Event 6: Acupuncture Evaluation

Mrs. Johnson decides to have an acupuncture evaluation.

Test Your Knowledge

Question: How appropriate is referral to acupuncture for this patient?

Mrs. Johnson Meets with the Acupuncturist

History of Present Illness

History of Present Illness, Continued

Summary of Findings on Inquiry

• Cold & Heat:  Does not report any abnormal sensations.
• Sweat: Sweating occurs readily on exertion or sometimes without exertion. Notices sweat primarily on her head. Does not awaken at night with sweating.
• Head & Body: Lumbar pain radiates to lower extremities, R>L. Standing or walking >5 minutes causes pain. Leaning, sitting, lying down bring relief. Back pain is “dull and achy,” leg pain is burning with “pins and needles sensation.” Heat reduces discomfort. Pain affects ADLs reducing social contacts and leading to isolation.
• Stool & Urine: stress incontinence, wakes to urinate, accidents, BM daily formed, can be loose.
• Drink, Food & Taste: Likes coffee, meat, and starchy foods. Knows “she should eat more vegetables.” Likes bean dishes with pork, fried chicken, desert. Discussed increasing bean dishes and vegetables and using less fat. 
• Chest, Ribside, Stomach Duct, & Abdomen: History of smoking and COPD.
• Ears & Eyes: Bifocals; reports “floaters”
• Thirst and Intake of Beverages: Thirst with little desire to drink, consumes sugary sodas, but knows she shouldn’t
• Sleep: Wakes due to pain 1-2 times per week. Wakes with need to urinate, reports some “accidents” at night.
• Questions Specific to Women: Menopause occurred about age 45, thinks it was early.

Test Your Knowledge

Question: Which impediment pain pattern does Mrs. Johnson seem to be experiencing?

Current Prescribed Medications

• Lisinopril 10 mg daily
• Amlodipine 10mg orally daily
• Glipizide XL 10mg daily
• Sitagliptin 25mg orally daily
• Tiotropium 18mcg Inhale daily
• Albuterol 90mcg/puff MDI 1-2 puffs inhale Q4h as needed SOB
• Citalopram recently increased to 40mg daily 
• Ibuprofen 600mg TID
• Zolpidem 10mg QHS as needed (using regularly)
• Hydrocodone/Acetaminophen 5/325mg as needed pain

Inspection & Palpation

• Inspection of
  • body
  • tongue
• Palpation of affected regions
  • shoulder
  • lumbus
  • legs
  • knees
• Palpation of radial pulse

Tongue and Pulse Findings

• Tongue
  • Swollen, greasy thick fur, peeled patches, tip is red
• Pulse
  • 65 bpm, slippery on right, string-like on left especially the cubit position, which is fine. Both cubit positions are weak.

Test Your Knowledge

Question: How does the Chinese Medicine diagnosis of “kidney vacuity lumbar pain” relate to an older patient with spinal stenosis pain?

Full Diagnosis for Mrs. Johnson

• Cold damp lumbar pain accompanied by:
  • wind cold damp impediment
  • phlegm heat in lung
  • kidney insufficiency
  • dampness encumbering the spleen

Treatment Plan

Acupuncture treatment in the US is often delivered on a weekly basis. This may be suboptimal for pain and other conditions. Cost, access, and convenience may prevent more frequent treatment.

Treatment

• Several modalities may be provided as discussed with the patient.
  • Acupuncture 
  • Local application of heat using a heat lamp and/or moxibustion 
• Other potential treatments include:
  • Tui Na (pushing and grasping) or Chinese Medical Massage
  • Cupping

Acupuncture Treatment for Mrs. Johnson

The treatment provided would be directed to:

• specific points selected on the basis of palpation and traditional theory 
• associated distal points 
• points selected to address clinical issues such as dampness accumulation and upper-body heat

Follow Up with Dr. Kent

Mrs. Johnson returns to see Dr. Kent for a follow-up visit.

Resources and References

Additional Material