|Posted on April 30, 2014 at 1:00 PM|
Disclaimer: This post is not for general consumption. I'm trying to clarify my own internal thought process about a diagnostic breakthrough. I'm going to use jargon & shorthand, and organize it for the non-professional acupuncture enthusiast later.
I had a magical moment two days ago, when an accurate diagnosis led to immediate relief of symptoms that were seriously scaring the patient. Not for the first time, I felt the importance of the difference between 證 (as in evidence 證據 vs. 症 (as in symptom 症狀;). They call this 'differential diagnosis' 辯證論治 in Chinese medicine, and the translation simply falls short. A closer transliteration is "differentiate evidence theorize/discuss treatment" but whatever, that's starting to sound like the gobbledygook of western medical jargon, and it doesn't get me any closer to my early morning epiphany...the thing with evidence is, it's a lot of symptoms that all point toward the same answer. I think as a young practitioner it's easy to be distracted by a single main symptom, the flagship symptom of a diagnosis if you will, which is often also the patient's chief complaint. In this case, it was a symptom (painful urination) that had utterly stumped me last year when it presented itself in the same patient. I don't know if my diagnosis skills are growing or if the evidence this time around was more clear or what. But once I started to see the pattern, nearly every other symptom (recurring neck and scapular pain, tight peroneals, waking early at 6am from a single hot flash with night sweating & heightened anxiety, almost a panic attack) fell into place. They ALL fit. And matched with the red sides of the tongue that have been present in this patient for months. Her pulse was even thin & wiry, even though she had contracted the cold that's going around & should have been floating.
My friends with Chinese medicine backgrounds may have the diagnosis in hand: foot shaoyang gallbladder. And seriously, I could press on almost any point on the gallbladder channel and achieve an immediate 30% reduction in pain and feelings of anxiety. Points on the sanjiao channel (hand shaoyang) also worked, but not as notably.
I think not so long ago I would've been confused by the night sweating (indeed, I tried san yin jiao first, thinking of yin deficiency), and the hour. 6am belongs to large intestine, not gallbladder, unless you are considering the Shang Han Lun which says dawn belongs to shaoyang, or lesser yang (and large intestine yangming happens in the afternoon, as the sun descends, just like your bowel movements should). Also I was reading a book about Shaolin kung fu which specified that breathing exercises should be done at 6am because it's the time when night turns into day (i.e. yin turns into yang). By the 12 hour clock, 5-7am is large intestine, but we had NO constipation, no bowel movement issues at all. I thought about heart fire moving down to the small intestine for a minute, until the patient specified that the burning sensation was not during but after urination: deficiency. Waking early is a sign of gallbladder deficiency. All the painful areas fell on the gallbladder channel. Uncanny.
Today I'm thinking about yin and yang and the three categories they get split into differently again. I've never had much of a handle on the stars but sun and moon cycles and seasons I can understand.
Sun Cycle (day):
Moon Cycle (month):
7 nights of First Quarter: Shaoyang
7 nights of Full Moon: Taiyang
7 nights of Last Quarter: Yangming
7 nights of New Moon: Taiyin
Year Cycle (based on lunar calendar):
Winter: Shaoyin, Jueyin