CYPA
Health Column August 2018

Reducing Allostatic Load & Stress Through Heightened Awareness
By Robert Hoffman, L.Ac.

Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways 
and brain neuro-chemistry medicine to alleviate the associated symptoms.

Allostatic load is a Western medicine term describing a buildup or accumulation of stress forces present in the human psychosomatic condition. The acute stage is called allostasis and causes general mind-body discomfort and restlessness affecting brain cognition, focus and concentration.1

Allostatic Load

The buildup and accumulation of allostasis is referred to as allostatic load and affects your practice and patient population in subtle ways since allostasis and allostatic load affect the homeostatic balance of the central nervous system (CNS), the autonomic nervous system (ANS), the sympathetic nervous system (SNS) and the parasympathetic nervous system(PSNS).

Traditional Eastern medicine (TEM) addresses 
this condition through calming the SNS where qi and blood stasis contribute to the origin of allostatic load accumulation. Your ability to address this is the inherent flexibility of a TEM treatment plan using the 8 limbs of TEM therapy to balance yin/yang and qi and blood. Just like the innate natural defense mechanism called the default mode network (DMN) Wei qi is rooted in Kidney Jing and qi, and, like the innate immune system or DMN, Wei qi stops or greatly reduces adverse effects to Heart Shen-mind, Kidney Jing and Spirit from accumulation of allostatic load.

Treating Allostatic Load

A flexible treatment plan includes assessing the Kidney Heart axis and brain-mind rational awareness, 
neuro biology and psychosomatics of allostasis and allostatic load and rooting it before the stasis manifests. Collectively the 8 limbs of TEM look curiously like the DMN to restrain stress and allostatic load accumulation. The DMN, innate immune system and Wei qi guard against allostatic load through a psychosomatic awareness rooted in Kidney Jing and Heart Shen axis.

As one of the 8 limbs a qi-gong and Nei Gong practice enable yin and yang balance just like the sympathetic (SNS) and parasympathetic nervous system (PSNS) Shen-mind and the brain-
mind form the practice of meditation, contemplation or other forms of prayer and physical components of Nei Gong that build and strengthen Wei qi levels inherent in DMN immunity.

As you practice Nei Gong (the internal form of Qi Gong) the central nervous system (CNS) is stabilized, awareness is elevated and clarity of mind, focus and inherent wisdom of Heart Shen-mind rooted in Kidney Qi are maintained. While we know TEM collectively make up the Sea of Marrow and complex
interaction of the brain, Shen-min, and Jing qi represents a gateway to manage allostatic load through the collaboration of eastern and western physiology.

Qi-gong and specifically Nei Gong remain scientifically valid wholistic forms of managing accumulated stress and allostatic load. As a practitioner of TEM your ability to reduce mental stress accumulation in the SNS and PSNS are rooted in the integrationofKidney and Heart axis. While we recognize psycho-pharmaceuticals are useful to reduce complex cases of allostatic load accumulation maintaining strong Wei qi levels link the power of Shen-mind rooted in Kidney Jing also command the DMN and immune system to effectively manage the allostatic load. Meditation and specifically Nei Gong practice stimulate several CNS nuances to calm or sooth any escalation or spillover effect of acute stress accumulation like allostasis and allostatic load.

While we may not know if allostatic load is extrinsically or intrinsically generated we do know the practice of neigong and qigong can help produce pro-active novel thoughts in the ANS, clearing a path to reduce allostatic load through the SNS and PSNS response to acute stress, Heart Shen mind reduces allostasis and accumulation allostatic load using the DMN and the immune system to harness the power of the complete CNS (specifically made up of the bio and neuro-anatomy of Shen mind and thought) to triumph over allostatic load.

Maintain your neigong practice or adding Nei Gong practice to your patient 
treatment prodical engenders the generation of wisdom and conscious awareness to optimize treatment plan results. As a TEM practitioner, you know meditation, prayer, Qi Gong or tai-chi practice done as a practice helps form yin/yang balance in patients. While creating deeper level healing a diligent Nei Gong practice strengthensWeii qi and builds DMN immunity as well. It also elevates your clinical skill-set, opens awareness of Heart Shen and Shen mind to engage forces larger than western psycho-pharmaceutical medication.

Retrieved from:Acupuncture Today https://www.acupuncturetoday.com/digital/index.php?i=725&a_id=33505 

 



Arm Numbness Medical Care Guide, Diagnosis, and Treatment
By Dr. 林杏青 & DPT 李冠頡
 
Your arm feels numb and a bit painful, and it feels strange in a way that’s hard to describe. At first, it only felt numb in certain positions when exercising, but now the numbness is constant. In addition to numbness, the arm feels weakened and the muscles may have even shrunk; all of your previous weight training gone to waste.
These symptoms could very likely be a nerve pain problem, which may be indirectly caused by aging or long-term poor posture, or it could be the result of nerve injury or nerve compression stemming from a sports injury or car accident.
 
This article will tell you:
  1. If you encounter this type of problem, how should you see a doctor?
  2. How should you communicate with your doctor?
  3. How can you easily determine the possibility of arm numbness?
  4. What methods are there to check for nerve pain and nerve compression?
  5. Is surgery necessary? Other than surgery, what treatment options are available?

How should you see a doctor for arm numbness and nerve pain? 

For arm numbness and nerve pain, you can choose to visit the Department of Rehabilitation, Neurology, or Neurosurgery. The following are important points you can discuss with your doctor in order to help them find the cause of your arm numbness:
  1. Where do you feel numbness? Where do you feel pain?
  2. How long ago did the symptoms start?
  3. How long do symptoms last during a flare-up?
  4. How does it become numb or painful? Which positions are uncomfortable and which are more comfortable?
  5. Is the numbness accompanied with weakness?
  6. Do you have any medical conditions? Have you ever had surgery? Are you taking medicine?
  7. Your lifestyle
These questions conform to the common"What, Where, When, How" ;  it is recommended that you frequently keep a record of your physical status, as this will help you to communicate with your doctor as opposed to relying on memory. Please remember that when describing your condition to your doctor it is not necessary to start from the story of how your grandparents met; time is of the essence.

A Brief Introduction of Your Nervous System

Before talking about how doctors test and diagnose nerve pain, we will briefly talk about the nervous system. Your brain is the boss of your nervous system, and your nerves start from your brain, going through your spine before spreading to each part of your body. Nerves outside of your spine are called peripheral nerves, which can be divided into autonomic nerves, motor nerves, and sensory nerves. If a part of this long nerve is injured, compressed, or poorly treated, nerve pain will emerge. As nerves are both dense and long, how should you have them tested? Apart from the doctor's consultation mentioned in the previous section, the following will tell you about possible diagnostic methods and testing instruments.

Possible diagnoses for arm numbness and nerve pain

From the previous chart we learned that nerves spread downward like the branches of a tree, dividing and becoming thinner; moreover, every nerve fork controls a different sensory area and movement. Generally speaking, when the problem area is farther upstream (closer to the brain), the areas downstream will also have problems. For example:
  1. If both of your arms are numb, the problem is very likely in your spine.
  2. If one arm is numb from the top down, it could be that the nerve is compressed at the point it branches out from the spine.
  3. If the numbness is below the wrist, and the thumb, index and middle finger are numb, the median nerve could be compressed.
  4. If the ends of your hands and feet are numb, it could be multiple neuropathies caused by diabetes.
  5. If your arm becomes numb when raised, and the numbness subsides upon release, it could be thoracic outlet syndrome, in which your neck muscles temporarily compress a nerve or blood vessel 

In addition, medications, alcohol, kidney disease, tumors and more may cause arm numbness, so maintaining a healthy lifestyle is extremely important. If your arm goes numb when you wake up from a nap at your desk and the numbness quickly subsides, then I don’t think you need to be too worried, you simply placed pressure on your arm for too long.
Next, we will be discussing some medical devices that can help doctors find the root cause of the problem.

X-Ray and Magnetic Resonance Imaging (MRI)
X-rays can be used to check for normal spinal alignment, bone spurs, narrowing and thinning of intervertebral disks that can affect the nerve cavity, spinal ligaments calcification, tumors, and more. In more serious cases, MRI is used to look at structural issues, such as if nerves are being compressed by a protruding disk. However, the images taken using X-ray or MRI cannot definitively identify the cause of the problem, just like how bigger people are not necessarily stronger, they may just be taller.
 
Soft tissue ultrasound 
If we suspect that your arm numbness could be caused by median nerve compression in your wrist or inflammation, then soft tissue ultrasound is a good choice. Most doctors using soft tissue ultrasounds have the ability to examine the median nerve in the wrist; although ultrasound cannot replace electromyogram (EMG) in testing for compression or inflammation swelling, it can be used to rule out compression caused by structural issues, choose the location of the injection, and help to make a diagnosis.
 
Electrical diagnosis 
Usually, only hospitals will have electrical diagnostic testing, such as EMG, nerve conduction velocity, and muscular electrical stimulation.
Simply put, EMG examines what areas have uncontrolled electrical discharge, the level of injury to the nerve, whether it is an acute injury,  if there has been recovery, and more. Using EMG, you can see what segment of your nerve conducts more slowly, or learn what segment of the nerve is decaying or growing based on the shape of the electrical waves. But (there's always a but), electrical testing is not always accurate. First, it relies heavily on the technique of the operator; second, if your arm numbness has multiple simultaneous causes it can be difficult to test; third, it can be difficult to test if your arm has not been numb for more than three weeks.
 

Treatment methods for arm numbness, nerve pain, and nerve compression 

Treatment methods can be divided into surgical and nonsurgical (conservative treatment).
 
Surgical: Generally, the doctor will evaluate whether surgery is necessary. Generally speaking, if the muscle feels weak and atrophied or there are involuntary movements, following three to six months of conservative treatment follow-up EMG or images show that your nerves' condition continue  to deteriorate or there is evidence of acute nerve necrosis, surgery is recommended; however, this recommendation is not a guideline, simply an expert's opinion.
 
Nonsurgical (conservative treatment): If your doctor determines that the problem is not serious, and there is no acute nerve damage or necrosis, conservative treatment will generally be administered.
  1. The most common conservative treatment is physical therapy covered by National Health Insurance (NHI), such as traction (e.g. neck pulling), which can relieve symptoms.
  2. A method with a higher level of supporting evidence is steroidal injection with a stabilizing splint to ease compression of peripheral nerves. If there is median nerve compression, such as carpal tunnel, we can try median nerve anesthetization, anti-inflammatory medicine, or nerve hydrodissection.
  3. Self-paid treatments include strength training because strengthening the small muscles that stabilize and support the spine can open up more space for your nerves. Nerve mobilization is a common form of manual therapy, in which a special push-pull technique and pump effect is used to increase blood flow to the nerves while simultaneously decreasing nerve tension. This can be used complementarily to injection and splint treatments.
 
Please remember, these treatments should be assessed and performed by a professional physical therapist in order to prevent your condition from worsening; for example, those with carpal tunnel should be especially careful.

Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊 https://blog.easepain.tw/lin-hsin-chin/neuralgia/ 
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