Peripheral neuropathy/foot pain

[Guest guest]

I am working with a 55 yo man who has numbness and/or pain from about

SP6 down to the toes.

He has a hx of lymphoma with two occasions of chemotherapy. Lymphoma

is considered " in remission " .

4 months prior to the diagnosis of lymphoma he experienced a tear in

his inguinal muscle on both sides. At that time, he was on lipitor

for high cholesterol. He has since stopped taking the lipitor.

He has a blood draw every 2 months to track his lymphoma.

 

His tongue is red, peeled with a crack in the center with a yellow

coat in the crack.

His pulse is thready in most positions and weak/thready in the KD yin

position.

 

I am looking at it as LV/KD/ST yin deficiency with phlegm in the ST.

(there was no coating in the crack on his last visit Tues after 6

treatments and 3 weeks of herbs)

 

I have been using a combination of traditional needling (ST36, GB34,

KD3, SP6, ST44, LV3, LV8) and microcurrent (ST36 to KD3, L4 to KD1).

Then I also added some Kiiko Matsumoto style acu after he said his

liver enzymes were elevated (ST25 bilateral plus LV13). Following

that treatment, he had numerous BMs which eventually was yellow and

watery, lots of sensation of pain in his feet. He still had

tenderness at ST25 when he came back 5 days later.

 

I also have him on teapills of Yi Guan Jian (I have since read the

thread re: dang gui and cancer with interest) for about 3 weeks.

 

He has had the most change in feeling (increased sensation, less

burning at night) with the dermatome/distal microcurrent treatment as

well as the tx for elevated liver enzymes via Kiiko.

 

I am thinking of making a custom granule formula and adding Wu Wei Zi

to reduce liver enzymes (per Bensky) and adding Zhi Gan Cao and Bai

Shao for pain.

 

1-Any thoughts about the treatment strategy?

2-any comments on prognosis or ideas based on your experience on how

often to treat or how long he should expect to receive treatment.

 

According to his numerous Western docs, it is idiopathic peripheral

neuropathy. There is no diabetes, no circulation problems, no alcohol

issues.

 

Thanks for looking this over. I appreciate your input.

Meredith Young, CAC, MSOM, ND

[Guest guest]

Meredith,

 

You are on the right track and the following are just my thoughts

-medicinals of Yin-nourishing may not be enough

-medicinals of blood-quickening are not enough

-medicinals to treat bowel movement IBM? are lacking (no enough data)

-more focus on local acupoints to treat the numbness

 

i would add chan tui, san qi, dan shen, guan zhong oo top of your

patent granule formula. Wu Wei Zi is good but cannot be used for too

long or the level of enzymes will rebound (according to phramaceutical

research).

 

Your interval is fine. Prognosis is complicated though, patient's

constitution, clinical efficacy.,..

 

SUNG, Yuk-ming

[Guest guest]

Meredith:

 

You have an interesting case, the sort of which we all seek and

occasionally avoid! Diagnostically, I sense simultaneous internal

and external components in addition to what you have noted. I agree

with your concerns for this gents past cancerous history and have

little to add about that part.

 

Regarding needling therapy and the leg numbness and pain, I might

think this relates more to the inguinal condition (internal cold)

rather than lymphoma history. You may wish to divide your thinking

and treatment between these two concerns for a while.

 

Regarding the leg conditions, I have only a couple of thoughts:

 

1) Look to the musculotendonous connection between the yin meridians

of the foot and the DU channel, specifically DU-1 through 4 for their

connecting nature and connection with KI and Qi. I especially like

DU-4 (Mingmen = Life Gate) in this case. I would also suggest

distant points, such as Fengfu(DU-16)at the nape of the neck, SI-3,

etc., as you see fit.

 

2) SI-3 (Houxi) is one of the eight cofluent points and connects with

the DU meridian. It is also effective in relieving spasm

and " tranquilizing " the mind.

 

3) Cranial Points for nerve in the lower extremity.

 

4) Try " anti-pain " points like Hegu (LI-4) during treatment to raise

Qi and eliminate the pain portion while needling. The point that

makes the symptoms disappear could be very significant from a

treatment and diagnostic standpoint.

 

The above reflects my sense that this is a post-traumatic external

condition progressing internally (yin cold). I also think the focus

is not at the ankle, though significant congestion may be found there.

 

Regarding prognosis and treatment expectations, my experience would

suggest a rather lengthy course, utilizing 10 to 20 treatments as

a " single course " , then monitor progress and alter therapy

accordingly. You could see very good results in another 6 weeks, but

think of this as a progress over several months. You may have to

modify your prognosis as the complexity of this persons conditions

becomes evident - or goes away!

 

Good luck. Hope these thoughts help.

 

Bill

[Guest guest]

Thank you, Bill and others for your very thoughtful and helpful respones.

 

What seems to create a positive response at one treatment does not

seem to repeat at the next treatment (usually 3-5 days apart).

Frustrating for him, I am sure.

 

I will be starting him on a granule tea formula on Friday and will

incorporate many of the insightful suggestions for acu treatment at

that time.

 

Thanks again,

Meredith