32. NOVEL MEDICAL ACUPUNCTURE TREATMENTS FOR ACTIVE COMBAT UNITS ON THE BATTLEFIELD

Transcription

1 32. NOVEL MEDICAL ACUPUNCTURE TREATMENTS FOR ACTIVE COMBAT UNITS ON THE BATTLEFIELD INTRODUCTION Acupuncture hs een employed in Chin since the second century BC to tret cute nd chronic medicl prolems. The technique ws introduced to Europe in the 16th century. In these regions, the enefits of cupuncture in treting musculoskeletl injuries re well documented, nd cupuncture is widely prcticed longside minstrem Western medicine. Moreover, ecuse of the convenience nd cost-effectiveness in treting vrious trining injuries mong the militry popultion, countries such s Chin, Jpn, Kore, nd Frnce hve incorported cupuncture into their militry medicl rmmentrium. Although its introduction to Americn medicine hs een very recent, cupuncture hs stedily gined populrity. The lterntive medicl prdigm underlying cupuncture energetics (the use of cupuncture to move qi pronounced chi or life force within the humn system) provides for novel pproch to treting difficult prolems fced y physicins in such specilties s pin mngement, sports medicine, rheumtology, nd internl medicine. Reserch hs provided vrious possile explntions for cupuncture s effectiveness, including the relese of enkephlins nd endorphins during needle stimultion with ctivtion or suppression of vrious res of the rin found on functionl mgnetic resonnce imging (MRI). Acupuncture offers unique dvntges s n djunct to trditionl medicine in treting conditions such s posttrumtic stress disorder, phntom lim pin, nd neuropthy. It is portle, cost-effective, dptle to hrsh environments, nd requires miniml trining. These qulities re prticulrly useful to ttlion surgeons (physicins emedded with ctive infntry units). Typiclly, ttlion surgeons work in tcticlly isolted ttle zone with limited medicl resources nd cpility. In ddition, s sole provider for the ttlion, the ttlion surgeon hs the dunting tsk of triging ll forms of trum, s well s mnging the dy-to-dy physicicl nd mentl helth of the troops with the gol of mintining criticl mission rediness. An dditionl dvntge cupuncture offers over trditionl pin medictions is the lck of side effects such s dizziness, somnolence, crdic depression, gstrointestinl disturnce, nd llergies tht cn potentilly interfere with soldier s ility to execute mission criticl tsks. Mny people who re unfmilir with cupuncture hve rised legitimte concerns over issues such s potentil infection from needles, pin with needle insertion, nd lck of evidence supporting cupuncture in the Western medicl literture. Although cupuncture hs een used in mny Asin countries s stndrd of medicine for over 2,000 yers, it is only in the lst severl decdes tht the United Sttes hs een introduced to its conventions. Studies suggest tht cupuncture needles, which re oth sterile nd disposle, involve miniml risk of infection. Also, ecuse the needles re lunt tip nd smll ore (smller thn 27-guge needle), they typiclly cuse miniml pin with insertion. Acupuncture should not e thought of s replcement for trditionl medicl tretment, ut rther s n djunct to enhnce trditionl medicine s prt of multimodl pin pln. It cn potentilly provide militry pin mngement physicins with nother medicl tool to further improve the cre of the troops on the ttlefield. The reminder of this chpter does not provide tretise on cupuncture energetics, ut rther descries exmples of severl tried nd true cupuncture tretments tht hve een effective during erly 21st century conflicts. ACUPUNCTURE NEEDLES Acupuncture needles consist of lunt-tip stinless steel shft nd coiled hndle. Ech needle is sterilely pckged inside hollow guide tue nd held in plce with smll plstic chd (Figure 32-1). Figure SEIRIN L-type cupuncture needle with insertion tue (SEIRIN-Americ, Weymouth, Mss). Ech L-type needle hs 20-mm stinless steel hndle with either 30-mm, 40-mm, or 60- mm needle length (lso mde of stinless steel), nd the guge is ville in 0.20 mm, 0.25 mm, or 0.30 mm, so the prctitioner my choose the est size for ech ptient nd ech cupuncture point. Photogrph: Courtesy of SEIRIN-Americ, Weymouth, Mss. The hndles of cupuncture needles re often heted with het lmp or moxiustion to further mplify the tretment. Moxiustion is technique tht employs smoldering mugwort her (mox), rolled inside long pper stick, to het needles fter they hve een inserted. It requires well-ventilted spce nd hs pungent odor, so it is typiclly more suitle in field settings. Acupuncture tretment cn lso e done through er ccess points with uriculr pins (Figure 32-2). Figure ASP rnd uriculr pins (Lhs OMS Inc, Weymouth, Mss); inset: detil of tip. Photogrph: Courtesy of SEIRIN-Americ, Weymouth, Mss. 129

2 32 NOVEL MEDICAL ACUPUNCTURE TREATMENTS NEEDLE INSERTION TECHNIQUE Although cupuncture needles do not cut the skin, prctitioners my still prefer to wipe the skin with lcohol or iodine efore insertion. Also, medicl prudence must e exercised so tht needles re not inserted into n re of dermtopthology (eg, cellulitis, tine pedis, eczem). Vrious methods re used to insert cupuncture needles. One technique egins with holding the guide tue etween the thum nd the index finger of the nondominnt hnd nd plcing it t the insertion site (Figure 32-3). The chd is removed with the dominnt hnd, nd using one gentle ut firm tp on the end, the needle is inserted into the skin (Figure 32-3). Once the epidermis is trversed, the prctitioner uses risk rottion of the coil of the needle while gently pushing the needle deep into the dermis, often into the musculr lyer. The insertion of the needle is complete when the ptient feels deep ching senstion with rottion of the needle. At the sme time, the provider will feel more resistnce with ech rottion of the needle, known s needle gring, or de qi senstion, signifying, ccording to trditionl Chinese theory, the enggement of the ptient s cupuncture energetics. The second method egins with removing the needle from the guide tue, holding it etween the dominnt thum nd the index finger like pencil (Figure 32-4), nd ligning it long the length of the extended third finger (Figure 32-4). While keeping the tip of the needle close to the tip of the third finger nd using the finger s guide, the needle is inserted in one motion. It is often useful to use the nondominnt hnd to stretch out the skin t the insertion site, so tht insertion cn e chieved perpendiculrly to the skin. This technique cn e more difficult thn the first nd often requires more prctice to mster; however, ptients often find it more comfortle. Figure 32-3 Figure

3 NOVEL MEDICAL ACUPUNCTURE TREATMENTS 32 BATTLEFIELD ACUPUNCTURE Auriculr cupuncture ws revolutionized in the United Sttes y Air Force Colonel Richrd Niemtzow s ttlefield cupuncture technique. In this technique, points on the ers re ccessed with ASP (Aiguille Semi-Permnent) needles to ctivte corresponding res in the rin tht hve een shown y functionl MRI to modulte oth cute nd chronic pin, minly the thlmus nd cingulte gyrus, respectively (Figure 32-5). Preloded in n injector, the ASP pins cn e plced t the site of insertion y gentle push of the guide tue. Becuse the pins cn e left in the skin for 2 to 3 dys, n lcohol pd should e used to clen the re efore insertion. TREATMENTS Severe Het Exhustion, Het Stroke, Shock, Unconsciousness, Acute Musculr nd Lower Bck Spsm Acupuncture point: Governor vessel 26 (GV26), locted on the fce t the midline, t the junction of the upper third nd lower two thirds of the distnce from the nose to the lip (Figure 32-6). GV26, potent reviving point for ptients with extreme het exhustion nd shock, cn e used in mss csulty setting. Plce the cupuncture needle into the GV26 point directed towrd the center of the hed, nd vigorously rotte it clockwise while chieving de qi senstion. This senstion is usully felt t n pproximte depth of 2 cm. Continue rotting the needle clockwise until the ptient is revived, fter which the needle should e removed. This procedure should only e instituted following stndrd trum protocols initited y the medicl unit. In ddition to use in shock, the GV26 point cn e used to revive ptients following vsovgl episode. GV26 is lso n excellent point for reliev- Figure Bttlefield cupuncture. Photogrph: Courtesy of Colonel Richrd Niemtzow. ing pin from cute muscle spsm. Physicins emedded in moile unit often hve limited or 26 difficult-to-ccess medicl supplies. When ptient develops cute lower ck or other musculr Figure GV26 spsm nd is unle to multe, plcing needle in GV26 nd hving the ptient rotte it while slowly stnding up nd wlking restores function within minutes, without prenterl or sedting medictions. c 131

4 32 NOVEL MEDICAL ACUPUNCTURE TREATMENTS Tension Hedches, Neck Pin, Shoulder Pin Acupuncture points (Figure 32-7): Smll intestine 11 (SI11), locted t the middle of the infrspinous foss in the infrspintus muscle. Smll intestine 12 (SI12), locted in the middle of the suprspinous foss. Gllldder 21 (GB21), locted in the middle elly of the trpezius. Tripe heter 15 (TH15), locted t the levtor scpul insertion t the superior ngle of the scpul. These re outstnding points for relieving severe shoulder nd neck strin nd tension hedches. SI11 is inserted perpendiculrly into the depression in the infrspinous foss. SI12 is inserted t the middle of the suprspinous foss, into the suprspintus trigger point. GB21 is inserted into the middle elly of the trpezius. To reduce concern for pneumothorx, grsp the nterior nd posterior elly of the trpezius muscle nd lift it off the ri cge, so tht the needle cn e inserted prllel to the plne of the ri cge. TH15 is inserted into the levtor c scpul insertion t the superior scpulr ngle. The depth of levtor scpul cn vry depending on the musculture of individuls, ut the de qi senstion is typiclly felt efore the needle is deeply inserted. Often n re of erythem ppers round the site fter insertion of cupuncture needles into n ctivted trigger point. This is neither side effect nor histmine relese; rther, the erythem correltes to the severity of the trigger tension. Once the trigger ctivtion hs een esed, norml skin color will return. Figure

5 NOVEL MEDICAL ACUPUNCTURE TREATMENTS 32 Hyperdrenergic Sttes, Comt Stress, Insomni, Anxiety, Agittion Acupuncture points: Liver 3 (LR3), locted in the dorsum of the foot, on the first interosseous spce of the mettrsus, in depression distl to the intermetrsl joint etween the first nd second mettrsl ones (Figures 32-8, ). c d Hert 3 (HT3), locted in the nterior ntecuitl region, t the ulnr end of the cuitl crese (Figures 32-8c, d). Governor vessel 20 (GV20), locted t the midsgittl point, depression on the hed t the intersection of lines drwn from the inferior er loes through the superior pices of the ilterl er loes (Figure 32-8e). e GV20 With the constnt thret of enemy ttcks nd frequent comt missions, mny troops develop erly signs of comt stress such s insomni, gittion, nd pnic ttcks. Comintions of ilterl LR3, HT3, nd GV20 provide clming effect on pnic symptoms, often llowing the ptient to fll sleep. In fct, more ptients preferred cupuncture to the trditionl etlockers, selective serotonin reuptke inhiitors, nd zolpidem. LR3 cn e found y sliding the thum etween the first nd second interosseous spce until it flls into depression. HT3 is est ccessed when the elow is flexed. GV20 cn e identified y plcing the middle finger on the inferior end of the er loe nd the tips of the thums together over the midsgittl line while the hnds trverse through the superior pices of ech er. Needles used t these points should not e heted, which could overstimulte n lredy hyperdrenergic stte. If necessry, keep the ptient wrm with wrming lnket. Leve the needles in plce for 15 to 20 minutes nd then remove them. A successful protocol in the deployed setting involved repeting the tretment twice week until the ptients symptoms ted. Figure

6 32 NOVEL MEDICAL ACUPUNCTURE TREATMENTS Soft Tissue Injuries nd Ankle Sprins At mny functionl points nd trigger points, typiclly found in muscles nd depressions in the skin, the strin nd stress of underlying tissues cn e reduced with the insertion of cupuncture needles into the surrounding tissue (Figure 32-9). Enough cupuncture energetic points trverse the ody tht needle plced sucutneously or into the trigger points of muscle will reduce pin nd swelling. The needles cn e heted with moxiustion to improve efficcy nd left in plce for 15 to 20 minutes. Trditionl tretment of nkle sprins is not fesile in n ctive comt zone, due to the need for immoiliztion, lck of ice, nd prolonged recovery period. An cupuncture protocol employing three or four needles inserted immeditely into the soft tissue surrounding the re of edem nd pin cn reduce swelling within 24 hours nd restore the ptient s functionl sttus. Most muscles strins were reduced with one to two needles plced into the most tender prt of the muscles for 15 to 20 minutes, often with moxiustion. c Figure

7 NOVEL MEDICAL ACUPUNCTURE TREATMENTS 32 Physicl Ftigue nd Emotionl Exhustion Acupuncture point: Ming men governor vessel 4 (GV4), locted t the interspinl spce of the L2 nd L3 spinl processes (two lterl depressions cn e found y sliding thums ilterlly from the GV4 point, Figure 32-10). Becuse this point is in the lrge prspinl muscles, needles cn e inserted deeper thn usul. Insert the needles until the de qi senstion is felt, het them with mox for 10 to 20 minutes, nd remove them. With stedy swinging motion of the mox from needle to needle, ptients should feel energized nd lower ckches relieved. Chronic Pin nd Recurring Acute Pin Niemtzow s ttlefield cupuncture cn help individuls who require frequent referrls to specilists, re often plced on light duty sttus, or hve chronic pin syndromes ut re otherwise cple of performing their duties. After clening the er with n lcohol pd, the prctitioner should plce ASP pins strting with the cingulte gyrus, thlmus, nd omeg-2 points on one er (Figure 32-11), nd then the next er. The Shen men nd point zero points typiclly provide clming nd lncing effect on the ptient. While the pins re in plce, the surrounding skin must e oserved for ny possile sign of infection. Ptients should e ressured tht the pins will come out y themselves. Figure Photogrph: Courtesy of Colonel Richrd Niemtzow.! Figure