Friday, October 10, 2014

Enterovirus D68 Suggested Abdominal Acupuncture Treatment:(Pediatrics, Paralysis Prevention and Treatment)


Adapted from the CDC, NPR and WebMD:

Introduction 

Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses. The “entero-“ part of their name means the viruses can survive stomach acid and infect the gut, as opposed to their cousins, the rhinoviruses, which can’t.

Target population: Young children, and of particular concern, children with a history of breathing problems, like asthma (WebMD). Children with a history of breathing problems are more susceptible to develop severe symptoms and may progress to “acute flaccid paralysis” for unknown reasons (see below).

What are the symptoms of EV-D68 infection? 
EV-D68 can cause mild to severe respiratory illness.

  • Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.
  • Severe symptoms may include wheezing and difficulty breathing.
  • For unknown reasons, and no causal link, some children progress to muscle weakness and paralysis: “weakness in their arms or legs, a drooping face or difficulty swallowing.” (NPR) May be called "acute flaccid paralysis.” Viruses other than enterovirus D68 have also led to "acute flaccid paralysis.” 

How does the virus spread?
Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.
What time of the year are people most likely to get infected?
In the United States, people are more likely to get infected with enteroviruses in the summer and fall. Cases are likely to decline later in the fall.

States with Lab-confirmed Enterovirus D68
From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people from 43 states and the District of Columbia with respiratory illness caused by EV-D68. The 43 states are Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.


Chinese Medicine and Acupuncture

I have experience treating acute H1N1 in China and Anti-NDMA encephalitis in recovery phase with the presence of muscle flaccidity, poor appetite, light sensitivity and irritability using traditional and abdominal acupuncture. I have NOT treated any enterovirus D68 patients so the treatment protocol is only a suggestion and open to discussion among peers. It is based upon the upper respiratory acupoint formula developed by Dr. Bo Zhi-yun, the founder of Abdominal Acupuncture, and I have used it repeatedly with success for common influenza, and used it to relieve symptoms in children with H1N1. 

Pattern Identification: The symptoms and signs I can find online do not indicate the presence of diaphoresis, thus it is a pathogenic cold invasion blocking the exterior leading to internal fever. 

Treatment principles: Release the exterior, vent heat, clear and descend lung qi. 

Traditional treatments

  • An exterior releasing formula like ma huang tang is appropriate if using Chinese herbs, especially once breathing problems occur. It is difficult to use this formula and others that contain ephedra given restrictions in the USA. 
  • Traditional acupuncture points appropriate for the enterovirus, like all influenzas include: GB20, UB9, DU14, LI4, 11… and points to support deficiency, like ST36 can be used when the fever is prolonged and deficiency is present. 
  • For children, it is important to use nie ji (pinching/rolling) the DU and UB channels until red and the child sweats. Slide cupping and gua sha can be used instead of nie ji.   

Abdominal Acupuncture

  • Basic acupoint formula: Upper Respiratory Track Infection 
    • Points: RN 12, 10, 10-below (0.2cun below), Ab1 (bilateral). 
    • Insertion order: 1. RN12, 2. RN10, 3. RN10-below, 4. Ab1 (bilateral).
    • Needling depth: RN 12 (S), 10 (S), 10-below (S), Ab1 (M). (S = superficial, M = medium) 
Needle gauge: #34 (0.22mm diameter)
Formula explanation:
RN12 corresponds to the mouth/nose and can open nasal passages
RN10 corresponds to the throat and can relieve sore throat, itchy/scratchy throat (wind), and diminish coughing. 
RN10-below increases RN10 function and disperses heat by releasing the exterior. 
Ab1 (located 0.5 cun lateral and 0.5 cun superior to ST24) opens the exterior, clears heat and resolves toxins.

Modifications:
  1. For fever lasting several days with signs of deficiency, use the above formula with the addition of RN 4 and 6 needled to a medium depth. 
  2. If cough is serious and/or constipation is present, add Left ST 25.  
  3. For high fevers that won’t abate, bleeding stasis veins on/near the apex of the ear. This worked for the first H1N1 afflicted child at our school in Shanghai. His fever, hovering around 40ÂșC, came down to nearly normal immediately. In some other cases, we bled stasis veins near LU 10. 
  4. Abdominal Acupuncture can be combined with traditional acupuncture when necessary.



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