A Case of Lymphoedema? Treated with Acupuncture?
Dr David Rhinds, Dr Feng Bing and Neil Johnson
Background
The patient is a 50-year-old white Caucasian male who developed lymphoedema secondary to a left axillary abscess. Prior, he was generally fit and well, apart from a slight hearing loss and obstructive sleep apnoea. He also had a history of an accidental injury to the same hand prior to the swelling. He was not taking any medications. His BMI is 26. He is right-handed. There is a positive family history of diabetes. There is no family history of lymphoedema.
Following the 4th Pfizer-BioNTech COVID-19 vaccine in April 2023, the patient experienced increasing fatigue, sleeping excessively, and within 5 days developed a painful left arm with an egg-size axillary mass associated with night sweats, weight loss, and loss of appetite. After 5 weeks of this enlarging axillary lump, he was admitted to the hospital. A CT scan was carried out to exclude lymphoma. A drainable collection in the axilla was confirmed. He had a left axillary abscess incision and drainage, and he was discharged the next day with a 7-day course of co-amoxiclav with paracetamol and odansetron for analgesia and nausea, respectively. Following discharge, he developed swelling of the left arm, which progressively increased in size. He felt that the swelling was less when the weather was cool and worsened as the day progressed. He had tried to reduce the symptoms through self-massage and elevation of the limb. He was concerned due to pain and numbness in the affected limb and the adaption of activities of daily living, such as having to type on a keyboard at work and looking after his children.
He was referred by his General Practitioner to the Lymphoedema Clinic and was seen in June 2023. On examination, his left arm was swollen and red compared to the right. There was a dressing on the left axillary wall. There was a 714-ml volume difference in the upper limbs, with the left being greater than the right. There was mild pitting to firm pressure on the left, with non-specific tenderness of the left upper limb. The diagnosis was one of lymphoedema secondary to infection (left axillary abscess). The patient was informed about lymphoedema, the lymphatic system, and the symptoms of cellulitis. The tendency towards chronicity was explained to him, and he was advised to avoid heavy static weight and to avoid having injections in the upper left arm. He was issued with a class two compression arm sleeve and an ongoing follow-up with the lymphoedema therapists.
Why Acupuncture Treatment?
The patient decided to try acupuncture as a result of NHS delays with follow-up appointments, and in July 2023, on DR's advice, she saw FB. The patient presented complaining of hyperalgesia of the left arm due to lymphoedema. On examination, a post-operative scar was visible on the left axilla. The scar coincided with the location of the Small Intestine Meridian. Due to the surgery, there was the possibility of the flow of qi in several meridians passing through the shoulder and arm, or, in other words, the circulation of energy, leading to energy blockage and the manifestation of surface symptoms. The treatment plan adopted the principles of overall energy regulation and local energy clearance. For overall energy regulation, Tung's Acupuncture was applied to the following acupoints: Shou San Hou, Liu Bai, and Zu San Chong. Local energy clearance involved the floating needle technique on three meridians passing through the left deltoid muscle: the Small Intestine Meridian, Triple Burner Meridian, and Large Intestine Meridian. The needles were retained for thirty minutes.
Results
After only one acupuncture session and on recommendation by FB not to wear the compression sleeve, the swelling resolved within a couple of weeks, and the patient fully recovered.
Patient’s Perspective
After developing the lump, I went to my General Practitioner at least five times and was advised to monitor the swelling despite sleeping up to 23 hours a day. On one occasion, I was prescribed antibiotics and finally advised to go to the hospital to have the abscess drained. Shortly after, the swelling of my left arm became apparent. I was referred to the Lymphoedema Clinic, and a diagnosis of lymphoedema was made. I was due to see a physiotherapist for a follow-up; however, at the time of writing, I have not been seen. I was off sick from work for over a month and, on return, discussed my case with my colleague Dr Rhinds, who suggested acupuncture for treatment. I went to discuss this treatment option with my General Practitioner, however, he said it was not recommended by NICE guidelines and therefore was not available under the NHS. I therefore decided to pay for acupuncture treatment, and after only one session with Dr Bing, all my symptoms resolved within a couple of weeks. Thankfully, I am now fit and well.
My General practitioner completed a Yellow Card for the MHRA regarding the arm swelling following the Pfizer COVID-19 vaccine.
Discussion
There are unique diagnostic methods and treatment plans in Traditional Chinese Medicine (TCM). Those with a basic understanding of TCM may have heard of the main diagnostic methods such as pulse diagnosis, tongue diagnosis, questioning, and observation, as well as the advanced method known as the Five Movements and Six Qi (or Wu Yun Liu Qi, or Yunqi Theory). This method, considered the pinnacle of TCM diagnostics and historically exclusive to the Royal Classes, was not allowed for common use until the SARS epidemic in 2003. During this period, it made significant contributions to the successful treatment of SARS patients and minimizing the death toll, gaining renewed attention from the global community. The Chinese government designated it as a national research project, even restricting researchers from teaching this knowledge abroad. Hence, knowledge about the Five Movements and Six Qi (or Wu Yun Liu Qi) is extremely scarce in the Western world. During the COVID-19 pandemic, the diagnostic and treatment methods of the Five Movements and Six Qi once again demonstrated positive results in controlling the pandemic and curing infected individuals.
In the field of TCM, the Huangdi Neijing, or The Yellow Emperor's Classic of Medicine, known as the 'Bible' of Chinese Medicine, has been universally recognised for centuries and is beyond questioning. For a practitioner of TCM and acupuncturist, neglecting an in-depth exploration of the Huangdi Neijing is equivalent to a Catholic failing to comprehend or study the Bible. Can someone who does not understand the Bible still be considered a devout Catholic? Similarly, can a TCM practitioner or acupuncturist claim their title without studying the Huangdi Neijing? Some dry needling acupuncturists may not find it necessary to read the Yellow Emperor's book. They can identify as acupuncturists, but they might not be classified as TCM acupuncturists. In the Ling Shu section of the Huangdi Neijing, there is a passage that explains the floating needling technique as follows: "The ninth is called Fuci (floating needling), which means to insert the needle superficially beside the affected part in order to treat cold spasms of muscles (https://archive.org/details/yellowemperorsinnercanonlingshujing1/page/n183/mode/2up?view=theater).
Through the analysis of NJ's condition using the diagnostic method of the Five Movements and Six Qi, NJ was diagnosed with Jue Yin Syndrome. One of the most crucial methods to treat Jue Yin Syndrome is the overall energy balance (with the role of floating needling to alleviate local symptoms). To achieve a holistic energy balance, FB chose the Global Balance technique from Tung's Acupuncture. Master Tung Ching-Chang Acupuncture is almost a mandatory course for all modern acupuncturists ( https://www.mastertungacupuncture.org). English-speaking acupuncture students might be more familiar with the numerical coding system for its acupuncture points. The Tung's acupuncture points used in this case included 77.15, 77.06, and 77.07 (Zu San Zhong or Zu San Chong), 33.04, 33.05, and 33.06 (Shou San Huo), Zhong Bai (22.06), Xia Bai (22.07), Shang Bai (22.03), Nei Bai (on eLotus website, called 22.19 Shoujingdian), Wai Bai (on eLotus website, called 22/18 Zhihan), and Fen Bai (it cannot be found in most English version books). These six points, in combination, are known as Liu Bai or Six Bai. (For related content, please refer to the attachment.). In 1992, Miriam Lee published a book called "Master Tung's Acupuncture: An Ancient Alternative Style in Modern Clinical Practice," which is the first English introduction of Tung's Acupuncture to the Western world. (FB recommends that those interested read it.) In Tung's Acupuncture, there are many points, like Fen Bai, that are not publicly disclosed and are typically known only to direct disciples. Complex formulations like Global Balance are unlikely to be known even by English-speaking acupuncturists with over 50 years of experience. FB is fortunate to have acquired this knowledge from one of Master Tung's direct disciples.
Conclusions
Dr Rhinds is a western-trained allopathic medical doctor and was taught at medical school that the lymphatic system cannot be repaired, so any damage will be permanent. The current understanding is that lymphoedema can be controlled but not cured. Traditional Chinese Medicine (TCM) has a comprehensive and unique diagnostic approach, and its understanding and nomenclature of diseases differ significantly from Western medicine. There is no disease named "lymphoedema" in Traditional Chinese Medicine (TCM), nor are there methods to diagnose lymphoedema. Therefore, as a TCM practitioner, Dr Bing must clarify that he has no expertise in treating lymphoedema, let alone methods or capabilities to cure it. However, the patient remains symptom-free for over 8 months after only acupuncture treatment. It is possible that the diagnosis made by the doctors in the Lymphoedema Clinic was incorrect; however, these are highly specialist practitioners in this field. It is also possible that this was an adverse event due to the Pfizer COVID-19 vaccine, and acupuncture was able to treat this, allowing the body to increase its immune response and heal. More research in this area is warranted.
Consent
The patient, Neil Johnson, gave consent for this article.
Correspondence
Dr Feng Bing
Acuspirit Healing Centre
15 Wollaton Street
Nottingham
NG1 5FW
Telephone: 0115 8822888
Email:info@acuspirit.co.uk
