Acupuncture and Chinese medicine

Patient: V. B  Sex: Male Age:57   Date of 1st Visit: 5/7/12

Chief Complaint & Duration:
•    Right buttock pain for over a year
History of Disease: (onset, characteristics of main symptoms, accompanying symptoms, relieving/exacerbating factors, development, tests, diagnosis and treatments, results of treatments)
•    Onset: Gradual onset over a year
•    Symptoms:  Radiating pain from R buttock to the lateral knee joint, sharp and dull pain, numbness and tingling sensation, Pain near GB30, L4-L5 region
•    Accompanying: Limited hip and knee ROM, especially pain with hip abduction
•    Relieving: Hot tubs and sauna
•    Exacerbating: Working, lifting heavy object, running, sitting too long
•    Previous treatments:  Saw a chiropractor and sports medicine doctor with limited improvement.  No x-rays.

General Information: (chills/fever, sweating, appetite/thirst, urine/stool, head/body, chest/abdomen, ears/eyes, sleep, emotions, energy, female disorders)

•    Chills/Fever:  Normal.
•    Sweating:  Normal.
•    Appetite:  Good appetite.
•    Thirst: Doesn’t drink too much fluid.
•    Urine:  Normal yellow color.
•    Stools:  1x/day, regular consistency.
•    Head: Normal.
•    Body:  Radiating pain from R buttock to R lateral knee. Please see above.
•    Chest:  Normal.
•    Abdomen: Normal.
•    Eyes: Normal.
•    Ears: Normal.
•    Sleep:  5 hours/day, remembers dream when he wakes up
•    Emotion:  Over-thinking, no stress
•    Energy:  Good.
•    Female: n/a
Lifestyle: (diet, exercise, stress, profession, smoking, drinking)
•    Regular diet.
•    Regular exercise.
•    Construction worker, soccer coach
•    No smoke
•    Drinks daily, moderate amount
Past History & Family History:
•    Family: none
•    Past: none
•    Medication:  none
Inspection of General Appearance: (spirit, speech, body shape and movements)
•    Looks little irritable
•    Red face, dry skin
Listening and Smelling:
•    Looks little irritable
Tongue: (body colour, shape, cracks, movements; coating: colour, moistness, thickness, peeled, greasy, ulcers)
•    Purple, swollen, no ct, some small cracks
Pulse: (location, strength, rate, quality)
•    R: Wiry, deep Kidney
•    L:  Wiry, deep Kidney

Summary of Main Symptoms and Signs
•    Right buttock pain for over a year
•    Gradual onset
•    Pain from R buttock to the lateral knee joint, sharp and dull pain, numbness and tingling sensation, Pain near GB30, L4-L5 region
•    Limited hip and knee ROM, especially pain with hip abduction
•    Worse with  working, lifting heavy object, running, sitting too long
•    Better with  Hot tubs and sauna
•    Remembers dream when he wakes up
•    Little intake of water/fluid during the day
•    Over-thinks
•    Drinks alcohol daily, moderate amount
•    Active life – work as a construction worker and a coach soccer
•    Looks little irritable
•    Red face, dry skin
Analysis:
•    In Traditional Chinese Medicine, the stagnation of the qi refers to a syndrome occurring in a certain portion of the body or zang-fu organ where qi is retarded and obstructed.  The symptom is due to the emotional depression, invasion by exogenous pathogenic factors, retention of phlegm, water-dampness and blood stasis, retention of food, trauma and deficiency of qi.
•    The stagnation of blood refers to retention of blood in the body, or in the meridians, and vessels of zang-fu organs due to the damage of blood circulation.  This syndrome is due to traumatic injury of the blood vessels leading to extravasation and accumulation of blood, obstruction of blood due to stagnation of qi, retardation of blood circulation caused by deficiency of qi, sluggish blood flow due to the invasion of cold into the blood system and the combination of blood and heat due to the invading the blood system.
•    The patient is very active working as a construction worker and a soccer coach.  His right sciatic pain was gradually developed from over-use trauma near the GB30 and along the gallbladder and urinary bladder channels.  This caused the damage of the qi and blood circulation and leads to the qi and blood stagnation in the GB and UB meridians.  Sharp, dull pain and numbness are results of the stagnation of qi and blood in the local area which inhibit the free flow of the qi and blood.
•    Liver ensure the smooth flow of the qi throughout the body, in all organs and in all directions.  Chronic qi and blood stagnation damage the liver’s smooth flow function and liver.  Liver also dominates the tendons and the dysfunction of the liver manifests as the tendon pain and loss of flexibility.  The purple tongue is a sign of the blood stagnation and the wiry pulse is the signs of the liver dysfunction and pain.
•    The emotional disturbance, such as irritability and over-thinking further damage the smooth flow of qi leading to the generation of the heat.  When the heat rises upward and disturbs the mind at night, vivid dream appears.  The heat rises upward and red face appears.  Over-thinking also damages the spleen’s transformation and transportation of fluid.  Alcohol consumption is another way of accumulating excessive dampness and heat in your body.  The swelling tongue is a sign of the dampness in the body. He should use Acupuncture in Toronto.

Diagnosis:
•    TCM:  Hip pain
•    Western Medicine:  Sciatica
Syndrome Differentiation:
•    Qi and Blood stagnation
•    Liver qi stagnation
•    UB and GB channel obstruction
•    Excess dampness and heat
Treatment Principle:
•    Move qi and blood stagnation
•    Remove channel obstruction – GB/UB
•    Resolve Liver qi stagnation.
•    Transform dampness and clear heat
Treatment Remedy
•    Tuina Massage: (Manipulations, channels and points; Principles: relax tendons/muscles, promote blood and qi circulation)
o    Manipulations: rubbing, one finger pushing, rolling, pressing, kneading, plucking, pulling on GB and UB channels from above to below the tender areas.
o    Point Selection:
    Right:  GB 30, Ashi near GB30,
    LI4, Liv3, SI3, UB60, UB40, Sp9, GB34, GB41

•    Acupuncture: (Point, explanation and manipulations)
o    LI 4: tonify method
    Yuan Prime: pathway disorders, targets origin of channel
    Dispels wind, releases & consolidates exterior, stimulates dispersing & descending of LU qi, suppresses pain, removes obstruction, tonifies qi, harmonizes ascending and descending
    Goes to the face
    Sometimes a pair point to LV 3 to free flow Qi of whole body
o    LV 3: tonify method
    Yuan Prime: pathway disorders, targets origin of channel
    Shu Stream: heavy body, pain of the joints
    Expels interior wind, subdues rising of LV yang, promotes the smooth flow of LV qi, calms spasms, calms the mind
    Pair Point: w LI 4 to promote free flow of qi throughout the body
o    GB 30: even method
    Tonify Qi & Blood, resolve damp heat, remove obstructions from channel
o    GB 34: tonify method
    He Sea: counterflow of qi, diarrhea
    Influential of Sinews
    Resolve damp heat, promote the smooth flow of LV qi, remove channel obstructions, subdue rebellious qi, relax the sinews and muscles
o    UB 60: tonify method
    Jing River: cough, dyspnea, chills, fever
    Expel wind, remove channel obstructions, relax sinews and muscles, strengthen the back, clear heat, invigorate the blood
o    UB 40: reduce method
    He Sea
    Back Communicator
    Clear heat and summer heat, cool blood
    Resolve dampness, remove obstructions from the channel
    Eliminate blood stasis, relax sinews and muscles
o    SP 9: even method
    He Sea: counterflow of qi, diarrhea
    Resolve dampness, benefit urination, remove obstructions from the channel, benefit the lower jiao, impeded qi flow in upper jiao

•    Herbal Medicine:  (Name of the formula and herbal composition including dosage and explanation)
o    Shen tong zhu yu tang
    Invigorate the blood, expel blood stasis, warm channel and stop pain
o    Ingredients:
    Chuan xiong 6g, Tao ren 9g, Hong hua 9g, Dang gui 9g, Qin jiao 3g, Qiang huo 3g, Niu xi 9g, Di long 6g, Mo yao 6g, Wu ling zhi 6g, Gan cao 6g, Xiang fu 3g

What have you learn from this case:
•    I have learned that the sciatic pain can be treated by using both local and distal points once you know the syndrome differentiation.  I also learned to needle properly on GB30 using 1.5 cun needle when working with this patient.