WorldJournal ofAcupuncture-Moxibustion(WJAM)ELSEVIER Vol. 24, No.1, 30th Mar. 2014

Medical Record

A case of lymphedema in both lower extremities

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YANG Zong-bao (tn~fH*-), ZHAN Ru-yu (~:Mi.I..)

·65 •

Guoyitang Out-patient Department, Medical College ofXiamen University, Xiamen 361005, Fujian Province,China ()JH1*~~~~~~~, ;fflHllJH1361005, 9='~)

ARTICLE INFO

First author: YANGZong-bao (1973-), male,

associate professor.

Research field: study on function and

mechanism of acupuncture.

E-mail:yangzb@xmu.edu.cn

Accepted on August 9, 2013

ABSTRACT

Patient suffering from lymphedema in both lower extremities was treated,acupuncture was carried out at Zh6ngwan (~.Im CV 12), Shulfen (7l<7t CV9), 5huTDao (7l<m 5T 28), ZusanlT UE.-=::..m. 5T 36), Yinllngquan (13Jj~~ 5P 9),5anyi"njiao (-=::.I3Jj3( 5P 6), Yanglfngquan (j)E~~ GB 34), Talchong (:~iJ=P LR3) and Taixl (jzm1C KI 3), and local TDP irradiation was also carried out toimprove local blood circulation and promote lymph fluid backflow, and thuseffectively alleviate lymphedema in both lower extremities. The treatmentcourses were short and painless, and no adverse effect was detected.

KEY WORDS: lymphedema in both lower extremities; acupuncture therapy;TDP irradiation

Patient, female, an undergraduate student,17 years old. She visited to our hospital for helpon April 20, 2013. Her chief complaints were asfollowed: repeated lymphedema in both lowerextremities for more than two years. Previous medicalrecords: pruritus was detected in her both toes whenshe was grade three in a junior middle school fiveyears ago, particularly in dorso ventral boundary ofthe feet. Prunosus papules were occasionally found,the patient had to scratch them and yellow fluid canbe detected after they were disrupted. Therefore, thepatient turned to a local county hospital for treatments,she was diagnosed as fungal infection in feet and thesymptoms were improved after she used Miconazolecream externally. The patient began to suffer fromlymphedema in both lower extremities after she cameto Xiamen University two years ago, depression couldbe detected after pressing and recovered after severalminutes. The swelling symptoms were particularlyobvious after walking at daytime, the patient felt skintenseness in her both lower extremities and senseof pressure at squatting, and she occasionally feltsoreness and distention in her both lower extremities.She had ever turned out the Yanwu Division ofZhongshan Hospital of Xiamen for examinations onrenal functions and hepatic functions, B ultrasound

examinations and other examinations, no abnormalitywas detected. She was diagnosed as lymphedema inboth lower extremities, and then she was subjected toelevation ofher diseased lower extremities, anti-fungaltreatments, massage and other treatments, and thesymptoms were not significantlyimproved. The patientthus turned to our division for help on April 20, 2013,lymphedema in both lower extremities was detected,she complained about skin tenseness in her both lowerextremities and sense of pressure at squatting, andshe occasionally felt soreness and distention in herboth lower extremities, she was depressed, her dietswere normal, she felt distention in her gastric cavityoccasionally, loose stool and normal urine. It wasfound in the physical examinations: depression can bedetected when the both low extremities were pressedand then it recovered after about one minute, the skincolor in her legs was normal, skin damages can bedetected between her toes, secretion was not detected,her skin temperature was normal, and the foot arteriesat both sides can be detected. Her tongue was pink,imprints of the teeth can be found at the edge, thelingual fur was thin and white, the right bar pulseswere soggy. Her father had previous medical recordsfor beriberi.

·66·WorldJournal ofAcupuncture-Moxibustion (WJAM)Vol. 24, No.1, 30th Mar. 2014 ELSEVIER

Diagnosis in western medicine: lymphedemain both lower extremities; diagnosis in TCM: wetberiberi (damp abundance due to spleen deficiency).Treatments: acupuncture therapy in combinationwith thermal design power (TDP). The acupointswere selected as followed: Zhongwan (~H* CV12), Shulfen (7l<7t CV 9), Shuffrao (7l<m: ST 28),Zusanl] (JE~.m ST 36), Yinlingquan (~~jRsp 9),SiinyInjiiio (~~3t: SP 6), Yanqlinqquan (~S~jR GB34), Taichong (*ilF LR 3) and TaixI (*~1\ KI 3).Manipulation: the selected acupoints were sterilized asroutine by using alcohol cotton balls, the acupunctureneedles (the diameter was 0.28 mm and the length was25 or 40 mm) were rapidly needled into the acupointsby bouncing-pin method, the mild reinforcing-reducingmethod was used for CV 12, rotate-twirl reinforcingand lift-thrust reinforcing methods were used forST 36, SP 6 and KI 3, rotate-twirl reducing methodwas used for CV 9 and ST 28, rotate-twirl reducingand lift-thrust reducing methods were used for SP 9,GB 34 and LR 3, and her both low extremities wereirradiated with TDP. Needling manipulation wascarried out once for every 10 minutes during thisprocedure, and the needles were withdrawn afterretention for 30 minutes, and then the treatments wereterminated. The treatments were carried out once forevery two days, the symptom of lymphedema in bothlower extremities was significantly alleviated after thetreatments for three times, no obvious depression wasdetected after pressing, the lymphedema in both lowerextremities completely disappeared after the treatmentsfor five times, tenseness in skin was no longerdetected, the patient felt soreness in gastrocnemiusmuscles in her both lower extremities at squatting,the lymphedema in both lower extremities and thesoreness completely disappeared after the treatmentsfor eight times, no obvious discomfort was detected,and the lymphedema in both lower extremities washealed.

Notes: Lymphedema cases are frequently seenin extremities, among which lymphedema in lowerextremities are the most frequently seen [11• Twomethods are mainly used for treating lymphedemain clinic: surgical methods and non-surgicalmethods. Non-surgical methods include heating andbandage, tie-up, local high temperature and nursingmanuduction and others [2]. Surgical methods includeexcision and skin grafting, skin flap burying andothers, but the practical operations are difficult, therisks are high, the operations may readily lead toscars, lymph leakage and other further problems, andthe therapeutic efficacy of surgical methods and non­surgical methods is not satisfactoryf", It is believed

in TCM that lymphedema may be induced by theinfection of wind, cold, dampness, heat and otherexogenous evils in the people showing decreasedfunctions in spleen-stomach transportation-metabolismin transformation of body fluid, liver controllingfree flow of qi and the kidney controlling watermetabolism and other functions, or qi stagnation,stagnant blood and accumulation of other pathologicalproducts, further aggravation in the accumulation dueto some other causes, which lead to disturbance intransformation ofbody fluid. The patient in the presentstudy was subjected to acupuncture therapy in CV12, CV 9, ST 28, ST 36, SP 9, SP 6, GB 34, LR 3 andKI 3 to treat lymphedema in her lower extremities, thetreatment course was short, the therapeutic efficacywas rapid and significant, the patient was painless anddid not suffer from adverse effects. CV 12 and CV 9are both major acupoints for conception vessels ineight extra meridians, whose function is strengtheningspleen, eliminating dampness, conducting body fluidsand regulating transformation of body fluids; ST 28and ST 36 are both major acupoints of foot-yangmingstomach meridian, which can regulate spleen andstomach, supplement the center and boost qi, transmitand distribute the fluids; SP 9 is the he-sea point ofspleen meridian, which can harmonize circulation ofqi and blood, qi can impel body fluid to flow and thendistribute fluids; SP 6 is the converging point of spleenmeridian, liver meridian and kidney meridian in feet,compatibility of SP 6 and CV 9 can eliminate edema;GB 34 is the he-sea point of foot-taiyang gallbladdermeridian, LR 3 is one of the major acupoints in foot­jueyin liver meridian, liver controls dispersion andregulates functional activities of qi, liver meridian andgallbladder meridian are exterior and interior related,they can synergistically dredge body fluids; KI 3 is oneof the major acupoints in foot-shaoyin meridian, thekidney controls water metabolism and thus puncture atKI 3 can promote and regulate the functions of otherviscera in transporting transforming and distributingbody fluids. Combination of these acupoints canpromote diuresis and expel dampness, activate bloodcirculation to dissipate blood stasis, and dredge themeridian. Local TDP irradiation can accelerate therepairing of micro-circulation system, improve localblood circulation, promote lymph fluid backstreamingand alleviate lymphedema in lower extremities.

REFERENCES

[1] Liu ZY. Lymphatology (Chin). Beijing: China MedicalScience Press; 2000: 240.

[2] Zhang N, Zhang Y, Cheng ZX, Liu M. Effectiveness ofChinese medicine in combination with digital enhancedpressure treating device in the treatment of lymphedema

WorldJournal ofAcupuncture-Moxibustion (WJAM)ELSEVIER Vol. 24, No.1, 30th Mar. 2014

oflower limb. J Nurs Sci (Chin) 2004; 19(23): 30-31.[3] Zhang DS. Diagnosis and treatment of lymphedema of

extremities. J Tissue Eng Reconstr Surg (Chin) 2006;

ABSTRACT IN CHINE SE

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2(5): 243.

(Editor: HANYan-jing Translator: ZHOU Dong-sheng)

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people may fall asleep; when yang qi transforms fromstatic into active, people may be conscious, and it isthe consequence of natural and regular transformationof yin qi and yang qi. Therefore, puncture atstimulation points on head can regulate qi and bloodall over the body by the transduction of meridians inorder to regulate yin - yang activities of viscera, adjustyin - yang balance of daytime and night, introduceyin into yang, and achieve the efficacy for treating. .msomma.

Moreover, with the persistent efforts ofacupuncture physicians in the foreign-aid medicalteams in Uganda in the past 30 years, acupuncturetherapy has been utilized in diagnosis and treatmentson numerous difficult miscellaneous diseases for localresidents and is highly favored due to its therapeuticefficacy. Therefore, the therapeutic efficacy for thetreatment on patients with insomnia in Uganda issignificant, convenient and liable to perform; patientsbelieve in the therapeutic efficacy and it deserves to befurther generalized.

ABSTRACT IN CHINE SE

REFERENCES

[1] Chinese Medical Association, Chinese Society ofPsychiatry. Chinese Classification and Diagnostic Criteriaof Mental Disorder (CCMD-3). 3rd edition (Chin). Jinan:Shandong Science and Technology Press; 2001: 118-119.

[2] Yang ZM. Manipulation of acupuncture and moxibustion(Chin). Shanghai: Shanghai Science and TechnologyPress, 1996: 108.

[3] Ministry of Health of the People's Republic of China.Guideline for the Clinical Research of Chinese Medicineand New Drugs (Chin). Beijing: the People's MedicalPublishing House; 1993: 186-187.

[4] Liu P, Lan SZ. Clinical examinations on insomnia andoptimal therapeutic regimen (Chin). Tianjin: TianjinScience and Technology Press; 2002: 25.

[5] Li N, Wu B, Wang CWo Systemic evaluations onrandomized controlled trials on treatments on insomnia byusing acupuncture therapy. Chin Acup-Mox (Chin) 2005;25(1): 7-10.

(Editor: LID Wan-ning Translator: ZHOU Dong-sheng)

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