patient presenting with stagnation of qi, moisture and phlegm. What points would you recommend. I haven’t started to treat her yet. Patient had laproscopic surgery for early stage breast cancer. Has become Lymphoedema. I believe i need to use SP6, GB34 and open to other suggestions. Thank You.
Comment by Chad J. Dupuis, L.Ac.
It’s impossible to generalize about what I might do with only basic information. But a general idea about how I might approach a patient like this would be the following:
GV 22, GB 20, huatuo T1, T2, T3, T4, T9, UB 32, SP 9, KD 3, ST 36, and ST 40 and then perhaps some other localized points depending on where exactly the lymphedema is most prevalent.
We use GV 22 for some of the emotional aspects, T1-T3 for the immune system and circulation into the arms, T4 for the breast, then tonify kidney qi and resolve dampness with the rest.
Comment by Archived User
Determining the etiology of the lyphedema is an extremely important first step, as an early stage laparoscopic resection is unlikely to produce anything systemic and/or of the lower extremities--because you did not mention location. Scarring from surgery can also be causative, and would not be unusual even with a laparoscopy of an early stage tumor, as sometimes a clear margin requires a lot of tissue excision. This, especially if the tumor was UOQ (closer to the axilla), in which case it could be localized swelling/scarring causing lymphatic constriction. How far post-op is the patient, and were there any (recorded, mentioned) complications (like drainage issues)? Or is it from secondary radiation therapy? Is there local/regional Heat or Damp-Heat present?
Secondly, is the condition even lyphedema, and not the result of kidney disease? Or heart disease? Or ascites from late stage liver disease? Unless it's strictly local to the excision site, do not necessarily assume that the patient was properly diagnosed within the biomedical setting. Sometimes, a system shock, as per that from a surgery, can cause dormant or subclinical conditions to present themselves. A drug or drug-drug reaction also needs to be ruled out. Question everything until you are crystal clear on causality, both systemic and local.
Regarding treatment, assuming it's a local inflammatory blockage, I'd also consider providing/referring patient for a session or two of some (mild) lymphatic massage therapy, as if it's sufficiently post-op yet still produces pain could be indicative of unresolved internal scarring or other obstruction from the surgery. In this case, mild Tui Na and or lymphatic massage if done properly can help withdrainage and resolve adhesions. But be careful, as such localized physical palpation could also exacerbate inflammation.
Regarding acupuncture, if the condition is indeed due to local inflammation, it may be prudent to first focus on clearing/diffusing the stagnant Qi. Then circulate Qi through the area.
If the etiology is due, for example, to the surgery itself, which has created a physical lymph blockage--as opposed to something temporary like inflammation--and it is you who point that it can't be ruled out, to the patient and some of her physicians, then you will gain their professional respect. For both yourself and the profession. But hopefully the condition is uncomplicated, and you treat the patient with full success. Good luck!