RSD Treated with Acupuncture and Chinese Herbs
Chief Complaint: Pain, constipation
Western Diagnosis: Total Body Reflex Sympathetic Dystrophy
Medical History: 46 year old, very active and successful, sportive white male, developed RSD after a de Quervain’s tendonitis from overusing his hand, doing repetitive movements. 4 weeks later his whole right hand was hurting, burning, sensitive to touch and AC, and turning blue. A stellate ganglion block revealed that he had developed RSD. Two month later he developed mirror image symptoms in his left hand, later in his feet. 1 years later he had total body RSD. Causing him excruciating pain, muscle twitches, difficulty in urination, constipation, depression, insomnia, poor memory, nightly hiccups, spontaneous localized sweating in the effected extremities, lethargy, skin sensitivity, hot flashes, migraines. The patient received during a period of 2 years 150 nerve blocks, and is on many medications (analgesics, anti-spasmodics, anti-depressants, tranquilizers, etc.) He still tries to stay active, since inactivity increases his symptoms. he can not use his hands very often, but can walk and swim. Good dietary habits, since red meet, alcohol and sugar make his pain worse. Patient is disabled.
Questioning exam: CC: pain, constipation
Energy level: very poor
Sleep: problems falling and staying asleep, nightmares (from medications)
Emotions: irritable, depressed, frustrated, anxiety
Appetite: poor in the morning, craves sweets, heart burn from medications
Thirst: not thirsty
Digestion: gas, cramps
Bowels: severe constipated
Urine: problems starting flow, yellow urine
Pain: in hands stabbing, aching, burning, exhausting, radiating, unbearable, worse with cold, touch, poor diet, stress, using hands; referred pain in upper and lower back; migraines twice a months with nausea and vomiting, pain in temple region and behind eyes
Body temperature: feels hot, gets ice cold hands, night sweats, hot flashes in the evening, spontaneous localized sweating in upper extremities
Pulse exam: Can not take radial pulse due to sensitivity to touch, use carotis. Wiry pulse
Tongue exam: cracked tongue, dark red body, dry, mapped tongue coating
OM Diagnosis: Qi and Yin xu w/xu heat, qi and blood stagnation, heart mind restlessness.
(definitely a very difficult case)
Treatment Principle: Move qi and blood, relieve pain, tonify Yin and qi, calm the shen, relieve pain
Point Prescription: Total Body RSD can get worse if you cause any minor injury to an effected area. So I never needle on his hands.
I used nearly all Jia Ji points along the spine, UB 14, 14, 20, 21, 23, 43, 25, ear points: heart, brain, shen men, nervous system
Herbal Formula: Started very simple with patent Shen Tong Zhu Yu Wan to move blood, 8 pills, twice a day (but increased pain), switched to Du Huo Ji Sheng Wan (helped with back pain, although I was worried formula is too hot), and Liu Wei Di Huang Wan, 8 pills at night at night. (Patient preferred pills) Hot flashes better. Right now I am working on raw herbs for patient, also to address his constipation and insomnia.
Lifestyle Prescription: Drinking more water, more cool foods, like water melons, oranges. Recommended psychologist.
Results: Back pain improved, no change in other pains, but pain threshold increased, feels less hot. Otherwise no change.
Synopsis: Very challenging case but patient very compliant.