DIAGNOSTIC AND TREATMENT ACUPUNCTURE AND VASCULAR AUTONOMIC SIGNAL (VAS) TECHNIQUES IN A TRADITIONAL/ECLECTIC PSYCHIATRIC PRACTICE: AN INTEGRATED MODEL

Having finished both my medical and psychiatric training plus military obligation as Director of Mental Health Services, Indian Health Service, Alaska, in 1970 I began to establish a private practice in Santa Barbara, California. I did this while working for 2 - 3 years at the very progressive community mental health center in neighboring Ventura. The Center's psychiatric Medical Director, Raphael Canton, M.D., was a native of Panama; working with him added to my already intense cross-cultural Alaskan experience.

Knowing my interest in the treatment of pain, a physiatrist colleague referred Canton and me to Toru Sato, M.D., Professor and Director of the Department of Anesthesiology, School of Medicine, Tottori University, Japan (Sato, 1979). He was doing a sabbatical at the U.C.L.A. Medical Center. In exchange for helping him write his lectures in more understandable English, he taught us the basics of Japanese Ryodoraku acupuncture - my first window into the world of applied biophysics (Bensoussan, 1991; Endler and Schulte, 1994; Radin, 1997; Smith and Best, 1989).

 

Soon after, I preceptored in the South Bronx (Lincoln Hospital) with psychiatrist, Michael O. Smith, M.D. He taught me the use of auricular acupuncture [the National Association Detoxification Acupuncture (NADA) technique] to assist in the treatment of addictions (Ackerman R, 1995; Brumbaugh, 1993; Bullock, Culleton and Olander, 1989; Culleton and Kiresuk, 1996; Margolin, Avants and Kleeber, 1998; smith, 1979; Smith and Kahn, 1988; Smith, Squires, Aponte, Rabinovitz, Bonilla-Rodriguez, 1982). Adding this technique to my private practice, I quickly learned that auricular acupuncture serves both as an entrance to addiction rehabilitation and helps to retain a patient in treatment. It facilitates a rapid elimination of substances from the system and bypasses, at the beginning of treatment, the need to speak, thereby allowing a silent healing to unfold. It quickly energizes, resulting in increased mental clarity, followed by better listening, quicker learning and more rapport with the support professionals. Fairly rapidly people experience an increased control, both psychologically and physically, thereby gaining a greater sense of self awareness, confidence and hope - eventually taking on more self responsibility.

During the five years that I utilized auricular acupuncture for substance abuse I did not hospitalize patients either for detoxification or treatment. Anxiety, agitation, violence, depression and isolated physical symptoms were never major challenges during an out-patient detoxification process; allopathic medications were rarely used. I found it important for the therapeutic alliance if I could help in a non-pharmacological way to eliminate physical or emotional symptoms that were a major distraction. This facilitated a more optimal psychotherapeutic experience. One week after acupuncture assisted out-patient detoxification, I used my traditional psychiatric training and clinical expertise to complete a dual or multi-diagnosis evaluation and prescribed medications, as indicated. I encouraged patients to simultaneously enroll in a meaningful Twelve Step Program.

As I learned to master Smith's technique, I was simultaneously confronted with a group of patients who experienced irritability, anxiety, depression and confusion after eating certain foods, unique to each person. Interested in knowing whether or not acupuncture techniques could be used diagnostically to evaluate what foods people could not tolerate, I stumbled upon an article. In 1982 Julian Kenyon, M.D., a British Ear, Nose and Throat surgeon, reported that the Auricular Cardiac Reflex (ACR) could clinically assist in the diagnosis of food intolerances. With personal guidance both from Kenyon and Nolon Cordon, M.D. (Petaluma, California), I slowly learned to use the technique.

Kenyon informed me that in the mid-50's Paul Nogier, a physician at the Medical School in Lyon, France, was the first person to document total body anatomic projections onto the auricular homunculus. Points that are erythematous and/or tender to palpation indicate pathology of those places in the body reflexly connected to the auricular points. The Chinese subsequently reported their own auricular projections most of which are identical to the points documented by the French (Oleson, Kroening, Bresler, 1980; Oleson, 1992). Nogier also discovered the Auricular Cardiac Reflex (ACR) which he subsequently renamed the Vascular Autonomic Signal (VAS). This radial artery pulse technique is a diagnostic parameter additional to auricular erythematous and tender projections.

The VAS as first utilized by Nogier was to more precisely locate those acupuncture points on the auricle (ear) that required treatment for a particular pathology. The VAS also defined the type of metal needle necessary for a particular acupuncture point (Nogier, 1969). Eventually, Nogier utilized the VAS to develop a diagnostic and treatment system that supplemented traditional Western internal medicine (Nogier, 1983). Navach learned that the VAS can be utilized to assess the patient's need for specific nutritional supplements frequently indicated as substrates prior to the use of acupuncture and/or allopathic medications; subsequently, smaller medication doses are often adequate. Foods that negatively impact a patient's central nervous system can be documented using the VAS (Kenyon, 1982). The VAS can also help to assess the need for specific allopathic medications, herbal and homeopathic products and their exact dilution as well as potential incompatibilities to various allopathic and supplementary remedies. This in turn often saves patients time and money - frequently faster than the trial and error search for medications.

Nogier was reported to have a following of several thousand physicians in France and Germany (Bourdiol, 1983).* After learning from Nogier, Kenyon went on to train many other physicians in South Africa, Australia and New Zealand.

Shortly after learning about the VAS pulse technique, I met Joseph H. Navach, M.D., an orthopedic surgeon in Van Nuys, California. He mentored me for the next twelve years; I was the only physician who preceptored with him over an extended period of time. Navach taught advanced VAS techniques that enabled me to highlight acupuncture points on the auricle which would facilitate a more in depth physical and emotional healing (Ackerman, 1998; Ackerman, 1998; Ackerman and Lewis, 1999). Treatment of such acupuncture points requires the addition of VAS suggested nutritional supplements (i.e., amino acids, vitamins, and minerals).

Utilizing the above information and advanced VAS techniques, over the past twenty years I have often been able to deal effectively with the following types of clinical situations: acute physiologic imbalances with female hormones, migraines, other acute pain, gastrointestinal upset, dizziness, anxiety, agitation, certain IGE-mediated allergic symptoms including food induced laryngeal edema. I have also had success with chronic conditions such as eczemoid dermatitis, withdrawal from long term use of Prednisone, insomnia, anger, depression, certain behaviors of the developmentally delayed, drug flashbacks, ADHD of all ages, post-amputation pain, sympathetic dystrophy, potassium deficiency presenting as panic attacks or fatigue, food induced “brain fog” mimicking alcoholism, some people with bipolar illness, certain aspects of chronic fatigue syndrome and seasonal affective disorder.

* personal communication with Julian Kenyon, M.D.

 Typical case example utilizing both auricular acupuncture and the Vascular Autonomic Signal: I was approached by a 28-year old, very bright Caucasian cocaine and alcohol addicted person who did not want to be treated in an inpatient or residential program or utilize allopathic medications. After a brief screening medical/psychiatric history, I began to use the auricular five point, NADA acupuncture treatment protocol for relaxation and detoxification. I initially used this treatment for 1 ½ - 2 hours. When needles fall from their insertions in the ear, it signals the end of the acupuncture treatment. Psychotherapy followed each time for 1 - 2 hours.

During the second week, acupuncture treatments diminished in time and were required only every other day. I was able to take a more complete history. By the third week the ears rejected the needles as soon as they were placed in the auricle. Subsequently, the patient required acupuncture only intermittently to assist with transient alcohol and/or cocaine relapses as psychotherapy proceeded. Within 3 - 4 months relapses no longer occurred.

Beginning with the second week, the VAS was utilized to assess the need for specific nutritional supplements (amino acid precursors to neurotransmitters and their co-factors: vitamins and minerals).

At 3 - 4 months the patient was ready to cope with the withdrawal of different foods assisted periodically with auricular acupuncture to attenuate food withdrawal symptoms. The acupuncture also assisted with PMS. Psychotherapy dealt not only with dynamic issues but also diet, blood sugar levels, daily detox hygiene, exercise, sleep, time management and whatever I, in the role of psychiatrist/case manager saw as necessary. I served as liaison with her primary physician and all other professional members of the therapeutic team whether allopathic or complementary.

Within two years the patient married and had a family; I heard nothing from the patient for 15 years. During the past year the patient called me with marital problems and bipolar symptoms. The patient is now under the care of a psychiatrist in her area.

Now at age 67, I look back at the private practice I have evolved into over the past 35 years. My training in complimentary techniques during those years has always been in the hands of competent physicians. I slowly put together one model which is integrated at several different levels. My orientation is still very much traditional as well as eclectic and holistic. I operate first as a physician insisting on a complete total medical differential diagnosis wherein I collaborate with those medical specialists necessary to understand a particular case and get the job done. Wearing the hats of a physician, social worker and case manager is valuable for patients who have “fallen between the cracks”. I always confer with the primary physician (usually an internist) prior to initiating any phase of my approach.

Even though my initial background was intensively psychoanalytic and psychodynamic, I have evolved into a systems orientation. I emphasize a preventative, learn-to-address-your-specific-needs and take-care-of-yourself model. I do whatever I can in a comprehensive fashion to help patients maintain their own physical and emotional balance. I add an amalgam of psychotherapeutic approaches (psychodynamic, Gestalt, hypnosis, neurolinguistic programming, education, EMDR and even colored lights with individual, couples or family therapy) as indicated. Only if a patient wishes to take advantage of my holistic knowledge and skills, do I then use the VAS to obtain additional information about diagnosis and treatment direction.

There are many different ways to incorporate acupuncture techniques into a medical practice. You can emphasize diagnosis or utilize both diagnosis and treatment. The physician has the choice of using only auricular techniques, only total body techniques (which I have not studied in depth), or both. During the past 7 - 10 years I have gravitated toward the diagnostic aspects of auricular acupuncture utilizing auricular erythema and/or tenderness plus the VAS. I now refer patients to local acupuncturists for their actual treatments.

The auricle and the VAS for diagnostic and treatment direction have been used internationally the past fifty-two years. A variety of VAS techniques can be used to assist in the evaluation of medications. As far as I know, Navach's is the only VAS system that categorizes prognostically as part of the baseline evaluation and emphasizes how essential it is to tailor nutrition for optimal acupuncture and allopathic medication results.

Many scientific symposia on Auricular Medicine have been sponsored by the Group Lyonnais d'Etudes Medicales (GLEM); Navach frequently presented (Navach, 1980-1984). The next international conference will be in Lyon, France, September, 2006. The GLEM has its own scientific journal, L'Aurculomédecine. In addition, the International Association for Auricular Medicine (IAAM) had an international following and a peer-reviewed English written journal, COHERENCE-International Journal of Integrative Medicine (ISSN 1565-0138), which commenced in 1998. It was published by IAAM and the Medical society of Acupuncture of the Israel Medical Association (MSAIMA). COHERENCE was preceded by the International Journal of Auricular Medicine. The first U.S. consensus conference on Auriculo-Therapy and Auricular Medicine was held in Las Vegas in August, 1999.

There is a great need to discuss international coordination of research priorities. For more information re: the beginnings of coordinated VAS research, go to www.membres.lycos.fr/auriculo. Soon, calls for a variety of VAS related small pilot studies will be posted.

Twenty-first Century medicine will utilize information from research in applied biophysics to facilitate better healing both for acute and chronic medical conditions (JAMA, 1998; Archives of Internal Medicine, 1998; ISSSEEM). Acupuncture as well as the VAS are two ways to manipulate biophysics utilizing subtle energy techniques. In June, 1998 I reported at APA (Toronto) on the “Uses of Acupuncture in Psychiatry”. The presentation was anchored with a 30-page bibliography (Ackerman, 1998). To obtain a complete copy plus handouts write to: John M. Ackerman, M.D., j439m@silcom.com.

In March, 2005 the first biophoton emission article as related to the biophysics of the VAS will be published in the new peer-reviewed journal, Explore, Vol. I, No. 3. Hopefully, our research team will be able to complete more significant VAS research.

REFERENCES:

Ackerman, JM (1998), An Integrative Approach to Psychiatry: The Use of Acupuncture In Psychiatric Treatment” presented at Annual American Psychiatric Association meeting, Symposium 108, June 4, 1998, Toronto, Canada.

Ackerman, JM (Part I: February, 1998; Part II: January, 1999), The Biophysics of the VAS: Its Relationship to Healing. COHERENCE - International Journal of Integrated Medicine.

Ackerman, JM, Lewis WM (Part III), Integration of VAS Techniques With Traditional Western Medical Techniques. COHERENCE - International Journal of Integrated Medicine, Vol. 1, 2000, pp. 24-33.

Ackerman JM, "The Biophysics of the Vascular Autonomic Signal and Healing", Frontier Perspectives (published by The Center for Frontier Sciences, Temple University, Philadelphia, PA), Vol. 10, No. 2, 2001, pp. 9-15.

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