Western Diagnosis: Peripheral Diabetic Neuropathy
Medical History: 6 years ago the patient was diagnosed with type 2 diabetes; concurrent with his diagnosis he began to experience signs of peripheral neuropathy in his lower limbs which include numbness, tingling and pain in the ankles and feet. The pain pattern is as follows: the toes are numb, the top of the sole and the sole of the feet are numb, and a numb pain and feeling of thickness with pain are felt around the ankle joint. There is also heaviness of the foot. The patient also reports a dull pain in the knees. The pain is on the yin side of the legs and the UB channel. The pain is aggravated by walking and is worse in cold wet weather. The pain is reported as a 6/10. Alleviating factors are warmth and massage.
Questioning exam: sweat- The patient reports no unusual sweating.
head and body- The patient has occasional headaches which are fairly nonspecific. He has left shoulder pain and weakness and very occasional back pain.
stool & urine- The patient reports one daily bowel movement that is easy to eliminate. He reports a weak urinary flow and pressure during urination.
food and drink- The patient is not a vegetarian, He does not eat a large breakfast and reports eating a healthy dinner. He reports always being thirsty and sips water frequently.
chest & abdomen- The patient reports an occasional heartbeat and was diagnosed 6 years ago with hypertension. He reports that coffee and cigarettes both give him a rapid heartbeat.
hearing & vision- The patient wears glasses and reports an occasional blurry vision.
Thirst- The patient is constantly thirsty and frequently sips water.
Sleep- The patient reports much difficulty getting to sleep, he takes ambien and reports getting 5 to 6 hours of sleep a night.
habits/ lifestyle- The patient smokes ten to twelve cigarettes a day, drinks three cups of coffee, and reports very infrequent use of marijuana and cocaine.
Pulse exam: Pulse: 100 BPM
Overall: weak slippery
Left: thin, slippery
Right: slippery, weak
Abdomen: slightly distended
Tongue exam: Tongue
Body: dry, pale red with a dusky edge, slightly enlarged with small cracks in the center
Fur: slightly yellow on sides and rear.
Sublingual vein: slightly distended
OM Diagnosis: Channel and zang fu Diagnosis:
Qi and blood deficiency and stagnation in the channels of the lower limb with underlying yin deficiency with dampness.
Correspondence of symptoms and signs:
Qi and blood deficiency and stagnation in the lower limbs
Numbness tingling and pain in the lower extremities
Enlarged tongue with dusky hue
Yin deficiency with dampness
1) Knee weakness
2) Thirst with sipping of water
3) dry tongue
4) thin rapid pulse
5)heaviness in the foot
6)body type (pear shaped)
7)mallar flush
8)poor sleep
Treatment Principle: Supplement and move qi and blood in the lower limbs; tonify yin, drain dampness and clear heat.
Point Prescription: Acupuncture:
Ki 2 Ran Gu- ying spring fire point on the water channel- it functions to clear deficiency heat regulates the kidneys and regulates the lower jiao.
LR 2 Xing Jian- ying spring fire point on the liver channel – it functions to spread liver qi, pacifies liver wind, benefits the lower jiao.
SP 6 san yin jiao- meeting point of the spleen liver and kidney channel- it functions to tonify the spleen and stomach, resolve dampness, harmonize the liver and tonify the kidneys, harmonizes the lower jiao, calms the spirit and invigorates blood.
St36 zu san li- he sea water point- this point fortifies the spleen and resolves dampness, tonifies and nourishes blood and yin.
Ht 3 shao hai- he sea water point on fire channel- this point functions to calm the spirit, transform phlegm, and clear heat.
Ren 12- Zhong wan, front mu of the stomach, meeting point of the fu- this point tonifies the stomach and fortifies the spleen and regulates qi and alleviates pain.
The focus of this treatment was to locally move qi and blood, clear heat, nourish yin, resolve dampness, benefit the spleen and stomach, and calm the shen. Ht 3 and KD2 are the fire and water points on the fire and water channels they connect the upper and lower jiaos. Ren 12 was needled to help further establish this connection between the upper and lower as it is the zhongwan or central pivot on the middle jiao. KI 2 and LR 2 are also local points which move qi and blood.
*While the above analysis and acupuncture treatment was for a TCM zang fu based treatment, Electircal stimulation was also applied, with similar point prescriptions used with low frequency e-stim in both ba-feng and in 6 needles surrounding the ankle in a subsequent treatment.
Herbal Formula: Modified: Zhi bai di huang wan
Shu di huang 18 g- tonifies yin and blood of the liver and kidneys
Shan zhu yu12 g- tonifies the kidneys
Shan yao 12 g- tonifies the qi of the kidneys
Fu ling 9 g- drains dampness and calms the spirit
Mu dan pi 9 g- moves static blood and clears deficiency heat
Ze xie 9 g- drains dampness, clears heat but not to damaging to the yin
Zhi mu- 9 g- clears heat and nourishes the yin
Huang bai 9g- clears heat from the lower jiao
Niu xi- 9g- moves qi and blood in the lower limbs
Tian hua fen 12 g- transforms phlegm and generates fluids
Gan cao 6 g- guides the herbs to the twelve channels and alleviates pain
Shi chang pu- 6- aromatically transforms phlegm and clears the head
Lifestyle Prescription: a nutritional supplement recommendation that was given for Alphalipoic Acid to be taken -200 g 3 times a day
Alpha lipoic acid- alpha lipoic acid (ALA) significantly and rapidly reduces the frequency and severity of symptoms of the most common kind of diabetic neuropathy. Symptoms decreased include burning and sharply cutting pain, prickling sensations and numbness.(www.mayoclinic.com). In addition the patient was advised to quit smoking cigarettes and using recreational drugs.
Results: After 10 treatmentst the patient reported feeling a decrease of the numbness and tingling. but not a complete resolve of the symptoms.
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