.
Hongmei Li, Hongyan Li, Yifan Feng, Sarah Nalbandian, Zhonghua Fu
The Thought Process Behind FSN Treatment
Case 4: Sports Injury: Lower Back and Leg Pain
The patient was a 15-year-old Chinese female. The initial intake was on June 12th, 2021.
Chief complaint: Lower back and leg pain for 3 days.
HPI: The patient was a 15-year-old female student and gymnast presenting with pain on the back and posterior side of her left leg due to a leg sprain that occurred in gymnastics training, which also triggered lumbar and back pain. The patient stated she did not have pain when walking. The pain was worse when she bent forward. She was referred by a friend for FSN treatment.
Past medical history: No prior history of injury.
Physical exam: The belly of the left posterior calf muscles was tense, with pressure-pain and limited range of motion.
Muscle exam: Erector spinae, quadratus lumborum, external obliques, biceps femoris, tensor fasciae latae, gastrocnemius, and soleus.
Diagnosis: Lumber and leg pain
Treatment process: With the patient in the prone position, the erector spinae, quadratus lumborum, gastrocnemius, and soleus were treated using FSN. The tip of the needle was aimed at the affected muscles, slowly inserted, and swept. The treatment was divided into 2 parts, each of which consisted of 100 sweeps/minute, for a total of 2 minutes. The whole treatment process lasted 60 minutes.
Immediate results: After treatment, the patient reported that the pain had noticeably decreased by 90%.
Treatment outcomes: After 2 FSN treatments, the patient’s pain level decreased to 1/10.
Medical advice: 1) Avoid carrying or lifting heavy objects. 2) Get adequate rest. 3) Exercise as appropriate.
Case analysis:
Leg pain is very commonly seen in sports injuries。
If there is pain, we must still determine whether it is joint pain or muscle pain. In sports, the leg joints are the most easily injured area; it is common to see knee and ankle joint damage, and pain is present in the majority of cases after such damage occurs. How should sports injuries be treated in rehabilitation?
First, muscular strength must be restored and exercised. This includes an exercise with active and passive contraction. The restoration of muscular strength is the most important and most fundamental aspect of sports injury rehabilitation, and the muscles are the target tissue in which FSN’s effects manifest most visibly. Sweeping enhances muscular strength and promotes local blood circulation, thereby enabling the injury to heal.
After a sports injury, the patient must limit physical activity and rest in a timely manner to allow the injury to heal. At an appropriate time, one can perform some functional rehabilitation and joint range of motion exercises, which FSN refers to as reperfusion. This will promote faster recovery so the patient can return to playing sports.
Second is joint range of motion, which includes active and passive range of motion. When different joints are involved in carrying out various movements, muscular strength on its own is not enough; the joints must have a certain degree of movement and range of motion to perform a variety of movements and activities.
Third and last are proprioceptive exercises, such as being able to go up and down stairs with eyes closed. Muscles actually have memory and proprioception; they know the locations of other muscles and joints, as well as how much to move in order to assist in completing a certain movement. This is part of the restoration of proprioception.
Case 5: COVID-19 Complication and Sequela: Headaches
The patient was a 45-yearold American male. The initial intake was on March 14th, 2021.
Chief complaint: Headaches for over 3 months after COVID-19 diagnosis
HPI: The patient was a 45-year-old male presenting with headaches. He was referred to the clinic by a medical practitioner friend because he had been experiencing headaches for the past 3 months after he was diagnosed with COVID-19 in December 2020. At that time, he had fever, cough, sore throat, and headaches. The cough was dry without phlegm and there was no difficulty breathing. After treatment with medication and quarantining for 2 weeks, his test result was negative. However, he had persistent headaches consisting of mostly dull pain with sharp pain at times. The pain level was 6-8/10. He also reported anxiety, lack of strength, and insomnia, which severely impacted his work and life.
Past medical history: No past medical history.
Physical exam: Right-sided neck and shoulder tension with pressure-pain. Normal range of motion.
Muscle exam: Frontalis, temporalis, trapezius, levator scapulae, splenius capitis, splenius cervicis, sternocleidomastoid, scalenes, supraspinatus, infraspinatus, with occasional involvement of the deltoid.
Diagnosis: COVID-19 complication: headaches
Treatment process: Because the patient’s condition was relatively complicated, he was treated using scalp acupuncture and FSN.
1. FSN: suspected muscle exam: frontalis, scalenes, supraspinatus, infraspinatus
2. With the patient supine, the frontalis, scalenes, and supraspinatus were chosen for treatment. The needle point was aimed at the affected muscles, and the needle was inserted slowly and swept. The treatment was divided into 2 parts, each of which consisted of 100 sweeps/minute, for a total of 2 minutes. The whole treatment process lasted 60 minutes.
Immediate effects: After treatment, the patient reported that the pain had decreased by 60%.
Treatment outcomes: After 4 FSN treatments and Jiao’s scalp acupuncture, the patient had significant improvement. His pain level dropped to 1-2/10. He was very appreciative when he realized he could sleep better at night without any pain.
Follow-up: Follow-ups were done at 3 months and 1 year post-treatment.
Case Analysis and Discussion:
Headache is a common clinical symptom that can be a real “headaches” for many doctors. Statistics show that 50-75% of the world’s adult population has experienced headaches. There are many methods to treat headache, such as traditional acupuncture, Jiao’s scalp acupuncture, stiletto needling, knife needling, fire needling, Tung-style needling, and so on.
1. Excerpt from FSN Medical Essentials: Extracranial headache is headache caused by pathological tension of the muscles of the head. Tension headaches, migraine headaches, and cluster headaches all belong to this category, and all are indications for FSN.
2.Main suspected muscles: Sternocleidomastoid, scalenes, trapezius, splenius capitis, occipitalis, temporalis, and frontalis. All of these are the original “root cause” and primary sites of pathology. FSN can be used to relieve these affected muscles.
3.Headache as a complication of COVID-19 may be caused by many factors and the treatment mechanism is currently not known. However, regardless of which method you use, as long as it can reduce the patient’s pain, then it is a good method and is worth trying.
Case Discussion:
1. The target tissue upon which FSN has the most obvious effect is muscle, such as the sternocleidomastoid or masseter, and the main characteristic of pain caused by muscle is soreness and distending pain with little sharpness. The correct direction of the needle is the prerequisite for ensuring the efficacy of treatment; the tip of the needle must be inserted from the distal to the proximal end in vertical alignment with the affected muscle, and then level or spiral sweeping may be performed.
2. One must understand the relationship between loose connective tissues and muscles. Muscle repair depends on a good blood supply. Muscle blood flow and quality will affect muscle repair, and the main factor affecting blood flow is muscle contraction. Loose connective tissue is like a network, wrapping all levels of muscle tissue, connecting the exterior and interior, interlocking and closely connected. This is the reason why FSN treats deep-rooted illness with shallow interventions.
Case 6: Induced Labor
Chief complaint: Neck pain and pregnancy 38wks +3d, requested induction of labor.
HPI: The patient was a 37-year-old woman, G1P0100, and she was 38w+3d pregnant. The patient presented with neck pain. She had been experiencing right-sided neck pain for the past 2 weeks. The pain was described as soreness, with a level of 7/10. Also, she denied any pain radiating to her arm and hand. She denied fever, cough, and shortness of breath in the past 2 weeks.
The patient stated that her OB/GYN doctor told her that she would need to be medically induced if her pregnancy went over 40 weeks. However, she was willing to try acupuncture if it could help to induce labor.
Past medical history: No past medical history.
Physical exam: Right-sided neck tension with pressure-pain. Normal range of motion. 38 weeks pregnant.
Muscle exam: Trapezius, levator scapulae, sternocleidomastoid, scalenes, supraspinatus, infraspinatus, and deltoid.
After initial consultation and acupuncture, the patient reported that her neck pain was reduced to 2/10 vs 7/10 on the pain scale, which is a significant improvement. She said that acupuncture was the most effective therapy for her pain compared to other therapies.
At the second visit, traditional acupuncture was used in an attempt to induce labor. We used points LI-4, SP-3, GB-21, and BL-60 for 20 minutes, 3 times in one week. However, there was no improvement.
Traditional acupuncture was used to induce labor at week 38, but due to poor results, in the 39th week we switched to FSN. With only one FSN treatment, our patient gave birth naturally. Since the patient was older and she had higher risk for complications, her obstetrician-gynecologist had planned to induce labor with medication after 40 weeks. But the day before she reached 40 weeks, her baby daughter was born into this world.
Case Discussion and Analysis:
The mechanism of action by which FSN induces labor: Mechanical irritation is caused by the stimulation of the pelvic muscles by FSN, which affects the pelvic plexus. The pelvic plexus is distributed in the body of the uterus, cervix, and upper bladder. The pelvic nerve contains parasympathetic fibers from sacral nerves II, III, and IV, and contains centripetally transmitted sensory nerve impulses that are sent to the center, causing reflex contractions of the uterus. In addition, the smooth muscle of the uterus undergoes rhythmic contractions that complete the delivery.
References
1. Zhonghua Fu, the foundation of Fu’ s Subcutaneous needling, People’s Medical Publishing House(PMPH), ISBN 978-7-117-23380-4/R·2338
2. Zhonghua Fu, Ryan Shepherd . Fu’s Subcutaneous Needling, a modern style of ancient acupuncture. J. Acupuncture in modern medicine. 2013; 06(3) DOI: 10.5772/53970
3. Zhonghua Fu, Yueh-Ling Hsieh, Chang-Zern Hong, Mu-Jung Kao, Jaung-Geng Lin, Li-Wei Chou, Evid Based Complement Alternat Med. 2012; 2012: 353916. Published online 2012 Dec 25. doi: 10.1155/2012/353916PMCID: PMC3544156
4. Ching-Hsuan Huang, Lung-Hung Tsai, Mao-Feng Sun, Zhonghua Fu, Jian Sun, Li-Wei Chou, Rapid Improvement in Neck Disability, Mobility, and Sleep Quality with Chronic Neck Pain Treated by Fu’s Subcutaneous Needling: A Randomized Control Study, Pain Res Manag. 2022; 2022: 7592873. Published online 2022 Sep 30. doi: 10.1155/2022/7592873 PMCID: PMC9553660
5. Yaping Li, Xianghui Gao, Hailiang Huang, Xiyan Zhou, Yunhua Zang, Li-Wei Chou, Effects of Fu’s subcutaneous needling on mitochondrial structure and function in rats with sciaticaMol Pain. 2022; 18: 17448069221108717. Published online 2022 Jun16. doi: 10.1177/17448069221108717 PMCID: PMC9210095
6. Jiangxia Yang, Chen Yang, Yajie Wang, Ning Li, Xingzhang Yao, Bowen Yang, Xia Xu, Xingyong Li,Effect of subcutaneous needling on visual analogue scale, IgG and IgM in patients with lumbar disc herniation. Medicine (Baltimore) 2020 Feb; 99(9): e19280. Published online 2020 Feb 28. doi: 10.1097/MD.0000000000019280 PMCID: PMC7478818
About the Author:
Hongmei Li Senior acupuncturist Cedars-Sinai Medical Center ，Los Angeles, CA.
Hongyan Li Senior acupuncturist Cedars-Sinai Medical Center，Los Angeles,CA.
Yifan Feng Acupuncturist Alternative Medical Center,Los Angeles,CA.
Sarah Nalbandian, Student at University of California, Los Angeles, CA.
The Institute of Fu’s Subcutaneous Needling, Beijing University of Chinese Medicine.
Zhonghua Fu Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine.
浮針治療臨床疑難病例研究(二)
李紅梅 李紅艷 馮一帆 薩拉·納爾班迪安 符仲華
浮針療法治療思路
病例四 運動損傷：腰腿痛
中國女性，15歲，初診2021年6月12日。
主訴：腰腿痛三天。
現病史：患者是一位15歲的女學生，是一個體操隊員。三天前，因為在做體操訓練的時候，腿部扭傷也引起了腰背痛。病人訴走路的時候，沒有感覺疼痛，但彎腰時疼痛加劇。經朋友介紹到我診所尋求浮針治療。
過去史：沒有任何受傷病史。
體檢：左後腿肌腹緊張，有壓痛。活動受限。
嫌疑肌查找：豎脊肌，腰方肌，腹外斜肌，股二頭肌，闊筋膜張肌，腓腸肌，比目魚肌。
診斷：腰腿痛
治療過程：俯臥位，選取豎脊肌，腰方肌，腓腸肌，比目魚肌等進行浮針治療。針尖對準患肌，緩慢進針，掃散，治療分上半場，下半場。分別掃散100/分，共2分鐘，全程治療60分鐘。
即時效果：病人治療後訴疼痛明顯減輕90%。
治療結果：患者接受2次FSN治療後，疼痛指標降為1/10。
醫囑：1）避免提起或舉起重物。2）注意休息。3）適當運動。
病例解析討論：
運動損傷，腿部疼痛非常常見。如果發生疼痛，我們還是要區分到底是關節痛還是肌肉痛。在運動中，腿部的關節是最容易受傷的部位，常見的是膝關節、踝關節的損傷，損傷後大部分都會有疼痛。運動損傷如何康復治療？
第一個是肌肉力量的恢復跟鍛煉，它包括主動收縮跟被動收縮的一個鍛煉。因為肌肉力量恢復，它是運動損傷康復中最重要的、最基礎的方面。浮針治療作用表現最明顯的靶組織就是肌肉，通過掃散而加強肌肉的力量，促進局部的血液循環，這樣可以促進損傷修復。
運動損傷後要及時制動休息，讓損傷有個好的恢復過程。可以在適當的時候進行一些康復功能鍛煉和關節的活動度，浮針療法稱之為再灌注。這樣會促使患者早日康復，重返運動場。
第二個是關節活動度，關節活動度是包括主動的還有被動的。因為在完成了不同關節各種動作的時候，僅僅有肌肉力量是不夠的，它需要通過關節一定的活動度和活動範圍，來完成各種動作、各種的運動。
第三個是最後的本體感覺的鍛煉，像在閉着眼睛的時候，也能夠上、下樓梯。其實肌肉是有記憶的，是有這種本體感覺的，它知道肌肉關節的位置，它也知道活動到哪種程度，能夠輔助說明滿足什麼樣的動作，這是屬於本體感覺的恢復。
病例五 新冠併發症及後遺症：頭痛
美國男性，45歲，初診2021年3月14日。
主訴：新冠後頭痛三個多月
現病史：患者是一位45歲的男性。因頭痛三月經醫生朋友介紹到我診所尋求針灸治療。患者在2020年12月新冠測試陽性。當時有發熱，頭痛，咽痛，咳嗽，干咳無痰，沒有呼吸困難。經藥物治療及隔離兩個星期後，再測試新冠為陰性。但有持續頭痛，有時會有刺痛，多數為鈍痛。疼痛指標為68/10，並有焦慮和乏力，夜無法寐，嚴重的影響其工作和生活。
過去史：無任何病史。
體檢：右側頸肩部緊張，有壓痛。活動不受限。
嫌疑肌查找：額肌，顳肌，斜方肌，肩胛提肌，頭夾肌，頸夾肌，胸鎖乳突肌，斜角肌，岡上肌，岡下肌甚至有時涉及三角肌等。
診斷：新冠後遺症：頭痛
治療過程：因病人病情較複雜，給患者用頭針和符氏浮針治療。
1.符氏浮針：嫌疑肌查找：額肌，斜方肌，岡上肌，岡下肌。
2.仰臥位，選取額肌，斜方肌，岡上肌等進行浮針治療。針尖對準患肌，緩慢進針，掃散，治療分上半場，下半場。分別掃散100/分，全程治療60分鐘。
即時效果：病人治療後訴疼痛明顯減輕60%。
治療結果：患者接受4次FSN治療後，疼痛指標降為1-2/10。
隨訪：三個月後隨訪。一年後隨訪。
病例分析討論：
頭痛是臨床常見的症狀，也是讓很多醫生“頭痛”的臨床問題。據統計，世界範圍內成年人中有50-75%的人口遭遇過頭痛。治療頭痛的方法有很多種方式：比方說我們學過的傳統針，焦氏頭針，鈹針，小針刀，火針，董針等等。
1.《浮針醫學綱要》摘錄：顱外頭痛由頭部肌肉病理性緊張所引發的頭痛，通常所說的緊張性頭痛、偏頭痛、叢集性頭痛都屬此類，均是浮針的適應症。
2.主要嫌疑肌：胸鎖乳突肌，斜角肌，斜方肌，頭夾肌，枕肌，顳肌，額肌等。這些都是初始“病竈”、第一現場。利用浮針治療，消除這些患肌。
3.新冠後遺症頭痛，有很多因素引起，其治療機理尚不明確。但無論你用哪一種方法，只要能夠減輕病人的疼痛，那都是好辦法，都可以去試一試。
病例討論：
1.浮針治療作用表現最明顯的靶組織就是肌肉。所以，胸鎖乳突肌或者是咬肌，而肌肉引發的疼痛主要特徵是周圍酸痛，脹痛少有刺痛。針刺的方向正確是保證療效的前提，針尖必須由遠而近的直對患肌，平掃和旋掃。
2. 瞭解疏松結締組織和肌肉關係。肌肉的修復有賴於良好的血液供應。肌肉血供的流量和品質都會影響肌肉的修復，影響血液流量的主要原因為肌肉的收縮。疏松結締組織像網絡一樣，包裹着各級肌肉組織，交通表裡，環環相扣，緊密相連，這是浮針“刺淺治深”的原因。
病例六〓浮針幫助引產
主訴：妊娠時頸部疼痛 38wks +3d，要求針灸引產。
現病史：患者為37歲孕婦，G1P0100，38w+3d，頸部疼痛。在過去的 2 週內，她一直經歷右側頸部疼痛。疼痛是酸痛，疼痛等級為7/10。否認了放射到她的手臂和手部的疼痛。在過去2週內否認發燒，咳嗽和呼吸急促。
患者說，她的婦產科醫生告訴她，如果她懷孕超過40wks，她需要做醫學誘導分娩。但是，如果有可能幫助她引產，她想嘗試針灸。
過去史：無任何病史。
體檢：右側頸肩部緊張，有壓痛。活動不受限。懷孕38週。
嫌疑肌查找：斜方肌，肩胛提肌，胸鎖乳突肌，斜角肌，岡上肌，岡下肌及三角肌等。
經過初次咨詢和針灸後，患者報告她的頸部疼痛在疼痛量表上以2/10與7/10減輕，明顯改善。她說，與其他方法相比，針灸是治療她疼痛的最有效方法。
第二次就診時，患者用傳統針灸誘導，使用LI4，SP3，GB21，BL60，20min，3/wx 1 週。但是，沒有改善。
第38週開始用傳統針灸引產，但因效果不佳，第39週改用浮針，僅用一次浮針，孕婦就自然分娩。因為孕婦年齡比較大，她的婦產科醫生原計划過了40週就用藥物引產。但在40週前一天，寶貝女兒就出生來到了這個世界了。
病例分析討論：
浮針引產的作用機制探討：由於浮針刺激盆腔肌肉而引起機械性刺激，從而影響了骨盆神經叢。而骨盆神經叢分散於子宮體、子宮頸及膀胱上部。盆腔神經神經叢中有來自骶II,III,IV骶神經的副交感神經纖維，並含有向心傳導的感覺神經沖動到中樞，從而引起子宮的反射性收縮。加之子宮平滑肌有節律的宮縮，從而完成了分娩活動。
全文完〖HT〗
參考文獻
1. Zhonghua Fu，傅氏皮下針法基礎，人民衛生出版社，ISBN 978-7-117-23380-4/R·23381
2. Zhonghua Fu, Ryan Shepherd， 傅氏皮下針法，古代針灸的現代風格。 現代醫學中的針灸杂志。 2013年； 06(3) DOI：10.5772/53970
3. Chunghua Fu，Yueh-Ling Hsieh，Chang-Zern Hong，Mu-Jung Kao，Jaung-Geng Lin，Li-Wei Chou，基於證據的替代醫學。 2012年； 2012：353916。2012 年 12 月 25 日線上發布。doi：10.1155/2012/353916PMCID：PMC3544156
4. Ching-Hsuan Huang、Lung-Hung Tsai、Mao-Feng Sun、Zhonghua Fu、Jian Sun、Li-Wei Chou，傅氏皮下針治療慢性頸部疼痛快速改善頸部殘疾、活動能力和睡眠品質：A隨機對照研究，疼痛研究管理。 2022 年； 2022：7592873。2022 年 9 月 30 日線上發布。doi：10.1155/2022/7592873 PMCID：PMC9553660
5. Yaping Li, Xianghui Gao, Hailiang Huang, Xiyan Zhou, Yunhua Zang, Li-Wei Chou，傅氏皮下針刺對坐骨神經痛大鼠粒線體結構與功能的影響。 2022 年； 18：17448069221108717。2022年6月16日線上發布。doi：10.1177/17448069221108717 PMCID：PMC9210095
6. Jiangxia Yang, Chen Yang, Yajie Wang, Ning Li, Xingzhang Yao, Bowen Yang, Xia Xu, Xingyong Li，皮下針刺對腰椎間盤突出症患者視覺模擬量表、IgG、IgM的影響。 醫學（巴爾的摩）2020 年 2 月； 99(9)：e19280。 2020 年 2 月 28 日線上發布。doi：10.1097/MD.0000000000019280 PMCID：PMC7478818
作者簡介:
李紅梅，資深針灸師，美國洛杉磯西奈山醫學中心。
李紅艷，資深針灸師，美國洛杉磯西奈山醫學中心。
馮一帆，針灸師，美國洛杉磯替代醫學醫療中心。
薩拉·納爾班迪安，加州洛杉磯分校學生。
符仲華，教授， 廣州中醫藥大學針灸與康復臨床醫學院，北京中醫藥大學浮針研究所。
