Sierra Clinic ~ Oriental Medicine

Welcome to our clinic. I wrote this pamphlet to answer commonly asked questions and to help you understand our approach to health care. I hope it serves you well.

Introduction

Classical Oriental Medicine and its modern variants are now practiced throughout the world and are increasingly integrated with conventional health care. Its safety and effectiveness over a wide range of disorders has been confirmed in millions of patients and a large number of scientific studies performed in hospitals and universities in every major country in the world. In California, Acupuncture and Oriental Medicine is legally defined as a primary health care system. Assembly bill 3040; "In its concern with the need to eliminate the fundamental causes of illness, not simply to remove symptoms, and with the need to treat the whole person, the legislature intends to establish in this article, a framework for the practice of the art and science of Chinese Medicine through acupuncture. The purpose of this article is to encourage the more effective utilization of the skills of acupuncturists by California citizens desiring a holistic approach to health..."

Integrative Health Care

The scope of practice of the Oriental Medicine primary health care license is not restricted to oriental medical assessment but also includes the right to order conventional laboratory testing such as blood tests, urinalysis, X-ray, CT scans and MRI, as well as specialized functional medicine tests which can be used effectively to inform the treatment of complex and chronic illness. Although I routinely order conventional lab work, this is not meant to imply that my practice is intended to replace conventional primary care, which is both necessary and complementary to our approach to holistic health care. In fact, conventional primary care screening is the foundation upon which all of our assessment and treatment of patients with chronic unresolved illness begins. Conventional assessment and diagnosis is necessary both to rule out serious disease and to provide the necessary test results that will be integrated with the functional testing that I will do to provide a comprehensive basis for your care. This is what is meant by "Integrative health care." I both refer to and receive referrals from Medical Doctors routinely. That said, our health care roles are very different.

Functional Medicine Assessment

My primary role in restoring and maintaining your health includes, insofar as possible, not only alleviating diagnosed disorders but also restoring overall health and well being by addressing the broader functional health profile that is specific to each patient. It is not uncommon for patients with chronic ill health and a complex of debilitating symptoms to remain undiagnosed with respect to conventional laboratory tests, or to have been treated for diagnosed disorders that have not responded adequately. Functional assessment complements conventional diagnostic testing by providing an overview of where and how our internal environment is stressed or compromised. This includes emotional, nutritional, hormonal, allergenic and toxic loads that can compromise health and well being in a variety of ways. Specialized lab tests, along with history and physical examination will determine the treatment plan which will then be addressed with evidence-based supplements, acupuncture and dietary and lifestyle modification when indicated.

In the interest of both shortening the clinical course of the patient and saving the expense of multiple forms of testing, I often begin with a specialized type of biofeedback assessment referred to as "electro dermal testing." This test is based on biofeedback measurement of electro-conductive changes at acupuncture points that reflect aspects of physiological function and assist in isolating functional stressors that can compromise health. This form of assessment has proven invaluable in our practice for the functional assessment of patients that have exhausted conventional diagnostic testing.

Treatment

Treatment may include acupuncture, the use of nutrition, homeopathy and herbs, dietary therapy, rehabilitative exercise, and counseling as it relates to stress reduction, behavior modification and optimizing health. Oriental Medicine is a highly diverse field and what constitutes assessment and treatment can vary dramatically. I was trained in Japan and completed a hospital residency that provided exposure to many approaches to treatment. I think it is accurate to state that the overall approach that I take to patient care is unique to my practice. Much of my training on the orthopedic side involved learning to evaluate the neuromuscular changes that accompany all injury and pain related syndromes.

This is done through a specific form of "Palpation": a precise and specialized use of the sense of touch to map neuromuscular changes on the surface of the body. I have been extensively trained in the use of this technique as well as specialized forms of treatment which have been developed into an integrated system referred to as neuromuscular mapping. This technique is central to my use of acupuncture to treat chronic and severe pain syndromes and is described in some detail in a published research paper that you are welcome to read.

Acupuncture

If you are apprehensive about the potential discomfort from treatment, let me assure you that the actual insertion of these very fine needles does not feel like a shot. In fact, most patients barely feel the insertion. When point contact is made a mild radiating sensation is felt. In any case, as with everything else regarding patient care at our clinic, my approach to you will be individualized to your needs. During the rest phase of treatment you will be comfortably lying down for 20 to 30 minutes. All acupuncture needles are single use disposables.

For most pain related conditions, the form of acupuncture used at our clinic is often the only modality required for successful outcomes and can be used to treat all areas of pain simultaneously. I specialize in the treatment of severe and chronic pain that has not responded adequately to other interventions (including surgery). For conditions other than pain and primary and preventive health care, acupuncture is used in conjunction with our other forms of treatment and assessment and performs many functions. I am often asked: what is acupuncture and how does it work?

Theory

Classical acupuncture theory describes all disease as arising from "energetic" imbalance within the body. In the early 1950's, it was discovered that acupuncture points do, in fact, have unique electro-conductive properties.

Active acupuncture points are distinguishable by a marked difference in electrical resistance from the surrounding skin. There are now numerous studies that have established that there is a correlation between the electrical properties of active points and physiological function. In fact, the defining characteristic of an acupuncture point is its electro-conductive properties. You can think of the points and meridians as an electrical circuit that can be used to both treat and evaluate specific internal function. This is the basis for the electro dermal biofeedback testing that is used in our office to provide initial functional assessment.

Acupuncture also has direct effects on the neuromuscular system and central, autonomic and peripheral nervous systems. Many of the more obvious effects of acupuncture in this area have been scientifically documented. For example: activation of immune function, assisting circulatory function, correction of faulty nerve transmission and reduction of inflammation and muscle spasm etc. But the mechanisms behind the documented beneficial effects of acupuncture on organ and glandular function, and a wide array of physiological functions, are now understood in much greater detail.

Our current understanding is that many of the diverse effects of acupuncture are directly related to its effects on the autonomic nervous system. The autonomic nervous system is the means by which the body regulates and balances its internal environment. We can think of the autonomic nervous system as a vast communication network which is constantly sending and receiving information in the form of chemicals and nerve impulses. Much of this internal monitoring and corrective action is mediated by the hypothalamus and pituitary gland, two important brain centers that function as a kind of "master computer," processing much of the information which governs organ and glandular activity and the overall balance of our internal environment. Many of the effects of acupuncture in restoring health are now understood as specific effects upon this complicated feedback system referred to as the "hypothalamic pituitary adrenal axis."

The diagrams on the left represent this complex set of interactions that "reset" and restore physiological balance.

Many questions remain unanswered: Why some forms of acupuncture can provide dramatic (and lasting) improvement in chronic pain that is caused by severe structural damage; or why acupuncture treatment can produce positive changes in the limbic system which is that part of our brain most responsible for our emotional health. Indeed, the greatest irony for modern science is that this ancient form of Chinese medicine still remains far more sophisticated in clinical application than our knowledge of how it works. Perhaps of even more significance is that acupuncture's many effects on restoring health are virtually without risk or serious side effect, and simply represent stimulation of the body's capacity to heal itself.

Scope and Application

This following is a representative overview of conditions that we can effectively treat. The goal in assessment and treatment is to address the complex of problems which characterize the individual patient and to restore health and wellbeing, not simply to address isolated symptoms. For example, a patient that has pain, digestive complaints, headaches, and fatigue and mood disorder will be assessed and treated with the goal of simultaneously addressing the complete clinical profile of that patient. Because the goal is to restore health, the patient's willingness to be an active participant in their recovery is critical. This may involve dietary modification, rehabilitative exercises, a stress reduction program and behavior modification.

Musculoskeletal and Neurological disorders:

For chronic pain patients who have no other health concerns, acupuncture is often the only modality necessary for recovery. We effectively treat the entire spectrum of pain related disorders. Although we are frequently able to help even the most challenging patients, a defined clinical trial of five to ten weekly treatments is the only means of decisively determining response and prognosis.

Internal Medicine:

We can effectively treat a wide spectrum of organ system related disorders: Digestive, Urological, Respiratory, Cardiac, and Reproductive. Acupuncture is combined with our other treatment modalities and, in general, we treat most of the same disorders that would cause you to seek out conventional care. It is always wise to begin with conventional assessment to rule out major disease and to provide the basic diagnostic testing that is the prudent first step in establishing a treatment plan.

Endocrine Disorders:

Hormonal imbalance, adrenal fatigue, weight management and other endocrine disorders can often be effectively treated.

Stress and Mood disorders:

The emotional and physiological effects of chronic stress on a wide range of health related problems are well documented. Ultimately, as with all other chronic mood disorders, it is the effect of stress on the delicate chemistry that is necessary for a healthy brain and the sense of well being that is the foundation for good health and a high quality of life that is at issue. We address the effects of chronic stress and a wide range of mood disorders through the use of specific amino acids, evidence based supplements, nutritional intervention, acupuncture and specific forms of behavior modification that help to restore neurotransmitter balance. Although we provide for a wide range of mood disorders such as persistent feelings of depression or anxiety, it is important to note that this is neither intended to replace medical nor psychological treatment. Reducing or stopping medication should be done in cooperation with your doctor as you demonstrate improvement.

Allergy and Autoimmune disorders:

Asthma, inhalant allergies, hives, eczema, irritable bowel and migraine and sinus headaches are some of the more common manifestations of food and inhalant allergies. We can effectively treat both food and inhalant sensitivity as well as assist many patients with the symptoms of autoimmune diseases such as Multiple Sclerosis, lupus, Scleroderma etc.

Compromised immune function and Chronic Fatigue:

We have assisted many of these patients on the path to recovery. These complaints, along with a host of other conditions, often elude conventional diagnosis but respond well to a functional medicine approach. Remember, everything we do is directed towards a targeted approach to stimulating the natural recovery systems of the body and, as general health is restored, persistent and poorly understood symptoms often improve as well.

Wellness and Preventive Medicine

There is now a general consensus that between 60% and 90% of the three leading causes of mortality in our culture -cancer, cardiovascular disease and diabetes- are largely environmentally induced. "Environment" is meant to include toxic exposures, diet, exercise and mental health. This should not alarm you. It should empower you! Isn't it reassuring to know that by healthful lifestyle modification and optimizing your health and wellbeing you can dramatically improve the quality of your life and reduce the risk of serious disease? This occurs even at the level of our genes. This is called "epigenetics" which simply means modifying genetic expression through positive lifestyle changes that inhibit or stimulate genetic effects on the body. Perhaps this is the most meaningful "insurance policy" that any of us can have. For patients that desire primary and preventive health care these concerns will be integrated into your care. It is advisable that you inform me that that is your wish so that my role in your future health care is clear.

But catastrophic disease aside for the moment, isn't it clear that if there is a high general level of health that disease will not have a hospitable environment? Isn't it also clear that health is not simply the absence of disease? No serious disease appears out of nowhere. There is usually a compromise in our health long before being diagnosed with a disease. This may manifest as persistent preclinical symptoms that also affect the quality of our lives. For example, maldigestion, headaches, low energy, persistent pain and chronic mood disorder.

Acupuncture and Chinese Medicine historically placed great emphasis on prevention, and for good reason. As you now understand, acupuncture aids in restoring functional balance throughout the body: maintaining vitality, down regulating the effects of stress, and bolstering immune function. This is referred to as "Wellness Care" when it is utilized for the purpose of preventive health care.

For the patients that have completed a successful course of therapy, this usually entails have a "tune-up" once a month. The same principle is at work for patients with chronic illness, autoimmune disease etc. that require booster treatments at some interval to maintain a high level of functionality. This also allows for ongoing monitoring of wellness goals: weight control, diet, stress management and conditioning and rehabilitative exercise programs. Generally, I will also provide a functional biofeedback exam and review your medical records yearly or as indicated. This is, of course, your choice. Please advise me if this is the approach you wish me to take.

Treatment Course

Initially, acupuncture treatments are performed weekly. Whether we are treating a specific pain related issue or a complex set of health related complaints, we expect initial improvement in the first five treatments. In the beginning there will be vacillation between improvement and regression which increasingly will stabilize into longer periods of stable improvement. It should be remembered that chronic problems that took years to develop cannot be eradicated overnight. Of equal importance is the second stage of treatment which defines the therapeutic limits and seeks to stabilize the improvements that have occurred so that they become lasting. It is good to remind yourself as you recover that your improvement is not based on a symptomatic medication dependent change but the natural regenerative effects of regained health.

It is very important for the optimal utilization of your treatments that you adhere to your treatment schedule. Acupuncture has a cumulative effect. In this respect, the treatment interval is analogous to the frequency and dosage of medicine, and you should give it a high priority. Lastly, I would like to remind you that your appointment is for you alone. Always call at least 24 hours in advance if circumstances are such that you cannot come.