HELP! - I don't know where to start with a case

I would probably start by describing exactly what points you did and any other techniques (cupping, etc.) and/or herbal formulas in detail. That will avoid people offering ideas that you are already doing.

That said, I wouldn’t overthink a case like this at this point in the process (i.e. one treatment in). Considering the amount of inflammation, etc. his body has been under it is extremely unlikely that you will not be able to help him quite a bit within even a few treatments, almost regardless of what you do.

Generally, I wouldn’t overthink his overall health issues either (again at this point). If you can get the pain under control and get him off the pain meds then half or more of the other issues will likely be gone. Remember that not every pattern you see is a causal pattern - many are the result of both the deeper patterns, but also from meds, surgeries, etc.

A general treatment that I would be likely to perform from our system might be something like:

• LV 8 - knees - swelling/inflammation in the lower jiao, etc.
• SP 9 - dampness, knees
• HT 7 - nervous system/pain
• UB 40, GB 34, GB 39, UB 60 - pain
• GV 20, GB 20, huatuo at T1, T7, L2, L4, L5 and UB 32

Then tuina if you know it from T7 through lower back and down through legs - and/or cupping T7 down through the sacrum.

But that’s just roughly what I might do, it’s very likely you’ll get much further with what you are doing now than you think you will. He’s not in that bad of shape, he’s just had some things that have festered longer than they should have.

In addition to what Chad has suggested you might also consider discussing food therapy and having him do moxibustion at home. You might be surprised (or horrified) how much soda people drink which for someone like this patient would almost assuredly slow down the progress they could make. Now whether or not you feel the patient would actually follow dietary recommendations is another issue.

Thanks so much for the encouragement! It can definitely be hard treating patients without the support of teachers and other colleagues at school. That is why I so appreciate blogs like this where we can ask questions and support each other.

Tumeric cleans up inflammation in the brain and if the formula has black pepper in it, it works about 16 X more effectively. It also tends to clean up systemic inflammation. There are so few things which cross the blood brain barrier. With so many drugs, I always make sure they are drinking water and have all their co-factors available via ancient salt and mg (either on the skin or pico ionic mg). They need something to exchange out waste and bring in nutrition while firing hot in the processes to do the clean up. At that point you can apply various herbs as you address issues one by one. I always throw in enzymes to help. I guess my favorite is protolytic enzymes on an empty stomach. Your needling releases endorphins which help with pain. Especially hit those essential master points of pain on the ear regularly.