David, age 55, a mechanical engineer by profession, is an old and close friend of mine. Our friendship began some 10 years ago when he called upon me to treat his nine year old daughter. She was hospitalized then for severe stomachache of unknown aetiology, from which she was suffering intermittently for a long time. I treated her with acupuncture and ever since she remained healthy. Another outcome of that treatment was our two families' friendship and my appointment as their family doctor from that day on...

On several occasions during the past ten years I also treated David himself. He was complaining of rather acute pressure behind both his eyes, and was diagnosed as having glaucoma. Before getting acquainted with Chinese medicine David took conventional remedies for his glaucoma. Despite that, the problem only seemed to worsen in the long run, but the medications had nevertheless some symptomatic benefit.

When I started to treat David for his glaucoma it was clear to me that it was related to a liver imbalance as the main pattern of disharmony. David had a wiry strong quality on his liver pulse (left hand middle position, deep level), and somewhat soggy floating quality to his lung pulse (right Cun position). He also had a red lean tongue, with a pointed redder tip. Both his inner eyelids were very red, and his sclera gave the impression of being blood shot.

To give a more detailed description of David's whole picture, one would probably be surprised not to find any liver Qi stagnation personality characteristics. David is hardly ever angry, nervous or depressed. On the contrary, he is a sworn optimist and an energetic and cheerful man. He is a red haired, freckled faced of middle build man, very intelligent and learned. David is a great expert in wines, and is very fond of the gastronomic arts, especially French cuisine. Oh, yes, and he develops occasional cancerous skin growths, resembling small warts, mainly on his face and head. These are removed when necessary by surgery. These growths usually appear after an exposure to direct sunlight, which David can not stand anyway.

Thus, configuring and weighing all these findings, I made up my mind that the primary imbalance in my friend's case was a heated liver. Liver Yang which ascends to his eyes, reddening his sclera and the flesh inside his eyelids, causing a heat stagnation there - resulting in glaucoma. The cause for this imbalance, as I explained to my bewildered friend, was an inherited tendency, which was activated by his behavior. His fondness for quaffing, the rich meals, coffee drinking, his demanding job, all these, I put forward to him, have contributed during the years to his condition. Being a general-manager of a big industrial plant, responsible for many employees, had had an impact too on his nervous system, accelerating at times the liver Yang mechanism which affected his eyes. Being of an internal heat pattern of imbalanced energy, David couldn't bear the direct heat of the sun which aggravated his skin condition and his eye pressure. Speaking of his skin condition, I concluded that here was a case of an insult to the lung system by the liver. The lungs have the role of the liver controller on the KO cycle of the 5 elements law. Metal controls wood. When wood is overactive and creating an ascending heat as in this case, metal is no longer able to restrain it and gets weaker. We say then that wood has insulted the metal element. An outcome of this phenomenon in this case, is a skin hypersensitivity to heat, producing on its extreme a skin cancer. The skin, we are told in Chinese physiology, is an organ related to the lung system.

This pathology was evidenced by David's pulse which was soggy and floating on his right Cun position, as was described previously. To summarize this in a diagram, here is an outline of David's condition when I treated him for his glaucoma.

The treatment, which was carried out some five years ago, consisted mainly of points such as: G-20 feng chi, tai yang (extra) and Liv-2 xing jian. Puncturing point G-20 feng chi would usually result in immediate release of pressure behind David's eyes, giving him a sensation, as he had put it rather picturesquely, of a deflated tire... After some ten treatments the glaucoma resolved, and David did not need any more treatments for this. At the time I did not address at all the skin/lung pathology, nor did I try too hard to balance the pulse equilibrium. I merely suggested to David some way-of-life modifications in order to check his liver and not aggravate the skin condition. I suppose that the limitation on was because I refused any payments for my treatments, and David did not like the idea to be treated on a prolonged basis without paying. One way or the other, when David came to my clinic again five years later (which is a few months ago), I had a sense that the current incident could have been avoided had I treated him more thoroughly last time.

This time David presented himself with a hoarseness to the degree that he could be barely heard at all. This had been going on for a few weeks already, getting worse all the time. A visit to an E.N.T specialist a few days earlier, established a diagnosis of two small tumors on the vocal cords. This was confirmed later by another examination, which was followed by an appointment for surgery. At that time David called me, whispering hoarsely through the phone the whole story, asking for my advice.

The next day, when David came to see me, he revealed the following story. Approximately one month ago he caught a severe cold with sore throat, cough and fever. This seemed to be a little stubborn and he had to travel abroad. He then took a course of antibiotics following the advice of his GP, and then traveled abroad to the USA. In the USA his condition worsened, and upon returning to Israel he had already lost his voice. Examining David I took note of the following facts:

Besides being hoarse to the degree of almost muteness, David was constantly trying to clear his throat, coughing up sputum and making strange noises while doing so.

He felt as if something was stuck inside his throat, which he was unable to swallow or spit out.

He felt constantly as if he had the flu, weak, tired and perspiring very easily. He also had a dull ache inside his left ear.

His pulse felt much the same as I remembered from the past, only the lung pulse quality was harder on the most superficial level, and soggier on the deeper level. The liver pulse quality remained wiry.

His tongue also did not change significantly, except that it had now a yellowish, filmy, damp coating.

L-1 zhong fu on the right side as well as Liv-14 qi men on the right were both quite tender.

Being familiar with David's energetic imbalances from the past, I took into account the possibility of “plum-seed in the throat” pathology as the core problem here (1). This "plum-seed" phenomenon is a prevalent pattern, in which people have a sensation of something stuck in their throat. This pathology is, in most cases, attributed to liver Qi stagnation affecting the throat, through where the liver inner branch ascends to the eyes and head. A stagnation (mostly of heat or Yang-Qi) in this route, combined with accumulation of phlegm, may give rise to this plum-seed sensation. In our case, the combination of excess liver Yang-Qi ascending through the throat, plus an external attack of Wind and Damp, caused the formation of these two small tumors in the vocal cords canal. The pre-existing lung Qi deficiency, which was described previously, was a contributing factor to this pathology. Also the lung internal meridian ascends to the throat (before descending to the lung organ), having the vocal cords resonating to the relative strength and amplitude of lung Qi. (2)

Taking antibiotics in this case, for that was probably only a viral infection, had its own role in lowering the body resistance mechanism - the Wei Qi. Wei Qi is an important component of lung Qi, and being depressed caused another insult to lung Qi, thus contributing to building up the stagnation in the vocal canal.

SUMMARY OF CLINICAL MANIFESTATIONS

Severe hoarseness, almost unable to speak at all.
Weakness and tiredness, as if having the flu.
A plum-seed sensation in the throat.
Constantly trying to clear his throat.
A damp and phlegmy cough.
A dull ache inside the left ear.
A wiry strong liver pulse, and a soggy, superficially harder, floating lung pulse.
A thin red tongue, even a little redder on its tip, with a filmy, wet, yellowish coating.
Tender right side liver and lung Mu points.
A history of glaucoma caused by a liver Qi pathology, which had been resolved by acupuncture some five years ago.
Occasional small cancerous skin warts on the upper parts of the body. Mainly aggravated by direct exposure to the sun.

THE TREATMENT PLAN

In my experience, even diseases that have already formed anatomic, or tissue changes, such as tumors, cysts, warts and the like, and that are of a relative short duration, may respond favorably, in many instances, to acupuncture. I told David so and suggested that we commence right away with the treatment. My plan was to work from the outside in. I wanted to get rid as quickly as possible of the external symptoms, and only then concentrate my efforts on reestablishing a proper circulation in the throat. The points' prescription for the first phase was therefore as follows:

Li-4 hegu, Li-11 quchi and Du-14 dazhui - as a combination to clear external pathogenic Wind and Damp from the face and head regions, to facilitate Qi flow and promote sweating.

Du-16 fengfu, B-12 fengmen, B-58 feiyang. This combination was used in conjunction with the previous one, in order to strengthen the action of dispelling the Wind systemically. The addition of B-58 feiyang has the effect of lowering an excessive upward moving of Yang Qi.

The patient lay prone during this treatment procedure, and all the needles were manipulated in dispersion. I used a strong thrust right to the appropriate depth, followed by relatively quick, gentle withdrawals of a few millimeters at a time to the superficial level, and so forth.

After some ten minutes the needles on the back were substituted with cupping for fifteen more minutes - to conclude the treatment. This precise treatment was carried out twice, in two consecutive sessions, after which all the flu symptoms were virtually gone. David felt much stronger on the third day and resumed his optimism.

The next phase of the treatment was aimed directly at the hoarseness and the tumors. For this I have formulated these combinations:

L-10 yuji, Li-18 futu, K-3 taixi. L-10 yuji is indicated especially for hoarseness, loss of voice and obstructions in the throat. It is a lung channel Fire point, and has the ability of cooling heat obstructions in the route of this meridian.

Li-18 futu was combined with L-10 yuji as a local point which belongs to the lung coupled meridian, the large-intestine. This point is capable of transforming phlegm in the throat, and of facilitating lung Qi. Among its indications are hoarseness and: "sounds in throat like a duck..."(3). (These duck-like sounds were quite descriptive of the queer sounds David had been performing while trying to clear his voice...)

K-3 taixi was chosen for its role as a major tonifying point, being able to assist both in subduing liver Yang, as well as in grasping lung Qi and facilitating its flow. Besides that it has a specific indication for clearing throat blockages.

These points too were reduced except for K-3 taixi which was mildly tonified. The tonification here was applied by pricking the point and gently maneuvering it, until a slight radiation started to propagate upward the medial calf. Li-18 futu was reduced in several directions after obtaining Qi, and then redirected medially towards the Adam's apple on both sides.

The second combination utilized these points:

Liv-5 ligou and Ren-22 tiantu. Liv-5 ligou is the luo point of the liver channel, and among other tasks it deals specifically with the phenomenon of plum-seed sensation in the throat. (JCM No.19 p. 18). It spreads liver Qi and facilitates its flow in the meridian.

Ren-22 tiantu is indicated for diseases of the vocal cords, it transforms phlegm and facilitates the flow of lung Qi in the throat.

These two points together enhance Qi flow in both of the meridians involved, while exerting a strong effect specifically on the diseased area. Liv-5 ligou was manipulated in dispersal, producing an upward Qi sensation along the tibia. Ren-22 tiantu was punctured obliquely until a Qi sensation was achieved through the entire throat, climbing distinctively and reaching both ears.

These two combinations were used together in each treatment, in the order of the listing of the points. They were used over a span of four weeks, three sessions per week.

In the course of the first week I also had to address the problem in David's left ear. This was done by puncturing locally of G-2 tinghui, and distally of G-43 xiaxi, both on the left side only. These two points were inserted, manipulated and withdrawn immediately. Twice was sufficient to eliminate the ear problem.

Starting from the fifth treatment David's voice started to clear up. It had its ups and downs during the treatment process, but with a definite improvement tendency. David was instructed not to eat Damp producing foods such as dairy products, fruit, too sweet or salty intakes, and the like. He was also asked not to strain his voice, and to speak as little as possible.

At the end of these four weeks David's voice came back to approximately 90% normal. There were times when his voice seemed completely clear, but at other times, especially when he was tired or upset, he got hoarse again. His pulse at this stage was less wiry on his liver Guan position, and less soggy on the Cun lung position on thr other hand. This time, I said to myself, I was going to straighten this out and harmonize the pulse for the sake of David's health in the future.

Occasionally, when I confront in my practice stubborn pulse patterns such as this one, I resort to a five-element needling technique which I find immensely helpful to correct pulse abnormalities (4). By this technique, one must define which are the excessive and deficient elements, and their relation to each other in the Sheng, or Ko, or the superficial flow of energy cycles. In David's case, as mentioned previously, his Wood element was in excess, while the lung-Metal element was deficient. This pattern presented itself in two planes. First, in the Ko cycle the Metal element was insulted by the excessive Wood, being thus unable to exert its controlling effect. The second was the superficial flow of energy, by which the excessive liver channel was unable to pass its free flowing Qi onto the lung channel which succeeds it.

In order to correct this imbalance I punctured Liv-4 zhongfeng - the Metal point of the liver channel - in sedation, and then the luo-connecting point of its coupled meridian G-37 guangming. This was done in order to open the hinge for the excessive Wood energy to flow into the Metal phase. Right after that I punctured both L-11 shaoshang, the Wood point of the Metal meridian, along with L-9 taiyuan, the source point of the lung. To complete the procedure, Liv-14 qimen, the exit point of the liver channel, was reduced only on the right side, while L-1 zhongfu, the entry point of the lung channel, was supplemented on the right side. The reader may recall that these two points, being also the Mu points of both channels respectively, were found tender when David came for the first treatment. This was the reason why I chose to treat them only on the right side.

This new prescription had a dramatic effect both on David's pulse quality, as well as on his disease. After three treatments during nine days, David's pulse was in excellent equilibrium, and the remains of his hoarseness were gone completely.

A month or so later David found time to go again to the E.N.T specialist, complying with my request. Both of the small tumors could not be found at this time.

References:

JCM No. 15 p. 17 "The Differentiation of Syndromes According to Zang Fu - The Liver"

JCM No. 31 P. 17 "A Discussion on the Relationship Between the Lungs and the Liver"

All the points' actions were drawn from these sources:
A - Acupuncture - A Comprehensive Text, by the Shanghai College of Traditional Medicine, 1985.
B - Acupuncture Points Images and Functions by Arnie Lade, 1992.

Wu Wei P'ing, Taipei, personal communications.

About the author: Shmuel Halevi Ph.D.

Shmuel Halevi Ph.D. has practiced Chinese medicine in Israel since 1980. He studied Chinese medicine in the U.S.A and in Taiwan, and obtained his Ph.D. degree in the U.S.A.

Shmuel has written many articles concerning Chinese medicine, in the past 20 years. Most of his articles have been published in the Journal of Chinese Medicine in England. He has also contributed a case-study article to the book: "Acupuncture In Practice " (Case history insights from the west - compiled by Ted Kaptchuk and Hugh MacPherson, Churchill Livingstone 1997).

Shmuel is the author of the book: Chopsticks Acupuncture (Trafford Publishing, B.C. Canada Jan. 2003). In this book he presents a totally new self-treatment technique by chopsticks, devised especially for the lay person.

For more details please visit: http://www.acumedico.com

Shmuel Halevi Ph.D.

Expert of Chinese Medicine
P.O.Box 159 Kfar Veradim
25147 ISRAEL
Tel: 972-4-9973480
Fax: 972-4-9571789
HaleviS@AcuMedico.com
http://www.acumedico.com