Aetiology, Pathology and Treatment (A Case History)
Miss E. was 23 years
old on January 1993 when she first presented herself at my clinic
in Nahariya, Israel.
At first glance it
was almost impossible to detect any health disturbance, major
or minor, from her appearance. She was a lean, good looking
young woman, who expressed herself fluently although somewhat
shyly. Her story, nevertheless, was rather depressing and revealed
a long-term illness.
At the age of 14.5
years Miss E. had her first menstruation, which was not quite
normal. Her menses color was brown and contained many clots.
There had been plenty of discharge, and it lasted 7 days. Inflamed
eruption of acne appeared on her face along with her first period,
and since then her ship of troubles set sail. Her dermatologist
first suggested antibiotics, along with regular visits to an
The antibiotics were
changed several times in the course of several months, due to
their failure to bring about any relief at all. Presumably because
of the antibiotics, as she herself suspected, the eruptions
wandered from her face down to her upper chest and back.
At the age of 17,
for no apparent reason, the acne suddenly disappeared both from
her face and trunk, and she was clear of it until she was 19
years old. At this time Miss E. started taking contraceptives,
and discovered, a few months later, that her old problem had
reappeared, in a much more serious fashion, but only upon her
Again she was given
various kinds of antibiotics, she changed her contraceptives,
managed her diet and changed her dermatologist....all to no
avail. The problem only seemed to worsen.
When I examined her,
after listening to her story, I was astonished by the extent
of the phenomenon. Her entire chest and upper back were covered
with deep red large papules and pustules, some of them clustered
together to form areas of inflamed lesions.
Her tongue had a
normal colour except for the tip and sides which were redder.
The left rim was scalloped, and the tongue coating was white,
thin and slippery.
Palpating the pulse
revealed that her left cun (heart) position was slightly tense
and somewhat hard, and so was the right guan (spleen) position,
which was also thin. Kidney pulse was absent on both wrists.
Overall, her pulse was at a normal rate (72 beats), and soft.
Moving on to her
trunk I was not surprised to discover that all her five Zang
Mu points were very tender, especially So Jen-17 (AKA Ren, or
CV-17) Tanzhong. Also SP-9 Yinlingquan was extremely tender.
These findings naturally
gave rise to a series of questions which uncovered the following
information. During her early teens Miss E. became very fond
of a certain milk product, which was very sweet and flavoured
by various fruit extracts. She used to consume this product
cold and in excess. Since her first menstruation, which was
described above, she suffered from excessive vaginal discharges,
which were white in colour, thick, and with an offensive odour.
She is usually quite irritable, and inclined to inner tension.
She is fond of drinking water, has occasional bouts of excessive
hunger , and dislikes hot weather.
Her periods are short,
her menses scant, and before each menstruation she experiences
low back pain.
In Chinese medicine
it is usually common to define the pattern of disharmony in
skin diseases, by the shape and appearance of the affected skin
lesions.1 Dark red and inflamed eruptions
which resemble pustules and are chronic, are usually attributed
to stasis of Qi and Blood. The dark red colour is a sign of
heat in the blood, and the white exudate is due to pathogenic
Damp. The body area on which the affected skin lesions occur
is also of significance. Usually the upper parts of the body
are generally considered to be mostly affected by wind pathogen,
while the lower parts of the body, by dampness. Sometimes the
lesions appear in the course of body segments, such as Tai Yang
or Shao Yang, and this also may help in the understanding of
the root of the imbalance.
In our case, as stated
above, the shape and appearance of the lesions, suggested a
pattern of Heat and Damp stagnation. The root of this imbalance
lay, of course, in the uterus, as indicated by the time of the
onset of the problem. The consumption during puberty of too
much cold and milky products, may be a cause for accumulation
of Damp-Cold in the lower Jiao. This may later give rise to
disturbances in the normal functioning of the uterus, such as
dysmenorrhea, vaginal discharge and the like. At the age of
14, as in our case, when menstruation begins, the Chong and
Ren channels are energetically activated, and then Damp Cold
may turn into Heat, which will travel upward along the routes
of these two channels. Ren May will thus carry Damp and Heat
to the face, while Chong Mai might disperse this pathogen over
the chest and upper back.2 In western
medicine too, the pathogenesis of acne is understood mainly
in terms of an imbalance of hormones.3
Acne begins at puberty when the increase of androgens causes
a corresponding increase in the size and activity of the pilosebaceous
glands. The pilosebaceous follicle becomes blocked and leads
to the formation of the comedo acnes. These are composed of
sebum, keratin and bacteria. Retention of the sebaceous secretions,
and dilation of the follicle, may lead to cyst formation. Rupture
of the follicle, and release of the contents into the surrounding
tissues, induces an inflammatory reaction which is seen as the
reddening, swelling and oozing of the affected lesions.
In my experience,
the administration of antibiotics in cases of inflamed skin
lesions (acne, boils, abscessess, etc.), which are the result
of an internal systemic process, usually produces an aggravation
of the problem, and/or diversion or peripatation to other sites
in the body. This was exactly the case with Miss E. The ample
use of various antibiotics banished the disease from the Ren
domain to the Chong Mai domain.
Two years later,
because of her use of contraceptives , she had a decrease of
her kidney Qi (evidenced by low back pain, scant menses and
profuse vaginal discharge), and a consequent restagnation of
Chong Mai. As a result the acne appeared again on her chest
Summary of Clinical
- Very serious acne
upon the upper parts of the chest and back, deep red and inflamed
pustules and comedones, filled with white pus.
- Thirst, dislike
of warm weather, bouts of hunger.
- Short periods,
scant menses, profuse white vaginal discharge, low back pain
- Tongue : red tip
and sides; scalloped left side; white and slippery coating.
- Pulse : heart
position tense and hard, spleen position tense and thin, kidney
position unpalpable, overall quality - soft. Mu points : all
major Mu points tender, especially Jen-17 Tanzhong.
- Eyelids : left
eyelid very red.
Evidence for the
Patterns of Disharmony
- Kidney Qi Xu with
dampness pouring down, is, as described above, the basic disharmony,
as shown by the absence of the Chi pulse, plus a general soft
pulse quality. The tongue has a white and slippery coating,
and in addition symptoms such as low back pain, scant menses
and vaginal discharge, all confirm this basic imbalance.
- Imbalance between
Ren and Chong Mai is suggested due to:
- The onset
of the disease right on first menstruation when these
two vessels begin to flourish.4
- The second
appearance of the disease after contraceptives (hormones)
were taken. Hormone consumption greatly affect the Chong
and Ren Mai that originate in the uterus.
- The location
of the disease, i.e. where Chong and Ren disperse.
- Imbalance between
spleen and stomach, which is usually the result of excess
Damp that weakens and clogs the spleen, thus creating Heat
within its related organ, the stomach. Symptoms of thirst,
bouts of hunger etc. mark this Heat, while the pulse on right
Guan position affirms it. Also the tongue, which was scalloped
only on the left side and reddish on both sides, suggests
a weak spleen and the presence of Heat. A tendency of the
heat to rise to the upper parts of the body is seen mostly
on the left side (due to an overriding Yang Qi). A red inner
left eyelid is one sign. Another, is a scalloped and red left
edge of the tongue.
- Heat in the blood,
is shown by the nature and appearance of the skin disease,
as well as by the close relationship between the stomach organ,
the Chong Mai, and the blood. Thus, Heat penetrating the Chong
Mai from the uterus, will easily find its way both to the
stomach and blood. Heat generated in the stomach due to Damp
stagnation of its Zang - the spleen - may penetrate the blood
and the Chong Mai.
the various components of this diagnosis, I felt it was essential
to treat the acute symptoms in first place, and put less emphasis
on the precipitating factors. Usually in chronic cases, the
opposite approach would be more appropriate. However in this
case there had been too much occurring of an acute nature, despite
its chronicity, that made me take this approach.
I therefore decided
to choose points that cool the blood, cool the stomach, and
resolve excess dampness. In addition, I instructed the patient
to omit heating and damp producing foods from her diet (such
as: dairy products, coffee, chocolate, spices, alcohol etc.)
and to eat more cooling foods (such as: celery, fruit, greens
and the like).
My prescription for
the first set of treatments was composed of two groups of points
which were used alternately:
- P-7 DALING,
- P-3 QUZE,
- REN-17 TANZHONG
- ST-30 QICHONG,
- SP-10 XUEHAI,
- ST-44 NEITING
- SP-6 SANYINJIAO,
- SP-9 YINLINGQUAN,
- DU-14 DAZHUI
- B-16 DUSHU,
- B-17 GESHU,
- B-40 WEIZHONG
Group A -
This group was composed of points capable of cooling the blood,
mainly via the stomach and pericardium systems.
P-7 DALING, P-3 QUZE
and CV-17 TANZHONG are situated, and/or having effect on the
pericardium. (REN-17 TANZHONG being the MU point of the pericardium).
The pericardium is related both to the heart (being its protector)
and to the liver (being its companion in the segment of JUEYIN).
Both organs, the heart and the liver, are closely related to
REN-17 TANZHONG served
also as a local point for the affected chest region. All points
were reduced by quick withdrawing maneouvers, and slow insertions.
P-3 QUZE was occasionally bled with a thick filiform needle.
LI-11 QUCHI, ST-30
QICHONG, ST-44 NEITING, are all situated on the YANG MING hand
and leg channel. This channel is related to the stomach, and
all of these points are renowned for their cooling ability.
LI-11 QUCHI is even a specialized point for skin diseases. ST-30
QICHONG is the hinge, or barrier point, of the Chong-Mai - where
the deeper Qi of the channel ascends to the surface.. It is
usually used to balance the stomach with this extraordinary
vessel, and, due to its location has a harmonizing effect on
SP-10 XUEHAI is also
a specialized point for blood disorders, especially for cooling
the blood. It makes an age-old and well-known combination with
LI-11 QUCHI to treat skin diseases. These points, too, were
Group B- SP-6
SANYINJIAO and SP-9 YINLIGQUAN, make a very good point formula
to regulate both spleen and kidney, water metabolism in general,
and damp accumulation in the lower jiao in particular. Thus,
this pair was selected in order to resolve the vaginal discharge,
promote uterus function, and regain hormonal balance. These
points were evenly manipulated.
DU-14 DAZHU along
with B-16 DUSHU the SHU point of the Du channel, have a cooling
and harmonizing effect on the Du channel. DU MAI, being the
collecting channel of all the YANG QI of the body, was thus
sedated, which assists in lowering the heat level in general.
B-17 GESHU - the
SHU point of the blood and B-40 WEIZHONG, both have the ability
to cool the blood and treat inflamed skin lesions.
This procedure was
carried out for five weeks, three sessions per week. During
this period there was quite a reduction both of the amount of
the acne already existing, and of newly formed lesions. The
chest area was quite dramatically cleaned up, while the back
seemed to be more stubborn.
At this stage I decided
to obtain a more radical blood cleansing effect with diet therapy.
I asked Miss E. to quit eating solid food for a whole week,
and prescribed to her different juices instead. She was to drink
a glass of carrot juice mixed with a small quantity of celery
juice twice a day, water as much as she pleased, and a glass
of almond extract once a day. All acupuncture treatments for
this period were suspended. Two days after she embarked on this
fasting program, she had a sudden raise of body temperature
with perspiration, and general malaise. Even though I considered
this a good sign (a release of long captured internal heat),
I instructed her to stop fasting, and start eating gradually.
A week later she resumed her fasting, this time without any
side effects, for one complete week. At the end of this week
, and a total of seven weeks since she came to my clinic, we
were happy to discover that her condition had improved by 80
Now we resumed our
treatments at a rate of two sessions per week. It is worthwhile
mentioning here, that by this time Miss E. had no more vaginal
discharge, no irritability, and no bouts of sudden hunger. Also
her last periods had changed for the better.
In the remaining
three weeks of treatment, I usually used points from both groups,
chosen at random, and administered two special techniques to
resolve the few remaining , or newly formed, acne.
The first technique
works wonders in treating large boils, abscesses (whether hot
or cold), and evidently, also big or tight clusters of acne
pustules and comedones. The abscess or pustule is surrounded
by 4-6 needles (usually gauge 30, length 1.5 inch), inserted
shallowly beneath the bottom of the abscess, in a horizontal
angle, forming a "blossom" of needles, and pointing
to the center. This is left in situ for approximately 30 minutes.
Where cold boils, or chronic QI XU type boils or abscesses exist
(which is not the case here), it is also recommended to administer
moxa. This is done either by a moxa roll above the boil, or
by warm needling of one or two of the needles in the needle-blossom.
The second technique,
which was also applied in our case, consists of shallow tapping
of the pustules (especially those with pus), with the seven-star
(plum-blossom) needle. This is done until slight bleeding and
pus exudes. Right afterwards , a cup is laid over the wound
for 20 minutes until an amount of blood is sucked out. The wound
should afterwards be cleaned and sterilized.
Both of these techniques
gave prompt results, and within the next 2-3 days the treated
wounds usually diminished and disappeared.
After 10 weeks of
treatment we achieved the result of a virtually complete cure,
and during follow-up over a year there has been no significant
recurrence or relapse.
- The Journal of
Traditional Chinese Medicine Vol 13, No. 1. P.69-71
- The Journal of
Chinese Medicine NO. 43 , P. 28-29.
- The Merck Manual
Edition - 14th edition p. 2048
- Su Wen-Ch.1
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:
Shmuel Halevi Ph.D.
Expert of Chinese Medicine
P.O.Box 159 Kfar Veradim