Reflex Sympathetic Dystrophy (RSD) is a neurological disorder characterized by pain and other sensory disturbances, as well as changes in color and temperature in the affected area. An initiating event (trauma to the nerve) fails to heal properly and the sympathetic nervous system takes an abnormal role in keeping the affected area in a constant, reflexive state of neurological stimulation. A feedback loop is in place in people with RSD such that the affected area is locked into the disordered sensation and other changes, despite the absence of ongoing trauma.

A woman came to me with a two-year history of severe RSD in the left lower leg and foot. The lower leg and foot were reddish purple and extremely cold. She couldn’t wear shoes with laces because she was so hypersensitive to the least little pressure against the foot. The left calf was also atrophied, measuring about 1-2 inches smaller than the right calf. The precipitating event was a car accident 2 years before in which she was rear-ended, which reherniated a disc that she had injured 20 years before while pregnant. The atrophy actually began with the earlier injury, but the sensory changes, the color changes and the cold temperature were triggered by the car accident. Also since the accident, extreme cold during the winter would drain all spring from her step in that foot, which caused her to limp.

The physical changes to the leg were so striking I was cautious about feeling the area with my fingers, but it is so helpful for proper understanding of the shen (spirit) of the flesh, I asked her permission, which she readily gave, and I asked her to please describe to me the sensory effect she experienced as a result of my light touch on the calf and foot. She said the light touch set off “pins and needles” throughout the foot, and to a lesser degree in the calf as well. I wondered what a needle in the area would feel like! I decided for the first several treatments to place no needles in the left lower leg or foot. I used needles elsewhere in the body, and used magnets and ion pumping cords on the lower leg. During each of these early treatments the client reported new sensations in her leg and foot, most often like that of rushing water. The effect would disappear as soon as the treatment was over and no changes occurred in her overall condition.

On the third or fourth time she law down on the table for a treatment, I thought, this is it. This is the right time. I gave myself a little pep talk to trust the needles, and I began to really palpate the points on the left leg for the purpose of choosing my points. As I placed the first needle I asked for some feedback. She said she didn’t feel a thing. The palpation on the skin set off more disordered sensation than the needle. Ahaa! I proceeded to needle the area liberally with very little pre-needling palpation, which is usually my style. I like to wait for the sense of the point to rise up and meet my finger before I insert a needle. It helps me to be very clear about my intention for every needle. But in this case, with my mantra in mind (trust the needles), I borrowed from one of my teachers, Dr. Tsay, and inserted using his “flying needle” technique. The needles were in quickly and easily for both of us. I tented a sheet over a TDP lamp directed at the feet to deeply warm the area. I also borrowed a point combination from Dr. Tan, called the Ling-Ku combination, which I had recently asked some colleagues to teach me as I had heard of their positive effect on low back pain. While this client had no low back pain it was the site of her original injuries and therefore, I felt a necessary area to engage. I also needled the sympathetic point in the ears. I decided to add an herbal formula called Si Ni San, which is designed for people with cold extremities due to heat being trapped in the interior. It seemed a good match for her because her body temperature was quite warm at the core, while her limbs in general were colder, her left leg being coldest of all.

This treatment strategy worked very well. The temperature of the left foot matched the right foot for about 24-36 hours after the first treatment of this kind. The coloration was not perfect all the time but at times it matched the right foot, and when it didn’t it was less extreme a contrast than it had been. And after a few acupuncture treatments like the one I described, and two weeks on the herbs, she came in one day wearing lace-up winter boots! She was very happy.

We haven’t been able to reverse the atrophy or completely eliminate the hypersensitivity and changes in coloration, which come and go. But the hypersensitivity has lessened enough to make laced shoes comfortable, and the temperature of the left foot is completely comparable to the right foot. We may work more with herbs…