DX: Motor paralysis of several major muscle groups in the upper and lower limbs likely due to febrile damage to the central nervous system
TCM DX: Wei syndrome due to qi and blood deficiency; Obstruction of the channels and meridians
PROGNOSIS: Due to the fact that this condition has been left untreated for 20 years, it is unlikely to expect significant response.
Treat with acupuncture 3 times per week for 10 treatments before reassessing. Focus on the Yang Ming to stimulate qi and blood. Make heavy use of electro-acupuncture crossing multiple joints, especially concentrating on anterior and lateral compartments of the leg and flexor/extensor complexes of the forearm. Internally, use Dang Gui San 4g TID to tonify and move blood.
Typical treatment: Left: ST36 electro to LR3, GB34 electo to GB41,
LI10 electro to LI4, HT3 (distal) electro to HT8, Ba Xie (with heavy
stimulation), Ba Feng (with heavy stimulation); Right: ST36, SP6, KI7,
HT7, DU 20, 24
Alternative treatment: Pi Ci needling of hand and foot Yang Ming
channels, scalp motor sensory (leg, foot and arm zones x3) on well
side with electro-stimulation
After 10 treatments, the patient reported no change in condition. The patient was informed that due to the long-term nature of the condition and the lack of response to treatment, it was unlikely that acupuncture treatment would be beneficial. The patient opted to continue treatment, but after 18 treatments she still reported “no change.” At this time, the patient was encouraged to discontinue treatment. The patient immediately broke into tears stating that she wanted to continue treatment because when she started, she was unable to carry the water bucket. Now, she could. Before she started treatment, she could not walk to the clinic. Now, she could. This was a major revelation of change in condition, which brought to our attention the concept that culturally, “no change” often means “I’m not cured.”
After a more thorough objective examination, it was observed that the patient now had weak, uncoordinated active movement of the fingers. She could also actively evert the foot. After this discovery, the patient was treated every other day for 4 weeks, during which time she made rapid improvement. Eventually, she was given exercises
to teach both the well and ill hands how to isolate individual finger movements. She was instructed to use her eyes to observe her well hand through a series of individual digital movements before trying to replicate the movements with her ill hand. Progress was slow, but continual. The patient was continuously encouraged to exercise. In every treatment session, the patient was reminded of how far she had progressed. After 48 treatments over 3 months, the patient had full, active dexterity of the left hand even though the left arm remained 10-20% weaker than the right. The left foot did not respond as well and remained 50% weaker than the right. Dexterity of the toes was not recovered. However, the patient could dorsiflex and plantar flex the foot.
This patient was nearly released from care due to poor communication, objective observation and subjective reporting. When dealing with paralysis recovery, careful objective observation and measures are imperative as the patient is not always aware of the slow changes that are taking place. Visual exercises, in addition to the acupuncture treatment, significantly accelerated the recovery process. Paralysis patients need constant encouragement as the course of treatment is slow. Often, the condition seems to plateau before new changes take place.
Credit: AcupunctureReliefProject, Nepal