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Archive for October, 2010

 

Using Acupuncture to Treat Liver and Pancreatic Pain Caused by the Dysfunction of the Sphincter of Oddi

By Kathleen Fraser, L.Ac., Dipl. Ac., C.Ht.

Having treated patients with acupuncture for nearly 15 years, my clinical experience coupled with biomedical research and biology has helped me effectively treat a variety of digestive disorders.  One of the most interesting digestive disorders to treat has been regulating the Sphincter of Oddi.  I find this disorder intriguing because it is often confused with other digestive disorders such as gallbladder disease, pancreatitis, ulcers, liver problems and more.  Take for instance, my 24 year old patient who came for treatment because of the sharp pains in the upper right quadrant of her abdominal region.  She described the pain as excruciating especially when the pain spread to her epigastrium and further into the pancreas (the upper left quadrant of the abdomen).  She also complained of a constant stabbing pain in her back between the ninth and tenth thoracic vertebra about 3 inches lateral to her spine.  She suffered nausea, vomiting and migraines.  She was diagnosed with gallbladder disease (no gallstones), pancreatitis and acid reflux.  Her doctor removed her gallbladder and prescribed a prescription for her stomach pain and anti-depressants and anti-anxiety medication for her emotional distress.  After the removal of her gallbladder she felt no relief and became increasingly depressed with daily symptoms that interrupted her life.  She was unable to work and spent more time at home.  She was later diagnosed with the Dysfunction of the Sphincter of Oddi. 

Symptoms of the Dysfunction of the Sphincter of Oddi.

The major presenting symptom in patients with Dysfunction of the Sphincter of Oddi is
sharp acute abdominal pain. The pain is characteristically located in the right upper quadrant of the abdomen or the epigastrum. The pain may be associated with nausea and/or vomiting, may last for several hours, and may radiate to the back or shoulder blades. Patients may also present with acute pancreatitis.   Please note that only your doctor may diagnosis Dysfunction of the Sphincter of Oddi.  As an acupuncturist, if the patient reports the symptoms listed above, I recommend they see their doctor for a complete check-up.  Having made this recommendation, I continue acupuncture knowing that the patient is being monitored by their physician.  This enables both the doctor and me to monitor the relief of symptoms over the course of treatment.  Acupuncture treatment has successfully helped numerous patients achieve relief from digestive symptoms as the patient’s need for prescription drugs and over the counter digestive remedies is reduced.

Where is the Sphincter of Oddi located?

The Sphincter of Oddi is located just beneath the liver in the upper right quadrant of the abdomen.  It is a muscular valve that surrounds a considerable portion of the distal bile duct of the liver and pancreatic duct of the pancreas.  The Sphincter of Oddi controls the release of digestive juices (bile and pancreatic juice) from the liver and the pancreas into the duodenum or small intestine..  There are three mini sphincters included within the muscular valve: the sphincter papillae, the sphincter pancreaticus, and the sphincter choledochus.

What is the function of the Sphincter of Oddi?

The sphincter of Oddi has three major functions: 1) regulation of bile and pancreatic flow into the duodenum or small intestine, 2) diversion of hepatic bile (bile made by the liver) into the gallbladder, and 3) the prevention of reflux of bodily waste from the duodenum intestine into the pancreatic duct. With the ingestion of a meal, the gallbladder contracts and there is a simultaneous decrease in the resistance in the sphincter of Oddi zone which allows digestive juices to flow into the small intestine.  In addition, Cholecystokinin (CCK) and nitrates decrease the resistance of flow allowed by the sphincter. Laboratory studies observing the effects of numerous peptides, hormones, and medications on the sphincter have suggested a multifactor control mechanism for the sphincter of Oddi.

Biomedicine’s Diagnosis of the Dysfunction of the Sphincter of Oddi.

There are two types of sphincter of Oddi dysfunction: 1) papillary stenosis and 2) sphincter of Oddi dyskinesia. Papillary stenosis is a fixed anatomic narrowing of the sphincter. Sphincter of Oddi dyskinesia refers to a variety of abnormalities of the sphincter of Oddi.

Chinese Medicine’s Diagnosis of and Treatment for the Dysfunction of the Sphincter of Oddi.

Chinese medicine looks at symptoms as the manifestation of a pattern of imbalance in the body.  Your practitioner may ask, “Is the symptom sharp or dull, hot or cold, does it move up or down, is the symptom constant or intermittent, and so on..  The predominant symptom associated with the Dysfunction of the Oddi Sphincter is sharp pain in the upper right quadrant of the abdomen.  To the acupuncturist, sharp pain is an indication of stagnated blood. If the area is hot, it indicates excess heat.  If the heat has become chronic, the area will become inflamed.  Stress, bad diet, alcohol, cigarettes, drugs, overwork, lack of sleep, strained relationships and not drinking water all have the potential to create excess heat.  With excess heat in an organ and stagnation of blood, the organ cannot function.

Since the Sphincter of Oddi is controlling the bile and pancreatic juices that enter the duodenum, there are some generalized symptoms that indicate that the sphincter is not functioning.  These symptoms may also indicate that the juices are accumulating in the immediate area of the liver, gallbladder and pancreas. Initial symptoms may include pain/discomfort in the upper right quadrant of the abdomen (Liver/gallbladder region).  It may also extend laterally across the midline of the body (thus irritating the esophagus) over to the left upper quadrant of the abdomen thus irritating the pancreas.  In addition to pain, the individual may experience loose stools with episodes of constipation.  Since bile is responsible for the brown coloring of feces (not a nice subject but necessary for a greater understanding), if the bile is not flowing properly, the feces may be light brown or even white.

If the bile and pancreatic juices are not entering the duodenum, where do they go?  The digestive juices that have been produced can move to other areas of the torso.  Since these digestive juices were meant for the duodenum, the juices will disrupt the function of whatever tissue it permeates outside of the duodenum.  For instance, if the juices move laterally in the body, they can cause irritation of the esophagus and inflammation in the pancreas.  The digestive juices may even move towards the skin surface causing itching and a yellowing of the skin (jaundice)

In addition, the dysfunction of the Sphincter of Oddi may allow fecal matter from the duodenum to move backward up the ducts and into the upper organs of the digestive system.

In Chinese medicine, when substances that are supposed to move downward in the body (bile, digestive juices, fecal matter, and waste material) begin to move up, the substance is referred to as “turbid fluid”.  The “turbid fluid” will cause a disruption in the functions of the upper portions of the body, which over time, may cause disruption to the lower portions of the body.  Upper body symptoms may include headache, migraines, swelling of the face, vascular constriction, nausea, vomiting, acid reflux, foul breath, acne, lack of concentration, poor vision and more.   Turbid fluid travels upward with the aid of circulating blood, normal body fluids, and rising energy (Qi) of the body.

The principle for treating the disorder with Chinese medicine is to strengthen and normalize the digestive system, resolve stagnant blood, drain the excess heat, normalize the circulation of the body’s energy and resolve the turbid fluid.  This approach relieves symptoms and restores health by reinstating the body’s normal functions.

In acupuncture treatment, there are 14 main pathways of energy that are stimulated in order to restore health.  These pathways course along the surface of the body as well as travel into the organs of the body. Each pathway has points which are located on the skin and when needled will stimulate the energy that runs along that pathway and will effect the associated internal organ.  The selection of acupuncture points for treatment of digestive disorders may include points along the Liver, Gallbladder, Spleen and Stomach meridians.  These points serve to strengthen digestion and to normalize the production of and secretion of bile, enzymes and digestive juices.  Additional points from the Kidney meridian and the Triple Heater meridian serve to normalize the body’s alkaline levels, metabolic processes (which helps to rid the body of toxins) and to correct the distribution of water circulating throughout the body.

Take for instance, our 24 year old patient suffering from the dysfunction of the Sphincter of Oddi.  After the first acupuncture treatment, she was relieved of the sharp abdominal pains and her migraines lessened in frequency and duration.  Within 4 treatments, she reduced her prescribed medication.  After 15 treatments, she discontinued all prescription medications for digestion and for anxiety.  She continues to reduce the prescribed anti-depressants (an anti- depressant that requires a slow reduction due to adverse effects if reduced abruptly).  Our patient has changed her diet, increased exercise and now feels more positive about her self and her life.

If you would like to discuss your current health condition or would like to receive additional information, feel free to call and receive a free 20 minute consultation.  I may also be reached by email, Kathleen@whitelotusonline.com if wish to contact me by email.

May the Best of Health Be Yours,

Kathleen Fraser, L.Ac., Dipl. Ac., C.Ht.

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