Pain Management ~ Case 1

Pain in the chest, hot flashes, night sweats
Female, 52

First session
Observation: red face; blowing herself throughout the consultation

Main complaint: hot flashes that wake her up several times during the night. She feels a surge of heat followed by a sharp pain in the chest and after few seconds she sweats all over the chest and neck. She also gets them during the day and feels very hot in general. Problem started last year when she became menopausal.

Secondary complaint: Bloated all the time. She feels thirsty and has a dry mouth; she burps. She used to have stomach ulcer and reflux. She still feels burning sensation in the stomach if she takes fried food.
Other complaint: She has always had back pain (less now with exercise). She also used to have knee pain, which is managed by regular exercise.

Her diet is quite low sugar as she is diabetic (takes Metformin). She generally does not have much appetite: drinks tea for breakfast; has rice, soups, fish and stews for lunch and her evening meal is usually low glucose fruits. She drinks 8 to 10 cups of black tea. She gets headache if she does not drink tea. She also snacks on digestive biscuits (only one piece a day).

It takes her long to wake up and she does not feel fresh in the morning. She describes herself to not be a morning person and she say that she feels a bit cranky in the mornings.


Tongue: Pale body, thin dry coating, peeled sides
Pulse: Deep and weak. Left much weaker and a bit slower than right.
            R: Tight on Guan, rapid on Cun
            L: Wiry on Guan

Diagnosis:

Counter-flow of Qi in Chong Mai with obstruction of Qi in the Chest
Stomach Qi stagnation leading to heat and counter-flow

Strategy: Redirect the Qi in Chong mai to smooth the flow of Qi in the chest

Treatment Principle:
Stop the pain in the chest, Redirect the Qi in Chong mai, Move the Qi in St

Points:
Sp4, Ren12, Ren15, Pc6

Observation after treatment: colour of the face started to change half way through the treatment (less red). She did not blow herself after the treatment.

Advice: reduce black tea intake.

Second session (after 5 days):

Report back: Pain in the chest happened only once (second night after the treatment) but no hot flush (neither during the day nor at night), but she still feels hot compared to other people around her.

She feels lighter when she wakes up and her mood is better in the morning as she is sleeping throughout the night without being disturbed.
She felt a bit of pain for few hours in the ovaries (she pointed at the area around St30). She does not have a red face anymore and is not blowing herself.

She took the advice and is drinking only 2 cups of black tea per day.

Main complaint on the second session is lower back pain. She mentions she has spinal stenosis around L2, L3. (though L3 and L4 were sore on palpation). It goes down to the middle of the buttock and then laterally travels down the leg.

Tongue: Sublingual veins distended (only at the root of the tongue), dry on top, teethmarks, thin coating.

Pulse: Deep but more even on both sides

Diagnosis:
Qi stagnation in Bl and Gb channels and Du mai around L3, L4

Treatment Principle:
Unblock the remaining Qi obstruction in the chest
Strengthen Middle Jiao
Move Qi and blood in Bl, Gb, Du channels

Front treatment: Ren12, Ren15, St36
Back treatment: Huatuojiaji at the level of L3 and L4, Bl40, Bl62, Gb30

Report back:
The chest pain never happened again. She leaves me a message in the evening that while laying down in the afternoon, she felt some movements of warmth in her spine going down from the neck and then down to the toes as if it was a warm water moving inside her body. And then the sensation travelled up the legs from front of the body and stored in naval. She had worked all day without having any pain throughout the day.
Report after a week: The chest pain never happened again since.

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