Zheng Tan, Yu Jin, Zhao-Xi Lan*Chengdu Sport Institute, Chengdu, China. The Famous TCM Doctor’s Studio, Chengdu Sport Institute’s Affiliated Hospital, Chengdu, China.

Abstract Objective: To analyze the cause and pathogenesis of nerve injury and find out the suitable acupuncture points. Methods:Acupuncture at the unilateral points of Hegu (LI4), Waiguan (TB5), Shousanli (LI10), Quchi (LI11) and the bilateral points of Zusanli (ST36), accompanied by method of electro-acupuncture. Results: After three courses of acupuncture treatment (30 minutes each time, 6 times each course), the patient presented the symptoms of making a fist strongly,disappearance of wrist drop, and positive sign of lifting wrist assay in turn. Simutaneously, the grip strength of hand increased and the strength of muscle reach over level 4. Conclusion: With the help of electro-acupuncture, acupuncture therapy can relieve pain, improve the local blood supply of nerve injury and then repair the damage of the nerve.

Key words: Radial nerve injury, Acupuncture treatment, Lan Zhao-xi

Background

Radial nerve injury, known as radial nerve paralysis, is also called as “Wei syndrome” in traditional Chinese medicine (TCM). Its main features contains the muscle weakness of the unilateral or bilateral forearm, wrist dropping, inhibited bending and stretching of finger joint,skin numbness at the area between the thumb and the forefinger and feeling disappear, which has resulted in negative effect on people’s well-being. The earliest studies in the SuWen·WeiLun pointed out that “the disorder of Yangming channals is responsible for Wei syndrome” [1]. ZhenJiuJiaYiJing specifically pointed out that Dicang (ST4), Taibai (SP3), Zhongfeng (LI4),Yangfu (GB38), Qiuxu (GB40), Guangming (GB37) et al.is involved in the treatment of Wei syndrome [2]. At present, Shi Zhen selected the acupuncture at the points of Quchi (LI11), Waiguan (TB5), Zhongquan (EX-UE3),Hegu (LI4), Houxi (SI3), Shousanli (LI10), Zhigou (TB6),Pianli (LI6), Yangxi (LI5), Yangch (SJ4), Zhongzhu(TB3) , whereas the treatment period is long and point is too much [3]. Xing Yue et al. treat this disease with the combination of acupuncture and drugs [compose of:Danggui (Radix Angelicae Sinensis), Chishao (Radix Paeoniae Rubra), Chaotaoren (Semen Pruni Persicae),Dangshen (Codonopsis), Shanyao (Dioscorea opposita),Dilong (Pberetima), etc.], of which the points include Quchi (LI11), Waiguan (TB5), Hegu (LI4), Houxi (SI3),Shousanli (LI10), Zhigou (TB6), Pianli (LI6), Kongzui(LU6), Zhongzhu (TB3), Lieque (LU7), Jianyu (LI15)[4].

Professor Lan Zhaoxi is an excellent acupuncture expert with outstanding contributions in Sichuan, China.Here we present a patient with the radial nerve injury who showed a complete clinical response after three courses of acupuncture treatment contains five points from Professor Lan.

Cause and pathogenesis of radial nerve injury

Historical literatures have many records on the incidence of Wei syndrome. The cause and pathogenesis is diverse.Yibian·Wei said: the cause of Wei syndrome is heat and wet [5]. ZhuBingYuanHouLun showed: the peoples with body weakness are prone to suffer from the wind-evil attacking spleen and stomach channels [6].JingYueQuanShu said: the heat is the factor that results in the occurrence of Wei syndrome, which has been detailed recorded in Neijing [7]. According to the understanding of theories of different schools and the clinical experience more than 40 years, professor Lan thought that the pathogenesis of Wei syndrome mainly due to the invasion of external-evil, blockage of Qi and blood flow, and nutritional deficiency of vascular and muscle.

In addition, Gerry's Anatomy said that radial nerve mainly composed by 5-8 of the cervical spinal nerve and the first pair of thoracic spinal nerve anterior branch through posterior cord. One part of it down with the deep brachial artery, close to the backbone in the lower one third of the humerus, then extended two branches of deep and shallow. Deep branch was through the spinous muscle to forearm posterior area. Superficial branch was through the deep brachioradialis reach the outside of the radial artery of the forearm [8]. Therefore, patient with radial nerve injury commonly present the symptoms of wrist dropping and inhibited bending and stretching of finger joint. The pathogenesis consisting of fracture,exercise-causes radial nerve injury and nerve infection can result in the incidence of radial nerve damage.

Therapeutic method

Deep needling first and leave needle to arrive Qi

The deeper the needling, the stronger the Qi is.LingShu·GenJie pointed out that: the arrival of Qi is prone to retain around the point and transmit to other places along the course of the channel, indicating that the stronger the Qi is, the more the beneficial efficacy is. In accordance with the distribution and the characteristics of radial nerve injury, professor Lan selected points at the large intestine channel of hand-Yangming and Sanjiao channel of hand-Shaoyang as the main meridians,supplemented by corresponding points located at the stomach channel of foot-Yangming.

Selecting points from both the far and near end and using electro-acupuncture to relieve pain

Based on the clinical syndrome differentiation, professor Lan selected the points at unilateral Hegu (LI4), Waiguan(TB5), Shousanli (LI10), and Quchi (LI11), respectively and bilateral Zusanli (ST36). Hegu (LI4), Waiguan (TB5),Shousanli (LI10), and Quchi (LI11) points are distributed along with the radial nerve distribution, following the acupuncture rule of local therapeutic effects (Figure 1A.).Due to the irreplaceable role of the stomach channel of foot-Yangming of in the treatment of Wei syndrome,Zusanli (ST36) is selected following the acupuncture rule of remote therapeutic effects (Figure 1B).

Supplement with the therapy of electro-acupuncture and TDP infra-red

The points of Quchi (LI11), Shousanli (LI10), Hegu (LI4)and Waiguan (TB5) were punctured with supplemental electro-acupuncture while Zusanli (ST36) point were given the method of deep needling with repetition for 2-3 times. The parameters of electro-acupuncture instrument is as follows: the period of treatment is 30 minutes with the frequency of 10-30 Hz, strength of 1-3 mA, type of wave: intermittent wave (work 15s and stop 5s) and output pulse width of 0.2ms. Studies have demonstrated that the therapy of electro-acupuncture with the frequency as low as 2 Hz can promote the release of the brain endorphins, morphine peptide and endorphins, to provide a long-term analgesic effect [9-10]. Liu Junling et al.found that the analgesic effect of low intensity (1mA)electro-acupuncture is superior to that of high-strength(5mA) electro-acupuncture [11]. Animal study in mouse model with inflammatory pain indicated that the analgesic effect of intermittent wave was slightly better than that of continuous wave, and intermittent electro-acupuncture can increase the excitability of striated muscle [12-13]. There is also emerging evidence that the irradiation treatment of TDP has the potentials to increase the secretion of brain-brown, promote the repair of microcirculation system, and improve the blood circulation and the activity of enzymes and immune function, etc. [14].

Figure 1 Acupuncture points in the therapy of radial nerve injury.

Case report

In November 2016, a 48-year-old male from Sichuan,China complained of the right wrist drop more than 5 days, aggravating 2 days. History of present illness: 5 days ago when slept at night, the patient placed his right hand outside the quilt and caught cold and then presented the right wrist droop and inability to lift. In Leshan Hospital, the patient was diagnosed with right arm radial nerve injury and gave the treatment of neurotrophic drugs.However, the curative effect is unsatisfactory.

Now the patient present: the finger, wrist and elbow joints of left arm and the right elbow joint moved freely,whereas the right wrist dropped and was unable to lift up,right finger had inhibited bending and stretching, along with adduction. Right hand is too weak to hold chopsticks and the area between the thumb and the index finger of the hand felt thumb. In addition, defecate is sticky. Diet and sleep is normal. But patient always worry about his disease. The tongue is bright red while the fur is yellow and greasy. The pulse of left hand is floating, taut and slippery, while that of right hand is slippery and weak.

The treatment aimed to promote blood circulation to remove blood stasis, stimulate the circulation of the blood and cause the muscles and joints to relax and tonify Qi and blood. Punctured perpendicularly (0.30mm) at the points of Hegu (LI4) with depth of 0.5 cun, Waiguan(TB5) with depth of 0.8 cun, Shousanli (LI10) with depth of 0.8 cun, Quchi (LI11) with depth of 1 cun, and bilateral Zusanli (ST36) with depth of 1.5 cun. After the arrival of Qi, electro-acupuncture was performed at the points of Quchi (LI11), Shousanli (LI10), Hegu (LI4) and Waiguan (TB5) with the frequency of 20 Hz, strength of 2mA for 30 minutes, while Zusanli (ST36) points was given deep needling with repetition for 2-3 times. After removing needle, gently massage was performed in the local channels. Once a day, six times each treatment and a total of three treatments.

After each treatment, the change of symptom was as follows (Table 1).

Table 1 Symptom comparison after treatment

Medical advice after treatment

During and after the treatment, the patient was encouraged to continue the grip training, rub both palms for 100 times, keep the body and right arm warm, take tonifying herb such as Gouqi (Lycium). Besides, the patient was administrated with herb of supplementing Qi and blood, promoting blood circulation to remove blood stasis, relaxing the channels and expelling phlegm and wetness. At a resent follow up, the patient had a complete clinical recovery.

Discussion

After the radial nerve injury, the recovery process is up to more than 3 months. However, acupuncture treatment has the potentials to shorten the course, stimulate Qi-blood circulation, and reduce the patient’s financial and psychological burden, to provide an effective way to sort it out. In this case, according to the theory of “the disorder Yangming channals of is responsible for Wei paralysis”, professor Lan used the local points consisting of Hegu (LI4), Waiguan (TB5), Shousanli (LI10), Quchi(LI11), whose function to expel wind and evil dredge the channels and clear the heat from Sanjiao channel as well as Zusanli (ST36) point, whose function to tonify Qi and blood [1, 15]. Besides, electro-acupuncture helps to enhance the power of acupuncture.

In conclusion, our patient shows the effectiveness of acupuncture on disease recovery in patients with recurrent HCC after radial nerve injury.