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Acupuncture Assessment: History

The patient history is considered the most important part of diagnosis in Chinese medicine.

  • Inquiry about the chief complaint, its onset and characteristics is critical.

Acupuncture Assessment: History

Because the menstrual cycle is considered physiologically important in Chinese medicine a clinician will ask about its characteristics and its relationship to the presenting complaint.

  • Pain prior to and during menses suggest stagnation of qi and blood.
  • Association of headache with onset of menses suggest qi constraint.

Acupuncture Assessment: History

Early history of cyclic vomiting can be associated with abnormal GI function later in life. Inquiry about bowel movements help in understanding the relationship between the normal qi dynamic (peristalsis and evacuation) and the chief complaint.

  • Reduction of headache intensity or resolution upon bowel movement indicates restoration of normal qi dynamic is palliative.
  • Loose stool can suggest abnormal GI physiological function due to disruption of qi dynamic.

Acupuncture Assessment:
Examination

  • Pulses
  • Tongue
  • Abdomen

Acupuncture Assessment: Pulse Palpation

  • The radial pulse is palpated bilaterally to assess rate, rhythm, arterial volume and force, and wave form.
  • The index, middle, and ring finger are applied to the artery.
  • A specialized vocabulary is used to describe the findings.

Acupuncture Assessment: Tongue Inspection

  • The tongue exhibits a range of signs.
  • Tongue coating can provide information about the digestive system and the health of the microbiome.
  • The color of the tongue body can provide insight into the quality of perfusion and the status of the cardiovascular system.
  • The sublingual veins are examined to assess for gross signs of blood stasis (reduced perfusion).

Acupuncture Assessment: Abdominal Palpation

  • Abdominal palpation provides tactile information and information from the patient that can help clarify the diagnosis.
  • The clinician is palpating acupuncture points and regions associated with specific organs to help understand Morgan’s presentation.
  • Regions associated with the liver and the primary organs of digestion (spleen/stomach) are sensitive.
  • Alarm point of the stomach is reactive.

Morgan's Findings: Summing Up

  • Childhood history of cyclic vomiting may have been an early sign of liver qi depression and digestive weakness.
  • Vomiting is "counter flow" movement of qi in Chinese medicine
  • Repeated vomiting can harm the qi dynamic (normal peristalsis)
  • This leads to body disorganization (disruption of qi dynamic), predisposition to headaches, irritability, and later dysmenorrhea associated with liver depression.

Concussion

  • In Chinese medicine any traumatic injury can produce blood stasis.
  • Persistent disruption of the qi dynamic can also cause blood stasis.
  • The hesitant quality of the pulse is important is assessing blood stasis.
  • Tongue signs also support this diagnosis.

Blood Stasis

  • Blood stasis (blood not moving smoothly).
  • Can be produced by trauma (sharp blow to the head) persistent disruption of orderly movement of qi and blood (early cyclic vomiting), and manifest in menstrual pain, headache and pulse and tongue signs.
  • Impaired circulation may be associated with the vascular components of migraine

Chinese Medicine Diagnoses

  • Liver overacting on the spleen (Qi and Blood Vacuity Pattern)
  • Blood stasis in the liver and gallbladder channels (Obstructing the Network Vessels Pattern)
 

Evidence

  • focal pain
  • menstrual exacerbation
  • relief with bowel movement
  • tongue stasis signs
  • tender Alarm Point of the Stomach

Findings Suggest:

  • Diagnostic Patterns of Liver depression – Qi & Blood Vacuity and Blood Stasis Obstructing the Network Vessels both leading to migraine headache
  • Acupuncture may be helpful
  • 6-8 weekly treatments
  • Key markers are reduction in frequency and severity

Does Acupuncture Hurt?

Needle Comparison

Treatment Planning

  • Acupuncture point selection is an important part of treatment planning

  • In Morgan's case, points would be selected
    • based on the diagnostic patterns
    • based on the regionalization of headache pain
  • According to channel distribution
    • based on the tenderness of established acupuncture points
    • based on the presence of transiently reactive points on the channel sinews
    • Treatment would be revised based on the patient's response

Acupuncture and Pediatric Migraine

  • The evidence base for the use of acupuncture in pediatric migraine headache pain is quite limited. One prospective interventional cohort study (case series) examined acupuncture as treatment for emergent pediatric migraine in the ED.
  • Conclusion: "With all subjects showing improvement or resolution of migraine headache, this pilot study introduces an alternative intervention to pediatric migraine management. Further studies are needed to evaluate the duration of symptom resolution and comparative effectiveness."

Graff et al. 2016 Auricular Acupuncture for the Treatment of Pediatric Migraines in the Emergency Department. Pediatric Emergency Care.

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