Acupuncture for Pain and Swelling in Ankles and Feet

Chief Complaint: pain and swelling in ankle and feet, alcohol abuse
Medical History: Patient: 53 year old female
Occupation: art student
History: family history of alcoholism, pain in legs since 1978
Current presentation: Patient has stiffness and swelling in her feet and ankles making ambulation difficult. The pain is 8-9 on a scale of 0-10 with deep, heavy, sharp quality that is worse at night. She can recall no injury or precipitating factors. Feet are cool to touch, soft, pale with non-pitting edema. The patient smokes and drinks six beers a night. She eats cold foods for lunch.
Symptoms: Patient is stressed with school work, and has a sensation of something in her throat. She has poor sleep and reads to fall asleep. Appetite is poor with an energy drop at 3pm. She has fatigue and states that legs bruise and bleed easily. Other symptoms are dizziness, ringing in the ears and eye strain with blurred vision. Patient wears glasses for reading. She is up twice a night to void and has loose stools which change to hard when anxious. Her back and knees are sore and weak and hips are stiff.
Questioning exam: low back and knee pain, ankle swelling that is pale and cool, tinnitus and up twice a night to void
painful, cool ankles that is deep and heavy.
Sharp feeling may be from cold causing some blood stasis as well
loose bowel movement, poor appetite, afternoon energy drop and easy bruising
curdy center of the tongue coating and slippery R guan pulse
plum-pit syndrome with feelings of stress.
Based on age, early menopause, smoking and alcohol habit, blurred vision and difficulty falling asleep this patient may also have an underlying Liver/Kidney yin deficiency but this was not viewed as significant at this time and was not addressed.
Pulse exam: Pulse: L-thin, weak R- slippery guan position, weak cun, weak, deep in chi
Tongue exam: pale, pink, purple, puffy with central crack to tip with thick, curdy center coat
stiffness and swelling in her feet. feet cool and pale
OM Diagnosis: Ki yang deficiency, cold-damp bi in ankles/feet
Spleen Qi deficiency with damp
Liver Qi and phlegm stagnation
Signs and symptoms supporting diagnosis:
Treatment Principle: tonify Kidney yang. Drain damp. Alleviate pain
Tonify Spleen Warm Qi. Move Liver Qi. Resolve phlegm accumulation
Point Prescription: tonify K7, K3 plus moxa to warm and tonify Kidney yang
tonify Sp6, St36 to promote Spleen Qi
sedate Sp9, St41(local point) to drain damp
even method for Liv3/Li4 to calm and promote movement of Liv qi
No herbal formula was given. With reduction in alcohol intake this will be an option
Patient was instructed to warm and dry feet after showering with a hair drier.
The benefit of cooked foods on digestion was explained and she agreed to cook lunches.
Visit 2: The patient returned the following week with reports of no more pain in her feet and swelling had diminished. She had reduced her alcohol intake to 3 beers a night. Sleep had improved though she woke twice to void. Low back and knee ache continued. Tongue was unchanged though a red tip was noted. Pulse was wiry and deep and weak in chi positions.
Diagnosis: unchanged though definite positive response to treatment.
Treatment: same body points were used along with moxa. NADA protocol was added using Sympathetic, Shenmen, Kidney, Lung, Liver and alcohol points in both ears.
Food therapy: Patient likes liver and dandelion greens which are foods to help strengthen and clear the Liver. She agrees to add these to her diet.
Visit 3: Swelling resolved and increased ease with ambulation stating she had not realized how bad her legs felt until noticing they felt better. This week she had experienced cold moving up and then heat moving down over her. Mouth was dry with thirst and urine had had a strong odor for a couple of days after the last treatment. She reported having had a lot of gas and bowels were pasty to normal.
Pulse: L- superficial position, slippery, slightly rapid thin weak deep in chi position
Tongue: moist, pale with curdy back, teethmarks and slight red edges
Diagnosis: Kidney yin and yang deficiency
Damp-heat in middle jiao from alcohol
Treatment: Nourish Kidney yin and yang. Drain damp-heat. NADA protocol
Tonify K3 for Kidney yin, K7 for yang, Reduce Sp6, Sp9, St40 to drain damp, Liv3/Li4
Herbal Formula: Silymarin (milk thistle was suggested as supplement to cleanse the liver)
Liver DTX was ordered
Chai Hu-moves liver qi
Huang Qin- clears heat from the liver channel
Hu Zhang- clears damp-heat
Ge Hua-
Bai Shao-nourishes liver blood
Yin Chen Hao- clears damp-heat from the liver
Zhi Zi- drains heat from the 3 jiaos
Da Huang- drains damp-heat through the stool
Wu Wei Zi- improves Liver function
Ma Bian Cao
Fu Ling-drains damp. Strengthens the Spleen
Yu Jin-moves stagnant Liver qi
Qing Pi-moves stagnant Liver qi
80% Silymarin-cleanse the Liver
Pu Tao Zi-antioxidant
Results: This patient continues to have weekly treatments. Back shu points have been used for the past two weeks for chief complaint of low back pain. Energy level is much better and she had stopped smoking. However, school proved to be quite stressful this past week and her smoking and alcohol intake increased. The NADA protocol is used each week to support her goals.