J. Acupunct. Tuina. Sci. 2010, 8 (1): 55-57 DOI: 10.

1007/s11726-010-0055-2

Case Report

Case Report of Three Patients with Wei-flaccidity Syndrome Cured by Acupuncture-moxibustion Therapy
WANG Jing-xi () Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, P. R. China

; - Key Words Brachial Plexus Neuropathies; Peroneal Neuropathies; Guillain-Barre SyndromeAcupuncture-moxibustion Therapy; Medical Records CLC NumberR246.6 Document CodeB Acupuncture-moxibustion therapy has an advantage in treating Wei-flaccidity syndrome resulted from peripheral nerve injuries. We have adopted acupuncture and moxibustion to treat 3 patients with Wei-flaccidity syndrome in clinical practice and now reports as follows. Diagnosis of traditional Chinese medicine: Wei-flaccidity syndrome (qi stagnation due to cold retention and blockage of meridians). Patterns identification: After a long-time driving in an air conditioned car seated in a fixed posture combined with contracting cold, the patients circulation became blocked in the blood vessels and meridians, leading to dystrophy in the tendons and muscles, followed by Wei-flaccidity syndrome in the upper arm. Treatment principle: To dispel cold and activate collaterals. Treatment: Zhongwan (CV 12) and Jiquan (HT 1), Tiaokou (ST 38) on the affected side were selected as the major acupoints. Fengchi (GB 20), Quchi (LI 11), Neiguan (PC 6), Wangu (SI 4), Baxie (Ex-UE 9) were the adjunct points. Zhongwan (CV 12) was inserted with a filiform needle of 50 mm in length downward by an angle of 25 degrees with the skin, and moxibustion was carried out at the same time. Jiquan (HT 1) was inserted with a filiform needle of 50 mm, taking a criterion of a needling sensation radiating to the wrist. Reducing manipulation by twirling needle was performed to Tiaokou (ST 38), Fengchi (GB 20), Quchi (LI 11), Neiguan (PC 6), Wangu (SI 4) and Baxie (Ex-UE 9). 5 treatments were given in every week with each treatment lasting for about 30 min. After 2-month treatment, the patient had completely restored the function of his upper arm. The symptoms such as aversion to cold and numbness disappeared. The muscle strength was

1 Cases
1.1 Brachial plexus palsy A patient, male, 56 years old, came for treatment on Sept 15, 2007 for the first time. Chief complaint: Weakness in the right upper arm and dysfunction in the fingers for 2 d. History of present illness: On Sept 13, 2007, after a long-time driving an air conditioned car, it was noted that the right upper arm had lost strength and the fingers could not grasp and hold. The symptoms got aggravated on the next day as the arm had difficulty in rising and the fingers could not move, accompanied by aversion to cold and numbness within the right upper arm. The neurogenic impairment was identified by electromyography. Physical examination: Drop-wrist, the muscle strength grading 3 in the right shoulder, grading 2 in the elbow and grading 0 in wrist and fingers, thin, white tongue coating, and a deep pulse. Diagnosis of modern medicine: Brachial plexus palsy on the right side.

Author: WANG Jing-xi (1953- ), male, chief physician

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 55-57

brought back to grade 5 and the fine motor skills of fingers were recovered. During the 2 years follow-up, no difference was noted between the function of the affected arm and the normal one, and the patient could work normally. 1.2 Common peroneal nerve palsy A patient, male, 41 years old, came to the author on Dec 1, 2008 for the first time. Chief complaint: Lack of strength in the right ankle, toes having difficulty in dorsiflexion accompanied by numbness in the right calf for 2 months. History of present illness: Two weeks ago, weakness in the right ankle and toes was identified in the early morning when the patient got up, slight numbness in the lower limbs was also noted and walking became troublesome. Neurogenic injury was revealed by electromyogram. The patient did not respond well to the treatment in other hospitals (the detailed treatment procedure was not known), then the patient changed to come to the author. Physical examination: Steppage gait, right foot-drop, the muscle strength of the right ankle grading 3 and that of the right toes grading 2, reduced pain sense in the posterior calf, thin and white tongue coating and wiry pulse. Diagnosis of modern medicine: Right common peroneal nerve palsy. Diagnosis of traditional Chinese medicine: Wei-flaccidity syndrome (blockage of meridians and malnourishment of tendons and muscles). Patterns identification: The onset was due to malnourishment of tendons and muscles brought by contracting cold at night and blood-qi stagnation. Treatment principle: Dispelling cold to unblock the collaterals; cultivating blood, tendons and muscles. Treatment: Zhongwan (CV 12) and bilateral Zusanli (ST 36) were selected as the major points, and Futu (ST 32), Yanglingquan (GB 34), Shangjuxu (ST 37), Jiexi (ST 41), Taixi (KI 3), Kunlun (BL 60) and Taibai (SP 3) on the affected side of the body were as the assistant points[1]. Zhongwan (CV 12) was inserted with a filiform needle of 50 mm in length downward by an angle of 25with the skin. The moderate reinforcing and reducing manipulation by twirling needles was used

for the rest of the acupoints. Zusanli (ST 36) and Jiexi (ST 41) on the affected side of the body were stimulated with electroacupuncture. Five treatments were given in each week with each treatment lasting for about 30 min. Meanwhile, Futu (ST 32), Zusanli (ST 36), Shangjvxu (ST 37), and Jiexi (ST 41) were punctured by warming needles, which was carried out only once a week. After 2 months treatment, the patient had restored the normal muscle strength, function and sense of pain. He could work effectively during the 6-months follow-up. 1.3 Guillain-Barre syndrome A patient: female, 62 years old, came to the author on June 6, 2007 for the first visit. Chief complaint: Lack of strength in bilateral lower limbs, trouble with walking for 2 months. History of present illness: The patient went to hospital for fever, sore throat and weakness in the lower limbs, and then was admitted for GuillainBarre syndrome. He had been sent to ICU due to apnea and then discharged afterwards when he got better, though he still could not walk or stand up on his own, with reduced grip strength, numbness plus pain in the four limbs, and had a low voice. Physical examination: The muscle strength graded 4 in the bilateral upper limbs, graded 3 in the bilateral knee joints, graded 2 in the ankle and graded 1 in the toes, thin white tongue coating and thin slippery pulse. Diagnosis of modern medicine: Gruillain-Barre syndrome. Diagnosis of traditional Chinese medicine: Wei-flaccidity syndrome (spleen losing its function of transportation and transformation due to deficiency, dystrophy in tendons and muscles). Patterns identification: The patient had been suffering from spleen deficiency, insufficient qi and blood, and then was affected by heat and dryness accumulating in the lung, and dystrophy in the tendons and muscles due to contracting exogenous pathogenic factors. Although the exogenous pathogenic factors were deprived during the stay in the hospital, insufficient healthy qi was left, thus qi and blood were not able to cultivate the tendons and muscles, leading to blocked meridians and collaterals and paralysis in the limbs.

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Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010

J. Acupunct. Tuina. Sci. 2010, 8 (1): 55-57

Treatment principle: To tonify qi and activate the spleen, meridians and collaterals. Treatment: Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), Neiguan (PC 6), Zusanli (ST 36), and Sanyinjiao (SP 6) were selected as the major points, and Shangjuxu (ST 37), Xiajvxu (ST 39), Jiexi (ST 41), Taichong (LR 3) were assistant points. Reinforcing manipulation by twirling needles were used for the major points, combined with moxibustion, 5 times a week and each treatment lasting for about 30 min. Zusanli (ST 36) and the assistant points were punctured with warming needles once a week. After 3 months treatment, the patient found no more discomfort left and the muscle strength was recovered to grade 5. He was still leading a normal life at the time of his one year follow-up.

2 Discussion
The Wei-flaccidity syndrome due to injuries of peripheral nerve has a good response to acupuncture and moxibustion therapy, even acupuncture alone may achieve good therapeutic effect in some cases, though a great number of patients need combined with warming needles or moxibustion. The three-unblocking therapy of acupuncture[2] developed by Professor HE Pu-ren is one of the efficient treatments against Wei-flaccidity syndrome. When treating Wei-flaccidity syndrome, Prof. HE always pays great attention to syndrome and meridian identification, and adopts acupuncture, moxibustion or warming needle therapy by differentiating the features of the diseases such as deficiency, excess, cold and heat, also combined with the analysis of the location of the onset of the disease. Acupoints Zhongwan (CV 12), Tiaokou (ST 38) and Zusanli (ST 36) are majorly used. Among which, Zhongwan (CV 12) is usually

inserted with a filiform needle of 50-75 mm in length by an angle of 25with the skin. The points of Yangming Meridian are often treated by warming needle therapy. Moxibustion is added for qi or yang deficiency. Doctor WANG Le-ting is an expert in acupuncture and moxibustion, whose ten-acupoints compatibility therapy, including Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), bilateral Neiguan (PC 6), Zusanli (ST 36) and Sanyinjiao (SP 6), has a good therapeutic effect for treating Wei-flaccidity syndrome of qi-blood deficiency, mainly used in limbs paralysis. It will have a marked increase in therapeutic effect if it is combined with the theory and method of three unblocking therapy. The common treatment principle for Weiflaccidity syndrome is to use the acupoints of Yangming Meridian exclusively[3]. However, to obtain satisfactory therapeutic effect in treating Wei-flaccidity syndrome, it still requires syndrome and meridian identification together with the analysis of its etiological and pathogenic factors when selecting meridians and acupoints.

References
[1] FU Xiao-hong, ZHANG Qiao-ling. Observations on the Efficacy of HEs Three-unblocking Therapy plus Point Injection in Treating Migraine. Shanghai Journal of Acupuncture and Moxibustion, 2008, 27(11): 12-13. [2] CHENG Xiao-fang, JIANG Jin-ping, PANG Si-si, et al. Clinical Observation of Electroacupuncture and Acupoint Injection in Treating Common Fibular Nerve Paralysis. Journal of Acupuncture and Tuina Science, 2008, 6(3): 169-172. [3] LENG Mei-zhen. Treatment of 20 Cases of Wei-flaccidity Syndrome with Acupuncture-moxibustion. Shanghai Journal of Acupuncture and Moxibustion, 2003, 22(10): 31. Translator: HONG Jue () Received Date: October 13, 2009

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