Neck pain worsened after treatment
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Patient: Female, 47 y
Complaint: neck pain, shoulder pain going to the right arm following large intestine channel
Symptoms: The patient presented a Yang attitude in general
and told me she had pain before her menstruation. Except from that no other symptoms
Tongue: Red, Dry, crack in the middle of the tongue with yellowish fur.
Pulse: Left pulse weaker than the right, all pulses weak in general.
My Diagnosis: The pain is situated on the Large intestine and small intestine, aggravated by work.
GB 20 and 21 ar painful with pressure. Localy it makes me think of a qi deficiency.
Adding the caracteristics of the tongue it makes me think of a stomach heat with phlegm due to yin deficiency.
My treatment: Liv 3, Liv 2, Sp 6, Kd 3, Pc 6, Gb 20 and 21, SI 10, LI 14 and 15.
The patient felt really relaxed after treatment. Nothing special happened on the next day.
I called her yesterday and she told me she had a horrible week with the pain worsened in the neck.
I'm used to telling my patients that there can sometimes be aggravated symptoms after treatment, a normal reaction to energy movement. But one week of worsened pain seems excessive to me.
How should I analyse this and, how should I face explanations due to my patient ?
Thank You
Tiburon
"anon65496" has published 4 other forum posts
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Comments / Discussions:
comment by "anon65496"
on Feb 2008
Hello Everyone,
Kenji, when I was talking about Qi Deficiency I thougt of te LI channel, since it's aggravated by work. Sure there was a Qi stagnation, on GB 20 and 21 since aggravated by pressure. I didn't explain it well, sorry for that .
Anyway, I saw the patient yesterday. She told me she felt a stong pain on all the right side of the head ( GB channel ). Wehn I had her on the phone, I thougt it was an aggravated pain of her neck and shoulder but that pain disappeared after just one treatment, all good :-) . This time I treated her with only GB 20 and 21, Liv 3 and Pc 6. The pain that was lasting since about one week left after 20 minutes of treating her.
Thanks for the comments.
Gassho Kenji San
Tiburon
Tiburon
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comment by "Kenji_Butsugan"
on Feb 2008
Diagnosis
The symptons would make me think the pulse is shallow and quick rather than weak, specially in the LV/KD area.
There is stomach heat and certainly yin deficiency =)
Pain with pressure usually means local qi stagnation rather than deficiency.
Treatment
LV2-> I like inserting and imediately removing the needle to treat LV fire and LV qi ascension (which could be the cause of the neck pain)
LV3 -> maybe its a bit too early to leave a needle here because it could tonify the LV yang more than LV yin at this time when the patient has a Yin deficiency pattern.
SP6 & KD3 -> Good for Yin deficiency syndromes!
PC6 -> excess stimulation could cause the Qi to stagnate further in the Jue-Yin channel
GB20 & GB 21 -> could have caused the neck pain if left without proper sedation of GB38 or GB44.
SI 10 & LI14 and 15 -> these are nice local points, I don´t think they would cause the pain to agravate unless left for too long on an excess syndrome which is probably not the case.
Also.. I´d use Huatuojiaji on the affected side i think it helps a lot (insert slowly and stop if the patient prompts for pain, careful with those vertebral arteries)
Considering the scenario you presented there is another possible explanation.
Ask if the patient stressed the affected area after the treatment, many people overwork the treated area if they feel better and it usually causes the symptons to get worse, specially if it´s a work-related disorder.
If it´s difficult for the patient to recover from Yin deficiency you could ask for him to take Chi Bao Mei Zan Dan for tonifiying LV Yin or Xiao Huo Luo Dan for Qi Stagnation.
Sorry about the English! Not my first language and not even a close second ^^
I really hope your patient gets better! And your treatment and diagnosis are not really wrong, these are just what i would do faced with the same situation!
>--(")--<
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comment by "archived-user"
on Dec 2009
It is a very regular situation for all practitioners, some patients have agravate pain. for this you should not talk on phone, you should talk to her face to face to make a new diagnosis, maybe some new situation happened you don't know. so make second appointment is very important.
Thank you
Regards
Feng Mei
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comment by "archived-user"
on Dec 2009
for some agravate pain, it is because after acupuncture treatment, the patient's energy channel is opened ( if you not close it by cotten ball), sometimes it is good for bad energy come out, but sometimes if your patient go home don't care of keep warm body, so cold energy will come into the channel make agravate pain.
Thank you
Regards
Feng Mei
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