Clinical Case StudiesReal Patients, Real Medicine

Allissa Keane RAc
November 2013

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, especially immediately after treatments, and an overall improvement in her well-being. Due to the severity of her condition, permanent change in her spasming is unlikely, however a 20% reduction in spasms was observed during the course of treatments.


Acupuncture Case Study38-year-old patient presents with involuntary spasming of her right and left hands, shoulders, head, feet and hips. Spasming started 4 years ago in her hands and feet exclusively. The spasming rapidly progressed to the rest of her body within a year and a half. When the condition started, she was taken to the hospital in Pokhara, Nepal where she received two CT scans and a panel of blood tests. The patient was then referred to a different hospital in Kathmandu where she began working with a neurologist. She was given an allopathic medication that made her sleep the majority of the day, only waking twice to eat. Over the course of 6 months, the patient visited the neurologist 3 times before discontinuing appointments. After those treatments, her family noticed that the spasming progressed to her head.

At home, family members report that she becomes easily angered and frustrated, especially around her delayed speech. She also experiences poor memory, concentration, and is unable to handle tasks around the home. Patient expresses feelings of depression and anxiety around her worsening condition. She reports poor sleep due to the involuntary movement. Lastly, she complains of her skin being dry and itchy on her legs, arms, back and chest.

Other than the involuntary spasming and body itching, she does not have any significant symptoms as evaluated by a thorough review of systems.

The patient does not have any medical records available. Her understanding of her condition is limited to “a neurological problem.” Her mother and sister also experience the same condition in varying severities.


Patient presents with bilateral, rapidly spasming movements of her hands, shoulders, head, feet and legs. While she is standing, the right side of her body swings from posterior to anterior. Her hips pop forward causing her back to arch. Her head moves in a fluid, circular motion towards the left. Left hand fingers have a rapid flexion and extension of the third, fourth, and fifth fingers. The thumb contracts over each of those fingers approximately 62 times per minute. The left hand is noticeably worse than the right. The patient’s right foot spasms from medial to lateral at a rate of 18 spasms per minute and with a delay of 1 to 2 seconds between spasms. While in the prone position, her right shoulder contracts backwards roughly 34 times per minute. When a response is required from the patient, her speech is delayed for 3 to 5 seconds, appearing difficult for her to formulate sentences. It is common for her responses to be short and minimal, and often times questions are not answered correctly compared to the answers given by her sister-in-law. When asked about the onset of her condition and any other related questions requiring a chronological sequencing of events, there seems to be confusion and lack of accuracy in her responses.

When asked to focus on controlling the spasms in her left hand, it is observed that they become worse in amplitude and frequency. Patient’s eyes are unfocused and often diverted to the right. She has some difficulty making eye contact while in conversation. Eye tracking test is done and shows an inability to follow the finger without movement of her head. The majority of the skin on her body is dry and has raised eczema-like bumps.

The tongue is pale, scalloped on both sides, cracks running horizontally in the centre, and is wet.


DX: Central Nervous System Degenerative Disorder

Due to the lack of medical records, it is important that there be a general discussion of possible neurological conditions that the patient may have in order to distinguish a potential diagnosis. Because her condition might potentially be in the earlier stages, diseases such as amyotrophic lateral sclerosis, Parkinson's, multiple sclerosis and Huntington's must be considered.

It is unlikely that the patient has Parkinson's disease. Parkinson's patients have slow and stiff body movements, rigidity of muscles, impaired balance, often a stooped posture and gait shuffle. Parkinson's patients may also experience non-motor symptoms before full-onset including drooling, change in taste/smell, choking and swallowing difficulties and cognitive impairment (Parkinson's Society of Canada). The patient has not reported any of the aforementioned non-motor signs when her condition began 4 years prior.

Amyotrophic Lateral Sclerosis (ALS) is also unlikely. Patients with ALS often present with signs and symptoms that are common in a wide variety of other neurological disorders, especially in the early stages. However, similar to Parkinson's, the presentation generally includes tightness, stiffness, weakness and muscular cramping. This patient presents with more choreal (spastic) movements than typically seen in an ALS or Parkinson’s patient.

This patient could be experiencing a form of Multiple Sclerosis (MS) called Primary-Progressive MS (PPMS). PPMS is characterized by a steady worsening of neurologic functioning without any distinct relapses or periods of remission ( The patient’s symptoms, primarily the spasming, started 4 years ago and has gradually worsened to the extent at which they are now. Other common signs of MS include urinary incontinence, constipation, extreme fatigue, pain, numbness and tingling. Because the criteria for properly diagnosing MS is so broad, and the degrees of symptoms vary, it is difficult to rule out with proper imaging. However, it appears that MS is a less likely diagnosis because the patient does not experience some of the more common signs such as extreme fatigue and pain-associated symptoms.

Huntington's Disease (HD) is the strongest candidate for a diagnosis. It is important to note that in early stages of HD, there are subtle signs of physical deterioration, such as involuntary movements beginning in the hands and feet, difficulty in walking, and an increase in difficulty performing daily activities (ie. household chores). The patient reports that the spasming started in her hands and feet, and over time, gradually moved up to her head and shoulders. Her family has reported changes over time in her cognitive abilities to recall information, and confusion when it comes to organizing routine matters. The patient also reports substantial feelings of depression and anxiety, which are consistent with an HD presentation. The most compelling evidence for a HD diagnosis would be the chorealike movements. Unlike the jerky, rhythmic movements of ALS or Parkinson's, Huntington's patients experience uncontrollable, fluid movements, often with a puppet-like gait. This is consistent with the patient’s presentation.

Further neurological testing would need to be done for a complete and accurate diagnosis.

TCM DX: External attack of wind on the channels and collaterals

Due to the fact that other than the obvious tremors, there are no signs of an underlying organ pathology, either excess or deficiency, the source of the wind must be external.


Poor. Due to the onset of this condition in middle age, it is unlikely that the patient will experience full reduction of the spasming. In fact, if a diagnosis of Huntington’s Disease is correct, it is expected that the condition will progress in spite of treatment. The goal of treating the patient is to aid in overall well-being, potentially slowing the progress of the degeneration of the central nervous system, and subduing the spasming. This can be accomplished through the use of acupuncture, Chinese herbs and patient counseling. Focusing on memory and speech improvement will give the patient a greater sense of independence. Referral to an appropriate hospital that will be able to provide a complete neurological examination will further the prognosis and outcome of this case..

Initial plan:

Due to the severity of the patients condition, daily acupuncture treatments are prescribed. Fortunately, the patient lives 15 minutes away from the clinic, and is able to walk unassisted to the clinic for treatment.

Overall, initial focus is to expel wind in the whole body to reduce the spasming, while simultaneously nourishing constitutional blood and qi. Typical acupuncture treatment includes combinations of SP10, SP6, ST36, LR8, LR3, RN4, RN6, LI4, DU19, GB 20.

Patient is counseled on the prognosis of her condition, the unlikelihood of a total reduction in the spasming, as well as the positive effects that acupuncture can have on her overall well-being and daily life.

The patients signature and drawings of circles and squares are recorded before and after acupuncture treatments to measure if there is a reduction, or stabilization, in her movements.


After 3 treatments, it appeared that when direct attention was focused on her during needling, her movements became more dramatic and active. A different approach was taken by placing her prone, and using the the Hua Tou Jia Ji (HTJJ) points to help sedate her during treatment. In addition to HTJJ, the back (shu) transporting points of the Heart, Pericardium, Liver, Blood, Spleen, Stomach and Kidney were needled to tonify those organ’s qi and to nourish blood.

After a period of treatments, patient reported that she experienced a feeling of 'lightness' during and after treatments. While the needles were retained, there was a significant difference observed in the amplitude of spasming and movement. The movements appeared to be smaller and smoother, and there was a general calmness about her body (see video # 2). There was less of a delay before she would start to speak. She sounded more clear and less interrupted. She was sleeping better at night and waking less frequently. The patient was asked to draw circles and spirals before and after treatment. There was a noticeable difference in the after-treatment drawing. It appeared that her hand was able to steady the pen and press more firmly on the paper (see visual). The drawing process was done every 2 or 3 treatments. She requested that this be done every time, and seemed to look forward to seeing if there had been progress made. Over the course of 13 treatments, her overall demeanor had improved. She came to the clinic with a smile on her face, and each time, more fully engaged in conversation with the practitioner. Family reported that after a period of time, they noticed that she was less frustrated in her speech, and in performing tasks around the home.

Please see links below for recorded evidence of the before-and-after, with needles retained for roughly 15 minutes.



The challenge in this case was the lack of allopathic diagnosis and medical records, coupled with the rapid progression of the patient’s condition over the last 4 years. However, it was clear that a significant difference was made in her life through the use of acupuncture and the building of a therapeutic relationship. The need for education about her condition could not be stressed enough in helping her understand and prepare for the potential of it worsening in severity. Family education is also important, at least in part for the purpose of patient support, so that they have an understanding of the severity and progression of her disease. In considering this patient’s case, perhaps the most important role for a practitioner would be to help the family research hospitals and neurological specialists and procedures that may be beneficial for the patient.

  • 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

    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

    Read More
  • 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

    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

    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

    Read More
  • 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

    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

    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

    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

    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

    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

    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

    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

    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

    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.

    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

    Read More
  • 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

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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,

    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

    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.

    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,

    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

    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

    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

    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,

    Read More
  • 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

    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

    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

    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

    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).

    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

    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

    Read More
  • Sequelae of Osteoarticular Tuberculosis

    Sequelae of Osteoarticular Tuberculosis

    Rachael Haley BAppSci (TCM)December 2014 OVERVIEW A 58-year-old man, of rural Nepal, presents with left hip pain, reduced strength and mobility in his left hip and

    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 s

    Read More
  • Spinal Trauma Sequelae with Osteoarthritis of Right Knee

    60-year-old female presents with spinal trauma sequela consisting of constant mid- to high grade pain and restricted flexion of the spine. In conjunction with the treatment

    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

    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

    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

    Read More
  • 1

Compendium of Clinical Case Studies

clinical case studies

Download our entire collection of clinical case studies.

View FlipbookDownload PDF

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.


Support our work

Donate Volunteer Get in Touch

Support Us