Treating peripheral neuropathy with Traditional Chinese Medicine

Photo Cred: Camilo Jimenez/Unsplash

By Melissa Carr, BSc, DrTCM

While I have some patients who identify neuropathic symptoms as their primary concern, it is often a secondary or tertiary issue that they mention only in a thorough initial interview and exam. Many of these patients have given up on being able to do anything about their condition.

According to the National Institute of Health (NIH), peripheral neuropathy is estimated to affect about 20 million Americans. The numbers are likely to be much higher, as there are more than 100 types of peripheral neuropathy, and many forego testing or are misdiagnosed.

As with any health issue, the longer and more severe the condition, the more treatments and time it takes to bring improvement. This is especially true when treating neuropathies because the assault on the involved nerve or nerves must first be addressed, and then nerve healing can be supported.

The most common causes of peripheral neuropathy are diabetes and traumatic injury, but it can also be caused by local nerve compression like with carpal tunnel syndrome, inflammatory diseases like arthritis, autoimmune disorders like Sjogren’s or lupus, infections like varicella-zoster or Lyme, exposure to toxins, vitamin B6 or B12 deficiency, tumors, and side effects from medication.

Whether the symptoms of peripheral neuropathy are numbness and tingling or sharp and shooting pain, one main component of the TCM diagnosis will include Qi and/or Blood stagnation because stagnation results in a lack of nourishment to the nerve and the tissues it supplies. Moving Qi and Blood will only temporarily improve the condition, however, unless the cause is addressed. TCM calls this biao (branch symptoms) and ben (root source).

Since there are many potential causes of peripheral neuropathy and treatment options are diverse and dependent largely on that trigger, it’s perhaps easiest to explain how TCM can treat this condition by offering a couple of case study examples.

Case Study: Musculoskeletal Injury

The simplest to explain—though not always the easiest to treat—cause of peripheral neuropathy is when nerve signals are impeded by other proximal tissue, as is the case with a traumatic or repetitive injury that creates inflammation, scarring, or compression. Study of neuromuscular anatomy is helpful here.

Ask the patient specific questions about the location and type of nerve sensations they are experiencing. Is it constant or periodic? If periodic, is there any particular movement or activity that alleviates or aggravates the sensation? Are they better or worse after exercise or activity and first thing in the morning or end of the day? Palpate the muscles and tissue along the path to feel for areas of tension, laxity, swelling, cold, or heat. Ashi points, Huo Tou jia ji, and motor and trigger points, can be used for both diagnostic and treatment purposes. While it might be tempting to treat only the affected tissue, it’s still important to get a TCM diagnosis because even though there may be an obvious injury that happened because of an accident or repetitive movement, the key is still to treat the affected person, not just the symptoms, in order to support and speed up the healing process.

Even seemingly minor movements can cause injury to a nerve if poor posture and muscle imbalances have been longstanding. Maria had struggled for years with numbness and tingling in one hand after awkwardly carrying a 15 pound load for just 10 minutes. She had had years of neck issues and forward-slouching posture, anemia, low blood pressure, dizziness, issues with needing to be in control of everything around her, occasional migraines, and fatigue that she ignored. Her diagnosis was local Qi and Blood stagnation along with Liver Qi stagnation and Liver Blood deficiency.

Because her hand symptoms were specific to her thumb, index, and middle fingers, I treated the radial nerve, acupuncturing points that included a selection of LU7, LI4, LI10, LI12, LI14, SJ13, and Huo Tou jia ji points at C5, C6, C7, and T1. I also chose ashi points in the infraspinatus and pectoralis major muscles, LV3, LV8, SP6, UB17, GB21, and ba xie points. I prescribed a modified Xiao Yao San with the addition of more bai shao and dang gui to better nourish the Blood and ji xue teng, dan shen, and yan hu suo to move the Blood. Along with exercises to strengthen weak upper back and neck muscles and stretches to release tight chest and neck muscles and release the nerve compression, her numbness reduced to just 5% remaining, and she then had to allow time for the body to repair the nerve and resume normal sensation.

Case Study: Chemotherapy-Induced Nerve Injury

While many think of hair loss, nausea, loss of appetite, and fatigue when it comes to cancer treatment, chemotherapy-induced peripheral neuropathy (CIPN) is amongst the most common side effects, and it is sometimes permanent. CIPN can be debilitating, causing pain, numbness, tingling, altered sensations, weakness, and sometimes impede a person’s ability to walk, stand, write, pick up small objects, button or zip clothing, and perform many usual daily tasks. It also makes them more susceptible to unnoticed injury to the hands or feet.

Claudine had been experiencing CIPN for the past three months, having completed chemotherapy treatments for colon cancer. She used to run marathons, but since chemo, she was unable to pick up her feet properly, her legs felt like jelly, and she felt like she was being stabbed by nails when she wore shoes or was on her feet for more than an hour. Her hands would cramp up after just a few minutes of writing, she was unable to open jars or do up buttons, and the tingling in her fingers would sometimes wake her at night.

She found she was always cold, especially her hands and feet, had diarrhea in the early morning, was bloated, had edema at her feet, and felt weak. Chemotherapy drugs are poison to the Yang Qi, impairing the body’s ability to generate warmth and move Qi, Blood, and fluids. Her TCM diagnosis was Spleen and Kidney Yang deficiency with Qi and Blood stagnation.

Acupuncture points included ST36, SP3, SP6, SP9, SP10, KI3, KI10, LI4, P6, DU20, ba xie, and ba feng. Her herbal formula included a modified Zhen Wu Tang (True Warrior Decoction) with added gui zhi, yu jin, dan shen, dang gui, du huo, and qiang huo. I suggested she focus on warm cooked meals, using warming herbs and spices like ginger, turmeric, and cinnamon, which were also in her herbal formula.

After one acupuncture session, Claudine noted an improvement in the sensation in her hands. The neuropathic symptoms receded to just the very tips of her fingers after two months of weekly sessions and she was able to return to work, including standing and writing. Her bowel movements normalized, and she was feeling warmer, even though the weather had turned cold and damp. She will likely need to continue treatment for a few more months, as she needs the physical and emotional support and time to recover from both the cancer and the cancer treatment.

References

National Institute Health. Peripheral Neuropathy Fact Sheet. Retrieved from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet