Acupuncture in combination with Chinese Herbal formulas Can Help Scleroderma accompanied by Raynaud’s Disease

Case No. 1:
A 68-year-old female was admitted to the clinic for help with a sixteen year history of scleroderma accompanied by Raynaud’s syndrome (disease). She was suffering from hardening and tightness of the limbs, face and abdomen; coldness, and a purplish color of the four limbs. The symptoms worsened when the weather became cold, and dermatological damage showed on the tips of her fingers.

Recently she has experienced increased coldness, a purplish coloration, hardening and tightness of the hands, wrists, fingers and feet – symptoms which get worse when the weather starts getting cold. She has also suffered from painful sensations on the hands and fingers, but lowered sensation on the tips of fingers; ulcers on the tips of fingers which often appear and disappear from time to time; necrosis that appeared on the tips of her right middle, small and ring fingers 12 years ago, and which broke the bone on the tip of her right middle finger 6 years ago. She also has stiffness and limited motion of the joints of the hands and fingers. She feels hardening and tightness of the face, and her movement of her mouth and chewing has been slightly restricted. She always feels fatigued, along with a coldness of the body, and has poor sleep, stress, and depression. These conditions get worse when it is cold. Her appetite is moderate, with occasional dryness of the mouth and tongue. She moves her bowels once daily.

Examination showed thinness of the body, dry skin, and paleness of the face and a fixed facial expression; purplish coloration of the hands, fingers and feet; white coloration with ulcers on the tips of fingers; necrosis on the tips of her right small and ring fingers; a damaged and broken bone on the tip of right middle finger; and finger flexion that is slightly limited. She has painful sensations to slight touch on local area of fingers, decreased sensation to touch in local area of the fingertips. There was tightness and coldness of the face, abdomen, arms, hands and feet with touch or pressure. Her tongue body presented as thin and atrophied, with a pale red color, with a thin white tongue coating. Her pulse was weak and deep, with a pulse rate of 72. Her BP was 120/80mmHP. (See the attachment of figures).

According to Traditional Chinese Medicine standards, her diagnosis is yang qi deficiency with cold of the meridians and blood stasis. The treatment principle is to warm yang and dispel cold, tonify qi and move blood stasis, and relieve pain.

The treatment points included Ren4, 6, 10, 12, SP6, ST36, LI4, DU20 and Yin Tang. These were applied once a week for acupuncture treatment.

The Chinese herbal formula selected for the case is a modified form of Dang Gui Si Ni San and Yang He Tang. The treatment calls for 50g powder of an herb Rx for one week, to be taken orally 3 times a day, 2g per time maximum, with about 2/3 cup of warm water. The herbs included are: Dang Shen, Huang Qi, Dang Gui, Chuan Xiong, Shu Di Huang, Bai Shao, Gan Jiang, Rou Gui, Da Zao, Gan Cao, Bai Jie Zi, Fang Fang, Xian Mao.

The treatment for follow-up visits modified some points of the acupuncture protocol, and herbs in the herbal formula, according to progression of the patient.

Result: After 3 months of treatment her condition was improved as indicated by symptoms of the body and signs on the limbs and face. Most symptoms were improved, such as coldness of the body, cold and pain of the fingers, hardness of the face, abdomen and upper limbs. Color of the limbs went from purplish back to to normal, and weather did not have as much of an effect on the limbs. White on the fingers became fresh and red, ulcers and necrosis on the tips of fingers were resolved, sensation on the tips was improved but slightly painful when touched. The patient’s condition was improved and fingers’ flexion limitation decreased.

During subsequent followup, the treatment plan was changed to once every two weeks, and then later to once a month, continuing acupuncture and refilling Chinese herbal formulas. At the sixth month of treatment the patient had healed sufficiently to discontinue regular visits. One and a half years after the termination of treatment, the patient reported no return of symptoms on the localized areas of the limbs, and only occasional coldness of the limbs when the weather changed.

Below are the photos of before and after treatment for the conditions of the hands and feet.

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Case No. 2:
A 19-year-old female was admitted to the clinic for help with a two year history of scleroderma accompanied by Raynaud’s syndrome (disease). She had a chief complaint of hardening and tightness of the limbs, face and abdomen; coldness, purplish coloration of the four limbs, ulcers on the fingers. The symptoms got worse when the weather became cold.

The patient presented with feeling a hardening of the arms, hands, lower abdomen and legs. The skin had become atrophied and thin on the arms and lower legs, and there was a stiffness and tightness of the face, with the movement of the mouth and chewing becoming slightly restricted. The patient also presented with coldness and a purplish hue of the hands, wrists, fingers, legs and feet – all symptoms that got worse when it was getting cold. She experienced painful sensations on the tips of fingers, ulcers on the tips of fingers, elbow and ears – symptoms which often disappear and re-appear again. She also has slight stiffness and limited motion of the finger joints. She was fatigued, had an aversion to cold, poor sleep, stress and depression. Her appetite was normal, with a bowel movement once daily. Her first period appeared at 11 years of age, it came regularly once a month with dark blood and clots, a moderate amount of flow lasting 5 to 6 days, with 27 days for each cycle. There was slight pain of the lower abdomen during the first day of the period cycle.

Examination showed thinness of the body, dark color of the skin, paleness of the face, and a slightly fixed facial expression; purplish coloration of the arms, hands, fingers, legs and feet; whiteness with ulcers on the tips of fingers; fingers flexion that was slightly limited. She reported painful sensations to slight touch in local area of the finger tips. There was thinness of the arms and lower legs, and tightness, hardness and coldness of the arms, hands, abdomen and legs when touched or pressure was applied. Her tongue body presented with a thin pale color, with a thin and white tongue coating. Her pulse was weak and deep, and the pulse rate was 78. Her BP was 110/75mmHP.

By Traditional Chinese Medicine standards, her diagnosis is yang qi deficiency with cold in the meridians and blood stasis. The treatment principle is to warm yang and dispel cold, tonify qi and move blood stasis.

The treatment points included Ren4, 6, 10, 12, SP6, ST25, 29, 36, 44, LI4, SJ6, SI3, DU20, Yin tang. These were applied once a week during acupuncture treatment. Cupping on the lower abdomen was also performed once a week following the acupuncture treatment.

The Chinese herbal formula selected for the case is a modified form of Dang Gui Si Ni San and Yang He Tang. The treatment calls for 50g powder of an herb Rx for one week, to be taken orally 3 times a day, 2g per time maximum, with about 2/3 cup of warm water. The herbs included are Dang Shen, Huang Qi, Dang Gui, Shu Di Huang, Bai Shao, Gan Jiang, Rou Gui, E Zhu, San Leng, Gan Cao, Bai Jie Zi, Fang Fang, Xian Mao.

The treatment for follow-up visits modified some points of the acupuncture protocol, and herbs in the herbal formula, according to progression of the patient.

Result: After a month of treatment her condition was improved, including symptoms and signs present on the limbs, face and abdomen. Her pain was also relieved, and the coldness and purplish discoloration of the limbs was improved. After two months of treatment, most symptoms were improved, especially the skin hardening of the abdomen and lower limbs which gradually became soft. After four months of treatment, the skin hardening of the arms gradually became soft.

The author has treated a total of five cases scleroderma and four cases accompanied by Raynaud’s syndrome (disease) from 2/2007 to 12/2010. Most of the symptoms of all patients improved with acupuncture and herbal formulas. Their different conditions improved after treatment lasting from one to six months. From clinical experience it has been found that acupuncture in combination with Chinese herbal formulas are effective to treat scleroderma and Raynaud’s syndrome, but these treatments are likely take an extended length of time to effect lasting results.