.
Ping Gong Yuhang Qi
Fentanyl is an extremely potent synthetic opioid, approximately 100 times more potent than morphine and 50 times more so than heroin［1］. Introduced into the U.S. clinical medical system in the 1960s as an effective intravenous anesthetic, fentanyl plays an irreplaceable role in the medical field［2］. However, its illegal manufacturing and distribution have turned it into a significant public health threat in the United States. In 2022, Anne Milgram, head of the Drug Enforcement Administration (DEA), identified fentanyl as the “single deadliest drug threat” the U.S. has faced［3］. Fentanyl and other opioids have driven the most severe drug crisis in American history, causing over 1,500 Americans to die from opioid overdoses each week, and it is the leading cause of death for Americans aged 18 to 45. In 2021, the total number of deaths soared to 80,411［4］. A study by researchers from the Mayo Clinic and Yale University found that deaths caused solely by fentanyl nearly tripled from 2016 to 2021［5］.
Extensive animal and clinical trial data confirm that acupuncture can significantly improve the withdrawal symptoms from opioids. Acupuncture, including both traditional and electroacupuncture therapies, can hasten the production and release of opioid peptides in the central nervous system, thereby achieving analgesic effects. This outcome is closely related to the stimulation frequency of electroacupuncture. Low-frequency stimulation (2Hz) can accelerate the production of endorphins and enkephalins in the central nervous system, while high-frequency stimulation (100Hz) can speed up the production of dynorphin［6］. By accelerating the release of various opioid peptides in the central nervous system, acupuncture alleviates the withdrawal syndrome in individuals addicted to opioid drugs. It is well known that drug dependence is a problem that can recur over time, with a high likelihood of relapse even after a period of abstinence. Therefore, the ultimate goal of treating drug dependence is not only to alleviate or cure withdrawal symptoms but more importantly, to reduce the craving for drugs (psychological dependence) and eliminate compulsive drug-seeking behaviors after detoxification［7］.
From the perspective of Traditional Chinese Medicine (TCM), opioids are pungent, warm, and dry. Consumption leads to intense toxic heat within the body, disturbing the mind and creating abnormal excitement, seemingly bringing pleasure to the mind and body. However, this internal accumulation of toxic heat damages the essence and consumes the blood, ultimately harming the yin and yang and injuring the vital energy. Without continued consumption, withdrawal syndrome appears, manifesting as listlessness, fatigue, excessive sleepiness, restlessness, indecisiveness, abnormal emotional fluctuations (such as depression, despair, and dejection), loss of interest in daily activities, frequent sighing, sadness, sleep disorders (difficulty falling or staying asleep), anxiety, irritability, slow reactions, and in severe cases, emotional instability, inability to work or socialize normally, and even self-destructive tendencies. In addition to psychological and emotional abnormalities, physical abnormalities also emerge, including frequent headaches, dizziness, chest tightness, palpitations, shortness of breath, loss of appetite, nausea, vomiting, and more, due to deficits in qi, blood, yin, and yang, and dysfunction of internal organs.
In clinical practice, combining acupuncture with herbal medicine and adopting a method of supporting the healthy and expelling the pathogenic have achieved certain therapeutic effects in treating withdrawal syndrome from fentanyl and other opioids, as well as in preventing relapse. Below is a typical case analysis:
The patient, a 36-year-old female, initially accidentally consumed Percocet laced with fentanyl and quickly developed a dependence on fentanyl. The patient described experiencing extremely painful withdrawal symptoms, encompassing a wide range of physical and mental symptoms such as anxiety, insomnia, cold sweats, muscle pain, nausea, vomiting, diarrhea, involuntary crying, and yawning. The intensity and range of these states once led the patient to despair. The acupuncture and Chinese herbal medicine treatment was as follows:
Acupuncture points chosen included LI-4 (He Gu), PC-8 (Lao Gong), PC-6 (Nei Guan), M-HN-3 (Yin Tang), SP-6 (San Yin Jiao), ST-36 (Zu San Li) on the abdominal side, BL-15 (Xin Shu), BL-18 (Gan Shu), BL-23 (Shen Shu), and the Jia Ji points (T3-T5) on the back side. The patient first lay in a supine position for needle insertion, using twisting and thrusting to achieve de qi sensation, followed by electroacupuncture stimulation, connecting LI-4 (He Gu) to PC-8 (Lao Gong) and SP-6 (San Yin Jiao) to ST-36 (Zu San Li). The stimulation used alternating waves of 2Hz and 100Hz frequencies, adjusting the current strength based on the patient’s tolerance. After leaving the needles in for 20 minutes, the patient was placed in a prone position to needle the back, leaving the needles in for another 20 minutes without electroacupuncture. Auricular acupuncture followed the National Acupuncture Detoxification Association (NADA) protocol, targeting five points: Shenmen, Sympathetic, Kidney,Liver, and Lung, with the needles left in place for 40 minutes. As an adjunct therapy, Chinese herbal medicine was used: Gui Pi Wan was prescribed, mainly to calm the Shen, strengthen the spleen, and harmonize yin and yang. The dosage was 8 pills taken twice daily, morning and evening, with warm water.
In the first week, treatment was administered three times, and according to the patient’s feedback, there was a significant improvement in withdrawal symptoms, with a decreased desire for drugs. From the second to the third week, treatment was reduced to twice weekly, with further improvement in various symptoms. Based on the symptoms, the herbal formula was switched to Gan Mai Da Zao Wan, and the patient was also taught Tai Chi to help calm the mind, stabilize emotions, and enhance physical strength. After four and a half months of continuous treatment, significant overall improvement was noted, and the patient returned to normal life, at which point treatment was discontinued. A follow-up call six months later confirmed the patient’s satisfaction, with a return to normal work and life activities and no relapse into drug use.
Author information:
Ping Gong, L.Ac. Ping Gong is an emerging star in the field of Traditional Chinese Medicine (TCM) in the US, currently serving as a researcher and instructor at the New York College of Health Professions. His research and teaching focus on utilizing TCM practices, such as acupuncture, to treat depression and drug addiction.
Qi Yuhang, L.Ac., LMT Qi Yuhang is an emerging star in the field of Traditional Chinese Medicine (TCM) in the US, currently serving as a researcher and instructor at the New York College of Health Professions. His research and teaching focus on utilizing TCM practices, such as acupuncture, to treat depression and drug addiction.
參考文獻
References
- Pardo, B., Taylor, J., Caulkins, J., Reuter, P., & Kilmer, B. (2021). The dawn of a new synthetic opioid era: the need for innovative interventions. Addiction, 116(6), 1304-1312.
- Choińska, M. K., Šestáková, I., Hrdlička, V., Skopalová, J., Langmaier, J., Maier, V., & Navrátil, T. (2022). Electroanalysis of fentanyl and its new analogs: a review. Biosensors, 12(1), 26.
- Li, J. (2023). The Effectiveness of Problem-Oriented and Intelligence-Led Policing on Reducing Illicit Fentanyl Overdoses (Master’s thesis, California State University, Long Beach).
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2022. Available at http://wonder.cdc.gov.
- Jeffery, M. M., Stevens, M., D’Onofrio, G., & Melnick, E. R. (2023). Fentanyl-associated overdose deaths outside the hospital. New England Journal of Medicine, 389(1), 87-88.
- Han JS (2003) Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 1(26):17–22. doi:10.1016/S0166-2236(02)00006-1
Wu LZ, Cui CL, Han JS (1996) Effect of Han’s acupoint nervestimulator (HANS) on the heart rate of 75 inpatients duringheroin withdrawal. Chin J Pain Med 2:98–102
運用中醫藥應對美國芬太尼氾濫之潮
龔萍 戚宇航
芬太尼是一種極為強效的合成鴉片類毒品，其鎮痛效果約為嗎啡的100倍，海洛因的50倍［1］。1960年代，芬太尼作為一種有效的靜脈麻醉劑進入美國臨床醫療體系［2］。雖然它在醫療界扮演著不可取代的角色，但非法製造和流通已讓它成為美國公共衛生健康面臨的巨大威脅。2022年，美國緝毒局（DEA）負責人安妮·米爾格拉姆（Anne Milgram）指出，芬太尼是美國遇到的「最致命的單一毒品威脅」［3］。芬太尼及其他鴉片類毒品推動了美國史上最嚴重的毒品危機，每週造成超過1,500名美國人因鴉片類毒品攝取過量死亡，而芬太尼則是造成18至45歲美國人死亡的主要原因。在2021年，總死亡人數更是飆升至80,411人［4］。梅奧診所和耶魯大學研究人員的一項研究發現，僅芬太尼造成的死亡人數從2016年到2021年幾乎增加了兩倍半［5］。
大量動物和臨床實驗數據證實，針灸能夠明顯的改善鴉片類毒品的戒斷反應。針灸（包括傳統針灸和電針療法）能加速中樞神經系統中阿片肽的產生和釋放，從而達到抗痛覺的效果。這種效果往往與電針的刺激頻率有密切關係。低頻的電針刺激（2Hz）會使中樞神經系統加速產生腦啡肽和內啡肽，而高頻刺激（100Hz）則可加速產生強啡肽［6］。針灸就是透過加速中樞神經系統中各種鴉片肽的釋放，從而緩解阿片類藥物成癮者在戒毒期間的戒斷症候群。眾所周知，毒品依賴是長期反覆出現的問題，即便在戒斷毒品一段時間後，復發的可能性仍極高。因此，治療藥物依賴的最終目標並不只是緩解或根治戒斷症狀，更關鍵的是減輕吸毒者對毒品的渴望（心理上的依存）以及在排毒之後消除患者尋求並吸食毒品的強迫性行為［7］。
從中醫角度來看，鴉片類毒品辛溫燥烈，吸食後身體會產生熾熱毒熱，熱擾心神，異常亢奮，似讓人感覺身心愉悅，殊不知熱毒內蘊，傷精耗血，進而損及陰陽，戕傷正氣。如不繼續吸食就會出現戒斷綜合徵，〖JP2〗表現為精神萎靡，疲倦乏力，過度嗜睡，心神不寧，志意不定；情緒異常波動，如精神抑鬱，感到絕望和沮喪；喪失對日常活動和興趣 的關注，長時間的嘆息，易於感到悲傷；睡眠障礙，表現為難以入睡或維持睡眠，焦慮煩躁，反應遲鈍，行動緩慢，嚴重時可能出現情緒失控，無法正常工作和社交，甚至產生自毀傾向。除精神情緒異常外，身體也日漸異常，常頭痛、眩暈，胸悶、心慌、氣短，食慾不振，噁心，嘔吐等等不一而足。這些都因氣血陰陽虧損，內臟功能失調所致。
筆者在臨床應用針灸結合中藥，採取扶正祛邪的方法治療芬太尼等阿片類毒品的戒斷綜合症以及防止患者復吸毒品方面收到了一定的療效，獲得一些經驗和體會。下面是一個較為典型的案例分析：
患者，女，36歲，該患者最初誤服摻雜芬太尼的Percocet （羥考酮），隨後迅速形成了對芬太尼的依賴。患者描述其經歷的戒斷症狀極為痛苦，涵蓋了廣泛的身心症狀：焦慮，失眠，出冷汗，肌肉疼痛，噁心，嘔吐，腹瀉，不自主的流淚和打哈欠等，其強度和範圍遠超過患者之前的任何經歷，這些狀態一度導致患者產生了絕望的念頭。
針灸和中藥治療如下：
體針選擇腹側合谷，勞宮，內關，印堂，三陰交，足三里，背側選擇心俞，肝俞，腎俞，夾脊穴（T3- T5）。先取仰臥位針刺，捻轉提插得氣後，用電針儀加以刺激部分穴位，分別連接合谷和勞宮以及三陰交和足三里。刺激頻率波為2Hz和100Hz的交替波，根據患者耐受度調節電流強度。留針20分鐘後，再取俯臥位，針刺背側穴位，留針20分鐘，不施以電針刺激。耳針則遵循美國國家針灸戒毒協會治療協議（NADA protocol）所建議使用的五個穴位，分別為：神門，交感，腎，肝，肺，留針時間為40分鐘。
中藥為輔助療法：採用中藥丸劑歸脾丸，主要起到安神，健脾，調和陰陽的作用。每次服用8粒，每日2次，早晚溫水送服。
第一周，共治療三次，根據患者反應，戒斷症狀大幅提升，感覺對毒品依賴的願望減少；第二周至第三週，每周治療兩次，各種階段症狀進一步得到改善，根據症狀，換服甘麥大棗丸，同時教病人練習太極拳，以幫助安神定志，穩定情緒，增強體力。連續治療4個半個月後，各方面都得到極大的改善，基本上恢復正常，隨即停止治療。半年後，電話隨訪，病人滿意，已投入正常的工作生活中，一切正常，未再吸毒。
作者簡介：
龔萍，紐約州執照針灸師，龔萍是美國中醫領域的後起之秀，目前在紐約健康學院擔任研究員和講師。她的研究和教學重點是利用中醫療法，如針灸，治療憂鬱症和藥物成癮。
戚宇航，紐約州執照針灸師，按摩師。戚宇航是美國中醫領域的後起之秀，目前在紐約健康學院擔任研究員和講師。他的研究和教學重點是利用中醫療法，如針灸，治療憂鬱症和藥物成癮。
