transform wind damp, dispel stasis (of blood), transform phlegm, warm the channels, and free the network vessels.  You would probably some additional qi movers. You would want to be particularly careful with this formula if there is extreme yin vacuity or heat. Evergreen makes a formula called “Symmetry” that uses the basic principles of Xiao Huo Luo Dan but mellows it a bit.

Acupuncture:
You might try Master Tong points GB 34, MTP 77.22, MTP 77.23.  I needle these points contralaterally.  Also, 77.01 and 77.02 are great points;  actually my most used Master Tong points.  Great for seizure disorders and epilepsy.  I have used this with great success for Trigeminal Neuralgia, so it may work for him…..and it won’t do any harm. If that does not work then I would use moxa and warm needle technique on local points.

Supplements:
Benfotiamine (fat soluble Thiamine) is #1 on my list for any neuropathy.  I would also use 3-5 grams of Vitamin C, OPC (oligomeric pro-antho cyanidins), and alpha lipoic acid to support the action of the benfotiamine.
L arginine is the best for arterial inflammation if you suspect it.  If there is erectile dysfunction this is a certain choice.
Serrapeptase is #1 if you suspect fibrin deposits or if high fibrinogen levels have shown up on labs.
Nattokinase is great if there is micro circulation (blood stasis) problems.  If the sublingual veins are engorged I would use nattokinase and a lot of Dan shen (salvia mitorrhiza) and huang qi.

If there are any heart/circulation problems, or if he is on statins, I would consider Ubiquinol at 300 mg, L-carnitine at 1 gram, magnesium glycinate at 500 mg, D- ribose at 3-5 grams

Let me know what transpires.

– Dr. John Nieters, L.Ac. DAOM, FABORM

Dr Nieter –
I’ve noticed a pain on the top of my foot, between the bones.  It’s at a very specific spot.  It can’t be touched without sending me thru the roof.  It doesn’t look particularly swollen or red.  It doesn’t hurt to walk on it.  It just hurts like the dickens to touch. I was looking online, and the pain sounds like a metatarsal stress fracture?  I’m wondering if I did it when I almost fell while walking on the cobblestones while in Barcelona.

Will acupuncture help, or do I need to get the diagnosis from my doctor to know what I’m dealing with before I try acupuncture?
– In Pain in Sacramento

Dear In Pain in Sacramento,
Certainly could be a stress fracture but it is more likely to be a Morton’s Neuroma with the symptoms that you mention.

Neuromas are not truly a tumor as the name ‘neuroma’ would suggest. They are actually bundles of fiber or fibrous tissues that grow around a nerve and so grow between the toes where the nerve runs. Technically this is a perineural fibroma (around the nerve growth of fibrous tissue). Sometimes these fibrous tissues contain calcifications.  I have a big neuroma in my right foot that i developed from teaching Tai Ji in my driveway at 6 AM every day while barefoot. At one time it was very painful.  t is still there but I no longer have any pain since getting acupuncture and acupressure.

The stress fracture would be more evident if you press on the bone; while a neuroma hurts when you press between the toes, or if the toes create pressure, because the hard calcium deposit is being pressed into the nerve. OUCH! Stress fracture generally hurts to stand on.

Other possible, but less likely possibilities are:  Capsulitis which is inflammation of the capsular ligaments around the joint, arthritis, or bursitis which is inflammation of the water filled cushioning sack around the joint.  There are many other lesser possibilities.

You can go either way as far as the sequencing of treatment.  If it is a stress fracture then acupuncture can speed healing quite a bit.   Best would be electro acupuncture on a micro current device with mixed frequencies, such as alternating 2/100 hertz at 4 second intervals in biphasic mode, around the affected area.  Micro current at this frequency raises localized ATP levels (the direct energy producer of the body) and is phenomenal for healing damaged tissue.  I have seen it reduce healing time by haIf.

If it is a neuroma they are a little more difficult, but I have seen pretty good success, including my own case.

If you have insurance that covers it, I would have your MD do films of it.  In most cases I would actually recommend a podiatrist rather than an MD for this, as all a podiatrist does is feet.  About a 99% chance that they won’t do anything for a stress fracture.  Probably won’t do anything other than possibly a cortisone type injection if it is a neuroma.  The cortisone will shut down the inflammation short term but it is not likely to heal it and does have side effects.
Even though you probably won’t get or want the treatment, it is worth it for the diagnostic imaging.

There are also herbal formulas and topical tinctures that can help with either condition.

So:
1. Get some films done.
2. Get some electro acupuncture
3. Bring the diagnostic info to your next visit and I will suggest formulae.
1. Stand barefoot, or sit with you feet on the ground, on grass, dirt, or in a pinch concrete, for a minimum of 10 minutes per day.

One more thing: In most cases the neuroma does not have calcific qualities so it won’t show up on x-ray.  It might be inferred from joint spacing net very hard to tell.  Cheapest way to visualize a neuroma would probably be an ultra sound.  MRI would be most accurate, but you probably won’t get one.

X-ray will probably show a stress fracture but not always, as they are difficult to see on X ray.  They are usually non-displaced and don’t give a large signature, especially if it is recent. An older stress fracture would have more time for bone healing so it would have more calcium deposited, making it easier to see on the x-ray.

I am personally familiar with this problem also. I have broken my left foot (non-neuroma) three times.  In each case the first X-ray was negative and then showed the fracture later.  The first time I broke it stepping on someone’s foot on the first play of the first game of a football season.  Severe pain with every step but I played on it all year because it “wasn’t broken,” and also because I have not always exhibited good sense!

– Dr. John Nieters, L.Ac. DAOM, FABORM

Hi John,
What do the terms “liver depression qi stagnation” and “depressive heat” mean?
-Berkeley Dad

Dear Berkeley Dad,
The majority of students do not fully understand these terms when they graduate from a four year masters degree program, so my explanation may not help much.

Liver depression qi stagnation:
The liver energetic system in TCM is responsible for the free interrupted flow of energy through the the body (as well as several other dynamics).  This energy runs in particular patterns.  In pathological conditions the energy will counterflow or flow in inappropriate patterns.

When the liver becomes depressed the qi does not flow along the proper course or direction and becomes stagnant.  when it becomes stagnant there is not proper flow of qi and blood to the other organs, which then become imbalanced and do not function properly.

The treatment principle is to “course the liver and rectify the qi”.  To make it course properly as a verb, to run on the proper course as a noun, and to be rectified or set right.

Depressive Heat:
Depressive heat will arise from stagnation.  In this case stagnant liver qi and phlegm pathogens.  This creates an inflammatory condition that can be found biomedically but is usually not looked for.  For example (and not related to your case)  autoimmune conditions seem to suddenly spring from nowhere in bio medicine.  We can track them years before they blow into full symptomatic problems by seeing latent depressive heat.

For example: Children, particularly girls, that have early childhoods with abuse or oppressive problems develop autoimmune disorders at 7-10 times the rate of those that have less stressful childhood experience. These disorders often manifest at 25-40 years of age.  In Chinese Medicine we clearly observe the link between these events in childhood and adulthood.  Biomedicine rarely does recognize the pattern until it blows up.

In your case, the depressive heat is continuing to flare up and cook the lungs leading to lung qi and yin problems.

I hope this abbreviated explanation helped. I could teach a course on these terms!

– Dr. John Nieters, L.Ac. DAOM, FABORM