Treatment & rehabilitation of affected arm in post-stroke sequelae

This is an account of Kaikit treating a patient with post stroke sequelae in Nepal, using scalp acupuncture and applying the principles of neuroplasticity.

Kaikit applying scalp acupuncture on patient with post stroke sequelae

Kaikit applying scalp acupuncture on patient with post stroke sequelae

I meet Buddhi for the first time at the end of the second last week of the camp. He had a stroke 5 years ago which affected the mobility of his left arm and hand. Although he can walk quite normally without limping, the stroke left constant burning sensation in his left hip and leg. 

I think to myself, “OMG, I only have 6 days left in camp. What can I do for this man?”

Buddhi has almost no strength in his left arm, and poor grip in his hand. I ask him to hold a stone the size of his palm. He gingerly wraps his fingers around it, lifts up a few millimetres, then drops it. 

I ask Buddhi what he expects me to do for him. He wants just for his hip pain to go away. He believes there isn’t much hope for his hand to recover.

“OK, ” I said. “We will concentrate on treating your hip but I still want you to work this hand.” I make him come for treatment everyday even though he travels a few hours to get to the clinic. I also gave him homework to practice holding the “magic stone” for one hour at home.

I treat him with scalp acupuncture, acupuncture on his left arm, hip and leg with electro-stimulation. This will be the same treatment repeated for the next few days.

The next day when Buddhi came in, I ask him to take the stone out of his bag and show me what he can do. I have a big surprise. Not only can he grip the stone, he is waving it above his head, with a beaming smile on his face. We clap and cheer his success. He said he had been practising until 6pm from the time he got home. 

“Now try this stone.” We progress to a stone smaller than his palm. He frowns with concentration, chasing the stone around while trying to hold it and losing it awkwardly. “Go home and keep practising.” We continue the same acupuncture treatment.

On the fourth day, Buddhi proudly shows me how he has overcome the smaller stone. I hand him his clinic card and challenge him to grip it with thumb and finger of his weak hand. With much focus, he closes thumb and finger on the card. He looks at me, his eyes filled with disbelief. Tears were welling in my eyes. We clap and cheer again. The next task is to practice finger grip on a pebble and placing down with control.

By now, I refrain myself and the interpreter from helping him with his dressing and packing his bag. He may be slow but I insist that he uses his weak hand, instead of favouring the good hand. This forces the brain to rewire his weak hand. It is believed that stroke patients can lose the use of their weak limb through “learned nonuse” (Doidge, 2010)

On the fifth day, his finger grip improves. He is able to hold a pebble with 2 or 3 fingers and place it down with control. The burning sensation in his hip has reduced. Yet he is complaining of pain in his head due to daily scalp acupuncture.

As we part, I encourage him to continue practicing with the stones for the next few weeks while waiting for the clinic to reopen. As his brain rewires, he may, one day, be able to resume most of the use of his affected hand and return to farming again. That is the wish he expressed.

My stint in Nepal has come to an end. Buddhi’s case touches my heart deeply each time I think of this experience. With his determination, he has shown me the magic in those stones that I picked from the roadside. ~ Kaikit Wong


Doidge, N. (2010). The Brain That Changes Itself: stories of personal triumph from the frontiers of brain science. Scribe Publications Pty Ltd. Australia. Chapter 5.

CASE STUDY: Amenorrhea with Polycystic Ovarian Syndrome 

This is a case study of a patient that I treated during my 2-month volunteer service in Bajra Barahi, Nepal.


20-year-old female presents with secondary amenorrhea since menarche at age 11. Menstrual flow prompted artificially with norethisterone pill. Ultrasound reveals multiple immature follicles in both ovaries. Case analysis investigates possibility of a menstrual flow without drug intervention.


Patient is a 20-year-old woman presenting with secondary amenorrhea. Menarche was at age 11. Her second menstrual flow was 8 months after, and the third flow 6 months after. Her parents’ concerns led to medical investigation, resulting in norethisterone treatment. For the last 4 years, she takes 5mg of norethisterone every month on day 18 for 10 days to induce a withdrawal menstrual flow. 

However, last menstrual flow was 2 months ago as patient decides to stop taking the pill. On average, each menses flows for about 9 days with chickpea-sized clots, dark colour blood, severe abdominal pain for 4 days, and breast distension.

Patient is the first child. Her younger sister also has amenorrhea. Her mother however does not have any problems with menstruation. At the time of her conception, her mother was 15 and her father was 17.

Patient feels cold easily. Her sleep is good, falls asleep easily and does not wake at night. She does have frequent vivid dreams. Bowel movements are daily with formed stools.


Patient appears to be in good health for age and environment. Her temperament is cheerful, always smiling and courteous. She tries to respond in English whenever she can. However, she seems embarrassed about her condition and prefers to have her close friend as the interpreter during all visits.

Hirutism is noted with increased coarse hair growth on her sideburns, jawline, arms, legs, lower abdomen and along the midline of her front torso along the Conception channel. When asked, patient reports noticing excess hair growth about age 15-16. 

Tongue is pale red with thin white coat, with red prickles on the side and tip. Pulse is choppy and tight. On palpation, her hands and feet are freezing cold to touch. Her abdomen feels cold, with no palpable masses.


DX: Fertility hormone test shows serum prolactin and follicle-stimulating hormone within normal range. Therefore pituitary dysfunction is ruled out. Thyroid function test shows thyroid-stimulating hormone, T3 and T4 within normal range. Therefore thyroid dysfunction is ruled out.

Insulin resistance is often a cause for PCOS and contributes to hirutism. Glucose tolerance test show normal sugar levels with fasting and after glucose intake at 60 minutes and 120 minutes. Therefore insulin resistance is ruled out.

Serum testosterone however is more than two times over normal range, confirming hyperandrogenism.

Ultrasound shows anteverted uterus of normal size 62mm by 31mm by 26mm, and normal endometrial thickness 4mm. No space occupying lesions found in the uterus as well as the adnexae (ovaries and fallopian tubes). Both ovaries however were bulky with multiple central and peripherally located follicles of less than 10mm diameter. There is no maturation of follicles noted.

Only 2 out of the following 3 criteria are required to diagnose PCOS. All 3 are fulfilled:

  1. Menstrual irregularities pointing to ovulatory dysfunction 
  2. Hirutism indicating hyperandrogenism 
  3. More than 10 immature follicles per ovary occurring in the periphery 

TCM DX: Kidney yang deficiency failing to ripen ovarian follicles. According to the Classics of Yellow Emperor, Kidney Qi is abundant at age 21 for females and at age 24 for males. Both parents were not at their respective age of best Kidney Qi at the time of conception. Hence prenatal Kidney Jing deficiency may be a reason for dysfunction of the reproductive system. 

Sluggishness and stagnation in the Chong and Ren channels causing blood that should be expelled as menstruation to manifest as body hair.

PROGNOSIS: With regular acupuncture and herbal treatments combined, it may be possible to restore a normal menstrual cycle. 


Treatment principles: Warm Kidney yang. Invigorate Chong and Ren channels.

Treat with acupuncture at least once a week for 4 months before reassessing need for drugs intervention.

Typical treatment: SP4 paired with PC6 needled on opposite sides to invigorate Chong channel. LU7 with KD6 needled on opposite sides to invigorate Ren channel. CV12, CV4, CV10, CV6 to return Qi to the source. ST25 to circulate Qi within abdomen. SP6 to tonify and move blood within the lower abdomen. Moxa over CV8 to warm Kidney yang. Du20 and Yintang to stimulate the pituitary gland for follicle-stimulating hormone.

Prescription of herbal formulas are limited to availability. Formula that contains Lu Rong, Yin Yang Huo, Tu Si Zi, Du Zhong, Xu Duan are prescribed to tonify Kidney yang. Formulas that tonify Kidney Yin are avoided so as not to exacerbate hair growth.


After 5 treatments, the patient reports no change in condition as in no menstruation. After treatment 3, there is some transparent, slightly sticky and ordorless vagina discharge. The patient is informed that due to the long term nature of the condition, it is unlikely to elicit a natural menstrual flow within the short duration. The patient agrees and wishes to continue with treatments. The patient is informed of the diagnosis and the implications.

After 2 weeks break from treatment, patient reports menstruation for 4 days. One and half month later, another menstruation is reported. Both are natural without intervention from norethisterone.


PCOS is a syndrome that involves anovulation or ovulatory dysfunction with androgen excess of unknown etiology. Up to date, pharmaceutical drug treatment of PCOS is symptomatic. 

An intermittent progestin pill (norethisterone in this case) is used to induce menstruation to reduce risk of endometrial hyperplasia and cancer. However as progestin is weakly androgenic, it may cause androgenic side effects such as acne, hirutism and voice changes in some women at high doses (10 to 40 mg per day). And our patient is taking 10mg per day. Therefore further time is needed to observe if hirutism decreases as patient weans off the effects of norethisterone.

Insulin resistance is a major cause of PCOS, affecting 70 to 80% of PCOS sufferers. High levels of insulin in the blood stimulate the adrenals and ovaries to produce excessive amount of androgens. If test results show insulin resistance, Metformin 500 to 1000 mg bid may be used to increase insulin sensitivity and reduce androgenic production. Side effects are nausea, vomiting, diarrhoea and vitamin B12 malabsorption. However our patient is not insulin resistance.

Patient is currently unmarried and not expecting to become pregnant in the near future. PCOS affects fertility due to ovulatory dysfunction. In the Nepalese culture, a woman who cannot bear children is very likely to be replaced by a second wife. Therefore this condition may be quite detrimental to our patient. When she intends to fall pregnant and has not been successful after 12 months, Femara (Letrozole) 2.5mg qd may be used to induce ovulation, to be taken from day 3 to 7. It works similar to Clomid (Clomifene), suppressing oestrogen and increasing follicle-stimulating hormone and luteinising hormone to enhance maturation of follicles for ovulation. Ovulation rate is 60-85% and pregnancy rate is 20-25%. Femara is quickly flushed from the body after one cycle,therefore does not cause the drying of cervix mucus and thinning of endometrium, as Clomid does. Side effects are twin pregnancy and occasional development of ovarian cysts with internal bleeding and torsion.

Drug treatments are accompanied with many undesirable side effects. Research has shown that regular acupuncture treatments may improve ovary function and ovulation frequency, and reduce abnormally high levels of testosterone and insulin. This will help improve fertility as well as skin condition for the patient.

The intention is to achieve menstruation without drug intervention, and subsequently regular monthly menstruation without drug intervention.

Nepal Part 6: Material poverty & spiritual poverty

A photo of Rachel and a patient greeting Namaste.


So why is it that the more affluent our society the less happy we are? Is it because the more we have, we become more selfish as we try to protect our comfort and mindlessly seek pleasure? Most of the patients we looked after own a small farm where they have just enough vegetables, buffaloes, goats and chickens to sustain themselves. Perhaps it is because the villagers don’t have many possessions that they have nothing to lose.

Over there we had to ask whether soaps are available in the villagers’ homes and educate them on how to prevent illnesses with good hygiene. Here, we can spend a long time choosing and deciding which flavor or colour of soap we want. It seems what makes our worlds different is that they don’t have a choice, and we have too many. After living in the village for 2 months and being on a diet that I had little choice over, when I returned to Kathmandu and was given a menu at a restaurant, I couldn’t decide what I wanted to eat because I would’ve been happy with anything that was served.

A photo of Rachel with a patient and her daughter.

We are lucky to be born needless to worry about our survival. We are bombarded with so much information and choices every day that if we don’t have a strong philosophy and a clear purpose in life, it can be very overwhelming. Lost in this information-focused society, we can spend our whole lives just merely existing, rather than creating something of long-lasting value. Dr Viktor Frankl is well known for surviving the World War II Nazi concentration camp. In his book ‘Man’s search for meaning’, he writes, “The abuse of every kind of passion has resulted in an age in which all types of idealism have been destroyed. While we would normally expect to find the younger generation extremely passionate and idealistic, today’s generation, today’s youth, have no ideals at all.” Our society is plagued with a sense of powerlessness and spiritual poverty, it is as if deep down inside, there’s nothing worthy for us to fight for.

Photo of a tin shed

Many of us don’t know where our food comes from, or what is in season. We can eat whatever we want, when we want, simply because we can. The average income earner is unable to own a house without being bound to a 30 year mortgage. We are obsessed with how we look. We fear being judged, and judge others by their appearance and what they have. We are one of the most heavily drugged countries in the world as we are no longer in tune with nature and have forgotten ways to prevent illness. Food – Shelter – Clothing – Medicine, our four basic necessities of life are exploited to the extent that there is no value in them anymore. We have to stop and ask ourselves what does it mean to be a responsible human being. Are we being true to ourselves?

Though the nature of suffering may be different, I realized that physical poverty and spiritual poverty are essentially equal in significance. Affluence alone doesn’t lead to happiness because I’ve seen with my own eyes that even though villagers living in third world Nepal have nothing, they can still be happy and have an enormous capacity to give. At the end of the day, what matters is whether we have lived a purposeful and contributive life true to ourselves no matter where we are.

A photo of a smiling patient

This patient has no voice, but her presence lights up the entire room every time she visits us.