Master Tung's Points - The Four Flowers (77.08 - 77.11)

Observations:

 

1.The skin irritation was predominately located in three major areas.  The upper medial chest around the sternum and clavicle, the elbows, the left foot from the area of LV 3 - LV 5, and from Master Tung's points 66.04 towards 66.05. The skin was noticeably red and rash like. The area around the bite (LV 3) also had a subtle purple color.  The area in the chest had patchy red papule within the larger rash. The elbows were red from the cubital fossa to the lateral epicondyle, the SI and SJ meridians were the most noticeable areas of redness around the elbow, the skin here appeared to be slightly leathery.  

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2. The right anterior shoulder pain was located between LU 1 and LI 15, and there was a palpable small mass about 1 cm in diameter.  The client had limited range of motion, internal rotations of the shoulder joint aggravated the pain, and external rotations alleviated it slightly.  The pain would sometimes radiate along the upper shoulder near GB 21, and rarely it would effect the area of SI 13.

 

Assessment:  

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From a meridian based perspective the skin condition mostly affected the liver meridian on the foot, the kidney and stomach meridians on the chest, and the SI and SJ meridians on the elbows.  

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Zang - fu analysis revealed many liver heat and fire symptoms.  Kidney yin and blood vacuity signs were also present with yin deficient heat patterns.  

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Procedures:

 

Primary points: Four Horses were chosen as the main points to treat the skin itchiness.  Points were needled on both sides and the points were very reactive, often resulting in raised skin around the needles.

 

Secondary points were used to treat the skin and shoulder conditions.  Not all points were needled in each session, the significant points included San Cha, Fan Huo Jie, LI 11, and Three Weights.

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For the first session Four Horses was needled bilaterally with LI 11 and San Cha on the left.  The patient was instructed to move the shoulder intermittently during the treatment.

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The client was instructed to use a topical antibiotic powder to help promote healing in the area of the bite.   

 

Outcomes: 

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After the first session the skin itchiness in the chest improved significantly.  No itching was reported and the rash and papule were no longer visible. The area of the bite showed little improvement, but the patient did report some decrease in itchiness.  The elbows also were less itchy.

 

No improvement in the shoulder was noted.

 

Second Session: 

 

In the second session the Four Horses were needled again. For the shoulder pain San Cha was needled on the left, with ST 38 and a nearby ashi on the right.  LI 11 was also added to the left side for its ability to treat skin conditions.  

 

After the second treatment the client reported improvement with the skin itching in the elbows, and possibly some improvement in the foot and leg.  The open wound from the bite showed some improvement.  No improvement was seen in the shoulder pain.  

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Third Session:

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As the patient was happy with the improvement in the skin condition, Four Horses continued to be the primary points for this.  In regards to the shoulder pain, no improvement was noted by the patient, and we had already used San Cha, ST 38, and a local ashi.

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To address the right anterior shoulder pain, San Zhong (77.05, 77.06, and 77.07) was needled on the left side.  

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Following the third treatment the clients skin conditions continued to improve, as did the shoulder.  She reported a 40% improvement in the shoulder with increased ROM.

 

Summary 

 

Follow ups were done two or three times a week, and Four Horses continued to be the primary points for the skin.  On occasion the Four Horses were needled unilaterally, while substituting with the Lower Three Yellows (88.12 - 88.14) on one side.  When this was done the patient reported less relief, or even a worsening of the skin condition.  Once this pattern was noted, the Lower Three Yellows were removed from the treatment strategy, and the Four Horses were again needled bilaterally.   

 

When the patient had skin flare ups, the Four Horses were more reactive and the skin surrounding the needles would rise up or turn red.  When this happened the client also reported more intensive needle sensation on these points.  

 

Over the course of treating the client for three months, the redness and itchiness on the chest only returned once, and this occurred when she had a particularly severe flare up.  Of the three major areas of skin sensitivity, the medial chest responded most rapidly and with the best results. This may have something to do with the Four Horses being located on the Superficial Front Line (Fascial Plane). Master Tung Acupuncture and Fascial Planes

 

The San Zhong combination was most effective for anterior shoulder pain, and the client reported a 60% improvement after three sessions. Her ROM improved significantly and she was able to do movements she was otherwise unable to do. As the shoulder pain did have a history of moving to the GB 21 area, its significant to note that the San Zhong points between the ST and GB meridians were most effective.  

 

After several weeks of using topical antibiotic powder for the bite, the wound healed up, and all discoloration and itchiness in the foot and leg ceased.  Previous doctors and therapists had used internal antibiotics and topical gels, and with those treatments the wound failed to heal completely.  

 

The client continues to receive acupuncture for her skin disorders as needed and is very satisfied with the treatment results.