Chapter 46. Treatment – pulling it all together
Chapter contents
Introduction359
Patient 1 – Andrew359
Patient 2 – Bernice363
Patient 3 – Caroline367
Patient 4 – David368
Patient 5 – Elisabeth369
Patient 6 – Felicity369
Patient 7 – Gordon371
Patient 8 – Holly371
Conclusion372
Introduction
The goal of a diagnosis is to understand the nature of a patient’s physical, mental and spiritual imbalances as clearly as possible. Diagnosis should answer four questions:
• What is the person’s CF?
• Which other Elements/Organs are in distress?
• Are there any ‘blocks’ to successful treatment?
• What is the primary level of treatment – body, mind or spirit?
The previous chapter described various methods practitioners can use to answer these questions in order to form a diagnosis. Once these questions have been answered, practitioners move on to the first stage of treatment which is based on ‘testing’ the diagnosis. When practitioners are certain of the CF, and are sure that any blocks have been cleared, they then need to discover how best to treat each individual patient. Some useful question to ask are:
• Does the patient primarily need treatment using command points?
• Does the patient need to be treated using points that focus on the spirit?
• Does the patient need to be treated on any other Elements besides the CF?
• Does the patient flourish with a small number of points or is a large number preferable?
• Will the patient benefit from moxa?
In the rest of this chapter are two longer case histories followed by another six shorter ones. These illustrate some of the various kinds of diagnoses and treatments practitioners might carry out. The names of patients and some aspects of the case history have been changed for confidentiality.
Patient 1 – Andrew
Andrew was 45 and single. He seemed friendly but rather distant when he first met his practitioner. He told her that he worked as a computer programmer and had been in the job for 4 years.
Main complaint
Andrew had been suffering from insomnia for the last 3 years. He said ‘I toss and turn and feel fidgety and too cold and it sometimes takes me two hours to get off to sleep. It’s bad even if I feel tired when I go to bed’. He didn’t know why it had come on, ‘just one of those things’, but it was now bad about 80% of the time. (His practitioner tested Earth at this point and gave him sympathy which he accepted and moved through easily.) He said he didn’t usually wake once he’d gone off to sleep although he’d occasionally wake in the early hours around 3 a.m. The insomnia was worse if he was stressed or feeling upset.
Secondary complaint
His secondary complaint was asthma. He’d had this since he was 10 years old. It had come on gradually and did not cause him much trouble these days although it was worse when he exerted himself. The asthma had been bad when he was a teenager but now caused him very little problem as long as he took his daily inhaler.
Present situation
Andrew worked very hard as a computer programmer and indicated that he loved the status and good financial rewards he gained from it. The job was now ‘too easy’. In the past he had changed jobs frequently and he thought he might look for another job soon. He also had difficulty with his boss at times, ‘the boss can be overbearing and pushy and doesn’t always understand things as well as I do. Like yesterday he was putting pressure on me to finish my current job without knowing what exactly I needed to do’ (the practitioner tested Wood here and suggested that this must be frustrating. Andrew agreed and got slightly angry – the practitioner judged this to be appropriate).
Andrew had very little social life although he had a sporadic sexual relationship with a colleague. He had had a few relationships in the past but all were fairly short lived. He had had a major relationship for two years when he was in his thirties but she’d gone off with someone else. He admitted that it had left a big hole in his life. (He choked up as he talked about this – indicating that he was still feeling some loss.)
Questioning the systems
Andrew’s appetite was good. He loved food and cooking and he talked about some cookery classes he had enjoyed. (The practitioner thought his joy came and went smoothly but he still seemed a little flat.) About twice a week he had indigestion and this could be quite painful, especially after a big meal. Antacid tablets helped this. Andrew also mentioned that his energy levels were down on what they used to be and had been worse for three years, since not sleeping well. He said his bowels were normal and he might go twice a day and they would be slightly loose. He had had a rumbling appendix several years ago. This was no problem now. The practitioner wondered if it might come back but Andrew said he didn’t think it would. (The practitioner thought this was an appropriate response and he could reassure himself.) He had a tendency to feel the cold rather than the heat. Urination, perspiration and other systems were all normal.
The pulses
| Left | Right | ||
|---|---|---|---|
| SI −1 | Ht −1 | Lu −2 | LI −2 |
| GB − ½ | Liv − ½ | Sp −1 | St −1 |
| Bl −2 | Kid −2 | PC −2 | TB −2 |
Andrew’s pulses were all very deficient and the Liver and Gall Bladder were the strongest pulses.
Family history
His relationship with his father had been very poor. His father had been a very successful entrepreneur who had little time for his son and his approval had been inextricably linked to his son’s level of academic and sporting achievement. He had been closer to his mother and she had died a few years ago. He showed little emotion about this and said he had not had difficulty accepting her death. He now saw his father ‘sporadically’.
The diagnosis
Andrew appeared to be a Metal CF. The practitioner thought his colour was white, voice tone weeping and the odour rotten. His grief seemed to be his most inappropriate emotion. At times he seemed to be extremely inert with little sense of loss when it might have been expected. At other times he would choke up and appeared to be feeling a lot of grief. When the practitioner showed him respect and appreciation for his achievements he had been unable to take this in.
Supporting evidence for the diagnosis was also present in his relationship with his father and the way he was driven to find ways of feeling better about himself in relation to his financial and career status. The practitioner also noted that although Andrew said that he had been unaffected by the death of his mother, the commencement of his insomnia had coincided with this. He also sometimes woke at 3 a.m., which is the horary time for the Lung.
He was also slightly irritable at times and had some green around the eyes. These both indicated that his Wood Element was imbalanced. The practitioner considered that there was a possibility of an Entry–Exit block between the Liver and Lung, especially as the pulse of the Liver was considerably fuller than that of the Lung.
The practitioner was also concerned to see an improvement in his Fire Element as he was also quite lacking in joy.
The practitioner’s diagnosis sheet looked like this:
Diagnosis Sheet
Name: Andrew, Age 45
Patient’s main complaint: Insomnia – tosses and turns and can’t get off to sleep.
Secondary complaints: Asthma
CF: Metal. Andrew looks white, has a weeping voice tone and has a rotten odour. His grief seems to be his most inappropriate emotion and he swings between grief and a lack of grief.
Next most likely CF: Fire. He seems to find it difficult to raise much joy.
Other Elements: Wood. He seems to be somewhat irritable and be green around the eyes. Earth. He accepts sympathy smoothly and does not appear to sing or be yellow. Water. Appears to be able to reassure himself. He shows appropriate fear when asked about the future. No blue colour. Metal.
Blocks:
H–W: Don’t think so.
AE: Possible, need to test.
Possession: Internal or external: Unlikely.
Entry–Exit: Pulses, colour and emotion indicate this is possible between Wood and Metal.
Level
Body: No apparent reason to think so.
Mind: Andrew seems to be able to think very clearly.
Spirit: I think this is the primary level, as he seems inert and unable to respond.
Physical Examination: Upper Burner is cold.
Akabane: Sp 5/16
The treatment strategy was as follows:
Treatment Strategy for Andrew
Treatment principles and order of priority
• Check for Aggressive Energy.
• Strengthen and warm Metal CF at the spirit level.
• Treat Fire Element if necessary.
• Clear Liver/Lung block.
Examples of appropriate points to use
1. Clear Aggressive Energy: Bl 13, 14, 18, 20 and 23
2. Balance Akabane: Sp 4
3. Treat Metal CF: Examples could be Lu 9, LI 4, Lu 8, LI 1, LI 11, Bl 13, Bl 25
4. Treat Fire CF: TB 4, PC 7, SI 4, Ht 7 and other points.
Appropriate number of points to use
Suspect will need only a small number of points as treatment is directed to spirit level.
Moxa, if appropriate how much, and on which points?
Moxa will be appropriate as patient feels the cold and the upper jiao is cold.
Lifestyle changes that the patient may need to make
Ensure spends some time relaxing before going to bed as can work late on his computer. May need to consider eating earlier as currently eats late at night.
How to assess if the patient is improving
May become less inert and able to express emotions. He may wish to have more interaction with others at work and create a more social life. Expect his sleep, asthma and indigestion to improve. Expect his pulses to become stronger and more harmonious.
Treatment 1
At the first treatment the practitioner tested for Aggressive Energy on Bl 13, 14, 18, 20 and 23. There was no redness around the needles and the pulses didn’t change, so the result was negative
The practitioner then decided to correct the Akabane imbalance on the Spleen and treated the luo junction point Sp 4 on the right side. This corrected the imbalance and brought up the Spleen pulse but no other pulses.
The practitioner then went on to ‘test’ the CF and treated the yuan source points of the Metal Element, Lu 9 and LI 4. These were tonified without retention. This produced an excellent pulse change. The Lungs and Large Intestine barely changed but all the other pulses came up and harmonised to a similar quantity. The rear positions remained more deficient. Moxibustion was then added to the same points. This had the effect of making all the pulses feel slightly stronger. Usually moxa cones are used before needling. In this case it was added after the needles to support the effect of the needle.
Treatment 2
Andrew reported that he felt more energetic for a couple of days but otherwise was much the same as ever. The pulses had gone back to how they were at the commencement of treatment. The practitioner decided to test for the presence of an Entry–Exit block between the Liver and Lung. This was based on the discrepancy between the pulses of these two Organs, the green colour, irritability and the presence of asthma – a symptom situated between the Exit point of the Liver and the Entry point of the Lung.
Liv 14 and Lu 1 were both tonified as both Organs were deficient. The change on the pulses was striking.
| Left | Right | ||
|---|---|---|---|
| SI −1 | Ht −1 | Lu −1 | LI −1 |
| GB −1 | Liv −1 | Sp −1 | St −1 |
| Bl −1 | Kid −1 | PC −1 | TB −1 |
All the pulses had changed and were now harmonious in terms of strength and quality. Despite being tonified, the Wood pulses were now more deficient, so they were more in harmony with the other pulses.
The yuan source points of Metal were then tonified again. This created a slight strengthening in all of the pulses.
Treatment 3
Andrew reported substantial improvement in his sleep and he was now getting off to sleep more easily most nights. His asthma and indigestion had also improved and he said that he had felt ‘on very good form all week. Really cheerful and better energy.’ There was no longer any green on the face. The pulses were slightly weaker than at the end of the previous treatment but the increase in harmony had been maintained.
The practitioner used moxibustion and tonification on the tonification points of Metal – Lu 9 and LI 11. All the pulses felt stronger at the end of treatment.
Treatment 4
Andrew said that progress had been maintained. He was sleeping better and had also reduced using his inhaler. He said he had been surprised to find that he needed to use it only once a day instead of the previous twice. He had also dramatically reduced his antacid consumption. He said that he felt ‘really well’. The practitioner did not treat the patient that week.
Treatment 5
Andrew had had an upsetting appraisal at work. His supervisor obviously did not hold him in anything like as much regard as he had thought he deserved. His sleeping and chest had been worse, as had his mood. His indigestion was fine. On examination his pulses were as follows:
| Left | Right | ||
|---|---|---|---|
| SI −1 | Ht −1 | Lu −2 | LI −2 |
| GB −1 | Liv −1 | Sp −1 | St −1 |
| Bl −1 | Kid −1 | PC −1 | TB −1 |
The practitioner thought that strengthening of the pulses was needed. The back shu points of the Lungs and Large Intestine – BL 13 and 25 – were tonified and moxa was used. The pulses felt stronger after this treatment. The practitioner had intended to also use the yuan source points if the change had been moderate, but did not need to use them.
Treatment 6
Two weeks elapsed, as the practitioner was on holiday, but the patient said he felt much better after the previous treatment. He commented that he had been very low for about 24 hours and then felt much better in himself (see Appendix E on treatment reactions). His sleeping and general energy had also improved. He had also on the practitioner’s advice been eating earlier in the day.
The practitioner tonified the luo junction points Lu 7 and LI 6 with moxa. All the pulses felt better.
Further treatments
The patient continued to benefit from treatment. Nearly all of the treatment was focused on the Metal Element. Other point combinations used were the Windows of the Sky, Lu 3 and LI 18, Bl 42 with the tonification points, and Du 12 with the yuan source points.
After treatment 6, Andrew’s treatment was spaced to fortnightly and rapidly moved onto monthly visits. He continued to come for treatment even though his physical symptoms had improved. This was because he had noticed that treatment had a positive effect on his well-being. He felt able to consolidate the previously casual relationship with his work colleague and they were even talking of moving in together. On one occasion the practitioner sedated his Wood as he was furious with his girlfriend and the pulse was very full. In general his Wood remained much better than before the Entry–Exit treatment. His indigestion never returned and he was less irritable. He also had fewer problems with his asthma, only needing to use his inhaler occasionally. He still had occasional bouts of insomnia but these were less prolonged. He also felt generally warmer in temperature.
On a couple of occasions the practitioner tonified his Pericardium and Triple Burner. Although he was obviously jollier than before, the pulses were inclined to remain low and the practitioner thought there was scope for improvement in this area. Treatment yielded only very slight pulse change and the practitioner did not persist.
Patient 2 – Bernice
Bernice was 56 and married. She had one child, aged 28, from a previous marriage. She looked young for her age and was well dressed but also pale and drawn.
Main complaint
Bernice said she had been very anxious and depressed since she had split up from her husband nine months previously. ‘We’re still seeing each other and are trying to make a go of it, but the fact he wanted to break up was a complete shock.’ Although somewhat anxious before, she had completely lost her emotional stability since the break-up. She was getting mood swings and had not felt herself at all. She admitted that he had always been a philanderer but she loved him. She now thought about him obsessively. She had been offered antidepressants but had refused to take them. (Bernice related this in a flat and joyless voice tone and she also cried. She accepted and appeared to enjoy the sympathy the practitioner offered. The practitioner noticed that her eyes looked very dull and lifeless.)
Secondary complaints
She had low energy and no vitality since her husband left. She also found it hard to sleep at night and would wake intermittently thinking about her husband and their situation and finding it hard to get off again. She also complained of some pain in her left shoulder that had been there for the last six months. This caused her no restriction in movements and tended to be worse when she was tired.
Present situation
Bernice ran the administration department of a large company in her home town. She said she loved her job and enjoyed both the organisation and overseeing her staff of six. She brightened up and became more animated when talking about it. She had been off work a lot recently because of the break-up and although the company had been sympathetic they were now putting her under pressure to work more regularly again. She said she felt frustrated by this but understood why they were doing it. (Her practitioner thought that her response was appropriate.) When questioned about any possibility of losing her job she looked a bit hesitant but said she didn’t think this would be a problem. (The practitioner didn’t think this was really enough to check her response to fear and decided to test again later.)
Bernice said she lived on her own but her husband occasionally visited at weekends. The house was on the market as she couldn’t afford to pay the mortgage.
Family and personal history
She had been a ‘war baby’. Bernice’s mother had been mentally ill and her father in the US army. The father had abandoned the family when she was a few months old and she had been taken from her mother when she was 7 years and sent to boarding school. ‘I loved the school because it gave me stability and I had one very close friend.’ She said she was still in contact with her mother. She described herself as ‘an introverted child’ and said she didn’t really come out of herself until her teens. ‘I now have issues to do with abandonment.’ (She related this sometimes laughing and at other times sounding very flat. When her practitioner gave her respect for how she’d survived this ordeal she agreed and said she thought she’d survived it well. Her practitioner also told her how young she looked – at this Bernice completely brightened up and her whole face lit up.)
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