I am treating a patient with polyneuropathy in both her feet. She did get that after chemo, for Kahler disease. She also has a kidneydeficiency (only working for 15%), so she has to drink a lot!
Now after the first treatment it became worse and she can't wear her shoes anymore!
Her feet are very cold, especially in the evening, she has a heavy feeling and sometimes aching. It feels like she is walking on pillows she says!
Her pulse is very weak and slippery, her tung is swollen, no coating and teethmarks.
The points I used where: DM20,Li4, liv3,RM12, Sp15, Gb34, St36, Bl64, Sp3, Kid7,Sp6, Liv3.
Can someone tell me what I did wrong?
Thanks a lott already and sorry for my english!
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I wouldn't say you have done anything wrong, certainly one treatment isn't enough to make the patient worse. Patients who have weak kidneys are going to experience these problems and one acupuncture treatment will have no effect on that. Also chemo induced neuropathy is a very difficult condition to treat in many cases and requires treatments over a long period of time.
What I would say about your points, however, is that they are not very specific. For example, LV 3 and LI 4 (together the 4 gates) are very strong moving points. They are incredibly overused generally in acupuncture and you would use them rarely if at all on a patient that is this weak constitutionally. That goes for other more moving points like GB 34 perhaps and maybe even SP 6.
I would focus on the case you have in front of you. Deep kidney qi/yang deficiency with dampness and focus on more tonifying points, ideally with a fair amount of moxibustion on the UB 23 and perhaps CV 4 as well. For the neuropathy we usually focus much higher up the spine to facilitate circulation so we use the huatuo of T7 (where nerves innervate abdominal blood vessels, etc. which effect circulation in the lower part of the body), and huatuo of L2, L3, L4, L5 area along with outer bladder points for the kidneys (UB 52, UB 54 as appropriate).
what a huge case aye?
well let me start off by saying well done for taking on such a demanding case as it is these cases that will give us a greater insight into the understanding of acupuncture and truely enhance our abilities as an acupuncturist. so well done
next i would say that in my opinion that chad is correct in determining that the root is kidney yang qi deficiency, and it looks like spleen qi deficiency is the branch (i base this on the tongue diagnosis, and that the spleen is the creator of dampness)
therefore my initial treatment principle would be to, supplement kidney yang qi, tonify spleen qi, eliminate dampness i would then add points that addressed the neuropathy (i suggest using the point that chad has suggested)
however i would also use pishu bl20 , weishu bl21, to tonify spleen qi and eliminate dampness. i would use the warm needle (moxa) technique for both points
i would also use mingmen du4, shenshu bl23, to supplement kidney yang qi. i would use the warm needle technique here as well
i would finish off the point perscription with moxa yongquan k1 to tonify kidney, eliminate dampness and cold
finally because this will be a prolonged treatment, i would alternate treatments by using back shu points one week and front mu points the next (but moxa yongquan everyweek)
Yes, the tuina can be too much for many patients with neuropathy. We focus the tuina on the T7 and lower lumbar area to facilitate the nerve function and usually do some work in loosening the calf as well. If the patient cannot tolerate the calf tuina then they should be shown stretching exercises for that area. Loosening the calf is an important part of allowing the feet to heal. This is due to an improvement in circulation, but also because less tension on the achilles is beneficial to releasing the fascia on the bottom of the foot.
Thank you for helping with this case!
Next week she will come again and I will try to help her with the points you recommended. I will let you know how she is doing then!
Last week I did use already more points to tonify Spleen and Kidney. She told me also that maybe massage is to much for her and that gives the pain. So last time I didn't do Tuina on her legs and feet.
I think its pretty clear that the Kidneys are the root problem here.
Classically, Chinese doctors used very few needles, 1, 2, sometimes 3 needles in a treatment, because acupuncture uses the patient's energy to work. Your patient is very clearly a deficient person, which is all the more reason to try to save her qi. Her negative reaction after your first treatment is to be expected because with the number of needles used, she was drained further. If you continue with needles, I would recommend picking 1, Kd3 (not bilateral).
I would only do moxa on this person. Indirect stick, 5-10 minutes on each point. As for point selection, keep it all below the knees and keep the heat level mild and you will not have to worry about any side effects from the heat. If you were to pick points on the torso, I would be absolutely sure that her blood pressure is ok and that she could tolerate the heat.
General points to strengthen: St36, GB39
Help circulation in the legs and feet: Lv5, Kd7 - this is a classical moxa prescription used for poor circulation in the low extremities due to deficiency. I use this very frequently on patients going through chemo, and diabetics.
Build Yin and Blood, strengthen Kidney: Kd2 - textbooks say this point is for reducing fire. But, indirect moxa here clears deficient heat by building Kidney Yin and blood.
As for putting these points together for treatments, when her foot pain is severe, I would do Lv5, Kd7 bilaterally, then moxa 1 Kd2. If her foot pain isn't so bad, I would do St36/GB39 bilateral with 1 Kd2.
Finally, at the end, I would always put some burn cream (Ching Wan Hung) on the points just to protect the skin.
What about Spleen 9 for Dampness?
SP 9 would certainly be appropriate for neuropathy cases that involve dampness. Not all cases, do however, particularly those that arise more from chemo induced damage. Diabetic induced neuropathy usually has more signs of dampness as they relate to the condition overall. Chemo induced neuropathy can exhibit with more signs of yin deficiency. Personally I find LV 8 more effective generally for either case as well as for knee problems and anything circulation issues in the lower leg.
The friend of a neighbor is afflicted with Renaud's Syndrome, Interstitial Lung Disease and Peripheral Neuropathy.
He gets shortness of breath with wheezing, sometimes stopping breathing and losing consciousness, his lips turning blue. His feet and ankles are very swollen, burning and numb at times.
He refuses to let his friend/caretaker call the paramedics, even just to give him oxygen.
He eats irregularly and poorly, having sometimes only a Cup of Noodles during the course of the day. He tends to get attacks of shortness of breath when he goes for long stretches without proper nourishment.
For situations acute situations I've suggested rolling the fingertips and clearing the webbings of the hand, holding Shuigou GV 26, as well as sandwiching Zhongfu Lu 1 with Feishu UB 13 & Pohu UB 42 AKA UB 38. This seemed to have headed off a full-blown attack recently when his friend did all of the above except, perhaps, Shuigou GV 26. I've also suggested holding Hegu LI 4 with Zusanli St 36, but that was more than the friend was able to do in the situation.
For times when he's not in a crisis, I've suggested tonifying Spleen and Kidney and resolving Dampness by holding Sanyinjiao Sp 6, Yinlingquan Sp 9, Taixi K3, and the Kidney corridor K 22-27, pulling gently sideways on the latter 6 pairs of points.
I've also recommended following RICE for the ankles, and he is now elevating his feet above his heart when he can and she is applying Zheng Gu Shui to the ankles and feet as frequently as possible. However, his compression socks give him a lot of added discomfort, so he has continued to shy away from them.
Any critiques of the above or suggestions for further acupressure, both to help in acute sitations and for ongoing support?
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