Woman in her 60’s who is suffering chronic fatigue and pain. She suffers from several issues and autoimmune diseases; including Addisons, Ehlers-Danlos syndrome (faulty collagen), Labrynthitis, OA, Fibromyalgia, Scleroderma, Sjogrens, Restless leg syndrome, Reynards, and chronic rhinitis, whilst also dealing with anxiety and depression. She has oedema and severe varicose veins all along her legs and ankles. Dealing with mainly her shen, to help her cope with the pain and her days (it takes 2 hours to get ready for all her medical appointments), and has to have a nap between 3-5pm everyday. The treatments have helped with helping her cope with the pain, but she is still in severe pain (shoulder that she had surgery on, and the hamstrings have torn away from the bone). Her pulses KD- are so deep that I can’t feel them, GB-tight and superficial, LV- sup and round, HT- round and rapid, SP- sup and thready, ST-sup, rapid and round, LU and LI are sup and round. Her tongue is dry, red on the outer front and sides, crack down the middle, but a thick white coat on the sides and back (probably from all the meds she is on). She cannot feel any needle sensation when working on Back Shu from T5- T12. She is now waking every hour, and her shoulder is in severe pain (even though she had a cortisone injection in it).
There are a number of levels we have to work on here- lets address each condition and tie them in together.
There is most certainly a severe Kidney Jing deficiency present and this you will find will be at the core of the treatment. The Addisons disease is obviously severe adrenal deficiency due to damage to the bodies defense mechanisms and immune system. The emotional side here is of great importance. Look for a history of fear, self doubt and lack of sense of purpose. These emotions combined with pent up resentment towards herself will make her immune system turn against her. The severe kidney deficiency especially the yin aspect (being closely related to the inner ear) will prevent kidney yin from reaching the inner ear and therefore the Labyrinth (balancing centre). If kidney yin can’t reach this it will inflame and cause labyrinthitis.It also makes sense that she experiences oedema and severe varicose veins in her legs and ankles, as remember the kidney yang provides qi and heat to the spleen so it can transform, transport, regulate lymph movement and hold blood in the vessels. This is clearly not happening given the above symptoms.
It also makes sense that her tongue is dry and red at the front, as the heart and kidneys are not communicating in the way that they should. The kidney water must cool heart fire and the heart fire must warm kidney water. If this is not happening, the heart fire will blaze, again giving rise to the tongue pattern presented (heart fire blazing and thick white coat at the back as water is cold and dominant not being wormed by heart fire). This will also result in the emotional side of the heart (joy & certainty of future) not communicating with the kidneys (purpose). This is also a very relevant TCM picture for her Scleroderma. To this end you need to tonify kidney jing and importantly get fire & water communicating. My recommended points here are Kid 3 (source pt to tonify), Kid 7 (Jing river & metal point to feed and nourish water, as well as dredge the kidney channel), Kid 23 (spirit seal to strengthen her spirit in her journey), kid 27 (palace mansion to help her see her purpose). Also do Heart 7 source point and Pc 6(inner pass).
Now to address the Ehlers-Danlos syndrome, this is where the yang wei mai extra vessel shines. Ehlers-Danlos syndrome is of course a lack of collagen and connective tissue, scar tissue, weak joints and easily dislocating joints. The yang wei mai is great for this as in this context, “wei” means defence. So as the YIN wei mai looks after defence of the innermost body (the shen), the YANG wei mai addresses defence of the relative outermost part of the body- the muscles, tendons, skin, fascia and connective tissue. So for an analogy of the Yang Wei mai vessel, picture a big compression bandage, loosely winding and bracing all the joints, fascia, connective tissue, tendons, ligaments and muscles of the body. When we activate the yang wei mai, picture an energetic TIGHTENING of the bandage, therefore supporting and bracing and strengthening all of these joints, muscles, tendons and ligaments- at a deep and constitutional level. I have used this many times for these type of pathologies with a lot of success. So to open the Yang wei mai on the female patient it will be SJ5 (1st point) on RHS and GB41 (last point) on LHS.
Remember there will be a big wood element dominance here where the muscles, fascia and tendons are involved as the liver sends blood to muscles/ tendons and the GB sends qi to muscles/ tendons. Which brings me back to the Labyrinthitis. Gb controls the middle ear (and even though the labyrinth is in the inner ear), the GB has a big role in balance. The classics say “If the qi in the 2 hemispheres of the GB channel is not in harmony, one will walk with a lateral swagger” ie they will be giddy and off balance. GB 34 and GB 41 will address this nicely as well as GB 2 and SJ21 (local pts for middle ear issues).
The other thoughts I have regarding the lack of sensation at T5-T12 which would indicate the nerve roots exiting at these vertebrae would be severely impinged. If you consider the dermatomal spread of these nerve roots, from T 5 to T12 they all form concentric “discs” around to the anterior part of the body (see diagram in comments). This means that at the exit of the nerve root to the jiaji point (which controls the neurological aspect of the organ at that level), it will in the same dermatome, cross through the back shu (energetic organ point), Outer bladder point (emotional organ point) AND front mu point (alarm point). So if you consider those organs related to the T5-T12 dermatomes ie: Heart, Diaphragm, Liver, Gallbladder, Stomach and Spleen, it is no wonder she is waking up so frequently at various intervals as the organs should be at their strongest at those times but are being hindered. Keep needling the back shu points but it is ESSENTIAL that you needle the affected Jiaji points at the T5-T12 level. These need to be needled 2 cun to stimulate the Dorsal Primary