SHARON SKOK, Phase I Intern
MING-DONG LI, Supervising Faculty
DOUG EISENSTARK, Supervising Faculty
Yo San University Clinic
Abstract: This case discusses the use of acupuncture in the treatment of
abuse of benzodiazepines and opiates in an adult male. Acupuncture can be a
successful adjunct therapy to the Western detoxification programs in treating
THEORETICAL AND RESEARCH BASIS
An estimated 22.0 million Americans aged 12 or older in 2002 were classified
with substance dependence or abuse – 9.4 % of the total population. Prescription
drug abuse is on the rise in the United States. According to the National
Institute of Drug Abuse, an estimated 4 million people (2% of the population
aged 12 and older) were currently using certain prescription drugs
non-medically. 2.6 million used pain relievers, 1.3 million used sedatives and
tranquilizers, and 0.9 million used stimulants. This case addresses the misuse
and dependency on sedatives (CNS depressants) and pain relievers (opiates).
CNS depressants are substances that slow normal brain function and are used to
Anxiety and sleep disorders. Barbiturates such as mephobarbital (Mebaral)
and pentobarbital sodium (Nembutal) are used to treat
Anxiety, tension, and
sleep disorders. Another class of CNS depressants is Benzodiazepines, which
includes diazepam (Valium), chlordiazepoxide HCI (Librium), and alprazolam (Xanax).
These substances are also used to treat
Anxiety and insomnia, as well as acute
stress reactions and panic attacks. CNS depressants act to increase the
neurotransmitter gamma-aminobutyric acid (GABA), which decreases brain activity
and produces a calm and drowsy effect. Used long term, the body develops a
tolerance and larger doses are needed to achiever the same effects. In addition,
the body becomes physically dependent and experience withdrawal when the drug is
stopped or reduced.
Opiates are a group of substances available in street and illicit forms as well
as by doctors’ prescription. They act as analgesics by mimicking endorphin-like
substances in the brain. Natural opiates are derived from the opium poppy and
abuse dates back to the turn of the century (and earlier in the Far East).
Naturally occurring opiates include opium, morphine, and codeine. Semi-synthetic
opiates include heroine and oxycodine (Percodan). Synthetic opiates are called
opioids and include propoxyphene (Darvon), meperidine (Demerol), and methadone.
Opiates/Opioids produce a floating sensation, euphoria, decreased respiration,
analgesia, drowsiness, and clouded mental function. Tolerance develops rapidly
with regular abuse, and this class of drugs is highly addictive.
Western Medicine’s definition of addiction requires two conditions – tolerance
and withdrawal. Tolerance involves the adjustments the body makes in the
presence of an addictive chemical. More of the chemical is needed to have the
same effect. Withdrawal is the physiological response of an organism when the
addictive agent is suddenly removed.
Benzodiazepines withdrawal symptoms:
anxiety, panic reactions, insomnia, seizures, and tremors.
Opiate withdrawal symptoms
insomnia, sneezing, violent yawning, weakness, nausea, vomiting, chills,
ejaculation, abdominal pain, muscle pain.
Treatments for drug addiction vary according to individual needs, however it is
not recommended that individuals addicted to benzodiazepines stop using the
drug(s) on their own due to potentially life threatening complications
associated with withdrawal such as decreased heart rate and seizures. Medically
supervised detoxification is advised, as the drug dosage must be gradually
tapered off. Behavioral therapy is also recommended. In terms of opiate abuse
treatment, either complete abstinence or medication is used for treatment in
addition to behavioral therapy. In some treatments methadone is used. It is a
synthetic opioid that block the effect of opioids/opiates, eliminating
withdrawal symptoms and relieving drug cravings. Methadone has been used for 30
years in the treatment of opiate abuse.
Chinese Medicine and acupuncture have successfully been used to assist in drug
detoxification. The use of auricular acupuncture in treating acute drug
withdrawal began in Hong Kong in 1972. However, China has a long history of
opiate use beginning in the early 18th century. In 1729, Emperor Yung Chen
attempted the first suppression of opium when issuing an edict banning the
smoking of opium. Opiate use became a major public health concern in the early
20th century China. In 1949, there were thought to be 20 million opiate addicts.
I would image that Traditional Chinese Medicine was used to assist in the
treatment of addicts during this time.
The mechanism of action of acupuncture in the treatment of Substance Abuse is as
Increases levels of endogenous endorphins
Directly acts on the central nervous system
Stimulates the immune system
SB is a 33 year-old Caucasian single male who works as an operations director
for a DVD distributor in Los Angeles. He found the Yo San University Clinic
through a referral from a chemical dependency counselor from the drug detox
program at a local medical center where he had sought treatment. He had
experienced acupuncture for the first time the day prior at another alternative
health care center that was too costly for regular treatments. He alternatively
turned to the Yo San University Clinic for treatment.
SB’s first visit at Yo San occurred on September 26, 2003. 15 days prior to this
visit, he had entered a drug detox program. He left the center on September 22,
2003, four days prior to his Yo San visit. He entered the drug detox program
after 9 months of daily drug use of benzodiazepines (Valium and Xanax) and 1 1/2
months of opiate use. During this 9-month period, crack cocaine (a stimulant)
was also used at times for energy to counter the lethargy/sedation from the
At his initial consultation, SB complained of physical discomfort associated
with drug withdrawal from benzodiazepines and opiates, and less frequent use of
crack cocaine. His main areas of concern were:
physical weakness and coordination problems – SB described feeling out of touch
with his body and felt like he was walking on wood planks. He described his
movements as unsmooth and felt that he couldn’t trust his movements. He also
experienced muscle spasms in the arms and legs.
dull stinging physical pain all over body, and especially in chest area. He
described feeling physically sensitive.
anxiety, restlessness, and agitation. This was accompanied by insomnia. SB was
only able to sleep for 3-4 hours with trouble falling asleep. Palpitations come
and go. I addition, he woke up several times during the night to urinate.
The above systems were experienced all the time
In addition to the above chief complaints, SB experienced night sweats. At the
time of his visit, he had experienced these for five consecutive nights prior to
the visit (since leaving the treatment center). He also experienced heat
sensation in the hands, feet, and chest. He sweats easily and frequently felt
chilled. While feeling both hot and cold, the feeling of coldness/chills was
predominant. SB also experienced dry mouth and thirst, short-term memory loss,
and dizziness upon physical exertion. He also experienced diarrhea six times a
day with strong odor, low appetite, abdominal distention after eating, and foggy
head and memory. He was experiencing no nausea, vomiting or headaches.
SB grew up in Los Angeles. He was in his last drug detox program 10 years ago.
Within the last 9 months he misused Valium and Xanax regularly to relieve
anxiety, as well as opiates during the month and a half before seeking the
substance abuse treatment. His
Anxiety stemmed from work and personal
relationships. He is in a 5-year relationship. His girlfriend was unaware of his
drug usage. She was informed after he left the medical center and was very upset
about the news.
CURRENT HEALTH STATUS
SB is a non-smoker. At that time of his visit at the clinic, he was drug free
for 15 days. In addition, he was not drinking alcohol. He was also not drinking
coffee, tea, or any caffeinated beverages.
SB has history of exercising regularly - working out at the gym 3 times per
week. This lessened during his substance abuse recovery time.
He is not taking any medications. One day prior to his Yo San University visit,
he had received Chinese herbs at another healing institute.
There is not known allergy to medications.
REVIEW OF ZANG-FU SYSTEMS
SB’s symptoms of night sweats, thirst, dry mouth, insomnia, five heart heat, and
frequent urination suggest Kidney involvement. His presentation of diarrhea,
poor appetite, foggy head, and muscle weakness points toward Spleen weakness.
Anxiety, insomnia, restlessness, and palpitations suggest Heart involvement
as well. The dizziness and muscle spasms suggest Liver involvement.
THREE DIAGNOSTIC SIGNS
SB presented with a pale complexion and anxious demeanor. He appeared unsettled
and overwhelmed by the busy, loud atmosphere in the lobby of the clinic. He
seemed relieved when able to come back to the treatment room. His gait toward
the room was stiff and deliberate. As he sat in the room during the intake, he
appeared fidgety and uncomfortable in his body. The
Anxiety could also be seen
in his eyes.
On examination, his tongue appeared purple-red with a red tip with a scanty
yellow coat. It showed teeth marks and quivered.
His pulse was deep, thready, rapid and wiry on both the right and left sides.
The left chi position was also weak.
ASSESSMENT AND IMPRESSION
SB’s TCM diagnosis: Liver and Kidney yin deficiency with heat, Spleen qi
deficiency, and Liver qi stagnation.
The predominance of Liver and Kidney yin deficiency with heat is demonstrated
through the night sweats, 5 heart heat, insomnia, dry mouth, thirst, and muscle
spasms (due Liver yin deficiency not nourishing the sinews/muscles). This Kidney
yin xu has also affected the Heart yin, and its deficiency has manifested not
only in insomnia, but also with palpitations and
Anxiety. His thready, rapid and
deep pulse further demonstrate yin deficiency with heat, His red-purple tongue
with a scanty yellow coat also indicates deficiency of yin.
Spleen qi deficiency can be seen through his poor appetite, diarrhea, abdominal
distention, foggy head, and weakness of the body. In addition, his tongue shows
teeth marks and quivers.
Liver qi stagnation is seen in his agitation. His pulse also has a wiry quality
and there is a purple hue to his tongue.
TREATMENT PRINCIPLE, OBJECTIVE, AND PLAN
Treatment principle: Tonify Liver and Kidney yin, tonify Spleen qi, move Liver
qi, and calm Shen.
Treatment plan: Daily acupuncture treatments for 2 weeks (with the exception of
Sundays because the Yo San Clinic is closed). After the initial two weeks,
acupuncture treatments three days/week for 2 weeks. Treatments were then reduced
to twice a week for 2-3 weeks and after that period to once a week for two
Daily use of Chinese patent medicines was recommended.
Point usage: Traditional acupuncture points were used predominately with some
usage of auricular acupuncture.
Liver 3 – Nourishes Liver blood and Liver yin, and spreads Liver qi. It used to
treat insomnia, thirst, and dizziness
Kid 3 – Nourishes Kid yin and clears deficiency heat. As the shu stream and yuan
source point, it is a key point in treating kidney zang disharmony.
St 36 - Fortifies the Spleen and fosters original qi, tonifies qi and nourishes
blood and yin, clears fire and calms the spirit, activates the channel and
alleviates pain. Treats poor appetite, diarrhea.
Sp 6 - Tonifies the Spleen and Stomach, harmonizes the Liver, tonifies the
Kidneys, and regulates urination, Calms spirit, and activates the channel and
alleviates pain. Treats the feeling of heaviness in the body, diarrhea, and heat
in the soles of the feet,
Pc 6 - Unbinds the chest and regulates qi, regulates the Heart and calms the
spirit, harmonizes the Stomach, and clears heat. Treats insomnia, distention in
the abdomen, poor memory, and
Ren 4 - Tonifies and nourishes the Kidneys, warms and fortifies the Spleen,
fortifies the original qi. Treats lack of strength in the four limbs, heaviness
in the body, and tremors.
Ren 6 – fosters original qi, tonifies the kidneys, regulates qi.
Ren 17 – Regulates qi and unbinds the chest,
Yin Tang – Calms Shen.
Si Shen Cong – Calms Shen. Treats insomnia and poor memory.
Du 20 – Calms the spirit and benefits the brain. Treats agitation, and sensation
of heat in the heart, poor memory, and lack of mental vigor.
Ear Shen Men – Calm the spirit. Alleviates stress,
restlessness, and excessive sensitivity.
(Needles used were 36 gauge – thin needles were used due high sensitivity of the
body from drug usage and detox).
After the treatment, SB reported feeling better and that walking/physical
movement felt more comfortable and smooth than prior to the treatment.
Chinese patent medicine: We recommended he continued with the patent formula
given by the another Chinese medicine practitioner the day prior until the
patents were completely used.
Shuo Xiao Zao Ren An Shen Wan – to calm shen and nourish yin, help sleep
Zhen He Lin Pill – assists in detoxification
Additional points used on subsequent visits:
An Mian – Calms the spirit and pacifies the Liver. For insomnia, palpitations,
agitation and restlessness.
Heart 7- Calms the Spirit and tonifies the Heart. Treats insomnia, poor memory,
palpitations, heat in the palms, and cold shivering.
Gb 34 – Benefits the sinews and joints, spreads Liver qi. Treats contraction of
Kid 2 – Clears deficiency heat, regulates the Kidneys. Treats night sweats,
Ear Point Zero – balances whole body energy, regulates internal organ
dysfunction. This point acts on the nervous system.
PREVENTION AND LIFESTYLE MODIFICATIONS
SB has made many lifestyle adjustments since seeking treatment for his substance
abuse. He regularly attends 12 step program meetings, on a daily basis at the
beginning of his treatment. He is also in regular contact with his 12-step
program sponsor. In addition, he shared that he has made the choice to no longer
be in contact with certain friends he abused drugs with. His drug detox program
arranged to have supportive assistance as he cleaned up his apartment and helped
him remove all the abused substances before coming home.
PROGRESS AND PROGNOSIS
SB has made good progress since his first visit in late September.
After his first visit he shared that he felt better in his physical movements
and he appeared more comfortably and relaxed after the treatment. By the fourth
visit he felt that his strength and appetite were beginning to come back. He
shared that he was feeling more confident in his physical movements. His bowel
movements were also more regular. By his fifth and sixth visit, his mental
acuity was coming back. He was sleeping approximately 6 hours a night but
continued to have night sweats. He also continued to have
Anxiety and emotional
ups and downs.
By October 3, 2003, he felt that his temperature fluctuations had mellowed and
Anxiety level had improved. He was still having trouble falling asleep (1
hour) and continued with night sweats. By his next visit on October 8th, he
reported that the night sweats had lessened and that he felt strong enough to go
back to the gym. He continued to have foggy head and poor memory. His other
digestive complaints such as abdominal distention have also diminished, and he
reports that his appetite for food is "too good.” His pulse began to show a
slippery quality, and continue to be wiry and rapid.
With his physical coordination and movement was improved, his main concerns were
Anxiety and insomnia. By November 6th, he was able to fall asleep easily and
was able to sleep through the night for five days after his last treatment on
October 30th. He also shared feeling some depression since things in his life
had calmed down. He continued to have relationship issues with his girlfriend
and they are seeking couples counseling. During this time his formula was
changed to the patent medicines Chai hu jia long gu mu li pian to treat his
emotions and soothe the liver and Gan mai da zao pian to support the Heart and
His difficulty with sleep (falling asleep and staying asleep) continued through
January, however, it was improved with some nights being able to sleep 7 hours.
He reported in January that he has cravings come up several times a week but
that there have been "no close calls.” He talks to his groups about this issue
or calls his sponsor. He energy is better and his sleep is overall improved.
During this time his tongue began to present with deviation to the left side and
a foamy white coat on the sides. In January, SB’s formula was changed to Wen Dan
Tang to address both the phlegm/dampness (seen on the tongue) as well as his
anxiety. In addition, he remained on Gan mai da zao pian to continue nourishing
the Heart and Spleen.
His most recent visit was March 4, 2004. He was 174 days sober, close to 6
months. He continues to go to group meetings. He reports that he sleeps 7 hours
a night and rarely wakes up during the night. He continues to have some
difficulty falling asleep (1/2 hour). His pulses are much changed since his
first visit. The left side is thready and slippery. The right side is wiry and
slippery. His tongue is dusky-red and quivers. He continues to have some
In this case, we used traditional acupuncture to treat symptoms related to drug
detox. The points chosen addressed the underlying condition presented by the
patient. Another alternative substance abuse treatment protocol includes only
auricular acupuncture as developed by the National Acupuncture Detoxification
Association (NADA). The protocol involves needling the following ear points -
sympathetic, shen men, kidney, liver, and lung. The needles are inserted in the
order of the above sequence. The same treatment is given regardless of the type
of drug abused and is given daily.
While drug detoxification can be a challenging emotional and physical experience
for the patient, Traditional Chinese Medicine can be a successful adjunct
therapy to a drug detox program and counseling. The use of acupuncture and
herbal medicine can address both the physical and emotional symptom and provide
a support for the body and spirit.
Brumbaugh, Alex. Transformation and Recovery: A Guide for the Design and
Development of Acupuncture-Based Chemical Dependency Treatment
Programs. Santa Barbara: StillPoint Press, 1994.
Given L.Ac., Steve. Lecture Notes for Acupuncture and Substance Abuse. 1999.
National Institute of Drug Abuse
SAMSA, agency of Department of Health and Human Services. (website)
Cohen, Howard M., Law-Yone, Byron, and Lu, Sunan. ”Poppy to Fugu: a Historical
Perspective of the Treatment of Opiate Addiction in China.” Journal of Chinese
Medicine. Number 60. May 1999.
Deadman, Peter, and Al-Khafaji, Mazin. A Manual of Acupuncture. East Sussex:
of Chinese Medicine Publications, 1998.
Sharon Skok is a clinic intern at Yo San University of Traditional Chinese
Medicine in Los Angeles, California. She will complete her studies in December
2004. She has a Bachelor’s degree in Communications from the University of
California, San Diego. In additional to pursuing her Master’s Degree in
Traditional Chinese Medicine, she currently teaches yoga in Los Angeles.