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-yearold 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.