CASE REPORT

Application of Acupuncture to Treat Low Back Pain

A 2-year case study of fascial needle manipulation on a patient whose
low back pain was unresponsive to medications.
Joseph Montalto, MPT Bin Xu, MD, PhD
Mantalto Physical Therapy, PC Clinical Supervisor
Oyster Bay, New York New York College of Traditional Chinese Medicine
Mineola, New York
Josephine Fan, MS
Owner of Aikakai Audrey Krapf, RN, MBA
Bay Shore, New York Director
Health and Wellness Center
Jenny Lam Farmingdale State College
Farmingdale, New York
Ryan Rojas
Ryan Whelan, LMT Rosemary McCarthy, RN, BS
New York College of Traditional Chinese Medicine Associate Director
Mineola, New York Health and Wellness Center
Farmingdale State College
Farmingdale, New York

W
orking adults (ages 18 to 64) represent The World Health Organization anticipates that as the
63% of the population and account world population ages, the incidence of LBP will increase sub-
for 72% of all low back pain (LBP) stantially and become 1 of the leading conditions for which
health care visits.1 Low back pain has the aging population will seek out medical intervention.2
been identified categorically as acute, Acupuncture may help improve quality of life as well as
subacute, or chronic, depending on reduce lost workplace productivity through more effective
the onset, duration, and severity.1,2 Risk factors have included and sustained pain relief.4,5 Stimulating nerves located in
occupational posture, depressive moods, obesity, gender, muscles and other tissues with the application of fine nee-
and age, and risk is most likely affected by a combination dles may lead to the release of endorphins and other neuro-
of several of these variables.2 Low back pain is not a dis- humoral factors.6 The expected result is a change in pain
ease but rather a group of signs and symptoms that affects processing between the brain and spinal cord.
all age groups across the lifespan. It has been shown to be Acupuncture has demonstrated efficacy in reducing inflam-
more common from age 35 to 55, with a higher prevalence mation by promoting the release of vascular and immuno-
in women.2,3 modulatory factors and increasing local microcirculation.6,7,8

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 Application of Acupuncture to Treat Low Back Pain

Table 1. Results of Initial Physical Examination disc dehydration, and diminished disc
space height. There was a Schmorl’s
Lumbar AROM flexion: 50° with pain both during movement and at end range
node (protrusion) located posterior Side Bar
Lumbar AROM extension: 10° to the inferior T11 endplate. In addi-
Lumbar AROM lateral flexion: 20° bilaterally tion, at L4-L5 a posterior annular disc Four Pillars of Traditional Chinese Medicine
bulge pressed upon the ventral thecal
Lumbar AROM rotation: 5° to 10° bilaterally sac with evidence of disc hydration.
At L5-S1, there was a posterior right- Looking at physical attributes such as the face, eyes, gait, and recognized within each of these positions. Palpating the pulse
Bilateral lower extremity strength: grossly 4/5
sided, subligamentous disc herniation tongue is the first pillar. We examined the map of the tongue as is an extremely detailed task requiring complete focus to feel
Lower abdominal/back extensor strength: 3+/5 impressing the right ventral epidural it laid out the internal viscera and details of the tongue such as for the quality. The pulse has several attributes that serve as a
space and right S1 nerve root as it shape, color, texture, moisture, coating thickness and color, size window between the practitioner and the patient, including the
Palpation: left to right lumbar paraspinal, left piriformis, left hamstring: 2+ tenderness (scale
0 to 3+) with increased hypertonicity approached the lateral recess. Also, of the papillae, and movement, as these features can be very depth, strength, consistency, and even the specific movement in
mid-facet hypertrophic changes were which the blood travels through the vessel.
AROM, Active range of motion. revealing.
noted at both L4-L5 and L5-S1.
In turn, this may support better joint prior when he sneezed and suddenly Transitional vertebrae were evi- Asking is the final pillar, which revolves around 10 essential
Listening is a second pillar in the evaluation. The patient’s
movement and relief of muscle stiffness felt intense pain in his mid-back in denced at the lumbosacral junc- questions that directly correlate to the patient’s overall being
voice might offer evidence of a disturbance or irregular pattern. and constitution. These questions journey from the chief
as well as aid the healing of swelling the T11-T12 area. After this episode, tion as a large ventral extradural
and bruising.6,7 he had 18 to 20 sessions of com- defect was detected at T11-T12. complaint and project to other life behaviors and inclinations
Palpation is the third pillar. For example, the pulse, like the that may encompass tendencies to be either hot or cold (or
While the evidence for acupunc- bined physical therapy and chiroprac- In the same location, a large her-
tongue, presents a blueprint of a patient’s condition. The left neither), sweating, gastrointestinal (ie, digestion, urination,
ture remains inconclusive, there are tic treatments, as well as 2 epidural niation with a subligamentous
a growing number of studies offer- injections. The patient reported not extrusion was evident on a post- and right side of the radial pulse is laid out into 3 sections (from bowel movements), sleep quality and quantity, emotional status,
ing clinical support for the benefits of only that these treatments were not myelogram computed tomography proximal to distal): qi, guan, and cun. Each pair of organs can be energy levels, and pain quality and consistency.
using acupuncture to address LBP.6-10 effective in eliminating his pain but (CT) scan. There was compression of
In this case review, the pain relief also that physical activity and bending the distal cord and the proximal por- Source: Four Pillars of Chinese Medicine. Available at: http://www.china.org.cn/english/health/225768.htm
achieved by fascial manipulation was forward while sitting made it worse. tion of the conus medullaris with the
demonstrated through the release of At the time of the first treatment at herniation at the midline without a A summary of the assessment was as We concluded that the patient was we were able to reduce the post-treat-
superficial stagnation in the tendino- our center, the pain was being con- lateralized fragment. follows: Qi and had blood stagnation. ment symptoms of pain with forward
muscular channels that are responsi- trolled by over-the-counter medica- A small herniation also was noted • On self-report, the patient bending and slouching, or slumping
ble for pain; this process has been cor- tions, including ibuprofen, naproxen at L4-L5 and L5-S1 with a mild sac described a tendency to be warm Treatment Plan and sitting.
related to benefits in the deeper muscu- (Aleve), meloxicam, and topiramate, effacement contained within the ven- while having an aversion to cold. Based on the diagnosis, the treatment From September 2015 to September
lar layers and related meridians.11,12 We which were taken as needed. tral epidural fat situated further to the He was sweaty but not thirsty. plan was to alleviate the patient’s pain 2016, a new set of points were used
used Master Tung points in a special right. The imaging findings as well as • His digestion was regular, with by removing the stagnation of Qi and largely to tonify Qi, blood, and yin due
3-needle arrangement called Dao Ma, Musculoskeletal Evaluation the patient’s initial description of his normal bowel movements, and he blood. The goal of planned sessions was to their classical clinical indications.
in conjunction with a method called The patient reported pain at 7, using pain led to an orthopedic physician had no gas, distention, or bloating. to reduce pain to as close to 0 as possi- Also, these points were selected because
Dong Qi (movement Qi) in which the a numeric 1 to 10 pain rating scale. diagnosis of multilevel herniated discs • He reported undisturbed sleep, ble while increasing range of motion. of their anatomical placement, dou-
needle is manipulated as the patient The patient complained of functional at T11-12, L4-5, L5-S1. averaging 7 hours a night. The acupuncture points were selected bling as local points along the affected
exercises the affected area.13 limitations, including bending for- • His sense organs and emotional according to point specificity, needling channel in the bladder and gallblad-
We found that acupuncture’s overall ward, lifting, and sitting for periods Assessment Using Traditional status were assessed as normal. He the right when the symptoms were on der14 (Figure 2).
therapeutic effects help in reducing the longer than 15 to 20 minutes due to Chinese Medicine reported a steady energy through- the left, needling the opposite end of the
use of medication for back complaints, increased lower back, left buttocks, In addition to imaging tests, we relied out the day. channel from where the symptoms were Needling Technique
providing a more cost-effective treat- and left posterior thigh pain (Table 1). on the 4 pillars of traditional Chinese • His pain was described as stabbing located, and arranging points according Qi puncture and fascial manipulation
ment over a longer period of time (eg, medicine (TCM) in evaluating the and constant and rated between to somatotopic arrangement. needle techniques were applied, using
at least 2 years).5,6,9 Testing and Diagnosis patient’s overall constitution and chief 6 and 7 in the 10-point numeric Between December 2014 and May traditional Qi puncture or triple punc-
Magnetic resonance imaging (MRI) complaint. Observation was a power- pain scale. 2015, treatment points focused on the ture with a 2-needle technique where
Case History scans and myelograms of the lumbar ful tool used for diagnostic purposes • The patient’s tongue appeared red urinary bladder and gallbladder, largely 1 needle is placed in the center and 2
A 28-year-old patient came to the spine and thoracic spine were ordered (Side bar).10 with a thin white coating and cen- to tonify Qi, blood, and yin due to their needles are placed on the sides. This
Farmingdale acupuncture clinic in by an orthopedist. The first MRI of With the information gathered from ter crack. classical clinical indications (Figures 1). technique has been used most often to
December 2014 with low back pain the lumbar spine, taken in October the diagnostic pillars, a quantitative • His pulse was very deep (sinking) To more efficiently and effectively treat areas of deep muscle tenderness.
radiating down his left leg due to disc 2014, revealed a posterior disc hernia- integration was gathered to get to the in both the chi and cun positions treat the left posterior thigh symptoms, In contrast, fascial manipulation is pre-
herniation. It had started 4 months tion on the ventral surface of the cord, root of the problem. and was slippery. especially for the bladder (BL) channel, sented by using a 3-cun needle inserted

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 Application of Acupuncture to Treat Low Back Pain Application of Acupuncture to Treat Low Back Pain

Back
BL 15 Xinshu L1-L2
BL 17 Geshu L3-L4
L4-L5
Shenmen
BL 20 Pishu GB 31 Fengshi
BL 10 Tianzhu (shoulder GB 32 Zhongdu
and back pain) BL 40 Weizhong
(lumbar pain) BL 23 Shenshu
BL 24 Qihaishu GB 34 Yanglingquan
BL 57 Chengshan
(relaxes sinews, BL 25 Daqangshu
activates meridian)
(L) SI 3 Houxi GB 38 Yangfu
BL 60 Kunlun (K) I 3 Taixai GB 39 Xuanzhong
(removes stagnation)
BL 53 Baohuang

(L) BL 62 Shenmai
Figure 1. illustration of bladder (BL) acupunture points used in phase 1 treatment. The prescription was formulated because of their anatomical
placement, in the bladder (BL) and spleen, doubling as local points along the affected channel to tonify the kidney Qi and Yin.
Figure 2. Illustration of gallbladder (GB), small intestine, and kideny meridians (K) acupuncture points used in phase 1 treatment.
into the superficial fascia overlying a
Table 2. Phase 1 Treatment--Points selected to tonify Qi, blood and yin due
to clinical indications for back pain--bladder (BL) and gallbladder (GB). taut or tender band of muscle tissue at a Upon initiating phase 2 acupuncture Qi and blood throughout the myofas- In Myers’s theory, tracks, or lines of
(See Figure 1 for body locations) depth of ¼-inch to ½-inch. The needle (Table 3), the patient reported con- cial system. pull through the fascia, are made from
was then gently bowed and the handle tinued pain in his left lower back and Given the efficacy achieved in this myofascial or connective tissue units
BL 10 Tianzhu (Activates the meridian, relieves pain)
BL 15 Xinshu twirled until a mild sensation—warmth upper buttocks with left lateral upper patient, we repeated this modality and show a continuity of fascial fibers.15
BL 57 Chengshan
BL 20 Pishu BL 60 Kunlun or vibration—was achieved and radi- thigh pain, especially when bending of treatment in other patients who These tracks must be delivered in a
BL 23 Shenshu GB 31 Fengshi ated distally away from the point of forward. The pain was 5 out of 10 on complained of similar pain; they also straight line or change direction only
BL 24 Quihaishu GB 32 Zhongdu insertion. the numerical pain scale. Acupuncture reported relief (unpublished data). in a gradual manner.
BL 25 Daqangshu GB Yangfu The patient received this treatment treatment in this phase emphasized The treatment approach addressed In this patient, the superficial back
BL 40 Weizhong GB Xuanzhong (phase 1) at a frequency of 1 to 2 times fascial manipulation and the use of pain stemming from the sciatic nerve line (SBL) in Myers’s system coincided
BL 53 Baohuang
every week from December 4, 2014, Master Tung points to address the and how its distribution was anatom- with the Taiyang tendinomuscular
Classical pair of points used to open up the Taiyang zone of the body where pain is [small to May 5, 2015, followed by phase 2 pain in the left buttocks and ham- ically a source of pain from the L4 to channel in TCM. Therefore, fascial nee-
intestine (SI) :
Left SI 3 Houxi and BL 62 Shenmai treatment consisting of once weekly string muscles.12,13 This treatment S3 segments of the sacral plexus. The dle manipulation was performed on the
visits for nearly 1 year after resuming reduced the patient’s pain to approxi- sciatic nerve has 2 branches: the tibial midline of the hamstrings (a main com-
The following point is used to tonify the kidney (KD):
in September 2015. mately 0 to 2 on the 10-point numeric nerve, which travels down the poste- ponent of the SBL and Taiyang chan-
3 Taizi
Auricular points, located in the ear—Homunculi theory--correspond to body pain: [EAR} pain scale between treatment periods, rior compartment of the leg into the nel) in the region of BL 36 and BL 37.
Treatment Results during which Bob admitted sitting in a foot, and the common peroneal nerve In the Anatomy Trains concept—a
Hua Tuo Jiaji points are used to activate the sympathetic nervous system, to promote better During phase 1 treatment, pain in the slouched position both with and with- (also called the common fibular nerve), map of the whole-body fascial and
circulation: patient’s lower back, left buttocks, and out his feet elevated. which travels down the anterior and myofascial linkages—muscle attach-
L1-2
L3-4 posterior thigh, on average, decreased lateral compartments of the leg into ments, or stations, were placed where
L4-5 from 7 to 2 on a 10-point numerical Discussion the foot. underlying fibers of the muscle’s epimy-
pain scale. This case illustrated an effective use of Research in Western medicine has sium or tendon were enmeshed or were
Extra points are located anatomically in the affected areas:
Yao yan The patient reported that the treat- facial needle manipulation and Master begun to correlate the fascial anatomy continuous with the periosteum of
Ashi (lower back and left buttocks) ment both with and without electro- Tung acupuncture to treat low back planes throughout the body with the 12 the accompanying bone.15 The more
The 4 Gates, remove stagnation and improves Qi stimulation was more effective than the pain/lumbar radiculopathy caused by main acupuncture meridians in TCM, superficial fibers of the myofascial unit
Right LR 3; LI 4 previous physical therapy and spinal local Qi and blood stagnation in the in particular of the tendinomuscular may, however, run on and communi-
injections that he had received. The Taiyang channel. Stagnation or block- channels. Thomas Myers described cate with the next piece of myofascial
Master Tung points:
patient stopped treatment in May 2015 age was relieved through the use of 7 myofascial meridians that coincide track. The SBL, like the Taiyang chan-
33.08 Shu Wu Jin
33.09 Shou Qian Jim and resumed acupuncture in September different acupuncture needling tech- with the 12 regular channels/tendino- nel, connects and protects the entire
A.04 Sanchansan 2015, continuing for 1 year. niques to enhance the circulation of muscular channels in TCM theory.15 posterior surface of the body from the

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 Application of Acupuncture to Treat Low Back Pain Application of Acupuncture to Treat Low Back Pain

bottom of the foot to the top of the of effective point selection is based on Prior experience includes being manager/ Table 3. Acupuncture Points Used in Phase 2 Treatment
head in 2 pieces: toes to knees and knees 3 types of correspondence: (1) image director at Physiologic Physical Therapy, Bladder (BL) acupuncture points (also used in Phase 1 treatment, Figure 1)
to brow. With the knees extended, as correspondence (diseased body area); PC, in Syosset, New York, and manager BL 10 Tianzhu: Clinically indicated for shoulder and back pain.
in standing, the SBL functions as one (2) channel correspondence (diseased of a satellite office for Orthopedic Physical
BL 40 Weizhong: The lumbar command point and therefore indicated for lumbar issues such as pain, sprains,
continuous line of integrated myofascia. channel); and (3) tissue correspondence Therapy Associates, PC, in Great Neck, and strains.
In comparison, the Luigi Stecco (diseased tissue).14 New York. He holds a master’s degree in
BL 57 Chengshan: Relaxes the sinews and activates the meridian; clinically indicated for lumbar issues.
approach recommends that the fasciae In comparison to these parallels made physical therapy from Touro College, Dix
of the limbs and trunk are divided into between the Western fascial system and Hills, New York, and Bachelor of Science BL 60 Kunlun: Removes stagnation from the meridian; clinically indicated for lower back pain.
the superficial fascia, deep fascia, and TCM theory, the Master Tung system degree in biology from Molloy College, in These gallbladder (GB) points smooth the flow of Qi and benefit the meridian
epimysial fascia.13 To be effective, the and theory was also applies.14 The most Rockville Centre, New York. He is board GB 20 Fengchi: Meeting point of the gallbladder, Sanjiao, and Yang Wei meridians; activates the channel and
fascial needle manipulation occurs at effective application observed was the certified in orthopedics. relieves pain down the back. Also clinically used to dispel wind.
the superficial fascial layer, including use of the large Taiji arm-leg correspon- Josephine Fan, MS, is owner of Long GB 25 Jingmen: Clinically indicated for pain in the lumbar or lateral costal region, especially when there is an
the membranous layer of the hypoder- dence where the right shoulder was Island Aikikai in Bay Shore, New York, underlying kidney Qi deficiency.
mis and the deeper loose connective used to treat the left lower back and one of the oldest martial arts schools in GB 26 Daimai: The meeting point of the gallbladder and Dai Mai channel; activates the meridian and relieves
tissue layer. This needle technique also left buttocks/posterior hip symptoms. the country. Until 2012, she was presi- pain in the lumbar region.
involves the deep fascial layer, more spe- Specifically, the point Jian Zhong (R dent of BC Fan & MC Peng Memorial GB 31 Fengshi: Clinically indicated to activate the meridian to relieve lower back pain and leg muscle pain.
cifically the 2 most superficial layers of 44.06), at the midpoint of the middle Nature and Humanity Foundation, a
the deep fascia, known as the undulated deltoid on the right shoulder, was nee- family-owned nonprofit organization GB 34 Yanglingquan: Classically indicated as the influential point of the tendons, therefore benefitting sinews,
muscles, and joints.
collagen fibers and the aponeurotic col- dled and manipulated during seated dedicated to serving the environment
lagen fibers. active range of movement (AROM) of and its inhabitants. Before that, she The following pair of points is the classical extraordinary pair used to open up the Taiyang zone of the body,
where the pain is located:
The functional application of Stecco’s left knee extension/flexion, which rou- was an account manager for Dynamic
Fascial Manipulation system is import- tinely reduced pain from 1 to 2 to a post- Decisions, Inc, a government-contracted (L) SI 3 Houxi: Confluent point of the Du channel. Activates the channel, relieves pain in the back.
ant to note because it correlates the fas- treatment rating of 0 out of 10. This IT company. She passed the National (L) BL 62 Shenmai: Master point of the Yang Qiao (Yang Motility) channel; clinically indicated to relax the
cial centers of coordination and fusion is the clearest example of the efficacy Certification Commission on Acupuncture sinews.
with the individual acupuncture points of the use of the Master Tung system. and Oriental Medicine exams and is Master Tung points are arranged topographically by an anatomical zonal concept where each zone functions as
on each channel.13 The center of coor- awaiting approval of her application a microsystem and has points that affect the entire body:
dination refers to a single point of ref- Conclusion for certification. She graduated from the (R) 44.06 Jian Zhong: Indicated for pain and issues in the lower back and posterior hip.
erence from which muscle fibers syn- The reduction in pain reported by the New York College of Traditional Chinese The following points were stimulated using the fascial needle technique to activate the fascia of the posterior
chronize to collectively move a joint in patient, achieved with a combination Medicine (NYCTCM) with a master’s thigh and leg:
1 direction. The center of perception of Master Tung points, myofascial nee- degree in health science/acupuncture and
BL 32 Ciliao: The meeting of the bladder and gallbladder channel. Clinically indicated for the lumbar region and
extends over a moving joint and cor- dle manipulation, and Qi puncture– a bachelor’s degree in business manage- the legs, relieving pain, numbness, and stiffness of those affected areas.
relates to a specific center of coordina- style acupuncture, demonstrates the ment (management and operations) from
BL 36 Chengfu: Activates the channel and relieves pain. Clinically indicated for pain in the lower back and
tion. For example, Stecco said, “When efficacy of managing the symptoms that Stony Brook University. 
 gluteal region.
the fascia overlying a center of coordi- had previously adversely affected the Jenny Lam is in the process of taking
BL 37 Yinmen: Benefits the lumbar area and is indicated for lumbar pain, as well as pain, numbness, and
nation becomes fibrotic, uncoordinated patient’s quality of life.13-15 Thus, it is an the National Certification Commission
weakness of the lower extremities.
movement results, leading to irritation option worth offering to patients with on Acupuncture and Oriental Medicine
of the articular nociceptors, thereby cre- chronic low back who have not found exams. She completed the program in acu- Auricular points are located on the ear, which correspond anatomically (Homunculi theory) to parts of the body.
ating pain in a joint (ie, the center of relief with other therapeutic methods. puncture from NYCTCM and holds an Shenmen: Translated as the Neurogate, or the point used for general pain relief and energy, indicated to bring
perception).”13 At end of treatment, the patient MBA in finance from the Stern School of balance to the body.
In addition, Master Tung theory relies reported pain of 0 to 2 out of 10 on the Business as well as a Bachelor of Science Auricular: Indicated for issues of the back
on many points not found in the domi- 10-point numeric pain rating scale, He degree in neural sciences from Brown
nant systems of TCM.14 Distribution of will continue to receive acupuncture University.
the points includes the entire body, but treatment to manage any future low Ryan Rojas has been a massage thera- certificate in massage therapy from the of holistic health, medicine, and practice. Bin Xu, MD, PhD, who is board cer-
the points are arranged topographically back pain. The patient’s prognosis is pist since 2011, providing a wide vari- New York College of Health Professions, He has extensive experience, enabling him tified in acupuncture, has been a clin-
by an anatomical zonal concept where good and considered improving based ety of services, including Swedish mas- Syosset, New York. He holds a Bachelor of to bring a full range of skills using modal- ical supervisor at NYCTCM since
each zone functions as a microsystem on the reduction of pain symptoms. sage, Asian massage, deep tissue massage, Science degree in computer science from ities of both Eastern and Western medicine 1999. Prior to that, he was a medical
and has points that affect the entire reflexology, medical massage, chair mas- Nassau Community College in Garden to capably attend patients’ specific needs. acupuncturist at the University Hospital
body.14 Authors’ Bios Joseph Montalto, MPT, sage, cupping, Reiki, body scrub, and hot City, New York. He holds a master’s degree in health sci- Medical Center/SUNY at Stony Brook
In the case study, the affected area was is sole proprietor of Montalto Physical stone massage. He earned a certificate Ryan Whelan, LMT, is a licensed mas- ence (acupuncture) and a bachelor’s degree where he was part of a multidisciplinary
not needled. The Master Tung system Therapy, PC, in Oyster Bay, New York. in acupuncture from NYCTCM, and a sage therapist motivated by the promotion in professional studies from NYCTCM. team caring for children, women, and

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 Application of Acupuncture to Treat Low Back Pain

families with HIV/AIDS. He was a can- New York, and a registered nurse at and Wellness Center at Farmingdale State
cer research scientist at the International Syosset Hospital, and South Nassau College (SUNY) in Farmingdale, New
Bioimmune System laboratory in Great Communities Hospital, Oceanside, New York. Prior experience includes being a
Neck, New York. He received a mas- York. She received a MBA from Dowling registered nurse at North Shore Glen Cove
ter’s degree in medicine from Harbin College, Oakdale, New York, and a Hospital in Glen Cove, New York, and
Medical University, China, and earned Bachelor of Science degree in community at Mercy Medical Center in Rockville
a diploma of acupuncture and traditional human services from Empire State College Centre, New York. She holds a bachelor’s
Chinese medicine from the University in Old Westbury, New York. In addition, degree in health and human services from
of Heilongjiang, China. He earned she is a pharmacy technician and is cer- Empire State College in Farmington,
a PhD in medicine and microbiology tified as a body movement and holistic New York.
from Kanazawa Medical University, health specialist. She is a labor relations These authors have no conflicts of
Japan. He completed a postdoctoral fel- specialist, with training from the Cornell interest.
lowship in the Department of Physiology University Institute of Labor Relations.
& Biophysics at SUNY, where he con- Ms. Krapf received the NYSCHA Susan Acknowledgments: We thank all of the
ducted research on the effect of natural Shearer Award for leadership, commit- NYCTCM interns who participated in
herbal inhibitors on oncogenic tyrosine ment, and enthusiasm in college health the treatment of the patient’s low back
kinases. Dr. Xu is the recipient of the in 2003. pain at the Farmingdale Health &
Japan International Education Award. Rosemary McCarthy, RN, BS, has Wellness Center. Each intern has pro-
Audrey Krapf, RN, MBA, has been more than 20 years of progressive super- vided an equal contribution to the writ-
director of the Health and Wellness visory experience in a wide array of health ing of this paper. NYCTCM and the stu-
Center at Farmingdale State College, care settings, including medical, surgical, dents interning at the Health & Wellness
Farmingdale, New York, since 1989. telemetry, and rehabilitation in both hos- Center would like to thank the nursing
Prior to that, she was a nurse at the SUNY pital and college health settings. She is and medical staff that supported us in
College of Technology, Farmingdale, currently associate director of the Health completing this case study.

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