Psoriasis with Neck and Shoulder Pain | Acupuncture Relief Project | Volunteer Community Health Clinic | Nepal

Psoriasis with Neck and Shoulder Pain


Phonexay Lala Simon EAMP LAc MSAOM
December 2013
OVERVIEW

Acupuncture Case Study45-year-old male presents with psoriasis for 5 years, possible psoriatic arthritis for 2 years, and idiopathic neck pain and stiffness for 2 months. After 17 treatments of acupuncture and herbs, he has regained full range-of-motion, has less pain in his neck, his rashes are less painful and itchy, and he has more movement in his fingers and toes due to a decrease in swelling.

Subjective

45-year-old male presents with lesions on his scalp, back and limbs that began about 5 years ago. When his condition began, the patient was in Qatar working with construction and plaster. The lesions subsided upon his return to Nepal, and completely resolved within a year of being back. He continued to work in Kathmandu with plaster and construction. 2 years ago, he noticed the lesions returning. When the lesions erupted again, they began on his scalp, and continued to spread down his back. From there, the lesions spread to his abdomen and legs. Patient reports moderately achy and sometimes burning pain, with moderate itchiness that can be a nuisance at night. He finds them to be most bothersome during the day, and especially when he first wakes up, because it is the first thing that he notices. The patient reports that when he scratches the lesions, they are "weepy with water," and bleed. He has seen 1 other doctor in Kathmandu who gave him some creams and medication, but the patient does not recall what they were. They were not helpful. The rash does not subside with soap, or cold or hot water, and is actually irritated by most of the soaps that are available. As a result, the patient has stopped using soap entirely. Other than soap, the patient does not know if there are triggers that aggravate his condition, and he denies being emotionally or physically stressed.

The patient reports swelling with stiffness in the joints that began about 2 years ago, and has gotten progressively worse. Swelling occurs in the small metatarsals of his right foot, and his thumb, index and middle metacarpals on his left hand. He experiences moderate pain in his wrists and shoulders. He reports that his fingers are hard to move and bend, are usually moderately painful, and occasionally feel hot and burning. They are sometimes aggravated by cold. His brother also suffers from the same type of lesions, and swelling.

The patient presents with neck and shoulder pain that began about 2 months ago. The onset was idiopathic, sudden, and he cannot recall any possible causes. He reports the pain to be very severe and achy, with no sharpness. He says he can feel an electric sensation running downwards to his fingers when he coughs. Occasionally, the pain radiates up to his temporal area, or down to his wrists and hands. However, he denies numbness and tingling, or loss of strength in his arms and hands. Patient has severe pain and stiffness when resting, and he currently takes Paracetemol (acetaminophen- dosage unknown) to provide about 12-13 hours of pain relief.

Currently, the patient is not working due to his conditions, and he is supported and cared for by his son and daughter.

Objective

Acupuncture Case Study

The lesions on the patient's body range from a large diamond-shaped patch on his lower back, that is about 5" wide and 8" long (his largest lesion), to multiple smaller ones ranging from .5" to 2" in diameter that stagger throughout his upper back, abdomen, elbows and legs. The lesions are discrete plaques that have a pink and tender appearance, as well as shiny, silvery white "scales." There are multiple breaks in the skin with some blood and weeping, possibly due to scratching. There is flaking and dryness on his scalp.

He has some obvious swellings on his toes and fingers. Most noticeably, his right second metatarsal, left thumb and third metacarpal are swollen to double the size of the same joints on the opposite hand and foot. He has limited range-of-motion in his right hand and can only clench his left hand 50% of normal, making a "C" shape.

The range-of-motion in his neck is 15 degrees flexion (normal 50 degrees), 30 degrees extension (normal 60 degrees), and lateral flexion of only 20-25 degrees bilaterally (normal 45 degrees). Most limited ROM is the lateral rotation of 10-15 degrees bilaterally (normal 80 degrees), and the patient has to move his entire torso to compensate for the lack of rotation. He reports moderate to severe pain in all movements past these ranges, and his face indicates that he is uncomfortable.

His labs are positive for elevated rheumatoid factor. This can be indicative of rheumatoid arthritis, but can also indicate other kinds of autoimmune disorders, such as psoriasis and psoriatic arthritis.

Acupuncture Case Study

The patient seems in good spirits and looks healthy for his age and environment. He smiles during the whole interview, even when he is doing something that is uncomfortable. He makes eye contact during conversation. When rising from the chair to go to the massage table to undress, he rises very slowly, deliberately and is gentle with his motions.

His pulse is soft, thin, slippery and empty in the deep Lung position. His tongue is pale pink, slightly puffy, with teethmarks and a white coat that is thin in the front, but thicker in the back with small, bilateral prickles.

Assessment:

TCM DX: Lung qi deficiency leading to wind-damp-heat, and qi and blood stagnation in the foot Shaoyang channel; Possible underlying blood deficiency

Lesions on the skin indicate involvement of the Lung organ system according to Chinese medicine, and the nature of resolving and recurring are indicative of a wind pathology with an underlying blood deficiency.

Western DX: Psoriasis with psoriatic arthritis

While rheumatoid arthritis is still a possibility, the history of a prolonged, severe psoriatic condition makes it more probable that it is psoriatic arthritis. However, both psoriatic and rheumatoid arthritis are treated similarly. His neck pain and stiffness are likely due to acute muscle strain and/or tendon sprain of the neck as a result of unidentified causes. It is a possibility that the arthritis is affecting the patient's neck, but physical examinations and presentation indicate a muscular source of his problem, rather than vertebral.

The pattern of lesions on the patient's skin most resembles a condition of psoriasis. Psoriasis is a dermatological inflammatory condition due to immune stimulation of epidermal cells (kerotinocytes). Although its exact cause is largely not understood, the result is erythematous lesions on the body. The presentation of lesions can be pustular, but the most prevalent and classic presentation is the discrete papules, or plaques, with thick, shiny, silvery scales. A family history is common, and there is a genetic susceptibility that can be triggered. Therefore, the condition can have episodes of spontaneous remission and recurrence, or triggered eruptions followed by remission when the trigger is removed.

Prognosis:

With regular use of both acupuncture and herbal treatments twice weekly, at least a 50% improvement in his severe neck pain and stiffness is expected within 13 treatments. The psoriasis is much more difficult to predict. Psoriasis is a difficult condition to completely understand and manage, even with good access to resources, unlike the situation the patient faces in Nepal, where resources are less accessible. Psoriasis is considered mild if less than 10% of the body is covered in lesions. Since the lesions cover about 20% of the patient’s body, his case is moderate. There are many important factors to consider, such as genetics, environment, lifestyle and psychoemotional triggers. Using acupuncture and herbs alone, a 25-50% improvement in the moderate pain, itching and size of the psoriatic plaque, and arthritis, is expected within 13 treatments.

Initial Plan:

Treat with acupuncture twice weekly for 13 treatments, in conjunction with Chinese herbal medicine, before reassessing. For the rash, focus on reducing moderate itch, and possibly the size of the psoriasis. In the joints, focus on reducing moderate pain and swelling. Reduce severe pain and increase range-of-motion in the neck. Use herbal medicine to reduce inflammation of the lesions and joints, then begin to tonify blood and strengthen Lung.

Typical points include wide Hua Tou Jia Ji points, inserted laterally towards the transverse processes, from C2 downwards, with SI14, GB20, SJ3 and SI3 to open the DU. Trigger points in the areas of the neck and shoulders are also indicated. To clear damp and heat, use LU5, ST40 and surround the largest lesion. To tonify and circulate, use ST36, UB13, UB17, LI4 and LV3.

Formulas to take internally are Xiao Feng San for clearing wind and itch. Add Dang Gui Yin Zi or Si Wu Tang to tonify blood once itching is reduced. Have patient take home moxa stick and 7 star needle, to try for 1 week, to see if it helps with the itchiness or size of the lesions.

Counsel patient to spend time in sunlight. UV therapy has been shown to be effective for psoriasis. Continue to guide patient on being emotionally aware, and to release negative emotions if possible. Psoriasis can be triggered or aggravated by emotions and stress. Educate patient on what psoriasis is, and what is going on in his body at a very basic level, and that the condition may come-and-go on its own. Try to identify possible environmental or lifestyle triggers so that he can take steps towards avoiding them, if possible.

Outcome:

After 13 treatments, the patient reported a significant decrease in the itchiness of his psoriatic lesions from moderate to mild, but no noticeable decrease in the size nor the amount of lesions. He wasn’t noticing the itchiness as much when he woke in the morning, nor during the day. He reported that the moderate pain in his fingers and toes had decreased to mild pain, and that it was easier for him to bend them. His left hand could close to about 75% of a completely closed fist. The most significant improvement was in the patient's neck. He reported that it was easier to move his neck, and the pain had decreased from severe to moderate pain. For the past few weeks, he needed his son or daughter to help him get up out of bed, but now he was able to rise from bed on his own. Range-of-motion tests showed that the patient could laterally rotate his neck, up to 55 degrees, without having to move his torso. His flexion improved slightly to about 25 degrees, or just half of full flexion. Extension was still around 30 degrees with minor pain in the front of his chest, and lateral flexion improved to almost full 45 degrees, but with moderate pain and stiffness.

Continued Plan:

Beginning at treatment 14, more emphasis was placed on recovering range-of-motion in his neck, rather than on surrounding the psoriasis lesions.

Continued Outcome:

On treatment 17, the patient had full lateral rotation to 80 degrees, and only with mild pain and stiffness. He could also manage full flexion, with only slight (very mild) pain in the back of his neck. Extension was much better, at 40 degrees, with very slight pain in his pectoral region. Lateral flexion had almost returned to a full 45 degrees, but he had to perform the motion slowly. He was able to lift his shoulders to 90 degrees more easily, which is not something he was able to do previous to the treatments, though it was not measured at the initial visit. Overall, there was about 80% improvement in the presentation of his acute neck pain.

The patient's movements became quicker and he no longer moved as gingerly as he had at the initial visit. He could also look up more comfortably during conversation. He enjoyed moving his neck to show the increased range-of-motion he was experiencing.

The patient's psoriasis condition improved slightly. There was a reduction in itching and pain. He said that the combination of acupuncture, herbs and the home moxa treatments had been incredibly helpful in decreasing the constant and moderate pain and itching from his lesions. He reported that the itching was no longer constant and the pain was more mild. Inspection of his lesions showed that many of the smaller ones had decreased scaling and appeared tender, but according to psoriatic progression, this was a small improvement. The largest lesion had less weeping and bleeding, possibly indicating that he had been scratching less. There was at least a 50% improvement in the moderate pain and itching of the lesions, though only a 10% (at most) improvement in the appearance and size of the lesions.

He reported that the swelling in his fingers and toes continued to improve. The moderate pain was mild and intermittent. The swelling had decreased to where the patient was able to close his left hand 90%, in comparison to the 50% from the first visit.

Discussion:

Psoriasis is an interesting condition because there are so many factors involved, therefore many therapies with which to try to manage. Western therapies include UV light therapy, vitamin D, immunosuppressants, corticosteroids and other anti-inflammatory drugs, along with education about possible environmental and emotional triggers that can be identified and possibly removed. Unfortunately, in Nepal, many drug therapies like Coal tar, Anthralin, and Calcineurin Inhibitors (anti-inflammatories) are not available. Also, it is difficult to educate the patient on how to use the drugs properly, and to monitor patients once they begin using potent drugs for a prolonged period of time. Therefore, drugs that tax the Liver and Kidneys such as Methotrexate or immunosuppressants like systemic corticosteroids are not viable options. More research needs to be done for viable therapies that are readily available to the patient, such as emollients (especially with salicylic acid), that can help to soften the lesions. Hydrocortisone is available in Nepal, but the large surface area of lesions makes it both contraindicated and expensive. Vitamin D3 analogs have been shown to be effective, and he can absorb it by UV (sun) therapy. The process of questioning, communicating and educating the patient about environmental, emotional and lifestyle triggers is also difficult, due to cultural and language barriers.
The acute neck pain and stiffness has been resolving nicely. Even though acute situations can resolve on their own, I believe that the treatments quickened healing, and helped him regain his range-of-motion. The patient has also begun mentioning pain "deep inside" his neck, so it may be worth considering if there is an arthritic cause to his neck pain, and if he may begin to develop chronic neck pain.

The most important part about this case, however, is that from the initial visit with the patient, I was focused on trying to help him with his psoriasis, due to my own interest and curiosity from a practitioner's standpoint. My perspective and perception about the case shifted at the reevaluation, when I realized how much the neck pain and stiffness was affecting his quality of life. At that point, I was able to focus more on making tangible gains in his mobility, and he was very responsive to the treatments. This shift in emphasis was vitally important to his daily well-being and a good outcome to this case.

Acute Cholecystitis

Acute Cholecystitis
70-year-old female presents with acute abdominal, chest and scapular pain, vomiting and diarrhea. At the local hospital, she was diagnosed with acute cholecystitis via labs and ultrasound. She received anti-nausea medication and was turned away for further treatment. After 7 treatments using… Read more:

Ankylosing Spondylitis

Ankylosing Spondylitis
25-year-old male presents with low back and sacroiliac pain, beginning approximately 15 months prior to consultation at this clinic, for which he had received a diagnosis of ankylosing spondylitis at a hospital in India. After 18 treatments with acupuncture in conjunction with moxibustion and… Read more:

Atrophic Vaginitis with Recurrent Urinary Tract Infections

Atrophic Vaginitis with Recurrent Urinary Tract Infections
57-year-old post-menopausal female presents with constant burning uterine and bladder pain for 3 years. Allopathic care has been unsuccessful in diagnosing and providing relief of symptoms. In using combination therapy of acupuncture, Chinese herbs and western antibiotics, the patient has had a… Read more:

Autism Spectrum Disorder

Autism Spectrum Disorder
20-year-old male patient presents with decreased mental capacity, which his mother states has been present since birth. He lacks verbal communication skills and his mother states he is prone to angry outbursts. Within 5 acupuncture treatments, he is less agitated, his violent outbursts have… Read more:

Bell’s Palsy (Facial Paralysis)

Bell’s Palsy (Facial Paralysis)
A 50-year-old female with Bell’s palsy presents with hemi-facial paralysis involving the eye and the mouth. After 5 weeks, 10 acupuncture treatments and 2 months of Chinese herbal medicine, she experienced a 90% recovery. Patient is a 50-year-old female presenting with right side paralysis of… Read more:

Bilateral Hip and Low Back Pain

Bilateral Hip and Low Back Pain
19-year-old male presents with trauma-related chronic hip and low back pain with limits in range-of-motion that interferes with daily life. After 24 acupuncture treatments over the course of 6 weeks, the patient has increased range-of-motion and significant pain reduction.  19-year-old male… Read more:

Bilateral Leg Weakness and Paralysis

Bilateral Leg Weakness and Paralysis
42-year-old female presents with an inability to walk due to slow-onset, partial bilateral leg paralysis occurring over a 15 year time span. After 23 treatments focusing on strengthening the DU and Kidney channels with acupuncture, electro-stimulation and moxibustion, the patient gained a… Read more:

Candidiasis and Vaginal Discharge (Type II Diabetes)

Candidiasis and Vaginal Discharge (Type II Diabetes)
63-year-old female presents with chronic purulent vaginal discharge, pruritus vulva and tingling in the extremities. Test results show hyperglycemia of RBS 540 mg/dl as well as vaginal candidiasis. Patient received 9 treatments of acupuncture, referral for insulin therapy, advice on diet and… Read more:

Cervical and Lumbar Spondylosis

Cervical and Lumbar Spondylosis
70-year-old male presents with severe cervical and lumbar pain, neuropathy of the arms, hands, legs and feet, incontinence of bowels and anal rash. His doctor has advised surgery. After 8 treatments he is able to sustain 40 -50% relief of pain for 4 days. Patient presents with severe lumbar… Read more:

Chronic Abdominal Pain

Chronic Abdominal Pain
31-year-old male presents with chronic abdominal pain. The patient has suffered from abdominal pain for the past 11 years, but has had a worsening of symptoms in the past year. Case analysis after 11 visits over 2 months. Patient presents with pain in the epigastric, umbilical, hypogastric,… Read more:

Chronic Gastritis

Chronic Gastritis
52-year-old female presents with chronic, burning epigastric pain accompanied by acid reflux, nausea, belching and decreased appetite. The patient also experiences daily headaches and dizziness. With conjunctive therapy of acupuncture, Chinese herbal medicine and antacid treatment, the patient… Read more:

Chronic Gastritis with Inflammatory Bowel Syndrome: Crohn’s Disease

Chronic Gastritis with Inflammatory Bowel Syndrome: Crohn’s Disease
40-year-old male presents with chronic, burning gastrointestinal pain with accompanied acid reflux, belching, fullness, diarrhea, weight loss and occasional rectal bleeding. The patient also experiences fatigue and insomnia. Receiving only acupuncture and Chinese medicine therapy for this… Read more:

Chronic Headache (Typhoid Fever Sequela)

Chronic Headache (Typhoid Fever Sequela)
43-year-old female presents with a severe headache. 9 months ago, the patient contracted Typhoid fever. During the illness, she had a headache that covered her entire head and a mild fever for 5 days. She has had severe headaches ever since. Acupuncture is providing some relief from the… Read more:

Chronic Non-Healing Ear Ulcers

Chronic Non-Healing Ear Ulcers
15-year-old female presents with purulent, non-healing ulcers in the right ear canal. After 20 treatments, using an integrative approach that included Chinese herbal medicine, acupuncture and antibiotics, the patient experienced a reduction of pus, reduced pain and itchiness. However, the… Read more:

Chronic Obstructive Pulmonary Disease with Osteoarthritis

Chronic Obstructive Pulmonary Disease with Osteoarthritis
65-year-old female presents with dyspnea and continuous cough. The patient also presents with chronic, severe pain and inflammation of all joints of the hands and feet. With 9 acupuncture treatments and the use of Chinese herbs, the patient experienced a 6% O2 increase, more than a 50% reduction… Read more:

Chronic Vomiting

Chronic Vomiting
80-year-old male presents with vomiting 20 minutes after each meal for 2 years. At the time of initial visit, patient was vomiting undigested food and water several times per day. Other symptoms include burning esophageal pain, the feeling of constant hunger, and a sensation of “something… Read more:

De Quervain’s Syndrome

De Quervain’s Syndrome
57-year-old female presents with hand tingling and severe wrist pain that began 9 months prior to visiting the clinic. Both wrists are affected. Patient reports pain began first in right wrist, but currently feels more pain in her left wrist. The western diagnosis for this patient is De… Read more:

Dupuytren’s Contractures

Dupuytren’s Contractures
  58-year-old male presents with persistent contraction of 3rd, 4th and 5th fingers of right hand. He reports it began insidiously 3 years ago, and that it might be due to a leech bite from 25 years ago. After just 3 treatments using electro-acupuncture and manual therapy, passive and active… Read more:

Emotional Depression

Emotional Depression
40-year-old woman presents with depression, emotional stress and dream-disturbed sleep. She presents with a secondary complaint of chronic ringing in her ears. 2 months ago her daughter committed suicide, and she is emotionally distraught from the incident. The clinic provides a safe place for… Read more:

Facial Paralysis (Bell’s Palsy)

Facial Paralysis (Bell’s Palsy)
35-year-old female presents with left-sided facial twitching and paralysis. After 7 acupuncture treatments, the patient regained over 50% of her facial functioning with 80% of the facial twitching resolved. Patient presents with left-sided facial twitching and paralysis. There is painful… Read more:

Febrile-Induced Cerebellar Ataxia

Febrile-Induced Cerebellar Ataxia
58-year-old male patient presents with ataxia, severe dizziness, vertigo and slurred speech. Symptoms started after a severe febrile illness in November 2012, and appear to be getting worse since that time. After 8 acupuncture treatments, patient reports a minimal decrease in overall dizziness… Read more:

Ganglion Cyst

Ganglion Cyst
11-year-old female presents with large lump over left radial artery at radial styloid process, causing pain to the local area. She had minor surgery to remove a gelatinous substance from within the cyst and was informed by the doctor that it will keep growing back. After 9 acupuncture… Read more:

Hemiplegia (Stroke Sequelae) with Acute Lung Consolidation

Hemiplegia (Stroke Sequelae) with Acute Lung Consolidation
81-year-old female presents with complete left-sided hemiplegia following ischemic stroke 2 months ago. Over the course of 7 weeks of acupuncture treatment, the patient regained limited voluntary dorsi and plantar flexion of her left foot, flexion and extension of her knee and elbow, and… Read more:

Hemiplegic Stroke Sequelae with Aphasia

Hemiplegic Stroke Sequelae with Aphasia
Patient presents with right-sided paralysis of his upper and lower limbs due to an ischemic stroke 9 months ago. Additional sequela includes speech impairment with the inability to say anything, but the phrase “la”. On presentation, this patient had not received any other post-stroke treatment.… Read more:

Hemorrhagic Stroke Sequelae

Hemorrhagic Stroke Sequelae
53-year-old male presents with right-sided hemiplegia following a hemorrhagic stroke 1 year ago. Patient complaints include decreased range-of-motion, pain, numbness and weakness of his right side including the shoulder and arm. Concluding 10 treatments, comprising of acupuncture with electrical… Read more:

Huntington's Disease

Huntington's Disease
38-year-old female presents with a 4-year history of involuntary spasming throughout her entire body. The patient does not have any available medical records and the cause of spasming is unknown. Over the course of treatments, the patient experienced a feeling of ‘lightness’ in her body,… Read more:

Ischemic Cerebrovascular Incident

Ischemic Cerebrovascular Incident
60-year-old male presents with sudden onset of motor deficit of right hand, tingling and weakness of right foot, as well as marked changes in function of glossopharyngeal and hypoglossal nerve. Within the course of 15 acupuncture treatments, including electric stimulation and moxibustion, there… Read more:

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis
10-year-old female presents with active phase of Juvenile Rheumatoid Arthritis (JRA) as demonstrated by multiple articular bony joint deformities, severely limited range-of-motion in all affected joints, and a history of recurrent episodes of alternating fever, chills and profuse sweating,… Read more:

Low abdomen pain due to roundworm and Urinary Infection

Low abdomen pain due to roundworm and Urinary Infection
30-year-old female presents with lower abdominal pain, burning urination and shortness of breath for the last 5 months. With the discovery and treatment of a parasitic infection, and with concurrent treatment of a urinary tract infection, the patient found significant relief. Patient presents… Read more:

Low Back Pain with Radiation

Low Back Pain with Radiation
30-year-old male presents with severe back and left leg pain, exhibiting postural deviation as a way to relieve pain from an L5/S1 disc herniation. When prescription of daily acupuncture and massage was followed diligently, patient experienced a more dramatic reduction in pain, improved posture… Read more:

Low Back Pain with Urinary Difficulties

Low Back Pain with Urinary Difficulties
32-year-old woman presents with constant low back pain and burning urination. She has been diagnosed with severe hydronephrosis in the right kidney and, due to pain, recommended to have a nephrectomy. After 10 treatments with various Chinese medicine modalities, her pain was reduced by 50% and… Read more:

Lumbar Stenosis due to Osteoartritis

Lumbar Stenosis due to Osteoartritis
36-year-old female with lumbar spinal stenosis presents with severe low back pain with referred pain down the posterior left leg and anterior right thigh. The patient lives several hours from the clinic, but was able to stay in Kathmandu temporarily in order to get daily treatment for 2 weeks.… Read more:

Massage for Chronic Back Pain Associated with Spondylosis of the Spine

Massage for Chronic Back Pain Associated with Spondylosis of the Spine
70-year-old male referred for massage treatments for pain associated with spondylosis of the spine and neuropathy. The patient is simultaneously receiving ongoing acupuncture treatments. At the time of the referral, he had completed 18 acupuncture treatments. The main objective, through the… Read more:

Neck Pain with Radiation

Neck Pain with Radiation
40-year-old male presents with right-sided neck pain, without nerve radiculopathy, down the arms bilaterally. He has seen his physician who diagnosed him with nerve impingement and wants to do injections of Xylocane and Tricant local to the area of pain, inferior and slightly lateral to his… Read more:

Outer Ear Infection

Outer Ear Infection
52-year-old male presents with right-sided, burning head and ear pain, right-sided hearing loss and anosmia. It is determined, after an initial ear examination with an otoscope, that the patient has a severe right-sided ear infection. After 12 treatments, which includes the use of acupuncture,… Read more:

Painful Ulcerations of the Throat with Chronic Sinusitis

Painful Ulcerations of the Throat with Chronic Sinusitis
28-year-old male presents with chronic sinusitis, nasal blockage, throat pain and ulcerations for 18 months. The patient also presents with gastric pain. After 9 acupuncture treatments over the course of 1 month, the sinus blockage is 100% resolved, with a complete resolution of subjective… Read more:

Palliative Care of Parkinson’s Disease

Palliative Care of Parkinson’s Disease
62-year-old male was diagnosed with Parkinson’s disease 8 years ago and has been receiving treatment in this clinic since 2009. This case explores the positive role that Chinese medicine can play in providing palliative care to patients living with a chronic degenerative disease. 62-year-old… Read more:

Palliative Management of End-Stage Emphysema

Palliative Management of End-Stage Emphysema
71-year-old male presents with cough and severe shortness-of-breath, caused by emphysema. Initially, patient was stabilized during an emergency home visit. At patient’s request, palliative home care was provided. This type of care is necessary for anyone suffering from chronic illness, yet as… Read more:

Parkinson’s Disease

Parkinson’s Disease
72-year-old female presents with left hand tremors that extend up the arm and into her neck and jaw. Tremors have been present for 2 to 3 years. Hospital and doctor records report Parkinson’s disease. Over the course of treatments, the patient experienced periodic relief, with regression and… Read more:

Primary Hypertension

Primary Hypertension
3 patients present with stage 2 essential hypertension (HTN), 1 of which is a female (76 yo) and 2 of which are male (61, 50 yo). In addition, each patient presents with knee pain and various other tertiary complaints. All 3 patient’s conditions are pharmaceutically unmanaged. However, through… Read more:

Psoriasis with Neck and Shoulder Pain

Psoriasis with Neck and Shoulder Pain
45-year-old male presents with psoriasis for 5 years, possible psoriatic arthritis for 2 years, and idiopathic neck pain and stiffness for 2 months. After 17 treatments of acupuncture and herbs, he has regained full range-of-motion, has less pain in his neck, his rashes are less painful and… Read more:

Rheumatoid Arthritis

Rheumatoid Arthritis
35-year-old female presents with multiple bilateral joint pain beginning 18 months previously and had received a diagnosis of rheumatoid arthritis at the Arthritis & Rheumatic Diseases Treatment Centre in Nepal. After 10 treatments of acupuncture, in conjunction with herbal medicine, she… Read more:

Sequelae of Osteoarticular Tuberculosis

Sequelae of Osteoarticular Tuberculosis
A 58-year-old man, of rural Nepal, presents with left hip pain, reduced strength and mobility in his left hip and significant muscle wasting in his left leg. After 30 electro-acupuncture treatments over 6 weeks and Traditional Chinese Medicine, the patient reports a significant decrease in his… Read more:

Spastic Quadriplegic Cerebral Palsy

Spastic Quadriplegic Cerebral Palsy
Severely malnourished and non-ambulatory 11-year-old female presents with increased tone and spasticity in all extremities, frequent seizures, and currently requiring assist for all mobility. Patient was seen for a total of 10 physical therapy treatments with significant improvement in passive… Read more:

Spinal Trauma Sequelae with Osteoarthritis of Right Knee

60-year-old female presents with spinal trauma sequelae consisting of constant mid- to high grade pain and restricted flexion of the spine. In conjunction with the treatment for the spinal pain, the patient is treated for pain of the right knee with mid-grade pain and global swelling of the area… Read more:

Stroke Sequela

Stroke Sequela
50-year-old male presents with post-stroke sequelae symptoms manifesting as severe right-sided paralysis. After 10 treatments starting in September 2012, the patient exhibited improvement in his condition and fair measurable progress. The patient had a stroke in November 2011. He received… Read more:

Typhoid Fever Induced Paralysis

Typhoid Fever Induced Paralysis
32-year-old female presents with left-sided paralysis of upper and lower limbs. At age 12, the patient suffered from a fever due to Typhoid that caused convulsions and coma. After a 20-year history of paralysis, this patient recovered most of her upper limb function and some lower limb function… Read more:

Ulcerative Colitis

Ulcerative Colitis
70-year-old female patient presents with urgent, frequent diarrhea. No enteropathogenic organisms are present, however blood is found in the stool. Allopathic care has been unable to resolve her symptoms. After 17 acupuncture treatments and the use of Chinese herbal medicine, the patient has… Read more:

Compendium of Clinical Case Studies

clinical case studies

Download our entire collection of clinical case studies.

View Flipbook

Download PDF

Subscribe to Our Blog

Enter your email address to receive news and updates from our clinic in Nepal

Featured Case Study

  • Ankylosing Spondylitis Ankylosing Spondylitis
    Lindsey A Thompson MAcOM EAMP LAc
    February 2013
    OVERVIEW

    25-year-old male presents with low back and sacroiliac...

  • 1
  • 2
  • 3
  • 4

Your Donations Help

In addition to volunteering their time and energy, our practitioners are required to raise the money it takes to support their efforts at our clinic. Please consider helping them by making a tax deductible donation in their name.

Donate Now