jpark: January 21, 2022, 2:49pm
Female patient, early 50s.
Cc: Neck and shoulder pain
She has had shooting, nerve like pain in her neck, posterior shoulder and scapula, and arm down to her elbow for
several years now. Diagnosis of cervical stenosis. Pain trajectory follows the SI and SJ channels. Worse with
computer use, which is a heavy part of her job. Has tried chiropractic, physical therapy, massage, none have given
her lasting relief.
Patient is very lean, petite, symmetrical, looks younger than her age, moist skin, extremely active despite neck
pain. Tendency to carry stress in upper back, which is often hypertonic and tight. Very driven. Bright eyes, detail
oriented, always asking very specific questions about treatments. Full time job and husband who also works full
time, well resourced.
She has a large gallstone which will occasionally give her problems when she eats greasy foods (which she
enjoys). She believes some of her right shoulder pain may be referred from the gallbladder.
She has a small cyst on her first finger on the right (Large Intestine Channel) which she believes developed due to
overuse of this finger at work.
Digestion unremarkable but does have diverticulosis, which normally doesn t have any symptoms but will
occasionally flare up causing abdominal pain and constipation.
Diagnosis: KD Excess
First four treatments over a period of 2 weeks, needles always inserted on the left (contralateral from chief
complaint):
First visit: SI+
She reported immediate relief of pain and improved range of motion after the first treatment, and was shocked at
how much she had improved – more than multiple rounds of PT and chiro with just 4 needles!
Second Visit: SI+
Continued improvement in pain and ROM of shoulder and arm. After this second treatment pain is mainly
concentrated in her right elbow, along the San Jiao channel.
She did report a flare up of gallstone pain between visits triggered by eating greasy food.
Third Visit LV+
She reported immediate relief of elbow pain after this treatment. No real nerve like pain for the first time in several
years.05/01/2024, 11:53Treatement Worked Until It Didn’t – Bothersome Clinical Problems – Qiological Community
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Fourth Visit: LV+
Would like to work mainly on stress, so I did another LV+ treatement to give her some additional shielding and
support her Blood. At this point I told her to just follow up as needed for maintenance, maybe once per week to
start.
She did report one diverticulitis flare up in between visits, but this resolved on its own.
Fifth Visit (one week later): SI+
Her workload has suddenly increased, and now her pain is coming back in the usual area, scapula, neck, arm and
elbow. Lots of stiffness in the neck.
Sixth Visit (one week later): LV+
She reports minimal relief from SI+. Feeling very stressed from work. I do LV+ to give some additional shielding.
I am not sure where to go from here, with really profound initial relief followed by some backsliding. SI+ and LV+
seemed like the right choices initially, but seem tapped out now.
Her pain is being triggered by repetitive strain due to her work. I am not sure if it s unrealistic to expect her to be
out of pain completely given that her job is constantly putting pressure on the neck, shoulder, etc.
I am wondering though if I am missing something more fundamental and constitutional here.
I am considering LU+ due to her body type, symptoms clustering on the right (including rib pain due to gallstone),
small cyst as surface dampness. I need to look at her thenars to confirm if this is the right approach.
(I realize I need to get better about assessing body areas like thenars, medial heels, ribs, abdomen)
I considered LI+ due to the fact that damp food is upsetting her digestion and the cyst on the LI channel, but her
small, lean frame and driven nature make me less inclined to select this.
I also considered KD+ because of the area of chief complaint, and having done SI+ several times now but I am
hesitate to consolidate when there is fixed pain.
I don t see any signs for HT/BL or PC/GB. I should probably inquire more about temperature.
Would appreciate any feedback !
George_Mandler: January 29, 2022, 1:09pm
Hi Joshua
Yes, no problem stays solved in a complex dynamic system. I find it can be maddening when a treatment works so
well for a problem and then weeks later that seemingly same problem does not provide results. I have experienced
that too many times in patients and also with self-treatment.
My view is that we give the body a medicine it needs, but then it no longer needs that medicine. I liken it to the
experience I have of eating something I have not had in a while and it tastes so delicious, but if I have it again a05/01/2024, 11:53Treatement Worked Until It Didn’t – Bothersome Clinical Problems – Qiological Community
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few days later it just doesn t taste as good as the first time. That 70 s Foreigner song Feels Like the First Time
seems to ring true in this Sa am system.
So in this case you ve hit SI+ and LR+ 3x each in a 5 week period.
I would consider other input. Could her pain be all gallstone pain?
jpark:
I am considering LU+
Yes thenars are helpful. You said she is well resourced. But more importantly check the right subcostal if that is
tender it can lend some more weight to consider LU+ supplementation. I d ask if growing up she ever had a
thought of not enough – heard of lack of money etc. It could be old resource issues even though now she is dong
well financially.
I would flush out the subtleties of the PC/GB system. She sounds like she has some GB energy to push. I have also
found upper neck/trapezius stress can relax with a PC+ treatment in some people if it fits. Does her energy sort of
come out at you at all even if she is saying nice things?
jpark:
She has a small cyst on her first finger on the right
If she runs warm, or there is some dampness signs (swollen tongue, craves sweets, sweaty) I might consider LI+
for 1 treatment even though it sounds like she is not one to get bored easily. However I d caution given her body
type – taken a deeper look at that SP/LI relationship.
I d also go through the nuances of HT/BL and see if one is just a little more than the other and consider if that is
what she may need in this particular moment.
I find when there are pairs that are so close I need to look deeper to find the pair that is a little more out of balanced
and ten consider supplementing the less excess channel. it can be a stepping stone to unlock the body so that the
prior treatments work again.
Daniel: January 28, 2022, 11:56pm
What is the nature of her work? how long has she been doing this work? Does she like it? What is the nature of her
relationships? Partner? No Kids? Was this by choice or biological? How old was she when menarche? Her
Menstrual history? Friends? Family? Early 50 s . . . did she go through menopause? What was it like? So thin –
even though moist skin – perhaps Sp+? – it fits her morphology – I not infrequently find soft tissue tightness like
this benefits from the moistening.
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