News BlogLatest News From Our Volunteers in Nepal


Jeanne Mare Werle MAcOM LAc 
November 2012

Acupuncture Case Study50-year-old male presents with post-stroke sequelae symptoms manifesting as severe right-sided paralysis. After 10 treatments starting in September 2012, the patient exhibited improvement in his condition and fair measurable progress.


The patient had a stroke in November 2011. He received medical attention 24 hours later at the hospital and was treated with western medical pharmaceuticals unknown to the patient. He stayed in the hospital for 9 days. While at the hospital, he learned of an acupuncture program in Kathmandu. He began getting treatments there 14 days after he left the hospital. He doesn’t remember exactly how many sessions he had. Perhaps about 7. He came to the Vajra Varahi Clinic in March 2012. Prior to my attending him, he had 15 treatments at the clinic. Current symptoms are paralysis of the right side of body, numbness in the hand and foot, inability to move fingers or toes, numbness of his lips (right side) and tongue, difficulty walking, an unsteady gait, the sensation of weakness in the right knee and ankle, stiffness in the shoulder, elbow, wrist, hip and knee joints, general fatigue and heavy sensation in the body. The patient is worse in cold weather, fatigue and when hungry. The quality of sensation that the patient experiences in his body is heavy, achy, tingling and weakness. The severity of the condition and the impact on his life is immense due to his inability to work, care for his animals or farm his fields.

The patient reports difficulty in walking due to his toes having no ability to move. This requires the patient to lift his leg straight up and land the foot on the whole sole as opposed to heel-to-toe walking. This gives the patient an unsteady gait that he reports also makes his knee feel like it could give out. The distance the patient walks to the clinic from his home would have taken him 20 minutes prior to the stroke. Currently, it takes him close to an hour.

While in the hospital, the patient received 1 physical therapy session. The patient maintains an exercise routine based on what he learned in PT while at the hospital. He reports that he massages his foot and hand daily. He doesn’t take any western medication or supplements, though he does take Tibetan herbs.

Despite the extent of his symptoms, the patient identifies that he would like to focus on improving his speech, reducing the swelling around his lips on the right side, regaining some use of his right hand and improving his ability to walk and feel more balanced.


Acupuncture Case Study

Patient appears to be in good health with a strong spirit and determination to improve. He has spent his life working the land and raising animals. This has taught him patience and endurance.

The patient’s left arm is used to lean on a walking stick as he raises his right leg directly up from his hip and places his foot down on the whole flat of his foot, as if it were one solid block. He is unable to walk in a normal heel-to-toe stride. His right hand is contracted and he holds his entire arm tight against his belly. His face appears symmetrical and bright except for about 10% swelling in the right upper and lower lips.

When seated, the patient uses his left hand to move his right hand into position. The right hand is contracted, however passive stretching of the digits and opening of the palm happens easily and reveals tremendous flexibility. The patient has a medium-strength grip in his right hand, about 50%, compared to the left. He has no ability to extend the fingers or even wiggle or twitch them. After opening the hand, it slowly folds back into a soft contraction within a few seconds.

Sensory testing using light, medium and heavy stroking of the patients affected areas, while the patient has his eyes closed, shows complete response. Hip flexion and extension has normal ROM, however the strength of the hip is reduced by 30%. Hip flexion and extension are occasionally affected by stiffness in the hip joint from the action of lifting the leg to place the foot. Most of the stiffness remains in extension position. Although I do not speak the patient’s language, I can hear that there is very minimal slurring in his words. When the patient leaves the treatment, he lifts his leg off the ground about 2 inches higher than when he came in.

Tongue – swollen, pink, light white coat

Pulse – slightly rapid, superficial and wiry


DX: Post-stroke sequelae with paralysis of the right hand, fingers, foot and toes; Overall stiffness, weakness and heaviness

TCM DX: Qi & blood deficiency; KI yang deficiency; Wind & phlegm obstructing the channels and collaterals

PROGNOSIS: The prognosis for a full recovery is poor, however we expect some hand mobility to return and sensation to continue returning to the foot and toe’s. As these functions return, we expect to see less weakness and stiffness in the joints affected by the stress caused by the impairment. The treatment plan will need to be long-term and the patient must remain hopeful and committed.

Initial Plan

Treat with acupuncture 4 times per week for 3 months before reassessing. Focus on strong stimulation with electro-acupuncture crossing affected joints. Use scalp points associated with motor function of upper and lower limbs using hand stimulation of needles.

Typical treatment: Left: Dr. Zhu motor points for upper and lower limbs with deep insertion and heavy stimulation. Dr Zhu speech points on scalp.

Right lower: Ba Feng, KI1, LV3, GB41, KI3, SP3, SP6, ST41, GB39, ST36, GB34, KI10, He Ding, Xiyan/Xiyuan, ST34; Right upper: Baxie, HT8, PC8, PC6, Xu Duan – 10 drains on the right hand and right toes, TB5, LI10 X 3, LU5, biceps ashi

Electro: 2/100 mixed – Dr. Zhu scalp points, biceps ashi – PC6, LI4 – LI10, ST 34 – ST 36; Alternative treatment consists of similar points crossing joints such as KI10 – KI3, SP6 - SP3 and/or GB34 - ST34.

The patient is given a bottle of Po Sum On (aromatic oil) and instructed to use it with his home routine that includes daily massage and physical therapy. Included in home therapy are visual exercises to stimulate the brain and motor connection. The patient is instructed to first perform the physical therapy routine with the unaffected side of the body while creating a strong eye connection with the movements. Then, the patient performs the same movement therapy with the affected side, again keeping a strong visual connection.

The patient uses Tibetan medicine as his herbal treatment and expresses positive feelings about this. Keeping detailed track of all changes and astute observations with each treatment is imperative. The smallest details are critical to observe and note, both for the clinician and patient. Constant encouragement through the likely long process of healing must not be overlooked. Reminding the patient of all the changes at each session will help in the process of staying positive.


Patient reported that over the course of the 9 treatments, he has, for the first time, noticed significant improvement. After each treatment, he reported more nerve sensation in his hands and feet, with greater ROM in his knee and ankle. The swelling in his lips responded immediately to the treatment and the patient reported clear speech. The patient had a 10-day lapse in treatment, which brought back 30% of the lip swelling and 5% of the speech problem. After 1 treatment, clear speech returned, even though the lip swelling returned quickly after treatment. The quality of the stiffness and pain is reported by the patient as deep, dull and achy. ROM in the shoulder joint and elbow progressed from about a loss of 40% in extension to 10% with complete disappearance of shoulder pain. There was still achy pain in the bone in the elbow joint. The contracture in the right hand remained, rendering the hand useless still, but the hand had a softness progressively allowing the hand to stay open longer. The patient reported a tingling sensation in his 3rd & 4th fingers which may be a forerunner to the return of nerve function. The patient was able to place his heel on the ground and land on his toes though there was a slight supination of the foot upon landing on the toes.


In the past, this patient received acupuncture treatments of a more constitutional nature without any change to his symptoms. His current response to treatment has been exciting. He has had fair outcomes with measurable changes in symptoms. At this time, the patient mostly hopes to regain sensation and functioning in his toes so that he may improve his gait, as walking is the only option he has in his village. It is imperative for the patient to continue with regular treatment in order to maintain the progress that has been achieved. In stroke cases, it appears that focused, aggressive and frequent treatments are critical. Using visual exercise where the patient first does the physical therapy with the healthy hand or foot, while keeping focused on the movement to imprint on the brain, and then repeats the same exercise with the affected hand or foot is important as are home massage and physical therapy in conjunction with acupuncture treatment. It is also important in working with post-stroke sequelae that the practitioner employ careful documentation and critical observation so to better track changes, however big or small, in the patient’s condition. Constant encouragement and reminders of change help to show the patient their progress throughout the frequently slow healing process.

More Articles

  • Walkabouts in Nepal’s Agricultural Nirvana

    Walkabouts in Nepal’s Agricultural Nirvana

    As an American Acupuncture volunteer for Acupuncture Relief Project (ARP) in Nepal, I stepped into an eastern culture that is a distant shadow of my own, regarding the traditional farming

    Read More
  • The Work of Farming

    The Work of Farming

    I’ve been moving around for awhile, but for most of my life I lived in one place. There is much to be said about having roots and feeling at home.

    Read More
  • Everyday Acupuncture Podcast

    Everyday Acupuncture Podcast

    Here in the west we are used to seeing acupuncture clinics in an urban setting, and it is often sought as an adjunctive therapy used in combination with other modalities.

    Read More
  • Jatra: The goddess

    Jatra: The goddess

    Patients come on a first come, first served basis, often arriving a little before 6am, slipping their appointment cards under a designated stone on the reception window sill. Many will

    Read More
  • Beyond the White Coat

    Beyond the White Coat

    When I started fundraising for this volunteer trip, many friends asked me why I chose to come to Nepal with ARP, and my simple response was, “to step out of

    Read More
  • Baskets and Knees

    Baskets and Knees

    In the foothills of the Himalayas, Bhajra Barahi is made up of steep hills, the slopes of which have been terraced for farming. These plots of rice, cauliflower, mustard, squash,

    Read More
  • A Day in Bajrabarahi: Where There are No Doctors

    A Day in Bajrabarahi: Where There are No Doctors

    When we open the clinic doors at 8:30, there are usually already a handful of patients waiting outside in the crisp morning air. Patients arrive throughout the day. There are

    Read More
  • Ten Years in Nepal: A Tale of Three Brothers

    Ten Years in Nepal: A Tale of Three Brothers

    The day started like most days, a brisk late-autumn morning with a light frost on the ground and clear blue skies. A breakfast of churra (beaten dried rice), chickpeas and

    Read More
  • Death


    Today's topic: Death! (the author does not pick blog topics; the blog topics choose him) I began thinking about this after hearing that one of our ARP staff members, Tsering,

    Read More
  • Together We Drink Tea

    Together We Drink Tea

    The morning sunlight, through a gap in my curtain reaches onto my bed and teases my skin. I look outside the window to see beautiful blue sky above our mountain

    Read More
  • I love food

    I love food

    Fun fact, my body is 85% digestive tract with the rest being sensory and motor structures that assist me in attaining more food. My genetics are closely related to a

    Read More
  • Return to Baseline

    Return to Baseline

    As part of our long term goals in Nepal, it is our aspiration to train several Nepali born practitioners to serve in our clinics. We have partnered with a small

    Read More
  • Today, I am very happy.

    Today, I am very happy.

    After clinic one day I had the opportunity to experience a wonderful delve into the down country culture of the local folks I've befriended over the last couple weeks. Gunaraj,

    Read More
  • My Bone Problem

    My Bone Problem

    Today I fitted my elderly patient with her (hopefully) semi-permanent shoulder cast. This woman came into the clinic a few weeks ago. I remember treating her knee pain and when

    Read More
  • Worth it

    Worth it

    Having lived my whole life in a developed country, with most of my needs magically looked after for me, it was a cultural shock to see the many inadequacies the

    Read More
  • More than just acupuncture

    More than just acupuncture

    In Bimphedi, a small remote village in the hills south of Katmandu where the acupuncture relief project has a clinic there is also an orphanage. The children that are there

    Read More
  • Trust The Process

    Trust The Process

    It’s been one week in Nepal and 3 days of clinic in Bajra Baraji. I’ve gone through so many emotions and learned so much about practicing primary care in a

    Read More
  • Bookends


    At the beginning of my service with Camp B at Bajra Bahari, my first patient is a 70 year old male with right-side hemiplegia resulting from a stroke. I look

    Read More
  • The Magic of Determination

    The Magic of Determination

    I meet Buddhi for the first time at the end of the second last week of the camp. He had a stroke 5 years ago which affected the mobility of

    Read More
  • Groundlessness


    Nepal for me was a practice in being comfortable with the feeling of groundlessness. Have you ever been on a suspension bridge? Nepal I came to learn, is full of

    Read More
  • Birth


    There was definitely a special something in the air that Saturday night. We had just had a fantastic day off from clinic visiting the home of one of our rock

    Read More
  • Two Realities

    Two Realities

    Has anyone ever seen the movie, or read the book The Hunger Games? I know it is a teen drama but I am not sorry to say I have done

    Read More
  • Compassion is the Communication

    Compassion is the Communication

    I come from a large Russian Orthodox family and an even larger community. I spent my childhood wondering what any limits might be. What would that look like, where would

    Read More
  • My Nepal Experience

    My Nepal Experience

    Nepal and people who live in this country, the Nepalese; where do I begin? It was sensory overload the moment our flight landed in Kathmandu, the capital city of Nepal.

    Read More
  • Avoiding the Finish Line

    Avoiding the Finish Line

    Upon arrival to the ARP Clinic in Bajra Barahi, nestled amongst the peaceful tree covered hills in the countryside of Nepal, I sensed a note of an “uh-oh, what have

    Read More
  • The Heart of Good Healthcare

    The Heart of Good Healthcare

    It has been a pleasure to spend two months as part of the project living and working with the people of Sipadol and Bhaktapur. In retrospect my role as a

    Read More
  • Compassion Connects The Series

    Compassion Connects The Series

    In the aftermath of the 2015 Gorkha Earthquake, Andrew Schlabach, Director of the Acupuncture Relief Project and Tsering Sherpa, Director of Good Health Nepal begin a new primary care clinic

    Read More
  • The Interpreters

    The Interpreters

    For me, meeting the local interpreters, acupuncture students and our cook, and getting to know them on a personal level, has been the most amazing experience. The high unemployment rate

    Read More
  • Context is everything

    Context is everything

    Time is flying by and we have less than a week before this camp’s rotation is over and the clinic will close until September. The first week or so here

    Read More
  • The Pushing Away, Pulls You In.

    The Pushing Away, Pulls You In.

    When it's all said and done, leading a team in any capacity is not an easy job. Being a medical volunteer here also stretches each of us. I thank my

    Read More
  • 1
  • 2
  • 3
  • 4
  • 5

News Archive

Latest Instagram

Follow Us on Facebook

Your Donations Help

In addition to volunteering their time and energy, our practitioners are required to raise the money it takes to support their efforts at our clinic. Please consider helping them by making a tax deductible donation in their name.


Support our work

Donate Volunteer Get in Touch

Support Us