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Cervical Dystonia


#1

Has anyone had good treatment success with a western condition called "Cervical Dystonia"? This particular case presents similar to Trigeminal Neuralgia with an added symptom of facial and tongue spasms - especially worse at night (with fatigue or under stress). The jaw tends to pull to the right side with excessive nerve firing and spasm on the right side as well.

I have given 4 treatmens to this 51 year old male patent with limited or no results. So far, I have made a diagnosis of ST/SJ Channel wind/phlem blocakage. Based on these effected channels I have treated the case with the basic treatments as I would with other facial conditions - Using standard points based on the diagnosis like: ST5/6/7, SJ 17, LI 4, Qian Zheng, DU 20/24, Ren 23/24, Ear Points for Face, etc.

This far, this approach has had very little success and I would be interested in any ideas with alternate approaches for this case. Thanks for you input.


#2

Cervical Dystonia, also known as Spasmodic Torticollis, can be quite difficult to resolve. It is a muscle control disorder that can be very difficult to resolve completely. That said, even without treatment, particularly in the early stages of the condition, people can go months to years in “remission” so there is hope. The way we look at dystonia is similar to our view of MS and other related auto-immune conditions - if it can go away for weeks to months to years it can go away for good.

At the base of it it is more of an auto-immune condition (hyper-responsivity leading to over control of some muscles and under control of others) than it is something merely structural.

First, I’d like to know what the patients overall diagnosis is from a TCM perspective (not looking at this “symptom”).

Our approach includes very specific and quite deep tuina along with needling and in some cases cupping. It would generally look like this:

  1. Start treatment with very strong tuina along the Sky Window areas of the neck. Basically using strong thumb tuina from the collar bone following up behind the SCM up the base of the neck. Small circles with the thumb works well with occasional upwards slides along the tissue (hold their shoulder down with your other hand). Include a point we call “tiandong” which is directly between LI 17 and LI 16 pressing “in” to foster circulation in the vertebral artery. Work the whole neck on both sides for just a few minutes - longer is unnecessary and people cannot handle much more than that.

  2. Needling - we needle only back points 90% of the time. The face points, etc. only serve to occasionally take care of some of the inflammation and local stagnation - this is a brain/muscle control problem at it’s root so a broader focus in required.

Points we would use in addition to those for the persons overall diagnosis would be as follows:

  • GV 20 - motor cortex
  • GV 17 - medulla area (affects circulation, blood vessel dilation, etc.) with UB 9 on either side - cerebellum area (involved with movement disorders)
  • GV 16 - open the spinal cord - head/body communication
  • GB 20 - open the head/body communication - facilitate communication of other points
  • Needle the most sensitive of the sky window points - if they are all sensitive use or you cannot really discriminate between them use SI 16 and SI 17 in this case. (Be very careful needling these if the patients is having active spasms - in that case either just needle them for a bit until you leave the room or focus on them with the massage before and after treatment).
  • Huatuo points at T1 (bone problems/immune/autoimmune issues), T2 (thymus/immune/autoimmune issues), SI 13 to spread the qi, then usually other huatuo related to the condition overall (in most cases liver stagnation and/or kd yin deficiency) - so huatuo at T9 and/or huatuo at L2.
  • UB 40, UB 60 to open the back and spine and descend the qi and then others as necessary related to their overall diagnosis… (KD 6 ?, SP 6 ?)
  1. Retain needles for 25 minutes or as long as the patient is comfortable, then similar tuina as before the treatment but longer and then through the shoulders and down either side of the spine as well. Cupping on the upper back may be appropriate particularly if there is rigidity.

Chinese herbs for dystonia and head shake
#3

Thank you Chad for this very complete treatment description! This is very helpful. I will see the patient tomorrow, give a treatment using this approach and report back.

Thanks Again!


#4

Update: Using the suggested approach to treat the back and neck I did get better results. Great news. This case is difficult and the progress is slow, but I did see a marked improvement after focusing on the back and neck instead of the typical approach to needling the face. Thanks again for the suggestions.


#5

Another tuppenny&#39s worth:

In how you described the symptoms, two things stick out: that the spasms are worse at night with either stress or fatigue.

If the spasms are worse with stress, perhaps the Liver is unhappy; if the spasms are worse with fatigue, there is deficiency. Put the two together, and we have qi with blood or yin deficiency of the Liver causing internal wind and spasm on one side of the face, and perhaps qi deficiency on the other. In a book somewhere, it says that spasm has more to do with blood deficiency, internal wind and the Liver, whilst long, protracted contracture, that is basically constant, has more to do with Phelgm blocking the channels.

So one idea might be to incorporate points to nourish blood to subdue wind, like GB 20, Sp 10, Lv 8, SJ 3, Bl 18 et c.

Things would be different if there were signs of external attack, but we just don&#39t know.


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