Acupuncture treatment for diaphragm muscle damage after peptic ulcer surgery

INTRODUCTION

The diaphragm is a muscle located in the base of the thorax, serving two main functions– inspiration and separating the abdominal and thoracic cavity. During some chest and abdomen surgeries the muscle can be accidentally damaged and cause pain and other severe symptoms.¹ The diaphragm muscle can be also damaged during some motor-vehicle accidents or blunt abdominal traumas, causing phrenic nerve injury, diaphragmatic rupture, hernia or paralysis. However, these injuries are relatively rare and most of the damages are congenital. Most of the injuries occur in male patients. Most frequently is involved the left hemi-diaphragm than the right, because of the liver protecting effect.^2-4 The most common symptoms that may occur in diaphragm muscle damage are: abdominal pain, pain in the left upper quadrant or the chest, respiratory distress, dyspnea, nausea, vomiting, insomnia, fatigue, etc.⁴ The diaphragmatic dysfunction causes are divided in two groups:

• • Anatomic causes – congenital (Morgagni, Bochdalek hernia) and acquired (trauma, injuries, surgery damages) defects.
• • Neurologic causes – phrenic nerve injuries, brain stem stroke, muscular disorders, spinal cord injuries, myasthenia gravis, multiple sclerosis, radiation therapy and etc.⁴

As a treatment option, western medicine suggests only surgical repair. Some severe conditions may also require ventilator support.⁴ However, before starting every treatment a good examination must be done and get a correct diagnosis. When working with patients, every detail should be taken in consideration. The mistakes of the practitioners may have very bad consequences and may be fatal. Iatrogenic conditions are unacceptable and inexcusable.

Acupuncture treatment as part of the Traditional Chinese Medicine (TCM) has shown through the years that it’s very effective treatment for pain, especially muscle pain.⁵ The treatment can successfully relieve the chronic pain, relax the muscles, relieve the stress, engage the immune system, promote fresh blood through the affected area, speed up the recovery and healing of the damaged tissue.^6,7

CASE REPORT

The treated patient is a 46 year old male, bulldozer driver, with constant pain variable in intensity, difficulty in breathing, dyspnea and nausea for 14 years. Because of the constant pain the patient was unable to sleep, stressed and anxious all the time. Other parameters were normal – blood sugar, blood pressure, appetite, no previous injuries, respiratory and cardiovascular functions were okay without previous diagnosis. The pain and the symptoms occurred after peptic ulcer surgery. The pain was located in the upper abdomen below the ribs in the epigastric region and in the spine area at the level of Th6, Th7 and Th8 vertebrae. The diaphragm muscle was damaged during the surgery and not spotted and treated post-operatively. Instead, the patient was given wrong diagnosis for chronic pancreatitis and was taking Tramadol, Ketonal and Zaracet for 14 years. The treatment started on 5^th of May 2017 in our clinic for Traditional Chinese Medicine and acupuncture. Treatments were done indoor, on a room temperature, with duration of 35-40 minutes. Treatments were done once weekly with normal (dry) acupuncture with fine sterile disposable needles made by Wuijuiang City Medical and Health Material Co., LTD, size 0.25×25 mm². The patient immediately felt better after only one treatment. After three treatments the patient was totally pain-free and all the accompanying symptoms were gone. Acupuncture points that were used in the treatment are: Du8 (JinSuo), Du6 (JiZhong), Du7 (ZhongShu), Du20 (BaiHui), Li6 (PianLi), Ki16 (Huangshu), Rm4 (GuanYuan), Rm11 (JianLi), St36 (Zusanli), Sp6 (SanYinJiao) and Lv3 (TaiChong).

DISCUSSION

Diaphragm muscle is as any other muscle, when injured it hurts and depending on the area it causes mild or severe symptoms. When the diaphragm muscle is injured, it produces pain in the chest area, abdominal area, nausea, vomiting, shortness of breath, etc. If only the pain is taken into consideration, at first sight it can be confused with chronic pancreatitis. But if correct analysis is made, with complete anamnesis, considering the previous surgery, with blood test analysis and abdominal ultrasound imaging it is not possible to confuse muscle pain from organ dysfunction. To be treated for a wrong diagnosis for 14 years is a big injustice and omission.

Once the damage is done, what follows is to put all the effort into finding the root cause and improving the situation. All acupuncture points that were used in the treatment are carefully selected with purpose to support the patient’s body and help to heal on its own. The points are located on the back, head, lower extremities and on the abdomen. Their main functions are to calm the pain, spasms, tremors, seizures, epigastric pain, abdominal pain, for excessive Yang in the upper body, Yang energy imbalances, anxiety, insomnia, nausea, irritability, etc. The treatment has a positive effect not only locally but also generally on all well-being. It helps in resolving stagnation, tonifies the Yin, balances the energy, calms the spirit, nourishes the blood, Yin and Yang, strengthens the organs, relieves the pain, benefits the brain and expels all pathogenic factors like wind, cold, heat and dampness.

In the Chinese medicine the diaphragm muscle is called Gé.⁸ The diaphragm plays very important role in our body, because all the main meridians go through it and it has the ability to control the flow of the energy that goes throughout the body. Because it represents a gateway between the lower and upper parts of the body, its job is to regulate the descending and ascending functions of the body i.e. to transport the blood, Qi and fluids to all body parts and nourish all organs. The diaphragm is also a place where the unconscious emotional tensions are stored. When under high stress and emotional intensity, the muscle bounds down and gets rigid and the whole body goes out of balance. The energy in the diaphragm can be also disrupted when taking some depression medication.^9,10 When the muscle is damaged, it’s not working properly and the breathing is constricted. This means that the heart doesn’t get enough fresh oxygen and the body constantly starves for fresh healthy oxygen and Qi.¹¹ Therefore, when we treat the diaphragm with acupuncture we aim to correct the Yin/Yang energy, bring its balance back, relax and open the diaphragm, release the pain and all tensions, warm up and invigorate the blood and revitalize all the organs.

CONCLUSION

Acupuncture is always effective treatment when done by well-trained and experienced practitioner. With correct diagnosis and proper treatment we succeeded to help our patient to relieve him from the long-lasting pain for a very short time.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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