2007年9月15日 星期六

搭乘電梯要注意的事項:

為了自己,為了朋友,為了親人 …… 有一天搭乘電梯,就遇上了電梯突然斷電,雖然緊急供電系統幾秒後就開始作用,可是電梯還是從 13 樓迅速往下墬。還好當時記起曾經看過電視教的,趕快把每一層樓的按鍵都按下,好在電梯在五樓終於停止了,..真的有撿回一條命的感覺!
當你面臨生死一線間時,當下的你所做的每一個動作將決定你的生死與否。生活中,難免會坐到電梯,但萬一遇到電梯發生事故,迅速往下墜落時,你可能只有一個念頭:「站在電梯裏等死吧!」可是今天 ....我在電視的一個外國頻道看到一個非常好的節目。其中,他們還請了專家示範 ..... 『電梯下墜時保護自己的最佳動作』
第一、 ( 不論有幾層樓 ) 趕快把每一層樓的按鍵都按下。
第二、如果電梯裏有手把,一隻手緊握手把。
第三、整個背部跟頭部緊貼電梯內牆,呈一直線。
第四、膝蓋呈彎曲姿勢。
說明:因為電梯下墜時,你不會知道它會何時著地,且墜落時很可能會全身骨折而死。
所以:
第一點是當緊急電源啟動時,電梯可以馬上停止繼續下墜 !
第二點是為了要固定你人所在的位子,以致於你不會因為重心不穩而摔傷.
第三點是為了要運用電梯牆壁作為脊椎的防護.
第四點是最重要的是因為韌帶是唯一人體富含彈性的一個組織,所以借用膝蓋彎曲來承受重擊壓力,比骨頭來承受壓力來的大。
這個資訊絕不虛構,只是我覺得很重要想讓大家都知道,以防萬一 .. 為了自己,為了朋友,為了親人 …… 花 5 分鐘轉寄一下吧

八十七年度中西醫藥對骨質疏鬆症防治的基礎與臨床研究研討會論文摘要

八十七年度中西醫藥對骨質疏鬆症防治的基礎與臨床研究研討會論文摘要

Decrescent Changes in Bone Mineral Density in Climacteric Perimenopausal Chinese Women

Teen-Meei Wang 1

Chung-Gwo Chang 2

Chang-Hai Tsai 3

1Departments of Dentistry and 3Pediatrics, China Medical College Hospital,Taichung, Taiwan, ROC

2Committee on Chinese Medicine and Pharmacy, Department of Health, Executive Yuan, Taipei and School of Chinese Medicine, China Medical College, Taichung , Taiwan, ROC.

The development of modern Chinese medicine and western medicine caused aprolongation of life span of human being.
Age-related changes in bone mineral density(BMD)contribute to the risk of fratures in aged people and estrogen-related changes in BMD lead to the risk of osteoporosis in postmenopausal women.
Osteoporosis is closely related with the symptom of low- back pain or fracture in the axial and/or appendicular skeleton.

It is a prevalentbone disease on the patient in the out-patient department (OPD) of the Chinese internal medicine, bone traumatology,gerontology, family medicine,orthopaedics, endocrinology and gynecology and obstetrics, clinically.
For the reason of precise diagnosis in clinicalpractice,the individual value of BMD has to be compared a reference value before a clinical decision is made. To describe the relationship between age and BMD in climacteric perimenopausal women for the diagnosis of osteoporosis is necessary, especially using Chinese data base is inevitable.

The purpose of this study was to investigate the value of BMD at each age level for climacteric perimenopausal Chinese healthy women on Taiwan for the reference of diagnosis, prevention and treatment of osteoporotic patient and research of osteoporosis.

Fourteen hundred and five women in age ranging from 40 to 60 years old were recruited from the cities in Taiwan district, Republic of China including off-shore islands and were invited in for bone mineral measurement by using single energy x-ray absorptiometry (OsteoAnalyzer SXA 2000) and assessment of health and factors of importance for BMD. In total, eighty one individuals were excluded from the investigation according to predetermined exclusion criteria, whereas 1324 females met all inclusion criteria and entered the reference population sample.

We found the age of spontaneous menopause in Chinese women was 47.43 years old and a strong inverse relationship between BMD and age 40-60 years old for the calcaneus. Obvious decrements in BMD between women aged 47-48 years in calcaneus, where the difference of BMD below the fracture threshold (325 mg/cm in this study) between the two age groups was nearly 4%.

The population percentage of BMD value below the fracture threshold in 60 years old group was exceeding 47% which exhibited the largest and then followed by exceeding 33% in 59 years old group. We conclude that the obvious BMD decrements in the postmenopausal women when compared to the premenopausal women and inverse relationship between age and fracture in Chinese healthy women.

A suggestion for the diagnosis, prevention and treatment of osteoporosis by the physician to the osteopenic women, especially during the climacteric perimenopausal period is needed.

:: 行政院衛生署中醫藥委員會

2007年9月14日 星期五

integrative medicine 統合醫學是世界未來醫學發展的趨勢


統合醫學是世界未來醫學發展的趨勢,日本對於中醫藥的發展非常積極。依台大呂鴻基教授最近到日本考察中醫藥的發展情形,發現日本已成立漢方醫學的專科醫師制度,要報考漢方醫學的專科醫師,他必須先具備西醫的專科醫師資格,經考試及格之後,才能取得漢方醫學的專科醫師資格。

如此看來,可見日本對於漢方醫學的重視與推廣情形。據說最近陽明大學也成立Resarch Center On Integrative Health Care,主要研究如何結合中西醫學醫療照護的優點,給病人作出最好的醫療照護。這是一條最貼近醫療實際需求且受一般民眾歡迎的醫療照顧方式,希望他們早日成功,能全台普及照顧大眾。

我是一個開業超過三十年的中、西醫師,平常以中醫、針灸為主為病人治病。平日來看病的病人,一大部分皆已曾在各大醫院看過醫師並接受西藥治療,當然這些病人,過去看西醫吃西藥多曾經有過很好的療效,但一段時間後發現療效再不如從前,甚至有部分病人已產生不如預期的副作用時,才前來求診中醫,看能否能給予他們幫忙解除病痛,諸如乾眼症、視覺障礙、睡眠障礙、憂鬱症、便祕、記憶力減退、掉髮、頸椎、腰椎神經壓迫症候群、進行性肌肉萎縮症、慢性蕁麻疹、異位性皮膚炎、過敏性鼻炎、虛寒性咳嗽、慢性肝炎、退化性關節炎、痛風、關節扭挫傷、眩暈、耳鳴、月經不規則、痛經、不明原因的不孕症、高血壓、高脂血症等等,這些疾病如能配合中醫的治療,其療效依本人的經驗遠大於單獨西醫的治療。

當然如這些臨床療效的成果要讓西醫師信服,只有透過臨床療效評估的科學統計數據的証實。但談何容易,每一個疾病的臨床療效評估都要透過臨床療效評估的技術平台,作比較統計,這些工作需要很多的人力、物力與時間的追蹤才能逐漸得出正確的成果。如沒有政府單位的支持,是無法完成的。目前很多病人針對同一個病,早上看中醫、下午看西醫,同時拿了中藥及西藥,到底是否可以同時吃或分開吃,其療效是否有加成作用( A+B > A或B )或會產生不良的副作用,病人不知要問誰!?

當下衛生主管單位,實有必要趕快委託醫療機構將此問題早日分別釐清,讓病人能很清楚地知道,什麼時候要看西醫吃西藥,什麼時機才看中醫吃中藥,何時中、西藥可以同時服用,可以在最短的時間得到最好的療效。

2007年9月13日 星期四

雲南白藥對促進骨折癒合及其機轉的研究 Yunnan Paiyao in Established Fractures


文章 期刊
6卷1期系統識別號 14954篇
名雲南白藥對促進骨折癒合及其機轉的研究並列篇名
Yunnan Paiyao in Established Fractures: Therapeutic Efficacy and Possible Mechanisms of Action in Rabbits

作 者

卷期/出版年月
6卷1期(2001/03)頁次 42-51
資料語文 中文摘要
背景

雖然雲南白藥具有止血癒傷、活血散瘀和破積通絡等功能為一種內服的臨床常用損傷要藥,稚近年來研究顯示該藥對骨折癒合具促進的效果。
方法 紐西蘭種雄性大白兔72隻,分成對照相和用藥組。以腓骨(fibula)切除0或6mm的骨折模式處理,並每天用藥連續到30、60或90天後分別犧牲之。
對照組再分為假性左側腓骨切除(sham,S)組和左側腓骨切除 (fracture F)組。
用藥組亦升為假性左側腓骨切除加內服雲南白藥(Yunnan Paiyao,Y)
每日0.25公克的S+Y組和左測排骨切除加內服雲南白藥的F+Y組。以血液生化學、顯微放射攝影學(microradiography)和骨組織形態學(histomorphometry)的技術來檢測和評估雲南白藥對促進骨折癒合的療效和機轉。
結果各組動物體手術處理30、60或90天後發現:
1) F與F+Y組I但情中驗性磷酸?濃度都較S和S+Y組增加,同時F + Y組的濃度亦較F組為高。
2)F組的顯微放射攝影像,在三個不同期間的骨折處,都未見有癒合的現象。而F+Y組則見有顯著癒合,且隨時間增加骨折處漸恢復成原有的外形。
3)F組的接觸性顯微放射攝影像,術後30天骨折處之外側,部分錨定骨痂形成,兩斷端的骨髓腔只有少量的封閉骨痂形成。在術後 60和90天,骨折處的骨痂量都較術後30天為多。
另在術後90天,兩斷端間雖可見微量的橋形骨痂和聯合骨痂的形成,惟仍有相當距離的骨折間隙、(fracture gap)存在。F+Y 組在術後30天,可見所有(四種)骨痂的形成,其量隨時間的增加而增加。在術後60和90天,兩斷端間先被封閉骨痂和聯合骨痂充滿,後因進行重塑。
(rmodeling)步驟,使原先充滿骨痂的骨髓牌幾近相通。4) F+ Y組的鬆質骨骨量和單位面績總骨量都分別較F組多,惟其增加最隨時間增加而相對減緩。5) F+Y組的活性骨生成表面和骨沉積速率都 較F組多,且其骨生成速率較F組快1.4至1.7倍。 結論內服雲南白藥對骨折處有增加造骨細胞的數目和活性,加快各種骨痂和骨量的生成以及骨化的過程,從而促進骨折癒合。
Background.
Although Yunnan-Paiyao CY) has been shown stop bleeding, increase wound healing, increase blood circulation and degrade clots, recent study results have highlighted the therapeutic efficacy of Y in healing bone fractures. Methods.
In our study, six rabbits were used in each group, the microradiographic and histomorphometric changes of the fibulae group between 0 mm- and 6 mm-operatedfracture (F) groups with and without oral treatment of 0.25g Y per day for30, 60 or 90 consecutive days were evaluated.
Serum levels of calcium, phosphorous and alkaline phosphatase (ALP) activities were also measured. Results. Increases in body weight, trabecular bone volume, total bone volume are, active bone formation surface, bone apposition rate and bone formation rate of the fracture in situ were observed at all times in the fibular fractures treated with Y (F+ Y) rabbits. All four kinds of callus, such as anchorage callus, sealing callus, bridging callus, and uniting callus were formed at 30-days in the- F+ Y group and significantly increased, at 60- and 90-days in the F+ Y groups. The progress of remodeling procedures of fracture healing was remarkable at 90-days in the -F+ Y group.
However, no union was monetary time in all F groups. Additionally, serum concentrations of ALP were significantly increased at 30,60- and 90-days in both F+Y and F groups when compared with the control group (S) and S treated with Y(s+ Y). However, serum concentrations of ALP were slightly, but not significantly higher, except for the group at 90-days, in the F+ Y group than in the F group.
These results indicate that callus formation and cancellus bone formation developed in the F+ Y group and that shortening of the inflame F+Y stage and promotion of reparative _and remodeling stages in the F+ Y group coincided with the maximal increase in bone formation.
Conclusions. Fracture healing of the rabbit fibulae was enhanced rapidly after using Y orally. Its possible mechanisms might be explained that Y caused and then increase the number and activity level of osteoblasts, thus, callus formation occurred in the fractured site, and induced bone formation. The method of operated fibular fracture.

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2007年9月12日 星期三

我對喝咖啡的看法與見解

這是一篇來自新光醫院營養師陳淑美的文章,我覺得陳小姐對於喝咖啡的觀念,關於喝咖啡對身體的助益與危害,寫得相當詳細,是值得研讀的一篇文章。今將其全文轉載如下:

一、咖啡新觀念

「來一杯咖啡」已經成為現在最流行,最常見的交際方式。絕大多數的西方人將它視為日常生活的一部份;在台灣,特別是最近這幾年,一家家各式風格的咖啡店,如雨後春筍般出現於台北街頭,可見,咖啡文化已深植台北人的心。 咖啡的魅力,讓許多人留戀其中,除了品嚐一杯好喝的咖啡外,更增添了不少生活樂趣。 但是您知道嗎?享受一杯美味咖啡的同時,更對您的健康有意想不到的助益呢!在你下回品嚐時,不妨對咖啡先有以下的健康認知。

1.抗憂鬱少量的咖啡可使人精神振奮,心情愉快,紓解憂鬱的現象。

2.控制體重咖啡因能提高人體消耗熱量的速率,一項研究現100毫克的咖啡因(約1杯咖啡),可加速脂肪分解,能使人體的新陳代謝率,增加百分之三至四, 增加熱能的消耗,適量飲用,有減重效果。

3.促進消化咖啡因會刺激交感神經,提高胃液分泌,如果在飯後適量飲用,有助消化。

4.利尿咖啡具利尿作用,可提高排尿量,因而使上廁所次數增加。

5.改善便秘咖啡可刺激腸胃激素或蠕動激素,產生通便作用,可當快速通便劑。

6.降低患腸癌或直腸癌的機率咖啡含有天然抗氧化物。

7.止痛咖啡因做為一個藥品時,可以加強某些止痛劑的效果。(可減緩偏頭痛 )
8.增強身體敏捷度咖啡因也有助於在運動時,使運動閥值隆低,增加身體的敏捷度,使運動員締造較好的成績。

9.降低得膽結石的機會最新來自哈佛大學公共衛生學院的一項研究指出,每天喝2-3杯咖啡者比起從不喝的人,平均得到膽結石的機會小了40﹪。此外, 咖啡所含的單寧酸,具有收斂性及止血、防臭的作用。

二、咖啡對身體的危害

※ 哪些人應該少喝咖啡?

當身體出現以下狀況或疾病時,應少喝咖啡

1發育中的兒童
2懷孕期間
3正在授乳的婦女
4老年人
5空腹前(或飯前)
6腹瀉者
7胃酸過多的人
8患有胃及十二指腸胃潰瘍者
9患有腸道過敏症候群者
10抽煙的人
11喝酒之後
12容易失眠的人
13有精神方面疾病的人
14 正在服用鎮定劑的人
15應限制鉀攝取的腎臟病患

三、咖啡的健康學問

醫界研究指出,每天喝咖啡最好的時間是:春冬季的下午三至五時,夏秋季的下午四至六時,因為這是人體最疲憊的時刻。

四、要健康的享受咖啡美味,還須留意以下事項:
1.每天喝五杯咖啡(每杯約 150cc)以上咖啡,即容易造成上癮,危及身體健康 。

2.早晨喝咖啡的確有助於頭腦清醒、精神抖擻,但 須先吃早餐後,才能飲用,否則容易傷害腸胃功能。 有胃及十二脂腸胃潰瘍的人,尤其應避免空腹喝咖啡。

3.酒後不宜喝咖啡 ,否則會更刺激血管擴張、加快血液循環,增加心血管的負擔。

4.喝了咖啡約十至十五分鐘,即有提神醒腦的作用,所以睡前不要喝咖啡,以免失眠。

5. 勿喝太濃的咖啡,否則會使人變得急躁且理解力減弱。 ( 心跳也會加速)

6.喝咖啡後,不能馬上抽煙,否則容易對心臟造成危害 。

7.服用抗生素和胃潰瘍治療藥物,不可同時喝咖啡 ,以免刺激胃部,造成疼痛不適。

8.喝咖啡時最好加一些奶精,以緩和對胃的刺激,但是奶精與糖皆有熱量,須控制攝取量,以免發胖。

9.適量的咖啡攝取,對人體應該無傷,所有的食物都是上天恩賜。因此下次在你悠悠閒閒品嚐一杯咖啡時,除了讓你享受優閒、輕鬆的氣氛,達到紓解壓力、放鬆身心、消除疲勞的作用外,這杯小小的咖啡正為你的身體健康築起了一道堅強防線,小心地保護著您,只要記得別喝得太多哦!

五、我對咖啡的看法與見解:

我在臨床三十年以上,每天看很多門診病人,發現常喝咖啡的人,容易長白頭髮,看起來比同年紀的人早日老化,所以我並不贊成每天養成習慣喝咖啡,喝咖啡確實有誠如陳淑美小姐所提的好處,我一直認為喝咖啡提神,就好比我們沒有錢的時候,就拿房地產去銀行抵押貸款,融資出來使用一樣,身體狀況好的時候,喝咖啡確實能提神;但身體狀況不好時,喝咖啡會造成心悸、冒冷汗,造成晚上睡不著覺,喝多者甚至於會造成精神恍惚,這種情況與長期整天喝茶的賣茶商人相同。
所以就我個人的看法,喝咖啡確實可以享受與提神,但是我建議應在需要時才喝,如開車時想打瞌睡、精神不濟,而你必須提神繼續開車趕路時才喝,這時喝咖啡對提神就相當有用。

2007年9月10日 星期一

THE TAIWAN REPORT Part 1

Philip A.M. Rogers MRCVS e-mail : progers@grange.teagasc.ie (1982)Postgraduate Course in Veterinary AP, Sydney, 1991

SUMMARY

Section 1 summarises the trip schedule between November 13-28th, 1982.
Section 2 summarises the present status of Chinese medicine in Taiwan. Acupuncture (AP) is only one part of Chinese medicine, which also includes "Western" medicine, moxibustion and herbal medicine.

AP and allied techniques, as seen there, are discussed under various headings: simple needling versus electro-AP, the use of AhShi ("Ah Yes!", sensitive) points, myofascial syndromes and AhShi points, Earpoints, Local points, Distant points, methods of needling, quick needling of AhShi points, the DeQi (Teh Ch'i) phenomenon, personal experience of "needle sensations", moxibustion, cupping, AP in paralysis/paraplegia. Scar therapy was not seen during this trip. It is discussed in the hope that it may stimulate interest in this valuable therapy.

Section 3 discusses 49 of the clinical cases observed at the Veterans' General Hospital, Taipei (VGH) and China Medical College, Taichung (CMC). Many other cases were observed, but details were not noted. Most of the cases presented for treatment involved pain syndromes but I was assured that many syndromes other than pain are also treated successfully. The great majority (69%) were helped markedly or moderately by AP in 1-20 minutes.

Cases are discussed under: multiple aches and pains, tension, insomnia, neurasthenia, pain following traumatic injury, head and neck stiffness/ pain, shoulder pain/stiffness, upper limb pain, respiratory difficulty, lowback pain/stiffness + sciatica, lower limb problems, post-CVA cases.
Section 4 discusses AP research in Taiwan under the main centres and topics for research listed in the literature and Symposium abstracts, which were made available to me.

Section 5 discusses AP training in Taiwan. Courses in English are available for foreign professionals. Emphasis ranges from classical (traditional) concepts to modern concepts of neurophysiology and trigger point therapy, depending on the teaching body and the type of course chosen.

What one sees and hears during a 2-week trip is automatically biased by the observer and by the people and places visited. It may not represent the real day-to-day situation of the whole country. Nevertheless, my report may interest open-minded Westerners to go and see for themselves.

1. SCHEDULE

Nov 13th: Aircraft Dublin-London-Dubai-Hong Kong.

Nov 14th: Landing in Hong Kong Airport was exciting ! Had I not known that this is one of the world's most tricky landing places, I might have thought we were crash-landing in the centre of the city! Coming in, after dark, the aerial view of the city, with its millions of street lights and multi-coloured advertisements, was astonishing. After a 2-hour stop, I got the China Airlines flight to Taipei.

On arrival at Taipei, I heard my name called. What had I done ? No! It was to report to the Airport Authority for VIP treatment! I was whisked through Customs and Immigration before I could say "Jack Robinson".

Dr. Jen-Hsou Lin met me at the Arrivals Hall and he had arranged transport to the city. My first impression of the city was the chaotic traffic. Thousands of motor bikes, cars, trucks, bicycles and pedestrians seemed to converge on intersections. Drivers who stay accident-free in Taipei must be among the best in the world.

Then Dr. Lin pointed to the Grand Hotel. It is a wonderful sight, a huge hotel in magnificent Chinese style, perched on top of a hill and fronted by a beautiful Chinese gate. So this was Taipei! The car swept up to the main door. We entered the lobby. What a sight! It must have been 50 m x 50 m - the most impressive hotel lobby I have seen. The architecture, sculpture and decoration was quite unlike anything in my previous experience.

Nov 15th: A lazy day, spent relaxing with Dr. Lin, his wife and children. We visited Yang Ming Mountain, in beautiful sunshine. The weather was like high summer in Ireland. (I had left Dublin in wet cold November weather).
Nov 16th: Down to business. Discussions with Dr. Lin about his work in the Department of Animal Husbandry, National Taiwan University. Introductions to his colleagues and some of his students. Afternoon with Dr. Chien Chung in the AP Department, Veterans' General Hospital, Taipei (VGH).

Nov 17th: Attended lectures by Chung at the Chinese AP Research Foundation (CARF) Headquarters, Taipei. The lectures were on his research and clinical effects of needling AhShi points, and on his use of YangLingQuan (GB34) in pain control in acute traumatic injury. These were excellent lectures and were listened to attentively by a group of visiting M.D.'s on a CARF training course. Lunch with Chung. Afternoon in the AP Department, VGH.

Nov 18th: Discussions with Dr. Lin at his laboratory. We attempted our first AP analgesia test in the cow. It was 90% successful (see later). Afternoon in the VGH. Lectures to Dr. Lin's students.

Nov 19th: Opening of the Taipei AP Symposium. Evening Banquet and Kampe!

Nov 20th: Symposium. Banquet and more Kampe!

Nov 21st: Symposium closed at 1700h. Banquet and still more Kampe

Nov 22nd: Trip to China Medical College, Taichung (CMC). Stayed at Lucky Hotel. Banquet and Kampe, Kampe!

Nov 23rd: Veterinary AP Seminar, Taichung Vet School. Another banquet. Kampe, Kampe, Kampe! I'll never survive this!

Nov 24th: Visit AP Department, CMC. Return to Taipei. Farewell to Drs. Ha, Hand, Pomeranz. Stay at YWCA! Dinner at the home of Dr. Lin and his family.

Nov 25th: Pig Research Institute, Chunan. Lecture to Institute staff and local vets. Evening meal with Dr. Lin's co-workers (Chang Chia, Shieh Meei Hwa, Tsou Li Mei, Ms. Wang and Chin Sun).
Nov 26th: Visit Dr. Sun at the Yang Ming Medi
cal School. See Dr. Ha's research facilities there. Afternoon in Chung's Department, VGH.

Nov 27th: Very relaxing day, driving around the Northern coast of Taiwan. Fishing and seafood. Our host was Eddie Tsang. Sulphur baths at Yang Ming Mountain. Final banquet (Mr. Tsang).

Nov 28th: Sad farewell to Jen-Hsou and Li-Fei Lin. Flew Taipei-Singapore-London-Dublin. Composed my poem "Taiwan" on the back of the Qantas menu card, leaving Singapore. This poem is dedicated to Jen-Hsou and Li-Fei Lin as a gesture of thanks for their friendship and hospitality and as a memory of a beautiful land and its people.

2. CHINESE MEDICINE IN TAIWAN

Four afternoons were spent at the AP Department, VGH, one morning session at CARF, two sessions at the AP Department of CMC and one morning at the Yang Ming Medical School, Taipei. The case load for AP in VGH and CMC clinics was said to be 100-150 patients/day.

The following section is based on personal observations in the clinics and on discussions with Drs. Chien C. Chung, Han Ping Lee, Ming T. Lin and Wei Tse Hsiung (VGH), and Drs. Hong Chien Ha, Chung-Gwo Chang and R.T. Chiang (CMC) and Dr. Albert Sun, Yang Ming Medical School, Taipei.

1. Chinese medicine, as practised in Taiwan, combines the best of "Western" and "Traditional Chinese" medicine. Some doctors are trained in "Western" medicine, some in "Chinese" medicine and some in both systems.

2. Traditional Chinese medicine (TCM) involves study of AP, moxibustion and HERBAL MEDICINE. The latter is most important. Although medical theory (Yin-Yang, Five Phases, Perverse Causes of Disease, Disease Syndromes and Diagnostics) is the same for all branches of TCM, some herbalists do not know AP and some acupuncturists do not know herbal medicine.

The Chinese herbal pharmacopoeia is very extensive. Some of the plants are cultivated locally and processed in special pharmacies, such as in the CMC. Some of the herbal medicines are imported in crude or processed forms. I did not witness the use or efficacy of these medicines, but I was told by many doctors that they are very powerful and (when used by experts) are extremely valuable in conditions as diverse as CVA, hypertension, neurasthenia and many other internal diseases. Western doctors (and vets!) have much to learn about these medicines.

3. AP and allied techniques in clinical practice: Considerable variation exists in the choice of points for therapy and in the methods of manipulating the needles. In general, I saw very little use of electro-AP (although the stimulators were freely available in every clinic visited). There was general agreement that manual needling alone was as good as, or better, than electro-needling for most conditions requiring AP. Exceptions are (a) in AP analgesia before surgery (not witnessed) and (b) in certain chronic conditions, especially paralysis/paresis after CVA or nerve injury.

3.1. AhShi points: AhShi means " Ah Yes, or Ouch!", the exclamation from the subject when a painful point is pressed. The best AhShi point for therapy is the Trigger Point (TP), i.e. palpation pressure on the point causes a pain sensation to radiate to the problem area, muscle, or organ. It is seldom located in the area of pain. Patients usually are unaware of its presence until it is palpated. Other pain-sensitive areas (motor points, "fibrositic nodules", local pain-points etc) may be useful in therapy but they are not as powerful as the TPs (the "real AhShi" points).

Great emphasis is placed on a careful search for AhShi points. These are usually present in pain conditions, such as headache (esp. neck and shoulder muscles), joint pain (shoulder, elbow, lowback syndrome, hip, knee) and myofascial syndromes. They may also arise in some cases of internal disease (lung, heart, liver, gall bladder, g/i/t, g/u tract). In internal disease the Shu points (organ reflex points on the BL Channel (paravertebral)) are carefully palpated, as are the Mu points (Alarm points on the abdominal/thoracic area). All pressure-sensitive areas are AhShi points but AhShi points are not always Trigger Points (TPs)!

AhShi points may be located near to or far away from the problem area. AhShi/TP points can recruit new triggers elsewhere, usually in the muscles. Painful areas in scarred tissue may also act as powerful TPs and these areas must be treated to obtain optimum results. Little emphasis was placed on this fact (see section 9 below).

AhShi therapy is the best introduction to the value of needle therapy. Unfortunately, AhShi points are not present in every case, and Western doctors who know only the AhShi method are unable to help by needle techniques in such cases. AhShi points disappear when the condition resolves and the disappearance of AhShi points during a course of therapy indicates a good prognosis.

Chung did extensive clinical research with AhShi points and published the English version of his book (C. Chung (1983) "AH SHIH Point: The pressure pain point in AP: Illustrated guide to clinical AP", Chen Kwan Book Co., Taipei). This book alone would enable Western MD's (and vets) who know little or nothing about AP to begin AhShi therapy immediately and to get very good clinical results from it. (Although AhShi therapy sometimes gives better results than traditional AP, it was agreed that even better results can be got if a proper study of the AP system is made).

3.1.1. Myofascial syndrome and AhShi points: Chung defines the syndrome as one involving muscle pain/stiffness, especially around joints. The joints often are stiff, but show no inflammatory or X-ray lesions. There often is a history of intermittent recurrence. AhShi (TP) points often are present, but the patient is unaware of them until they are pressed. The diet usually is satisfactory and the neural causes of the pain are obscure.

The AhShi points usually show decreased electrical resistance and decreased local skin temperature. Local vasomotor abnormalities and dermatographic changes occur in the AhShi area.

Histology of the AhShi area shows local cell infiltration and non-specific inflammatory changes. There is sometimes a fibrous infiltration of the AhShi area (ropy muscle sign). Pressure on the AhShi often refers pain to the "problem area". Needling the AhShi often causes the "Jump Sign"; local muscle contractions cause the needle to jump.

Chung emphasises that some acupuncturists needle the problem (local) area i.e. the area of referred pain. This is inferior AP (although it can help). Much better results can be obtained by a careful search for the TP (AhShi point). In myofascial syndromes, AhShi therapy can give dramatic (and often immediate) relief of pain. AhShi therapy in these cases can give better results than traditional AP using local and distant points.

AhShi points may arise anywhere in the muscles, but they are often near the problem area. The most important muscles to search for upper body problems are: the neck muscles, infraspinatus and GB21 area. For lower body problems search the gluteus, vastus medialis, soleus, gastrocnemius. In upper limb pain (shoulder, elbow, arm, etc) the AhShi is often in the infraspinatus of the affected limb. In shoulder pain, the AhShi may be in the GB21 area, or scalenus muscle. In bilateral anterolateral shoulder pain, the AhShi is often in the sternalis muscle. In such cases, one needle in the sternal AhShi can give immediate pain relief. In abdominal and intercostal pain, check the back and sides for AhShi. In heel pain, the AhShi is often in the soleus area, left or right of BL57. In plantar pain, the AhShi is often in the gastrocnemius. In middle finger pain, search muscles near TH08. In lowback/leg pain, search the gluteus muscle.

About 33% of all cases of aching pain are myofascial in origin and respond fast and reliably to AhShi therapy. Expect excellent results in 38% and good results in 60% of cases (98% total cases). Disappearance of the AhShi is an excellent prognostic sign.

Chung's AhShi findings agree well with Western experiences of TP therapy, as described by Ronald Melzack (Canada), Pekka Pontinen (Finland) and Alex Macdonald (UK).

Miscellaneous (Chung):

Renal colic pain/spasm: GB34, LV03, SP04,06

Gastric colic/pain/spasm: ST36, CV12

Biliary colic/pain/spasm: GB34

3.2 Earpoints

I did not observe a single case of ear-AP. However, I was told by some local doctors that earpoints are sometimes used alone or in combination with body points, with good success (see Symposium report also).

3.3 Body points

a. The most commonly used points seen in use were the Channel points, especially LU07, LI04,10,11,15, ST25,36,37,38, SP04,06,09, HT07, SI03,06,09,11,19, BL10,11,23,40,57,60,62, KI03, PC06, TH05,14,15, GB20,21,30,31,34,39, LV03, CV04,12. (GV points were seldom seen used. GV15 (YaMen), needled 2" deep in one patient, appeared to cause a very severe left-sided headache, needle shock and some loss of power in the legs. The patient, an elderly lady, was being treated for facial paralysis and slurred speech following a minor CVA. She was most unhappy when questioned by me about one hour after treatment. (See CVA, later).

b. Extra-Channel Points (points not on the main Channels): These points often were used for their local or distant effects. The most commonly observed were Hand Points "Loin & Leg" between the proximal heads of metacarpals 2-3 and 4-5 respectively. These Hand Points gave immediate relief in some cases of lumbago and lowback/leg pain. Hand Point "Neck" (between the knuckles of fingers 2-3 with fist tightly closed, needled 1" deep towards the wrist. This point gave immediate relief of neck pain/restricted movement in one patient. Other Extra-Channel points used were: LanWei (Appendix point) in abdominal pain/constipation, XiYan (Knee Eyes) in knee pain, YinTang (between eyebrows) and TaiYang (temporal fossa) in headache, sinusitis.

c. Distant points: Distant points are often used in VGH (and to a lesser extent in CMC). The clinical response to needling distant points (when no local points are used) can be dramatic and cannot always be explained by short reflexes. It is known that a stimulus via one spinal nerve may activate reflex responses in areas innervated by up to 6 segments above or below the input nerve. Examples are the use of the points "Loin and Leg" or "Lumbar Area" (on the dorsum of hand) or SI06 to treat lowback/leg problems; ST38, GB39 or GB34 to treat shoulder or neck problems; LU07 in headaches. The use of TH03, SI03, Hand point "Neck" is not so inexplicable in neck/shoulder problems because the innervation is related to these areas.

In myofascial and some arthrotic syndromes, Chung prefers to use Distant rather than Local points. If patient is not helped within 20 minutes, the needles may be left in situ for up to 40 minutes and other points (AhShi, local points) may be tried also.

4. Needle Manipulation

All operators were very careful to cleanse the skin (alcohol swab), use sterile needles (disposable in VGH) and to touch only the handle (not the body) when inserting the needle.

Styles of inserting the needle varied between operators. In general, staff at VGH inserted the needle while twirling vigorously clockwise and anticlockwise until the skin was penetrated, and then the needle was advanced with less twirling. "Sparrow pecking" (up and down movement) was fast and strong, often combined with some twirling.

Vigorous needle twirling and pecking was continued for 5-30 seconds until definite "DeQi" was reported by the patient and the visible signs were observed by the operator.

In contrast, Dr. R.T. Chiang (CMC) inserted the needle through the skin with one, deft half-twirl and push. He then advanced the needle with minimal, if any, twirling to its correct depth. His sparrow-pecking and subsequent twirling was slower and more deliberate than in VGH. He also scratched the handle vigorously and "went around the clock" (moved needle handle like the hands of a clock through 360 degrees) once or twice, to get DeQi. He told me that the classic (traditional) methods of needle manipulation ("tonification" and "sedation" manipulation) are very important in difficult cases. (Staff at VGH do not appear to put importance on the classical needle manipulations used to tonify or sedate Qi).

In both hospitals, needles usually were left in position for 15-30 minutes (estimated average 20 minutes). In VGH, some twirling and pecking was repeated just before needle removal. This was mainly to ensure that the needle was not "caught" in the tissues and to avoid rough removal of a "caught" needle. In contrast, at CMC, a quick check that the needle was "free" was followed by gentle removal of the needle.

At VGH, a cotton-bud was used to apply pressure at the point for a few seconds after removal, to prevent local pinpoint bleeding.

4.1. Needling AhShi/TP points: This was one exception to the 20-minute needling time. Chung twirled the needle and pecked very strongly for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds. To my amazement (and that of other observers) the pain or stiffness which the patient had reported before needling seemed to have disappeared (as judged by the consternation or smile on the patient's face and/or visible and marked improvement in neck/shoulder/lumbar/knee movement)!!

The immediate responses seen after AhShi needling in some patients at VGH were hard to believe but I witnessed them many times (see case notes later). This is certainly similar to the Huneke "Sekunden phanomen" (instantaneous phenomenon) and is a typical reaction to TP therapy (Melzack, Pontinen, Macdonald, Lewit ). See Section 9. I was told that similar responses are not uncommon at CMC but I did not witness any there, probably, because the total number of cases I observed there were much less than in the VGH, due to shortage of time to stay at CMC.

5. DeQi

All experts agreed that it is essential to get DeQi if the best results are to be obtained in needle therapy. In Chinese medical experience, DeQi is known to have subjective (patient), subjective (operator) and objective characteristics.

5.1. Patient's sensations: The patient reports strong sensations running, proximally, or distally from the needle. Sometimes the sensation is said to travel proximally and distally. The sensations are described as: "sore", "heavy", "tingling," "electric shock-like", "running", "aching" (but not painful). The observable reactions of the patient at this time included grunts, groans, flinching of the limb or part being needled, explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives.

During the Symposium, I was needled at left LI10 by a Master. This man claimed that with really expert needle use, the PCS sensation should be felt not only along the needled Channel (LI Channel goes from index finger to nose) but also into its following Channel (ST follows LI, goes from eye to second toe via nipple and anterolateral knee). I felt the classic DeQi sensations and reacted as a typical strong reactor, as described above and in 5.3 below. However, the sensation travelled a maximum of 6" upwards, whereas it travelled distally to the dorsum of the hand and was most marked in the 6" below the point. After 3-4 minutes, the palm of my left hand became very cold and sweaty. My right palm was (normally) warm and was sweating less than the left. I had no queasiness, nausea or other signs of needle shock. The dull ache (6" above, to 6" below LI10) persisted about 2 hours afterwards. The point was slightly sensitive to local pressure for 2 days afterwards. I have needled many AP points on my body, obtained DeQi most times but without such a strong PCS reaction.

5.2 Operator's sensations: The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl).

5.3 Objective signs of DeQi are the "nipple" and the patient's reaction. After a few minutes, a definite zone of hyperaemia (1-3 cm diameter) may appear around the needle in some patients.

5.4 Propagated Channel Sensation (PCS): When needled correctly, certain ("sensitive") patients claim to feel the sensation (PCS) radiating along most or all of the Channel. Some also report sensations radiating to the organ controlled by the Channel! Chung stresses that correct needling of the AhShi point almost always sends strong sensations to the problem area, muscle or organ.

5.5 Over-stimulation of points such as LI04, ST36, etc can cause "needle shock" (weakness, dizziness, nausea, vomiting, fainting, syncope, etc).

6. Moxibustion

Although Moxa was available in all clinics, it was not seen in use except once or twice. This is because (a) the smell of moxa smoke is a nuisance in a crowded clinic, and (b) patients are shown by the nurse how to apply moxa at home. The points for moxibustion (if required) are circled with biro or felt pen. Moxa is considered helpful in: Asthma, chronic G/I problems, general malaise, physical development problems (ill-thrift), arthralgia, rheumatism, obstetrics (to turn the baby in-utero) moxa BL67.

7. Cupping

Was not observed in VGH. It was seen in two cases in CMC. It was applied for 1-3 minutes (over the needles) until the skin became red-purple. The cups were then removed but the needles were left in situ for the usual 20 minutes. Both were cases of lowback syndrome and the cups were applied bilaterally in the area of BL23-34 (4 x 2 cups in one patient and 3 x 2 in another).

8. AP in paralysis/paraplegia

At both VGH and CMC, workers told me that AP and herbal medicine can greatly help many patients suffering from paralysis as a sequel to CVA or in peripheral paralysis due to trauma. They also mentioned facial paralysis as being a good indication for AP. The number of patients which I observed being treated for post-CVA paralysis was small - one in VGH and two in CMC. There was general agreement that sensory paralysis on the affected side abolishes the needle sensation (DeQi) and there is little value in needling the affected side. In that case, needles are put in the unaffected side at key points such as GB34, ST36, BL40, GB30, LI04, TH05, LI11, GB20,21. Facial paralysis, slurred speech or absence of speech, etc are treated by local needles. GV15 (YaMen) is a dangerous point (mutism) if needled too deeply. Scalp motor points on the contralateral side are often combined with body points.

9. Scar therapy

"Anything that happens along or near the course of a main Channel influences that Channel and the organ that bears its name" (Felix Mann).

Many authors emphasise the role of scars as causes of referred pain, functional disorders and (in late stages) organ disease in man (1,5,6,7,8,9) . Scars also may cause similar problems in animals (2,3). In Germany, scar therapy (especially scar infiltration with procaine solution) has been used for decades to relieve pain and other disorders triggered by the scar (4). The relationship was observed quite independently of AP. The reaction to scar injection was often instantaneous. Problems which had existed for months or years disappeared in seconds, the "Sekunden Phanomen" of Huneke (4).

Acupuncturists have noted that injuries, bruises, or bad scars (especially if heavily fibrosed, twisted or keloid) along the course of a Channel may cause functional symptoms associated with the Channel or its organ. If the scar remains untreated, the symptoms may progress to physical (organic) pathology of the organ. Furthermore, the Channel above and below the scarred Channel ("mother" and "son" in the Qi cycle: LU - LI - ST - SP - HT - SI - BL - KI - PC - TH - GB - LV - LU) may be involved as a secondary effect. For example, I treated a man who had a very twisted scar across the BL Channel on the right thorax.
He complained of recurrent intermittent symptoms over 8 years including: haematuria, haemorrhagic cystitis, right sciatic area pain and lumbar pain, right scapular and shoulder area pain in the area of BL Channel, right headache near the BL Channel, right eye conjunctivitis, right ear tinnitus, right arm pain/spasm in the SI Channel area and pain in the little finger.
Orthodox treatment by eye-, ear-, orthopaedic-, cardiac- and internal disease specialists over years had only temporary effects and symptoms continued to recur (usually singly) at intervals. All the symptoms related to KI, BL, KI, Channels, but mainly to BL. (In the Qi cycle, the sequence is SI->BL->KI. A block in BL would give excess in SI and deficiency in KI, as well as excess in the upper part and deficiency in the lower part of BL Channel). Scar therapy (physiotherapy, massage and needling of the scar), with needling of the BL Channel, eliminated all the symptoms and the patient remained well.

This is a most important concept! Bruises, injuries and scars may cause disease. The blockages include: moxa scars, surgical scars (external and internal), injury (external and internal), cuts, local fibrosis (cicatrization due to abscess, carbuncle, etc. Reinhold Voll taught that individual tooth sockets relate to specific areas and that socket inflammation/scars, dental caries, etc may cause reflex pathology in the associated Channels and organs.

A routine part of anamnesis should be to question the patient or client as to the existence of any scars, bruises or injuries on the body and to examine the location of these injuries in relation to the location of the other symptoms and the time of occurrence of the injury in relation to the time of onset of the symptoms.

Not all scars need cause problems. Longitudinal scars are not as serious as transverse (they are less likely to cut as many nerves or Channels). Well healed (clean) scars are not as dangerous as thickened, twisted, keloid scars, or scars which have painful spots to pressure.

Scar therapy can use simple needles (under the scar, or at each end), ultrasound, physiotherapy, laser or procaine injection or B12 injection along the scar. The concept is to restore energy flow through the scarred area and to reduce size, thickness and adhesion in the scar. One to three treatments are usually sufficient.

Seeing many scars on patients in Taiwan, I was amazed that I did not see a single case of scar therapy. On questioning my colleagues in the Clinics, I was told that the concept of scar therapy was not widely known in Taiwan. Perhaps this section may awaken interest in this valuable therapy ?

SCAR THERAPY REFERENCES

1) Austin, Mary (1974). AP therapy. Turnstone Books, London, 290 pp.

2) Cain, Marvin (1981,1982) Effects of superficial scars in horses. Personal communication.

3) Gilchrist, David (1981). Manual of AP for small animals. Box 303, Redcliffe, Queensland 4020, Australia.

4) Huneke, F. (1961). Das Sekunden Phanomen (The Instantaneous Phenomenon) Karl F. Haug Verlag, Ulm, Donau, Germany.

5) Kajdos, V. (1974). Neural therapy: its possibilities in everyday practice. Amer. J. Acup. 2, 113-.

6) Khoe, Willem H. (1979). Scar injection in AP: Huneke's "Sekunden" neural therapy. Amer. J. Acup., 7, 15-.

7) Lewit, Karel (1979). The neural effect in the relief of myofascial pain.
Pain, 6,3-.

8) Mann, Felix (1973). AP cure of many diseases. William Heinemann Medical Books, London, 123 pp.

9) Rogers, Carole (1982). AP therapy for postoperative scars. Amer. J. Acup., 10, 201-.

This page created by Karanikiotes Charisios MD , Dip.Ac.

2007年9月9日 星期日

Titre du document / Document title Stimulation of insulin release in rats by die-huang-wan, a herbal mixture used in Chinese traditional medicine

Titre du document / Document title Stimulation of insulin release in rats by die-huang-wan, a herbal mixture used in Chinese traditional medicine

Author(s) :

CHENG Juei-Tang (1) ; LIU I-Min (1) ; CHI Tzong-Cherng (1) ; SU Hui-Chen (1) ;
CHANG Chung-Gwo (2) ;

Affiliation(s) du ou des auteurs / Author(s)

Affiliation(s)
(1) Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan City, TAIWAN, PROVINCE DE CHINE

(2) Committee on Chinese Medicine and Pharmacy, Department of Health, Executive Yuan, Taipei, TAIWAN, PROVINCE DE CHINE

Résumé / Abstract Die-Huang-Wan is a herbal mixture widely used in Chinese traditional medicine to treat diabetic disorders.

We have investigated the effect of Die-Huang-Wan on plasma glucose concentration in-vivo. Die-Huang-Wan was administered orally (5.0, 15.0 or 26.0 mg kg [1]) to three rat models.
Wistar rats were used as the normal animal model, rats with insulin-resistance (induced by the repeated thrice daily injection of human long-acting insulin) were used as the non-insulin-dependent diabetic model, and streptozotocin-induced diabetic rats were used as the insulin-dependent diabetic model.

In normal rats, approximately 1 h after oral administration of Die-Huang-Wan the plasma glucose concentration decreased significantly in a dose-dependent manner, from 5 to 26.0 mg kg[-1].

A similar effect was observed in rats with insulin-resistance. However, this effect was not observed in streptozotocin-induced diabetic rats, even at an oral dose of 26.0 mg kg[-1].

These results suggested an insulin-dependent action, a view supported by the increase of plasma insulin-like immunoreactivity in normal rats receiving Die-Huang-Wan. The results indicated that Die-Huang-Wan had an ability to stimulate the secretion of insulin and this preparation seemed helpful in improving the diabetic condition, especially hyperglycaemia in type-II diabetes.

Revue / Journal TitleJournal of pharmacy and pharmacology (J. pharm. pharmacol.)

ISSN 0022-3573 CODEN JPPMAB
Source / Source2001, vol. 53, no2, pp. 273-276 (14 ref.)
Langue / Language Anglais

Editeur/PublisherPharmaceutical Press,Wallingford, ROYAUME - UNI (1949) (Revue)

Mots-clés anglais / English Keywords Insulin ; Hypoglycemic agent ; Release ; Regulation(control) ; Plant origin ; Medicinal plant ; Pharmacognosy ; Folk medicine ; China ; Animal ; Rat ; Oral administration ; Asia ; Rodentia ; Mammalia ; Vertebrata ;
Mots-clés français / French KeywordsInsuline ; Hypoglycémiant ; Libération ; Régulation ; Origine végétale ; Plante médicinale ; Pharmacognosie ; Médecine traditionnelle ; Chine ; Animal ; Rat ; Voie orale ; Asie ; Rodentia ; Mammalia ; Vertebrata ;
Mots-clés espagnols / Spanish KeywordsInsulina ; Hipoglicemiante ; Liberación ; Regulación ; Origen vegetal ; Planta medicinal ; Farmacognosia ; Medicina tradicional ; China ; Animal ; Rata ; Vía oral ; Asia ; Rodentia ; Mammalia ; Vertebrata ; Localisation / Location
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