The Blog

By: Tracy Brobyn, MD

I think from now on, anyone who is old enough to say they lived through the pandemic will look at the world as “before covid” and “after covid” or at the very least “during covid”.  Those women who menstruated during the pandemic, often have an especially intimate relationship with the terms “before” or “after covid” because many of them experienced changes their cycles due to COVID infection and the issue has only been tentatively addressed by our healthcare system.  Fortunately, the literature tells us that most women whose cycles were disrupted by infection experienced only a temporary abnormality.  However many women who meet the definition of so called “long covid”  also experience seemingly more persistent gynecological changes.  In my practice, many patients have complained of disruptions in their menses related to covid and/or the vaccine.  Turns out it’s not just “in their head”.

What happens when COVID messes with your period?  It runs the gambit from irregular cycles and heavy bleeding to worsening menstrual pain (like we need more of that).  However, perimenopausal symptoms and PMS reared their ugly heads as well.  In fact when gynecological symptoms accompanied long covid; fatigue and poor quality of life runs rampant.  Many things in life can mess with a period including stress.  Menstrual disruption due to COVID however, isn’t that simple.  Turns out that there is a receptor in body for an enzyme called ACE2 and these receptors occupy many areas of the body including the lungs, hypothalamus in the brain, ovaries and the uterus.  The COVID virus needs to bind to the ACE2 enzyme and its subsequent receptor in order to invade cells which could explain why COVID has a predilection for our lady parts as well as our lungs.  Furthermore, the hypothalamus is the area of the brain that controls our lady parts which adds insult to injury.    When COVID hogs all the ACE2 and its receptors, the body’s system that controls these chemicals goes haywire and releases inflammation.  This is how many people died of COVID but it also explains why COVID leaves residual inflammation even in those who have won their fight with the nasty virus.  So how do we bring put out the COVID fire?

At our practice, we are all about “de-inflaming” whether that’s through a discussion of mindfulness meditation, improving your sleep or just not letting the little things get to you (and yes, the coronavirus is little believe it or not…lol).  Nevertheless, when you need a little more help, we can use the body’s internal energy system through acupuncture to further things along.  Acupuncture is a beautiful thing because it is especially helpful for overall de-inflaming (is that a word?  If it isn’t it should be). But nirvana, it can also be tapered to a given organ system such as the kidneys, lung or, you guessed it, our lady parts.  And here’s a little secret, the highway of energy that gives us a nice menses is coupled to the highway that serves the lung so you can kill 2 birds with one stone so to speak.  We also look at both the microbiome and homeopathy to help us further attenuate inflammation.  Long COVID can be treated but it requires an out of the box approach that traditional medicine often lacks, i.e. the whole person approach.  You aren’t just a uterus after all and COVID knows that.  So why not use all your systems to take him out?  Just a thought.

1.         Dong, J., et al., The impact of “long COVID” on menstruation in Chinese female college students and the intervention of acupuncture. Medicine, 2024. 103(6): p. e36818.

2.         Sakurada, Y., et al., Clinical characteristics of female long COVID patients with menstrual symptoms: a retrospective study from a Japanese outpatient clinic. J Psychosom Obstet Gynaecol, 2024. 45(1): p. 2305899.

3.         Li, K., et al., Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online, 2021. 42(1): p. 260-267.

4.         Maybin, J.A., et al., COVID-19 and abnormal uterine bleeding: potential associations and mechanisms. Clin Sci (Lond), 2024. 138(4): p. 153-171.

5.         Pourmasumi, S., et al., Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review. Balkan Med J, 2023. 40(3): p. 153-164.

6.         Wang, J., et al., The role of macrophage polarization and associated mechanisms in regulating the anti-inflammatory action of acupuncture: a literature review and perspectives. Chin Med, 2021. 16(1): p. 56.

7.         Yang, Y., et al., Observation on efficacy and underlying mechanism of cheek acupuncture on ovulation induction for infertile women with PCOS: Case series. Medicine, 2024. 103(10): p. e37370.

8.         Whitmont, R.D., The Human Microbiome, Conventional Medicine, and Homeopathy. Homeopathy, 2020. 109(4): p. 248-255.

9.         Bellavite, P., et al., Immunology and homeopathy. 1. Historical background. Evid Based Complement Alternat Med, 2005. 2(4): p. 441-52.

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Dr. Kevin Q. Ng

Have you ever woken up and felt like your neck was tight for no particular reason? If you said yes, I would not be surprised and in fact I would be surprised if you said no.

Chronic non-specific neck pain is a frequent complaint often attributed to myofascial pain. One study estimated the prevalence of myofascial pain as the chief complaint to be 30% in a primary care practice. . In our practice the prevalence is even higher affecting all levels of activity from professional athletes and fitness enthusiasts to sedentary and chronically immobile patients. 

What is Myofascial pain syndrome (MPS)? It is a regional pain disorder caused by the presence of trigger points within muscles or their fascia. It has been described as “hyperirritable spots, usually within a taut band of skeletal muscle or in the muscle’s fascia that on compression can give rise to characteristic referred pain, tenderness, and autonomic phenomena” . The pain of MPS is of a deep aching quality, occasionally accompanied by a sensation of burning or stinging, or restricted active movement. A useful website to determine if these pain patterns are related to MPS is http://www.triggerpoints.net/.

In our recent post on Chronic Dizzyness we discussed briefly how different providers including chiropractors, osteopaths, physical therapists, massage therapists, body work experts, acupuncturists, prolotherapists, and neural therapists would approach myofascial dysfunction. I would like to highlight one of the modalities in trigger point release. Trigger point release is a manual therapy technique used to alleviate muscle pain and tension by releasing or softening muscle knots. I believe nearly all patients should be doing some form if not multiple modes of self-trigger point therapy. When these self-treatment modalities do not completely resolve the issue, or they seem to recur frequently this would warrant an evaluation. A systematic review and meta-analysis found that wet needling (injection therapy) was more effective than dry needling (solid needle therapy) for sustained relief in the neck and shoulders (3). In my experience the key to a successful trigger point injection is a hybrid technique with elicitation of a local twitch response followed by injection as demonstrated in this video. I believe the key to sustaining a trigger point release is a combination of neural therapy, trigger point release followed by acupuncture.

Information for physicians and health care providers:

Myofascial pain and trigger points are a common cause of neck stiffness and pain that may evolve into headaches, dizziness, numbness and weakness. Conservative management can include hydration with repletion of electrolytes, manual therapies, stress reduction and life style changes.  When the above treatments are inadequate trigger point therapy is a simple and effective tool to consider.

1. Skootsky, S. A., Jaeger, B., & Oye, R. K. (1989). Prevalence of myofascial pain in general internal medicine practice. Western Journal of Medicine, 151(2), 157.

2. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1 – Upper Half of Body, 2nd Edition, Williams & Wilkins, 1998. 

3. Liu, L., Huang, Q. M., Liu, Q. G., Ye, G., Bo, C. Z., Chen, M. J., & Li, P. (2015). Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 96(5), 944-955.

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By Dr. Andrew Oswari

Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition where the liver has greater than 5-10% fat accumulation by weight. It is estimated that 30% of NAFLD can progress to Non-Alcoholic Steato-Hepatitis (NASH) which includes inflammation and scarring of the liver. Approximately 20% of NASH will progress to cirrhosis which may lead to Hepato-Cellular Carcinoma and failure requiring liver transplants. These non-alcohol related conditions have now surpassed alcohol related disease as the leading cause of liver related diseases. (1), (2)

In addition to the above risks, having fat in the liver doubles the risk of cardiovascular disease (CVD) including heart attacks, strokes, and atherosclerosis. CVD is the leading cause of death from NAFLD and its other forms.

It is estimated that 30-40% of the general global population has some form of fatty liver disease. Latin American countries are closer to 44% and the United States is a little over 30%. Most of these patients are undiagnosed, asymptomatic and have liver laboratory values within the normal reference range. (1)

The American Diabetic Association, American Academy of Clinical Endocrinology, American Association for the Study of Liver Diseases, and the American Gastroenterological Association recommends screening for NAFLD on individuals that fall into these categories:

• Type 2 Diabetes
• Pre-diabetics
• Or have two or more of the following:

If the criteria above is met, screening would include a Fibrosis-4 (FIB-4) index blood test and other non-invasive testing.  Standard ultrasounds have a poor sensitivity in screening and should not be used. Almost 70% of patient referrals for NAFLD evaluation are due to elevated liver enzymes on their laboratory blood work results (reference). If much of the NAFLD population is undiagnosed, asymptomatic and within normal reference range of liver enzymes, there is a significant population that is being overlooked. Magnetic Resonance Elastography (MRE) is considered the gold standard for non-invasive testing, but due to costs and access, Vibration Controlled Transient Elastography (VCTE) via a Fibroscan device is recommended. (3),(4)

After finding out that close to 40% of the general world population has NAFLD, better methods of screening are mandatory. We are pleased to announce that VCTE in the form of a Fibroscan is now available at the Chung Institute. This is the perfect addition to our philosophy of preventing disease and restoring health. Insurance will cover the procedure as long as the above conditions are met. Screening is also available for those who do not meet the criteria but want to pay for it out of pocket.

It is interesting to note that the conditions discussed have recently been renamed to reflect the real cause of fatty liver which is metabolic dysfunction. NAFLD is now MAFLD (Metabolic Dysfunction Associated Liver Disease) and NASH is now MASH (Metabolic Dysfunction Associated Steatohepatitis). That being said, the condition can be improved or even reversed by a change in diet and lifestyle.

One study has already shown an improvement in MASH with just 6 days of a change in diet (ref). The Chung Institute will help you along in your journey to get metabolically healthy and prevent disease allowing you to achieve not just a numerical age but ensure your wellness as your age.

Take this quiz to see if you are at risk: thinkliverthinklife.org/quiz

For additional information, please see these articles:

American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings (endocrinepractice.org)

Fatty Liver Disease (Steatotic Liver Disease) – American Liver Foundation

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2023 | Diabetes Care | American Diabetes Association (diabetesjournals.org)

1. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023 Apr 1;77(4):1335-1347. doi: 10.1097/HEP.0000000000000004. Epub 2023 Jan 3. PMID: 36626630; PMCID: PMC10026948.

2. Harrison SA, Gawrieh S, Roberts K, Lisanti CJ, Schwope RB, Cebe KM, Paradis V, Bedossa P, Aldridge Whitehead JM, Labourdette A, Miette V, Neubauer S, Fournier C, Paredes AH, Alkhouri N. Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort. J Hepatol. 2021 Aug;75(2):284-291. doi: 10.1016/j.jhep.2021.02.034. Epub 2021 Mar 18. PMID: 33746083.

3. Kwo, Paul Y MD, FACG, FAASLD1; Cohen, Stanley M MD, FACG, FAASLD2; Lim, Joseph K MD, FACG, FAASLD3. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology 112(1):p 18-35, January 2017. | DOI: 10.1038/ajg.2016.517

4. Rinella, Mary E.1; Neuschwander-Tetri, Brent A.2; Siddiqui, Mohammad Shadab3; Abdelmalek, Manal F.4; Caldwell, Stephen5; Barb, Diana6; Kleiner, David E.7; Loomba, Rohit8. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 77(5):p 1797-1835, May 2023. | DOI: 10.1097/HEP.0000000000000323

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Do you suffer from chronic dizziness?  When I was practicing conventional family medicine over 25 years ago, chronic dizziness was one of the complaints that most family doctors hated to deal with. The practitioner knew that he/she could not help them and knew that referring them to a neurologist or otolaryngologist rarely helped.

What are the causes of dizziness? Dizziness is an imprecise term. Here are the most common categories of conditions that might make a patient say they feel dizzy.

Cardiovascular causes: when the person has a drop in the blood supply to the head due to either episodic low blood pressure or heart rhythm problems, the person will feel “dizzy” but when carefully asked, it is more of a “lightheadedness or feeling faint” sensation. They do not have spinning or balance symptoms.

Dizziness due to an abnormal vestibular system.  The vestibular system comprises of fluid filled labyrinth canals in the ear that detects both position and motion of the head. If these are injured, inflamed, or if the nerve that supplies these canals are inflamed or injured the individual will experience vertigo. This is typically a violent sense of motion and spinning.  This type of dizziness is called vertigo. It is extremely unpleasant. When the nerve is involved there often is ringing and hearing loss additionally associated with the condition. True vertigo has visible physical eye signs (a rapid jerking eye movement called nystagmus). The diagnosis is straight forward by mainstream doctors. There are “vestibular” tests done by ENT doctors, but they are merely confirmatory. The symptoms of true vertigo are quite distinctive. A CT or MRI can rule out physical lesions such as tumors or infarcts to that region.

Dizziness due to disequilibrium.  Patients describe a sense of being off-balance, swaying sensation, sea sickness type symptoms. To understand dizziness caused by disequilibrium, one must have some basic understanding of what gives us a sense of balance and equilibrium.

For the mind and body to feel a normal sense of equilibrium, one must have three components of our body system working in coordination and harmony.

1. We must have adequate vision.  Our vision gives us information as to where our bodies are in relation to our external environment.
2. Our inner ear vestibular system must work properly. The vestibular system comprises of fluid filled semi-circular canals. When the head/body moves into a different orientation the resulting fluid motion is detected and the brain can sense where our head is in space. E.g., when we tilt our heads, the fluid level tilts, and our brain can detect that we have tilted our head even when we have our eyes closed.
3. We must have accurate proprioception. We have proprioceptor sensory nerves located on all our muscle/tendon, that give information about the length of each muscle in our body. For example, when we tilt our head to the left, our brain senses that our neck muscles on the right are longer and stretched and our neck muscles on the left are shortened and contracted.

To feel in balance all three components must give appropriate and congruent information and our brain must integrate thatinformation to tell us exactly where our body is in space.

When the information is incongruent, we feel disequilibrium and dizzy.

For example,

• When we are below deck in a rocky ship at sea.  The boat is rocking, our vision shows no real movement of the walls, our proprioceptors show no rocking or tilting of the neck, but our vestibular system senses rocking. That mismatch makes us dizzy and sick.
• When we watch a video shot with a shaky handheld camera.  Our vision senses marked shaking, but our bodies are not shaking so both the vestibular system tells us we are not shaking, and the proprioceptors tell us that there is no shaking. This mismatch of information makes us dizzy and sick.
• When we have injured our proprioceptors in our neck due to trauma, such as an auto accident, the proprioceptors can give wrong information. That is why, trauma to the neck following an auto accident can result in chronic disequilibrium/dizziness. Unfortunately, you do not have to have a history of trauma do have problems in the neck.

By far the most common cause of disequilibrium is due to incongruent proprioceptive information going to the brain. This type of dizziness is due to an abnormal muscle, tendon, ligament, proprioceptive nerve dysfunction (the myofascial). 

Disequilibrium, however, is poorly diagnosed and managed by mainstream medicine. This is because the diagnosis and treatment of chronic neck myofascial dysfunction is poorly taught in medical school. Many patients and physicians do not realize that many cases of dizziness due to disequilibrium are problems with the proprioceptors in the neck.

Typically, the average neurologist or ENT doctor rarely ever examines the neck for clues because they were not trained to do so. I know this because every patient with dizziness that I have ever treated tells me the neurologist and ENT never physically palpated their p neck. I have also taught medical students for over 30 years and know that they are barely taught how to manage myofascial problems in their four years of schooling.

When carefully examined, most patients with disequilibrium have abnormal findings in the neck.

Chiropractors, Osteopaths, physical therapists, massage therapists, body work experts, acupuncturists, prolotherapists, neural therapists and other alternative therapists  generally have more practical knowledge regarding managing symptoms related to the functional management of the musculoskeletal system than allopathic conventional medicine.

Unfortunately, all these alternative practitioners can only manage a portion of the causes of myofascial dysfunction and tend to be biased towards their own area of training and knowledge. The chiropractor will want to mobilize joints and vertebrae, the osteopath might use muscle energy technique or Jones strain counter strain, the physical therapist might use proprioceptive neuromuscular facilitation, heat, ultrasound, passive stretching, the massage therapist might use deep tissue massage, the prolotherapist will try to inject the ligaments and tendons, and the neural therapist might inject abnormal scars.

At the Chung Institute we are familiar with almost all the different myofascial diagnostic and treatment techniques and know which combination will most likely restore the proprioceptive system in the myofascial in the shortest number of visits. We have successfully treated numerous patients over the past 25 years with chronic dizziness due to disequilibrium by correcting their neck issues.

Information for physicians: that might want to learn how to manage dizzy patients.

Here are some key suggestions:

Define by history taking what type of dizziness the person is likely to have:

Cardiovascular: if sounds like lightheadedness or feeling faint or history or syncope. Check blood pressure issues, orthostatic symptoms, palpitations. Do cardiovascular work-up
Vestibular: if true vertigo symptoms, rule out benign positional vertigo with a Halle-Pike maneuver. Check hearing loss and tinnitus. Consider CT or MRI to rule lesions on or near the eighth nerve.

Disequilibrium: History of neck pain, tightness, history of trauma.  Physical exam: check for limited range of motion and/or tenderness of attachment sites of splenius capitus, rectus capitus oblique, splenius cervices, facet ligaments, trapezius, levator scapula. Learn to exam these structures and be able to ascertain myofascial knots (trigger points), textural changes in the tissue.

Check for scars of head and neck; especially wisdom teeth extractions, tonsillectomy, head laceration, facial surgery, tail bone injuries. Scars of the upper extremities, especially carpal tunnel scars often cause problems with neck stiffness and pain. All should be treated appropriately with neural therapy.

Finally, there are some patients who have chronic dizziness due to partial deterioration of all three components. E.g., an elderly person who has poor vision, poor hearing, and stiff neck muscles.   Many of these patients can be helped following the protocols discussed above.

For any physician truly interested in learning to treat this type of problem you are welcome to contact our office and spend some time in our office under a preceptorship.

M. Kyu Chung, MD

Director, Chung Institute of Integrative Medicine,

Clinical Professor, Cooper Medical School

Contact: either Carolann: 856-222-4766

Or email Brigid Bandomer: bbandomer@wonsookchungfoundation.org

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We recently have developed a new therapy that seems to improve neurological symptoms that we would like to present.  We call it ‘Auto-sanguineous Neural Therapy’. We believe this is the first description of this therapy.

In neural therapy, one of the methods to treat the brain is a technique called “Crown of Thorns”.  This involves about a dozen simple small subdermal injections of procaine given in a circumferential manner around the scalp (hence the name crown of thorns)

We published a particularly remarkable case in resolving concussion symptoms. Our patients are generally very pleased with the results when treating new as well as old concussion symptoms including brain fog. Often patients remark spontaneously their brain clarity improved immediately after a treatment.

Those who are familiar with neural therapy either as a practitioner or as a patient agree that simple procaine injections have remarkable healing effects. The theory is that the local anesthetic briefly shuts off the nerves and allows it to reset back to their original default setting. We estimate that we have given over 500,000 procaine injections without an allergic reaction in the past 20 years. We believe this is an extremely safe and effective therapy for everyone except for those with a known procaine allergy.

Auto-sanguineous therapy was a medical treatment used by some practitioners in the early 20^th century . This involves the injection of the patient’s own blood or blood component back into the patient (usually intramuscular, subcutaneous, ligament, tendon, or joints). Blood has remarkable healing effects due to its abundant cytokines and messenger molecules which attract various healing components to the area where it is injected. We have used it to help heal various injuries, including injuries that have been resistant to more traditional treatments.

We now have found that combining the two therapies improves or eliminates more serious neurological symptoms. We call these treatments auto-sanguinous neural therapy.

Please view the two before and after demonstrations below.

Dosch Neural therapy

Wiley Clinical Case reports 2019

Autoblood- The Magic Shot, Stuart H. Shakman, Library of Congress Catalog Card#98-96133, © 1996

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