Articles

Introduction

Refractory facial paralysis, is also known as intractable facial paralysis. The degree of the severity is normally above moderately severe, and the symptoms don’t improve after a long period of treatments.

Intractable facial paralysis can be diagnosed if Bell's facial palsy lasts longer than 2 months, Ramsay Hunt syndrome lasts longer than 4 months, and there are still no sign of improvement, or the paralysis is still very obvious. In addition, linkage symptoms (mouth and eyes move together), inversion (reverse asphyxia), crocodile tears syndrome (the shedding of tears while eating or drinking), facial spasm, facial atrophy and other complications can occur.

Patient Profile: 73 y/o, female

Initial consultation: 29th July, 2016

Major complaints: Eye and mouth drooping on left side over a month

Present illness: The patient developed mouth and eye drooping without obvious cause and was admitted to QiMei Group General Hospital to be treated for facial neuritis. After being discharged she was transferred to the outpatient acupuncture department for further treatment. She was referred to me to try FSN treatment since she didn’t show any improvement after a month of acupuncture treatment.

Observation: (Left side)

Loss of the left frontal lines, flattened nasolabial fold, the corner of the mouth pulled to the right side, incomplete left eyelid closure, inability to frown and puffy up cheeks, pain behind the ear.

Examination :Blood pressure: 160/100mmHg, Fasting blood glucose: 6.98mmol/L.

Past medical history:Hypertension;Left side facial paralysis in 2007. Patient complained that she was not fully recovered, still suffering from incomplete eye closure and slightly mouth drooping.

TCM diagnosis: Facial paralysis

WM diagnosis: Facial neuritis

Muscle examination : Frontalis ++ Temporalis +++ Masseter ++ Orbicularis oris +++ Infrahyoid muscles ++++ Sternocleidomastoid ++++ Scalene +++ Trapezius ++++ Pectoralis major ++Rectus abdominis ++++

FSN Treatment:

1. Distally treat Pectoralis major by needling from forearm.

2. Treat neck muscles locally.

3. Treat facial muscles locally.

Immediate effect: Improved eye closure, Patient felt the corner of her mouth relax.

Medical advice:

Self facial massage and exercise for the muscle of facial expression, 3 times a day;

Watch diet and blood sugar, keep the affected area warm at all time.

Initial treatment plan:This being a prolonged illness case, with a patient of an advanced age, who also has high blood sugar level, all the above factors resulted in a poor recovery. For that reason, the time interval between treatment was recommended to be a bit longer. The first course of treatment was once every 3 days, 3 times as a course.

The third visit: 6th August, 2016

A nice surprise : patient’s chronic diarrhea has improved. Patient complained that bowel movements has never been formed since childhood. Suffer from abdominal pain, rumbling, diarrhea immediately after eating soy products and drinking milk. After two sessions of the treatment, bowel movements became formed, and no adverse reaction to soy products and milk. Patient felt the corner of her mouth relax, eye closure also had been further improved.

Treatment remains the same.

The plan of second course: once every 5 days, 3 times as a course.

The fourth visit: 10th August , 2016

Further improvement of eye closure, deepened nasolabia fold, alleviated mouth drooping.

During the treatments, it was noticed that the patient has significant immediate effect, but it didn’t last very long. The progress was quite slow.

Summary and reflections: No key principle points has been missed during the treatments. The major reasons for the slow progress are still the age and her underlying illness, such as diabetes. The patient only manage her blood sugar level by diet which is not as reliable as medications.

Continue the treatment with faith and confidence.

Plan of The third course: the time interval between treatments is 7 days, 3 times as a course.

The ninth visit: 30th September, 2016

Complete eyelid closure, nasolabia fold and the corner of mouth has recovered to the state prior to onset.

Conclusion: The result was satisfactory, and the patient planned to continue the treatment for her complications of facial paralysis developed 9 years ago.

Thank Ms. Liu and her family for their trust and faith in me, also thank FSN for bringing hope to cure intractable facial paralysis!

Bravo, FSN!

Translated by Jing Ye(UK)

Chapter I The General Theory

1.Concept

Leaking urine, refers to their own know, but can not control, more in laughter, coughing, sneezing, hear the sound of running water when the phenomenon of urine leakage. It is both a separate symptom and a symptom of other diseases. This happens mainly in female, with high incidence between 45 and 55 years old.

2. Clinical performance

The disease manifests itself as a physical activity such as coughing, sneezing, bumping or lifting, when abdominal pressure increases significantly and unconscionable urine flows out. Some patients can't control their urine when they hear the sound of tap water.

Severe cases, this can happens when they are walking, standing, usually not accompanied by frequent urination symptoms.

3. General Knowlage

3.1. Related factors

(1) Age

The age of high incidence of urinary leakage in women is 45 to 55 years old. The supposed correlation between age and urinary leakage may be related to pelvic floor relaxation, estrogen reduction, and urethra sphincter degeneration. Some common diseases of aging, such as chronic cough, lung disease, etc., can also lead to urine leakage.

(2) Fertility

The number of births is associated with the occurrence of urine leakage. Older women are more likely to leak urine, women who give birth vaginally are more likely to leak urine than women who give birth by caesarean section, women who have a caesarean section are more likely to leak urine than women who do not give birth, and midwifery techniques such as midwifery, fetal inhalers, oxytocin, etc. also increase the likelihood of urinary leakage, and the risk of urine leakage in mothers of over-weight children is also high.

(3) The pelvic organ prolapse

Presure urine leakage and pelvic organ prolapse are closely related, and they are often accompanied by the presence of both. Pelvic organ prolapse patients with pelvic floor support tissue and smooth muscle weakness, muscle fiber thinning, aligning disorder, connective tissue fibrosis and muscle fiber atrophy, pelvic floor muscle group weakness. This forms the basis of urine leakage, easily trigger pressure urine leakage.

(4) Obesity

The risk of pressure urine leakage in obese women increased significantly, especially in the case of abdominal obesity, and losing-weight can reduce the incidence of urinary leakage.

(5) Ethnic and genetic factors

Genetic factors and pressure leakage have a clear correlation, and the prevalence of pressure urine leakage patients is significantly related to the prevalence of their immediate family members.

3.2. Pathological mechanism

The pathological mechanism of pressure urine leakage is not clear, the current research suggests that the following factors are related: bladder neck and near-end urethra downshift, urethra mucosa closed function decreased, urethra inherent sphincter function decreased, pelvic floor muscle and connective tissue function decreased, the nervous system that governs the structure of urine control dysfunction.

3.3. Check

At present, there is no specific laboratory examination, mainly clinical, the most commonly used is pressure test.

Check with the bladder full, often take the lithotomy position, tell the patient to cough several times in a row, pay attention to observe the urethral orifice wheather there is leakage phenomenon. If yes, the test is POSITIVE. If there is no leakage of urine when lying on the back, the patient should stand on her(his) feet apart with shoulder width, cough for several times, to observe wheather there is leakage phenomenon. If yes, this pressure test is POSITIVE.

3.4. Treatment

3.4.1. General treatment

(1) Maintain a good lifestyle, lose weight, quit smoking, change diet and so on.

(2) Rehabilitation training

Refer to the following methods: continuous contraction of pelvic floor muscle (Kegel Exercise) 2 to 6 seconds, rest for 2 to 6 seconds, repeat 10 to 15 times, do 3 to 8 times a day, keep exercising for 8 weeks or more. This method is simple and suitable for all types of pressure urinary incontinence.

(3) Medication

Selective alpha1-adrenaline receptor agonists, can stimulate the smooth muscle alpha1 receptor in the urethra, as well as stimulate motor neurons in the body, increasing urinary tract resistance. Commonly used drugs: Midodrine, Methoxamine. Midodrine's side effects are less than Methoxamine. Such drugs have been shown to be effective, especially when combined with Estrogen or pelvic floor muscle exercise. The side effects are, high blood pressure, palpitations, headache, cold limbs, and stroke in serious case.

3.4.2. Surgery

The main indications of surgical treatment include:

(1) Non-surgical treatment in not effective, can not tolerate or the expected effect is not good

(2) Moderate and severe pressure urinary incontinence, seriously affecting the quality of life

(3) Patients with higher quality of life requirements.

(4) Patients with accompanied by pelvic organ prolapse and other pelvic floor functional lesions need pelvic floor reconstruction, should have anti-pressure urinary incontinence surgery at the same time. At present, the tension-free vaginal tape(TVT), trans-obturator tape(TOT) have gradually replaced the traditional open surgery, with small damage, good efficacy and other advantages, The complications are, urinary retention, bladder injury, sling erosion, etc., but the incidence is very low.

Chapter II FSN

1.Urinary Leakage in FSN

FSN recommends a distinction between urinary incontinence and urinary leak-age. Urinary incontinence refers to the lack of consciousness to control, unknowingly occurred, it is only noticed when it happens, most of this happens in the central or peripheral nervous system damage. Urine Leaking is noticeable, but not able to control, mostly happens when laughing, coughing, sneezing, exercising, or even hearing the sound of running water. FSN treatment for unconscious urinary incontinence caused by damage to upper motor neurons is ineffective, but for pressure leakage is very effective.

Pressure urine leakage is often found in middle-aged and elderly women, after childbirth, trauma, occasionally happens in elderly men. Long-term urine leakage seriously affects the mental health of patients, some patients do not even dare to take a bus to public places, increasing the incidence of depression, so that many women's ability to live and work decreased. Many patients are ashamed to speak out, and even some patients think that urination leakage is a normal physiological response into old age, and the effect of conventional treatment is not good, many patients do not want to seek medical attention in time. Even after recovery, they often don't tell anyone.

There is no unified understanding of how urine leakage is related to muscles and how muscles cause urine leakage. Pelvic floor muscle exercises and biofeedback therapy for muscle can also be effective. Generally we think it is caused by the weakness of pelvic floor muscle.

Constipation, lung disorders and chronic cough, abdominal obesity, abdominal space-ocupying lesions, pelvic organs sagging and other causes high abdominal pressure. Obesity is also a major cause of urine leakage.

2. Common Pathologocal Muscles

Main suspect muscles: Abdominal Oblique Muscle, Rectus Abdominis, Adductor, Quadriceps femoris Muscle inner head, Soleus Muscle, Gluteus Muscle, Piriformis,Quadratus Femoris.

FSN treatment alreays from the far end to the near end, such as Soleus Muscle ankle flexor resistance, abdominal muscle re-perfusion activities, when lying on the back, keep legs together and lift up, for the Adductor muscle, to do hip adduction, internal rotation resistance, for Piriformis muscle, Quadratus Femoris, prone position to do hip external rotation resistance.

3. Extra

3.1. Self-pelvic floor muscle exercises, such as Kegel Exercises, increase the self-control of urination. sit-up exercise, stretching the pelvic floor muscle.

3.2. People with a long history of constipation need to be treated for constipation.

3.3. People with Obesity, try to loss weight appropriatly

3.4. Treat the original incidence of chronic cough, allergic rhinitis and so on.

Chapter III FSN Case Study

By Suling Wang, XiaoXian,SuZhou,China

Patient information: Ms Peng, female, 78 years old, 2nd September, 2018 First visit

Main complaint: Involuntary urine leakage while coughing and sneezing for 5 years

History of present illness: 5 years ago, the patient noticed that involuntary urine leakage while coughing and sneezing without obvious cause, which seriously affected her life and has not been treated systematically.

Past history: Deny the history of chronic internal medical illness such as "hypertension, diabetes".

Diagnosis: Urinary Leakage

Examination of affected muscles: bilateral rectus abdominis (+++), bilateral tibialis anterior muscles (+++), bilateral rectus femoris (+++), bilateral abdominal obliques (+++), bilateral Adductors (++).

FSN Treatment: Insert a disposable FSN needle to around the above-mentioned affected muscles, sweep and do reperfusion movments for the corresponding affected muscles, such as abdominal bulging with pressure, knee flexion and abduction resistance, reperfusion movments should be slow and gentle .

03-09-2018 Second visit: the urine leakage was better when she coughed at night. Examination of affected muscles: bilateral rectus abdominis (+++), bilateral tibialis anterior muscles (+++), bilateral rectus femoris (+++), bilateral abdominal external obliques (+++), both sides of adductor muscle group (++). The treatment is the same as above.

05-09-2018 Third visit: Patient was able to notice when she urinate, no leakage of urine when she coughed. Examination of affected muscles: bilateral rectus abdominis (++), bilateral abdominal external obliques (++), bilateral adductors (++), bilateral tibialis anterior Muscle (++). Continue the same treatment as before. During the treatment, the lady told me that she used to have social phobia, now she is willing to go out and chat with others, she is very happy with the result.

Translated by Daming Gong(UK)

Sharon Lai Hing Low, Female, 77, first visit on April 3 2021.

Chief Complaint: Both wrist pain with numb thumbs 3 months. Aggravated for one month and half. Right side worse.

History: Chronic onset. MVA four years ago. Neck pain and headaches after MVA. Acupuncture comanaged with physiotherapy for six months, neck pain and headaches were gone. No wrist pain and finger numbness that time. Diabetes type II over 20 years, blood sugar controlled well with daily insulin injection. No hypertension. No other chronic diseases. Wrist pain aggravates after carrying heavy pot. Patient lives alone, needs to cook by herself. Currently, It hurts even if she doesn't hold anything. Right thumb is numb. Other acupuncturists have been treated more than 10 times, and it was ineffective.

Exam: The tenderness is located at the radius styloid process. There is a date-sized protrusion on the radius styloid process of the right wrist. The pain is obvious when palpated.

Diagnose: Stenosing tenosynovitis of styloid process of radius (De Quervain's tenosynovitis)

Tightened Muscles: bilateral: biceps brachii, brachioradialis, flexor carpi, extensor pollicis brevis, abductor pollicis longus.

Treatment: disposable FSN needle inserted from lateral side of right forearm, close to wrist line with needle tip upwards. After sweeping movement, ask patient to perform the reperfusion approaches with resistance, such as the flexion of elbow, hand grip, radial flexion of wrist, abduction and extension of right thumb. Repeat the same process for left wrist as well. Retention of needle for 30 mins.

Patient felt relax of both arms before leaving.

Medical Advice: Reduce the frequency of using both hands, try not to lift heavy objects, and keep warm locally.

Second visit on April 10

Patient reports her left wrist was much better, slight improvement on right wrist.

TM: bilateral: brachioradialis, flexor carpi, extensor pollicis brevis, abductor pollicis longus

same treatment as last time

Third visit on April 17

Patient reports her left wrist was fine. Right wrist still hurt, but less than before. Numbness of right thumb is improvement as well

TM: Right: flexor carpi, extensor pollicis brevis, abductor pollicis longus

Treatment: disposable FSN needle inserted from lateral side of right forearm, close to elbow with needle tip downwards. After sweeping movement, ask patient to perform the reperfusion approaches with resistance, such as hand grip, radial flexion of wrist, abduction and extension of right thumb

Fourth visit on April 24

Patient reports the bump on lateral side of right wrist is smaller. Pain decreased more, but if carry some heavy stuff like pot, right wrist still hurt.

TM: Right: extensor pollicis brevis, abductor pollicis longus

Treatment: disposable FSN needle inserted from lateral side of right forearm, close to elbow with needle tip downwards. After sweeping movement, ask patient to perform the reperfusion approaches, like radial flexion of wrist, adduction, abduction and extension of right thumb.

From May 8 to July 10, Patient finish 6 sessions of FSN treatment with the interval of two to three weeks between each treatment. Improvement on right wrist pain was slow but steady.

Last visit on July 24

Patient report the pain on her right wrist was totally gone. The bump on her right wrist disappeared as well.

Advice: because she lives alone and need to cook by herself, advise her not to carry heavy pot too much to prevent recurrence.

Elaina Darby, female, 80. First visit on August 31, 2021

Chief Complaint: Stinging pain on the right back for two days, accompanied by rashes for one day.

History: The patient was tired recently and suddenly started to feel mild tingling on her right back 2 days ago. She didn't pay attention at first, but the pain worsened the next day. The location of the pain was the same area where she had herpes zoster 2 years ago, so she checked her back in the mirror and saw that there are a few rashes on the right back. She had herpes zoster in this area 2 years ago, and it stinged first and then developed to rashes, and finally blisters. After taking antiviral drugs, she slowly recovered in 3 weeks. The experience during this period made her very tortured and impressed. So this time, she immediately went to see a doctor, who diagnosed herpes zoster and prescribed antiviral and painkillers to her. She felt that taking the medicine was too slow, and found that acupuncture can help to cure shingles by searching online. The patient has no other chronic diseases. Did not take any drugs. Currently, the right back stings, and there is a slight burning sensation. After a hot bath, the burning sensation worsens.

Exam: There are large scattered rashes on the local skin, but blisters have not yet appeared (see picture).

Diagnose: Shingles

Tightened Muscles: Serratus anterior, latissimus dorsi, abdominal oblique, erector spinae are all in good condition, no stiffness or tightness on palpation.

Treatment: Directly aim at the rashes and select 2-3 insertion points from different angles to enter the FSN needle and perform large-angle sweeping movement. After sweeping for 2 minutes, retract the needle to the needle hole, slightly change the direction, push it under the skin again, and continue to sweep for 2 minutes. Repeat this operation 2-3 times for each needle entry point. During this period, the patient did not perform reperfusion activities. The needle was retained for about 30 minutes, after which the cannula was not retained. Patient felt the tingling on her back was decreased after treatment.

Medical Advice: one treatment per day for three consecutive times. Don't eat spicy food. The bath water should not be too hot.

Follow up: Two weeks after three treatments, the patient was followed up by telephone. She made an appointment for the fourth treatment a week later, but after 3 treatments, the rashes disappeared completely and no chance of blisters. No more tingling on right back, so the appointment was cancelled. Advise her not to overwork and prevent recurrence.

Rajneesh Pandey, male, 61 first visit on January 22, 2021

Chief Complaint: Insomnia for years. Fingers are cold, more on right side.

History: it is difficult to fall asleep, he can only sleep 3-4 hours a day, wake up easily, tired during the day. Sometimes he needs to take sleep pills to help. During the consultation, I learned that his fingers had been cold for several years without any obvious cause. The fingers of both hands were cold, not painful, and sensation is normal, just cold and uncomfortable. He has seen a family doctor, but there is no clear diagnosis, and some routine examinations are normal. There is no change after taking the medicine. GP recommended him to discuss the operation with a surgeon, and the patient is scared away. No history of trauma. He needs a lot of finger movements in his work.

Exam: His right middle finger and ring finger are white. The colors of the other fingers are close to normal, but the fingers are cold and the temperature of the palms is also low. The temperature of the forearm is normal. Cunkou pulse is weak. The modified Allen Test is positive.

Diagnose: Raynaud’s Syndrome of fingers

Tightened Muscles: Flexor carpi ulnaris and finger flexors

Treatment: Needle entry point is selected on the inside of the forearm near the elbow, with the needle tip down, and after sweeping movement for two minutes, ask the patient to do the reperfusion approaches of clenching the fist, flexing the fingers, and flexing the wrist against resistance. During the needle retention period, about 20 minutes after treatment, it is found that the two white fingers gradually become bloody, but the fingers are still cold. The Cunkou pulse on the right is stronger.

Medical Advice: Keep hands warm. Minimize excessive finger movement.

Second visit on January 26, 2021

Patient reports his sleep didn’t change much, but the fingers are no longer white, still feel cold, but way better that before.

Female, 43 Years Old, Occupation: Farmer

First Visit: 29^th Jul, 2021

Chief complaint: right abdominal pain for more than three months.

History: Three months ago, the patient had lithotripsy treatment in hospital for right side Ureteral Calculus. Whereas her right side of abdomen was still feeling dull ache and discomfort after treatment, the results of the Type B ultrasounic inspection showed that there was residual rubble in the right ureter and the size was about 9mm. The patient was advised to drink plenty of water and exercise at home to facilitate removal of calculus. However, the symptoms were not alleviated and the patient came to our hospital asking for help.

Past medical history: Healthy, denied history of hypertension, diabetes, heart disease, cerebrovascular or psychiatric diseases. Denied acute and chronic infections disease such as like hepatitis, malaria and tuberculosis. Also denied any history of trauma, blood transfusion.

History of Vaccination: unknown

Allergic history: unknown

Physical examination:

No abdominal distention or ecchymosis. Pressing pain in the right abdomen. Signs of Peritoneal irritation were negative. Shifting Dullness was negative. Percussion of Abdomen sounded drum.

FSN examination:

Right rectus abdominis (++++), right abdominal oblique muscle (++++), right quadratus lumborum (++++), right anterior tibial muscle (++++)， right iliopsoas (++++).

Imageological examination:

Urological ultrasonography showed before FSN treatment : right upper ureteral calculi with mild hydronephrosis of the right kidney. There is a 9mm mass of strong echo at the right ureter, 31 mm away from the renal hilum. There was no dilation of the left ureter.

Laboratory inspection: unknown

Diagnosis: Ureteral Calculus(right side)

FSN Treatment:

First Visit: 29th July, 2021

Identify pain points and look for affected muscles:

Identified pain points according to the patient’s chief complaint and physical examination.Located the affected muscle in supine position.

Affected muscle as follows: Right rectus abdominis (++++), right abdominal oblique muscle (++++), right quadratus lumborum (++++), right iliopsoas (++++), right anterior tibial muscle (++++).

After routine disinfection, the needle was inserted 5-10cm away from the affected muscle with tip pointing towards the affected muscle.

FSN sweeping with reperfusion movement: the common methods of reperfusion for ureteral calculi are:

rectus abdominis: sit-up with the lower limbs closed together as well as hips flexed 30 degrees, in the meantime straighten her own arms to touch her toes with her hands as best as she can; Ask patient to keep tensing abdomen up.

Abdominal oblique muscle: sit-up and twist upper body left and right.

Quadratus lumborum: bend down close to her knees and twist waist to the right and left.

Iliopsoas: hip flexion resisting

Anterior tibial muscle: Ankle dorsiflexion resisting.

Do not perform more than three reperfusion activities in each area and no longer than 10 seconds.

Second Visit: 30th July, 2021

After the initial treatment, abdominal pain was significantly reduced.

Found: right rectus abdominis (+), right abdominal oblique muscle (++), right quadratus lumborum (++), right. Iliopsoas (++), right anterior tibial (+).

Result:

After repeating previous manipulation and reperfusion approach, the dull pain in the abdomen disappeared completely. All the effected muscles above were recovered to normal. Reexamination of urinary ultrasonography showed that bilateral ureter with no abnormalities.

Discussion:

Ureteral calculus is a common clinic acute abdomen, resulting in urinary tract obstruction which can lead to renal function damage. The severe pain, infection can also cause serious consequences, so it is crucial to remove the calculi safely and quickly as well as pain relief. FSN treatment can improve local blood circulation, correct ischemia, hypoxia state, effectively relieve pain and promote the removal of calculi by finding and eliminating the affected muscles.

In conclusion, the advantage of FSN in the treatment of ureteral calculi lies in its quick effect, safety and without side effects, which provides an exact effective treatment method for this disease, and it is valuable for clinical practice.

Article translated by: Dr Suya Yuan(U.K.)