Zhu’s Scalp Acupuncture in Stroke-Related Aphasia: A Case Study

Submitted Toward Practitioner Certification in Zhu’s Scalp Acupuncture
by Dr. Scott Whitfield L.Ac., D.A.O.M.
San Jose, California
June, 2017

COMPREHENSIVE CASE REPORT

SECTION 1: GENERAL INFORMATION

Name: Sandy M.
Sex: male
Place of Birth: Scotland, UK
Age: 89
Occupation: retired
Marital Status: married
Race: Caucasian
Case History Provider: Dr. Scott Whitfield L.Ac., D.A.O.M.
Date Of First Visit: 12/16/2016
Date Of Last Visit: 4/18/2017

SECTION 2: DATA COLLECTED FROM FOUR DIAGNOSTIC TECHNIQUES

2.1 INQUIRIES

2.1.1 Chief Complaint: Aphasia and Cognitive deficits due to embolic stroke, secondary to atrial fibrillation, on 12/3/2016.

2.1.2 Present case history: The following information was given to the provider verbally by the patient’s daughter. The patient was hospitalized with a “large” left temporal embolic stroke which also featured some hemorrhaging. No allopathic interventions were performed. The patient can sit up in bed, stand, walk, and is generally alert and responsive. The patient’s speech and cognition seem to be most affected by the stroke. He clearly exudes aphasia but can enunciate words properly. He has difficulty understanding phrases spoken to him and makes up nonsensical words when he can’t come up with the right word needed to complete his thought. This is frustrating to the patient as he led an intellectually stimulating life prior to the stroke. He expresses his frustration with this situation by reverting to a form of faux French (including some actual French words, but more commonly gibberish which sounds French). The patient has control of his limbs and can write a little. His daughter (who is here from out of town to help coordinate her father’s care) reports progressive improvements in the days following the stroke. She has also noticed that his right eye wanders laterally. She states, “more words are coming back,” on a daily basis and that he’s slowly regaining control over his urination. Other home health care providers visiting him these days include a physical therapist, a speech therapist, a massage therapist, nurses, and personal assistants. Lastly, the patient will be receiving 2x/week radiation therapy for prostate cancer starting 12/26/2016.

2.1.3 Current problem list: Prostate cancer, left-sided frozen shoulder, left middle finger injury (an infection caused swelling and limited range of motion with extension and flexion), hemochromatosis, chronic anemia, chronic lymphocytic leukemia, long-standing left ankle injury, right knee partial replacement surgery, osteoarthritis of both knees, diabetes mellitus type II, hypertension, atrial fibrillation, and heart murmur.

2.1.4 Personal history (includes menstruation, pregnancy, leucorrhoea, and delivery for females): The patient has lead a very full, rich life. He served as a pilot for the Royal Canadian Air Force and later made a significant endowment to the arts as educator and philanthropist.

2.1.5 Family history: no significant facts were obtained in interrogation

2.2 INSPECTION / OBSERVATION

2.2.1 Spirit: good Shen, bright, responsive

2.2.2 Complexion: nice color for his age, slightly on the dusky-white side

2.2.3 Appearance: alert, calm, friendly, cooperative, and well-groomed

2.2.4 Body stature: frail, bony, thin, tall, but somewhat hunched over

2.2.5 Tongue: slightly swollen, dusky-red colored body; greasy yellow coat

2.2.6 Other parts of the body: thick bands of darkly-mottled skin encircles the patient’s lower extremities, approximately half the total lower extremity in size.

2.2.7 Excretion and Secretion: not obtained

2.3 AUSCULTATION & OLFACTION

2.3.1 Auscultation: breathing is not audible to my naked ear

2.3.2 Olfaction: no distinct odors were detected

2.4 PALPATION

2.4.1 Pulse: Right: flooding. Left: irregularly intermittent, choppy.

2.4.2 Palpation of different parts of the body: The dark areas of the skin in the lower extremity are taught to the touch.

SECTION 3: WESTERN MEDICAL RECORDS

3.1 Physical examination: The patient is alert, friendly, and cooperative. He responds when spoken to, but not usually with relevant responses (aphasia). He’s a tall man and some evidence of muscle atrophy in the limbs is observed. He is currently able to stand and walk short distances with the aid of a walker. His range of motion is limited in the left upper extremity and left ankle.

3.2 Laboratory tests results: not available

SECTION 4: DIFFERENTIATION AND ANALYSIS

4.1 List all the evidence of the differential diagnosis (i.e. the differentiation of the syndromes and provide evidence to support this): Zhong Feng Wind-stroke (mild type), Dual Spleen and Kidney Yang Vacuity, Phlegm-Fire obstructing the channels and collaterals, Heart Blood stasis, Lower Jiao Damp-Heat

4.2 Analysis of the etiology and pathogenesis (i.e. to explain the differentiation of your main syndrome or condition): This patient’s embolic stroke did not leave the patient severely crippled in terms of physical mobility and function, therefore it is the mild type Wind-stroke. The patient is aging, and due to his orthopedic issues had slowed down physical activity considerably in the past decade. His increased sedentary lifestyle led to some stagnation of Qi and Blood. What probably started in mid-life as irregular diet and overwork led to Spleen Qi vacuity, which progressed over time to dual Spleen and Kidney Yang vacuity, ending up as phlegm-fire (the practitioner guesses that this may have occurred after some emotional or intellectual upset, although it is not expressly mentioned in the history).

4.3 Principles of treatment: Remove obstructions from the channels, subdue Wind and resolve Phlegm, invigorate the Connecting channels, regulate the circulation of Qi and Blood in the channels, resolve dampness, drain heat, nourish Spleen and Kidney

4.4 Prescription and Administration (includes acupuncture and herbal medicine):

4.4.1 Zhu Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (1), Lower Jiao (3), Shoulder (right-side only), Lower Limb (bilateral x2), Auricular-Temporal (3, left-side only)

4.4.2 Daoyin: The practitioner asked the patient to, “tell me a story,” and he does so (speech practice), sit on the edge of the bed successful under own volition; standing (assisted, using a walker to brace self).

4.5 Advice relating to measures of prevention and health care (including diet and exercise): Keep the patient as active as possible, physically and mentally. Practice speaking, saying individual sounds, singing, reading simple words aloud, and identifying pictures by name from flashcards, and other ad hoc exercises.

4.6 Prognosis: moderate to good, especially considering the level of home health care he’s receiving and his current improvement trend.

4.7 Plan of care: 2-3x sessions per week treatment frequency, not fewer than 10-20 sessions are required to speed recovery and make functional gains.

SECTION 5: TREATMENT PROGRESS

5.1 Treatment Session #2 12/19/2016

5.1.1 Progress: The patient’s caregivers report that today he’s having pain in the left upper extremity after a hard session of physical therapy earlier today. His needles from the first session were retained 2+ days before they were removed yesterday. The patient’s nurse states that he’s been showing improved speaking skills over the past two days. He’s started taking 1300 mg Tylenol for his shoulder pain. Lastly, he’s been “up a lot, and now able to use the urinal,” according to his nurse. No other changes were reported.

5.1.2 Palpation of pulse: Right: full, flooding. Left: irregularly intermittent, wiry/slippery.

5.1.3 Observation of tongue: contracted body, red tip (peeled); greasy yellow coat

5.1.4 Zhu’s Scalp Acupuncture: Head & Face (1), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (1), Lower Jiao (3), Shoulder (right-side only), Upper Limb (bilateral x1), Lower Limb (bilateral x2), Auricular-Temporal (3, left-side only)

5.1.5 Daoyin: massage of the left upper extremity, push-pull left upper extremity, attempted to vocalize vowel sounds (the patient did not succeed in following this command).

5.1.6 Assessment: The patient is progressing nicely and resting now after a full day of various therapies.

5.1.7 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.2 Treatment Session #3 12/21/2016

5.2.1 Progress: The patient’s recovery continues. According to his caregivers, today the physical therapist helped him walk and he’s able to stand at the urinal. He was also able to stand at the bathroom sink and brush his own teeth. However, when handed a hair comb immediately after brushing his teeth, he was not able to make the connection to use it on his hair, but instead attempted to comb his teeth with it. Nevertheless, his cognition and speech continue to improve between acupuncture treatments. No other changes were reported.

5.2.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (1), Lower Jiao (3), Auricular-Temporal (3, left-side only)

5.2.3 Daoyin: Chou Qi needle stimulation throughout the majority of the session. The patient is relaxed/sleeping through it.

5.2.4 Assessment: The patient is progressing nicely.

5.2.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.3 Treatment Session #4 12/22/2016

5.3.1 Progress: The patient is finishing up his appointment with the speech therapist as I arrive. His needles are still retained, so the practitioner removes them. Next, the patient and practitioner go through some picture ID cards together. The exercise is as follows. Practitioner shows the patient a card with a picture and a word describing the object, person, or animal on the card. The practitioner then asks the patient, “What is that? What is this animal’s name?” etc. A positive result is a correct response from the patient. Today he identified 2 of 14 cards he was shown. The rest of the time, the patient is making up words and stories to explain what is going on in the picture to “fill in the blanks” in his comprehension. No other changes were reported.

5.3.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (1), Lower Jiao (3), Auricular-Temporal (3, left-side only)

5.3.3 Daoyin: Flashcards identification game (see Progress section above)

5.3.4 Assessment: The patient is progressing nicely.

5.3.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.4 Treatment Session #5 12/29/2016

5.4.1 Progress: The patient is sitting upright in his chair and knows he’s about to get an acupuncture treatment but calls the needles by a nonsensical made-up word. Upon looking at his face, the practitioner notices that some measure of Shen has returned to his face, which appears generally brighter and more alert. His nurse reports that he’s noticed good daily improvements in the patient’s speech and overall alertness. He also reports that he had a bad reaction to one of his medications which caused diarrhea (and which was subsequently stopped). It’s reported that an impromptu quiz on the Cold War rendered a 100% correct score from the patient this morning. The nurse notes that generally, his cognitive abilities are at their maximum in the morning, despite the fact that for decades he lived as a night owl. No other changes were reported.

5.4.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (1), Lower Jiao (3), Auricular-Temporal (3, left-side only)

5.4.3 Daoyin: Flashcards identification game: he identified 6 cards correctly today. 5.4.4 Assessment: The patient is progressing nicely.

5.4.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.5 Treatment Session #6 1/3/2017

5.5.1 Progress: The patient just finished speech therapy and his therapist states that he’s speaking bilingually, and a little more easily in French. Much of his French it seems consists of made-up words with French-like pronunciation. He seems quite happy and is currently babbling in this form of pseudo-French. No other changes were reported.

5.5.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb – L (2), Vertex, Perineum, Foot (1), Lower Jiao (3), Lower Limb – R & L (4), Auricular-Temporal (3, left-side only)

5.5.3 Body Acupuncture: bilateral LV-8, LV-5, LV-4, LV-3, LV-2

5.5.4 Daoyin: Flashcards identification game: he identified 4 cards correctly today. 5.5.5 Assessment: The patient is regressing a little bit in terms of the aphasia.

5.5.6 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.6 Treatment Session #7 1/5/2017

5.6.1 Progress: The patient’s speech therapist and personal assistant both express their concern that the patient is declining in speech and cognitive functions. The use of pseudo- French by the patient has become exclusive since the last session. His nurse reports that the physical therapy he has received has improved his mobility over the past week. No other changes were reported.

5.6.2 Zhu’s Scalp Acupuncture: Head & Face (1), Upper Limb – R (1), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Shoulder – R

5.6.3 Daoyin: Flashcards identification game: he identified 4 cards correctly today.

5.6.4 Assessment: The patient “perked up” quite a bit with acupuncture treatment, performing better cognitively, started speaking more English, and generally appearing more alert and attentive. I have counseled the patient’s caregivers to relax regarding these expected up and down days that the patient is experiencing. It’s my opinion that it is too soon to say for sure that this patient is truly in decline. All post-stroke patients have up days and down days, so this seems to be a normal part of the recovery period.

5.6.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.7 Treatment Session #8 1/9/2017

5.7.1 Progress: The patient’s nurse and personal assistant report that he has continued to improve in terms of cognition and speech since the last session. No other changes were reported.

5.7.2 Zhu’s Scalp Acupuncture: Head & Face, Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilateral, x1), Shoulder (right-side), Auricular-Temporal (3, left-side only)

5.7.3 Daoyin: Flashcards identification game: he identified 5 cards correctly, and 3 partially-correct today.

5.7.4 Assessment: The patient is progressing nicely.

5.7.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.8 Treatment Session #9 1/12/2017

5.8.1 Progress: The patient is asleep when the practitioner arrives, having had a busy day of medical appointments, including radiation therapy for his prostate cancer. The patient did not arrive back home until late this afternoon. His nurse reports that he is scheduled for a blood transfusion for his long-standing anemia next week. His personal assistant reports that she’s seen “dramatic” acupuncture effects in the patient’s case in terms of his improved cognition, speech and left arm pain. His use and range of motion of the left upper extremity have increased. She lastly reports that he now knows (and comments upon) the fact that he’s unable to identify an object on flashcards correctly. No other changes were reported.

5.8.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Upper Limb (right, x2), Shoulder (right), Auricular-Temporal (3, left- side only)

5.8.3 Daoyin: No ID cards were used today, as the patient sleeps through his treatment.

5.8.5 Assessment: The patient is progressing nicely.

5.8.6 Plan: continue the plan of care described above (on the initial visit 12/16/2016). The patient’s personal assistant agrees to keep up her efforts with flashcards in-between acupuncture sessions.

5.9 Treatment Session #10 1/16/2017

5.9.1 Progress: The patient’s nurse reports that he’s done a lot of “good” speech and physical (walking) therapies today. The patient’s personal assistant reports that she’s discovered something about the patient’s behavior. She postulates that when he’s trying to communicate something but can’t get the idea across, that resulting frustration leads him to revert back to poor speech patterns (i.e. speaking in “French”). No other changes were reported.

5.9.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper limb (right, x2) Vertex, Perineum, Foot (3), Lower Jiao (3), Shoulder (right), Auricular-Temporal (3, left- side only)

5.9.3 Daoyin: Flashcards identification game: he identified 7 cards correctly today, a new personal best.

5.9.4 Assessment: The patient is progressing nicely.

5.9.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.10 Treatment Session #11 1/23/2017

5.10.1 Progress: The patient is awake and alert when the practitioner arrives. It’s reported that he just had an urge bowel movement, which is an ongoing problem now. His personal assistant reports that he’s been working on the alphabet using Scrabble letter blocks and got A, B, C, D, E all in clear, rapid succession. After that, he got “stuck” and could make no further progress in the exercise. After the needling procedure, the patient becomes keenly interested in looking at a calendar (send by his personal assistant’s mother from his hometown in Scotland). He started talking about it and got very close to predicting the age of the ancient stone cross pictured in the calendar. No other changes were reported.

5.10.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (right, x2), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Shoulder (right), Auricular-Temporal (3, left-side only)

5.10.3 Daoyin: Q&A about the calendar, a free-form discussion about the people and places pictured.

5.10.4 Assessment: The patient is clearly very passionate about the topics discussed in today’s session. The patient is progressing nicely.

5.10.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.11 Treatment Session #12 1/26/2017

5.11.1 Progress: The patient’s nurse reports that when looking at pictures, a lot more English is coming out, “he’s making progress for sure.” Also reported is that the patient switched from the use of Immodium to the use of Kaopectate for diarrhea. His bowel awareness and control is improved and there have been no ‘accidents’ in two days. No other changes were reported.

5.11.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (right, x2), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilaterally), Auricular-Temporal (3, left-side only)

5.11.3 Daoyin: Flashcards identification game: he identified 5 cards correctly, and 2 partially-correct today.

5.11.4 Assessment: The patient is progressing nicely.

5.11.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.12 Treatment Session #13 1/30/2017

5.12.1 Progress: When the practitioner arrives, the patient is resting but awake and in a supine position. His nurse reports that he’s been struggling with alternating diarrhea and constipation. He’s also lost some coordination according to his PT and his personal assistant who reports that he could not actually get his hand to mouth at dinner last night. Despite all this, he appears to be in good spirits. No other changes were reported.

5.12.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (bilateral, x2), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilateral, x2), Auricular-Temporal (3, left-side only)

5.12.3 Daoyin: Flashcards identification game: he identified 4 cards correctly, and 4 partially-correct today.

5.12.4 Assessment: The patient is progressing nicely, but may be experiencing a bit of a setback currently.

5.12.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016).

5.13 Treatment Session #14 2/2/2017

5.13.1 Progress: The patient is finishing up with speech therapy as the practitioner arrives today. The patient is awake, alert, and sitting up in his wheelchair. The practitioner observes the patient stand up, walk over to his bed, and get in (with some minor assistance). His personal assistant reports that his RBC & WBC counts are low according to recent lab results. No other changes were reported.

5.13.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (bilateral, x2), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilateral), Shoulder (right), Auricular-Temporal (3, left-side only)

5.13.3 Daoyin: Flashcards identification game: he identified 11 cards correctly (and 1 partially-correct) today, a new personal best.

5.13.4 Assessment: The patient is progressing nicely.

5.13.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016). The patient’s hemochromatosis prevents me from prescribing Blood Builder by Megafood. For WBC try Astragalus Supreme by Gaia Herbs.

5.14 Treatment Session #15 2/6/2017

5.14.1 Progress: The patient is just finishing with speech therapy, is awake, alert and in good spirits. He recognizes the practitioner and tells the others that he wants nothing to interfere with or delay his [acupuncture] treatment. His personal assistant reports his continued difficulties with speech and a new symptom. He’s developed a sore on the left medial buttock. She states that she thinks it may be related to the radiation therapy he’s undergoing for the treatment of prostate cancer. No other changes were reported.

5.14.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (bilateral, x2), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilateral), Shoulder (right), Auricular-Temporal (3, left-side only)

5.14.3 Daoyin: rest

5.14.4 Assessment: The patient is progressing nicely. My assessment of this case was written in email format on 2/8/2016, as follows:

“The following assessment is due, so I’m grateful that our chance meeting sparked me to proceed. I think that Sandy has made good progress, as evidenced by his overall upward trend in functional and cognitive abilities. He (and his staff) report functional gains, lowered pain levels, and a generally improved sense of well-being and independence.

During our last session, I watched him walk to the restroom and back to his bed and was impressed with his ability to control his body during those short traverses. You may remember me witnessing him getting out of bed and standing on my first visit, and what I saw recently represents a decided improvement. He continues to improve (sometimes in obvious or subtle ways) every time I see him.

He also seems to have made it through this round of radiation with fewer negative effects than I would have expected, considering his age and condition. Sure, there are improvements that can be achieved, but his active mind, and regular, balanced diet has a lot to do with his ongoing constitutional resilience. My advice is to redouble these efforts. An optimal diet and regular exercise are absolutely necessary for patients with serious health and chronic concerns.

In regards to Sandy’s cognitive and communication skills, I can say with confidence that he is making documentable improvements. As I mentioned when I saw you on Monday evening, he achieved the highest score yet with flashcard identification since starting our sessions. His high score was 11 correct, with a previous high of 8 correct answers. When compared to his much lower previous average, this is an objective improvement.

I think I have identified one source of Sandy’s frustration in his knowledge of how well he does or does NOT do on individual tests we run him through. I think this translates to general frustration over his condition, and his state of recovery, which commonly seems infinitesimally slow or non-existent to patients. This is completely understandable, and anticipated.

So during our last session, I spent a lot of time positively reinforcing Sandy, acknowledging his current and ongoing achievements and struggles. It seemed to help, so far as I can tell.

I have made a point of trying to approach Sandy conversationally, and there’s some evidence that this approach is working. I listen to what he has to say, no matter what kind of gibberish it may seem to be. This tendency may have contributed to his recent shift in acceptance of acupuncture therapy, and his curiosity around it.

For example, when I saw him last Monday evening, he clearly recognized me, which signaled to the room (very decidedly), that the shift between his work with his speech therapist and his work with me had changed. This shift was clearly precipitated by his own doing, and in his own “language,” and we all understood what was going on.

The experience above has given me a sense of what a *force* Sandy must have been prior to his stroke.

Later, we had a long conversation, wherein he did most of the talking, and I struggled to understand his meaning. I stimulated his acupuncture needles and listened intently, while he attempted to articulate his meaning. I purposefully “bent my ear” to his meaning.

Eventually, I ventured a guess (and perhaps I was channeling my inner Lyn) at his meaning. He immediately agreed that yes, in fact, he was asking about that! This may be my first step toward understanding your father in a way I had not previously achieved. This breakthrough now allows me to work with him on a yet deeper level still. I think there are further improvements that I can “tease out,” as it were.

In my estimation, Sandy’s prognosis is good. Despite his advanced age, Sandy has quite the spark of Shen in his eyes. By this sign, and by his progress achieved so far in our work together, I am greatly encouraged. I hope to continue my work with him, and to help him bring back as much function and cognition as is possible.

For the reasons articulated above, I propose a change in the frequency of treatment to four-times per week, to help accelerate his recovery and allow me to provide the best and most specific acupuncture service available anywhere.”

5.14.5 Plan: continue the plan of care described above (on the initial visit 12/16/2016). The patient’s care coordinator (his son) requests we increase the frequency of treatment to 3-4x/ week, or to “whatever you think is best.”

5.15 Treatment Session #16 2/9/2017

5.15.1 Progress: The patient is sitting up and working on speech therapy when the practitioner arrives. He’s in a talkative mood, and he continues to talk straight through the session today. No other changes were reported.

5.15.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Upper Limb (bilateral, x2), Middle Jiao (3), Vertex, Perineum, Foot (3), Lower Jiao (3), Lower Limb (bilateral), Shoulder (right), Auricular-Temporal (3, left-side only)

5.15.3 Daoyin: Flashcards identification game: he identified 4 cards correctly, and 1 partially-correct today.

5.15.4 Assessment: The patient is progressing nicely.

5.15.5 Plan: continue the plan of care amended above (on 2/6/2017). 5.16 Treatment Session #17 2/13/2017

5.16.1 Progress: The patient’s personal assistant reports that he had an allergic reaction, possibly to sunscreen which she applied to him before going outside for walking practice. The area around the superior edge of the right orbit, temple, forehead, and scalp have red, swollen, painful to the touch areas. The practitioner concludes that no scalp acupuncture is possible given the patient’s current condition. No other changes were reported.

5.16.2 Palpation of pulse: Right: Wiry. Left: slippery / hidden / hidden

5.16.3 Observation of tongue: dusky purple, no Shen; no coat

5.16.4 Body acupuncture: SP-10, ST-36, LV-8, LV-5, LV-4, LV-2, all bilaterally

5.16.5 Ear acupuncture: Point 0, Skin Disorder point, bilaterally

5.16.6 Assessment: The patient is progressing nicely overall, and likely experiencing a setback which may be due to (or contributed to by) the introduction of radiation therapy to the patient’s body.

5.16.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.17 Treatment Session #18 2/22/2017

5.17.1 Progress: It looks like the patient got a very good result in terms of pain and swelling of the head, which has all but receded. There is one patch or pink, swollen, soft skin centering around Baihui DU-20, about 1 inch in diameter. No other changes were reported.

5.17.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.17.3 Body acupuncture: bilateral LI-4, LV-2, LV-3, LV-5, SP-10; right-sided Shenguan, Dihuang, Renhuang; left-sided ST-36, KI-3

5.17.4 Ear acupuncture: Point 0, Skin Disorder, Head (bilaterally)

5.17.5 Daoyin: Flashcards identification game: he identified 3 cards correctly, and 2 partially-correct, 7 incorrect today.

5.17.6 Assessment: The patient is progressing nicely. The patient states, “it makes me feel much better,” in reference to the acupuncture treatments.

5.17.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.18 Treatment Session #19 2/23/2017

5.18.1 Progress: Upon inspection, the patient still has a raised, pink lump at the vertex Baihui DU-20, the same size as during yesterday’s sessions. No other changes were reported.

5.18.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.18.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-4, SP-10, GB-41, UB-65, Ashi (center of heel); right-sided Cesanli, Cexiasanli, Shenguan, Dihuang, Renhuang

5.18.4 Ear acupuncture: Cingulate Gyrus, Thalamus, Point 0 (bilaterally)

5.18.5 Assessment: The patient is progressing nicely.

5.18.6 Plan: continue the plan of care amended above (on 2/6/2017).

5.19 Treatment Session #20 2/27/2017

5.19.1 Progress: The patient is outside enjoying the sunshine and letters identification practice with his personal assistant as the practitioner arrives. He seems quite cogent and aware this afternoon. Getting him back into bed for treatment is a little agitating to the patient, and he struggles to get positioned comfortably. His scalp still shows swelling and pink flesh around the vertex, this time in a slightly bigger area than was seen in our previous session. No other changes were reported.

5.19.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.19.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-5, SP-10, SP-9, ST-36; right- sided Zhongjiuli, Xiajiuli, Shangjiuli

5.19.4 Ear acupuncture: Ear Apex, Point 0, Shenmen, Autonomic Sympathetic (bilaterally)

5.19.5 Daoyin: rest x 30 minutes

5.19.6 Assessment: The patient is progressing nicely, all except the skin lesion at his vertex.

5.19.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.20 Treatment Session #21 3/1/2017

5.20.1 Progress: The patient reports that he’s relaxed, which makes sense considering that the treatment began during his afternoon nap. His nurse reports that he’s still got an “egg” at the vertex of his head. She also reports that his walking and balance are improved. His personal assistant reports that for the first time, he’s been asking about what happened to him (the event, the stroke) and that generally he’s been making great strides in the area of speech. His speech therapist agrees with this and acknowledges improvement. She finally states, “we had an emotional day.” No other changes were reported.

5.20.2 Zhu’s Scalp Acupuncture: Head & Face (2)

5.20.3 Body acupuncture: bilaterally LV-2, LV-3, LV-5, LV-8, SP-10, SP-9, ST-36; right- sided Renhuang, Dihuang; left-sided KI-3

5.20.4 Ear acupuncture: Point 0, Brain, Skin Disorder (bilaterally) 5.20.5 Daoyin: rest x 30 minutes

5.20.6 Assessment: The patient is progressing nicely.

5.20.7 Plan: continue the plan of care amended above (on 2/6/2017). 5.21 Treatment Session #22 3/2/2017

5.21.1 Progress: The patient seems a little irritated today upon the practitioner’s arrival, and his frustration is aimed at his nurse. He wants his hair comb for some reason, and he’s trying to tell his help to look for it, to check in his jacket or pants, etc. It’s as if he’s lecturing the nurse with genuine concern, however nonsensical his language is. The “egg” at the patient’s vertex is looking closer to expressing today. No other changes were reported.

5.21.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.21.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-4, LV-5, KI-3, ST-36, Shenguan

5.21.4 Ear acupuncture: Shenmen, Autonomic Sympathetic, Skin Disorder, Thalamus (bilaterally)

5.21.5 Daoyin: rest x 30 minutes

5.21.6 Assessment: The patient is progressing nicely.

5.21.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.22 Treatment Session #23 3/3/2017

5.22.1 Progress: The patient has had a visit with his primary physician, and the “egg” was thought to be a sebaceous cyst by that practitioner. His nurse and acupuncturist agree except they are also of the mind that these phenomena have a root in the patient’s body releasing Toxic Heat from the Liver Channel. No other changes were reported.

5.22.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.22.3 Body acupuncture: bilaterally LI-4, LI-1, LV-2, LV-3, LV-4, SP-10, SP-9, ST-45, GB-44, GB-40

5.22.4 Ear acupuncture: Ear Apex, Shenmen, Autonomic Sympathetic(bilaterally) 5.22.5 Daoyin: rest x 40 minutes

5.22.6 Assessment: The patient is progressing nicely.

5.22.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.23 Treatment Session #24 3/4/2017

5.23.1 Progress: The patient continues to improve on a daily basis, according to his caregivers. The cyst at his vertex is very near expressing, but he’s suffered some hair loss in that area as well. His personal assistant reports that his speech has been “great” today, with the inclusion of words he had been previously omitting. His nurse reports on speech and gait improvements in the patient that he’s noticed. No other changes were reported.

5.23.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.23.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3,SP-10, Shenguan, SP-6, ST-36, GB-43, ST-44, ST-40, KI-1

5.23.4 Ear acupuncture: Right: Ear Apex, Kidney, Prostate, Thalamus, Cingulate Gyrus; left: Shenmen, Autonomic Sympathetic, Skin Disorder, Point 0, Brain

5.23.5 Daoyin: rest x 30 minutes

5.23.6 Assessment: The patient is progressing nicely.

5.23.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.24 Treatment Session #25 3/6/2017

5.24.1 Progress: “He’s bright, animated, more expressive, and less frustrated,” states his nurse. “He’s rambling a lot. If he’s talking, he’s laughing a lot.” She also reports that the cyst at the vertex has started to express. Upon examination, the practitioner observes a red dot with a scab and a smaller, dark raised area (30% smaller). She further reports that the patient’s been dealing with two episodes of loose stools in the past few days. No other changes were reported.

5.24.2 Zhu’s Scalp Acupuncture: Head & Face (2)

5.24.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-5, SP-10, Shenguan, KI-3, ST-36, GB-34

5.24.4 Ear acupuncture: Ear Apex (bilaterally); left Prostate, Thalamus, Cingulate Gyrus; right Shenmen, Autonomic Sympathetic, Point 0

5.24.5 Daoyin: rest x 30 minutes

5.24.6 Assessment: The patient is progressing nicely.

5.24.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.25 Treatment Session #26 3/8/2017

5.25.1 Progress: The patient’s nurse reports that he’s had an emotional time earlier today. This was probably triggered by unannounced changes to his daily schedule (his PT arrived late). It’s reported that the patient does not like surprises such as this. Upon examination, his scalp at the vertex is not yet fully expressed. Lastly, his nurse reports that he’s been using his left arm more often these days. No other changes were reported.

5.25.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.25.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-4, LV-5, KI-1, Shenguan, ST-36, GB-34

5.25.4 Ear acupuncture: Point 0, Ear Apex, Skin Disorder (bilaterally) 5.25.5 Daoyin: rest x 30 minutes

5.25.6 Assessment: The patient is progressing nicely.

5.25.7 Plan: continue the plan of care amended above (on 2/6/2017). 5.26 Treatment Session #27 3/9/2017

5.26.1 Progress: The patient’s nurse reports, “week after week his speech continues to improve.” The skin lesion at the vertex is still there and appears ready for expression. No other changes were reported.

5.26.2 Zhu’s Scalp Acupuncture: Head & Face (3), left Auricular-Temporal (3)

5.26.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-5, SP-10, ST-36, GB-34, KI-1, Ashi (center of the heel); right; Shenguan, Dihuang, Renhuang

5.26.4 Ear acupuncture: Point 0, Brain, Ear Apex, Shenmen, Autonomic Sympathetic (bilaterally)

5.26.5 Daoyin: rest x 30 minutes

5.26.6 Assessment: The patient is progressing nicely.

5.26.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.27 Treatment Session #28 3/10/2017

5.27.1 Progress: The patient’s scalp lesion is still there. The practitioner attempts to lance the cyst today, with the nurse’s assistance (unsuccessful). No other changes were reported.

5.27.2 Zhu’s Scalp Acupuncture: Head & Face (3)

5.27.3 Body acupuncture: bilaterally LI-4, LV-1, LV-2, LV-3, LV-5, SP-10, SP-1, ST-36, ST-45, Shenguan, KI-3, GB-34

5.27.4 Ear acupuncture: Point 0, Shenmen, Ear Apex (bilaterally) 5.27.5 Daoyin: rest x 30 minutes

5.27.6 Assessment: The patient is progressing nicely.

5.27.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.28 Treatment Session #29 3/13/2017

5.28.1 Progress: It appears that the lesion at the patient’s vertex is starting to heal now, and almost all the swelling is now resolved. Now there are areas which look normal, and those which look bruised or scabbed. The area is no longer so tender to the touch. Today he was able to get outside and enjoy the sunshine. No other changes were reported.

5.28.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3)

5.28.3 Body acupuncture: bilaterally LI-4, LV-2, LV-3, LV-5, KI-1, SP-10, ST-36, GB-34, KI-3

5.28.4 Ear acupuncture: Point 0, Ear Apex, Shenmen (bilaterally) 5.28.5 Daoyin: rest x 30 minutes

5.28.6 Assessment: The patient is progressing nicely.

5.28.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.29 Treatment Session #30 3/15/2017

5.29.1 Progress: The patient’s vertex is healed so the practitioner will resume scalp acupuncture protocols today. No other changes were reported.

5.29.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum and Foot (3), Lower Jiao (3), left Auricular-Temporal (3)

5.29.3 Ear acupuncture: Point 0, Thalamus, Shenmen (bilaterally)

5.29.4 Daoyin: rest x 30 minutes

5.29.5 Assessment: The patient is progressing nicely.

5.29.6 Plan: continue the plan of care amended above (on 2/6/2017).

5.30 Treatment Session #31 3/16/2017

5.30.1 Progress: The patient’s primary caregiver (his son) called to let the practitioner know that the patient had a stroke or a TIA and several seizures just this morning and had intended to cancel today’s appointment. The practitioner employed him to reconsider, stating that he felt that this was the most critical opportunity for the patient, that acupuncture should be used now to help save the patient’s life. When the practitioner arrived, he spoke with the patient’s son. He said that this morning he came in to say good morning to his father when the speech started getting sloppy, then he started crying. The patient was at that moment having the event in the presence of his son. He became incoherent and unable to sit up, stand up or walk, and his previously “good” right side seemed to become affected. His nurse reports that the first was a grand mal seizure lasting over 4 minutes, and the others were focal seizures, lasting about 2 minutes each, all included tremor and clonus. There were 6 seizures in total. Upon observation of the patient, the practitioner observes that there’s been a clear shift, he is visibly affected by his condition, there’s far less Shen in his eyes now, which appear as hollow and darkened. His lusterless complexion has darkened considerably to a dusky gray color. He writhes in discomfort and agitation, and he’s been sweating. No other changes were reported.

5.30.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), left Upper Limb (x2), Vertex, Perineum, and Foot, Lower Jiao (3), left Lower Limb (x2), left Auricular-Temporal

5.30.3 Body acupuncture: bilaterally LV-2, LV-3, LV-5, LV-8, SP-10, SP-9, ST-36

5.30.4 Ear acupuncture: Point 0, Brain, Skin Disorder (bilaterally)

5.30.5 Daoyin: rest x 30 minutes

5.30.6 Assessment: The patient has suffered a major setback, but is calmed immediately following treatment with acupuncture.

5.30.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.31 Treatment Session #32 3/17/2017

5.31.1 Progress: The patient’s nurse reports that after acupuncture yesterday, he “calmed down quite a bit,” considering the level of agitation and anger he was expressing yesterday. Some Shen has returned to his eyes and he attempts to speak and respond to the practitioner’s questions. He is able to acknowledge yes or no questions with nods or shakes of the head. His caregivers are concerned about dehydration so they have been administering Gatorade and his urination continues unhindered. It seems as if the patient is now seeing double or having some visual disruption, he does better when closing one eye. Lastly, it’s reported that his right upper and lower extremities are moving more easily today. No other changes were reported.

5.31.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), left Upper Limb (x2), Vertex, Perineum, and Foot (2), Lower Jiao (3), left Lower Limb (x2), left Auricular- Temporal

5.31.3  Ear acupuncture: Point 0, Cingulate Gyrus, Thalamus, Eye (bilaterally)

5.31.4  Daoyin: rest x 30 minutes

5.31.5  Assessment: The patient is on an improvement trend.

5.31.6  Plan: continue the plan of care amended above (on 2/6/2017).

5.32 Treatment Session #33 3/20/2017

5.32.1 Progress: The patient is awake, aware, and smiling when the practitioner arrives, which makes him think for a brief moment that nothing at all had happened on 3/16/2017. Much if not all the Shen had returned to the patient’s eyes, and he’s been able to walk short distances (assisted) over the weekend. Another seemingly dichotomous finding noted by his caregivers is that he is now more confused but less agitated about it than prior to last Thursday’s events. Yesterday he eventually had a large bowel movement, then slept 60% of the day, according to his nurse. The patient was able to feed himself earlier today, has enjoyed improved speech and cognition but still conflates the meanings of things (aphasia is still present). That being said, just now he and the practitioner had a perfectly cogent conversation about the comfort level of the acupuncture needles being placed in his scalp. No other changes were reported.

5.32.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), bilateral Upper Limb (x2), Vertex, Perineum, and Foot (3), Lower Jiao (3), bilateral Lower Limb (x2), left Auricular-Temporal

5.32.3 Body acupuncture: right-sided Linggu, Dabai

5.32.4 Daoyin: rest x 30 minutes

5.32.5 Assessment: The patient is progressing nicely.

5.32.6 Plan: continue the plan of care amended above (on 2/6/2017). 5.33 Treatment Session #34 3/22/2017

5.33.1 Progress: The patient is asleep when the practitioner arrives and his nurse reports that he’s been sleeping a lot lately. She states that he’s “too weak” to stay up for very long. No other changes were reported.

5.33.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), bilateral Upper Limb (x2), Middle Jiao (3), Vertex, Perineum, and Foot (3), Lower Jiao (3) NOTE: I could not insert the Lower Limb needles because it was too painful for the patient. Today he seems to be much more sensitive to needling than I have ever seen.

5.33.4 Ear acupuncture: Point 0, Thalamus, Cingulate Gyrus (bilaterally)

5.33.5 Daoyin: rest x 30 minutes

5.33.6 Assessment: The patient is progressing nicely.

5.33.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.34 Treatment Session #35 3/23/2017

5.34.1 Progress: The patient is again asleep as the practitioner arrives. He wakes during the acupuncture procedure, apologizes, and the practitioner reassures him that all is well. The patient is starting to show signs of continued increased sensitivity to acupuncture needling in the scalp (physical starts with insertion sensation). His nurse reports that he’s “doing better, especially with his right hand and leg.” The practitioner realizes that the patient is sleeping a lot more, and yawns more frequently too, which makes perfect sense considering what he’s been through and his body’s attempt to heal his brain. No other changes were reported.

5.34.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Vertex, Perineum, and Foot

5.34.3 Ear acupuncture: right Eye, Cingulate Gyrus, Thalamus, Point 0, Master Oscillation

5.34.4 Daoyin: rest x 30 minutes

5.34.5 Assessment: The patient is progressing nicely.

5.34.6 Plan: continue the plan of care amended above (on 2/6/2017).

5.35 Treatment Session #36 3/24/2017

5.35.1 Progress: The patient did some standing today, and brushed his teeth on his own, which represents improved function. He received an oxygen treatment earlier today. He’s feeding himself lunch as the practitioner arrives. His nurse reports that he’s taken Tylenol for pain today. He’s eating well, bowel movements are regular, he’s interested in watching television, all which can be considered to be improvements at this juncture. No other changes were reported.

5.35.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), bilateral Upper Limb (x2), Vertex, Perineum, and Foot, Lower Jiao (3), bilateral Lower Limb (x2), right Shoulder, left Auricular-Temporal

5.35.3 Body acupuncture: right Linggu, Dabai

5.35.4 Daoyin: rest x 30 minutes

5.35.5 Assessment: The patient is progressing nicely.

5.35.6 Plan: continue the plan of care amended above (on 2/6/2017).

5.36 Treatment Session #37 3/25/2017

5.36.1 Progress: The patient is awake and alert as the practitioner arrives, his daughter is there from out-of-town, as well as other family members congregated and all are chatting around the patient’s room. There’s a lot of conversation and when invited to participate, says “yes,” to indicate that he’s been listening and understands what’s going on. Even though he does not say much, everything that the practitioner hears him say today sounds perfectly clear and cogent. He appears to be leaning toward the left side in bed today. His nurse lastly reports that he’s been more gassy than usual as of late. No other changes were reported.

5.36.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, and Foot (2), Lower Jiao (3), bilateral Lower Limb (x2)

5.36.4 Ear acupuncture: bilateral Point 0

5.36.5 Daoyin: rest x 30 minutes

5.36.6 Assessment: The patient is progressing nicely.

5.36.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.37 Treatment Session #38 3/27/2017

5.37.1 Progress: The patient is awake and in bed when the practitioner arrives today. He’s already had lunch and his nurse reports that he’s been experiencing joints pain lately and that he was constipated yesterday but has since moved his bowels. She reports that his urine has been dark in color and she’s been giving him water to try to get him hydrated. No other changes were reported.

5.37.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Vertex, Perineum, and Foot, Lower Jiao (3)

5.37.3 Body acupuncture: bilaterally LI-4, LV-3, LI-11, Xinmen, SP-10, Xiyan, ST-34, ST-35, ST-36, Shenguan, LV-8, GB-33

5.37.5 Daoyin: rest x 45 minutes

5.37.6 Assessment: The patient is progressing nicely.

5.37.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.38 Treatment Session #39 4/5/2017

5.38.1 Progress: The patient’s nurse reports that he’s been doing well since our last session. She states that he was able to get up out of bed and use the toilet unassisted. Today the patient is suffering from seasonal allergy symptoms of post-nasal drip, sneezing, cough, and very irritated, red, runny and itchy eyes. She also reports he’s been having a stiff and painful neck accompanied by difficulty getting comfortable in bed. Lastly, it’s reported that cognitive training activities have been scaled down to 20-30 minutes per day to prevent too much frustration from occurring in the patient at this point in time. No other changes were reported.

5.38.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), bilateral Upper Limb, Vertex, Perineum, and Foot, Lower Jiao (3), Cervical Area (3), bilateral Lower Limb (2)

5.38.3 Body acupuncture: bilaterally GB-20, LI-4, LV-3, LU-7, ST-36, Shenguan, GB-37, KI-6

5.38.4 Daoyin: blink eyes vigorously, look close, look far away; rest x 30 minutes 5.38.5 Assessment: The patient is progressing nicely.
5.38.6 Plan: continue the plan of care amended above (on 2/6/2017).

5.39 Treatment Session #40 4/6/2017

5.39.1 Progress: The patient’s personal assistant reports that the patient is still weak and having difficulty staying balanced while walking. She states that he’s still battling the allergies or perhaps a common cold, with continued red swollen eyes, stuffy nose, and cough. Lastly, his neck stiffness and pain persists, along with lower back pain which became evident in observing his gait (he was stooping forward). No other changes were reported.

5.39.2 Zhu’s Scalp Acupuncture: Head & Face, Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, and Foot, Lower Jiao (3)

5.39.3 Body acupuncture: bilaterally ST-36, LI-10 5.39.4 Ear acupuncture: bilateral Lung #2

5.39.5 Daoyin: rest x 30 minutes

5.39.6 Assessment: The patient is progressing more slowly now, or plateauing the improvement trend.

5.39.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.40 Treatment Session #41 4/7/2017

5.40.1 Progress: The patient’s nurse reports that he’s had “a big day” and is resting now (he’s currently asleep). His allergy symptoms have not changed much yet. The nurse lastly reports that the patient has been having quite a bit of sensitivity in the scalp at the vertex. The practitioner noticed this too when needle stimulation resulted in grimaces and audible groans. No other changes were reported.

5.40.2 Zhu’s Scalp Acupuncture: Head & Face (2)

5.40.3 Body acupuncture: right GB-20

5.40.4 Ear acupuncture: right Point 0, Allergy point, Cervical spine, Lumbar spine

5.40.5 Daoyin: rest x 30 minutes

5.40.6 Assessment: The patient is progressing more slowly now, or plateauing the improvement trend.

5.40.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.41 Treatment Session #42 4/11/2017

5.41.1 Progress: The patient is resting when the practitioner arrives, and his nurse reports that he has a lot to say these days, but most of it is still gibberish, or out-of-context. She also reports that the patient has been having numbness and pain in the soles of the feet, which she thinks may be contributing to his difficulty walking. No other changes were reported.

5.41.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (1), Vertex, Perineum, and Foot

5.41.3 Body acupuncture: left Wuhu #4 & #5

5.41.4 Ear acupuncture: bilateral Point 0

5.41.5 Daoyin: rest x 30 minutes

5.41.6 Assessment: The patient is progressing more slowly now, or plateauing the improvement trend.

5.41.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.42 Treatment Session #43 4/13/2017

5.42.1 Progress: The patient’s caregiver is giving the patient a neck and upper back massage. He reports that yesterday the patient experienced a lot of ankle pain during physical therapy, but that today the ankle seems okay. No other changes were reported.

5.42.2 Zhu’s Scalp Acupuncture: Head & Face (3), Upper Jiao (3), Middle Jiao (3), Vertex, Perineum, and Foot (3), Lower Jiao (3), Cervical Area (3), right Lower Limb (2)

5.42.3 Body acupuncture: right Wanshunyi, Wanshuner; left Linggu, Dabai, bilateral GB-20

5.42.4 Ear acupuncture: bilateral Point 0

5.42.5 Daoyin: rest x 30 minutes

5.42.6 Assessment: The patient is progressing more slowly now, or plateauing the improvement trend.

5.42.7 Plan: continue the plan of care amended above (on 2/6/2017).

5.43 Treatment Session #44 4/18/2017

5.43.1 Progress: The patient was about to eat lunch when the practitioner arrived for his treatment, but he insists on getting back into bed to receive acupuncture instead. When asked how he’s doing, he moves his left hand in a way which the practitioner recognizes to mean pain in the left upper extremity and shoulder. His nurse reports worsened walking function lately. No other changes were reported.

5.43.2 Zhu’s Scalp Acupuncture: Head & Face (2), Upper Jiao (3), bilateral Upper Limb, Middle Jiao (3), Vertex, Perineum, and Foot, Lower Jiao (3), bilateral Lower Limb (2), right Shoulder

5.43.3 Body acupuncture: bilateral GB-20

5.43.4 Daoyin: rest x 30 minutes

5.43.5 Assessment: The patient is progressing more slowly now, or plateauing the improvement trend.

5.43.6 Plan: The patient is discharged per the request of his primary caregiver.

SECTION 6: RECOMMENDATIONS UPON DISCHARGE

  • Continue to keep the patient comfortable and allow for as much mobility and function as he can muster
  • Be extra supportive during physical therapy and when he walks, you want to prevent him from falling
  • Work concertedly to keep the patient hydrated and continue with his good dietary hygiene
  • Consider inclusion of foods that supplement and nourish the Spleen and Kidney, such as butternut squash, yams, pumpkin, black sesame seeds, black wood ear mushrooms, etc.
  • If possible, consider Bu Zhong Yi Qi Tang or Astragalus Supreme by Gaia Herbs to keep up healthy white blood cell counts and to stave off the negative effects of radiation therapy
  • Consider the use of Saw Palmetto (herb) to protect the prostate from unnecessary damage while being targeted with radiation therapy
  • Keep an eye on the patient’s energy and activity levels – he should be just as active as possible without completely draining him energetically
  • Should scalp acupuncture be resumed in the future, the recommended starting frequency of treatment is two times per week with 2-3 days of needle retention between sessions
  • Keep up efforts with physical therapy, speech therapy, and cognition using flashcards, Scrabble pieces, pictures, worksheets, etc. (as described above in the Daoyin sections of the case)

SECTION 7: DISCUSSION

7.1 What did you learn from this case?

  • The Zhu’s Scalp Acupuncture system offers a useful approach in post-stroke aphasia
  • Zhu’s Scalp Acupuncture techniques can be used to save a life
  • Some cases of aphasia may take a long course of treatment before results are seen
  • Lots of Daoyin practice by the patient will speed up the recovery process
  • Best results occur when Daoyin exercises are performed by the patient at the time of needle stimulation
  • Choice of Daoyin exercises matters to the results or the lack thereof
  • Language is a complex human function and aphasia has a way of bringing out the bizarre and erratic aspects contained within it
  • When the limitation of financial constraint is removed, patients and practitioners can move forward decisively to solve life-threatening conditions
  • Given the right mindset, resources, and support, almost anything is possible

7.2 What limited your treatment outcome?

  • Setback on 3/16/2017
  • Inability to needle the scalp and/or perform Daoyin with every treatment session
  • The limits of the practitioner’s own training and skill7.3 What would you recommend for your colleagues to do for a similar case study in future?
  • Gain the trust of the family and caregivers quickly
  • Get the patient very involved with the treatment process (i.e. doing Daoyin) from the very first session
  • Encourage the patient to retain needles for as long as possible and to do Daoyin exercises at in between acupuncture sessions
  • Engage the care staff to assist in your goals for the patient
  • Practice extreme patience when speaking with and trying to understand a patient with aphasia
  • Block off enough time on your schedule to be able to get to and from your house call without undue stress

SECTION 8: CONCLUSION

This extraordinary patient was able to make it through some extremely challenging health events while under the practitioner’s care. Because of the concerted efforts of his family, caregivers, and staff, he’s had an easier time than many other stroke patients might. His medical care was not hindered by financial roadblocks, which allowed for great continuity of care and application of longer-term treatment plans. He’s also had access to all the appropriate modalities which could possibly move him forward. The thoughtful and systematic approach his family used to coordinate his care is impressive.

The treatment frequency and the total number of treatments were optimal in this case. The practitioner is particularly gratified that so many long-distance house calls could be delivered so close together and in such large quantities. It is his experience that house call patients rarely can sustain long-term acupuncture house calls due to the high fees associated with such an approach.

There are several great advantages to using Zhu’s Scalp Acupuncture in a case like this. One advantage is the fact that because needles are retained for several hours to several days, they can continue to work for a longer time and have a deeper impact on the patient’s condition than removing needles after 30-60 minutes in the clinic.

Another advantage is that when the needle stimulation is combined with Daoyin exercise, the patient is likely to make exponentially better progress than without this targeted, customized approach. Without concomitant, patient-specific, results-driven exercises performed by the patient during needling, we are not really doing everything we can to help stroke patients recover as quickly as possible.

One disadvantage of this system which was revealed to the practitioner is that sometimes we cannot needle the scalp zones. Versatile acupuncturists will not be stymied by this, but it underscores the importance of remaining flexible and being able to think on one’s feet.

In retrospect, there was one main thing the practitioner would have done differently. He would have tried to awaken the patient more often and engage him in Daoyin, conversation, word recognition, etc. as much as possible during each session. The practitioner has assessed his own performance in this regard to be in need of improvement. He let the patient rest too often during treatment and this is a mistake he will be on the look out for in the future.

The practitioner considers himself extremely lucky to have become trained in Zhu’s Scalp Acupuncture. Without Dr. Zhu’s system, he would have had no clue how to go about working on a case such as the one presented above. He’s grateful for the experience of having treated this specific patient as well. Doing so has given him incontrovertible proof that ZSA can work in emergency and severe medical situations. It also has allowed him to touch a life deeply, and in helpful, meaningful ways.

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