Translated by Jing Ye(UK)
My colleague’s Ninety-year-old grandmother with postherpetic neuralgia, I was not confident enough, but I’m overjoyed in the end－by Youling Gao(China) the FSN world, 08/08/2021
Mrs. Yin, female, 90 years old, my colleague's grandmother.
Thursday, 13th May, 2021 First visit
Main complaint: Pain from the left eye to the top of the head for one and a half years.
History of present illness: Shingles occurred during the epidemic last year, and it was inconvenient to go out and there was no systematic treatment. After that, she has always had sequelae pain during the day. The symptoms are aggravated on cloudy and rainy days, and the symptoms are slightly relieved on sunny days. She feels no pain when sleeping. She dare not touch the left side of the head and face. Open eyes, wash face, and wash hair are all affected. When she without touching it, it hurts like a needle pokes. She has to take Tramadol orally to relieve the pain.
Past history: Denying "Hypertension", "Diabetes", "Heart disease" and other medical history, "Chronic Gastritis" for decades, oral taking Omeprazole regularly. She has been a vegetarian for decades and has history of "Anemia".
Diagnosis: Western medicine diagnosis: Sequelae of Herpes Zoster
TCM diagnosis: Snake string sore
Diagnosis and treatment: Due to decades of hunchback, she can only lie on her side. Left trapezius muscle and cap-shaped aponeurosis ++++, Frontalis Muscle ++++, after FSN treatment they have reduced to ++, she feels the pain has more than half gone, touch the eyelid with her hand, the eyes are instantly no longer painful, she can open her eyes without any difficulties; During the treatment, she was very happy to say that the needle didn't hurt at all. In the end of treatment, kept the canula in for observation.
Saturday, May 15th, 2021 Second visit. The left eye opened much better, the eye could be opened wider, the tearing symptom was better, and the pain was relieved by half. Found tight muscles as below: Bilateral rectus abdominis, left oblique, erector spinae, trapezius, rhomboid, cap-shaped aponeurosis, frontal muscle.
Tuesday, 18th May, 2021. The third consultation is more than half better overall. she feels a nail on the top of her left head. She used to have pain on the upper eyelid, but now she only has pain in the corner of her eye, like a clip. After treating the left rhomboid muscle, trapezius muscle, cap-shaped aponeurosis, frontal muscle, and temporal muscle, the nail sensation on the top of the head disappeared immediately, and the pain in the corner of the eye was relieved.
Thursday, 20th May, 2021. Fourth visit. she is more than half better overall, with occasional tingling sensation on the left side of the head and left eye hurts. Using the same treatment as before.
Eventualy, Mrs. Yin did not continue the treatment. I had her feedback on 26th May, she was told heard by neighbours and villagers that the disease would not be cured. Feedback on 16th June, the pain was significantly relieved.
Thought and Discussion
Treating patients in this category, most of them feel better immediately at the first visit, and some of them feel the pain from time to time, especially for patients whose pain is not obvious during treatment, and we need to observe the result after treatment. So far I have treated dozens of such patients, most young people completely painless after 1-3 times, for older patients, some require more than ten treatments to be completely painless.
For patients with anemia, rheumatoid arthritis, diabetes, etc., the recovery is relatively slow. Most of them have good immediate effects, but they are easy to recur, improving the blood environment will speed up the recovery and shorten the treatment period.
Some patients are thinking that the sequelae of shingles will not be cured, and will be discouraged and disappointed if they encounter recurrences during the treatment, so it is very important to strengthen their confidence and fight the pain together with the doctor.
Translated by Daming Gong(UK)
Urinary Leakage－by Xiaoming Hao,Yali Tian(China) the FSN world, 20/01/2019
Chapter I The General Theory
Leaking urine, refers to their own know, but can not control, more in laughter, coughing, sneezing, hear the sound of running water when the phenomenon of urine leakage. It is both a separate symptom and a symptom of other diseases. This happens mainly in female, with high incidence between 45 and 55 years old.
2. Clinical performance
The disease manifests itself as a physical activity such as coughing, sneezing, bumping or lifting, when abdominal pressure increases significantly and unconscionable urine flows out. Some patients can't control their urine when they hear the sound of tap water.
Severe cases, this can happens when they are walking, standing, usually not accompanied by frequent urination symptoms.
3. General Knowlage
3.1. Related factors
The age of high incidence of urinary leakage in women is 45 to 55 years old. The supposed correlation between age and urinary leakage may be related to pelvic floor relaxation, estrogen reduction, and urethra sphincter degeneration. Some common diseases of aging, such as chronic cough, lung disease, etc., can also lead to urine leakage.
The number of births is associated with the occurrence of urine leakage. Older women are more likely to leak urine, women who give birth vaginally are more likely to leak urine than women who give birth by caesarean section, women who have a caesarean section are more likely to leak urine than women who do not give birth, and midwifery techniques such as midwifery, fetal inhalers, oxytocin, etc. also increase the likelihood of urinary leakage, and the risk of urine leakage in mothers of over-weight children is also high.
(3) The pelvic organ prolapse
Presure urine leakage and pelvic organ prolapse are closely related, and they are often accompanied by the presence of both. Pelvic organ prolapse patients with pelvic floor support tissue and smooth muscle weakness, muscle fiber thinning, aligning disorder, connective tissue fibrosis and muscle fiber atrophy, pelvic floor muscle group weakness. This forms the basis of urine leakage, easily trigger pressure urine leakage.
The risk of pressure urine leakage in obese women increased significantly, especially in the case of abdominal obesity, and losing-weight can reduce the incidence of urinary leakage.
(5) Ethnic and genetic factors
Genetic factors and pressure leakage have a clear correlation, and the prevalence of pressure urine leakage patients is significantly related to the prevalence of their immediate family members.
3.2. Pathological mechanism
The pathological mechanism of pressure urine leakage is not clear, the current research suggests that the following factors are related: bladder neck and near-end urethra downshift, urethra mucosa closed function decreased, urethra inherent sphincter function decreased, pelvic floor muscle and connective tissue function decreased, the nervous system that governs the structure of urine control dysfunction.
At present, there is no specific laboratory examination, mainly clinical, the most commonly used is pressure test.
Check with the bladder full, often take the lithotomy position, tell the patient to cough several times in a row, pay attention to observe the urethral orifice wheather there is leakage phenomenon. If yes, the test is POSITIVE. If there is no leakage of urine when lying on the back, the patient should stand on her(his) feet apart with shoulder width, cough for several times, to observe wheather there is leakage phenomenon. If yes, this pressure test is POSITIVE.
3.4.1. General treatment
(1) Maintain a good lifestyle, lose weight, quit smoking, change diet and so on.
(2) Rehabilitation training
Refer to the following methods: continuous contraction of pelvic floor muscle (Kegel Exercise) 2 to 6 seconds, rest for 2 to 6 seconds, repeat 10 to 15 times, do 3 to 8 times a day, keep exercising for 8 weeks or more. This method is simple and suitable for all types of pressure urinary incontinence.
Selective alpha1-adrenaline receptor agonists, can stimulate the smooth muscle alpha1 receptor in the urethra, as well as stimulate motor neurons in the body, increasing urinary tract resistance. Commonly used drugs: Midodrine, Methoxamine. Midodrine's side effects are less than Methoxamine. Such drugs have been shown to be effective, especially when combined with Estrogen or pelvic floor muscle exercise. The side effects are, high blood pressure, palpitations, headache, cold limbs, and stroke in serious case.
The main indications of surgical treatment include:
(1) Non-surgical treatment in not effective, can not tolerate or the expected effect is not good
(2) Moderate and severe pressure urinary incontinence, seriously affecting the quality of life
(3) Patients with higher quality of life requirements.
(4) Patients with accompanied by pelvic organ prolapse and other pelvic floor functional lesions need pelvic floor reconstruction, should have anti-pressure urinary incontinence surgery at the same time. At present, the tension-free vaginal tape(TVT), trans-obturator tape(TOT) have gradually replaced the traditional open surgery, with small damage, good efficacy and other advantages, The complications are, urinary retention, bladder injury, sling erosion, etc., but the incidence is very low.
Chapter II FSN
1.Urinary Leakage in FSN
FSN recommends a distinction between urinary incontinence and urinary leak-age. Urinary incontinence refers to the lack of consciousness to control, unknowingly occurred, it is only noticed when it happens, most of this happens in the central or peripheral nervous system damage. Urine Leaking is noticeable, but not able to control, mostly happens when laughing, coughing, sneezing, exercising, or even hearing the sound of running water. FSN treatment for unconscious urinary incontinence caused by damage to upper motor neurons is ineffective, but for pressure leakage is very effective.
Pressure urine leakage is often found in middle-aged and elderly women, after childbirth, trauma, occasionally happens in elderly men. Long-term urine leakage seriously affects the mental health of patients, some patients do not even dare to take a bus to public places, increasing the incidence of depression, so that many women's ability to live and work decreased. Many patients are ashamed to speak out, and even some patients think that urination leakage is a normal physiological response into old age, and the effect of conventional treatment is not good, many patients do not want to seek medical attention in time. Even after recovery, they often don't tell anyone.
There is no unified understanding of how urine leakage is related to muscles and how muscles cause urine leakage. Pelvic floor muscle exercises and biofeedback therapy for muscle can also be effective. Generally we think it is caused by the weakness of pelvic floor muscle.
Constipation, lung disorders and chronic cough, abdominal obesity, abdominal space-ocupying lesions, pelvic organs sagging and other causes high abdominal pressure. Obesity is also a major cause of urine leakage.
2. Common Pathologocal Muscles
Main suspect muscles: Abdominal Oblique Muscle, Rectus Abdominis, Adductor, Quadriceps femoris Muscle inner head, Soleus Muscle, Gluteus Muscle, Piriformis,Quadratus Femoris.
FSN treatment alreays from the far end to the near end, such as Soleus Muscle ankle flexor resistance, abdominal muscle re-perfusion activities, when lying on the back, keep legs together and lift up, for the Adductor muscle, to do hip adduction, internal rotation resistance, for Piriformis muscle, Quadratus Femoris, prone position to do hip external rotation resistance.
3.1. Self-pelvic floor muscle exercises, such as Kegel Exercises, increase the self-control of urination. sit-up exercise, stretching the pelvic floor muscle.
3.2. People with a long history of constipation need to be treated for constipation.
3.3. People with Obesity, try to loss weight appropriatly
3.4. Treat the original incidence of chronic cough, allergic rhinitis and so on.
Chapter III FSN Case Study
By Suling Wang, XiaoXian,SuZhou,China
Patient information: Ms Peng, female, 78 years old, 2nd September, 2018 First visit
Main complaint: Involuntary urine leakage while coughing and sneezing for 5 years
History of present illness: 5 years ago, the patient noticed that involuntary urine leakage while coughing and sneezing without obvious cause, which seriously affected her life and has not been treated systematically.
Past history: Deny the history of chronic internal medical illness such as "hypertension, diabetes".
Diagnosis: Urinary Leakage
Examination of affected muscles: bilateral rectus abdominis (+++), bilateral tibialis anterior muscles (+++), bilateral rectus femoris (+++), bilateral abdominal obliques (+++), bilateral Adductors (++).
FSN Treatment: Insert a disposable FSN needle to around the above-mentioned affected muscles, sweep and do reperfusion movments for the corresponding affected muscles, such as abdominal bulging with pressure, knee flexion and abduction resistance, reperfusion movments should be slow and gentle .
03-09-2018 Second visit: the urine leakage was better when she coughed at night. Examination of affected muscles: bilateral rectus abdominis (+++), bilateral tibialis anterior muscles (+++), bilateral rectus femoris (+++), bilateral abdominal external obliques (+++), both sides of adductor muscle group (++). The treatment is the same as above.
05-09-2018 Third visit: Patient was able to notice when she urinate, no leakage of urine when she coughed. Examination of affected muscles: bilateral rectus abdominis (++), bilateral abdominal external obliques (++), bilateral adductors (++), bilateral tibialis anterior Muscle (++). Continue the same treatment as before. During the treatment, the lady told me that she used to have social phobia, now she is willing to go out and chat with others, she is very happy with the result.
Translated by Daming Gong(UK)