Foot Bones

[Ada Sobieszczuk]

Hi everyone, looking for some clarity around a case:

A patient I started seeing maybe 8-9 years ago.
Back then she came in with alot of back pain.
She had scoliosis and when she lay prone on the table her shoulders were up and you could quite clearly see the twist through her upper back. We did alot of tuina, and she also had regular osteopathy.

She also had Chronic Fatigue, which was perhaps her main complaint. This started after a virus.
She was in her early twenties.
At age 24/26 her mother committed suicide and she was the first on the scene. Her mother was schizophrenic.
The patient is very petite. She was born prematurely and is thin. She works as a computer programmer part-time.
A few years later her chronic fatigue journey led her to a naturopath who did stool testing and had her on a strict fodmaps diet and three rounds of targeted antibiotic therapy to modulate her gut microbiome.
I didn’t see her much during this period.

The last treatment I did with her, her back looked symmetrical and even, though the shoulders were quite tense and I could feel the thoracic muscles still pulling towards scoliotic position. I did a massive dragon moxa ginger session along her spine.
A year later, she’s back in clinic, she’s booked in for a sore back.
She hobbles into the office.
I assumed the distortion in her gait was from the back pain.
But actually – she now has alot of pain in her feet.
She’s been diagnosed with bilateral osteochondral lesions and hallux rigidus.
It’s all affecting the ball of the foot – the metatarsophalangeal joints (MTP joints).
The worst pain is stepping forward. And weight-bearing hurts.
They had her in moon boots for 3 months.
She is booked in to see me now because her foot rehab specialist wants her to have massage on her feet.

She told me that when this all started she was also experiencing pain in her hands. And clicking and pain at the base of the fourth finger, little finger and thumb.

For the past year or so she’s doing an ordinary diet and feels better for it. She’s since got married. She’s 32. And definitely starting to think about having a family.

The last time she came 6 months ago she had a ren mai pulse. Her k pulses were there but thin, but much louder than when I first started seeing her 8 years ago. I mean back then all her pulses were teeny tiny. And she had a small retracted shaking tongue.
She said that if she can’t solve the pain in a few months she will have her MTP joint fused.

She is coming to see me in a couple of days time.
I will listen to her pulse.

I haven’t done divergents yet.

So I could work with EVs and Sinews.

* Could I massage her feet whilst the pins are in for EV?

* I know this is all connected together but I can’t seem to piece it together.

* Theoretically, one could work the EVs to make deep changes, then use the Sinews to implement them? For musculoskeletal?

I would be grateful for any guidance. Thank you so much, Ada

[Ada Sobieszczuk]

So E came in for her treatments.
She’d just been to the rheumatologist.

I felt a Yang Qiao mai pulse, and needled accordingly and went to do Tuina on her feet.

Her feet are like her back was. I feel a strong tight pulling in the muscles on the soles of the feet, inner line from the heel to the ball of the foot, pulling contracting, like a cork screw, and her feet were freezing and bluish. The pulling travels up the back of the calf. All very taiyin. Same (but very slightly different) on both sides.

I sent her home with some Sichuan peppercorn + mugwort foot soaks to do daily.

Where does this tugging-pulling-coiling in come from? Is it ‘just’ cold?
It’s completely stopped her in her tracks.
There is constant pain, maybe 4 out of 10. But as she starts walking, it escalates quickly to a 9. Walking round the supermarket is completely out of the question.
At home she’s confined herself to one room too.

Let’s see how this unfolds.

(I also felt shaoyang and taiyang sinew pulses. How can you do sinew treatment when the patient is freezing?)

[Armin]

Hi Ada,

I’ll give it a try, but for sure a tough case!
Obviously, her overall system must be pretty taxed in mediumship already given her history and everything. So, the way I see it, it’s a matter of building up resources any way you can. You could try sinew for couple of sessions to see if it would shift it, but it feels to me that this would require deeper work, either divergents to build up mediumship as well as addressing the arthritic condition. But as you haven’t done the training for that yet, then the 8ev’s look like a good option.

Given that her chronic fatigue started after a viral condition and given that she never really recovered and this has been taxing her system, I would consider Yang Wei mai. The whole thing has a bit of Shao Yang feel to it; a lingering pathogenic condition. But the qiaos are definitely indicated too as you said yourself. Taking a stance for herself in life and wanting to start a family, but can not move forward due to lack of resources. You could also consider Yin Wei mai to boost resources.

* Could I massage her feet whilst the pins are in for EV?

I would say best to do a bit of massage first to loosen things up and then do the 8ev treatment. I wouldn’t do the massage while the needles are in when you are doing an 8ev. The needles are working on the Yuan level and you’ll be working on the Wei level simultaneously and that may confuse things energetically. But that’s just what I think.

* Theoretically, one could work the EVs to make deep changes, then use the Sinews to implement them? For musculoskeletal?

When I have seen Ann giving treatments and say there is a sinew pulse as well as an 8ev pulse, she would first quickly release the sinew channel, sometimes by simply putting the jing-well and then do the 8ev treatment in the same session. I am not sure if you meant doing these two approaches at the same time or a few sessions of one style first followed by the other. Anyway, same treatment for both is an option but sinew release should come first so you are not taking a superficial condition to the yuan level.

*Where does this tugging-pulling-coiling in come from? Is it ‘just’ cold?

Likely from the lack of mediumship. She must be very blood and fluid deficient so everything gets tight and spastic. The peppercorn/mugwort foot bath may work but it may also be a bit too warming and drying her more. I don’t know, depends on how much damp-cold is in her system.

*I also felt shaoyang and taiyang sinew pulses. How can you do sinew treatment when the patient is freezing?)

When you are doing the prep work for a sinew treatment, you can moxa Du 4, 14 after you Gua Sha them. And maxa Kd 3 on left to boost yang qi. For the actual sinew channels, if cold and flaccid, you can moxa along the channel on those points as well.

Hope this helps Ada.

[Armin]

After thought:

I forgot to say that it’s probably a good idea to find out what was happening in her life before the onset of the viral condition in her early 20’s. Some luo treatments could be applicable too!

[Ada Sobieszczuk]

Hi Armin,
Thank you so much for reflecting on this case.

I just saw E.

Today Taiyang sinew pulses were most predominant. (I could feel Yang Qiao on both sides also)

I started with DU4 and DU14 guasha.
Her feet was cold, but not freezing blue as last time.

Her pulses were juicy.

I asked if she’d been feeling thirsty, following up on your suggestion that the foot soak herbs might be too dry. Her reply was that she’d been drinking heaps of water. Because she had a UTI.
She hadn’t mentioned this before.
She said she gets them all the time. Maybe for the last 2 years.
She has to stagger having relations with her husband to at least a week apart otherwise the UTI always flares up.
She said she started getting them after the GI antibiotic therapy she went through.

I started setting up the Taiyang Sinew leg treatment.
And lo-and-behold there were heaps of Luo vessels along the BL on both legs, mostly the right, on Feiyang, Weizhong, and all along the back of the legs.
I did the sinew treatment.
Then did a full BL empty treatment.

Then Tuina just on her feet because technically that’s what she booked in for.

So now there is this UTI pathology to fit into the puzzle?

She is going back to her podiatrist now, so will have to wait and see if she books in again.

Thanks again Armin,
Ada

[Armin]

I am not surprised that UTI’s would have started after the antibiotic treatments for gut health. I guess that approach can help with a few cases but most of the people I come across who have gone through with it for SIBO or what have you, end up feeling worse after, perhaps a bit better for a short time right after but then worse than before.

Recurring UTI’s would be divergent territory, but I think sinew treatments would address it too as, if I’m not mistaken, Wei qi goes to the bladder organ too, along with the gut. I would think one of the leg yin channels, Spleen or Kidney!?

But you are doing well with following the pulses. As long as she’s improving, you are on the right track 😉

[Mònica Martín]

Hi Ada,

It sounds like a challenging case, indeed! I was wondering what’s her situation like emotion-wise. How does she really feel about starting a family of her own? I’m wondering whether the possibility to become a mother triggers any issues related to her own deceased mother and what was unresolved between them too.

A Bladder Divergent channel treatment could help to consolidate Yang and address the foot problem as well as the UTI. Antibiotics are bitter and cold in nature. If her Yang was not consolidated in the first place (a manifestation of it would be scoliosis), the antibiotic might have worsened the condition by introducing Cold in the interior (intestines) and activating the unresolved PF (virus) that originally triggered her fatigue. Her cold feet could be an attempt of the body to release that Cold through the external layers of the body (Wei level) and also through the inferior portals, the Fu-bowel (Bladder) through urination leading to UTI. Possibly there’s not enough mediumship to neither mount a release nor even to keep latency for the virus in the deepest layer of the exterior anatomy (bones) so Cold (PF) flares up from the joints and it stagnates there causing cold, tight and painful joints in the feet. If she’s drinking a lot of water for the UTI, make sure that the water is not cold, but warm, otherwise that can further weaken her condition. If you’re not too familiar with Divergents this could be a perfect patient to start working with them.

Within an 8X scope, I wonder if you’ve encountered any Yin Qiaomai pulse in this patient (damp wrist, deep pulses, pulses only felt on the chi position…). It might be interesting to correlate her present physical symptoms (freezing cold limbs, fatigue, UTI…) with her emotional state (in particular how she feels about herself and whether she feels “fit” enough to start her own family given her history). How did she deal with her mother’s suicide? Is there any sense of trauma, guilt, grief that has settled deep down enough to “prevent” her from taking that important step in life, namely, starting her own family? What’s freezing and paralyzing her?. I can’t help thinking that her mother’s death must having deeply traumatic.

Tuina sounds like a great idea, the warmth of human touch might work wonders to counteract cold.

Keep us posted with any updates, Ada 🙂

Monica

[Ada Sobieszczuk]

Thank you Monica.
Thank you for putting the pieces together.
I think we once talked about her mother’s passing. Skimming the surface perhaps. There might be is guilt because she felt a sense of relief at the time.
When she comes into clinic she often has a flushed face – like a guilty/ashamed look – like someone put the blame on her for something. But it’s also the same look when my toddler sneaked some choclate under the table, hiding, and then got found. That red flushed face.
I can’t quite put my finger on it.
Looks like it’s time to get stuck into that Divergents chapter. 🤔
Yes will keep you updated.
Thank you again,
Ada

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