Acupuncture Effectively Treated A Patient with Type 1 Progressive Neurogenic Peroneal Muscular Atrophy and Chronic Inflammatory Demyelinating Polyradiculoneuropathy

This blog was written in Chinese on November 28, 2023. Here is the translation.

On March 31, 2021, 77-year-old Mr. L came to the clinic accompanied by his wife due to neck and shoulder pain and dizziness caused by herpes on his head. I noticed that when he walked, his head and chest were bent forward at nearly a 40-degree angle, staggering like a drunkard who might fall at any moment, so I asked what the reason was.

His wife explained that it was partly due to dizziness from the herpes, but also because of another condition. She recounted that starting in 2009, Mr. L began experiencing weakness in both legs and feet, difficulty standing steadily, and walking unsteadily. His right foot was particularly weak, making it hard even to press the brake pedal, which led him to stop driving. After consulting multiple specialists in neurology, oncology, and other fields, he was diagnosed with peripheral neuritis.

Because abnormalities were detected in the lumbar spine (L3-L5), the patient underwent lumbar surgery in 2016, followed by knee surgery in 2017 due to knee pain. However, after both surgeries, the weakness, numbness, and imbalance in his legs and feet did not improve; instead, they gradually worsened. In 2019, ten years after the symptoms first appeared, Western medicine finally diagnosed him with Type 1 Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Progressive Neurogenic Peroneal Muscular Atrophy (Charcot-Marie-Tooth Disease Type 1, CMT1) after genetic and blood tests, but he was told there was no treatment available.

They then flew to China and consulted several renowned doctors of Traditional Chinese Medicine (TCM) at hospitals in Kaifeng, Beijing Union Medical College Hospital, and Shanghai Longhua Hospital. They ultimately decided to undergo treatment at Longhua Hospital. However, after a month of daily acupuncture sessions, there was no improvement. They decided to return to the United States. Upon returning, they brought a three-month supply of herbal medicine prescribed by a famous TCM doctor, but after taking it, there was still no improvement. Now, his right calf was gradually losing sensation, especially the big toe of his right foot, which had become completely numb.

Progressive Neurogenic Peroneal Muscular Atrophy (Charcot-Marie-Tooth Disease, CMT, also known as Peroneal Muscular Atrophy or Charcot-Marie-Tooth Disease), is named after the three French researchers who first discovered the condition. It is a rare genetic disorder. Early diagnosis of CMT is now possible through DNA testing. The incidence of CMT is approximately 1 in 2,500. 

Peroneal Muscular Atrophy is divided into several types based on different genes. The patient mentioned above has Type 1 (CMT1). Patients with this subtype experience damage to the myelin sheath, which insulates nerves, affecting communication with muscle tissue and sensory organs in the skin. This leads to degeneration and weakness of the small muscles in the feet, loss of sensation, and subsequently impacts motor and sensory functions. CMT1 is a progressive disease, meaning symptoms slowly worsen over time. Eventually, weakness and loss of sensation gradually move closer to the trunk and affect the arms and hands. Ultimately, patients may lose motor coordination or balance due to the loss of proprioception—the ability to sense the position of the body (and limbs) in space. The patient mentioned above said that among his five brothers, three older brothers also exhibit symptoms of CMT to varying degrees. The eldest brother's body is bent forward at approximately 90 degrees.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is an autoimmune motor-sensory peripheral neuropathy characterized primarily by chronic demyelination of the proximal peripheral nerves. It belongs to the category of chronic acquired demyelinating polyneuropathy (ADP) and is the most common type of CADP, following a chronic progressive or relapsing-remitting course. Some of its symptoms resemble those of CMT1. Typical weakness manifests as symmetric weakness in both proximal and distal limbs, usually starting in the lower limbs and progressing from distal to proximal areas. The global incidence is estimated to be between 1 and 9 per 100,000 people.

Mr. L said he was very healthy and enjoyed sports before 2009, with no abnormalities. However, issues began to emerge starting in 2009. When he first came to the clinic last year, he not only had difficulty controlling his balance while walking, but the nerves in his calves were extremely insensitive. There was a large brownish patch on the inner side of his right calf, and the big toe of his right foot was numb and without sensation.

  I first treated his postherpetic neuralgia. After 2-3 acupuncture sessions, the pain and dizziness disappeared. The patient then requested trying acupuncture for CMT and CIDP. However, he did not want to try herbal medicine. Since he had unlimited acupuncture coverage under his insurance, I began giving him acupuncture twice a week. In addition to selecting points on the affected legs and feet, I also administered scalp acupuncture. At the beginning of treatment, his response to electroacupuncture was very dull; the current dial had to be turned to the maximum for him to feel the pulse of the needles in his legs and feet (equivalent to 3-4 times the intensity needed for other patients). 

After several acupuncture sessions, the patient first regained sensation in the big toe of his right foot. Gradually, his walking became much steadier, and the forward leaning of his head and chest significantly reduced. Now, watching him walk, I no longer worry that he might fall. The area of discoloration on his right calf has also decreased, and the color has faded considerably. The patient is very pleased.

Last month, when I asked him how much he felt his symptoms had improved, he replied, "About 50%." He praised the wonders of Traditional Chinese Medicine left by our ancestors. He particularly likes scalp acupuncture and is very cooperative with the treatment. Due to the weakness and lack of sensation in his right foot, he had been unwilling to drive. So, for the first few visits last year, his wife drove and accompanied him. However, after several treatments, when his right big toe regained sensation, he told his wife she no longer needed to accompany him, and since then, he has been driving himself to the clinic.

Western medicine says this disease is genetic and cannot be treated. How can we explain the efficacy of acupuncture? Why did daily acupuncture for a month at Longhua Hospital show no effect, while acupuncture only twice a week at my clinic proved effective?

Mr. L has a genetic disease, but before 2009, he was completely normal in movement with no symptoms. Some genetic diseases present symptoms from birth, while others appear and gradually worsen at a certain age, possibly triggered by some external environmental stimulus or when cellular aging reaches a certain point. The discoloration of the skin on his severely affected right leg indicates poor circulation in that area. Myelin sheath damage in both CMT and CIDP is certainly accompanied by chronic inflammation. CMT1 is congenital and hereditary, while CIDP is acquired later in life. Mr. Li was diagnosed with both CMT1 and CIDP. Whether it was the initial diagnosis of peripheral neuritis or the later diagnoses of CMT1 and CIDP after ten years, I treated him based on Traditional Chinese Medicine pattern differentiation. The patient's problems were caused by deficiency and blockage of qi and blood. Acupuncture treatment can effectively improve qi and blood, promote blood circulation, and eliminate chronic inflammation. Scalp acupuncture is particularly effective for mobility issues caused by brain nerve damage.

Because each acupuncturist has a different understanding of the etiology and pathology of diseases, the selection of acupoints, as well as the direction and depth of needle insertion during treatment, can vary. This is why many of my patients who received ineffective acupuncture or herbal treatment elsewhere find treatment at my clinic effective. I asked the patient which areas were treated during his time in Shanghai. He said he was asked to lie prone on the bed, and acupuncture was applied to his lower back, legs, and feet; the head was not treated. Of course, I also have cases where treatment is not effective. Therefore, I am constantly learning, hoping to help more patients. But we are all human; there is no doctor in this world who can cure every patient.