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Managing Cancer Pain with the Exclusive and Newly-Developed Reinforcing Yang-Nourishing Yin Acupoint Protocol

TongZheng Hong*

As-You-Wish Healthcare Institute, Taiwan

Corresponding Author: Tong-Zheng Hong, As-You-Wish Healthcare Institute, MS in Acupuncture awarded by National University of Health Sciences in IL, Taiwan

Received: April 13, 2019; Published: April 20, 2019

Abstract

To observe the therapeutic effects of acupuncture for the cancer pain management, this exclusive and newly-developed protocol composed of Yuan-Source and Luo-Connecting acupoints was conducted to the patient at stage IV with urothelial carcinoma. Through the pain scale answered by the patient, the result showed that this protocol is effective to reduce the pain from level 9 down to level 4 with the four consecutive treatments.

Keywords: Cancer pain; Yin-Yang; Yuan-source/Luo-Connecting acupoints

Introduction

Cancer patients usually go to the conventional medicine for solutions to relieve pain which may impair the quality of life. In most of the cases, the tumor pressing on bones, nerves or other organs in the body can cause cancer pain; however, symptoms in some cases results from the cancer treatment, such as numbness and tingling in hands and feet, can be caused by chemotherapy drugs and skin irritation and redness may be due to radiotherapy.Cancer pain can be either acute or chronic. Having an operation can cause acute pain, but tends to last only a short time. Meanwhile, painkillers usually work to keep the pain under control. On the other hand, changes to the nerves is the most common cause of chronic pain/ persistent pain, which can range from mild to severe and last all the time. In general, nerve changes may be due to chemicals produced by a tumor or cancer pressing on nerves (Cancer Research [1]). Different types of pain like nerve pain, soft tissue pain, bone pain, phantom pain, and referred pain need the different treatments [Cancer Research UK. Causes and types of cancer pain].Up to now, there have been over 40 medical conditions identified by the WHO that may be effectively treated with acupuncture (Jonathan WJ, et al. [2]). In addition, acupuncture has also been verified to be beneficial to patients suffering from chronic pain with its clinically relevant effect on chronic pain that can persist over time, though the acupuncture still remains a controversial treatment (Vickers AJ and Ingraham P, et al. [3,4]). Yi-Yang is the unique and philosophical concept serving as the foundation and guideline for the developments of acupuncture and traditional Chinese medicine (TCM) theories, such as the Qi-Blood and Five Elements. A disease is understood to present the imbalance of Yin and Yang, leading to the signs and symptoms in the TCM are broader than those in Western medicine. In general TCM physicians and acupuncture practitioners usually do not follow the Western pathological classifications of diseases, but only depend on the patterns individualized by the imbalance of Yin and Yang, Qi, and Blood, and body fluids in the body (Hong TZ [5]).This study aims to introduce the newly-developed combination protocol combined of Yuan-Source and Luo-Connecting Acupoints in relieving the cancer pain, which may be one of the choices in clinical practice in the future.

Case Presentation

The male patient is 57 years old, who had been diagnosed five months ago as diabetes, infiltrating urothelial carcinoma, right pelvis and suspected of lower ureter with Thoracic spine metastasis, cT2N3M1, Stage IV before the acupuncture treatments. Medications prescribed are Lyric, Transamine, Ranitidine, Fentanyl citrate, Acetaminophen, Oxycodone, and Fentanyl patches.The chief complaints included he was not able to stand up with asthenia, numbness in the left hand, constipation, edema in the feet, poor appetite and sleep for at least three months, and consistent low back pain.

Differential Diagnosis

Subjective and objective information gathered from the four diagnosis skills, Looking, Listening, Asking, and Feeling, can be helpful for acupuncture practitioners to consider for synthetic diagnosis and treatment strategy.

Looking

In Figure 1 the information from Looking indicated slight yellow & pale complexion, the color of the tongue is pink in the middle Jiao, sticky white and yellow coating on the Lower Jiao, and slight purple and a little bit of teeth marks at the tip and on the left side. A little bit swollen with a crack in the middle of the tongue.

Figure 1

Listening

When the patient was questioned, his voice was weak and it seemed there was phlegm in the chest.

Asking

The patient responded he felt tired easily, failed to sleep soundly, and always slept dream-disturbed. He felt sharp and stabbing pain in the lower back and had constipation.

Feeling

Pulse checking indicated wiry, slippery, and weak

Analysis of information

Pink in the middle Jiao may suggest diabetes, tiredness, teeth marks and pale complexion indicated Spleen qi deficiency, which obstructed Qi flow in the body leading to Kidney qi deficiency presented with sticky white and yellow coating in the lower Jiao to cause pain in lower back. Wiry pulse presented Liver qi stagnation that invaded Spleen, leading to Spleen qi deficiency with weak pulse, sticky white coating and phlegm in the chest that refers to coldness in the body. Yellow and slight purple of the tongue indicate that coldness in the body is turning into Heat.

Treatment Plan

The patient’s pain was rated level 9 on the pain scale on the first day of the four consecutive treatments. The top priority of the treatment is out of doubt to relieve his pain in order to help his sleep.The sooner, the better. As an acupuncture practitioner, “Less needling for the best outcome” is the golden rule to follow because this enables patients to have a better quality of life in a short time [Hong TZ. Clinical Considerations of Using Extra Acupoints and Traditional Acupoints]. Based on this rule, the unique and newlydeveloped Reinforcing Yang-Nourishing Yin acupoint protocol was taken into consideration to reduce pain in this case.

Introduction to Reinforcing Yang-Nourishing Yin acupoint protocol

Yin-Yang is the abstract and unique concept, but plays a key role to the successful treatment with the TCM and acupuncture. In accordance with Yin-Yang theory, the traditional and regular meridians can generally be divided into Yin and Yang meridians shown in the (Figure 2).

Figure 2 Characteristics of Yin and Yang

The concept of Yin-Yang is incorporated into this protocol because it can enable patients to retrieve the Yin-Yang balance viewed as the foundation of health in the TCM and acupuncture faster. According to acupuncture theories, acupoints refer to specifically chosen sites gathering Qi in the body and are the basis for understanding the mechanism of acupuncture. Stimulation on different acupoints on the body surface could provide various therapeutic benefits. Each of the twelve meridians has a Yuan-Source acupoint to pool theYuan (original) Qi while Luo-Connecting acupoints are responsible for connecting Zang and Fu organs which has the exterior-interior relationship.In Chapter one of the Volume of the Spirit Pivot in the Huang Di Nei Jing (Yellow Emperor’s Inner Classic), it is presented and discussed that Yuan-Source acupoints can be used to treat Zang organs while Fu organs can be treated with Luo-Connecting acupoints in Chapter four.

Manipulation procedures

Since this new protocol is developed on the basis of YinYang balance in order to reinforce Yang and nourish Yin, Yin-Yang principles should be strictly followed.The YinYang theory indicates that left refers to Yang while Yin lies in Citation: TongZheng Hong. Managing Cancer Pain with the Exclusive and Newly-Developed Reinforcing Yang-Nourishing Yin Acupoint Protocol 2019;1(1): 5. © All rights are reserved by TongZheng Hong. Page 3 of 5 right. In conducting this protocol, the steps listed below need attention for the best outcomes.

a) The protocol must be conducted four consecutive times, one time a day.
b) Selecting Yuan-Source acupoints of Zang organs on the Yin meridians and Luo-Connecting acupoints of Fu organs on the Yang meridians.
c) Start with Yuan-Source acupoint on the Lung meridian, following the circuits of the flow of Qi, and end on YuanSource acupoint of Liver on the Liver meridian.

Results

The pain was rated level 10 before the first treatments, even though Fentanyl patches were used. The levels of pain on the Wong-Baker FACES Pain Scale as (Figure 3) each treatmentwere rated by the patient

Figure 3 Pain scale used in the treatments

The result showed that the levels of pain decreased with each treatment shown in Table 1.

Table 1: Major reactions with pain levels

In addition to rating the pain, the tongue diagnosis served as the one of the objective information for evaluation of treatment also showed the patient’s condition had been improved a lot with the treatments as in Figure 4.

Figure 4 Tongue coating after three treatments

Compared to (Figure 1), it is obvious that the sticky white and yellow coating on the Lower Jiao (Lower Burner) in Figure 3 decreased a lot, showing Yang was reinforced.In addition, symptoms such as low back pain, edema in the feet, and numbness in the left hand also improved.

Discussion

Extremely different from the Western medicine physicians to get the information with scientific and technological instruments, an experienced TCM practitioner or acupuncturist can only depend on four skills for diagnosis of patterns to give prescriptions to balance Yin-Yang (Hong TZ [6]). Yin-Yang, the concept of two opposing but complementary forces constituting the world and the life, is viewed as the top guide for acupuncture practitioners and the TCM physicians in practice. On the other hand, Yin-Yang imbalance in the body is understood to lead to diseases, including cancer (Hong TZ [7]). It is noted in the TCM and acupuncture that Yin referring to materials is the basis of Yang, while Yang is the representations of Zang-Fu organs in exerting Yin (Hong TZ [8]).A human body is constituted by the three essential and vital treasures Jing (Essence), Qi, and Shen. Jing (Essence) is viewed as Ying while Qi viewed as the energy to benefit the body refers to Yang to maintain functions of the body for transporting Blood to nourish the all the systems of the body to fight against external evil Qi (pathogens). The functions of the systems of the body may be affected with the activities of ascent and dispersion of Liver because the functions of Liver are to store Blood for regulating the blood volume to nourish the constituents of the body and to regulate the distribution of fluids and blood with free flow of Qi in the traditional twelve meridians. On the other hand, the Liver qi can affect the Spleen qi to ascend and the Stomach qi descend correctly, which has a critical impact on the metabolism (Hong TZ [9]).TCM and acupuncture are pretty complex developed on the inductive reasoning and tailored to the patient’s specific needs and patterns; therefore, using randomized clinical trials to test TCM to compare the results from the perspective of the conventional medicine are difficult in a way for the Western doctors to test whether it works for treating or preventing cancer (Hong TZ [10]). However, the evidence currently available shows that acupuncture is an effective and safe therapy in managing cancer and treatment related symptoms, such as pain, depression and anxiety, hot flashes, leukopenia, fatigue, radiation-induced xerostomiahas, etc. in the care plan (Lu W, et al. [11]).

In terms of the TCM etiology, pain is generally affected by the imbalance of Yin-Yang and classified into

1) Deficiency
2) Excess patterns resulted from either stagnated Qi or

Blood stasis in the systems of the body. Abnormal fluid from the perspective of the TCM is defined as Dampness with the presentation of white tongue coating and teeth marks, which damages the Spleen Yang to make stagnated fluids to cause Qi stagnation and Blood stasis. Conversely, stagnated Liver qi can invade Spleen to lead to Spleen qi deficiency and eventually compromise the immunity system due to the congestion of the lymphatic system and autoimmune conditions (Hong TZ [12]). In Figure 3, the sticky white and yellow coating decreased a lot, which indicated that this protocol is effective in activating the twelve meridians at the same in order to reinforce Yang to drain Dampness and nourish Yin to energize Zang-Fu organs for reducing pain and clearing Heat.It is discussed and presented that the level of pain resulted from cancer can depend on:

a) The type of cancer
b) Where it is
c) The stage of the cancer
d) Whether the cancer or treatment has damaged nerves

Other factors, such as fear, depression, anxiety, and the lack of sleep can also affect how server the pain may be (Cancer Research [1]). The results of scientific studies revealing that poorer sleep is significantly related to higher levels of nighttime pain and hot flashes (Rumble ME, et al. [13]), which can explain why the pain was improved immediately because the patient could sleep soundly with the second treatment. Poor sleep or insomnia can be caused by the Blood/ Jing (Essence) deficiency resulted from Qi stagnation. Blood can nourish Qi while Qi can move Blood, based on the concept that Qi is the commander of Blood and Blood is the mother of Qi presented in the Essential Questions of Yellow Emperor’s Inner Classic (Huang Di Nei Jing), which suggests one is inconceivable without the other in the TCM. With the collaboration of Qi, Blood circulation can benefit the tissues to fight with inflammation, which can be impaired with the stagnated Qi (Hong TZ [14]). Ample evidence shows that sleep and pain are closely relatedand some of the key processes contributing to the development and maintenance of chronic pain may be impaired with sleep disturbance (Pain health [15]). Recent experimental studies also suggest pain indicates that the nervous system is much more active, interfering with how quickly a person can fall asleep and how deep a sleep he/she may get (Finan PH, et al. [16]).The results of using this protocol show that the most amazing reaction in common is that most patients can have a sound sleep only with one or two treatments in the past cases. In other words, it suggests that this protocol is effective to reduce/relieve pain as shown in Table 2 because it can enable patients to have sound sleep.

Table 2: Cases of using the protocol

Conclusion

This exclusive and newly-developed acupoint protocol works effectively to reduce cancer pain for the patient in this case, enabling him to have a better quality of life in a short time, which suggests referral for acupuncture treatment is a reasonable option for patients with chronic pain, particularly for those patients who have cancer pain. This case and the past experiences show this protocol can improve the patients’ sleep to reduce/relieve pain and help patients stay energetic through activating Yin and Yang at the same time. In other words, the successful application of this protocol suggests the balance of Yin-Yang needs more attention in the clinical practice. However, how to understand the mechanism of this protocol with the science-based evidence needs more research in the future since this protocol introduced in this case is totally developed with the limited experiences.

CJBRT