TCM: @thechannelproject Case Study & Follow-Up Questions
Andrea from @thechannelproject asked me to chime in to review the first of her Case Study Files. You can check out the case study itself here: https://www.facebook.com/groups/thechannelprojectcasefiles/
What ensued was a 45-minute video that I uploaded to Youtube breaking down the case study using 8 Differentiation Diagnosis. This is a collection of diagnostic steps which includes 8 Principles, Qi/Blood/Body Fluids, Zang-Fu and Other (6-Stage/4-Level/Triple Warmer/Five Element).
Today I received five follow-up questions from Andrea and I wanted to share them with you! I think these questions are great and I can take all the white space of a blog post I need to write all my thoughts down.
1. The cystitis - could this be damp heat? Also a tutor mentioned that damp heat can sometimes be a cause of insomnia.
No. I don’t see any Damp-Heat signs or symptoms. If there were, there would likely be a (thick) sticky-yellow coating on the patient’s tongue with the tongue body being red. Also, the pulse would be a lot stronger than it is; most likely rapid and slippery. Damp-Heat is an excess Heat condition and this patient has a lot of deficient and Cold signs. We could easily call the swelling in the ankles and feet Dampness but this is due to Cold, Spleen Qi Deficiency and Kidney Yang Deficiency.
Damp-Heat can be a cause of insomnia. Think of it as a milder case of Phlegm-Heat affecting the Heart.
2. Maciocia talks about arthritis being bony painful syndrome?
Yes, and I have learned to diagnose arthritis a little differently. It can be any of the types of Bi Syndrome and I talk about it extensively here in my podcast: https://sotcm.podbean.com/e/episode-seventeen-treatment-of-internal-diseases-part-one/ Arthritis can act like Wind Bi, Cold Bi, Damp Bi and Heat Bi, and these can be combined with the location it is occurring in such as Muscle Bi, Tendon Bi, Skin Bi, Bone Bi, Joint Bi and Vessel Bi. That being said, if a diagnosis doesn’t fit with the elements (Wind, Cold, etc) then a practitioner can diagnose just by location alone. Here is the breakdown that is found in my workbook:
Bi Syndrome can be categorized by the following pathogenic factors:
* - Wind (wandering) Bi: characterized by migratory pain, especially affecting large or medium-sized joints. Wind attack is the initial stage of an exterior syndrome, and its main feature is chills and fever. Tongue: nothing specific at initial stage; Pulse: superficial, slow if Cold, rapid if Heat, rolling if Dampness
* - Cold (painful) Bi: most painful of all, characterized by severe, sharp or stabbing pain, usually fixed, relieved by heat. For Blood stagnation, note the color changes in the painful area (pale or bluish purple). Tongue: pale or blue or purplish spots with thin, white or moist coating. Pulse: superficial or deep, tense or slow
* - Dampness (fixed) Bi: characterized by stagnation, turbidity, numbness or heaviness of body, especially common in the rainy season. Tongue: teeth marks, swollen if severe, with sticky/greasy coating; Pulse: rolling or soft
* - Heat Bi: characterized by local swelling, redness and pain, especially around joints, fever or other heat features in body. Tongue: red body with yellow coating; Pulse: rapid, forceful, superficial if recent, deep if longer
Bi Syndrome can be categorized by the affected regions:
* - Muscle Bi
* - Tendon Bi
* - Bone Bi
* - Joint Bi
* - Vessel Bi
* - Skin Bi
3. For a lady her age and who is deficient would 10-16 needles be ok? I don't actually know what is ok depending on patient state!!
16 needles total would be my maximum for anyone, really. If I could design treatments with 12 needles every time I would. But I can’t. Because everyone is unique. There are times where I have used up to 50 but that is rare. My biggest goal for planning any treatment is to have focus. Focus should be placed on the patient’s chief concern first and foremost. Other needles can take care of the larger problems. Where a practitioner places their root cause focus is what makes our medicine a personal art.
Probably more important than a patient’s age in regards to total needles is to make sure they have eaten something substantial and they don’t feel they have an empty stomach. Acupuncture tends to affect blood sugar and makes patients hungry. It’s happened to me where a patient ate a yogurt for breakfast and it was now 2pm. The acupuncture made them feel faint. Water and food rectifies this immediately.
4. Can you use moxa even if you suspect damp in the body? I didn't know if this would lead to heating it up and becoming phlegm?
What is quite interesting about moxibustion is that when it is taught it is quite easy to tell students, “Moxibustion is used to add Heat to the body. Don’t use moxa if there is Heat. Don’t use moxa if there is Damp because you’ll dry it out and cause Phlegm.” It’s more complicated (read: freeing) than that. Moxibustion can be used for Heat conditions, Damp conditions, Cold conditions and just about any condition. Traditionally, a practitioner would gently blow on the moxa to get it to burn a little faster to reduce. This is why, in my opinion, you’ll hear some practitioners caution using moxibustion outside because the wind will blow on the herb. That being said, Dr. Chen Rixin has a method called Heat Sensitive Moxibustion where he has moxibustion heat an area on the body for 45 minutes! He uses it for any health condition.
5. Would you add any points to help with question 2?
We definitely could. We could add some acupoints for the location of the Bi Syndrome - such as for the hands (LI4 + SI3, Ex-UE10 Sifeng), the feet (ST41, ST42, SP3, UB64), for Joint Bi (GB39) and for Bone Bi (UB11). As I explained in the video, when debating a case study the goal is to get as many acupoints on the chalkboard as possible and then build a treatment from there.