Treatment of Chronic pain - trauma to c2-c3 - Study case - a post for tcm practitioners.

Aaron, Male, age 34. occupation: IT

Neck pain for 9 years after a water skying accident

scar tissue around C1-C3

Chiropractor every 1 month

Pulse: weak on cun and chi, wiry and weak on guan

Tongue: red with patchy white coat – add picture

History: severe asthma as a child. History of migraine since puberty. No allergies.

History of glandular fever (one episode before and one episode after the injury )

Medication: patient took large dosages of medications daily during the first 2 years after the accident.

Main complain: Dull Pain and stiffness of the neck every day. Can be acute with sharp pain radiating to the scalp, can cause sever migraine headache lasting 5 days with nausea and vomiting. Swollen area.

light broken sleep.

can get bloating and nausea after meals. If eating “bed” food – oily, alcohol, spicy, or if meals are irregular, it will aggravate the headache and neck tension.

often have vivid floaters, mainly night time with blurry vision when tired.

no tinnitus

occasionally face is getting swollen, mainly in the morning.

weak knees joints, intercostals pain - level with umbilicus, radiate to the lower back. .

sweat during the night accompanied with hot flushes.

more hot than cold in the body with cold feelings in the hands and feet

low 5/10

low pitch , broken sound (hoarse voice), as if making an effort to talk.

dull and pale

there is tenderness and swollen around C1-C3.

Qi and Blood stagnation in Shao Yang with underline deficiency of Qi and Blood, Yin deficiency with fire rising,

channels involved: initially:

This is condition of excess on top of a deficiency. Trauma to the Tai Yang channels (SI + UB ) transferred to Shao Yang channels(GB + SJ) during the last 9 years. The reason for this is long term untreated Blood Stasis, causing Qi stagnation and depletion of both Qi, Yin and Blood. “Qi is the commander of blood: if Qi moves, than blood moves. Blood is the mother of Qi: if blood reaches a place, than Qi also reaches it”

So why Shao Yang: shao yang is between tai yang and yang ming, symptoms between external symptoms to internal symptoms, its when evil Qi penetrate deeper and attacking GB channel without relieving the Tai yang symptoms (“Cou Li” - area between the skin and muscle, where the Ying and Wei interact) .

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• Pulse: wiry and week: Wiry pulse indicates retention of pathogenic factors in the GB channel.

• location of the injury and nature of the pain along the GB and SJ channels (also UB, DU, Yang wei mai )

• swelling of the face: often swelling of the face will be a sign of wind: in this case from my understanding it shows the struggle between the exterior and interior which is an indication of shao yang syndrome. Can also be due to liver wind.

• pain on the side of the trunk : shao yang channels – GB and LIV path through these areas

• Lack of appetite, irritability and desire to vomit are caused by accumulation of heat in Shao Yang channel causing disruption to the ST channel. Also, the fact that irregular eating and wrong diet aggravate the headache and neck tension, shows a disruption to the liver and GB channel (reverse cycle - liver yang rising/GB heat)

• Dry throat, Hot flushes, blurred vision with floaters, and the light sleep come from flaring up of the Fire of the GB. Liver channel open to the eyes, can cause the blurred vision. (LIV being the zang organ of the GB)

• Dull expression is caused by hypo function of Shao Yang channel

in promoting smooth circulation of Qi.

• Patchy thin white coat with red tongue, dry throat, thirst, hot flushes and sweating at night are indication of Yin Xu (mainly kidney)with fire rising.

• Pulse: week on Cun and Chi are indication of deficiency of Qi and Blood

• Weak, low pitch broken voice: the voice is the direct expression of the Lung Qi, and low weak voice indicates lung Qi xu , along with the pale complexion.

• feeling of cold in the hands and feet may indicate the stagnation of Qi and Blood

• low energy – xu of Qi and Blood

• Low back pain and week knees – jing and kidney xu (mother is suffering from the same nature of pain in the knees) week and painful knees can be a sign of kidney yin xu as well.

• Light sleep may also be a sign of Blood xu

GB is the coupled point of the Liver zang. Liver channel manifest in the eyes and GB passes through the eyes

From the pathway of the GB channel, we can see that the initial injury was on the GB channel

GB channel meet the stomach channel at the Jaw

In the Chinese system, the common tension headache is caused by obstruction in the gall-bladder meridian, which runs up over the shoulders and back of the neck to the top of the head and forehead. Hence such headaches are usually accompanied by neck and shoulder tension.

When a GB lou channel is in excess it will manifest as cold extremities.

symptoms: pain and swelling of the neck

An extra meridian may be emptied of its excess of energy by stimulating it s master point, for example: master point SI 3 with coupled point UB 62.

Lou meridian of the du ascend to the nape of the neck and disperse over the occipital. When the du is blocked there will be stiffness of the spine, headache and pain of the eyes.

master point SJ 5. master point of Yin wei mai is PC 6: balance Yin and Yang.Yang Wei mai channel goes through head , neck and shoulders : crossing points such as GB 21, GV 16 (at this point the du channel enters the brain). “The yin and yang wei mai acts as the binding network of al the vessels. Yang wei mai interconnects the most with GB and UB channels (where is our injury started). “Yin wei move all the yin and control ying, ying become blood”

:

tai yang channel – injury location, Gua sha results – red/purple marks.

:

SJ impairment may be another reason for Kidney xu symptoms, as SJ distribute the kidney Yang energy up and acts as a water passageway: symptoms: hot flushes and night sweating, knee pain and weak joints. Low back area is dull in colour and sunken.

: history of severe childhood asthma depleted the lungs: manifest with low broken weak voice without energy, also, the lungs regulate water metabolism by sending fluid to the kidney and UB, and when UB channel is injured, there is a disruption to the fluid metabolism. An interesting thing that happened after the 2nd treatment is the large amount of phlegm and saliva in the lungs and mouth – i imagine this treatment as if someone is doing a plumbing work and opening a blockage in the sink – the gunk and dirt which accumulate along the years has to come out, and that what happened.

– relive local blood stagnation, and reduce the local inflammation at the neck by treating the affected channels (in other words - relive the excess condition): GB, SJ, DU, Yang Wei mai. This will be done by using Gua Sha, cupping and points to treat neck and headache.

– regulate Qi.

- tonify Qi, Blood and Yin

2. To relieve Blood stagnation

3. relieve pain, and reduce inflammation of the neck

4. To regulate Qi and Blood

5. To strengthen Lungs, Spleen and Kidneys

Main points used often:

SJ 5

GV 20

SI 2+UB 62: they open the DU channel, and influence the cervical region of the neck.

bai hui GV 20– in all treatment.

: Xiao Chai Hu Tang + Chaun Xiong and Niu Xi

Chaun xiong: to relieve pain and reduce inflammation, promote the flow of Qi and blood. Often prescribed to relieve headaches.

Niu xi: invigorate blood, move blood, relive blood stasis, promote downward movement of blood, used when yin deficiency with fire or hot blood in the upper warmer.

The main focus behind this method is to harmonise.

Chai hu and huang qin are to sooth the liver and clear heat from gall bladder. The other herbs(ban xia, ren shen, gan cao, da zao, sj) are for the stomach and spleen, tonify spleen, harmonize the stomach, dispel phlegm stop nausea. Harmonious ying and wei (sj and dz)

POT: relive blood stagnation, relieve pain, move and regulate Qi and Blood.

SJ 2 → SJ 3 needling from sj2 towards sj 3. experience point for neck pain.

GB 41- shu point – wood, (where a branch connect to the liver 1) , GB 1 : to open the gb channel

SI 3, UB 62 – to open the du

SJ 5 – umpirical point to treat the neck. Luo point of the sj

Gua Sha + cupping on neck and scapula areas, bladder channel

treatment #2

Present signs and symptoms:

Did not have any local pain since last treatment, just light neck tension until yesterday morning.

None: headaches, dizziness, nausea, swelling, stomach bloating

Voice: still very deep and low.

Other:

Have flu symptoms: nasal congestion (morning and night), sore throat, slightly cough with yellowish phlegm.

Pulse: week, wiry on liver with emptiness underneath, kid – week and deep.

Tongue: red with patchy white coat.

: still didn’t finish the herbs from the first treatment.

GB 21

DU 16: feng fu: meeting point of yang wei mai, du, UB

BL 23: shen shu

BL 24 qi hai shu

DU 4: ming men

Gua Sha + cupping on neck and scapula areas, bladder channel (less purple)

treatment #3

Slightly neck tension this morning, didn’t sleep well this night (woken up by noises)

None: headaches, digestive upset

Feel more settled

Energy increased

Sleep: in general has improved: not waking up as often as before, deeper sleep, sleep longer hours.

Sweating and hot flushes had been reduced

Flu symptoms: still sore throat

Pulse: week, wiry, slow. stronger on kidneys, liver: empty

Bleeding LI 11: to relieve heat from the Li +Lu channel to relieve sore throat.

Back:

UB 17: ge shu

UB 19: dan shu

Shen shu

Ming men

Front:

SJ 4 – yuan source of sj

Si 3 +UB 62

Liv 3

Gua Sha + cupping on neck and scapula areas, bladder channel (less purple)

treatment #4

Pain: wakes up with neck tension (much less than before, but still uncomfortable)

Had headache once, went away after couple of hours.

Sweating: improved

Appetite: improved, eating more.

No stomach aches and bloating. No nausea

BM: 1/day

Energy: improved, feeling of “recovery”

Voice: higher pitch, stronger

Sleep: deeper sleep, improved

No swelling of face till date, no floaters

Cold feet and hands.

Tongue: pink

Coat: patchy white

Pulse: left: cun: hard and week, guan: wiry, kidney – week

Right: stronger than left on lungs and kidney

Gan shu

Ge shu

Dan shu

Moxa box on ren 8

Heart 7

Liver 3

GB 25

Reason for doing REN 8 and heart and kidney points:

Felt a great weakness of the heart and kidney, and at this point of the treatment, especially when things started to move (hence the excess saliva and phlegm), I wanted the fire and water to communicate better, heart 7 being the shu stream earth point, and GB 25 as the front mu of the kidney.

Other treatment: Gua Sha + cupping on neck and scapula areas, bladder channel (less purple)

traetment #5

Still have excess phlegm and saliva

Woke up thirsty this night

Sleeping long hours

Went to the chiropractor yesterday : today slightly stiff neck and low back with pins and needles. Often after chiro treatment will have 2 days of severe headaches, but it didn’t happened this time.

Tongue: less coat

Other treatment: Gua Sha + cupping on neck and scapula areas, bladder channel (less purple)

Acupuncture:

UB 40

Fei shu

Pi shu

Shen shu

Sp 5: toxin: continue treatment of chiro

St 40: excess phlegm

Tenderness last night at the neck, didn’t sleep well

Less phlegm

Pulse: more rounded, more rapid, wiry

Wiry – week upper and kidney week

Fei shu

Ge shu

Dan shu

Shen shu

GV 4 – ming men

Lung 9

massage tui na

conclusion and fututre treatment:

It took me a long time to analyse the stage we are at now. A phone call I made to the patient at the beginning of the week, after he missed last treatment, and something he said in a previous treatment helped me come to a conclusion.

The patient said at one point ” I feel as if I need to do this treatment for the rest of my life, because I feel so good now”

On the phone he was so excited to tell me that he is sleeping well, and have no pain what so ever, but he is coming for another treatment again, because it is so helping.

The fact is that the excess symptoms are gone, there is a slight tension sometimes, but 95% of the symptoms are gone, so what bring Aaron to still comes 2 times a week. From my point of view, it is the fear that his “previous” life which including lots of pain and agony will come back. The organ that is associated with this emotion is the “Kidneys”.

Another very weak organ is the Lungs, which a weakness of them we can see in the severe asthma in childhood, and the weak voice at the moment.

Lungs are Metal element and are the Mother of Kidneys, therefore the treatment will focus on tonifying the lungs and strengthen the kidney function (one of the methode will be via the SJ channel – SJ carry the yang energy of the kidneys up to meet with the lung Qi.

Formula: Bai he gu jin wan modified weekly. pills form