Body Pain and Insomnia Case

[Clint Cain]

For those of you that like reading cases, can you let me know if you think I am on the right track with this one? 8/28/17 A 42 year-old male presents in my clinic. He has had eight surgeries on his left leg — knee and hip — which were originally due to a fall at work in 2010. February 2017 he had a total L knee replacement. His knee is swollen and painful, especially above the patella in the quadriceps; his L leg feels warm to him, and he has some numbness and tingling in his foot. His lower back is also stiff on the L side. He has had extreme difficulty falling asleep for the past 20+ years. He has hearing loss in his L ear that MDs tell him is due to treatment that he received for a neuroblastoma when he was just one year old. He is infertile, with a zero sperm count. He reports zero digestive complaints other than sometimes experiencing slight anorexia. He can get some sinus headaches and nasal congestion that is clear and drippy. Pulses: L: slightly deep rapid slippery weak overall, guan wiry, rolling up; R: 1 slippery wiry tight, 2 and 3 slippery weak, 2 is also slightly big. Herbs: CHGZGJT 9/5/17 During this visit he reported that his knee was noticeably less stiff and painful after the last treatment — approximately 20%. He couldn’t sleep immediately after the treatment, but a few days later he started to notice some improvement in sleep quality. Pulses: L: 1 thin wiry, 2 slightly big wiry, 3 deep, dong 1-2, rolling up, slightly faint overall. R: 1 and 2 wiry, 2 big, 3 deep, slightly faint overall. Herbs: CHGZGJT + ZSXBGZT 9/12/17 On this day he reports that although his knee is still swollen and stiff, he still feels an overall improvement. His lower back has been stiff, and he had a frontal HA. Pulses: L: 1 slightly tight, 2 slightly big thin wiry and slightly faint overall, rolling up. R: 1 tight, 2 big, 3 deep slightly tight, slightly faint overall. Herbs: TXS + GCFZT + LGZGT. 9/21/17 Here, he reported that for the first time in over 20 years he has not had to take anything, prescription or otherwise, to help him fall asleep. He slept especially well for the first five days or so after the last treatment. His L knee is still stiff, painful, and weak. His clear nasal dripping is lessened. Pulses and herbs: refill of TXS + GCFZT + LGZGT. 10/2/17 His knee showed more improvement after the last treatment. He also had a cold with yellow-green phlegm, post-nasal drip, some coughing, aches, and a sinus HA. His MDs are telling him that he will need two more surgeries on his L hip because of degeneration. Pulses: L: speedbump, 2 thin wiry, faint overall, rolling up. R: 1 slightly wiry, 2 big, dong 1-2, rolling up. Herbs: CHGZGJT – THF, + GLXBBXT + GG, FL, LG. 10/16/17 Today, he reported that he had three HA in his right eye since the last treatment. His nasal dripping is back to clear, and there is no more post-nasal drip. His hip and knee feel the same — slightly improved, but still stiff and swollen. He is only experiencing poor sleep every third night or so. He also said that he has been feeling noticeably more tired lately. Pulses: L: faint and rapid overall, 1 wiry tight, 2 wiry, 2 and 3 deep, rolling up. R: 1 tight big hollow, 2 and 3 deep faint, 3 slightly wiry, rapid overall, rolling up. After feeling his pulses, I asked about some urinary symptoms. He told me that he is thirsty, and that he feels like he has a small bladder, meaning that he has to urinate a lot sometimes. HIs urine is mostly clear. Herbs: I switched to TXS + SQW, – BZ, with FZ at 60. At this last visit, the size in his R2 dropped, and quite noticeably R1 was big hollow and tight; and his pulses have been showing more and more faintness every week. I decided that going to SQW would be a good idea considering the SDH to help fill the PC so he can sleep, and because he had several HA this last time he was on a shaoyang formula, which makes me think perhaps some jueyin treatment is in order. Thoughts?

[laurieayres]

Harbinson

[Clint Cain]

Thanks, Laurie Ayres. My feeling is also that I am moving in the right direction with him, albeit slowly.

[laurieayres]

After 8 surgeries, I’d be surprised if progress was fast

[Clint Cain]

Not only that, but there’s some obvious deep constitutional/blood layer stuff going on here. He had surgery for a neuroblastoma at age 1, which lead to hearing loss in his left ear and complete infertility; his knee, hip, and back are having a very tough time recovering from both the original fall and injury, as well as from the surgeries; etc.

[Clint Cain]

Laurie Ayres, today he returned and said that he felt great for a week after the last treatment. He was sleeping better, and his knee was less stiff and had better range of motion, etc. But now he feels like the effects are wearing off slightly. Although he’s still definitely improving overall. He still has some mild nasal dripping, and occasional headaches in either eye. Pulses today are: L: 2 slightly big wiry, 1 and 3 deep faint, rollup; R: 1 big hollow, 2 and 3 deep faint slightly tight. I refilled TXS + SQW and increased the dose from 16 grams/day to 24 grams/day.

[Clint Cain]

We’re also increasing the frequency of the acupuncture treatments.

[laurieayres]

turiya@jps.net

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