amyjenner: June 24, 2020, 7:47pm
75 yr old woman with chronic back pain. Had someone jump on her for a piggy back as a teen and has had pain
ever since. Spinal fusions of the lumber in 2010 and 2014. 3-6 (has extra vertebrae)
She walks gingerly with little steps. Very stiff looking. She is very neatly dressed with matching handbag and
shoes. Takes time to do a little lipstick Sits quietly with ankles crossed and hands in her lap. Dull eyes +8. Medium
build, not over or under weight. Very little facial expression. She feels heavy to be with, like conversation is going
to be work +8. I get the feeling sitting with her that she is exerting tremendous control to maintain a placid exterior
composure +8. Drives a lexus and has a fancy address.
Pain: left sacral pain good days 4/10 bad days 8/10. Hydromorphone 2 mg daily
Better with walking
better with ice
better with lying down
better with support brace. wears one all the time
worse with over doing
worse with heat (cant use car seat heaters)
Sleep: insomnia +9. since childhood. uses lunesta daily. Childhood trauma of abusive dad, felt she
needed to protect other siblings
hot and sweats at night +6
Diet: No sugar. she is very mindful as excess weight would aggravate pain
Stress: +8 difficult marriage of 50 years. states that her husband wont fight with her just walks out of the room.
= frustrating nothing feels like worked through in 50 years.
Digestion: feels gross on waking nausea +6, poor app +6
Constipation +8 -Takes Linzess a Med for IBS with idiopathic chronic constipation and colace x3/wk.
with that combo, BM daily
Hands and feet tingle all the time like they are falling asleep +3
Temp: cold all the time +7
Varicosities: none that I can see -10
Skin: dry, oiled all the time +10
Tongue: red body, dusky center. thin coat, no distended sublinguals
Analysis:
Liv xs: heavy lifting to be with her, dull eyes
GBxs: frustration/anger with husband and chronic pain, pain better with movement, pain location, insomnia
PCxs: very quiet and controlled, need a brace to stand upright, cant seem to be heard in relationship
HTxs: pain likes cold, pain along BL channel
BLxs: she is cold, not a warm fuzzy person, pain location15/01/2024, 12:25Difficult chronic back pain – Qiological Community
https://forum.qiological.com/t/difficult-chronic-back-pain/1104/print2/6
LIxs: dryness, dry constipation, dry skin,
SPxs: Tingling extremities?
Luxs: not much moisture anywhere that I can see for the inside, but she is well resourced, nausea daily on waking
STxs:
SIxs: little bld stag, mixed hot and cold, age
Kid xs: attention to dress and presentation, Pain ?, mixed hot and cold
1st TX: BL+R – reported feeling better when getting up the next day but didn t last
2nd TX: BL+R & SI+L – again, reported feeling better the next day but didn t last.
3rd TX: PC+ – pain started ramp up, started burning and radiating down to the top of the thigh. I removed needles
and put in GB+. It calmed down again. During the flair of the pain I could just feel her wanting to sob. So I asked
if she were a cryer? She said not much but started to cry as we talked about all she was carrying and holding in.
She pivoted the conversation to be about a friend who died recently of cancer. Reported this morning that it was
pretty bad on waking.
There is definitely some GB/PC stuff to get sorted out here. In retrospect it I m wondering about the GB fighting
situation maybe manifesting as pain in this situation. I guessing the timing was just off Scary in the moment. I
remember a retelling of a Toby experience of using BL+ to help chill out the GB when it fights back didn t think
of it in the moment and I had already used it twice in a row.
In typing this up, I m getting more of a picture of how much repressed emotion and unresolved trauma she is
carrying.
I would appreciate any thoughts, my friends.
sweiz: June 25, 2020, 12:10am
Hi Amy, I feel a bit strange replying as I haven t been practicing acupuncture now for a while and there are those
that have so much more depth with Saam than me. However, this case really struck me. I felt so badly for her that
she has been suffering for so long with such STASIS! The emotional aspect feels so primary with your description
of her control and primness. It s like I want to wake her up to what is possible in life! That makes me think about
GB deficiency/PCexcess. Where is her MOJO! I can understand the Bl/Ht approach but the emotional repression
was painful for me to read. I wonder about supplementing GB since the anger is so repressed? I ve done this on
people for whom I just want to wake them UP to how awesome they are. This is diagnosing by my own experience
when I am with them. Each time I have done this, treated the GB deficiency, it has been noticeably helpful. I look
forward to what others say.
KristinWisgirda: June 25, 2020, 12:11am
Hi @amyjenner. Thanks for the very interesting case.
amyjenner:15/01/2024, 12:25Difficult chronic back pain – Qiological Community
https://forum.qiological.com/t/difficult-chronic-back-pain/1104/print3/6
SPxs: Tingling extremities?
I see the question mark. I would want to see more loss of sensation than tingling. Maybe it is a mix of both.
Anyway her tongue is red and her back doesn t like heat but her extremities are cold and tingly.
amyjenner:
I remember a retelling of a Toby experience of using BL+ to help chill out the GB when it fights back
If Gb excess was resisting the P+ treatment, I would think that needling GB+ would be agitating. The UB+
application you mention is when the patient is so agitated and erratic and all over the place, the calm grounding
influence of P is not going to be enough. They need a cold bucket of water to shock them out of their frenzy. Those
who attended the Tucson class last year saw such a case at the end of one of the days.
The P/GB axis is such a can of worms for her. I hope she stays with you so that you can help her sort it out.
My mind at first went to SI+ on the right, for her decades of stuckness in old patterns but also because the shu
point is on the sacrum. I caught a peek of your post as you were writing it and saw that you mentioned her
matching items were all pink. My imagination conjured a woman in costume from an earlier era and dampened my
impulse to diagnose K excess. Maybe it is less odd than my imagination lead me to believe. The lack of varicosities
at her age also really stands out to me and makes me now want to avoid SI+, especially since she has also already
had it on the left side and her pain is better with support/lying down. More needs to be cleared up before trying K+.
My favorite idea is ST+. The St/Lung very clearly goes to Lung excess with the poor appetite, the dry skin, the
great resources, the nausea, the constipation. ST+ will lighten her load and help open her up to receive future
treatments even though it might not immediately impact her pain. Opening up the middle will help circulation to
her lower body. It is a clear and safe next step. You might even explain that this treatment is preparation for future
treatments to set her expectations about pain relief low. You can see what settles out after this treatment.
SJ+ could be considered at some point except that her back doesn t like heat.
Clinic is hard. It can be helpful to ask yourself which quality she needs most during the next treatment.
Please let us know what happens.
KristinWisgirda: June 25, 2020, 12:18am
Amy used GB+ when P+ went south without any improvement in pain. Maybe the crying she did after GB+ could
be considered a net gain. As well:
amyjenner:
states that her husband wont fight with her just walks out of the room. = frustrating
Sounds like part of her is looking to shake something up.15/01/2024, 12:25Difficult chronic back pain – Qiological Community
https://forum.qiological.com/t/difficult-chronic-back-pain/1104/print4/6
amyjenner: June 25, 2020, 10:12am
Thank you all, like Sharon I wanted to move all the stuckness, but after the PC/GB experience, I don t think she is
ready for that at this moment. I thought I would try ST as I often find I have to step back and ignore the primary
complaints and just treat what I see in terms of body type. Despite having a bad day after the treatment, she
reached out last night and is coming in this morning. I ll let you know how it goes.
I was re thinking the SI/Kid. With all her attention to presentation I am thinking kid xs, but lack of varicosities and
age go with SI xs. I did ask her about her menstrual hx to go fishing for blood stagnation and she said she had
awful cramps . Course that was 30 years ago at this point
What do you make of the fact that the pain hates heat but she is cold? I was thinking about Liv +HT as it is gently
warming, and moving. She does seem like a reassuring mom hug would go a long way. And then SJ, with all the
Liv xs to give her some lift which she needs physically and emotionally. I wasn t sure what to with the fact that the
pain is aggravated by heat but she is cold all the time. I think of SJ as a bit warm but mostly light. Thoughts?
KristinWisgirda: June 25, 2020, 1:42pm
Good morning,
amyjenner:
What do you make of the fact that the pain hates heat but she is cold?
Lots of life force stuck in the center, unable to warm her extremities.
Since you used GB+ last time, with unclear improvement, you wouldn t want to use it again for this treatment
anyway. How much the response was from the off input of P+, I m not sure.
The Liver+ with H+ came to my mind as well though with really complicated people I like to stick to 1 channel at
a time for clarity s sake. The liver/H combo is a special exception. H+ goes to the problem spot and Liver+ would
moderate the heat while relaxing what is too tightly held and meeting the left sided problem.
How much of her attention to presentation is real look at me K excess and how much of it is her being good girl
and following someone else s idea of what she should look like?
amyjenner: June 25, 2020, 6:21pm
15/01/2024, 12:25Difficult chronic back pain – Qiological Community
https://forum.qiological.com/t/difficult-chronic-back-pain/1104/print5/6
Good question on her appearance I think it is more a part of her tightly holding things together. She very badly
wants it to look ok to the outside world. So, maybe that is more in the PCxs column?
When she arrived today, she said she was having more pain than she had experienced in a couple of years. Could
hardly move to hinge forward or to rotate at all. I had her lie in her most comfortable position which is on her right
side. I put in ST+ and she said it all started relaxing. After 10 min or so, she said it was getting sore again, so I took
out the needles and had her shift to a more comfortable position. the Pain went away, so I put the ST+ needles back
in for another 10 min. She had less pain and stiffness and more ROM when we were done.
We also had a conversation about the complexity of the situation. All the emotional issues being rolled up in it as
well as the physical. I told her I shared the case with all of you and she was pleased to have a team on her case. So,
for now anyway, she is on board. We will see how it unfolds.
KristinWisgirda: June 25, 2020, 6:39pm
amyjenner:
Good question on her appearance I think it is more a part of her tightly holding things together. She very
badly wants it to look ok to the outside world. So, maybe that is more in the PCxs column?
PC is the rule follower. SJ is the controller though I don t know how that sits with the rest of her presentation. It
may be enough just to question the Kidney excess.
It sounds like you gave her an extra Liv/H combo treatment in how you cared for her today.
Do you get a sense that she is overall more excess or deficient? It is really helpful in complicated cases to ask this
question.
The significant aggravation of her pain, clearly takes GB+ off the table for the time being. This case reminds me of
a patient with a similar history and a similar P/GB imbalance situation. I hope to present this case at the advanced
class since we finally had a breakthrough though it took a long time and an unconventional approach to get her
relief.
amyjenner: June 26, 2020, 12:44pm
well, that was a teaser!
I think it is both the rule follower and the controller. Although she is pretty depressed and heavy feeling so I
probably wouldn t do Liv+. I was actually thinking of using SJ+ for the light and opening aspects. I ll see her next
week and we will see what happens.15/01/2024, 12:25Difficult chronic back pain – Qiological Community
https://forum.qiological.com/t/difficult-chronic-back-pain/1104/print6/6
cassiopeia: July 26, 2020, 2:34am
Sooooo, what s been happening? I m going through all the threads to learn via firehose. Totally on the edge of my
seat to hear what this pink-wearing rule-following unhappy woman is up to.
amyjenner: August 3, 2020, 11:53pm
Thanks for the nudge to fill you in on the sad tale. Well, she came back in, I did ST+ after our forum discussion.
She is only comfortable on her side so I did it in that position. It was feeling good but she started to feel a
throbbing pain after 10 min. I removed the needles and had her re adjust position to the other sides and put the
needles back in for the final 10 min. She left feeling better. Looser and more relaxed. That was a thursday. I got a
text Sunday evening saying she was in tremendous pain, had been all weekend and wanted to cancel the monday
apt. Monday I get a text saying she is in a lot of pain and can she come in. So, she comes in on Tuesday. I decided
to use Liv+. The pain subsided immediately. Then it comes back full force after about 4 minutes. I had her switch
sides and re inserted the needles. Again, good for several minutes, and then comes blasting back. I took the needles
out and was basically just trying to do some energy work and praying. Then I had the idea that maybe my friend
Connie, fellow Sa am-er and also a PT might be able to see her. So I text Connie to see if she has time. I get the
text back, I m in your driveway . A prayer answered, right? So, Connie comes in, muttering about how much she
hates SI pain cases, and sets about doing some evaluation and some did some hands on work with her which
followed the same pattern relief at first and then the throbbing comes back. At that point the situation was pretty
aggravated so we didn t want to push it. After that, I transferred her care to Connie, who saw her a couple of times
and wasn t able to make much headway either. It is a complicated, long term situation. From both Connie s and my
standpoint, there are things the patient could do to help herself but is unwilling to do. It would be a long slow go no
matter what. Sorry it wasn t better news!
KristinWisgirda: August 4, 2020, 1:47pm
Thanks for the update Amy. Sorry to hear that there was no happy ending to her story even with extra help from
Connie.
Clinic can be heartbreakingly hard some days.