The material in this workbook is directed towards the assessment and treatment of womenâ€™s health concerns and conditions and specifically techniques and protocols directed to the thoracic, abdominal, and pelvic regions.
Dr. Gregory Lawton
Thoracic, Abdominal, and Pelvic Techniques
THE APPLIED PRACTICE OF MANUAL MEDICINE Introduction Since 1980 I have been writing about manual medicine, first on homeosomatic theory, then on naprapathy, followed by medical massage and medical manual therapy (MMT) during the 1990’s, and finally on Scandinavian Mobilization Therapy (SMT) beginning in 2008. My work on the development of SMT training materials and curriculum, techniques and protocols is built upon the progressive development of all of my efforts in the field of manual medicine since the mid 1970’s. I have attempted to instill within my students, teachers, and associates a treatment model that is based upon a graduated patient treatment program that is directed by the therapist or doctor and is defined and determined by the patient’s condition and the goal of obtaining a positive clinical response. My early training in the field of manual medicine, naprapathy, taught me to develop a patient treatment plan that provided daily, biweekly, or triweekly patient care that was appropriate to the condition of the patient so that the patients chief complaint would be effectively treated and the patients signs and symptoms of disease would be addressed and corrected. A therapist who does not treat patient conditions, but rather provides relaxation or palliative care does not need to concern themselves with positive patient outcomes but a medical massage or medical manual therapist or an SMT practitioners who does treat patient conditions does need to be very concerned regarding achieving a clinical response. Not only does the patient deserve such an outcome but the self-esteem and the reputation of the therapist depend upon it. Patient Management Business Model In my early writings on the medical massage therapy practice model I outlined a patient management and financial business model that provided a cost-effective plan by which the therapist could treat patients’ multiple times per week at a fee that patients could afford to pay. Some of my graduates have established practices that have successfully established such a plan, and some have not. Many graduates of our training programs at the Blue Heron Academy and through American Health Source are simply utilizing the relaxation or general massage treatment and business model and are ensnared in the 60 to 90-minute massage therapy session and flat hourly fee. I view this approach as costly to the therapists, conducive to business failure, and as a significant cause of early therapist burnout and exiting the profession. This current relaxation or spa business model is not the original practice model seen in early medical massage and manual therapy. The spa model is an offshoot of the development in the late 1960’s and 1970’s of a new age form of massage based upon metaphysical practices and energy work. To those therapists who are successfully employing this model, helping people, and successfully deriving their livelihood from this work, congratulations to you. However, this is not the manual medicine or mechano-therapy that has historically been part of a patient centered health care system, nor is it the kind of therapy that is taught at the Blue Heron Academy, and promoted by American Health Source, the American Medical Massage Association, the American Manual Medicine Association, or more recently the Academy of Scandinavian Mobilization Therapy, all of which champion the practice of applied manual medicine. 1|Page
Our Naprapathic Historical Roots Much of the work that I have done in the area of manual medicine originated with the work of Dr. Oakley Smith, a medical researcher and early chiropractic practitioner and professor. I always attempt to acknowledge Dr. Smith’s work prior to talking about mine since so many of my theories, concepts, and procotols are based upon his brilliant work on connective tissue pathology and treatment. For those of you that do not know this, Naprapathy is derived from the Czech word napravit, which means to correct and Greek word pathos which means to suffer, and it is system of manual therapy or manipulative therapy that focuses on the evaluation and specialized treatment of neuromusculoskeletal conditions. Naprapathic practice means the evaluation of persons with connective tissue disorders through and palpation and it is the treatment of patients by the use of connective tissue manipulation, therapeutic and rehabilitative exercise, postural counseling, nutritional counseling, and the use of the effective properties of physical measures of heat, cold, light, water, radiant energy, electricity, and other assistive devices for the purpose of preventing, correcting, or alleviating a physical disability, condition or disease. Naprapathic practice includes, but is not limited to, the treatment of contractures, muscle spasms, inflammation, scar tissue formation, adhesions, lesions, laxity, hypertonicity, hypotonicity, rigidity, stiffness, structural imbalance, bruising, contusions, muscular atrophy, and partial separation of connective tissue fibers. Original naprapathy, or Oakley Smith Naprapathy, is based upon the late 1800’s and early 1900’s theories of Dr. Smith. Modern naprapaths have done little if anything to bring naprapathy into the 21st century. The study and practice of traditional naprapathy has remained the same since 1906. Scandinavian Mobilization Therapy adopts Dr. Smith’s theories regarding connective tissue pathology but has adopted evidence-based research and contemporary physiotherapeutic treatment methods. Women’s Health Issues Workbook The material in this workbook is directed towards the assessment and treatment of women’s health concerns and conditions and specifically techniques and protocols directed to the thoracic, abdominal, and pelvic regions. As such, extreme caution, and the highest ethical and professional standards and boundaries must be observed. Surgical draping must be performed to the highest level to protect both the patient and the therapist. No patient, whether, male or female, should receive these techniques and protocols without having signed and dated a written informed consent and release form. Minors, anyone under 21 years old, may not be touched, assessed, or treated in any way without the written release of a parent or guardian, and where possible a parent or guardian should be present in the treatment room during the treatment. Observe this recommendation where patient confidentiality does not supersede it. Do not mistake and do not accept a patient’s verbal agreement to constitute their acceptance of these techniques, or others that manually approach areas of caution, endangerment, or sensitivity. Verbal approval does not constitute legal acceptance and verbal approval can later be denied by the patient who may state that they did not understand your verbal description of the treatment of the technique applied to them. Always get approval in writing.
ABDOMINAL AND PELVIC ORGAN PTOSIS Clinical obesity and morbid obesity are found in 39.8% of Americans and affected about 93.3 million of US adults in 2015-2016. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. Hispanics (47.0%) and non-Hispanic blacks (46.8%) had the highest age-adjusted prevalence of obesity, followed by non-Hispanic whites (37.9%) and non-Hispanic Asians (12.7%). The prevalence of obesity was 35.7% among young adults aged 20 to 39 years, 42.8% among middle-aged adults aged 40 to 59 years, and 41.0% among older adults aged 60 and older. Obesity is associated with numerous secondary diseases and health conditions including displacement of, ptosis, of the abdominal and pelvic organs. The displacement of an organ adversely affects its function and health. Cardinal signs of organ displacement or ptosis is abdominal and central trunk obesity with a pendulous abdomen or abdominal apron. When you see abdominal and central trunk obesity with a slacking, weakness, distortion, and atrophy of the anterior and lateral abdominal and trunk muscles this is a sign of abdominal and pelvic organ displacement or ptosis. The slackening and atrophy of the male or female abdominal wall makes the diagnosis easy, while the retention of tone in the abdominal wall of men and women not only makes visceral ptosia rare but more difficult to diagnose. The typical enteroptosia occurs in conjunction with obesity, at any age, and when a lack of exercise and muscle tone has resulted in weakened core muscles. In a normal health person with a normal weight and percentage of body fat, as well as, condition of the abdominal viscera the internal organs share a balance positional relationship to each other, no nerve plexus is stretched or slackened, and function, secretion, assimilation, circulation and rhythm move without dysfunction. When dislocated organs pull or compress irregularly on the nerve plexuses, deranging secretion and assimilation, the pathology becomes results in derangement of nervous tone and circulatory function.
SMT MANUAL THERAPY ABDOMINAL TECHNIQUE The following techniques for the treatment of abdominal conditions were published in the Text Book of Osteopathy, American College of Mechano-Therapy, in 1910 and was taught to me in a modified form at the Chicago National College of Naprapathy in 1976. In the foreword of the textbook it states, “This treatise was written with a view of presenting to those interested in Physiological Therapeutics, and particularly in that branch known as Mechano-Therapy, a concise resume of the Practice of Osteopathy as now carried on by its foremost practitioners.” Early osteopathic and manual therapy treatment of the abdominal region was applied for the treatment of many pathological conditions and disorders. The following descriptive material is taken from the Text Book of Osteopathy and relates to the treatment of chronic constipation: “CONSTIPATION Definition - An infrequent or difficult evacuation of the feces. Causes - Persons of a bilious or nervous temperament are mostly subject to this condition. Sedentary habits, lack of exercise, prolonged mental work, and anxiety or worry are the most frequent causes. Irregular habits, diet and drugs and the constant use of cathartics are usually exciting causes. It may also be associated with other intestinal disorders. Symptoms - The abdomen is usually distended. A considerable amount of gas is passed, and often colicky pains are present. The symptom most prominent is absence of regular fecal evacuation. Associated with this disorder are coated tongue, bad taste in mouth, nausea, dizziness, belching of gas, fitful appetite and irregular pulse. A large fecal mass can usually be felt on inspection and palpation.” “Treatment – 1. Correct vertebral lesions. (The lower half of spine will usually be found the cause.) 2. Manipulate the liver by vibration and kneading. 3. Knead the bowels along the line of the colon. 4. Knead the abdomen. 5. Set the coccyx, if dislocated. 6. Dilate the sphincter ani with a rectal dilator. 7. Relax the muscles of the lower part of the back by proper measures. 8. Raise the lower ribs. 9. Extend the neck and neck muscles. 10. Apply vibration to the spine from the first to the fourth sacral vertebra. Diet - Drink plenty of water, buttermilk and acid beverages. Eat cooked fruits, vegetables and honey. Avoid too much starchy foods and sweets. Cases should be treated at least twice a week.” The following material and instructions taken from the Textbook of Osteopathy is a closer representation of the abdominal techniques that were taught at the Chicago National College of Naprapathy. 4|Page
â€œTREATMENT OF THE ABDOMEN 1. Place the patient on back with knees flexed. Relax the abdominal muscles with the palm of the hand. Begin low down on one side, work up on that side and repeat the movement on the other side. Spring the ribs. Move the abdominal contents from one side to the other between the palms of the hands. 2. Apply direct pressure to the abdomen with the flat of the hand over the center of the abdomen below the umbilicus. Use side pressure to force the contents of the small intestines toward the caecum. 3. Lift the intestines. Flex the knees several times, in the meantime holding the abdominal contents for a minute or two. 4. Stimulation of Solar Plexus. Apply deep, steady pressure with a slightly circular motion just below the sternum, backward and upward. 5. Stimulate the liver, spleen, stomach and other abdominal organs by placing one hand on either side of the ribs and applying pressure, alternated with a few seconds of rest. 6. Alternate pressure and relaxation directly over the liver for the purpose of toning up this organ, as well as the adjacent abdominal viscera.â€? The following abdominal technique protocol was taught at the Chicago College of Naprapathy (Chicago College of Naprapathic Medicine) in the mid to late 1970â€™s. Many years have passed since I learned these techniques and I may have modified what I was originally taught, but the techniques are as close as I can remember over forty years later. Abdominal Technique Protocol: Assessment - Assess the ileocecal valve to see if it is open or closed. If it is closed open it. 1. Begin circular compression over the central abdominal region and small intestine. Move the contents of the small intestines towards the ileocecal valve. 2. Massage the area directly over and lateral to the lower descending colon. 3. Massage the area directly over and lateral to the ascending colon. 4. Massage the area directly over and superior to the transverse colon. 5. Massage the area directly over and lateral to the descending colon moving towards the sigmoid. Organ Compression: (with the patient lying supine) 1. 2. 3. 4. 5.
Apply a palm heel compression over the solar plexus region. Apply a palm heel compression directly over the stomach, feel for fullness and arterial pulsing. Apply a palm heel compression directly over the liver and gallbladder region. Apply a palm heel compression directly over the spleen region. Apply a thumb or double deep pocket compression into the constipation point on the lower abdomen.
Therapeutic Exercise: (with the patient lying supine) With the in a supine position bring both knees to the abdomen (chest) and gently rock them against the abdominal muscles for several cycles, then rock them from side to side for several cycles. Continue this movement for up to two minutes. This repetitive movement stimulates the abdominal and pelvic nerves (mesenteric) and blood supply. It also tonifies the muscles, ligaments and fascia of the abdominal and pelvic regions. This treatment protocol should be performed every other day. In a case with lumbar abnormalities or disease of the lumbar spine, sacrum, coccyx and/or piriformis syndrome these conditions should receive standard SMT therapy. Early History of Manual Therapy Treatment of the Abdominal Region and Gastrointestinal Conditions: In the textbook by John Harvey Kellogg, M.D., The Art of Massage, published in 1895, Dr. Kellogg wrote the following which appears on page 396 of his book: “(2) Nerve Compression (Figs. 35, 76). - The stomach and the intestines are directly controlled by the solar plexus and the lumbar ganglia of the sympathetic. The solar plexus is at the epigastrium, just below the lower end of the sternum. The chief lumbar ganglia are situated on each side of the umbilicus, about two inches from it. Pressure upon these ganglia has a marked stimulating effect, because they send out energetic nerve impulses into the parts which they supply, which include not only the stomach and the intestines but all the abdominal viscera. It should be remembered that these nerve masses lie beneath the abdominal contents, resting upon the bodies of the vertebrae. It is hence necessary to make a considerable degree of pressure in order to reach them. The tips of the fingers, being placed upon the points indicated, should be carried directly back toward the spinal column, the patient in the meantime being directed to take first a full breath and then to exhale as completely as possible. This diverts the mind of the patient from the procedure which is being executed, and also diminishes the abdominal tension, thus making it less difficult to bring pressure to bear upon the posterior wall of the abdominal cavity. With patients who are extremely fleshy, and in cases in which the abdomen is greatly distended with gas, this procedure can be executed only in a very imperfect manner.” In his instructions Dr. Kellogg clearly outlines one of the reasons for abdominal and pelvic mobilization and its effects, and that is stimulation of the nerves that innervate the abdominal and pelvic viscera. Dr. Kellogg mentions the problems associated with “fleshy” patients and he suggests that abdominal obesity interferes with the correct application of manual therapy techniques. I would suggest that the application of abdominal and pelvic massage would be greatly assisted by placing the patient in a side lying position so that gravity will allow the skin, fat, perhaps flaccid muscles and connective tissues, and the small and large bowel to move away from the lateral aspects of the abdominal and pelvic contents, allowing deeper and somewhat less obstructed access to the underlying reproductive organs, major blood vessels, and nerve branches, trunks, and ganglia. I do not know whether utilizing a side lying position when employing abdominal and pelvic massage ever occurred to Dr. Kellogg, or the early medical massage therapists. I only know what I have read 6|Page
in books like The Art of Massage and other textbooks from the same era and what I was taught in the mid to late 1970’s by instructors, some of whom either practiced or trained in the late 1800’s to early 1900’s during what may have been the “Golden Age” of medical massage therapy. In an unrelated note, I once treated a patient of Dr. Kellogg’s who as a young girl lived for several years at the Kellogg Sanatorium in Battle Creek, Michigan. She related to me that she had been diagnosed as a child with Type 1 Diabetes and was “cured” of this disease by the massage, hydrotherapy, exercise, and dietary regimen provided at the sanatorium. I think that it is important to also share the following information from Dr. Kellogg’s book: “The following rules should be carefully observed in abdominal massage: 1. General abdominal massage should not be administered until two hours after eating. 2. The bladder, should always be emptied just before abdominal massage. 3. In obstinate cases of fecal accumulation, a coloclyster (large enema taken in right Sims's, or knee-chest, position) of warm water should be administered, the water being allowed to pass off before treatment. 4. The patient should be taught to relax the abdominal muscles, and to breathe deeply and regularly during treatment. 5. If the abdomen is very sensitive, apply a hot fomentation before giving the massage. 6. If the skin perspires very freely, render it firm and smooth by sponging with cold water. 7. Very "ticklish" patients require careful education by avoidance at first of superficial movements. 8. Pain and coldness of the extremities, or depression, after abdominal massage, is due either to bungling or violent treatment, or to extreme hyperesthesia of the abdominal sympathetic. In such cases, employ fomentations and the moist abdominal bandage in connection with massage. 9. It is important in all manipulations of the abdomen to exercise great care not to excite pain. All movements should be executed in such a manner as to avoid sudden thrusts, thereby causing the patient pain or other disagreeable sensations, as such disturbances create rigidity of the abdominal muscles, thus seriously interfering with the effects of the manipulations. 10. In applying massage to the abdomen, the operator should stand over the patient, so as to aid his hands, as far as possible, by the weight of his body, taking care, of course, to graduate the pressure to the requirements of each individual case. 11. All deep-kneading movements in massage of the abdomen should be slower than for other parts of the body, to allow time for movement of the fecal mass.” Dr. John Harvey Kellogg’s book The Art of Massage is available for purchase on Amazon as a Kindle book for $7.99.
GYNECOLOGY - DISEASES OF WOMEN- GENERAL TECHNIQUE SMT Treatment of General Reproductive Complaints of Women The above described abdominal techniques (protocol) with organ mobilization and compression is usually performed prior to the delivery of the gynecological protocol. In cases where the patient is acutely or chronically constipated evacuation of the bowels either through herbal, colonic hydrotherapy, or the application of the abdominal protocol is recommended prior to the execution of the gynecological techniques. The following technique(s) may be applied to a patient in either a right or left side lying position, prone or supine. Lumbar/Sacral Spinal Technique: 1. Begin at the appropriate spinal level and in accordance with the nerve outflow of the sympathetic and parasympathetic nerves. 2. Place the patient in a left side lying position and initiate treatment at the level of the first lumbar vertebra (unless assessment has determined that treatment at a higher level is needed. 3. Moving from the spinous process of the first lumbar vertebra compress your fingers as deeply as possible into the spinal erector muscles and stretch them upward and away from the spine. Mobilize the muscles as far as possible away from the center line of the spine. 4. Complete this technique for every vertebral level from the first lumbar vertebra to the last sacral vertebra (the five fused levels of the sacrum). 5. Beginning again at the level of the first lumbar vertebra perform standard SMT bony lever technique to the lumbar vertebral to the fifth lumbar vertebra. 6. Move the patient into a right side lying position and repeat the same techniques from the level of the first lumbar vertebra to the last sacral vertebra using both the muscle mobilization technique and the SMT bony lever technique. 7. In a side lying position apply compression to the sacrum while mobilizing the superior leg in a posterior direction (hip extension). 8. In a prone position apply a double finger compression in the laminar grove along both sides of the spine. This technique may be applied from the cervical region to the first sacral segment. 9. In a prone position apply a double palm compression on the sacrum. 10. To stimulate sacral nerve and ganglia outflow, apply vibratory technique to the sacrum and the soft tissue on both lateral aspects of the sacrum. Sympathetic and Parasympathic Nerve Function in the Pelvic Region: The splanchnic nerves are paired visceral nerves (nerves that contribute to the innervation of the internal organs), carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers). All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympathetic fibers. Visceral afferent fibers go to spinal cord following pathway of pelvic splanchnic nerve fibers. In the distal 1/3 of the transverse colon, and through the sigmoid and rectum, and the cervix in females, the pelvic splanchnic nerves supply parasympathetic function, including transmitting the sensation of pain. The pelvic splanchnic nerves, S2-4, work in tandem to innervate the pelvic viscera. Unlike in the cranium, where one parasympathetic is in charge of one particular tissue or region, for the most part 9|Page
the pelvic splanchnic nerves each contribute fibers to pelvic viscera by traveling to one or more plexuses before being dispersed to the target tissue. These plexuses are composed of mixed autonomic nerve fibers (parasympathetic and sympathetic) and include the vesical, prostatic, rectal, uterovaginal, and inferior hypogastric plexuses. The preganglionic neurons in the pathway do not synapse in a ganglion as in the cranium but rather in the walls of the tissues or organs that they innervate. The fiber paths are variable and each individual's autonomic nervous system in the pelvis is unique. The visceral tissues in the pelvis that the parasympathetic nerve pathway controls include those of the urinary bladder, ureters, urinary sphincter, anal sphincter, uterus, prostate, glands, vagina, and penis. Unconsciously, the parasympathetic will cause peristaltic movements of the ureters and intestines, moving urine from the kidneys into the bladder and food down the intestinal tract and, upon necessity, the parasympathetic will assist in excreting urine from the bladder or defecation. Stimulation of the parasympathetic will cause the detrusor muscle (urinary bladder wall) to contract and simultaneously relax the internal sphincter muscle between the bladder and the urethra, allowing the bladder to void. Also, parasympathetic stimulation of the internal anal sphincter will relax this muscle to allow defecation. There are other skeletal muscles involved with these processes but the parasympathetic plays a huge role in continence and bowel retention. A study published in 2016, suggests that all sacral autonomic output may be sympathetic; indicating that the rectum, bladder and reproductive organs may only be innervated by the sympathetic nervous system. The sympathetic and parasympathetic nerves in the pelvic region regulates activities pertaining to the following body functions: 1. Sensation and pain 2. Blood flow to organs â€“ (Uterine blood flow is increased with parasympathetic stimulation and it is decreased with sympathetic stimulation. 3. Reproductive and sexual activity (sexual arousal is parasympathetic stimulation and ejaculation is sympathetic stimulation) 4. Urination Parasympathetic stimulation 5. Defecation â€“ Parasympathetic stimulation Nitric oxide and uterine receptors and relaxation: Nitric oxide (NO) is a potent smooth muscle relaxant in blood vessels, the gastrointestinal tract and the respiratory system. Recent evidence has shown that NO has a relaxant (tocolytic) effect on myometrium. NO is produced within the female genital tract during pregnancy, and a reduction in NO synthesis may be involved in the initiation of parturition. Furthermore, the administration of NO donors may be useful in inhibiting uterine contractions in situations where such activity is unwanted, e.g., in preterm labor. NO is also produced in the myometrium in the nonpregnant state and has potential roles in the treatment and the prevention of dysmenorrhea. General Uterine Anatomy: The uterus is made up of three special layered linings of tissue and muscle. The innermost layer is called the endometrium. After the onset of puberty, the endometrium lines the main body of the uterus and is where a fertilized ovum implants at the earliest moment of pregnancy. It provides a nesting place with immediate nutrition for the fertilized egg. If a woman is not pregnant, this lining is not needed, so it separates from the uterus and leaves the body as the menstrual flow 10 | P a g e
during the menstrual period. This process is repeated monthly. Immediately a new lining begins to form in case a pregnancy occurs during the woman's next cycle. Except during a pregnancy or some abnormal circumstances, this series of events continues uninterrupted from puberty to menopause. The second layer is called the myometrium. This gives the uterus its great strength and elasticity. The myometrium contracts during the birth process and forces the fetus out of the uterus into the birth canal. The third layer is called the perimetrium. It is a thin external covering for the other two layers. The uterus is held loosely in place in the pelvic cavity by several sets of ligaments: the broad ligament, the round ligament and the uterosacral ligament.
11 | P a g e
12 | P a g e
SMT MANUAL THERAPY THORACIC TECHNIQUE The techniques to follow were taught to me by Dr. Stewart at the Chicago National College of Naprapathy sometime during 1976. In Dr. Stewarts introduction to the technique he stated that the procedure was “an old osteopathic” technique for treating various conditions affecting the thoracic regions, ribs, and lungs including injury or fractured ribs, strains and sprains to the thoracic region, as well as, breathing disorders to include asthma, emphysema, and COPD. I regularly employed thoracic technique on my patients in my practice of manual medicine and expanded the technique to include patients with restricted breathing related to smoking. In later years, and in my role as the Director of Continuing Education for the American Naprapathic Association, I discovered that (to my knowledge) no one in the naprapathic profession was utilizing this technique or anything like it. Apparently, I was the only student in Dr. Stewart’s class that was paying attention the day that he taught this technique and protocol! This does not surprise since many of my naprapathic associates focused almost solely on treatment of the spine and mimicked chiropractic adjustment techniques as opposed to applying naprapathic technique as presented by Dr. Oakley Smith, the founder of naprapathy. On pages 380 through 384 of the above aforementioned book by Dr. Kellogg we see a description of what was a typical treatment protocol that would have been performed by a medical massage therapist trained in “Swedish” massage. “Massage of the Chest. - Order of movements: 1. Friction - centripetal (very light). 2. Fulling (carefully). 3. Friction. 4. Palmar kneading. 5. Percussion - tapping, hacking, spatting, beating, clapping (for very fleshy persons only) 6. Assistive and resistive respiratory movements. To assist expiration, compress the sides of the chest during expiration, or raise the arms outward and upward with inspiration. To resist inspiration, place one hand upon the abdomen, causing the patient to lift it upward by the inspiratory movement, making at the same time a degree of pressure adapted to the patient's condition; or a shot-bag may be used instead of the hand (Fig. 72). To resist expiration, have the patient breathe through a small tube (Fig. 72) or through a small opening in the lips. In massage of the chest, great care should be observed that the patient breathes properly. The patient should be taught the proper mode of chest and waist expansion in breathing (Fig. 73). Few women know how to expand the lower part of the chest. Patients should be made to inspire through the nose, and to take deep and slow respirations.” 13 | P a g e
In the early 1980’s homeosomatic medical manual therapy system adopted many of the techniques and mobilization described in the above material written by Dr. Kellogg. However, the techniques employing friction, percussion, and assistive and resistive respiratory movements were all taught by Dr. Stewart. Again, he stated that he learned these techniques from “an old osteopath”. The actual origin of the original thoracic technique is unknown to me. Thoracic (Rib) Technique: 1. Place the patient in a comfortable supine position on the table. 2. Place pillows or bolsters under the head and neck and knees of the patient. 3. Some patients may require a large firm bolster or wedge under their knees and legs and some patients may require additional pillows or support under their upper back, neck, and head to increase their elevation. 4. Beginning at the lower accessible ribs, vertebra-chondral ribs, ribs 10 and 9, place the palms of both hands on the right and left side of the rib cage. 5. Address as many contact points between the 10th and 9th ribs as is possible. Make firm but comfortable bony lever contacts between these two ribs. 6. Instruct the patient to take in a slow, even, deep breath while raising their arms above their head. Instruct the patient to breath and move at their own pace and to not strain or force their breathing on the inhalation or the exhalation. 7. As the patient inhales and raises their arms deepen your approach and bony lever contact between the 10th and 9th ribs. This technique spreads or opens the space between the two ribs. 8. Once you have achieved a firm but comfortable contact between the 10th and 9th ribs instruct the patient to slowly exhale and to lower their arms. 9. Do not release your pressure or remove your hands from their position, as the patient exhales resist the return of the two ribs to their normal closed position. Keep the ribs open. 10. In the open position slowly and firmly “bounce” or further stretch the intercostal muscles to maintain and to increase the space between the ribs. 11. Hold and maintain this open position for as long as is necessary to stretch the intercostal muscles. 12. Move to the space between the 9th and 8th ribs and repeat the entire sequence of mobilizations described above. 13. For men, repeat this technique up the rib cage and until you can no longer make effective contact between two sets of ribs. Ribs higher, more superior, may be accessed more efficiently in a side lying position. 14. For women, use extra draping across the breasts, use a heavy towel and or a weighted bag to hold the toweling and draping in place. Instruct women in how to drape themselves and where to place a towel and/or the weighted bag. Avoid all contact with the breast. 15. For women, repeat this technique up the rib cage until just below the patient’s breast tissue. Do not make contact with the breast. 16. For women, to apply rib technique you may chose to treat women with large breasts in a side lying position with surgical draping and towels applied to the lateral aspect of the rib cage. 17. An alternative method of addressing, stretching and opening the upper rib cage, perhaps the intercostal spaces between the 4th and 3rd, 3rd and 2nd, and 2nd rib to the clavicle, use the contact points on the spaces between the thumb and the 1st finger (index). This technique may be used on both men and women but with women use surgical draping and extra heavy 14 | P a g e
toweling over the breast region. DO NOT REST YOUR HAND ON THE UPPER BREAST TISSUE OR TOUCH THE UPPER ASPECT OF THE BREAST. 18. The intercostal stretching and opening techniques may be applied in a supine, side lying, or prone position. In all positions the technique is applied in the same manner utilizing bony lever contact points between the ribs. 19. The next technique in the protocol is the application of â€œpetrissageâ€? or worming between the intercostal muscles of each rib. This is a very slow and detailed process. It cannot be hurried. 20. Now apply percussion techniques to the entire rib cage (in women avoid the breast tissue) the primary percussion techniques that may be employed are pounding and cupping. 21. At this stage of the treatment apply rib springing compression to the lateral aspects of both sides of the rib cage. 22. The next stage is the application of assistive and resistive respiration mobilization as the patient is instructed to slowly inhale and exhale. 23. The patient should be taught proper abdominal breathing and diaphragmatic breathing with the diaphragmatic lift. 24. At this point in the treatment protocol the patient can receive a castor oil pack to the thoracic area. In men, apply the pack to the anterior and posterior chest region, in women apply the pack to the posterior and lateral back and thoracic areas. 25. After the patient has received castor oil pack therapy remove the access castor oil by briskly rubbing the skin with a towel(s). 26. As the final stage of the treatment protocol apply a friction rub and/or vibratory technique to the thoracic region, anterior (avoid female breast tissue) lateral, and posterior.
15 | P a g e
16 | P a g e
GYNECOLOGY - DISEASES OF WOMEN- GENERAL TECHNIQUE SMT Treatment of General Reproductive Complaints of Women The above described abdominal techniques (protocol) with organ mobilization and compression is usually performed prior to the delivery of the gynecological protocol. In cases where the patient is acutely or chronically constipated evacuation of the bowels either through herbal, colonic hydrotherapy, or the application of the abdominal protocol is recommended prior to the execution of the gynecological techniques. The following technique(s) may be applied to a patient in either a right or left side lying position, prone or supine. Lumbar/Sacral Spinal Technique: 11. Begin at the appropriate spinal level and in accordance with the nerve outflow of the sympathetic and parasympathetic nerves. 12. Place the patient in a left side lying position and initiate treatment at the level of the first lumbar vertebra. 13. Moving from the spinous process of the first lumbar vertebra compress your fingers as deeply as possible into the spinal erector muscles and stretch them upward and away from the spine. Mobilize the muscles as far as possible away from the center line of the spine. 14. Complete this technique for every vertebral level from the first lumbar vertebra to the last sacral vertebra (the five fused levels of the sacrum). 15. Beginning again at the level of the first lumbar vertebra perform standard SMT bony lever technique to the lumbar vertebral to the fifth lumbar vertebra. 16. Move the patient into a right side lying position and repeat the same techniques from the level of the first lumbar vertebra to the last sacral vertebra using both the muscle mobilization technique and the SMT bony lever technique. 17. In a side lying position apply compression to the sacrum while mobilizing the superior leg in a posterior direction (hip extension). 18. In a prone position apply a double finger compression in the laminar grove along both sides of the spine. This technique may be applied from the cervical region to the first sacral segment. 19. In a prone position apply a double palm compression on the sacrum. 20. To stimulate sacral nerve and ganglia outflow, apply vibratory technique to the sacrum and the soft tissue on both lateral aspects of the sacrum.
17 | P a g e
18 | P a g e
HOMEOSOMATIC LYMPHEDEMA TECHNIQUE UPPER EXTREMITY The lymphedema techniques and protocols to follow are modified and expanded from the methods that I was taught at the Chicago National College of Naprapathy in the mid to late 1970’s and prior to my completion of the four-year naprapathic doctoral program and the one-year internship. Upon leaving the college of naprapathy I joined Dr. James Schleichert in a sixty-year-old practice in Evanston, Illinois I became to apply the original modified Vodder lymphedema technique that I was taught at the college. I say “modified” because as I continued my naprapathic practice and met massage therapist claiming to be using Vodder technique I quickly realized that the techniques that I had been taught were radically different from those commonly practiced by therapeutic massage therapists. As I evaluated the methods used by “Vodder” certified practitioners I was profoundly unimpressed with their abilities and formed the opinion that the Vodder method for lymphedema treatment was too superficial to be of much value. I greatly appreciated the techniques taught to me at the naprapathic college and over several decades of clinical practice I have built upon them. As we continue our review of women’s health issues, we need to examine homeosomatic lymphedema techniques for the upper extremities, axillary area, anterior chest, and descending cervical chain, as well as, the combined treatment protocol for this region and conditions such as edema, pain, inflammation, adhesions, and scar tissue. Lymphedema Treatment Protocol: Fluid movement in the human body is governed by many interacting and complex factors. Some of these factors are chemical and others obey the laws of physical mechanics. Fluid commonly accumulates around joints causing soft tissue swelling, discomfort or pain, and interference with the normal function of the affected joint. When fluid accumulates in the interstitial spaces in between joints, the large areas of soft tissue mass, basic lymphedema techniques involving elevation, progressive soft tissue compression, and contraction and relaxation of the muscle tissue will readily stimulate movement of fluid through the lymphatic vessels. However, the joint complex because of its bony architecture is resistant to compression technique. Therefore, other forces of physics must be employed. To effectively stimulate the movement of fluid out of the joint complex region Repetitive Movement Technique is utilized. Repetitive Movement Technique simply involves the repetitive movement of a joint in accordance with its primary plane of motion. This movement of the joint encourages accumulated fluid in and around the joint to move out of the joint capsule, and the interstitial spaces and into the venous or lymphatic systems. Fluid reduction results in the following: 1. 2. 3. 4. 5. 6.
Less hydraulic pressure on the soft tissue structures Reduction in pain or discomfort Improvement in joint range of motion Reduction in inflammation Improvement in the normal circulatory processes of the joint complex Reducing the stress on the joint complex
These benefits of Repetitive Movement Technique are important objectives in the goals of patient rehabilitation. It is only through the step-by-step application of this medical massage treatment protocol that a serious impact can be made on significant lymphedema.
19 | P a g e
20 | P a g e
Repetitive Movement Technique: Step One The affected extremity or joint is elevated to at least a minimum of 20 degrees. This elevation is necessary to encourage fluid drainage toward the major lymphatic collection centers where the collected fluid is processed back into the vascular system. Step Two With the extremity/joint elevated, begin to repetitively move the joint through its prime direction of movement. Repetitions are performed slowly. The movement of fluid out of the joint capsule and out of the interstitial spaces is a slow process. The therapist will need to allow several minutes for the combination of elevation and repetitive motion to result in a clinical response. Step Three In a joint that has more than one plane of motion the therapist may choose to repetitively move the joint through all range of motion movements. Also, to alternate movement through the various ranges of motion and passive joint motion for several minutes. Step Four Leave the joint and extremity in an elevated position and begin the next procedures: a. Progressive capillary Propulsion b. Muscular contraction and relaxation Elevation: Water generally flows to the lowest point. The purpose of using elevation in lymphedema technique is to use this principle of physics to aid in movement or flow of body fluids from the most distal points to the centrally located lymphatic collection centers. It is important to understand that in this procedure there are many physiological processes involved; some mechanical and some metabolic. In lymphedema therapy, we are attempting to encourage the flow of lymph fluid through the lymph vessels. We are, also, attempting to stimulate a reduction in interstitial fluid accumulation. The movement of fluid in the lymph vessels is hydraulic, but the interstitial fluid exchange system is metabolic. Mechanical and hydraulic systems can be relatively easily affected by manual techniques. Metabolic processes only occur at a predetermined rate. Mechanical techniques can encourage and stimulate homeostasis but will not overstimulate natural systems. Synthetic drugs, such as diuretics can and do over stimulate the bodies fluid balance systems resulting in eventual cell and tissue damage and failure. Progressive Capillary Propulsion: Most systems of manual lymph drainage contain compression techniques that encourage the movement of fluid from the distal portion of an extremity toward the lymph collection centers and the heart. This system uses the same principle. Progressive Capillary Propulsion describes the process of capillary action. Once we begin to apply a progressive, compressive, squeezing manual technique from the distal end point of the extremity toward the lymph collection centers, the molecular movement of the fluid tends to draw additional fluid along in a process called capillary action. 21 | P a g e
Muscular Contraction and Relaxation: The primary method by which lymph fluid moves through the lymph system is through muscular contraction which propels the fluid through the lymph vessel. Within the lymph vessels are one-way valves that, when intact, prevent a back flow of lymph fluid. By using a patient assisted active muscular contraction and then muscle relaxation, in between the manually applied Progressive Capillary Propulsion technique, we utilize the muscular system to assist in the movement of lymph. This combination procedure is more effective than simple elevation and squeezing alone. Manual Technique – The Ringing and Squeezing Method Various hand techniques may be employed for the purpose of encouraging lymph flow through the lymphatic system. Some hand techniques involve using the edge or palm of a single hand and applying an intermittent compression or pumping action. The technique of ringing, that is, surrounding the extremity with the hands (as much as the circumference of the extremity or area will allow) and applying a squeezing compression of the soft tissue is recommended. This technique is a two-handed technique. The ringing and squeezing compression is applied from distal to proximal and usually requires several repeated applications. In order to maximize the flow of lymphatic fluid toward the lymph collection sites, this should be done three to four times. Manual Technique – Thoracic Pump Both the thoracic and abdominal regions receive and process most of the lymphatic fluid in the body. The thoracic lymphatic duct, or left thoracic duct processes the lymphatic fluid from all but the right chest, arm and head. To perform the thoracic pump technique, the therapist stands at the head of the patient and places both hands on the right and left upper chest regions. The hands are placed just above the breast area. The therapist applies a firm compressive pressure, resistance, to the right and left chest when the patient inhales. Since lymphatic fluid moves in the thoracic cavity, when inspiration creates a negative intra thoracic pressure you are assisting lymph movement with this procedure. Resist the inhalation through the inhalation cycle and repeat this procedure ten to twelve times. Therapeutic Modality – Vibration, Light, and Medicated Liniment The use of a small handheld low frequency vibrator directly over chains of lymph nodes will open assist with the movement of fluid through the node. Research studies have shown that the lymph drainage will be active all the way till 15-30 Hz of vibration frequency, on the higher side. But as the machine vibrates slower, the lymph drainage improves. This is because the lymph nodes, with a slower vibration rate, have enough time to open, drain and close down in the process of lymph drainage. Low power light therapy such as that provided by the Bioptron light therapy system in the red-light frequency (600 Hz) has been found to reduce edema and discomfort in patients. An alcohol based medicated liniment combining alcohol, aloe vera juice, and witch hazel has been shown to reduce skin damage, inflammation, and infection will cooling the area and causing some analgesic effects.
22 | P a g e
TISSUE STIFFNESS, SCAR TISSUE AND ADHESIONS Adhesions are scar tissue and are usually the result of injury (such as a cut or blunt force trauma), surgery, radiation, infection or chronic inflammation. Inflammation may be either specific, due to a pathogenic organism, or general in the case of chronic inflammation. Adhesions are sometimes due to mechanical irritation of one serous surface when opposed to another under undue pressure. An example of this is when a retroverted uterus becomes adherent to the posterior wall of the pelvis. As further examples may perhaps be placed, those cases in which the pelvic colon is found adherent to the uterus or bladder. If chronic constipation is a factor and the pelvic colon is often distended with feces and from pressure the opposed serous surfaces may become irritated, abraded and then adherent. The colonic bacillus, as well as, streptococci and staphylococci found in the colon, may also play a part in these processes. These adhesions vary all the way from gossamer-like films and spider web threads, easily broken by slight traction, to sheets and cords of organized tissue which it is impossible to rupture without serious damage to the organs to which they are attached. Viscous lymph may become adherent to the ovary and an ovarian or a tubo-ovarian abscess (severe PID) may form. The ovary may escape, direct involvement only to be surrounded and covered by this fibrinous exudate which as it organizes, and contracts not only interferes with the rupture of the mature ovarian follicles but may compress the ovary. Because of the inflammation of its peritoneal covering the ovary may become closely adherent to all other peritoneal surfaces which come in contact with it. Should the stroma of the ovary become involved a true ovarian abscess, even to the size of 5 to 10 millimeters may develop. This may cause an atrophic or "cirrhotic" ovary may result. The ovarian function is now damaged, if not destroyed, and severe symptoms may arise particularly with the onset of the menstrual congestion. The inflammation may extend further causing a more or less extensive peritonitis. If this is fibrinous in nature and sufficiently extensive, the coils of intestines in the pelvis will become adherent to the pelvic organs. If purulent, in addition, there will be one or a number of small collections of pus within the pelvis. These collections of pus may be found to lie among the adherent organs or may have even burrowed into the connective tissue. The picture is now one of general pelvic inflammation, salpingitis, plus ovaritis or per-ovaritis, plus peritonitis, plus cellulitis - with the involved tissues bathed in and infiltrated by pus and agglutinated with fibrinous exudate. Should a progression of this pathogenic condition occur and pass into a stage of chronicity, there would be found a conglomerate mass in one or both sides of the pelvis composed of tube, ovary, peritoneum, connective tissue and perhaps coils of intestines and adhesions. The fibrinous exudate of the acute stage has followed its natural course of organization and contracture and is now binding these deformed and distorted tissues together in some abnormal position. If the connective tissues in the uterine ligaments were affected in the acute stage, these, too, have contracted (shortened) and have drawn the uterus into some malposition. In severe cases with extensive involvement the resulting contracture may have almost obliterated the ligaments and connective tissues and left the uterus immovably fixed in a displaced position. The disastrous effects of this condition upon the blood and lymphatic vessels which so freely traverse this connective tissue is easily imagined. As connective tissue, following its inflammation, is organized into scar tissue with its inevitable contracture, blood vessels are obliterated, and vital functions are correspondingly disordered. The same is true of the lymph channels. They, too, disappear and 23 | P a g e
proper nutrition and drainage become impossible. Even more important is the involvement of the nerve tracts and plexuses. Interwoven as they are through this connective tissue and in turn permeated by it, if by any means they escape destruction in the acute attack, they are subject to continuous pressure and tension and distortion by the unrelenting grip of the contracting tissues. It also seems possible that adhesions might result from long continued passive edemic congestion with stagnation of lymph fluid. The presence of a low-grade infection in the interstitial spaces may be a causative factor as well. Certainly, it is well demonstrated in imaging studied and surgical videography that a hallmark of endometriosis is the formation of significant amounts of abdominal and pelvic scar tissue and adhesions. It may be appropriate to consider that a disruption of function of the abdominal and pelvic sympathetic and parasympathetic nervous system function adversely affects the physiological functions of the abdominal and pelvic organs, and not only the organs but secretion, peristalsis, circulation, and lymph drainage and fluid dynamics. Disruption of the motor, secretory, circulatory, and lymph drainage and fluid dynamics could be a factor in irritation and inflammation of fascia and serous membranes covering the organs. There may well be a vaso-motor component to the development of scar tissue and adhesions in the abdominal and pelvic regions. When it is suspected that there may be a vaso-motor component to a patientâ€™s chronic inflammation and resulting scar tissue and adhesions manual therapy as described on pages and eight and nine should be performed and directed at the lumbar and sacral ganglia, sympathetic and parasympathetic outflow. The therapy is achieved by manual therapy compression techniques directed into and over the ganglia. In the thoracic region, the anterior chest wall, axillary area, and the breast, especially where there is chronic inflammation, lymphedema, or lymph fluid stasis, inflammation may be the cause of tissue stiffness, pain and discomfort. When a patient has been subjected to surgery, mastectomy, and radiation scar tissue, adhesions, and chronic inflammation are often the hallmark. Rarely, is a female patient referred for manual therapy for the reduction of scar tissue, adhesions, and chronic inflammation. If the female patient does receive any form of post-surgical therapy it is either because the surgery resulted in limited range of motion in one or both shoulders, thoracic scar tissue that adheres to the shoulder area preventing full range of motion, and/or lymphedema in one or both upper extremities. Fibrocystic Breast Disorder or Changes Fibrocystic breast disorders or changes is thought to affect 50 percent of all women with over 3 million women currently suffering from the disorder. This condition is related to changes in a womenâ€™s hormonal cycle but is also known to be related to a lack of physical activity that results in blood and lymph stasis in the breast tissue. During the hormonal changes that occur before, during and after menstruation fragments of dying and broken cells and inflammation may lead to scarring (fibrosis) that damages the ducts and the clusters (lobules) of glandular tissue within the breast. The inflammatory cells and some of the breakdown fragments may release hormone-like substances that in turn act on the nearby glandular, ductal, and structural support cells causing broader inflammation and fibrosis. The amount of cellular breakdown 24 | P a g e
products, the degree of inflammation, and the efficiency of the cellular cleanup process in the breast vary from woman to woman. The scenario described above can and does also occur in the pelvic region and affects the uterus, ovaries, and the surrounding eliminative organs.
25 | P a g e
GYNECOLOGY - DISEASES OF WOMEN- HERBAL MEDICINE Five Botanical Medicines for the Treatment of Reproductive Complaints of Women There are four single herbs and one combination formula that deserve investigation relative to the treatment of womenâ€™s gynecological disorders, and they include: 1. 2. 3. 4. 5.
Tang Kuei/Tang Kuei 4 Cinnamon and Hoelen Motherwort Chaste Tree Berry Saw Palmetto
Tang Kuei or Angelica sinensis: Tang Kuei or Angelica sinensis, commonly known as dong quai or "female ginseng" is a herb from the family Apiaceae, indigenous to China. Tang Kuei is one of the most popular Chinese herbal medicines, known for its use in the treatment of a wide variety of gynecological conditions that are generally not easily treated with conventional therapies, such as uterine fibroids, ovarian cysts, endometriosis, and infertility. "Dang gui is especially important because it fills a therapeutic niche not readily addressed in Western conventional or herbal medicine," said Roy Upton, AHP executive director. "It has been used successfully for several hundred years for a broad range of gynecological conditions and can help broaden therapeutic options for women beyond hormone replacement therapies and hysterectomies. Hopefully, increased use of dang gui and its appropriate formulas will help to eliminate at least a portion of the 600,000+ hysterectomies performed annually in America." Effects Vasodilatation Uterine muscle relaxant Contains vitamin E Adverse effects The herb contains furanocoumarin, which renders the skin photosensitive. May cause loose stools Drug interactions Angelica sinensis may increase the anticoagulant effects of the drug warfarin (as it contains coumarins and consequently increase the risk of bleeding.
26 | P a g e
Cinnamon and Hoelen: Ingredients Gui Zhi, cinnamon twig, cassia twig Ramulus Cinnamomi Cassiae Cinnamon twig’s spicy delicious taste stimulates blood flow in the lower abdomen. Fu Ling, sclerotium of tuckahoe, China root, hoelen, Indian bread Poria Cocos “Blood stagnation” the herb (fu ling, or hoelen) is thought to increase blood flow and to reduce edema in tissue. Bai Shao, white peony root, peony Paeoniae Radix alba Thought to have analgesic properties beneficial for PID, PMS and endometriosis or fibroids. Tao Ren, peach kernel, persica Persicae Semen [don’t use if pregnant] This is another very potent “blood moving” herb commonly used to regulate menstrual flow, and by extension female hormones. Mu Dan Pi, moutan root bark, tree peony root bark Cortex Moutan Radicis Moutan is the bark of the root of the peony tree. Benefits Supports blood circulation Cools temporary hot flashes Regulates the menstrual cycle Supports vaginal health Relaxes pre-menstrual tension Diuretic Adverse effects – Never experience any in clinical use Possibly constipation Dose Use 2-4 capsules three times per day. Drug interactions – Possible conflict with diuretic medications.
Motherwort 27 | P a g e
Traditional uses of motherwort, emphasized its use as a calming and relaxing herbal agent with tonic effects on hormonal, nervous, and cardiac systems. It was long been classified as a hypotensive nervine, capable of both relaxing the blood vessels and calming nervous tension while restoring energy in those with “nervous exhaustion.” For its ability to correct the action of the heart from varied causes, it is often referred to as a cardiotonic. Leonurus cardiaca contains monoterpenes, diterpenes, triterpenes, nitrogen-containing compounds, phenylpropanoids, flavonoids and phenolic acids, lectins, and phytosterols as well as volatile oils, sterols, and tannins. Quality Leonurus products should contain at least 0.2% flavonoid, often standardized to hyperoside content. In addition to these ubiquitous compounds, Leonurus contains iridoid glycosides such as leonuride and the alkaloids leonurine, leonurinine, and stachydrine, all credited with medicinal effects. Effects – Motherwort (Leonurus cardiaca) is known as a cardiac tonic and women's health tonic. It helps to regulate the menses, it promotes blood circulation, stimulates the development of new tissues, is a diuretic and helps to reduce swelling. Cardiotonic Antispasmodic Nervine Adverse effects – Leonurus is considered safe and not associated with any known toxicity or side effects. Dose – Leonurus capsules will usually contain between 200 and 500 mg of dried herb, and this herb is generally considered safe at high doses up to 2 g/day. Drug interactions – Possible problems with cardiac medications such as beta blockers but no research exists to show this.
Chaste Tree Berry 28 | P a g e
Vitex agnus castus has been used for centuries to treat menstrual, menopausal, and fertility disorders in women, and it is a valuable medicine to consider in a broad treatment protocol for PCOS. Vitex is also known as monk’s pepper, a name that stems from the use of its peppercorn-like fruits to help maintain chastity in men’s religious orders. Vitex has a long history of use in formulas to treat premenstrual syndrome, mastalgia, male gynecomastia, adolescent acne, amenorrhea, ovarian cysts, hot flashes, bleeding irregularities, and menopausal complaints. Vitex agnus castus fruits contain flavonoid glycosides such as casticin, vitexin, penduletin, orientin, and apigenin; the iridoid compounds aucubin, agnuside,5 agnucastosides A, B, and C, mussaenosidic acid, and hydroxybenzoylmussaenosidic acid7; and labdane diterpene alkaloids such as vitexlactams A, B, and C8 and clerodadienol. Vitex influences dopaminergic transmission. It also regulates prolactin, follicle-stimulating hormone, and luteinizing hormone (LH), which may regulate testosterone levels, as well as levels of other reproductive hormones. Vitex has also been shown to bind opiate receptors, which in turn promotes dopamine activity. Effects – Vitex can increase progesterone levels and reduce elevated prolactin and testosterone levels, all of which contribute to the restoration of regular menstruation in women with amenorrhea. Stress, elevated estrogens, and thyrotropin-releasing hormone18 can promote prolactin release, which may suppress ovulation and lead to amenorrhea. Vitex reduces elevated prolactin helping to restore menstrual regularity and improve fertility. Adverse effects – Vitex is generally well tolerated, the main side effects being nausea and gastrointestinal irritation, dizziness, dry mouth, headache, menstrual disorders, acne, pruritus, and erythematous rash, all of which reversed upon cessation of the medication. Vitex is presumed to be contraindicated in pregnancy and lactation, although evidence for its impact on lactation is contradictory.23 Given that Vitex affects numerous hormones, it is advisable to avoid it during pregnancy until more evidence is available. Dose – Traditionally, 20–1800 mg/day of the crude herb powder in divided doses is used. Doses from 4 to 40 mg of the extract have been used in clinical trials. Drug interactions – No herb–drug interactions have been reported, but it is possible that Vitex may have additive effects if combined with dopaminergic drugs or interfere with the action of dopamine antagonists.
Saw Palmetto 29 | P a g e
Serenoa repens or Saw Palmetto extracts have been used for centuries in the treatment of benign prostatic hyperplasia. Classic herbal books and folkloric traditions report Serenoa to be a genitourinary tonic in both sexes. Serenoa berries contain fatty acids known collectively as liposterols and named individually as lauric, oleic, myristic, and linoleic acids. All of these fatty acids have been shown to inhibit the 5 alphareductase enzyme, found in the adrenal glands (and in men, the prostate as well) that converts testosterone into its most active form, dihydrotestosterone. Women with hirsutism and elevated testosterone may have excessive 5 alpha-reductase enzyme activity. Male pattern baldness, also known as androgenic alopecia in men, and thinning of the hair in women may also be initiated and promoted when 5 alpha-reductase is up regulated. Saw palmetto has been shown to promote hair growth compared to placebo in men with androgenic alopecia, and the herb might benefit women as well. Serenoa is indicated for benign prostatic hyperplasia, polycystic ovarian syndrome, and hormone imbalances (estrogen or testosterone). It promotes genitourinary health in both sexes, improves libido and sexual vigor, and chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Effects – Saw Palmetto may help reduce elevated androgens and prolactin typically seen in women with PCOS. Animal studies show Saw Palmetto to block prolactin receptors on ovarian cells overexpressing prolactin receptors. Environmental toxins can disrupt reproductive development and function by both mimicking and inhibiting endogenous steroids contributing to infertility, polycystic ovarian syndrome, hormonal cancers, thyroid disease, and other ailments. Adverse effects – There has been an anecdotal report of a single incidence of cholestatic hepatitis in a patient using Saw Palmetto, however dosage ranging within normal human dosage (9.14 or 22.86 mg/kg/body weight/day) did not elevate liver enzymes or any other biomarkers of liver toxicity in rats. There is no information on the safety of Saw Palmetto in pregnancy or lactation in the scientific or traditional literature. Dose – Dosage: 160 to 450 mg twice daily of an extract containing 45-95% fatty acids. Drug interactions – Saw Palmetto may interact with pharmaceuticals via cytochrome p450 effects.
GYNECOLOGY - DISEASES OF WOMEN- ACUPUNCTURE
30 | P a g e
Acupuncture Sedation/Tonification for the Treatment of Reproductive Complaints of Women One of the prior strategies of medical acupuncture for the treatment of womenâ€™s reproductive organ complaints is to apply either sedation to calm the sympathetic/parasympathetic nervous system and tonification to balance all physiological functions, nervous, circulatory, lymphatic, and hormonal. The acupuncture points to follow are the acupuncture/acupressure tonification points. You may use needles (with medical delegation and supervision), acupressure, laser, or press tacks or pellets on these points.
Acupuncture/Acupressure Tonification Points: 31 | P a g e
LU 9 Taiyuan (Large Deep Abyss): at the tip of the wrist crease, in the depression on the radial side of the radial artery (avoid the artery) (Shu-Stream, Yuan and Earth Point) Influential point for Vessels. P 9 Zhongchong (Middle Impulse): at the midpoint of the tip of the middle finger or 0.1 cun proximal to the nail bed of the middle finger on the radial side (Jing-Well, Tsing, and Wood Point). HT 9 Shaochong (Minor Impulse): on the radial side of the tip of the little finger, 0.1 cum proximal to the corner of the nail bed (Jing-Well, Tsing, and Wood Point). SI 3 Houxi (Posterior Brook): at the end of the main transverse crease of the palm, proximal to the 5th metacarpo-phalangeal joint when the hand is clenched (Shu-Stream and Wood Point). TH 3 Zhongzhu (Center of the Small Island): on the back of the hand, between the 4th and 5th metacarpal bones, in a depression proximal to the metacarpo-phalangeal joint (Shu-Stream, and Wood Point). LI 11 Quchi (Pond on the Curve): in a depression at the lateral end of the elbow crease when the elbow is half flexed (He-Sea and Earth Point). SP 2 Dadu (Big City): on the medial side of the great toe, distal to the 1st metatarso-phalangeal joint, at the junction of the "white and red" skin (Ying-Spring and Fire Point). LIV 8 Ququan (Spring in the Curve): at the medial end of the transverse crease of the knee joint, in a depression at the anterior border of the semimembranosus and semitendinosus muscles (He-Sea and Water Point). KI 7 Fuliu (Re-established Flow): 2 cun above KI 3 on the anterior border of the Achilles tendon (JingRiver and Metal Point). BL 67 Zhiyin (Outer Yin): on the lateral side of the little toe, 0.1 cun proximal to the corner of the nail bed (Jing-Well, Tsing and Metal Point). GB 43 Xiaxi (Intermediate Brook): between the 4th and 5th metatarsal bones, 0.5 cun proximal to the margin of the web (Ying-Spring and Water Point). ST 41 Jiexi (Relax Cramp): on the midpoint of the dorsum of the foot at the transverse malleolus crease between the tendons of extensor digitorum longus and hallucus longus (Jing-River and Fire Point). Source: Dr. John Amaro, International Medical Acupuncture Association
32 | P a g e
About your seminar presenter Dr. Gregory T. Lawton is the author many books, most of them in the area of health science. In 1980 he founded the Blue Heron Academy a state licensed vocational school that offers classes in traditional and conventional health care and has trained over 12,000 students. Dr. Lawton is a licensed chiropractor, licensed naprapath, and a licensed acupuncturist and a graduate of the National College of Naprapathic Medicine, the National University of Health Sciences, and the International Medical Acupuncture Association. All rights reserved. No part of this program or its content shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from Dr. Gregory T. Lawton, the American Manual Medicine Association, and American Health Source, Incorporated. Gregory T. Lawton, D.N., D.C., L.Ac., D.Ac. The Blue Heron Academy of Healing Arts and Sciences 2040 Raybrook SE, Suite 104 Grand Rapids, Michigan 49546 888-285-9989 Toll Free 616-285-9999 616-956-7777 www.blueheronacademy.com firstname.lastname@example.org Every effort has been made to ensure that permission has been obtained for use of text references herein. If any required acknowledgement has been omitted or any rights overlooked please notify the publishers and omissions will be rectified in future editions.
33 | P a g e
The workbook was written for a Scandinavian Mobilization Therapy workshop presented at the Blue Heron Academy of Healing Arts and Sciences
Published on Apr 16, 2019
The workbook was written for a Scandinavian Mobilization Therapy workshop presented at the Blue Heron Academy of Healing Arts and Sciences