July 2008

Acupuncture for Restless Legs Syndrome

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

Restless Leg Syndrome (RLS) is a neurological disorder characterized by a variety of crawling, pulling, tingling, prickly, sometimes painful, often unpleasant sensations that accompany an uncontrollable desire to move the legs. It can occur intermittently or daily. In many people the symptoms are most severe at night, and cause restlessness, anxiety, and sleeplessness. At worst this is a very distressing and even debilitating problem, because both functioning and sleep can be severely affected.

There is no definitive test for RLS, but in 1995 the International Restless Legs Syndrome Study Group identified four basic criteria for diagnosing RLS: (1) a desire to move the limbs, often associated with paresthesias or dysesthesias (unusual or unpleasant sensations), (2) symptoms that are worse or present only during rest and are partially or temporarily relieved by activity, (3) motor restlessness, and (4) nocturnal worsening of symptoms. The National Institutes of Health considers that RLS "is generally a lifelong condition for which there is no cure." Conventional medical treatments for RLS are based on the discovery that RLS patients have reduced activity of the critical neurotransmitter dopamine. Treatment has centered on alleviating symptoms with the use of medications such as Mirapex and Relafen that stimulate dopamine receptors.

In Chinese medicine, we have a slightly different point of view. We understand RLS as a complex, treatable condition that can be healed, within the natural limitations imposed by the condition and age of the patient and the severity of the symptoms. While acknowledging the neurological quality of the symptoms, we see the problem as primarily one of blood circulation.

In Chinese medicine the uncontrollable leg movements of RLS are interpreted as internal wind, and indicate liver blood stagnation and deficiency. I have found that patients with RLS, particularly older patients, often have weak, congested liver pulses, indicating reduced and sluggish circulation in the liver and kidneys. In addition, the leg acupuncture channels associated with venous return in the legs are the liver, kidney and spleen channels, and these are the channels that acupuncture treatment focuses on. (Circulation problems in the leg are almost entirely venous, because there is no blood pressure in the venous system where the tiny capillaries in the legs and feet block the arterial pressure originating from the heart.)

Of the patients we have seen, one who stands out is Ann, a woman in her late 50's with severe, long-standing RLS that stemmed originally from her first pregnancy. She suffered, also, from anxiety, and was concerned about her alcohol intake. After two weeks of acupuncture treatments she was able to sleep without medication for the first time in months. After two months of taking herbal formulas and acupuncture treatment she felt better than she had in years. After three months, when we stopped treatment and herbs, she had reduced her RLS medication by half, and was taking her sleep medication only once a week. She also told me she had stopped drinking.

If you have RLS, there also are things you can do for yourself. Here are some good ones: In a German study magnesium was supplemented orally at a dose of 300 mg. in the evening over a period of 4-6 weeks. Patients had significant improvement in both leg symptoms and sleep.

Iron supplementation has been used in patients who are found to have low levels of bound iron, or ferritin. For these RLS patients this therapy can have a rapid and dramatic effect. But because iron can be toxic, don't take it unless a blood test finds you are deficient.

Eat liver and lots of green, leafy vegetables for the iron, folic acid, and B-vitamins. They can help everyone with RLS to feel better. And take a walk every day.