Chemo-Induced Peripheral Neuropathy
Overview
Chemo-induced peripheral neuropathy is an iatrogenic disorder occurring in cancer patients after treatment with platinum agents, taxanes, vinca alkaloids, and other chemotherapeutic drugs, characterized by symmetrical numbness, tingling, burning sensation, hypoesthesia, or paresthesia at the distal extremities. In TCM, it falls under the categories of "bi syndrome," "wei syndrome," and "numbness." The core pathogenesis is toxin from medication invading internally, damaging qi and blood, causing stasis and obstruction of the collaterals, and depriving the skin and flesh of nourishment. The disease is located in the collaterals of the four limbs and is closely related to the liver, spleen, and kidney. Common patterns include qi deficiency with blood stasis, cold-dampness obstructing the collaterals, and liver-kidney depletion. The condition is often dose-dependent; some patients improve after discontinuation, but others have prolonged, refractory courses.
Pattern differentiation (clinical patterns)
Qi Deficiency with Blood Stasis
Numbness and insensitivity at the distal extremities, tingling or burning sensation, aggravated by fatigue, mental fatigue and lack of strength, shortness of breath and reluctance to speak, dull complexion, pale-dark tongue with petechiae, and a fine choppy pulse.
Benefit qi and invigorate blood; unblock the collaterals and relieve pain.
Cold-Dampness Obstructing the Collaterals
Cold pain and numbness in the four limbs, aggravated by cold and relieved by warmth, heaviness of the limbs, difficulty in flexion and extension, white greasy tongue coating, and a deep tight or soft moderate pulse.
Warm the meridians and dispel cold, remove dampness and unblock the collaterals.
Liver-Kidney Depletion
Numbness and weakness of the four limbs, muscle wasting, soreness and weakness of the lower back and knees, dizziness and tinnitus, five-center heat or aversion to cold with cold limbs, red tongue with little coating or pale swollen tongue, and a deep fine weak pulse.
Tonify the liver and kidney, strengthen tendons and bones.
Connections
Daily care & prevention
Patients should keep the limbs warm, avoid cold water and cold environments, and may soak the hands and feet daily in warm water (not exceeding 40°C) to promote qi and blood circulation. The diet should warmly supplement qi and blood, for example, a soup of Huang Qi, Dang Gui, and Sheng Jiang stewed with mutton; avoid raw, cold, and cooling foods. Engage in gentle exercises such as Ba Duan Jin and Tai Ji Quan to assist the movement of qi and blood, and avoid overexertion. Those with numbness of the hands and feet should prevent burns, frostbite, and trauma, and pay attention to even ground when walking. Maintain a relaxed mood, regular rest, and attend follow-up visits to assess neurological function.
When to seek medical care
If there is progressive worsening of limb weakness, difficulty walking, unsteady grip, or rapid expansion of numbness to the trunk, or if accompanied by bladder or bowel dysfunction, this suggests disease progression or spinal cord involvement, and immediate medical attention is required. If ulcers, gangrene, or severe infection appear on the hands or feet, or if there is high fever or altered consciousness, emergency management is necessary. In addition, chest tightness, palpitations, and dyspnea, which indicate autonomic nerve involvement, are also critical signs and should not be delayed.