Patient: "Jane," female, age 32
Chief Complaint: Seasonal pollen allergies
Symptoms:
Each year, around the first week of May, Jane gets dry skin; bilateral sinus pain and pressure; a clear, runny and stuffy nose; and red, itchy eyes. The worst of it lasts about two weeks. She is lactose-intolerant, but she is Asian, and so this might not be indicative of Spleen qi problems, but rather genetic in origin. She has one formed bowel movement each day. She urinates about every two hours during the day, but is not sure exactly how often she goes. She has nocturia once per night since the birth of her child three years ago. Her urine generally is pale-yellow and she reports that it is darker in color lately. Her mouth is dry; she is thirsty and likes cool drinks. She gets colds and the flu only once a year.
Emotionally, Jane says she experiences guilt and fear the most. Upon further questioning, it appears she has difficulty expressing herself, lets her frustration build and then blows up. Upon getting to know her better over the course of the treatment, my general impression of her is that she is irritable, has quick mood swings and is quick to temper. She is friendly to those she lets get close to her, but keeps most people away with her crusty temperament. Her pulse is slightly slow, steady and strong and her tongue is slightly reddish overall, with red spots on the tip.
Diagnosis:
After the first treatment, I diagnosed her with Lung wei qi being blocked by an external pathogen, most likely heat initially, along with Liver qi stagnation turning to heat.
In the beginning of April, Jane came in hoping to stop her allergies before spring. (In Toronto, where Jane lives, pollen comes with spring around the beginning of May.) She came once a week for six total treatments.
Acupuncture points:
- Taichong (Liv3) and Hegu (LI4) - course liver qi, cool the liver. Hegu also was used for its effect on the face and to help expel the external pathogenic factors by promoting the circulation of wei qi.
- Lieque (Lu7) - promote circulation of wei qi to expel external pathogenic factors and to help clear the nose.
- Waiguan (SJ5) - expel external pathogenic factors, especially from shaoyang to prevent the EPF from going more internal.
- Quchi (LI11) - expel external pathogenic factors and to generally clear heat.
- Sanyinjiao (Sp6) - cool liver and protect the yin.
Herbal treatment: Jane was not comfortable taking decocted herbs, so I gave her a pill formula of yu ping feng san jia cang er san from Golden Flower, huang qi, bai zhu, fang feng, chi shao yao, lian qiao, cang er zi, xin yi hua, and bai zhi. She initially took one pill, three times a day. For financial reasons, we decided to just use this formula and treat the liver stagnation with only acupuncture instead of getting her another formula to address that aspect of her pattern.
The morning after her first treatment, she felt foggy-headed, congested and had slight pain and pressure. Except for a clear, runny nose, the other symptoms went away that day.
I found out more about her mood swings as well. I changed my diagnosis to add Spleen qi deficiency, causing dampness to manifest in the lungs, took out some heat points and added a spirit-calming point.
I used the same acupuncture points except for quchi (LI11), and added
- Yin tang - for calm spirit.
- Qihai (Ren6) - to tonify Spleen qi to help resolve dampness.
By Jane's third appointment, she was clear-headed. During treatment, I discovered more about her general irritability and quick temper.
Acupuncture points:
- Changed sanyinjiao (Sp6) to yanglingchuan (GB34) - to deal more with the Liver qi stagnation and heat.
- Subtracted qihai (Ren6) and waiguan (SJ5) - to simplify the treatment because she was premenstrual and quite sensitive to the needles that day.
On Jane's fourth appointment, she came in feeling the symptoms start that day, with a side headache too. Her nasal mucus was slightly better, but still flowing.
Acupuncture points:
- Add - zusanli (St36) to help the Spleen transform dampness and to tonify wei qi.
- Add - waiguan (SJ5) - to help expel remaining pathogenic factors.
- Add - taiyang - local point for headache.
Herbal dosage: Went up to two pills, three times a day.
On her fifth treatment, all her symptoms had disappeared except for her headache. I suspected her liver problems were contributing to her headaches.
Acupuncture points:
- Add - sanyinjiao (Sp6) - to help enrich yin to anchor yang.
- Subtracted - waiguan (SJ5) - pathogenic factors not as present that day.
- Subtracted - zusanli (St36) - no dampness symptoms any more.
On her sixth treatment, during mid-May, while the pollen was flying everywhere, she had been symptom-free all week. She had the same acupuncture treatment as the week before and finished her herbs one week later. Jane has stayed symptom-free for three spring seasons now.
