Case Studies

Case Studies

Ganglion Cyst


Seven Crow MAcOM LAc
February 2012
OVERVIEW

Acupuncture Case Study11-year-old female presents with large lump over left radial artery at radial styloid process, causing pain to the local area. She had minor surgery to remove a gelatinous substance from within the cyst and was informed by the doctor that it will keep growing back. After 9 acupuncture treatments, including internal and external herbal medicines, the cysts presented with 70% reduction in size.

SUBJECTIVE

Patient presents with large lump over radial side of left wrist. She reports (with the help of her mother) that it started to grow a year and a half ago and refers to it as a “bone growth.” She saw a doctor to inquire about removing the lump and was informed that it was not possible due to the innervation of the cyst.

There is no change to the pain or growth with temperature. Some stimulation via massage has been helpful to reduce pain and swelling. Patient states she visited a doctor to have it surgically removed and was prepped for the procedure when the doctor opted not to do a complete removal due to innervation of the cyst by the radial artery. The doctor did remove a gelatinous substance from the top layer of the cyst, but the mass grew back. The size of the cyst at first visit to this clinic on January 17, 2012 has been the same for 1 year.

At age 2, she contracted pneumonia. Since then, she catches colds easily, 3-4 times per year, each lasting up to 2 weeks. These present with a runny nose with clear mucus, cough with some phlegm, body aches, headaches, loss of appetite and slightly looser stools with frequent urination. Since beginning treatment, she has had no common colds.

OBJECTIVE

Acupuncture Case StudyPatient has a thin body, but appears energetic, smiling, talkative and open to conversation with full eye contact. She knows some English and answers the questions directly when she is able. Upon palpation, the skin is warm, tougher than the surrounding skin, and exhibits a hard central mass that is moveable. The cyst sits half an inch off the skin and about half an inch wide, on the crease of the left wrist, with localized sharp pain when palpated deeply, which she expresses through guarded behavior. There is also some additional swelling and redness at the height of the mass, but no lack of range-of-movement in the joint.

Tongue: Pink body with a red tip, white tongue coat, thicker at root

Pulse: Thin, slippery overall with deficiency in the right cun position, and deep in both chi positions

Patient records include:
X-ray of left wrist, July 20, 2010 (1 ½ years prior to current treatments): No abnormal bone growth is shown
Ultrasound of left wrist, July 4, 2010 (1 ½ years prior to current treatment): Reveals cysts growing on either side of radial artery, with possible nerve innervation

Approximately 1.7 x 0.9 cm of cystic legion is noted in the volarradial aspect of the wrist, with a smaller cyst measuring 0.6 x 0.3 cm rooted deeper. The left radial artery is intimately related to area of the posterior wall of the superficial cyst. It shows normal color and doppler flow in the radial artery.

Hospital visit, February 20, 2011 – check-up (1 year prior to current treatment): Swelling in left wrist for past 10 months, gradually increasing in size. Positive for pain, but no trauma indicated. At time of check-up, 4 x 3 cm2 in the wrist at the ventral surface and lateral margin

ASSESSMENT

DX: 2 ganglion cysts growing around the left radial artery, with some innervation by the surrounding nerves of the local area

TCM DX: Mass due to phlegm accumulation in the channels and collaterals of the Lung with some qi and blood stagnation present as indicated by the fluid filled node over TaiYuan (LU9) and slight compression of the artery. Condition is due to constitutional wei qi and Lung qi vacuity, with Spleen qi vacuity, allowing for retained pathogens to harbor within.

PROGNOSIS: Due to placement of the cyst, it may not be possible to completely resolve the node. It is likely that herbal treatments, acupuncture and self-massage will reduce the size of the cyst, but it may not resolve completely.

PLAN

Acupuncture Case StudyPatient to be treated at the satellite clinic 2 times per week for 10 weeks and reassess progress after a second ultrasound. The focus will be on constitutional points, surrounding the area with needles, herbal treatments internally and externally, along with self-massage and qi gong. Aim is to reduce pain and size of the cyst to avoid surgery.

TYPICAL TREATMENT

Acupuncture: Surround the dragon technique with 5-7 needles includes LU7 (Lie Que), LU9 (Tau Yuan) and LI5 (Yang Xi) all threaded towards the center of the cyst; ST36 (Zu San Li), SP6 (San Yin Jiao), SP9 (Yin Ling Quan) and KD3 (Tai Xi) to boost constitutional deficiencies.

Moxa: Indirect pole moxa for short duration to reduce pain and swelling in the area. In the future, try small rice grain moxa directly on the swelling.

Massage: Light yin tuina massage mixed with qi gong to the area to increase qi and blood flow.

Herbal Medicine: San Zhong Kui Jian Tang (Hai Zao, Kun Bu, Jie Geng, San Leng, E Zhu, Bai Shao, Gang Gui Wei, Hunag Qin, Huang Lian, Long Dan, Lian Qiao, Zhi Mu, Huang Bo, Tian Huan Fen, Chai Hu, Shang Ma, Ge Gen, Gan Cao) drains pus, reduces swelling, abcesses and hard nodes; 1 capsule TID internally and 1 capsule mixed with oil to make paste to apply externally over area morning and night. Once the cyst has shrunk by 80%, Yu Ping Feng San (Huang Qi, Bai Zhu, Fang Feng) will replace San Zhong Kui Jian Tang internally for the constitutional deficiencies.

Lancet: At the 3rd treatment, the cyst was punctured with a lancet. A small amount of gelatinous fluid and blood was extracted.

OUTCOME

After 9 treatments, the cyst reduced in height and redness by 70% from initial inspection. The swelling spread in width, but reduced in height. There was no longer a hard mass underneath and no redness to area. Palpation revealed little to no pain, and no guarding to area.

CONCLUSION

Continue care for 4-6 more treatments. Follow up with ultrasound for further assessment. Prognosis is good, revealing no current need for surgery. However, it is unlikely the node will stay dormant without continued care, and attention to underlying constitutional deficiencies.

Rheumatoid Arthritis


Elissa Chapman BAppSc (TCM)
February 2012
Overview

Acupuncture Case Study35-year-old female presents with multiple bilateral joint pain beginning 18 months previously and had received a diagnosis of rheumatoid arthritis at the Arthritis & Rheumatic Diseases Treatment Centre in Nepal. After 10 treatments of acupuncture, in conjunction with herbal medicine, she experienced a significant reduction in joint pain and inflammation.

SUBJECTIVE

Patient is a 35-year-old woman presenting with bilateral multiple joint pain which began approximately 18 months ago. She describes bilateral knee and shoulder pain, pain in her wrists, hands and ankles. Her symptoms originally began with pain in the right shoulder, which after 1 to 2 months was followed by pain in her left shoulder. Within 2 to 3 months, the pain spread to her wrists, then hands. The most recent development has been the pain in her knees and ankles, which began approximately 6 months prior to her first consultation at this clinic. She reports that the severity of the pain in each affected joint is intermittent and unpredictable, and has a tendency to move around. She describes the pain as aching and stiffness, which is worse at night, and for which she takes non-steroidal anti-inflammatory medication (aceclofonac 200mg). This allows her to sleep an average of 6 to 7 hours straight per night, whereas without it she only manages to achieve 5 to 6 hours per night of broken sleep.

Prior to the onset of joint pain, the patient reports she had intermittent cold and flu symptoms over a period of 12 months, including nasal congestion, sore throat and generalized body aches. She did not consult any health practitioners regarding these symptoms.
She was prescribed medication approximately 12 months ago, which she had been taking up until 2 months prior to this consultation. She reports that the medication has provided no relief, therefore she has ceased taking it. Her symptoms have not noticeably worsened since ceasing the medication. She has been having Ayurveda oil massage and steam baths every other day for the past 12 days. This has not provided any relief.

The patient reports that the most severe pain is in her right hand, in particular the fifth metacarpal joint, and in her left shoulder.

Bowel movements are 1 to 2 times daily and fully formed, and urination is 3 to 4 times daily and is pale to medium yellow in colour. Menstruation is regular with mild pain with medium to heavy bleeding for 2 days and light flow for 3 days. Her sleep is disturbed by pain, for which she takes anti-inflammatory medication, daily, to manage.

Stiffness and pain is worse in the morning and for the first 1 to 2 hours upon waking, is less in the afternoon and then worse again late at night.

Objective

Acupuncture Case StudyPatient’s overall health appears to be above average for age and environment. Her demeanour is generally relaxed and cheerful, but with a tendency to carry herself with a slight unease. She occasionally winces due to pain. There is distinct rebound tenderness when palpating the joints of the right hand compared to the left, especially the metacarpal joints. There is also strong palpable tenderness when applying mild to medium pressure to the medial and superior borders of the scapula on both shoulders, and when applying medium pressure to the posterior and anterior borders of the glenorohumeral joint of the left shoulder. There is distinct tenderness when applying moderate pressure to the lower borders of the patella and medial epicondyle of the tibia on both knees. Ankles do not produce distinct tenderness when palpated.

The knees, ankles and fingers can be passively and actively moved through all range-of-movement without restriction, with the exception of the left shoulder, which triggers pain on passive and active lateral abduction above 90 degrees. There is no apparent swelling of the joints in the knees, shoulders and wrists and none appear misshapen.

There is mild palpable swelling in the fifth metacarpal joint of the right hand. The joints of the hands and knees feel slightly warmer to touch than others.

Tongue is light red with normal body, thick yellow root and red tip. Pulse is rapid and slightly slippery.

Assessment

DX: Initial blood analysis taken at the Arthritis & Rheumatic Diseases Treatment Centre in Lalitpur, 12 months ago, shows elevated serum rheumatoid factor and raised white blood cell count. This result, combined with symptoms of multiple bilateral joint tenderness, mild joint swelling (in greater than 3 joints including in the hands and wrists), and morning stiffness for greater than 1 hour, resulted in the patient meeting the criteria for a diagnosis of rheumatoid arthritis which was given at the above clinic where her initial assessment was carried out.

TCM DX: Wind-damp bi syndrome due to damp-heat, and wind-heat toxin due to latent heat invading the joints causing qi and blood stagnation and damp retention. Over time, if left unabated, this typically would lead to swelling and deformity due to phlegm stagnation and blood stasis.

PROGNOSIS: Besides mildly visible signs of synovial thickening in several small joints, the patient is otherwise free from any severe pathological tissue changes. Therefore, successful management of systemic joint inflammation may help to preserve the mobility and dexterity of the joints. Depending on the outcome of acupuncture and herbal treatment, this may include conventional drug therapy.

PLAN

Treatment principles: Dispel wind, resolve damp and clear toxic heat. Open channels and collaterals. Invigorate qi and blood.

Treat with acupuncture 2 to 3 times weekly for 10 treatments before reassessing. Treatment approach is to use Shaoyang channels to dispel wind and damp and Yangming channels to purge heat toxin and move qi and blood. Points are also used to nourish blood and qi to anchor wind and prevent pathogenic factors from attacking the channels.

Typical treatment: TB5 and GB41, needled contra laterally, with Shaoyang points such as TB2, GB39, GB35, GB36 and GB34 to dispel wind-damp from the channels. LI11 and ST3 are used to expel heat. SP6 is used along with LI4 and LIV3 to anchor wind and circulate blood and qi throughout the body.

At the third consultation, Shu Jin Huo Xue Tang was given as a powder with a dosage of 4g twice per day to dispel wind and damp, invigorate blood and remove blood stasis. The prescription is to be followed for 10 days and then reassessed.

OUTCOME

As early as the third consultation, she found it easier to walk for longer periods, as she had less pain in both knees and no pain in her ankles. She could take a shower without pain, whereas before, this used to cause pain in her shoulders and hands. The palpable pain in the first and second metacarpal joints of both feet increased significantly since the fourth treatment, with distinct visible and palpable swelling. Initially, she had reported mild pain in these joints and no noticeable swelling.

After 10 acupuncture treatments over 5 weeks, the patient reported having not taken painkillers for 2 weeks and was sleeping 6-7 hours per night without them. She reported only mild pain in her left shoulder (the initial site of most pain) with some mild to moderate tenderness upon palpation around the medial and posterior borders of the scapula. She could laterally abduct her left shoulder to 120 degrees and passive abduction was to 160 degrees without pain. Palpation of the medial epicondyle of the tibia of both legs produced mild to moderate pain.

From treatment to treatment, the patient reported fluctuating levels of pain and inflammation in her left elbow and both hands. In particular, the pain in her left hand would move from joint to joint, sometimes over a period of 24-48 hours.

After the fourth acupuncture treatment, the patient had been recommended by a friend, to consult a Tibetan medicine doctor specializing in the treatment of arthritis. It was agreed that she would cease the Chinese herbal medicine and proceed with the Tibetan herbal medicine prescribed to her alongside acupuncture. Tibetan herbal medicine would be more consistently available to the patient over a longer period.

Conclusion

This patient experienced a significant reduction in pain and inflammation within 10 treatments. She is advised to continue treatment 1 to 2 times weekly for another 4 to 6 weeks with the hope of continuing to improve her symptoms. Whether or not acupuncture treatment and herbal medicine alone, without conventional drug treatment, will result in a full remission from symptoms, is unknown. However, it appears that acupuncture may be a useful therapy for managing pain, inflammation and preserving joint mobility and delaying long-term site and enzymatic damage, which usually results from persistent and chronic inflammation and swelling of the synovium in the joints. It is also possible that her progress over the last 6 treatments was aided by the prescription of Tibetan herbal medicine. However, as she experienced significant relief after the initial 4 acupuncture treatments, it is presumed that acupuncture has and may continue to play a significant role in managing her symptoms.

Parkinson’s Disease


Jessica Maynard MAcOM LAc
February 2012
Overview

Acupuncture Case Study72-year-old female presents with left hand tremors that extend up the arm and into her neck and jaw. Tremors have been present for 2 to 3 years. Hospital and doctor records report Parkinson’s disease. Over the course of treatments, the patient experienced periodic relief, with regression and return of tremors. Overall, her posture, mood, outlook and sense of independence improved, leading to a significant improvement in personal affect over time.

SUBJECTIVE

Patient presents with tremors in her left hand and arm, extending up through her neck and into her face and jaw. Hospital charting from 6 months prior shows a diagnosis of Parkinson’s disease. The patient reports having previously taken tri-hexyphenidyl hydrochloride, propanolol hydrochloride, levadopa and carbidopa tabs, but states that she is not on them now and is seeking a cure from Chinese medicine and acupuncture. She also reports having been diagnosed as a diabetic and declares that she has blood sugar levels tested regularly. The most recent reading was 145 mg/dL.

O-Tremor symptoms have been present for 2-3 years.

P-Patient reports that warm weather alleviates her symptoms and cold weather exacerbates.

Q-In addition to tremors, she experiences numbness in her tongue and has trouble speaking clearly, a symptom that fluctuates on a weekly basis. She reports mouth dryness, dizziness and blurry vision when walking.

R-Tremors begin in her left hand, move up into her arm, and eventually spread to her neck and jaw. During the course of treatment, the patient reported experiencing tremors in her right hand and arm as well.

T-The patient reports constant tremor while in a waking state throughout the day and evening.

Objective

The patient presents with stooped posture while walking, arms held closely in front of her. While she sits in the treatment chair, her hand and fingers tremor with an inch of movement back-and-forth. Her lower jaw shakes when she is not speaking. The tremors disappear with movement, and her movements are bradykinetic. She exhibits signs of depression from day-to-day—diminished affect, low voice, frequent sighing and responds to questions about her condition with frustration.

From treatment-to-treatment, her tongue changes from pale and dusky to more red, and sometimes purple-tinged. Her pulse is thin and easy to push through, but at times will have a wiry/tight quality or will show a superficial flooding or slippery quality.

Assessment

DX: Parkinson’s Disease

In order to differentiate the patient’s diagnosis of Parkinson’s disease from benign essential tremor, it is important to clarify the differences. Benign essential tremor—Typically hereditary, benign essential tremor is characterized by tremor present with movement and absent at rest. It is normally bilateral and increases with age (Merck, Mayo Clinic). Essential tremors are not associated with stooped posture or shuffling gait, although they may cause other neurological symptoms. Benign essential tremors typically start in the hands, and can eventually affect the voice and head.

Parkinson’s disease—Characterized by voluntary and involuntary movement affected by tremors, the symptoms typically begin unilaterally, but can progress to affect the body bilaterally. Symptoms are mild at first, and the severity of the disease is quite variable from person-to-person. Cardinal symptoms are: tremors, rigidity, bradykinesia, postural instability and Parkinsonian gait (characterized by short, shuffling steps and diminished arm swinging). Secondary symptoms include: anxiety, confusion, memory loss, dementia, constipation, depression, difficulty swallowing, slow, quiet speech and monotone voice.

Acupuncture Case StudyTo note, occurrences of misdiagnosis can happen. There are no medical tests for this disease and a definitive diagnosis of Parkinson’s is not possible while a patient is still alive. The most accurate diagnosis would be made by a neurologist who specializes in movement disorders. Therefore, the true diagnosis in this case study is speculative and impossible to confirm.

The patient exhibits stooped posture, impaired gait (she requires help walking to clinic on certain days), and holds her hands stiffly in front of her, while walking in a shuffling manner. She also experiences tremors while seated with hands in her lap (at rest). It appears likely that her condition is, in fact, Parkinson’s disease. During the course of treatments, she displays intermittent confusion and memory loss, both in repetitive questions, the need for counseling on her condition, and interpreters stating that she is incoherent. These are indications of possible mental degeneration accompanying the Parkinsonian condition.

TCM DX: The patient shows a mixed excess/deficiency pattern consisting of underlying deficiencies leading to uprising of excess, Kidney yin deficiency and Liver blood deficiency, with an uprising of wind in the channels, Liver qi stagnation and uprising of Liver yang.

KI yin deficiency is apparent with thin pulse, red tongue tip (empty heat) and low back pain, and can partially be assumed with age (72) of the patient. Liver blood deficiency is apparent in the thin pulse that is easy to push through, the dizziness and blurry vision with activity, and dryness of the tongue. Wind in the channels (due to blood deficiency) and uprising of yang, is exhibited by the tremors, and can be detected in the pulse. Liver qi stagnation is exhibited by frequent sighing and mood swings from day-to-day. Blood stagnation and empty heat alternate in her pattern. Tremors are observed by the practitioner as more pronounced when stagnation is present, indicated by the dusky and/or purple tongue alternating with a redder tongue tip concurrent with less pronounced tremor of the hands and mouth. 

INITIAL PLAN

Treat 3 times per week for 3 weeks. Diminish wind in the body while tonifying underlying deficiencies.

Typical treatment: Scalp tremor line, later with electro-acupuncture. ST36, LR8, SP6 to nourish blood, KI3, LI4 and LI11 to diminish stagnation and clear heat, as well as locally to treat tremors in the arms. GB20 is used to expel wind. Tiger warmer therapy is applied to the left arm, and often both arms and the sides of the face and neck. Electro-acupuncture typically connecting points LI11 and Hegu (LI4), or LI5.

Additional treatments: ST3, ST4, ST41 and LR3. Parkinson’s may be a condition of reversal of Stomach channel qi, which enters the GB channel through ST8(Janice Walton-Hadlock). An intention of descending Stomach channel energy has come to be a focus in treatment.

Herbal formulas prescribed include Gastrodia 9 (Seven Forests formula) to diminish tremors and Tao Hong Si Wu Tang to move and nourish blood.

Patient is encouraged to engage in light movement of the body, and to receive massage from family members. She is referred to the physiotherapist, though exhibits significant resistance to exercise.. 

OUTCOME

The patient arrived for treatment daily for a total of 6 weeks.

Tian Ma Gou Teng Yin (for wind) and Liu Wei Di Huang Wan (for Kidney yin and blood tonification) were later added to her treatment plan.

She only had 1 visit to physiotherpaist.

Given the advanced state of the patient’s condition, it was clear that acupuncture may not decrease symptoms of tremor over the longterm, but may help on a short-term, symptomatic basis. The patient experienced relief the night after each treatment, less numbness in her tongue, and an increased ability to speak clearly. However, her condition would subsequently relapse after each period of relief, so it cannot be known whether the acupuncture and herbs were helping, or if it was a natural regression of symptoms typical of the disease. Significant time was committed to answering the patient’s (sometimes repetitive) questioning of her condition, educating her about the severity and irreversibility of the disease, and encouraging her to think positively and actively engage in her own process of healing.

What was striking over time was the improvement in the patient’s mood and affect. She began to walk to clinic on her own on a regular basis and was visibly happier over the course of treatments. Her posture improved, and she became more engaging, which despite her shifting moods, remained at a higher level than when she originally came into the clinic (although this can be due to trust and relationship that grows over time between patient and practitioner). As seen within the first 5 treatments, her mood changed significantly and her speech clarified. She was more likely to engage in conversation, both with her healthcare provider, as well as with family, and began to open up.

In subsequent treatments, she exhibited moods that showed a decline in outlook, including frustration over not experiencing the amount of relief desired, and seemingly, over a lack of control over her body and her life. During the fourth week of treatment, the patient reported a remarkable improvement. On 1 visit, she stated that she experienced the feeling of being “completely cured” following her treatment the day before. This type of relief, although short-lived, also added to the hope and positive outlook that overrode her frustration throughout the course of treatments. After 7 weeks in treatment, she went home to her village in a warmer climate, returned to the clinic during the ninth week, and reported a complete disappearance of symptoms while she was home. This brings to question both the power and possibility of acupuncture, as well as what the role of stress-reduction can play in Parkinson’s disease and other neurological disorders. Acupuncture and Chinese medicine has been shown to reduce stress, and if relief of symptoms from disease is a secondary outcome, then the importance of this therapy is of paramount significance.

In the Vajra Varahi clinic, this patient experienced periodic relief of symptoms, with relapse and gradual decline. Parkinson’s is a degenerative disorder, and slowing the progression became the main focus in direct treatment of the disease. In addition, the role of the acupuncture practitioner for this case has been one of guiding healthcare and outlook, counseling her towards a full understanding of her condition so that eventual acceptance is possible, and helping to facilitate a state of contentment and happiness that can be applied to her life as a whole.

Typhoid Fever Induced Paralysis


Andrew Schlabach MAcOM EAMP
December 2008
OVERVIEW

Acupuncture Case Study32-year-old female presents with left-sided paralysis of upper and lower limbs. At age 12, the patient suffered from a fever due to Typhoid that caused convulsions and coma. After a 20-year history of paralysis, this patient recovered most of her upper limb function and some lower limb function with acupuncture treatment.

SUBJECTIVE

Patient presents with left-sided paralysis of the upper and lower limbs. She has no pain in the effected limbs, but reports numbness and tingling in the fingers and toes of the effected side. This condition started at age 12 after suffering a high fever, due to Typhoid, which caused convulsions and a 5-day coma. She was treated at the local hospital for Typhoid, but has received no treatment for the paralysis. Patient also reports right-sided knee pain, likely due to poor structural alignment and asymmetrical walking posture. Patient reports persistent low energy, sadness and is easily moved to tears. Patient has 3 children and works as a farmer. Menstruation is regular at about 30 days with scanty flow of pale color for 2-3 days. No menstrual pain or PMS symptoms.

OBJECTIVE

Patient appears to be in good health for age and environment, but has a slow affect and appears somewhat mentally diminished. Her demeanor is of a person in her early teens.

The left arm is held closely to the chest and the fingers of the left hand are tightly contracted. The fingers can be passively extended with little force, but they return to a contracted condition immediately upon release. The patient can move the shoulder normally, but cannot actively flex or extend the elbow. The hand lacks active response. All joints can be passively moved through all ROM without pain or difficulties. Sharp/dull test on the fingertips shows no objective numbness. DTR on bicep and tricep tendons is normal. DTR on brachioradialis is unresponsive.

The left leg is normal in size and coloration. The left foot is inverted at rest and requires some force to passively evert. Hip flexion and extension have normal ROM and are well coordinated. Muscle strength is similar to the well side. Leg flexion and extension has normal AROM but are poorly coordinated, taking about 15 seconds of concentrated effort to complete the motion. Muscle strength is about 20% of the well side. Patient does not have any active control of the left foot. DTR on patellar tendon and hamstring is sluggish and weak. DTR on the calcaneal tendon is unresponsive. Sharp/dull test of the toes shows no objective numbness.

Pulses are deep and weak and tongue is pale and deeply scalloped.

ASSESSMENT

DX: Motor paralysis of several major muscle groups in the upper and lower limbs likely due to febrile damage to the central nervous system

TCM DX: Wei syndrome due to qi and blood deficiency; Obstruction of the channels and meridians

PROGNOSIS: Due to the fact that this condition has been left untreated for 20 years, it is unlikely to expect significant response.

INITIAL PLAN

Treat with acupuncture 3 times per week for 10 treatments before reassessing. Focus on the Yang Ming to stimulate qi and blood. Make heavy use of electro-acupuncture crossing multiple joints, especially concentrating on anterior and lateral compartments of the leg and flexor/extensor complexes of the forearm. Internally, use Dang Gui San 4g TID to tonify and move blood.

Typical treatment: Left: ST36 electro to LR3, GB34 electo to GB41, LI10 electro to LI4, HT3 (distal) electro to HT8, Ba Xie (with heavy stimulation), Ba Feng (with heavy stimulation); Right: ST36, SP6, KI7, HT7, DU 20, 24

Alternative treatment: Pi Ci needling of hand and foot Yang Ming channels, scalp motor sensory (leg, foot and arm zones x3) on well side with electro-stimulation

OUTCOME

After 10 treatments, the patient reported no change in condition. The patient was informed that due to the long-term nature of the condition and the lack of response to treatment, it was unlikely that acupuncture treatment would be beneficial. The patient opted to continue treatment, but after 18 treatments she still reported “no change.” At this time, the patient was encouraged to discontinue treatment. The patient immediately broke into tears stating that she wanted to continue treatment because when she started, she was unable to carry the water bucket. Now, she could. Before she started treatment, she could not walk to the clinic. Now, she could. This was a major revelation of change in condition, which brought to our attention the concept that culturally, “no change” often means “I’m not cured.” After a more thorough objective examination, it was observed that the patient now had weak, uncoordinated active movement of the fingers. She could also actively evert the foot. After this discovery, the patient was treated every other day for 4 weeks, during which time she made rapid improvement. Eventually, she was given exercises to teach both the well and ill hands how to isolate individual finger movements. She was instructed to use her eyes to observe her well hand through a series of individual digital movements before trying to replicate the movements with her ill hand. Progress was slow, but continual. The patient was continuously encouraged to exercise. In every treatment session, the patient was reminded of how far she had progressed. After 48 treatments over 3 months, the patient had full, active dexterity of the left hand even though the left arm remained 10-20% weaker than the right. The left foot did not respond as well and remained 50% weaker than the right. Dexterity of the toes was not recovered. However, the patient could dorsiflex and plantar flex the foot.

CONCLUSION

This patient was nearly released from care due to poor communication, objective observation and subjective reporting. When dealing with paralysis recovery, careful objective observation and measures are imperative as the patient is not always aware of the slow changes that are taking place. Visual exercises, in addition to the acupuncture treatment, significantly accelerated the recovery process. Paralysis patients need constant encouragement as the course of treatment is slow. Often, the condition seems to plateau before new changes take place.

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