Editor: Dr. Holmes Keikobad MBBS DPH Dip Ac NCCAOM L Ac. Volume VI Issue 101 ~ Biomed 2010 Publisher & Copyright acu-free.com LLC Free Online Edition

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1 1 Editor: Dr. Holmes Keikobad MBBS DPH Dip Ac NCCAOM L Ac Volume VI Issue 101 ~ Biomed 2010 Publisher & Copyright acu-free.com LLC Free Online Edition Haiti Epidemic A cholera patient drinking oral re hydration solution CDC Public Health Image Library (PHIL) Courtesy Centers for Disease Control and Prevention N Applied anatomy of the Foot T 3 4 5

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3 3 In this Issue Pages 4-12 The Impending Epidemic in Haiti and the Role of Acupuncture in its Containment Pages Applied Anatomy of the Foot Page 15 Acufree.Com Courses for Renewal NCCAOM & States Pages 16 Contact Information & Update Mailing List Whatever you will seek you will find, and therein lies the rub Faramoush the Forgotten

4 4 This is written to support the Acupuncturist who decides to go to Haiti and help in the rehabilitation, and if an epidemic hits, help in its containment Epidemics Epidemics are when an endemic situation suddenly decides to proliferate. Endemics are where an epidemic has decreased in intensity and now infects cases on a random and low key basis. In which case the culprit organism never leaves the location and continues to exist under the surveillance systems put in place by the health authorities. In many cases the organism is millennia old, having become more adapted to changing circumstances, more adept at killing, maiming and then receding to survive, and attack another day. In that sense it is not a question of if the epidemic will ravage, but when will it do so. Role of the Acupuncturist The Doctor of Acupuncture can play a pivotal role, as an individual, and as part of the Emergency Team. While any other system of containment will require an infrastructure of medication and instrumentation for diagnosis and treatment, the Acu Team requires simply a few sterile needles and a steady hand. Acupuncture in such an environment is in fact critical, as it: 1. Works with raising the resistance, the anti Pathogenic Factor 2. Addresses the emotional backdrop in the situation such as grief, fear and anger. 3. Works to restore the internal Harmony in terms of Qi, Blood and Fluid. 4. Addresses on an immediate basis the issue of pain. 5. Can restore a sense of relaxation and calm on an immediate basis. 6. Can work to Heat an imminently Cold condition. 7. Is supremely amenable to sustained relief using seeds in the ears. Moreover simple measures Copyright can acu-free.com be taught as LLC. homework All rights using reserved ear seeds and indirect moxa with due precaution.

5 5 As part of a larger team? Certainly. The conventional responders are trained professionals and are composed of field doctors, nurses, paramedics. In addition there are administration staff, support personnel for setting up field hospitals, surgeries and clinics. For every one actual hands on professional there are some 5 subsidiary personnel, the ratio in most emergencies being 1:5. The Acu Team would ideally be a part of this structure for administrative and logical purposes, but, and this is critical, with a free hand to handle its own clinical delivery. The Universal Point Protocol In case you fly in and begin to work, an idea of a point protocol which could be applied universally would be required adapted to the epidemic situation you will find there. Whatever else is happening in terms of the illnesses, this protocol would work to bolster the resistance, the Anti Pathogenic Factor. Over and above this, more points can be added to address the particular illness which has presented. The preliminaries Insertion: shallow, people are already low on Qi, Blood and Fluids Needle gauge: 36, with length 1.5 inches which works on everyone Manipulation: invariably reinforcing technique Time per session: no more than 20 minutes Stimulation: once at outset, once at the 10 minute mark Frequency: once a week, you are treating hundreds Patient position: recumbent on back Age limitations: 9 years upwards Case records: becomes difficult in field conditions during a raging epidemic, still best to keep basic information such as name, address even if the building is gone, next of kin; often later your records could help other agencies find a person who got lost in the milling thousands

6 6 The 7 Point Universal Protocol 1. Stomach 36 - this is the Earth point of the Earth vessel and holds powerful Qi at all times 2. Large Intestine 11 - this is also the Earth point of the Metal Yang vessel and holds powerful Qi at all times; together the two points access the Yang Ming Qi as these comprise of the Yang Ming Pair, LI above and ST below; use the one on right side, because this will activate the lymphatic plexus gathered at the the ileo cecal junction in the tight side abdomen 3. Spleen 6 - all 3 great leg yins gather here on their journey from the foot upwards; one needle here can activate Spleen, Liver and Kidney Qi at the same time 4. Heart 7 - source point for Heart vessel, will help calm the patient 5. Lung 7 - one of the great points communicating with the Ren Channel 6. Liver 3 - Earth point on Wood vessel 7. Kidney 3 - Source point on Kidney vessel This set of points address Qi from: Earth [Stomach and Spleen] The Metal - Wood Axis [Lung and Liver] The Fire - Water Axis [Heart and Kidney] The Earth Qi centralizes [A], and the other two Axes balance out each other [B] and [C] C Wood Liver & Gall Bladder Water Kidney & Urinary Bladder Fire Heart & Small Intestine B Metal Lung & Large Intestine A Earth Spleen & Stomach

7 7 An extended action As with most 5 element applications, there is an obvious and immediate effect, and then a not so obvious and extended effect. Here are the extended effects of that one treatment you would give: 1. When Kidney is stabilized in the Fire Water Axis: It nourishes Wood, its Child and It benevolently controls Fire, its Stepchild 2. When Heart is stabilized in the Fire Water Axis: It nourishes Earth, its Child and It benevolently controls Metal, its Stepchild 3. When Metal is stabilized in the Metal Wood Axis: It nourishes Water, its Child and It benevolently controls Wood, its Stepchild 4. When Wood is stabilized in the Metal Wood Axis: It nourishes Fire, its Child and It benevolently controls Earth, its Stepchild Ear seeds These work excellently in field conditions when there has been no prior needle acupuncture on the ears, meaning on unbroken skin. The preliminaries Stimulation: press till area around ear warm, tingling Frequency: once a week, you are treating hundreds Patient position: recumbent on back, sometimes process causes fainting Age limitations: 4 year upwards, infants just acupressure ear On right ear: Stomach Lung Shenmen On left ear: Heart Liver Kidney

8 8 Stay connected The one thing which one does not figure on is how soon one gets involved in the goings on in the field. One can so easily lose track of time and even the day. Vertically connected: this means with your leader above you and the people who you lead below you. Laterally connected: this means with professionals who are in the field with you. Solar power Don t leave without a sturdy cell phone which needs very little maintenance. Make sure it is charged all the time, which means on the field where there is no electrical outlet for miles, off a solar powered charger. Stay connected and stay Green. Connect schedule Once you enter fieldwork make a schedule of calling with your leader above you and with someone farther afield, say your office in the States. Connect with your leader once in the morning and once last thing at night, and with the home resource, once a day. This allows you a resource which looks after you while you look after Copyright the others. acu-free.com LLC. All rights reserved

9 9 Organism types Cases seen in the clinic such as an e coli infection, salmonellosis, rarely become involved in an epidemic. The organisms likely to be seen in such a dramatic situation are more like vibrio cholerae which causes the dreaded water-wasted cholera, which can infect a healthy robust man of 40 weighing 180 lb in the prime of health by morning, and leave a shrunken, shriveled person of 100 lb, on a wet, stool sodden bedstead, on the verge of death, by nightfall. If there is also summer heat and no particular waste disposal, the possibility of mycobacterium typhii may arise, with Typhoid rearing its head. Cholera kills where Cold is a significant factor, Typhoid where Heat figures largely. In cholera expect subnormal body temperature, in Typhoid, fever with temperature rising to 104 F. Vibrio cholerae attacks the lining of the large intestine and renders it weak so that there is massive loss of Fluid. Mycobacterium typhii attacks only small patches in the lining of the small intestine and sets up inflammation with release of toxin. Both are possible in Haiti in the coming months. Lab work Do you in cases you may suspect of being cholera or some infectious disease on the rampage, send a sample to the field lab? You do not, if there have been many similar cases. There is usually no time, lab reports take days, and in an epidemic the fact that similar cases are seen from the same location is taken as satisfying the criteria needed to diagnose. Here is a close up of vibrio cholerae, on the left as a stained stool specimen, note comma type shape; on the left a closer look with an electron microscope. Image Courtesy of Public Health Image Library

10 10 Stay focused Often one so involved with the human side of things that one is in the danger of losing track of why you are there. While being as human as possible, there will be times when, in an epidemic situation, you will be called upon to decide who gets priority in treatment. Stay clinical, even when being reasonably emotionally involved. Make a template on how you decide things in the field, and stay with that. Practice in the clinic is not even remotely comparable to practice in the field in epidemic conditions. Serious debility, death, degradation and chaos are apparent, and this is where you get to see humanity at its darkest, and occasionally, at its finest. Stay safe Make sure you rest enough, nourish yourself well, stay fit and maintain the right kind of emotional equilibrium. The experience of working in an epidemic will likely change you for life, and make you see things in a different way than ever before. The present writer when just spilled out of Medical School an MD in a sprawling city on the Indian Sub Continent, that was a long time ago, found himself neck deep in a cholera epidemic. So many cases piled up so quickly that the hospital beds were not enough, people lay in the corridors and fought for their lives. Soon a school for kids was commandeered and students went home and patients poured in, into makeshift beds in classrooms. The principal s office became the central administrative hub, I am sure he enjoyed that privilege when he returned, and a team of fresh doctors wet behind the ears, battle hardened nurses, orderlies, and cleaning staff began the churn which went through 3 shifts of work in 24 hours non stop. Many came, few left. Having had the finest fantasies of saving the world during the years at college, we were brought face to face with the savagery, the rank ravage, of an unseen microbe gone mad. Cholera kills by shaming the patient, I am talking of the East of those days. Grown men fall like flies. Beauty fades, families are broken in a single day, it seems the Gates of Hell have Copyright opened wide acu-free.com and let loose LLC. an All anathema rights reserved which will never cease.

11 11 One battles with glucose and saline bottles, trying to find collapsed veins in cold arms, working an entirely losing battle. Hours become days, which feel like a lifetime. Will this ever cease? It does. The bug decides to call it a day, it has ravaged enough; it recedes back into the dark corners it came out of. Epidemiologists say the epidemic is over. What they mean is that it has backed off and will stay dormant for a few years a decade or two, even 25 years, and will return. Again stay focused For all practical purposes Haiti is a city from the East which finds itself in the wrong hemisphere. Expect to work in difficult, almost dysfunctional circumstances, mainly by yourself. Expect to face death at its most uncivilized. Expect to be drained of all that you can bring up in terms of emotions. Finally, expect to come away changed, by and large for the better. Other illnesses in an epidemic Right after, and often in concomitance with the increased prevalence of microorganisms, there is a sudden and horrendous increase in insects, which in turn carry pathogens and transmit these to human hosts. Some are: Trypanosomes. These are a parasitic protozoa with a single flagellum, a whip like tail. Several species cause major diseases in humans. Diseases are: Trypanosomiasis, African Sleeping Sickness South American Chagas Disease Leishmaniases

12 12 Tuberculosis in Haiti Cases of tuberculosis in Haiti are more than ten times as high as those in other Latin American countries The chances of getting infected from tuberculosis while in Haiti on a campaign are very remote because most of the cases will be mainly in the dormant stage. Of all types of tuberculosis infection the one in the lungs, Pulmonary Tuberculosis, is most common. This runs its course in the acute phase and then becomes chronic. At this time the patient produces much Damp Cold type of sputum with a productive cough, which is laden with the microorganism, Mycobacterium Tuberculosis. It needs constant and ongoing contact with such a patient to become infected, and then a very poor state of Anti Pathogenic Factor to become afflicted. However if one has never had contact with tuberculosis at any stage, one will have a system which has no recognition of that organism, and therefore an immune system which has no prior information to work with. Which is a signal for greater vigilance. Mosquitos at evening Watch out for these, some may be harboring the malaria organism. These are night creatures and need warm blood and usually gravitate to sleeping people in the outdoors. Soon as dusk comes about these are on the wing and can infect. Conclusion This more or less gives an immediate and short overview to the professional who will venture into Haiti at this time.

13 13 Applied Anatomy of the Foot Very many points you use all the time appear on the foot: ST 44 LV 3 GB 41 K 3 UB 60 SP 4 GB 40 Almost all of these are strategically situated on anatomical sectors on the foot. The image shows the K vessel, the only one in the body which hits the ground every time you walk, and the only one to even touch Earth if you are barefoot. An odd thought is the in 5 E terms Earth Controls Water, which is to say to have a healthy K organ one ought to have a healthy meeting of the foot on earth. Which could mean walking barefoot for a while in the day, to making sure no corns and calluses develop An odder thought is that if Earth goes crazy on the element Water and becomes an Oppressor, it can easily damage Water, which is Kidney, which is the foot. Earth here probably means the philosophical and Traditional Earth element, which if Disharmonious, would spell trouble for Kidney, which is to say the lower back, spine, ears and hearing, equilibrium, hair fall and overall immunity as blood cells generate in the marrow. On the next page please see images of the skeletal foot. We have worked out an easier way to remember the bones which you may find useful. If anatomy were to fall within the province of the practicing acupuncturist, and it should, it ought to be the working version, Applied Anatomy. nued next page

14 14 The bones of the foot fall into 3 sectors, posterior, middle and anterior. Anterior holds the metatarsals and phalanges and that takes care of that. Posterior holds the calcaneum and the talus. Rest of small bones fall into the middle third. 1 2 N T 3 4 Believe it or not when you are sitting in a practicum and an assistant professor of anatomy is grilling you on bones of the foot and hands you an X-Ray of one and asks if this is the medial or lateral view, one is likely to make the wrong call. Easiest way to decide that is locate the protuberance of the navicular bone [N]. Next is the protuberance of the talus [T] which in medial view falls just posterior to the navicular protuberance. You find the navicular and you have found the medial side. Some acupuncture points are marked with a blue dot. Can you name these? Answers below UB UB K SP SP 3

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