Gout‧痛風

Gout is a rheumatic disease caused by the deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. It can present itself in a number of ways, though the most common is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). These crystals cause the joint to swell up and become inflamed. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected. Other joints, such as the heels, knees, wrists, and fingers may also be affected. Joint pain usually lasts between 2–4 hours, and during the night. An acute attack of gout will usually subside after five to seven days without treatment. However, 60% of people will have a second attack within a year. Those with gout are at an increased risk of hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular disease. This often accompanies an increased risk of death. 　　Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons including: diet, genetic predisposition, or under-excretion of urate. Urates are the salts produced in uric acid. Renal under-excretion of uric acid is the primary cause of hyperuricemia consisting of about 90% of cases, while overproduction is the cause in less than 10%. About 10% of people with hyperuricemia develop gout at some point in their lifetimes. The exact cause is unknown. Gout may run in families. It is more common among men, women after menopause, and those who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in their blood. The condition may also develop among people with diabetes, kidney disease, obesity, sickle cell anemia (as well as other anemic conditions), leukemia, and other blood cancers. 　　There are several medications used to treat hyperuricemia, each with its own side effects.  Alkaline drugs, non-steroidal anti-inflammatory drugs, uricosuric drugs use, and drugs that inhibit the production of uric acids may be fast and effective; but will generate various side effects and even liver and kidney toxicity. On the other hand, Chinese medicine and acupuncture is a safer alternative with a reduced risk of toxicity and side effects. 　　Traditional Chinese medicine believes the disease is the result of greasy foods, which leads to internal pent-up heat and moisture. Wind and cold invades channels and collaterals, blocking the movement of qi and fluids. This causes stasis of moisture and heat that become phlegm which clogs the collaterals, causing swelling and burning pain in the joints. Traditional treatment seeks to clear heat and moisture; disperse phlegm; and remove stagnancy.  This will dredge the channels in order to stop pain while facilitating the functions of the Spleen and Kidneys. Patients are advised to avoid extreme fatigue, wind, and cold for the duration of the treatment.  Diets and lifestyles should to be controlled, while alcohol and smoking are discouraged.

痛風，關節內尿酸結晶引起的炎症性關節炎，導致腫脹和劇烈疼痛。隨著肥胖的流行，在過去的二十年，新的研究表明，痛風已成為美國常見疾病，它影響到在美國的約4330萬成年人，約佔總成年人人口的21％。其多見於男性，患病的風險也隨著年齡而增加。 　　高尿酸血症是引起痛風的主因。研究指出在男性身上，血尿酸濃度愈高者，出現痛風症狀的機會愈高，血尿酸濃度超過每9毫克/分升者，4.9%會出現痛風。近年的大型流行病學研究發現，痛風與飲酒（尤其是啤酒）及肉類（尤其是內臟）和海產攝取有關，亦有研究指出碳酸飲料及果糖也可能導致痛風。另一方面，維生素C，咖啡和奶制品則可能對阻止痛風的發生有所幫助。 　　臨床上一般可將痛風分為四期描述，但並不表示每位痛風病人都須依序經過這四個時期；痛風的四個分期包括(1)無症狀的高尿酸血症，(2)急性痛風關節炎，(3)間歇發作期，(4)慢性痛風關節炎等，腎結石可在第二至第四期發生。 　　痛風在中醫的辨證上，是由於脾腎功能失調，脾失健運，致使濕濁內生；腎分清泌濁的功能失調，則濕濁排泄障礙。此時若又酗酒暴食、勞倦過度等，則促使濕濁流注於關節、肌肉，造成氣血運行不暢而形成痺痛，也就是痛風關節炎。如濕濁之邪進一步傷於腎則可導致腎損害，就是痛風性腎病甚至慢性腎衰。 　　醫學證據也表明，痛風與代謝綜合徵相關，像是肥胖、胰島素抵抗、血壓高和高血脂等問題，還可能會增加心臟病發作和糖尿病風險。而在痛風的西醫治療方式，無論是抑制尿酸生成的藥物、鹼性藥物、非甾體類抗炎藥和排尿酸藥等的運用，確實是快速而有效的，但對患者都有產生著不同程度的副作用甚至肝腎毒性反應。相對於中醫治療，不論是在急性發作期的治療或是慢性期間的預防，中藥和針灸等治療手段都是相較安全且少副作用。

Case‧病案‧0609A

Patient Stats: Male, 54-year-old, software engineer. Complaints: Lower back pain for four years, intermittence. In the past 2 months the pain increased and sometimes radiated to the thigh on both sides, and could not stand long and had sedentary. The examination of M.D. showed a slipped disc between 4 and 5 lumbar vertebrate. After taking painkillers for two weeks, the situation showed no significant improvement, so the M.D. suggested him acupuncture. Chinese Medicinal Assessments: Physical examination: lumbar paravertebral tenderness 3,4 and 5, positive straight leg raising test on both sides. Tongue: light color and teeth mark, and coating was thin and white. Pulse: Deep and slightly slippery. TCM Diagnosis: lower back pain, bi syndrome. Syndrome: spleen and kidney yang-deficiency type stasis. Treatment: tonify kidney and spleen yang to expel dampness, and clear the meridian. Treatment: acupuncture 22.04, 22.05, 77.18, SP7, SP6, BL65 and other points. Patient felt 90% relieved after treatment. The pain disappeared after two weeks of treatment. This showed clinical cure. He came back once after two months and has had no recurrence.

男，54歲，軟體工程師。 腰痛四年，時好時壞。近二月疼痛感加重，有時並會放射到大腿兩旁，無法久站久坐。經西醫檢查，腰4、5椎間盤突出，服用止痛藥兩週，情況無明顯改善，西醫建議針灸治療。 查體：腰3、4、5椎旁壓痛，直腿抬高試驗兩側陽性。舌質淡有齒痕，苔淡白，切診：沉稍滑。 中醫診斷：腰痛、痹證。證屬：脾腎陽虛挾瘀滯型。 治療：補腎助陽，健脾化濕，通經活絡。治療：毫針刺靈骨、大白、腎關、漏谷、三陰交、束骨等穴。治療一次後病患自覺疼痛有 90%明顯緩解。再持續治療兩週，疼痛消失，臨床治愈，兩個月後回診一次，無復發現象。

Dysmenorrhea‧痛經

Dysmenorrhea (Menstrual Cramps) is a common gynecologic complaint, reported by 25% of women, and by up to 90% of adolescents. It has been reported to be one of the most common causes of periodic absenteeism from school or work in young women. 　　Dysmenorrhea is commonly categorized as ‘primary’, i.e. in absence of proven pelvic pathology, or ‘secondary’, i.e. in presence of pelvic pathology. Pain is the dominating symptom, and several other symptoms, may contribute to the pre-menstrual syndrome. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are at least partly effective in relieving primary dysmenorrhea in about 90% of sufferers and completely effective in 65%. 　　Acupuncture is the standard treatment for severe dysmenorrhea in the Traditional Chinese Medicine (TCM). It is commonly used to treat chronic pelvic pain, and its use has been recently recommended by the National Institute of Health for the treatment of several diseases, including dysmenorrhea. 　　Acupuncture points are stimulated by inserted needles, by heat generated from moxibustion, or by manual pressure at the site. It is well tolerated and free of relevant side effects and has been approved by FDA.

痛經是指女性月經期前後或行經期間，出現以下腹部痙攣性疼痛為主，嚴重時還可能影響日常生活的一種常見婦科疾病。 　　其有原發性和繼發性兩種。經過詳細婦科臨床檢查未能發現盆腔器官有明顯異常者，稱原發性痛經，也稱功能性痛經。多發生於月經初潮的青春期少女或已生育的年輕婦女。經過詳細臨床檢查生殖器官有器質性病變者所致的痛經，是為繼發性痛經。 　　痛經發作時，輕者小腹疼痛明顯在經期或其前後，伴腰部酸痛，無全身症狀，有時服止痛藥即可解除痛疼。較嚴重者可見經期或其前後小腹疼痛難忍，伴腰部酸痛，噁心嘔吐，四肢不温，止痛藥物可暫緩疼痛但不能解除。最嚴重者常見經期或其前後小腹疼痛難忍，坐臥難安，須臥床休息，伴腰部酸痛，面色蒼白，冷汗淋漓，四肢厥冷，嘔吐腹瀉，或肛門墜脹，甚至會因痛而休克，止痛藥不能明顯緩解痛症。 　　關於痛經，在中醫最早見於《金匱要略·婦人雜病脈症並治》稱為“經行腹痛”。其理論認為該病乃由於氣血運行不暢所致，蓋經水乃氣血所化生，血隨氣行，氣載血運，氣血充沛，氣順血和則經行暢通。在中醫“通則不痛”的治療原則下，可以取血海和內關或中極、關元、三陰交、足三里等穴，借助毫針的刺激和艾灸的溫熱以調氣和血後，經血順暢則痛疼自然得解。

Headache‧頭痛

Headaches give rise to notable health, economic, and social costs. There are four types of headaches: vascular, muscle contraction, traction, and inflammatory. The most common type of vascular headache is the migraine. Right now, more than 45 million people in the United States experience chronic, recurring headaches and, of these, 28 million also suffer migraines. 　　Many headache sufferers are compelled to take pain-relieving drugs that may only temporarily relieve the pain and can cause undesirable side effects. This leads patients to try, and health professionals to recommend, non-pharmacological approaches to headache care. One of the most popular approaches seems to be acupuncture. 　　Traditional Chinese Medicine does not recognize migraines and recurring headaches as one particular syndrome. According to TCM, one cause of headaches is a blockage in the smooth flow of Qi and blood. Treatments that focus on removing this blockage may treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, acupressure, Chinese herbs, and Qi-Gong to restore imbalances found in the body.

「頭痛」是現下最常見的疾患之一，現代人壓力大，生活緊張，睡眠品質差，由肌肉緊繃引起的頭痛比例也大幅增加。但百分之八十的頭痛原因是不明的，目前常見的治療，除了止痛藥、阿司匹靈等藥外，多無其他有效的療法。 　　針灸在治療頭痛方面有其獨到的效果。傳統中醫理論認為引起頭痛的原因很多，如外感風、寒、暑、濕、燥、火六淫，上犯巔頂，使氣血運行受阻，屬於「外因」；或內傷喜、怒、憂、思、悲、恐、驚七情，久病，氣血不足，失於充養，或痰濁瘀血，阻於經絡，屬於「內因」；還有飲食不節、勞動過度或意外受傷的「不內外因」都可導致頭痛。 　　這三大病因所造成頭痛，其型態也各不相同，治療方式也不同。一般而言，外感頭痛，發病較急，痛勢較劇而無休止，多屬實證，治療以袪邪為主；內傷頭痛，起病徐緩，病勢也較緩，時作時停，多屬虛證或虛中夾實證，治療以補虛為主。