TCM Case Work-Up

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file number located on the patient’s folder.

Patient File Number: 004 Intern Name: Huiying Chin

Date of Treatment:6/25/21 Clinic Day/Time: Fri 11:15 Supervisor Signature: Stacey F

Synopsis:
32 F acupuncture student.
MC: Stress and anxiety, asked for support for her pacemaker surgery next week for hypertrophic
cardiomyopathy.
Patient runs hot all over her body. Frequently feeling anxious and worrisome since childhood.
Weekly temporal headaches and rare migraines, pain is achy and throbbing. She takes ibuprofen to relieve
it.
Mild seasonal allergies (itchy throat since she moved to CA and back here a year ago). Tight chest,
palpitations, shortness of breath, difficulty to take full inhale/breaths, not triggered by exertion, can
happen anytime. Takes beta blocker for the cardiomyopathy. No exercise routine. Good appetite, two
meals a day, usually skips breakfast, if not, she eats a breakfast smoothie, prefers warm meals. Pescatarian
at home, sometimes eats meat outside. Feels bloated and gassy after dinner and wakes up feeling gassy.
32-40 day cycle, 7 days scanty period that gets spotty to the end, no clots. Cramps during the onset for 36
hours, relieved by ibuprofen. Never taken birth control.
Easy to fall asleep, a few insomnia episodes a month, usually sleeps from 2am to 9am, takes a long time to
wind down. Sleeps in on weekends. Anxiety creeps in after lights out.
Itchy scalp after hair is wet through sweat or showers. Dry skin patch on upper back since young –
moisturizes it.
Daily BM, complete, formed but sometimes sticky.
Wakes up feeling 5/10 and energy dips after dinner, big breakfast also makes her feel tired.
Stress 5/10. Father-in-law passed away suddenly last year, stress from partner’s family.
Muscle tension in posterior neck and upper shoulder muscles.

Pulse: Due to tech issues with UP server, did not have time to take pulse.

Diagnostic categories with signs and symptoms to support each category:

Hot: Heat over body
Cold: Loose stools
Excess: Cramps, headaches, bloatedness, gas, chest tightness
Deficiency: Shortness of breath, palpitations, dry skin/scalp, low energy
Exterior: Seasonal allergies
Interior: Heart palpitations, shortness of breath, chest tightness, anxiety, worry, dry skin

Diagnosis based directly on above diagnostic categories (include a diagnosis for each MC/SC):
Heart yin and blood deficiency – Palpitations, heat, chest tightness, shortness of breath, anxiety, worry
Lung qi deficiency – Shortness of breath, seasonal allergies, itchy scalp/skin

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Spleen qi deficiency – Fatigue after meals, gas, bloatedness, sticky stools, worry, low energy, long cycles,
long menses
LV qi stagnation – Stress, muscle tension in neck and upper shoulder, cramps, temporal headaches
GB channel stagnation – temporal headaches related to LV blood deficiency
Blood deficiency – scanty period, long cycles, dry skin, itchy scalp
Kidney qi deficiency – difficulty taking full breaths inhales, low energy

Explanation of Diagnosis:
According to CAM, the heart houses the mind. When the heart is deficient, the mind tends to be anxious
and restless. The 71st chapter of the Spiritual Pivot says, “The heart is the residence of the spirit.”

Deficiency of the heart qi and heart yang. Both deficiency of the heart qi and deficiency of the heart
yang may exhibit palpitations and shortness of breath, which become worse on exertion,
spontaneous sweating and a thready, weak pulse or a missed-beat pulse.

Etiology and pathology: They are usually caused by gradual declining of the heart qi after a long
illness, damage of yang qi by an abrupt severe disease or weakness of the qi of zang due to old
age or to congenital deficiency. Insufficiency of the heart qi or heart yang implies weakness of the
heart in propelling the blood, which explains palpitations and shortness of breath. As exertion
consumes qi, they become worse on exertion. Insufficiency of blood in the vessels ' due to
weakness of blood circulation leads to a thready and weak pulse. A missed-beat pulse is
produced by discontinuation of the< qi of vessels due to weakness of the heart in propelling the
blood. In case of deficiency of qi and yang, the muscles and body surface fail to be controlled,
spontaneous sweating results. Deficiency of qi leads to hypofunction of zang-fu organs, bringing
on listlessness and lassitude.

Both deficiency of the heart blood and deficiency of the heart yin may manifest as palpitations,
insomnia, dream-disturbed sleep and poor memory. If there are also pallor, pale lips, dizziness
and vertigo, a pale tongue and a thready and weak pulse, this suggests deficiency of the heart
blood. The accompaniment of mental restlessness, dryness of the mouth, heat sensation in the
palms, and soles, tidal fever, night sweating, a red tongue and a thready and rapid pulse
indicates deficiency of the heart yin. Etiology and pathology: They often result from a weak body
constitution, asthenia after a long illness or mental irritation which consumes the heart blood and
heart yin. Insufficiency of yin blood deprives the heart of nourishment, leading to palpitations
and poor memory. Disturbance of the mind results in insomnia and dream-disturbed sleep.
Blood deficiency with inability to newish upwards may produce dizziness and vertigo, pallor,
pale lips, and a pale tongue. The insufficient blood in the vessels is the cause of a thready and
weak pulse. Insufficiency of the heart yin produces deficiency type heat in the interior, which
causes mental restlessness, dryness of the mouth, heat sensation in the palms and soles, malar
flush, tidal fever, night sweating, a red tongue and a thready and rapid pulse.

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Palpitations, with red zygomatic area, night sweats, irritability and five-palm heat, scant tongue
coating, and thin rapid pulse. - Insufficiency of heart yin resulting in production of deficient heat.
- Heart yin deficiency

Insomnia is generally caused by yang qi failing to enter the yin system, and the mind failing to
become calm. Difficulty falling asleep, irritability, dream-disturbed sleep, tidal fever, night
sweats, and soreness and flaccidity of the loin and knees. - Insufficiency of kidney yin (water) in
the lower body with stirring upward of heart fire - Noninteraction of heart and kidney

Insomnia (also known as sleeplessness) can manifest as difficulty in falling asleep, waking up
frequently during the night, interrupted sleep, sleeplessness throughout the night and
dream(nightmare)-disturbed sleep.
Deficiency patterns of insomnia are often caused by yin blood deficiency of the heart, spleen and
kidneys, and excess patterns of insomnia by fire, heat, phlegm and food retention affecting the
heart, gallbladder and stomach.

There are three points that should be noted: First, the heart houses spirit and serves as the
monarch organ, so damage to other zang-organs may inevitably involve the heart. Whenever
there are abnormal emotional changes, the heart will be the first to be influenced, marked by
palpitation, forgetfulness, vexation, insomnia or constant laughter. Second, clinically the heart,
the liver and the spleen are the most susceptible ones to abnormal emotional changes; for
example, excessive thinking will weaken the heart and spleen, leading to palpitation,
forgetfulness, night sweat, lassitude, anorexia and insomnia, etc.

Contemplation is attributed to the spleen, but as early as the period of Nei Jing, it has already
been noticed that contemplation is closely associated with the heart. Prolonged indulgence in
contemplation may disturb heart qi, often bringing on palpitation, amnesia, insomnia and
dreaminess, etc.

The disorders of the heart yang and the heart qi are mainly manifested as relative exuberance or
relative debilitation of heart yang qi.
(1) Relative exuberance of the heart yang qi is, in essence, the hyperactivity of the heart fire which
is marked by either excess or deficiency. Pathogenic heat, phlegmatic fire or emotional
depression may lead to excess fire; while mental overstrain may damage the heart yin and blood,
leading to hyperactivity of deficiency fire. Clinically they are interchangeable, manifested in the
following aspects.

Uneasiness of the heart spirit: yang qi is characterized by ascending and moving, so hyperactivity
of the heart yang may disturb the spirit, leading to restlessness or hyperactivity of the heart sprit
such as palpitation, vexation, insomnia, dreaminess, talkativeness, and even ravings. Hastened
blood flow driven by heat. Exuberance of heart yang produces heat while excess of heart qi
generates fire, leading to accelerated circulation of blood inside the vessels with the symptoms of

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palpitation, fluster, rapid pulsation, reddened tongue with prickles, or even bleeding due to
deviated flow of blood driven by heat.

The relative debilitation of heart yang is related to other viscera such as the lung and kidney.
Since both heart qi and lung qi are related to the pectoral qi, deficiency of heart qi may involve
the lung qi by impairing the pectoral qi. Since deficiency of heart yang is developed on the
insufficiency of heart qi, so deficiency of heart yang may involve the lung qi with the
manifestations of weakened respiration, wheezing, palpitation and unsmooth blood flow, etc.
Besides, if the deficiency of heart yang persists, the kidney yang may be involved, leading to
deficiency of both with the manifestations of overflowing of water like edema, or panting with
inability to lie flat and palpitation due to water qi attacking the heart.

2. Disorders of heart yin and heart blood are mainly manifested as insufficiency of heart yin,
consumption of heart blood and stagnation of heart blood, etc
(1) Insufficiency of heart yin, or deficiency of heart yin, is mostly due to mental overstrain,
prolonged malnutrition and impairment of heart yin; or due to emotional depression
transforming into fire which consumes the heart yin; or due to hyperactivity of liver fire or heart
fire scorching the heart yin, and so on. Deficiency of heart yin is characterized by yin deficiency
and yang hyperactivity with the manifestations of feverish sensation over the five centers,
reddish complexion, night sweat, dry mouth and throat, reddened tongue, and thin-rapid pulse,
etc. Another aspect of deficiency of heart yin is marked by uneasiness of heart spirit due to
weakened action of tranquilization, manifested as restlessness, insomnia, and spiritual
uneasiness, etc.
(2) Consumption of heart blood, or depletion of heart blood, is mostly due to excessive loss of
blood or inadequate production of blood, or insidious consumption of heart blood by fires
transformed from emotional depression, etc. Deficiency of blood is marked by insufficient blood
inside the vessels due to malnutrition with the manifestations of thin and feeble pulse, etc.
Besides, it is also accompanied by general blood deficiency manifested as pale and lusterless
complexion, mental and physical lassitude, and pale tongue and lips, etc. Another aspect of
deficiency of heart blood is marked by mental derangement due to malnutrition of heart spirit,
manifested as listlessness, distraction, absentmindedness, insomnia, dreaminess, palpitation or
even fright and terror, etc.

The Relationships Between the Heart and Kidney

The relations between the heart and kidney can be discussed in terms of yin-yang and water-fire.
The heart, located above the kidney, pertains to fire and yang, while the kidney, located below
the heart, pertains to water and yin. From the ascent-descent theory of yin-yang and water-fire,
the heart fire must descend to reach the kidney and the kidney water must ascend to arrive at the
heart. Only by doing so can they maintain the balanced physiological functions. That is why we
say “coordination between heart and kidney” and “inter-promotion between water and fire.”
Pathologically, if the heart fire cannot reach the kidney and the kidney water fails to arrive at the
heart, there will be imbalanced conditions such as “disharmony between the heart and kidney”

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and “discordance between water and fire,” clinically marked by insomnia, palpation, vexation,
weak loins and knees, nocturnal emission in males and dreamed coitus in females, etc.

1. Overwork. This covers three aspects: excessive physical work, excessive mental work or sexual
indulgence. This is marked by impairment of qi and direct damage to the involved organs and
tissues, and is manifested as lassitude, shortness of qi and long-term fatigue, or sourness,
distension and weakness in the laboring regions. Excessive mental work refers to over thinking,
which may impair the heart and spleen, characterized by palpitation, insomnia, anemia,
indigestion, anorexia and loose stool, etc. Sexual indulgence refers to excessive sexual activities,
marked by weak knees and loins, dizziness and tinnitus, and reduced sexual function, etc.

Treatment Principle based directly on above diagnosis (include a treatment principle for each MC/SC):
Stress and anxiety – calm the shen and relieve liver stagnation
Tonify Heart
Tonify Spleen
Tonify Lung Qi

Pool of points, adjunctive techniques: with clear reasons for using each, what method and what adjunctive
techniques will be used:
SP4 and PC 6 – Strengthen spleen and heart, moves blood in chong EV
LU7 and KD6 – tonify Yin and kidney
LV3 and LI4 – Four gates – relieve qi stagnation
GB40 and LV5 – GB channel stagnation host guest combination
CV 6 – tonify qi
CV 12 – tonify stomach
ST 36 – tonify blood and qi
HT 7 – tonify heart blood, heart yin
LU 9 – tonify lung qi
Yin Tang – calm the shen
LV 8 – Tonify LV blood
SP 6 – tonify blood and yin channels
BL13 – Lung Shu
BL14 – Jueyin Shu
BL15 – Heart Shu
BL18 – Liver Shu
BL23 – Kidney Shu
BL20- Spleen Shu

Citation in support of diagnosis:

Information/quote, Author, Book Title (italics), Edition (if applicable), City of Publisher: Name of Publisher; Year of
Publication, (page numbers)

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 Chen Xinnong, Chinese Acupuncture and Moxibustion 3rd Edition, Beijing, Foreign Languages Press
1987, (289-292)
Chen Ping, Diagnosis in Traditional Chinese Medicine, Taos, New Mexico, Complementary Medicine Press,
2004 (70-73 pain)
Hong-zhou Wu, Zhao-qin Fang, Pan-ji Cheng, Chou-ping Han, Introduction to Diagnosis in Traditional
Chinese Medicine, Hackensack NJ, World Century Publishing Corporation, 2013 (255 back pain)
Hong-zhou Wu, Zhao-qin Fang, Pan-ji Cheng, Ye-Bo He, Fundamentals of Traditional Chinese Medicine,
Hackensack NJ, World Century Publishing Corporation, 2013

Treatment Plan: #4 of treatments for 4 weeks, then re-evaluate.

Prognosis: Patient is young and motivated in her self-care. Good prognosis.

Research Article Summary (Article 1)

Title Acupuncture Reduces Hypertrophy and Cardiac Fibrosis, and Improves Heart Function in Mice with
Diabetic Cardiomyopathy
Author/s Yumei Ye, Yochai Birnbaum, Steven G. Widen, Zhaohui Zhang, Shipeng Zhu, Mandeep Bajaj &
Huan Chen
Journal Cardiovascular Drugs and Therapy

Publication Date 07 August 2020

Key Findings (at least 200 words)

Purpose
To assess the effects of electro-acupuncture (EA) on glycemic control, myocardial inflammation, and
the progression of diabetic cardiomyopathy in mice with type 2 diabetes.

Methods
Db/Db mice received EA at PC6+ST36 (DM-Acu), non-acupoint simulation (DM-Sham), or no treatment
(DM). EA was applied for 30 min per day, 5 days a week for 4 weeks. Heart function was assessed by
echocardiography. Myocardium was assessed by RT-PCR, immunoblotting, and histology. Serum TNF-α,
IL-1α, IL-1β, IL-6, and IL-8 were measured.

Results
DM-Acu, but not DM-Sham, reduced fasting blood glucose without affecting body weight. DM
decreased systolic function. DM-Acu, but not DM-Sham, attenuated the decrease in systolic function.
Heart weight was significantly smaller in the DM-Acu than in the DM and DM-Sham groups. Percent
fibrosis and apoptosis were reduced in the DM-Acu, but not the DM-Sham, group. Serum levels of IL-
1α, IL-1β, IL-6, IL-8, ICAM-1, MCP-1, and TNF-α were significantly lower in the DM-Acu than in the DM
or DM-Sham groups. Protein levels of P-Akt and P-AMPK and mRNA levels of phosphoinositide-3-kinase
regulatory subunit 6 (PIK3r6) were significantly higher in the DM-Acu group. Myocardial mRNA and
protein levels of insulin-like growth factor 1 receptor (IGF1R) were significantly lower in the DM and

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DM-Sham groups compared with the DM-Acu group.

Conclusions
EA reduced serum glucose; prevented DM-induced hypertrophy and deterioration of systolic function,
inflammation, and fibrosis; and restored IGF1R, P-Akt, and P-AMPK levels in mice with type 2 diabetes
mellitus.

Application to your case (Article 1)

How might you incorporate the information in this article into your care of the patient? (at least 300 words)
It is interesting that they did electro-acupuncture on PC6 and ST36 for glycemic control, myocardial
inflammation and diabetic cardiomyopathy.

I want to look into trying electro-acupuncture for cardiomyopathy in human trials and treatment as a
possibility. It is interesting that treating these two points can help reduce blood glucose in mice without
affecting body weight. It also reduced heart weight and prevent hypertrophy of the heart in mice.

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Research Article Summary (Article 2)

Title The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A
Systematic Review and Meta-Analysis
Author/s Bingxue Liang, Cui Yan, Lu Zhang, Zhonqi Yang, Lingjun Wang , Shaoxiang Xian, and Lu Lu

Journal Evidence-Based Complementary and Alternative Medicine

Publication Date 20 Oct 2019

Key Findings (at least 200 words)

Background. Acupuncture and moxibustion (A&M) has been used for treating heart failure in China
since the Han Dynasty. This ancient therapy can be applied to many diseases according to the WHO
recommendations. Although there are many clinical reports on the treatment of heart failure by A&M,
its effectiveness is still not fully demonstrated. We aimed to systematically review the related
randomized controlled trial (RCT) studies and conduct a meta-analysis. Methods. The PubMed,
MEDLINE, EMBASE, AMED, CENTRAL, CNKI, Wanfang, and Weipu databases were searched
electronically until December 2018. The data were extracted, and the risk of bias was evaluated. Meta-
analysis, subgroup analysis, and metaregression were performed. Heart function was the main
outcome assessed. The details of the intervention were also investigated. Results. Thirty-two RCTs
involving 2499 patients were included. Most studies had an unclear risk regarding blinding and
allocation concealment. Compared with the traditional treatment group, the experimental group had a
higher efficacy rate (odds ratio (OR) = 2.61, 95% confidence interval (95%CI): = [1.84; 3.72], I2 = 0%, )
and a significantly improved left ventricular ejection fraction (LVEF) (mean difference (MD) = 6.34,
95%CI = [4.11, 8.57], I2 = 93%, ), cardiac output (CO) (MD = 1.02, 95%CI = [0.65, 1.39], I2 = 94%, ), 6-
minute walk test (6MWT) (MD = 43.6, 95%CI = [37.43, 49.77], I2 = 0%, ), and reduced brain-type
natriuretic peptide (BNP) (MD = −227.99, 95%CI = [−337.30, −118.68], I2 = 96%, ). Adverse events were
inadequately reported in most studies. Conclusions. A&M may be a promising intervention as an
adjunctive therapy to medication for treating heart failure. However, the evidence was inconclusive.
Further large and rigorously designed RCTs are needed for verification.

Application to your case (Article 2)

How might you incorporate the information in this article into your care of the patient? (at least 300 words)

In the discussion of the paper, analysis of the acupoint groups included in the present study revealed that
the most commonly used acupoints for the clinical treatment of HF were Neiguan, Shenmen, and Back-Shu
points.

They explained it as: Neiguan is located in the pericardium meridian of hand Jueyin, and its afferent
neurons are mainly C5∼T1 spinal ganglion, converging with the cardiac afferent nerves at the C8∼T1 spinal
cord. Shenmen is located in the Shaoyin heart meridian of the hand, and its afferent neurons are located in
the T1∼T3 spinal ganglion, converging with the visceral afferent nerve that innervates the heart in the
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posterior horn of the upper thoracic medullary segment. Therefore, heart disease can be induced to the
body surface of the medial area of the upper limb, and acupuncture of heart meridians can affect heart
function. Back-Shu acupoints are very close to the dorsal root of spinal nerves, and the distribution law is
roughly consistent with the segmental distribution characteristics of spinal nerves. Back-Shu acupoints can
adjust somatic sensory nerve endings and sympathetic nerve endings and then act on the nerve center of
the corresponding segment of the spinal cord to adjust the visceral function. Additionally, these acupoints
can be transmitted to the brain by somatosensory fibers and visceral sensory fibers, realizing the benign
adjustment of the whole body by the connection of downward conduction fibers related to the brain.

So I will focus my point prescription on PC6, HT7 and back shu points as well.

Several implications of this review are presented for future research and practice. First, the single
treatment time and the number of treatment times have different effects on the improvement of cardiac
function. Follow-up clinical studies can set up treatment course groups to clarify the correlation. Second,
many studies lack long-term follow-up. As a physical therapy with low side effects, acupuncture is suitable
for long-term application, but no studies have observed the survival curve of acupuncture in the treatment
of HF.

Thus, I will try and keep my treatment strategy more consistent for a few treatments to observe the
treatment course and establish a mid to long-term follow up observation period. I hope that I can observe
and adjust my treatment strategy with patient’s compliance and regular treatment schedule.

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Research Article Summary (Article 3)

Title Acupuncture for Treatment of Insomnia: A Systematic Review of Randomized Controlled Trials

Author/s Huijuan Cao, M.D., Ph.D.(Cand.), Xingfang Pan, M.D., Hua Li, M.A.(Cand.), and Jianping Liu,
M.D., Ph.D.
Journal Journal of Alternative and Complementary Medicine

Publication Date 2009 Nov

Key Findings (at least 200 words)

Background
Acupuncture is commonly used in treating insomnia in China, and clinical studies have shown that
acupuncture may have a beneficial effect on insomnia compared with Western medication.

Methods
We included randomized controlled trials on acupuncture for insomnia. We searched PubMed, the
Cochrane Library (2008 Issue 3), China Network Knowledge Infrastructure (CNKI), Chinese Scientific
Journal Database (VIP), and Wan Fang Database. All searches ended in December 2008. Two authors
extracted data and assessed the trials' quality independently. RevMan 5.0.17 software was used for
data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95%
confidence interval (CI).

Results
Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality
of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-
analyses showed a beneficial effect of acupuncture compared with no treatment (MD −3.28, 95% CI
−6.10 to −0.46, p = 0.02; 4 trials) and real acupressure compared with sham acupressure (MD −2.94,
95% CI −5.77 to −0.11, p = 0.04; 2 trials) on total scores of Pittsburgh Sleep Quality Index. Acupuncture
was superior to medications regarding the number of patients with total sleep duration increased for
>3 hours (RR 1.53, 95% CI 1.24–1.88, p < 0.0001). However, there was no difference between
acupuncture and medications in average sleep duration (MD −0.06, 95% CI −0.30–0.18, p = 0.63).
Acupuncture plus medications showed better effect than medications alone on total sleep duration
(MD 1.09, 95% CI 0.56–1.61, p < 0.0001). Similarly, acupuncture plus herbs was significantly better than
herbs alone on increase of sleep rates (RR 1.67, 95% CI 1.12–2.50, p = 0.01). There were no serious
adverse effects with related to acupuncture treatment in the included trials.

Conclusions
Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous
designed trials are warranted.

Application to your case (Article 3)

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How might you incorporate the information in this article into your care of the patient? (at least 300 words)
According to the review, the top 10 points used for acupuncture treatment of insomnia are:
HT 7, GV20, SP17, Anmian, EX-HN1, Du 24, PC 6, KD 6, EX-HN3, ST36
For auricular treatment, the top five points used wereL TF4, AT4, AH6n, C015, C012

I will consider incorporating these points in my treatment course/strategy.

In this review, Outcome measures include duration and quality of sleep, such as total sleep duration and
increased sleep duration, Pittsburgh Sleep Quality Index (PSQI) scores, Index of Severity of Insomnia, Sleep
Quality, and other validated scores, as well as adverse effects. I want to try some of them in my intake
follow up as consistent outcome measures to track my treatment plan’s efficacy. I usually ask my patient
how long it takes them to fall asleep, I will start asking how long do they stay asleep and if they noticed any
change in their sleep quality.

As the authors explained, since insomnia may wax and wane with or without treatment, a longer follow-up
period with serial measurement of outcomes is important to determine the effectiveness and long-term
effect of acupuncture. I will also track my patient with a consistent treatment plan over a longer
observation period to measure efficacy and outcomes of my treatment strategy.

Biomedical How does the patient’s biomedical diagnosis inform your approach to treatment?
Diagnosis
(For example, are there any points or herbs you are avoiding? Are there ways in which the patient is
limited in the types of treatment they can receive? Are there ways in which you are coordinating care
with other treatment providers?) (at least 200 words)

Hypertrophic cardiomyopathy. Patient is scheduled for a pacemaker surgery in a few days after
treatment.

I researched a few cases of patients with pacemaker who received electroacupuncture and the
research all supported the use of EA despite having a pacemaker.

Case 1: Electroacupuncture on a Patient with Pacemaker: A Case Report

The case is described of a 50-year-old female patient, who has had severe low back pain resistant both
to conventional and unconventional treatment methods. The only treatment that seemed to have
some positive effect, but of extremely short duration, was acupuncture. Her condition deteriorated
considerably, and after due consideration she was treated with EA. Even after the first EA treatment,
the patient's condition improved. Since then, she has received many EA courses during the past 2 years
without any complications or side effects. The results of this case study suggest that EA might be a safe
alternative for patients with a pacemaker, confirming the current recommendations on use. Every
patient should be considered with care, individually.

Case 2: The Influence of Low Frequency Acupuncture on a Demand Pacemaker

Various complications with demand pacemakers have been known to originate from their own sensing
mechanisms. In these complications, electromagnetic interference is one of the well known causes of
oversensing with demand pacemakers. The influence of low frequency acupuncture as a specific type
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of electromagnetic interference on a demand pacemaker was examined during a cervical operation. It
was found that low frequency acupuncture is a cause of electromagnetic interference with demand
pacemakers. Therefore, caution should be exercised when using the low frequency acupuncture on a
pacemaker patient.

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