I wanted to relate an interesting clinical case.

Wang XX, female, 55 years.

Accepted in the ward with the following symptoms: Pain in the left ear since 3 days, followed by facial palsy.

The patient shows a left swollen ear with a few middle blisters, she refers auricular pain but no itch and paresthesia around the left part of the mouth and tongue. There is also a left side ageusia and hyperlacrimation.
Before coming to our ward she was diagnosed as having an otitis, but the antibiotherapy did not bring any symptom reduction.
A new diagnosis was made as Herpes zoster and the following antiviral treatment gave immediate results in pain reduction.
The above symptomatology was followed by the apparition of facial asymmetry, with a right deviation of the mouth and salivary incontinence.
As for the general state symptoms, the patient refers cold aversion in the lumbar area, insomnia, unformed stool and polyuria with nocturnal recrudescence.
There is a story of high blood pressure and diabetes for 8 years.
Inspection revealed hyposensitivity on the left half of the face, missing wrinkles the left half of forehead, weakness of peri-ocular, peri nasal and peribucal muscles, Weber's test showed a right deviation. Pathological reflexes were all negative, the tongue was pale and dark with a yellow, viscous and thick cover.
Diagnosis in western medicine was finally a Ramsay Hunt syndrome.
Diagnosis in TCM was a facial palsy with a heat in the ShaoYang? meridian, Qi deficiency and blood stasis, obstruction of capillaries (Luo) by humidity and Tan.
The first acupuncture session was as follow:
Blood letting in the left Guan Chong (SJ1)
Followed in the left side by the insertion of acupuncture in : Yang Bai (GB.14), Si Zhu Kong (SJ.23), Di Cang (S.4), Jia Che (S.6), Yi Feng (SJ.17), Feng Chi (B.20), Gong Xue (extra), Quan Liao (SI,18) and the points A Shi on the retroauricular zone on the Shaoyang meridian. Insertion of points on the face was shallow with very mild stimulation.
On the body were inserted bilaterally: He Gu (LI. 4), Wai Guan (SJ 5.), Zu San Li (S. 36), Zu Lin Qi (GB.41), Tai Chong (Liv.3)
At last a quick insertion was made at point Nei Guan (PC.6).

The herbal prescription was as follow:
Fu Ling10g Chen Pi 10g Ban Xia 10g Chai Hu 10g
Huang Qin 10g Bai Zhi 10g Chi Bai Shao (all 10g) Da Qing Ye 2og
Yi Ren 30g Shan Yao 10g Ze Xie 15g

I shall continue to relate on the patient condition and treatment
federico

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I wanted to relate an interesting case we had yesterday morning in the outpatient acupuncture clinic of Dongzhimen hospital.

A French business man comes in referring a glaucoma in the left eye diagnosed 20 years ago and a persistent insomnia.
The patient has been undergoing eye surgery fourteen times and is considering an eye prosthesis. His left eye vision has been reduced to external visual field and with poor quality vision. The patient refers congestive sensation in the left eye and itch bilateral eye itch. He is taking daily beta blocker eye drop medication to control ocular hypertension which produces chronic conjunctivitis. Both eyes conjunctiva is red and inflamed.

The patient also refers chronic insomnia that he has been treating with benzodiazepine and somniferous drugs with inconstant therapeutic results.
Overeating in the evening meal is an aggravating factor as is stress and anxiety.
The patient is extremely nervous and short-tempered, with thoracic oppression, bitter taste in the mouth and flatulence.
His tongue is red with a string pulse (Xuan pulse).

TCM diagnose is "ascension of Qi and fire"

Treatment principle is fire clearing with liver unblocking.

Point prescription:
bilateral points: He Gu (LI. 4), Tai Chong (Liv.3), Yang Lao (SI.7), Guang Ming (GB.3), San Yin Jiao (Sp.6), Zhao Hai (K.6), Feng Chi (GB.20)
left side points: Mu Chuang (GB.16), Shao Ze (SI.1), Tai Yang (extra.point), Yang Bai (GB.14), Zan Zhu (B.2), Cheng Qi (S.1)

Prescription analysis:
Local and satellite points: Mu Chuang (GB.16), Shao Ze (SI.1), Tai Yang (extra.point), Yang Bai (GB.14), Zan Zhu (B.2), Cheng Qi (S.1)
The pathogenic factor is located in the eye, therefore local and satellite points are being used with neutral stimulation (Ping Bu Ping Xie) in order to activate the Qi and blood flow in the eye, remove the pathogenic factor and the accumulated heat in the eye.

Feng Chi (GB.20) is a point belonging to Shao Yang territory it is used for its action on the eye capillaries (Luo) and acts as clearing the hepatobiliar fire and clearing the heat in the eye.
Tai Chong (Liv.3)is the Yuan point of liver meridian, it has the action of regulating and unblocking Qi circulation in the eye and acts as an ocular hypotensive.
San Yin Jiao (Sp.6), crossing point of the three leg Yin meridians, and Zhao Hai (K.6), kidney meridian point and acting on the eye through the meridian Yin Qiao Mai, their combined action permit the Yin strengthening in order to lower the ascending pathologic Yang.
San Yin Jiao (Sp.6) associated to Tai Chong (Liv.3) act as Yin and liver Yin enhancing in order to eliminate insomnia.

Yang Lao (SI.7), Xi point of the small intestine meridian associated with He Gu (LI. 4), Yuan point of the large intestine meridian and Guang Ming (GB.3), Luo point of the gall bladder meridian, have the combined action of activating the ocular blood and Qi circulation, remove the eye fire and act as an eye analgesic.
Shao Ze (SI.1), Jing point of the small intestine meridian, is acting distally on the eye territory to cleat the ocular fire.

The treatment objective is to avoid the eye surgical removal, decrease the eye inflammation, improve the vision and eliminate the insomnia.
I shall keep you informed on this patient treatment evolution.
federico

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I am finishing a 10 days seminar in the south of France, for the TCM School Chu Zhen, which invited me to teach about the clinical aspect of acupuncture.



The place is lovely, near Arcachon, in a pinewood, with both a lake side and seaside.
This is of course a perfect setting for TCM teaching.
Coming back to Chinese Medicine, I divided my course with 50% clinical theory and 50% acupuncture techniques.
I realized during the needling techniques, that quite a few student were at odds with their left hand (for the right handed).
In other words, they did not know what to do with their left hand or worst they were hindering the right hand needling work with their left hand.

There are various method to hold the acupuncture needle, but basically we can chose between two main methods:
1. holding the needle with one hand
2. holding the needle with two hands
Most acupuncturist hold the needle with one hand and in this case the other hand should be used as a helper, either for preparing the skin for needle insertion or to perform stimulation on the meridian (rubbing, pressing etc) to draw blood and Qi towards the acupuncture point.

On the contrary, what happens with quite a few beginner's is that the left hand is used in useless activities, such as touching the patient body (usually near the insertion point) or palpating the point which is supposed to be the work of the right hand.

Why do I emphasize on this point?
Well in the acupuncture practice, movement economy is very important.
First of all if we can reduce all parasitic movements, what remains are clean and perfect movements, that of course will bring gain in efficiency on the one hand and on the other hand leaves more space for mind concentration.

If we want to describe the work of the right hand, we can see that the medium finger can locate the point, eventually palpate the meridian looking for "A Shi" points and it is also used as the needle support during insertion.
If the acupuncturist is well train, the right hand can perform all the above functions in a light manner, without unnecessary movements and most of all, obtain a totally painless needle insertion. When it is required, the left hand can do all the supplementary movements that can help in obtaining the acupuncture point stimulation and the Qi response (De Qi).
I thus concentrated the first part of our needling technic's class in correcting these short comings.
I shall continue to post more about my experiences and views.
federico

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These are briefly my main activities: I am working in the Dong Zhi Men TCM University hospital, following a master of clinical acupuncture.
I am also the director of jadecampus, which is an online continuing Chinese medicine education campus.
In the following link you can find more information about myself

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