Photography Hu Ronghe

Don't think that Hu Xinshi only focuses on pain treatment, and he is also very attentive to the improvement of anesthesia technology, as long as it is beneficial to patients. Text/Wu Jingmei Photography/Zhong Junxian He is a doctor with orthodox medical training and saves lives in the medical center. However, seeing many patients running around in the hospital may not necessarily improve their pain. Therefore, based on the anatomy of western medicine and the concept of meridians of Chinese medicine, he used the simplest and most convenient method to solve the painful problem that is not necessarily fatal to patients. He is Hu Xinshi, head of pain control group of Taipei Rongzong. Hu Xinshi, who yearned for the ocean to study medicine for his parents, yearned for the romantic life at sea from an early age. In order not to disappoint his parents, he gave up the first volunteer marine engineering department of Ocean University and entered the National Defense Medical College. Although I was bent on surgery, I felt that surgery was like a real doctor, but there was no shortage of surgery in the General Hospital of the Three Armies at that time, so I chose the anesthesiology department that was most related to surgery and worked in the field of anesthesiology for 40 years. Many people may think that the anesthesiology department is equal to the pain department, but it is completely different to really invest in it. For example, oral morphine and other patch preparations commonly used by pain doctors are not used by anesthesiologists; Injections used by anesthetists, such as opioids, are not used by pain doctors. Although nerve block is necessary in clinic, they are completely different. "In fact, any doctor who has received pain medical training can be engaged in pain control. Without a professionally trained pain doctor, even an anesthesiologist can do nothing about chronic pain. Hu Xinshi said so. In recent years, Hu Xinshi has focused on pain control of skeletal muscle. Generally, the pain that attracts people's attention is mostly acute pain, which is caused by diseases, such as appendicitis, fracture, or cold, headache, sore throat and so on. As long as the condition improves, the pain will go away. But sometimes the disease has healed, but the pain still exists, such as banding? This is the case with post-rash neuralgia. Blister has disappeared, but it has become a chronic pain that has existed for many years. Physical Pain and Neuralgia Hu Xinshi said that he paid special attention to skeletal muscle neuralgia because it is very common and almost everyone has experienced it, such as back pain, sprain, mother's hand and fifty shoulders. Sometimes the pain stops, but because of this, everyone doesn't pay much attention to it, thinking that it is good to take some painkillers at most, instead of going deep into it. In the end, many people go to see a doctor everywhere, and they can't be cured. In addition, most of the skeletal muscle pain can be naturally improved, which is too common and not fatal, so many doctors do not pay attention to it and have not found a very suitable treatment for patients. But Hu Xinshi regards skeletal muscle as the largest organ in the whole body. He said that all muscles belong to skeletal muscle except involuntary muscles of heart and viscera. Its contraction and relaxation will affect joints and movements, and many diseases are related to it, which can not be ignored. For example, the most common low back pain, many people think it is related to disc herniation. In fact, it is less than 65,438+00% of all low back pain, but more than 80% is caused by muscle problems. Even after some diseases improve the problem of muscle pain, the treatment effect of subsequent diseases will be better. Another often overlooked cause of myofascial pain syndrome is metastatic pain with different pain points and problems. This kind of pain can only be improved by starting from the source of the problem. However, because there are many sources of the problem, it is difficult to find the source of the problem if the pathology and muscle direction are not clear. Muscle pain is actually caused by myofascial dysfunction. For example, the myofascia hurts when it is not used or overused. Therefore, most muscle pain can be found and improved, but only by understanding the overall concept can we find the location of the pain point. Hu Xin said that sometimes western medicine will call it tendinitis or fasciitis, but it can't find the redness, swelling and heat pain that pathological inflammation should have, so it should be called myofascial pain syndrome or myofascial insufficiency. Hu Xin said that Western medicine didn't have a clear understanding of muscle orientation, pathological mechanism and treatment until nearly 30 years ago, but in fact, as early as hundreds of years ago, Sun Simiao discovered the "Ashi point" on the human body (when the patient's pain can't find the source, the doctor presses each part of the patient one by one, and when it is found, the patient will scream "Ashi point ..."), while traditional medicine has the so-called "Jing". Hu Xinshi, the founding member of Taiwan Province Pain Medical Association, has been promoting the idea that "most pain is caused by myofascial dysfunction" for more than 20 years, which has been recognized by many doctors. He said that acupuncture is an important method to treat pain in traditional medicine. When he was young, he studied with an acupuncture Chinese medicine practitioner and also studied in the acupuncture training class of Taipei Rongzong, which gave him a lot of ideas. When the pain point is activated due to traction, resulting in muscle pain, a low concentration of * * * can be injected to achieve the effect of inactivation. Although the efficacy may last only 1 or 2 hours, the inactivation effect may make the affected area painless for many days, and the affected area that is too painful to move may stop the pain because of continuous activities after the pain. Later, some studies found that dry acupuncture can also achieve the effect of activating and relaxing fascia muscles, but the needles used in western medicine are very thick and painful to tie up, so patients often can't stand it, so they try to use fine needles of acupuncture to activate the pain points of dry acupuncture, and the effect is very good. After continuous research and improvement, now, Hu Xinshi's clinic often has a row of long and short needles. Other pain doctors may use different needles according to the depth of muscle movement when giving injections to patients, but they are completely different from traditional acupuncture, such as retaining needles and twisting needles. It may only take 65,438+00 seconds to insert the needle, and the local muscles will react, and the pain problem will be magically solved. For example, 50 shoulder joints, in Chinese medicine, a total of three needles are inserted in the acupoints before and after the shoulder joints (called "shoulder three needles"). Some are quite effective, but others cannot be improved. He thought, if it is effective, it means that this practice is reasonable, but if it is ineffective, it means that the needle is wrong. He saw that Chinese medicine was based on the lines and creases on the skin, and it was not accurate and scientific that the hours were different for fat and thin. He learned from the anatomy of western medicine and the pathology of myofascial pain that any one of the four muscles of rotator cuff may be related to shoulder pain. Coincidentally, the tendons of these four muscles just pass through the acupuncture points near the so-called shoulder three needles in traditional Chinese medicine. Hu Xinshi used the concept of myofascial dysfunction to find out the exact pain points of acupoints, so he also used three needles, but moved the position slightly, which immediately relieved many people who had suffered from fifty shoulders for a long time. Hu Xinshi believes that any kind of medicine is based on certain logic and no one is perfect. Therefore, doctors must be open-minded and should not exclude alternative medicine. In addition to more in-depth professional discussion, he is willing to accept Chinese medicine and even folk therapy, and take it for himself. As long as he thinks it is helpful to patients and conforms to physiological logic, he will teach patients to use it, so that patients can solve their illness faster. Another thing that Hu Xinshi has been promoting in the Pain Medical Association for many years is "self-stretching". Physical therapy is an important and effective method to improve pain. Self-stretching is unlikely to cause secondary injury. For example, lying on an extended bed and pulling the spine with a machine, based on mechanical theory, a single direction and a single force exert different forces on muscles in different directions, some muscles are likely to be injured, and some may have no therapeutic effect. If you can do stretching exercises designed for specific muscles at home, other muscles will not bear more tension and will not be injured. At the same time, the daily stretching times can be carried out as needed, which also saves the time and money of running to the hospital, as long as the doctor visits on time. Therefore, every patient, Hu Xinshi will teach him the most suitable stretching movements, so that patients can go home and recover, and the results are often very satisfactory. A middle-aged lady had a pain point under the soles of her feet and was diagnosed as having a problem with a flexor digitorum plantarum. According to the orthodox treatment in the book, she should have an injection (but it hurts) and break her toe for rehabilitation. Hu Xinshi suggested that she go home and get a small ball, and watch TV and step on it for 10 minutes every day, just like stepping on a healthy path, but she wouldn't. The lady stepped on it for half an hour every day, and the pain for many years was improved in a few days. Of course, there are also some patients who have not achieved the expected results after his diagnosis and treatment. Most patients have no patience to do the specified actions, or just believe that taking medicine can solve the problem. Hu Xinshi said helplessly that all these depend on the patient's own efforts, and the doctor can't do it for him. Don't think that Hu Xinshi only focuses on pain treatment, and he is also very attentive to the improvement of anesthesia technology, as long as it is beneficial to patients. 65438-0998 With the support of Professor Wu, a gastric cancer expert from Taipei Rongzong, we began to study and improve the local anesthesia of lumbar epidural space abroad to segmental nerve block analgesia of thoracic epidural space. Although this practice is very difficult and few people are familiar with it, he found that it can not only greatly reduce the dose of drugs, but also cause less harm to patients. For example, patient-controlled analgesia after appetizing surgery, analgesics can be reduced from 20c. C. to 6c. And the concentration of the drug is also adjusted to the appropriate minimum dose according to the constitution of China people. Moreover, because the nerve innervating the wound at the surgical site is blocked, patients do not need to use a larger dose of painkillers after surgery as in the past. He put forward this method and the experience of Taipei Rongzong in many academic conferences at home and abroad, and said that so far, many large hospitals in China have adopted this kind of "segmental nerve block" for postoperative analgesia, and anesthesiologists have also used thoracic epidural injection as a routine operation because of their more experience. Faced with more and more medical disputes, Hu Xinshi often tells students that it is necessary to spend more time to let patients know what treatment they are doing, and to explain sincerely and patiently, so that doctors and patients can communicate better and reduce some disputes. An 80-year-old patient was sent to hospital because of severe intestinal embolism. The only way to save his life is surgery. However, due to his age and the deterioration of his physical condition caused by intestinal necrosis, the risk of surgery is quite high. A year ago, Hu Xinshi's father suffered from the same disease. Doctors admit that the chances of saving lives are less than 5%, and surgery is risky. Results After operation, he spent 37 days in the intensive care unit and died. With this experience, Hu Xinshi sincerely explained and analyzed the advantages and disadvantages to patients, and provided other treatment methods such as patient-controlled analgesia similar to hospice care. The son of an elderly patient chose not to have surgery. Although the patient died a week later, he still brought his family to thank Hu Xinshi. Because the old father spent a week calmly and painlessly, five sons at home and abroad came back to surround themselves and enjoyed the last family in the obvious sense. This incident had a great influence on Hu Xinshi. In the future, you must use the same attitude to explain clearly and sincerely enough for patients to fully understand. He has been practicing medicine for 40 years. Hu Xinshi said that it was a long time. He spent a lot of effort and spirit to improve the patient's pain. He hopes that what he has learned will continue and help patients for a longer time. He said with a smile, I have been thinking recently that many interests I used to like, such as painting and writing brush, have long been lost. He wants to regain his interest and spend more time with his wife. Present position: Head of Pain Control Team of Taipei Veterans General Hospital, Clinical Professor of National Defense Medical College, and Professor of Pain Medicine in Department of Medicine. Awards: 1998 Outstanding Service Award of Taiwan Province Pain Medical Association, 10 1 Honorary Member Award of Taiwan Province Pain Medical Association. Expertise: pain control, anesthesia medicine. This article is taken from issue 35 1.