Acupuncture Case
Patient: C J(33-F)
Main Complaint and duration:
Pain in the shoulders for 2 days
Details in the main complaint
2 nights ago, she ate much food and drank alcohol and stayed up late. The next day, the aching, dull pain started around GB meridian, especially between GB20-GB21 on both shoulders. She used this Acupuncture clinic in Toronto and got better.
(accompanying symptoms)
Heavy feeling in both limbs
not formed sticky stool
(what makes it better)
massage
(what makes it worse)
N/A
General questions, 10 questions
Cold or Hot
usually feels warm
Apetite
good
Thurst
normal
Urine
fine, clear to light yellow
Bowel movements
more than usual. not formed and sticky
Eyes/Ears
n/a
Abdomen
n/a
Sleep
normal
Emotions
less stress than before
Energy
8/10
Women problems
no change
Family history
n/a
General impression
n/a
Tongue
pale pink, yellow greasy coating
teeth marks
Pulse
L: weak kidney, slightly soggy
R: weak kidney, slightly slippely
Summary of Main symptoms and signs
*Pain around along the GB meridian(GB20-B21) for 2 days
*Unformed sticky stool,
*heaviness of the limbs
*tongue: yellow greasy coating, tooth marks
*soggy and slippery pulse
TCM Disease
Bi Zhong
TCM Differentiation
Damp (Heat) obstruction in GB Meridian
Treatment Principles
Clear heat, resolve damp in the body and GB channel, alleviates pain
Acupuncture
GB-20 – local point
GB-21- local point
GB-34-resolves damp-heat, removes the obstruction from the channel
SP-9- regulate spleen, resolves dampness
Ash-points
Ren-12 – resolves dampness and phlegm
ST-44-regulate the intestines and resolves damp heat
Herbs
chu shi juan bi tang
herbs which drain/dry dampness such as yi yi ren, can zhu, fuling, zhu ling, bai zhu, can zhu
Tuina
Manipulations especially along the GB meridian
Analysis
An invasion of dampness in the body cause damp painful obstruction syndrome.(damp bi syndrome). Dampness first attacks the meridians, which locate most surface of the body. It is the acute stage of damp bi syndrome. It manifests as achy and swollen joints with a feeling of heaviness. It usually happens with sudden onset.
In this case, she shows many sings of dampness in the body. Heaviness of the limbs is a typical sign of dampness. Her stool has become stickier, and that is a sign of the dampness as well. Her slippery yellow tongue coating, teeth marks, soggy/slippery pulse all suggests dampness. Her pain is only along the GB channel around the neck and shoulders, therefore it is dampness obstruction in the GB channel.
Bi syndrome is exterior dampness attacking the body. In her case, the wei qi(defensive qi) did not function properly while she was staying up late, therefore it allowed the evil damp to invaded the body. She has internal dampness too however. Improper food intake impedes spleens transportation and transformation functions, and body fluid is not properly dispersed throughout the body, thus forms the dampness.
In this case, external and internal dampness are both cause of her condition.
She has a slight body constitution of the heat type and there are some heat sings (yellow coating, feels warm).
What I have learned
How dampness affect the meridians and how it manifests
Acupuncture case 2
Main Complaint and duration:
Stress (for a year)
Details in the main complaint
She has been having stressful life taking care of her mother, who is a cancer patient.
It makes her irritable, and she feels a sense of being a victim. It happens especially when she has PMS.
(other symptom and sings)
Especially when PMS: She feels bloated, feels angry, craving for sweet and spicy food, physically “tense”
(what makes it better)
good diet, exercise – too busy to do either
General questions, 10 questions
Cold or Hot
feels cold at night
Sweat
not easy to sweat, if she does, only on the forehead
Appetite
good – bloating after eating hot/spicy food, diary, alcohol etc
Thirst
normal but likes hot drinks
Urine
Normal,
Bowel movements
1-2/day on the soft side but varies
Eyes/ear
good
Head/body
tension headache on the forehead and back of the head (around GB meridian)
Chest/Abdomen
1-2 a year, she has severe cramps on the stomach which radiates to the side of the body to the upper back
Sleep
sometimes difficult to fall asleep, vivid dreams
Emotions
suppressed, sad
Energy
very low,
sluggish
feel “disconnected” from the world
Women Issues, periods
irregular intervals, 3 days flow
sometimes heavy, dark red, pain and cramping
Family history
Mother: cancer
Grandmother: High blood pressure, alcoholism
General impression
Nothing to mention about
Tongue
Pale body, thin coating
Purple spot in the middle
Tooth marks
Little coating
Pulse
(right)
wiry
(left)
slightly slippery
Summary of Main symptoms and signs
*Stressed for 1year,
*irritable/anger
* low energy
*gets better with exercise
*heavy appetite, craving for sweet, hot/ spicy food
*dream disturbed sleep
*irregular period, heavy period
*heavy bloating, cramping
*Tongue: pale body, purple spots, teeth mark
*Pulse: right slippery, left wiry
TCM Disease
stress
TCM Differentiation
Liver Qi stagnation
liver and spleen disharmony,
(spleen qi deficiency)
blood deficiency
Treatment Principles
Sooth the liver and move qi
harmonize liver and spleen
nourish blood
Acupuncture
liv13: harmonizes liver and spleen
liv14: harmonizes the liver and promotes the smooth flow of liver qi
liv-3: promotes the smooth flow of liver qi and calms abdominal pain
GB34: promotes the smooth flow of liver qi and calms abdominal pain in combination with ren6
ren-6: stops abdominal pain and moves qi in the abdomen with GB-34
SP4 and PC6:opens chong mai. Sp-4 tonifis spleen
St-36:tonifies spleen
Sp-6: benefit spleen, tonifies spleen qi
Herbs
Xiao Yao San
Analysis
Stress in life can cause the flow of qi impeded. Liver is in charge of dispersing the whole body’s qi, and when liver qi is stagnated the whole body’s qi is internally stagnated. This stagnation gets into heat, and can cause irritability. Even though she can’t do it these days, she did feel better after she did exercise. This is because exercising disperses stagnated qi.
Stagnated liver qi can impair Ren and Chong meridians, and it affects the Uterus. This explains menstrual problems (irregular periods). Left wiry pulse explains the liver pattern. stagnated liver qi by itself brings about distention and bloating in the 英語 abdomen.
Also, when stagnated liver qi goes up and disturbs shen, it brings about difficulty sleeping, bad dreams.
Stagnated liver qi impedes the coming and going of the ethereal soud (hun) and this results in depression, feeling of aimlessness, lack of project, dreams.
She has cravings for sweet food. She also has a tongue with teeth mark. Her right pulse is slippery. These signs suggest that she has dampness due to deficient spleen qi. This is probably caused by spleen being attached by liver. Her heavy period could be explained by spleen qi not being able to hold blood. Her tongue body is pale and it shows some kind of blood deficiency. When spleen qi is not functioning, blood can’t be produced enough.