Acupuncture Therapy for Age-Related Muscular Degeneration

Acupuncture Therapy for Age-Related Muscular Degeneration

اسلاید 1: 1www.tabaye.ir

اسلاید 2: 2Acupuncture Therapy for Age-Related Muscular Degeneration“The Santa Fe Eye Protocol”American Academy of Acupuncture And Oriental Medicine 18 July 2012Alston C. Lundgren, MD, FAAFP, FAAMASanta Fe NM USAFull Text: www.ReverseAMD.come.mail: Alston@LundgrenMD.com

اسلاید 3: My acupuncture training is mostly European and Canadian. I am here to share with you acupuncture principles which may not be familiar to you .In particular, I am giving you a tool to treat many patients who previously have been unable to be treated – thus helping alleviate human suffering3

اسلاید 4: This AMD treatment is the first situation I know of where acupuncture treatment can do something with quantifiable endpoints that other medical modalities cannot. That means credibility in conventional Western Medical eyes4

اسلاید 5: 5SignificanceMillions of persons afflicted with AMD can now have help.This can help legitimize acupuncture because the condition is quantifiable – and conventional medicine cannot help.

اسلاید 6: Presentation outline6AMD backgroundCurrent conventional treatmentDescription of the Santa Fe Eye ProtocolResults of the Santa Fe Eye ProtocolStatistical significanceHistoric and Suggested TreatmentTechnical Details

اسلاید 7: 7Prevalence : up to 9 million cases in USCause: Unknown Risk factors: Northern and Western European ancestryUltraviolet exposureSmokingFamily historyMost significantly, growing older

اسلاید 8: Two varieties8Dry AMD represents 90 % of cases – usual course is a slow decline in vision.Treatment is limited to hypertension control, avoiding UV exposure, quitting smoking, and AREDS vitamins and lutein.Wet or Neovascular is 10% of cases - but the more likely to lead to sudden and severe vision loss.

اسلاید 9: 9Ophthalmologists are now able to stop bleeding by various techniques.Thermal laser started 20 years ago – with 3 line vision loss an immediate consequence.Photodynamic Therapy – IV Verteporfin with cold laser – could treat 40 % of wet AMD cases without the laser 3 line loss.

اسلاید 10: 10Anti Vascular Epithelial Growth Factor: intraocular injections of: Macugen, Lucentis, and off label Avastin.Literature and advertising reports 20+% of these patients regain lost vision – BUT most likely the vision gain is the body reabsorbing blood after leak stops –NOT the action of the drug itself.

اسلاید 11: Since 2001 more than 1500 persons have been treated with variations of the same protocol involving several different acupuncture modalities.Overall, 85% of patients had an overall improvement in visual acuity.11Today’s Report on My Work

اسلاید 12: 12Basic DefinitionsAMD = Age-Related Macular DegenerationOS = left eye OD = right eyeETDRS charts (Early Treatment of Diabetic Retinopathy Study)5 letters each lineLogarithmic -3 lines = doubling visionValidated by National Eye Institute

اسلاید 13: The Santa Fe Eye Protocol works on related retinal conditions - but only half as well. In Asians, Myopic Degeneration is the most common type of retinopathy. In Caucasians it is Retinitis Pigmentosa, Stargardts, and Best’s Disease plus many other rare congenital conditions. 13

اسلاید 14: 14Reporting ConventionMost of my patients were not local and came for a week for daily treatments and were tested on Monday, Wednesday and Friday before treatment. Thus reports were standardized to reflect 4 treatments

اسلاید 15: Overall Population Characteristics15Total# individuals 736Male/Female385/351Average age77.4 yearsAge range44-102 yearsInitial Acuity ETDRS Near20.75 (Snellen 20/96)Initial Acuity ETDRS Far24.06 (Snellen 20/84)Previously Reported 2010 ICER, Beijing

اسلاید 16: Overall Results16Letters

اسلاید 17: MethodsAt intake:Measure visual acuity using ETDRS eye charts for both near and distant vision.VF-14 subjective measuresColor screen using HRR isochromic color chartPelli-Robson Contrast Sensitivity measurement17

اسلاید 18: Inclusion Criteria18Must have ophthalmologist diagnosed AMDMust have ophthalmologist exam saying no bleed:Within 3 months if Wet AMDWithin 12 months if Dry AMDIf any significant vision lossMust not be dementedNo seizure history

اسلاید 19: 19ETDRS Visual Acuity Chart

اسلاید 20: ETDRS Near Chart20

اسلاید 21: Pelli-Robson Contrast SensitivityPelli-Robson Contrast Sensitivity21

اسلاید 22: Santa Fe Eye Protocol ComponentsGerman Ear AcupunctureCanadian Neuroanatomic AcupunctureClassic Chinese Scalp AcupunctureYamamoto Scalp Acupuncture22

اسلاید 23: Indirect stimulation of specific parts of brain through ear acupuncture23

اسلاید 24: XMHN # 1, Yamamoto CN needles. Visual cortex over lambdoid suture is being re-investigatedX15 mm needles, 2 cm lateral to midline, insert down, at lambdoid sutureYamamoto CN:30mm Needles, insert 2 cm behind hairline, 1 cm either side of midline.

اسلاید 25: Direct Electrical Stimulation of Periorbital area25

اسلاید 26: Dry AMD Gains after 4 Tx26Lettersn=367n=398n=370

اسلاید 27: Wet AMD Gains after 4 TX27Letters

اسلاید 28: Overall Gain vs Intake Acuity28

اسلاید 29: Vision Gains By Tx Date29Sum of letters OS and OD, both Near and Far

اسلاید 30: Hard to Quantify GainsDistortions lessen.Scotomas diminish or disappear.Less light needed to see.Sensation of a film over eyes decreases.Colors become more vibrant. 30

اسلاید 31: 31Function vs Physical Changes Most patients and I focus on function. For many retinologists, the more important issue is changes in retinal photographs , angiograms or OCT measurements . A few patients have reported significant gains in those tests, but I have not performed them. Those studies should be performed by an independent, academic center in a systematic way.

اسلاید 32: DurabilityAn IRB study is underway to determine durability and also late gains. Release of records forms have been signed – but it is a massive effort yet to be done.Anecdotally, patients have retained vision gains upwards of 5 years. When there are losses, a big portion of the time they are associated with a CVA. Rarely is it a hemorrhage – but that is the big concern.32

اسلاید 33: Late Gains33A significant portion of patients report late gains – scotomas clearing, more colors, clearer vision, etc. Since most patients are not local, the next stage of research is obtaining vision records from treating eye doctors.

اسلاید 34: Risks34To date only black eyes – which always spontaneously resolve.There is a concern that there might be an increase in the number of bleeds in persons with wet AMD. Only 2 cases have occurred near the time of treatment.Periorbital infections are rare – but must be treated aggressively with antibiotics.

اسلاید 35: Statistical SignificanceCentral Limit Theorem: Standard deviation of a group of N independent distributions equals the standard deviation of an individual divided by the square root of N.35

اسلاید 36: For a 100 member group of those individuals, the standard deviation is 0.1 x 0.75 or 0.075. For groups the size in this presentation, the p value < 0.001 that the improvement is from random variation. The results are real!! Typical test-to-test variation for visual acuity is 1 ½ lines with 95% confidence. That is, one standard deviation = 0.75 lines.36

اسلاید 37: Conclusion37The acupuncture protocol reported here increased visual acuity for both dry and wet varieties of AMD much more than can be explained by random chance or test variation.

اسلاید 38: 38Research QuestionsWhat electric frequency to use?Duration of each treatment?Interval between treatments?Are there observable changes in retinal photographs/angiograms?Optimal needle placement?

اسلاید 39: 39Santa Fe Eye Protocol2012 Suggested Needle Placement and Technical Details

اسلاید 40: MethodsAt intake:Measure visual acuity using ETDRS eye charts for both near and distant vision Pelli-Robson Contrast Sensitiviy measurementColor screen using HRR isochromic color chartVF-14 subjective measures

اسلاید 41: 41German Ear: Bilaterally gold ASP at Eye, CN 2, Pineal, Diazepam Analog and Interferon and steel mastoidScalp: XMHN#1, 15 mm x 0.20 mm needle (-) at lambdoid to ipsilateral Yamamoto CN line (+)Canadian Neuroanatomic 0.20 mm x 15 mm Nasal infraorbital ridge (-) to 0.20 x 30 mm temporal supraorbital ridge (+)Temporal infraorbital ridge (-) to nasal supraorbital ridge (+)

اسلاید 42: German pineal, CN 2, pineal, diazepam analog, interferon and steel ASP needle behind earlobe

اسلاید 43: 43German Ear  Simplified protocol:Both ears the same:  non dominant eargold at named Pineal, Diazepam Analog, Interferon, CN 2 and Eye point with steel on mastoid earlobe  opposite CN 2.   This represents “cookbook recipe” as opposed to practitioners needing to know German Auricular.

اسلاید 44: 44Be sure to add gold ASP studs Bilaterally at eye and CN 2 points And a steel ASP on mastoidEarlobe to form a Bahr Forceps

اسلاید 45:

اسلاید 46: 46Modified XMHN#1 using 0.20 x 15 mm needles oriented not to fall out As of 2012 my preferred approach is (-) at lambdoid suture over visual cortex, 2 cm from midline to (+) at ipsilateral Yamamoto CN site 1 cm lateral to midline. This starts 2 cm cephalad of hairline toward foreheadScalp 

اسلاید 47: XMHN # 1, Yamamoto CN needles, visual cortex over lambdoid sutureX15 mm needles, 2 cm lateral to midline, insert down, at lambdoid sutureYamamoto CN:30mm Needles, insert 2 cm behind hairline, 1 cm either side of midline.

اسلاید 48: Direct Electrical Stimulation of Periorbital area

اسلاید 49: 49Nasal infraorbital ridge  (-)  to temporal supraorbital ridge (+) and temporal  infraorbital ridge (-) to nasal supraorbital ridge    Needles arranged such that electric current will flow through the whole retina – including the maculaSuggested Eye Needle Placement

اسلاید 50: Old array – no time for new slide. Crisscross pattern (-) nasal infraorbit to (+) temporal supraorbit, (-) tempral infraorbit to (+) nasal supraorbit

اسلاید 51: 51 ENERGYThis is my historic protocol. Going forward I will simplify my protocol by eliminating this part except in those persons suffering excess fatigue. I started it because older persons coming from sea level to Santa Fe’s 7000 foot elevation suffered.

اسلاید 52: 52SP 4  connected to KI 3 (-) to ST 30 connected to CV 2/4(+),   CV 12, 17, tack at PC 6 with return LI 11 (-) to ST 36 (+) This is Chong Mo expanded – to add energy to the system, with a French Energetics return that stimulates the immune system.  These circuits alone are a very powerful combination to add energy and stimulate immune system in  a very large number of clinical situations.Abandoned Energy Component

اسلاید 53: {KI 3 to SP 4} (-) to {CV 2/4 to ST 30} (+), tack or needle at PC6LR 3 (-) to LR 9 (+) Return: LI 11 (-) to ST 36 (+)

اسلاید 54: 54PrecautionsPeriorbital infections MUST BE aggressively treated with antibioticsSeizures are a contraindicationDemented persons do not respond well and cannot validly report

اسلاید 55: 55 Anti-coagulation is not a contraindication Black eyes are very common – but always resolve spontaneously. I always apply an ice pack for 5 – 10 minutes after each treatmentHelpful Pointers

اسلاید 56: Technical DetailsI have no business interest with any supplier ETDRS and Pelli-Robson charts from several sources. Precision Vision, La Salle, IL is one.Needles: Many sources. I use Accuglide from Helio and gold ASP semipermanent needles from Lhasa56

اسلاید 57: Stimulators: Most stimulators do NOT deliver the frequencies indicated. Ito and several Chinese devices are commonly off by 50%. Pantheon Electric (Santa Monica, CA) devices cost twice as much but are exactly correct as tested by oscilloscope. They also will set units at Nogier frequencies. Electrodes formerly from Helio, now from Lhasa. Better ones are small wires, 3 prongs on one clip and 2 on the other.57

اسلاید 58: Thank you for your attention. 58Full Text Posted: www.reverseAMD.comAlston@LundgrenMD.com