Integrating Acupuncture and Herbal Medicine to Help a Rare Small Fiber Neuropathy Patient Improve Symptoms

August 2025, a 62-year-old female patient living near Chicago contacted me. She said she had read my blog titled "Acupuncture Effectively Treats Type 1 Progressive Neurogenic Peroneal Muscular Atrophy and Chronic Inflammatory Demyelinating Polyradiculoneuropathy" on wenxuecity.com (in Chinese) and wanted to consult me about whether I could treat her Small Fiber Neuropathy.

After a phone consultation, I told her that although I had not treated this specific condition before, I had successfully helped several patients with other complicated neuromuscular disorders that were also first-time cases for me using a combined acupuncture and herbal medicine approach, including the two neuromuscular disease cases mentioned in the blog post. I believed I could help her with the knowledge I have gained from both Chinese and Western medicine.

Two months later, the patient flew to Southern California for her first visit to my clinic. During the consultation, she told me that her symptoms had persisted for 8-9 years. Initially, the main symptoms were tingling and burning sensations in her hands and feet. In the early stages of the illness, various Western medical tests failed to provide a clear diagnosis. Three years later, as the symptoms continued, she was diagnosed with Small Fiber Neuropathy via a skin biopsy, which was later confirmed by specialists at the Mayo Clinic. Since all tests failed to identify a clear underlying cause, she was diagnosed with Idiopathic Small Fiber Neuropathy. With the cause unknown, treatment could not target the root cause, leaving only symptomatic pain management that did not address the fundamental issue.

Due to the prolonged lack of targeted treatment, the patient also developed anxiety. Additionally, she reported feeling significant muscle loss in recent years, along with weight loss. At the time of the visit, she felt some numbness and weakness in her toes, felt cold all over, especially in her lower back, legs, and feet, with a particularly cold sensation around her waist and hips. Recently, she also felt bloated and often needed prescription medication to deal with insomnia and anxiety. However, her blood pressure, lipid levels, and blood sugar were all normal. The patient had also tried Chinese medicine and acupuncture treatment before but was unable to adhere to a regular regimen. As her symptoms became more pronounced recently, she appeared quite downcast during the consultation.

During the examination, I observed that her tongue was fat with tooth marks and had a white coating in the center. Her pulse on the left side was superficial, thin, and slightly wiry. Palpation revealed significant tenderness points in the upper thoracic spine, around the 5th lumbar vertebra, the 1st and 2nd sacral vertebrae, and the hip joints.

Small Fiber Neuropathy (SFN) is an extremely rare neurological disorder, with an estimated incidence of about 5 in 10,000 in the general population. This disease damages the small nerve fibers responsible for pain, temperature sensation, and autonomic functions. It typically manifests as burning sensations, tingling, and numbness in the hands and feet, and can be accompanied by autonomic dysfunctions such as abnormal sweating, gastrointestinal, urinary, and cardiovascular issues. It is often associated with conditions like diabetes and Sjögren's syndrome. Diagnosis relies on clinical presentation, laboratory tests, and skin biopsy.

I explained to the patient: From a Western medical perspective, although she does not have issues with the "three highs" (hypertension, hyperlipidemia, hyperglycemia), her symptoms are related to years of depression and anxiety, as well as chronic inflammation associated with age-related joint degeneration and consequent impaired blood circulation. From a Traditional Chinese Medicine (TCM) perspective, her neuropathy is primarily due to liver qi stagnation, spleen dampness, blood stasis, and yang deficiency. Addressing the root cause would lead to symptom improvement. I recommended a combined treatment of acupuncture and Chinese herbal medicine.

The treatment aimed to promote blood circulation and remove meridian blockages, warm yang and strengthen the spleen, soothe the liver and regulate qi, and calm the mind to aid sleep. I also advised her to soak her feet in hot water every night. I shared my own 25-year journey of facing Rheumatoid Arthritis with her, encouraging her to find joy and actively confront her illness. The patient accepted the advice, received acupuncture that day, and took a ten-day supply of prepared herbal granules I formulated for her.

The next day, when she came for her second acupuncture session, she said her lower back felt a bit more comfortable. Six days later, when I saw her again, she had a smile on her face and told me that the symptoms in her lower back had reduced by about 50%, her bloating had disappeared, and her calves and feet already felt warm. The warm weather and bright sunshine in Los Angeles had greatly improved her mood.

Subsequently, I performed acupuncture for the patient on the thoracic, lumbar, sacral vertebrae, and hip joint areas. Each session also included needling points along the spleen, stomach, and liver meridians on her lower leg and feet. During this period, I also performed moving cupping and "fire dragon" therapy for her once. In addition to acupuncture and herbal treatment, I also guided the patient on how to regulate her emotions and strengthen her muscles through exercise.

After seven acupuncture sessions and over half a month of herbal medicine treatment, the patient's mood and physical condition showed significant improvement, and the numbness in her toes had also lessened.

After the 8th acupuncture session, the patient took herbal medicine home. I instructed her to soak her feet in hot water daily at home and suggested she regularly perform cupping along her spine and go to the gym to exercise her muscles and joints.

Upon returning home, the patient sent me a text message: "Dr. Liu, thank you, not only for your medical skill but also for the strength and optimism I see in you. I am a rather sensitive person, prone to anxiety. I know many of these principles intellectually, but I need to strengthen my execution in the future. I will learn from you to be strong, optimistic, and confident. I hope to have the opportunity to see you again and enjoy the bright, warm sunshine in Southern California! Thank you again!"

Two weeks later, I texted the patient to ask how she was feeling. She replied: "I feel much better overall now. I soak my feet in hot water every day, continue taking the medicine, and have started going to the gym." She expressed hope that I could continue to help her address insomnia and hair loss.

I am grateful for the Chinese medicine heritage left by our ancestors, thankful for the patient's trust, and grateful to God for giving me the wisdom to help patients with various difficult and complicated disorders over the past 20 years using acupuncture, Chinese herbal medicine, cupping, blood-pricking, and other methods.

Over a decade ago, when I returned to China, I asked a classmate to write the three characters "精气神" (Jing, Qi, Shen) for me to hang in my clinic. Jing (the essential foundational substance of life), Qi (the energy and motive force of life), and Shen (the vitality and spiritual consciousness of life) are core concepts in traditional Chinese philosophy and medicine, the three fundamental elements constituting life. A TCM practitioner should not only treat a patient's symptoms but also help the patient proactively adjust themselves from three aspects: body (physical), mind (psychological and emotional), and spirit (the essence or consciousness beyond body and mind), to elevate their own Jing, Qi, and Shen, thereby achieving physical and mental health and the goal of longevity.