Simply put, Community Acupuncture is low cost acupuncture treatments designed to make acupuncture more accessible to low and middle class families. The cost of each acupuncture session is based on a sliding scale from $20 to $40 and is performed in a community setting. We are offering it exclusively at our Hanford clinic. We may be the only Community Acupuncture clinic in the Central Valley. Kings County has one of the lowest median household income levels in the United States. Moreover, the recent ecconomic downturn and sky high unemployment has made it difficult for people to take advantage of acupuncture, a form of natural, holistic and non pharmaceutical medicine which not only works for acute diseases and pain management but excels in the areas of prevention and chronic disease management as well. You can say that this is our way to offer a free market approach to healthcare reform. As you may know, there is much more to TCM (traditional Chinese medicine) than acupuncture. For a reduced fee, patients can have access to our TCM herbal medicine. Your practitioner will first use acupuncture as a first line treatment before recommending remedial herbal medicine. The first visit involves gathering health data and setting up patients in our system. The practitioner will spend additional time assessing your condition, diagnosing your chief complaint(s) based on a TCM differential diagnosis and developing a treatment plan. One or more courses of treatments will be suggested. Each course of treatment will have a fixed number of acupuncture sessions that you will be asked to commit to. We believe this is important for two reasons. One, a commitment to follow through on the recommended number of acupuncture sessions tends to lead to better patient compliance to all treatment and lifestyle suggestions made by the practitioner. Two, higher levels of frequency of treatments improves the chances for positive outcomes. Since everyone responds differently to acupuncture both patient and practitioner need time to determine the effects of treatment. Due to the nature of the work involved on the first visit the initial fee is higher but still affordable. At the end of your course of treatment an evaluation will be made as to the patients progress and a decision will be made on whether to continue working on the initial problem, move on to treat other health concerns, refer the patient to our full service facility in Visalia, refer to another doctor or discontinue treatment altogether. Should you have additional questions, please call our Hanford office at 587-0469, Sandy or Landi will be more than happy to assist you. Or watch this video to experience Community Acupuncture. CIM - Hanford Community AcupunctureThank you for your interest in our Community Acupuncture Program. Sincerely, F. E. Robbins, MSTCM, L.Ac. President and CEO, Center for Integrated Medicine
Population-based studies have consistently shown that about 5% of men and 15%17% of women suffer migraine attacks. In the United States the estimated annual cost, including costs of direct medical care and lost productivity, exceeds $17 billion. However common, migraine is still underrecognized and undertreated because there are no biological markers to confirm the diagnosis. The need for a reliable diagnostic tool led to the publication of the International Headache Society (IHS) criteria. All of these criteria tend to have high levels of either specificity or sensitivity, but not both. Although imperfect, these criteria are being increasingly accepted as an aid in diagnosis. Clinical practice guidelines aim to state general principles for the improvement of clinical effectiveness and quality of care and to allow informed decision-making by both physicians and patients. It is anticipated that effective guidelines for the diagnosis and treatment of migraine will improve symptom relief, increase quality of life and reduce the economic burden of this condition. Description The term migraine refers to periodic, hemicranial, throbbing headaches which usually begin in childhood, adolescence, or early adult life and recur with deminishing frequency during advancing years. Types: "Neurologic" or "aura" migraine: Where the patient experiences a vague premonition of attack associated with disturbance of vision which may be bright spots or zig zag lines and giving way to a blind spot in the field of vision. Soon after there may be mnumbness and tingling of the lips, face, hand, slight confusion in thinking, weakness of arm or legmild aphasia, dizziness, drowsiness, uncertainty of gait or confusion. Only a few of these are present in any given patient and tend to occur in the same combination with each attck. They last 5-15 min or more, if these body sensations spread over the body they do so in a matter of minutes (not in seconds as a convulsion). Just as inexplcably they come, they recede and within minutes are followed by a unilateral throbbing headache. This attack is occurs without the neurologic patterns previously mentioned but with the same hemicranial or generalized headache with or with out nausea and vomiting and followed by the same temporal pattern. Causes Vasodialation and excessive pulsation of branches of the external carotid aretrery have been observed during headache. As the pulsation decreases as does the pain. Supported further by surgical observations that the extracranial, temporal, and intracranial arteries with stretching of surrounding sensitive structures is beleiver to be the mechanism of most pain in migraine. This is called the vascular theory of migraine which has come to be accepted. But the theory does not explain why these intracranial and extracranial arteries undergo spasms and dialation, nor does it account for the nausea and vomiting (infrequent in all other types of headache except those due to tumor.) Diagnosis Migraines are difficult to diagnose for several reasons, some of which are, it is hard to elicit precise information from a patient who is trying to translate symptoms into words. In describing the quality of pain the patient usually assumes that the word headache should have conveyed enough info to the examiner about the nature of the discomfort. When asked to analogize the sensation to another sensory experience, the patient may make some illusions to tighness, pressureor bursting feeeling. Questions about the intensity of the pain are seldom of much value since they reflect more of the patients attitude towards the conditon and a customary way of reporting things that happen rather than the true severity. As usual the brawny, heraty person tends to minimize discomfort where the neurotic dramatizes it. The symptoms are similar to those of tension headaches, and the manifestation of individual migraine attacks varies considerably between and among individuals. A physical exam of the head itself is seldom useful. A careful history taking, inqueries as to the location of pain and the degree of incompacity to the pateint are better indexes to use. The overall methods used to elicit information and the interpretation of the individual diagnostic criteria and patient responses must be orderly and consistent. Criteria for diagnosing migraine without aura: 1. One attack every few weeks, more than this is considered exceptional 2. At least 5 attacks fulfilling the following criteria. A. Each attack, untreated or unsuccessfully treated, lasts 2-72 hours.B. The attack has at least 2 of the floowing characteristics:-Unilateral location: Migraines are most commonly unilateral; however thay can be bilateral in 30%40% of cases and sometimes the pain begins on one side and later spreads to the other. Location should therefore be characterized at different phases of the attack, and early or mild attacks should be differentiated from full-blownattacks. Useful questions to ask the patient include: Do you feel pain on one or both sides? If one-sided, is it lways on the same side? If present on both sides, did the pain start on one side? Is it usually maximal on one side? -Pulsating quality: Over 50% of people who suffer migraines report nonthrobbing pain during some attacks, and 30% of patients with tension-type headaches may report pulsating pain. Headache quality may also vary over the duration of the attack. If the pain is throbbing at any phase of the attack, it is recommended that, for consistency,the quality be considered as throbbing overall. Useful questions include: What kind of pain is it — tightening, pressing, throbbing, pounding, pulsating, burning or other? Do different types of pain occur at different times in any one attack? If so, which types? Moderate or severe intensity: The severity of the migraine inhibits or prohibits daily activity. Pain is aggravated by walking up and down stairs or similar routine physical activity: Patients who prefer not to move around should be considered as experiencing aggravation of pain by physical activity. Possibly useful questions about other, less equivocal aggravating factors include Do you avoid movement of even a minor nature (head movement or bending down) during an attack? -During an attack at least 1 of the following symptoms should be present. 1. Nausea or vomiting: It is important that nausea be differentiated from anorexia, which is common among patients with anxiety or tension-type headaches. 2. Photophobia, phonophobia and osmophobiam (aversion to oders) since these are highly sensitive and specific features of migraine. Useful questions to ask the patient include: During a headache, are you unusually sensitive to light, noise or odours? Do you take steps to avoid them? Because there is some degree of overlap of symptoms between migraine and tension-type headache, theseverity of such symptoms should be graded as mild, moderate or severe as with pain severity. C. There is no evidence from the patient's history or physical examination of any other disease that might cause headaches. Criteria for diagnosing migraine with aura: These diagnostic criteria are the same as those for migraine without aura, bit they include symptoms of neurological dysfunction (including visual disturbance) occurring before or during the attack. Additional questions : The patient should be questioned further in order to enhance the specificity and sensitivity of the above criteria, and to improve the "pattern recognition" of migraine. Additional questions concerning other typical migraine characteristics should be asked to investigate the following:-The regular or near-regular timing of attacks around menstrual or ovulation periods.-The gradual appearance of headache after sustained exertion -Abatement of headache with sleep -The presence of symptoms such as irritability or other mood variations, hyperactivity, inability to think or concentrate, food cravings and hyperosmia prior to an attack. -The presence of a family history of migraine.-The consistent precipitation of headaches by food, odours, weather changes or stress.- The occurrence of headache at times of let-down, particularly after a high level of activity or stress. Features that should raise concern that a more serious underlying cause may be present, possibly indicating the need for further investigation, should be investigated include the following: -The first or worst headache of the patient's life, particularly if the onset was rapid .-A change in the frequency, severity or clinical features of the attack from what the patient has commonlyexperienced (no longer conforms to the IHS criteria) -The new onset of headache in middle-age or later, or a significant change in a long-standing headache pattern -The occurrence of a new or progressive headache that persists for days -The precipitation of head pain with the Valsalva manoeuvre (by coughing, sneezing or bending down) -The presence of systemic symptoms such as myalgia, fever, malaise, weight loss, scalp tenderness or jawclaudication -The presence of focal neurological symptoms, of any abnormalities found on neurological examination, or ofconfusion, seizures or any impairment in the level of consciousness Physical examination:The general physical examination performed at the first consultation for headache problems should evaluate at least the following: vital signs (blood pressure and heart rate); cardiac status; extracranial structures (sinuses, scalp arteries, cervical paraspinal muscles and temporomandibular joints); and range of motion and the presence of pain in the cervical spine. A screening neurological examination capable of detecting most of the abnormal signs likely to occur in patients with headaches due to intracranial or systemic disease should be performed, including evaluation of neck flexion (for evidence of meningeal irritation) in certain cases; the presence of bruits over the cranium, orbits or neck; and the optic fundi, visual fields, pupillary reactions, sensory function of the fifth cranial nerve, corneal reflexes, motor power in the face and limbs, muscle stretch reflexes, plantar responses and gait. The presence of such abnormalities, unusual in uncomplicated migraine, suggest the need to consider further investigations. Symptomatic treatment: Patients respond to a variety of medications, and the medication of choice is often individual and idiosyncratic. benefits and hazards of the agents available should be considered as relevant factors in determining the mostappropriate medication. The goals of therapy should be the relief of headache and associated symptoms and a return to normal functioning. Drug therapy is indicated if the headaches threaten to disrupt the patient's ability to function normally. Patients seldom suffer more than a few migraine attacks per month. Although these attacks may be incapacitating and require treatment, and because other types of headache may also occur, patients must be warned that frequent use of symptomatic treatments (analgesics and ergotamine in particular) can lead to medication-induced (rebound) headache and eventually to chronic daily headache. Without appropriate treatment, patients are more likely to consume increasing amounts of less effective compounds, which thus increases the risk of rebound headache. Asking the patient to keep a diary of headache symptoms and medication use may be valuable in preventing this situation.
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Getting Results With Traditional Chinese Medicine Menopause typically occurs in women between the ages of 46 and 54 with the median age in the United States at 51 years old. Most women will usually notice a change in menstrual bleeding for several months before their final menstrual period as their ovaries begin to slow their hormonal secretion. This period is known as premenopausal and may last for months to years. Menopause is considered to have occurred when a whole year has passed without menstruation. Physiologically, premenopausal is a stage in the female reproductive system, where the ovarian function declines gradually, presumably because the ovaries become less and less responsive to gonadotropin aignals (FSH and LH). Due to these age related changes in the ovaries and adrenal glands the production of female sex hormones of estrogen, progesterone as well as male sex hormones (androstenedione, testosterone and DHEA) decrease. Many ovarian cycles become anovulatory, and menstrual periods become erratic and shorter in length. Eventually, ovulation and menses cease entirely and this event is what we call menopause. More than one-half of all women who go through menopause experience the classic physical symptoms of vaginal dryness, hot flashes which are intense vasodilatation of the skin's blood vessels, which causes uncomfortable sweating, dizziness, headache, weight gain, muscle or joint pain, bone loss, and slowly rising blood cholesterol levels, which places post-menopausal women at risk for cardiovascular disorders. Accompanying psychological of fatigue, anxiety, irritability, memory loss, difficulty in sleeping and depression. The exact cause of the psychological symptoms are not known but be tied to lower hormone levels. After menopause, the average women today will live 30 years without the benefit of natural estrogen. So in order to ward off heart disease, osteoporosis, dry skin as well as the usual symptoms of menopause many doctors think hormone replacement therapy (HRT)is the answer. However, recent research has found that the overall risk for breast cancer for women on HRT is 20% higher than for women who take estrogen alone. Because of this many women don't stay with HRT for fear of cancer. In the classic ancient Chinese medical texts (Nei Jing) the 7-year cycles of women is described, according to which menopause occurs at 49 (7X7); this is not far from the above-mentioned median age of 51. This proves that ancient Chinese medical theory understood the natural aging process and their effects on the body. Although the causes and pathologies of menopause in TCM are somewhat different than those of western medicine. The fundamental principle in TCM of treating the cause of the problem rather than just the symptom can be applied. Because of this holistic approach life during menopause in China has been more enjoyable because of a properly balanced diet and the availability of natural herbs which are incorporated into daily life.
Setting The Record Straight On the Safe Use of Herbs Recently, I responded to an article I read in an industry magazine for Pharmacists regarding the the "safe use of Chinese medicinal herbs." Since I am a licensed Pharmacist (Pharm.D.) with a post doctorate degree in Traditional Chinese Medicine, state licensed acupuncturist and herbalist and a board certified TCM medicial practitioner I felt compelled to respond. These types of articles and the issues discussed should not be the private domain of any particular group of health care professionals whether they be Pharmacists, Medical Doctors, Nurses, or research scientists, rather, they should be part of the public debate as to what is going on in the exploding market of herbal supplements. So, it is all the more reason that a general response be printed in a daily newspaper for the public at large to read. I will attempt to set the record straight on this article as well as any other negative or inflammatory articles you may have seen in the recent past or in the future for that matter regarding the safe use of Chinese medicinal herbs. Specifically, this article had to do with an outbreak of kidney failure caused by a particular species of Chinese herb called Guang Fang Ji (Aristolochia fangchi). This occured when Belgium physicians mistakenly prescribed Guang Fang Ji to a group of patients for weight loss purposes. Several months later they developed kidney failure. This tragic epiosde is an example of serious misuse and abuse of medicinal herbs. The public needs to know that the toxic effects are not caused by the ingestion of herbs as they are properly prescribed by a trained practitioner but by the consumption of a toxic product for an extended period of time as a result of human error and inadequate training of the practitioner. The original formula for dietary treatment should have contained han fang ji (Stephania tetrandra) but the formula, used for a period of more than 12 months by the pateints with renal failure, contained guang fang ji (Aristolochia fangchi) which contains the renal toxic component of aristolochic acid. It is clear from the Chinese National Pharmacopoeia that han fanj ji is from a completely different plant than guang fang ji! The moral of this story is that Chinese medicinal herbs are safe and highly effective when prescribed by a qualified Chinese herbalist, a professional practitioner who has undergone pre-med courses and has had extensive course work in herbology culminating with a graduate degree from an accredited college which includes, I might add, a clinical internship on the use of herbs. The general public is certainly entitled to seek out herbal information from whatever source they choose. But the prudent consumer would be wise not to ingest any herbal supplement, including Chinese medicinals without consulting a qualified practitioner. On the same token, other healthcare practitioners whos conventional training does not include medicinal herbal training should consult or refer their patients to qualified practitioners as well. If this advice is not taken, and as these mishaps occur out of no fault of the wisdom of Chinese medicinal herbology which spans thousands of years of safe and effective practice, one by one these herbs will be banned by the FDA. In the state of California look for Oriental Medical Practitioners or Traditional Chinese Medicine practitioners with L.Ac. (licensed acupuncturist) behind their name to denote qualification. As they are the only healthcare practitioners who are required to study herbal medicine, be examined for competency and specifically licensed to prescribe herbs. L.Ac.'s, therefore, have extensive training in TCM medical theories, herbal medicine, acupuncture, acupressure, tui-na massage, moxibustion, cupping, medical exercises, food therapy, etc.. In the state of California, TCM medical practitioners/L.Ac.'s are primary care providers and are authorized under the Labor Code to be pre-designated treating physicians.
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Loreto Bay is a resort town outside Loreto, Mexico, on the eastern coast of Baja California Sur, along three miles of pristine Baja beach front. This lovely and historic region is bordered by the Sierra de la Giganta mountain range, to the west, and by the Sea of Cortes, to the east. The house is only ten minutes south of downtown Loreto, the original capital of the Californias. One of the highlights of the area is the Isle Coronado, with it's pristine water, and white sandy beaches. And Isle Carmen, known for it's abundant sea life. Both are just a short Ponga boat ride away. 
