cupupuncture Rx for diabetic peripheral neuropathy, etc...

Dear Dr. King,
I am lucky in that being a medical doctor here in Naples, Florida, I am able to practice my TCM techniques on actual patients. I have 2 patients that I am using acupuncture on at this time. One is an elderly diabetic women with associated peripheral neuropathy of her legs and feet. I have used acupuncture on Ashi points on her bilateral hands & feet (from my understanding of Reflexology) as well as some acupuncture points on her external auricles (from my understanding of auriculotherapy). I have another elderly woman who is suffering from right-sided thoracic post-herpetic neuralgia and have treated her similarly (Ashi points on the hands & feet as well as auricular acupuncture points). Both patients are improving with my puncturing but what I would love from you is an actual body acupunture prescription for these 2 patients and their respective disease states. Thanks you.
Doctor V.

Dear Dr. King,
It's so good you started to treat patients with acupuncture!
For your first patient, my personal prescription could be such as ST 36, SP 6, and LR 3, as the primary ones, while GB 34, SP 9, KI 3, ST 34, SP 10, ST 32, and BL 60 as the secondary ones. I recommend that each time you can do only 5 points on each side, so totally 10 needles for the leg and the foot. The primary ones should be needled every time bilaterally, so you may have a different choice from the secondary ones.
As to the second patient, I can only recommend some distal points such as SJ (TE) 5 or 6, LI 4, LR 3, SP 6 and GB 34 or 41 as the primary ones; while SI 1 and LU 11 as the secondary ones. I cannot tell any one in the local region, for I don't know the exact focus of the affected area.
Acupuncture claims a good effect for the second case, but for the first one, it would take a longer time. But absolutely it works anyway.
Please tell me your opinions.

Dear Dr. King,
Thanks you so much for your prompt reply!
I'll perform the Rx you mention when I next see my patients (I have been seeing them on Mondays & Fridays for their puncturing). I'll get back to you in the next week or so to inform you on my progress.
Thanks again.
Doctor V

I hope you dont mind if I add my bit. Dr. King's suggestions are very good. However if you wished you could also use abdominal points. Diabetes is traditionally treated using points from the three yin meridians, and I have seen diabetes and diabetic neuropathy treated in China mostly with abdominal points in this way, and distal points such as those mentioned. With very good effect.
Herpes zoster lesions are often treated with local points around the outside of the lesion site, needled laterally and toward the lesion. Indirect Moxa is also very good and frequently used, especially for a fresh eruption, even though this would seem contraindicated due to the damp-heat nature of the illness. For post herpetic neuralgia, consider using the local points around the site, needled laterally toward the area, with electro-stimulation.
I am not sure however, whether you are practicing so called "medical acupuncture" or whether you are differentiating your patients according to TCM theory? In the latter case you can always select points according to the patients individual differentiation.
Good luck.

Dear Bun,
Thanks for your insight. It is true, being a medical doctor, I am practicing what you term "medical acupuncture" at this point. Having 13 years of total training and 14 years of total experience in the principles and practice of Western Medicine, I find it easy to Dx my patients from this perspective. Acupuncture is effective for my patients (just yesterday I resolved a severe migraine headache in one of my patients with 3 filiform needles inserted into 3 auricular acupoints) but I'm sure it would be even that much more effective if I based it upon proper TCM Dx. I just need more training and experience to feel comfortable and competent in doing so. Thanks again.
Doctor V.

Hi there, Its good that you wish to learn more about the TCM principles side of it. The practice of Chinese medicine today CAN be integrated with WM principles. The degree course that I studied sought to give students the equivalent of the training provided in China, with both western medicine and chinese medicine. With some diseases there are empirical treatments (herpes zoster and post herpetic neuralgia being one of them) but then there are illnesses that really do need to be differentiated according to TCM differential diagnosis. This becomes really important when designing effective clinical trials.
Many of my classmates were WM trained doctors, and once they managed to suspend those preconceptions they soon discovered that TCM principles are logically consistent and common ground could be found. I remember one discussion where my classmate (An MD) couldnt understand how the kidneys govern bone. It wasnt until I pointed out to her that at a certain stage of foetal development, the kidneys actually release a chemical that stimulates bone growth that she was able to accept it. Of course sometimes you have to suspend your disbelief, such as in the case of the heart being the location of the mind. In cases such as this the treatment for heart/shen problems works, so differentiating in this manner is still OK, even though in WM we know the brain is the seat of consciousness. (TCM does say however that the heart nourishes the marrow, and the brain is the sea of marrow, so you could just think like that.)
You are actually very lucky, as a WM diagnosis is very often needed in the practice of TCM these days, and you dont need to refer patients. I was taught that in diagnosis you should always have the disease (The name, generally a WM diagnosis such as "Migraine" or "Headache" etc) Then the differentiation, eg "Liver yin deficiency with liver yang upsurge" and based on the differentiation you can then provide the treatment principles eg "Alleviate pain, tonify liver yin, descend liver yang")
Because medical acupuncture is based on empirical treatments, you can have good efficacy in the symptomatic relief of ailments, such as your excellent treatment of the migraine patient , but its definitely helpful to then be able to diagnose the underlying pathology to aid in the prevention of future migraines. All that being said, you probably have great results with musculoskeletal problems with medical acupuncture. In fact, the TCM traumatology I was taught is more in line with medical acupuncture.
Oh, well, Ive probably dribbled on for long enough now. Hope you dont mind my digressions! I really think that you are in an excellent position with having a western medicine background. Ive considered going back to Uni to do medicine, but there are very few postgrad medicine programs available in Australia (and they are all very far away), and I dont know if I can be bothered (or afford) to be an undergrad again.
PS Nobody can really work out a perfect TCM differentiation of fibromyalgia or hayfever, so there are exceptions to every rule.

Dear Bun,
I really appreciate all of your "digressions." All along, I have felt that the TCM Dx and Rx principles made good sense to me. I've always had a pretty open mind about things and the foundation of my practice of WM has always been that if something "simple" works, especially if there is no real capability of causing harm, it was my favorite thing to so and I truly respected both its simplicity as well as its power. I see the principle of balance/homeostasis and the body functioning as a unit every single day in my patient practice. I look forward to going to China to have more "hands-on" experience. By the way, I've always wanted to visit Australia as well. Take care.
Doctor V.

Dear Dr. King and Bun,
I finally performed acupuncture today for my patient with diabetic peripheral neuropathy using your recommended acupoint Rx. Previously, I had used "ashi" points on the hands, feet and external auricles with some definite improvement in symptomatology. The patient had complained of "heaviness" in her bilateral shins and calves as well as burning pain in the soles of her feet. My "ashi" point puncturing had relieved the shin/calf symptoms but her sole symptoms persisted. Today I punctured ST36, LR3, SP6, KI3 and SP9. I left the needles embedded for about 20-30 minutes and subsequently the patient stated her sole symptoms were "almost entirely gone." Thanks. Any further suggestions?
Doctor V.