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Chinese Medicine Times : Keeping You Informed

Case Study - The Treatment of a Lifelong Alcoholic

by Attilio D'Alberto


Male, 62, unemployed.

Main complaint(s)

Addiction to alcohol for 40+ years. Psoriasis for ten years.

Signs and symptoms

The patient suffers from the shakes, pins and needles, irritability and dizziness if he doesn't drink. The psoriasis is dry, red, flaky, slightly scaly and itchy. It is present on the scalp, right and left leg and buttocks. It is worse on the right leg. He sweats in the day and at night, feels hot and never cold and has a lack of energy throughout the day. He has insomnia, needs to drink alcohol to sleep, but has no dreams. He has a poor appetite and slight tinnitus. He has occasional shortness of breath and coughs up sputum that is thick, yellow and copious. His bowels are loose everyday. He wakes to urinate at night and is irritable and sometimes depressed. Tongue: red body, red tip with a thick yellow coating and teeth marks. Pulse: left side; forceful, slippery and wiry, right side; forceful and wiry.

Aetiology

The main signs and symptoms are typical of a heavy drinker: the red face, dry skin, feels hot, insomnia, tinnitus, night sweating are all characteristic of excessive Yang with a deficiency of Yin, otherwise known as a empty or false heat pattern. The psoriasis is a direct result of the excessive consumption of alcohol and irregular lifestyle. Urinating at night is common for a person of that age. The loose stools illustrate a deficiency of the Spleen, caused by his irregular eating, in this case, not eating enough and drinking alcohol excessively. The patient has been unable to withdrawal from alcohol before because of the adverse withdrawal symptoms.

Pathology

The patient has been a heavy drinker all his life and drinks everyday. He has attended numerous AA (alcoholics anonymous) meetings without success, mainly because the patient suffered from severe withdrawal symptoms of constant shaking, pins and needles and dizziness when he stops drinking alcohol. Last time the patient tried to stop drinking (a year ago), he had a fit. The psoriasis has been present for several years and is worse when the patient drinks and feels run down. Alcohol caused internal Heat (excessive Yang). After continued use, the internal Heat burns the Yin causing dryness. The secondary effects of not eating and leading an irregular lifestyle caused a deficiency of the Spleen and Stomach, which in turn caused dampness in the body as well as a deficiency of Blood, which was then unable to nourish the skin. These two elements together formed Damp Heat.

Acupuncture Diagnosis

Excessive alcohol consumption causing Damp Heat, which in turn, after a prolonged number of years, caused the psoriasis.

Treatment principles

It was explained to the patient that excessive alcohol consumption was the main cause of his psoriasis. It was therefore necessary to tackle the alcohol addiction first before treatment could start on the psoriasis. A treatment plan of a month was outlined to the patient in which only his alcohol addiction would be treated. The treatment principles included reducing cravings for alcohol, reduce adverse effects of alcohol withdrawal, boost the genuine qi, nourish the Yin, clear internal Heat and pacify internal Wind.

Treatment plan including adjunctive treatments

NADA protocol with electric stimulation on Lung point, plus points Taichong (LV 3) and Taixi (KI 3). The needles were inserted, de Qi obtained and then retained for 25 minutes. Electrical stimulation was given at the highest comfortable level for the patient. Three treatments were given a week for two weeks, then once a week for two more consecutive weeks. An additional adjunctive treatment given was a traditional Chinese patent: Jia Wei Xiao Yao Wan: 8 pills, 3 times a day, for the whole duration of the treatment.

Treatment progression

Session 2: Has ceased drinking any alcohol. Has no cravings and doesn't suffer from shaking caused by alcohol withdrawal, although he has been a little irritable. Appetite is better and bowel movements are firm and regular, every morning. Tongue: red body (less than previously), thick yellow coating on centre and back (less on front than previously), with teeth marks. Pulse: left side; wiry and forceful, right side; wiry. Acupuncture treatment protocol remained the same as previously. Taking Chinese herbal patent: Jia Wei Xiao Yao Wan: 8 pills, 3 times a day.

Session 4: Still not drinking any alcohol. No cravings and no shakes. The psoriasis has made an improvement. Has pain on hypochondriac region and a slight cough with plum pit qi. Has insomnia due to not drinking alcohol and is taking night nurse to induce drowsiness. Looks less red in the face. Appetite is good and is eating at regular times. Bowel movements are regular every morning and are firm. Has a slight dry mouth and is drinking plenty of soft drinks. Feels his body temperature is moderate. Tongue: red body (less than previously), thick yellow coating (less than previously) with teeth marks. Pulse: left side; wiry, right side; wiry and slightly forceful. Acupuncture treatment protocol remained the same as the previous week with the addition of Shenmen (HT 7) for the insomnia. Taking Chinese herbal patent: Jia Wei Xiao Yao Wan: 8 pills, 3 times a day.

Session 6: Still not drinking any alcohol has no cravings or shaking. Appetite is good and bowel movements are regular. Looks less red in the face and psoriasis is getting better. Still taking night nurse to sleep at night. Tongue: red body that is slightly dull, with a thick yellow coating (less than previously). Pulse: left side; wiry, right side; forceful. Acupuncture treatment protocol reverted back to original session; NADA protocol with electric stimulation on the Lung point, plus Taichong (LV 3) and Taixi (KI 3). Taking Chinese herbal patent: Jia Wei Xiao Yao Wan: 8 pills, 3 times a day.

Session 8: Final session. Still not drinking any alcohol. Hasn't drunk any since the start of treatment. Have no cravings or adverse withdrawal symptoms. The psoriasis is still making an improvement. Doesn't have a dry mouth or lips. Still drinking plenty of fluids. No pins or needles or dizziness. Appetite is good and eats at regular times including breakfast. Still using night nurse to sleep at night. Bowel movements are regular every morning and are firm. Tongue: dark pink/slightly red body, with a thick yellow coating. Pulse: right side; wiry, left side; wiry.

Discussion

The first record of the auricles importance was recorded in the Huang Di Nei Jing, chapter 28 of the Spiritual Axis (circa 100BCE) "All the vessels congregate in the ear". During the 1950s, Nogier first developed the practice of auricular acupuncture with the concept that each part of the body is represented on the ear. Wen and Cheung (1973a; 1973b and 1973c) further developed the use of auricular acupuncture in alleviating the addiction to opiate based drugs. In 1985, Michael Smith M.D., City Lincoln Hospital, New York, developed this research into the newly formed National Acupuncture Detoxification Association (NADA) protocol (D'Alberto 2004).

The NADA points act to tonify the Yin of the Liver, Lung, Kidney, Heart (Shenmen) and the Sympathetic region. Taichong (LV 3) is the Shu and Yuan point of the Liver and was used to spread Liver Qi, subdue Liver Yang, extinguish Liver Wind and nourish Liver Yin (Deadman and Al-Khafaji 1998). This point helped to reduce the adverse effects of alcohol withdrawal, which in this patient were characterised by uncontrollable shaking, pins and needles and dizziness. The shaking and dizziness were caused by internal Liver Wind, whilst the pins and needles were caused by a Qi and Blood deficiency. Issues relating to the Liver were viewed as being a branch problem. The root problem lied with the Kidney. From a Zangfu spirit perspective, the lack of will in resisting drug cravings coupled with fear and the false need for the drug, are the elements that drive the addiction. Will and fear are both associated with the Kidney (D'Alberto 2006). Taixi (KI 3) is the Shu and Yuan point of the Kidney and was used to nourish Kidney Yin and clear deficient Heat. Shenmen (HT 7) is the Shu and Yuan point of the Heart and was used once during the series of treatments in an effort to calm the spirit and relieve the patient's insomnia. However, the patient was quite clearly dependant upon night nurse. The patient was advised repeatedly to stop taking night nurse but was unable to do so. The use of Shenmen (HT 7) was cessed as its effects could not be utilised and the number of points used was kept to an absolute minimum.

Blum, Cull, Braverman and Comings (1996) suggest that stimulating the vagus nerve, which is located in the concha and at the Lung point on the auricle with the insertion of an acupuncture needle, stimulates the hypothalamus. Under normal conditions, hypothalamic stimulation initiates the reward cascade. Hypothalamic neurons release serotonin (5HT), which activates methionine enkephalin, an opioid peptide. Met- enkephalin is released at the ventral tegmental region and interacts to inhibit receptors controlling the release of gamma-aminobutyric acid (GABA). Met-enkephalin and/or other opioid peptides finely tune the system. The primary role of GABA is to control the output of dopamine in the ventral tegmental region. The result of inhibiting GABA is an increase in dopamine. Acupuncture acts to reduce cravings, thereby assisting the drug addict into self recovery. This stimulation can be increased using electric stimulation as used by Wen and Cheung in their original research into addiction (1973a; 1973b and 1973c).

A traditional Chinese herbal patent, Jia Wei Xiao Yan Wan (Augmented Rambling Powder) was used to spread the Liver Qi and clear Heat (Benksy and Barolet 1990). This greatly helped with the adverse effects of shaking, dizziness and pins and needles, caused by alcohol withdrawal.

Conclusion

At the end of treatment, the patient had not consumed any alcohol for one month. He was then asked to return and start treatment for his psoriasis.

References

Bensky, D. & Barolet, R. (1990). Formulas & Strategies. Seattle: Eastland Press.

Blum, K., Cull, J., Braverman, E. & Comings, D. (1996). 'Reward Deficiency Syndrome', American Scientist, March-April, p135-145.

D'Alberto, A. (2004). 'Auricular Acupuncture in the Treatment of Cocaine/Crack Abuse: A Review of the Efficacy, the Use of the National Acupuncture Detoxification Protocol and the Selection of Sham Points', Journal of Alternative and Complementary Medicine, 10, (6), p985-1000.

D'Alberto, A. [online]. Understanding Cocaine Addiction According to Chinese Medicine Theory, (2006). Available from http://www.chinesemedicinetimes.com/section.php?xSec=51 [Accessed 1st November 2006].

Deadman, P. & Al-Khafaji, M. (1998). A Manual of Acupuncture. Hove: Journal of Chinese Medicine Publications.

Wen, H & Cheung, S. (1973a). 'How acupuncture can help addicts', Drugs and Society, 2, p18-20.

Wen, H & Cheung, S. (1973b). 'Treatment of drug addiction by acupuncture and electrical stimulation', Asian Medical Journal, 9, p138-141.

Wen, H & Cheung, S. (1973c). 'Treatment of drug addiction by acupuncture and electrical stimulation', American Journal of Acupuncture, 1, p71-75.


Case Study - The Treatment of a Lifelong Alcoholic

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Case Study - The Treatment of a Lifelong Alcoholic

Case Study - The Treatment of a Lifelong Alcoholic

by Attilio D'Alberto
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