I have an older patient who has had numbness from his mid-shin down through his feet on both sides. This was apparently caused by some antibiotics he was given a couple of years ago to fight an infection after surgery. Although he is experiencing no pain, he has a difficult time walking and says the feeling is very uncomfortable. Additionally, I have noted that the skin on his legs from his knee down is very severely dry and cracked, indicating lack of qi and blood flow to the area. Doctors have advised him to use moisturizing cream for his skin problem, but he says that has not helped. It appears that his condition is isolated to the skin area, as he is able to feel pressure from my fingers and needles once they have penetrated the skin. I have diagnosed him with qi and blood deficiency, internal wind (marked by a stiff tongue and full floating pulse), and kidney qi deficiency. So far, I have used mostly local points along the ST and GB channel to encourage qi and blood flow into the area. I have also instructed him to use a moxa pole on ST36 and KD1 at home.
I have been contemplating the use of plum blossoming in the area to promote further qi and blood flow. My concern is risk of infection. Since the patient appears to have lack of blood nourishment in the area, would I be putting him at risk of infection by using plum blossoming technique (even if it is very light)? My patient is not diabetic. Any thoughts would be greatly appreciated.
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How old is he and what other health issues does he have (if any)?
My patient is aged 70+. He has had a knee replacement on his left side. Other than that, I believe he is on blood pressure medications to keep his blood pressure under control (which it is). No diabetes or other major health issues that I know of.
Any thoughts would be much appreciated. Thanks!
I am also curious how many times you have treated him and how long he had the condition before he came to see you. Many cases of neuropathy can take a while to treat successfully and depending on what type of internal damage has happened can respond in a limited fashion initially. In other words your treatments may be fine, it just takes a little while.
I would focus a little higher up on the back to facilitate more circulation into the legs. Something like GV20, huatuo of T1 (bone marrow), T7 (abdominal blood vessels, circulation into lower body), L3, L5 and S2 (actually whatever points are pressure sensitive in the L2 through S2 area), with needling and tuina, then UB 40, LV 8 (slightly deeper insertion, aid circulation in lower leg/knee), GB 34 and/or GB 39. Something along those lines to help draw more circulation down from above.
As for plum blossom that's not a bad idea and, no, so long as proper procedures are followed you are not risking any infection by using it. You could also consider blood letting out the jing well points on related channels to see if that doesn't clear some of the underlying stagnation as that is slightly less invasive.
I've only treated this patient one time, and this patient has had this condition for about 1 to 2 years. The condition appears to be very much at the surface, as he is able to feel pressure and needles in the area.
Thanks for your suggestions. I didn't think of bleeding jing well points, but that sounds like a good idea.
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