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

forum post

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

Published on 01-05-2018

"anon129242" has authored 2 other posts.

I am a recent graduate of TCM (new practitioner). I had a new patient today that I need some guidence with.
Age 53 Male
Cheif Compliant: Back pain and Neuropathy in both lower legs and hands.

He has a degenerative disk in L5 - S1, he has had this for 7 years and is now developing scoliosis in lower lumbar.
His lower legs are puffy and dark in color because of poor blood circulation and low sensitivity.

He had a spinal tap 6 years ago which resulted in bacterial spinal meningitis for 6 days. He now has brain fog.

He has had a knee replacement in right knee 2 years ago. Recovering well. He also will be needing one in his left knee in the near future.

He is overweight, tall, and big boned. He has loose stools always for the past 4-5 years, bruises easy, and bleeds easy.

He is on about 2 different pain medications. Which I am guessing might explain the loose stools.

Sleep apnea.

Sciatic pain on left leg.


Also feet also cramp up when standing for long periods of time.

Tongue: Pale purple, with white coat, teeth marks, red tip, stagnation lines.

Pulse: Right- Wirey/ Strong, weak lung
Left- Weak Liver, wirey.

I am seeing all sorts of signs here.
Spleen Qi def.
Kidney Qi def.
Liver qi stagnation
Blood Stasis

I just don’t know where to start. I treated him today with some Master Tung points for pain, focusing on low back and sciatica. Points to boost the KD and SP. Move Qi and Blood.

He is coming in again next week for another treatment.

Does anyone have any suggestions of where to start or tackle a case where everything seems to be going wrong!

Thank you in advance.


This post has the following associations:

Acupoints: ex huatuojiaji, gb 20, gb 34, gb 39, gv 20, ht 7, lv 8, sp 9, ub 32, ub 40, ub 60

Below are the most recent, view all here.

Comments / Discussions:

comment by "ChadD" (acupuncturist)
on Jan 2018

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:

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.

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comment by "anon129242"
on Jan 2018

Thank you so much for the feed back! You have really brought some clarity to me in this case.

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comment by "StephenS" (acupuncturist)
on Jan 2018

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.

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comment by "anon112280"
on Jan 2018

It seems like you’re on to the right track from your description and the replies you’ve gotten.

I just want to encourage you (as someone who is still in school and has the help you are wanting), remember to treat the main complaints of pain first. It sounds like you did this with the Master Tung points, so right on!

The other things sound like a Kidney Qi and Essence Deficiency (bones, back pain, scoliosis, sciatica, knee pain, marrow issue - even though this was caused by a phlegm pathogen/bacteria).
There also seems to be a Spleen Qi Deficiency due to long-term medication use, as well as the leaky blood and blood stasis (not enough Qi to move in the vessel).

I am still a student, but the one of my professors always says, “be an expert of the basics!”

You’ve got this!

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comment by "anon129242"
on Jan 2018

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.

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comment by "Dr.NubbyDAOM" (acupuncturist)
on Jan 2018

Don’t know what state you’re in , but here in California there’s so much competition that you need to get results fast or patients just walk to another practitioner. Accordingly, it may be best to focus on his pain–branches, since his systemic issues–roots–will take more time to sort out.

Don’t know which Tong points you’re using, but when used properly they’re great. Unfortunately, they don’t combine well with other 12-channel protocols, so I’d do either/or.

Ear points–and other micro-systems can be added to Tong needle Rx.'s without issue; which is something I often use. Add some lumbar ear points to maximize pain relief.

Long-term, he’ll need support for his deficiency and stagnation issues. As earlier posters have advised, diet is crucial for this. I’d also put him on a single patent formula, like a Xiao Yao Wan variant, which is inexpensive and will help accelerate healing.

Also, educate him that he’ll be needing a fair amount of care from you to feel better. If money is an issue, then have him do regular qigong.

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comment by "leapingfrog"
on Jul 2018

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.

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