Parasomnia and such

[Elizabeth Evans]

Firstly, I should probably state that I am very new to Classical Acupuncture. I’ve been practicing TCM and herbs for about 10 years and my transition to Classical has been a process mainly due to practicing in a UK NHS doctors surgery and getting patients that Drs didn’t know what to do with. My patients are incredibly complex and eager to improve their lives. I was getting stuck with their treatment with what I had learned at school and getting dissolutioned. I learned the sinew treatments last year from a colleague. I starting using it in clinic and was absolutely hooked. I will be taking Ann’s divergent course in April 2020 here in the UK and have been reading the red book. However, I feel a bit like I did when I was a first year student. I’m still connecting dots and feeling very new (which is wonderful and exciting despite it also being daunting). 🙂

So, my patient is a 49 year old male who came in with constant, intense pain in his right leg. He is a former heroin addict (he’s used “everything” [his words]) and his leg became instantly inflamed 8 years ago when he injected heroin into his left femoral artery and the heroin was bad (mixed with some unknown substance). His opposite leg immediately became inflamed and he was sent to A&E (Emergency). When I first saw his leg, it was swollen, hot, discoloured (especially on the yin side, with a mass of dicolouration directly on Liv 5), veins are very big, protuding along the entire channel. In the mornings his leg is less swollen and hot, but with movement it worsens. However, because of the condition and the risk of DVT, he is on heavy blood thinners. The doctors have stated that massage is contraindicated.

A bit more about the patient. He originally said his spiritual pain was worse than his leg pain even though his leg was excruciating. He felt suicidal every moment of the day. His doctor has labeled him a “big challenge” because he records her consultations on his phone, argues with her, and posts them on Youtube saying she’s incompetent. He takes pictures of the police just because they hate it and then he can argue with them about his rights. He “hates authority”. This is because when he was an addict he got into trouble and went to prison. As a part of a plea, he named the drug dealer. He wrote a letter in prison telling his mother this and a corrupt guard saw the letter. My patient was invited to a card game in prison. When he showed up, a copy of his letter with the part stating he had named the dealer was highlighted. He was then gang raped by 8 men. He said if he saw that guard he would kill him. His hate and anger was immense and intense. It extends to the outside world- racists, misogynists, polluters, Trump, police. He said he doesn’t want to live in a world like this. (8 extra?)

My patient suffers from parasomnia (his mother had this too) and insomnia (both were formally diagnosed in a sleep clinic). He will find himself with a t-shirt on and nothing else, 1/2 a mile from home at 5am after being awoke by a shop delivery driver. Needless to say he is terrified when this happens. His girlfriend finds him trying to climb out of the window on a regular basis (his previous suicide plans and attempts were with jumping off a building).

When he attends appointments, he wraps a blanket tightly around his waist so I do not feel as if I can needle anything in the hip area or below the navel as this is a vulnerable area. But I have found him wonderful to work with. He started out VERY angry and skeptical (I think he his words were that he is willing to try my witch craft since nothing else is working. I’ve treated him about 10 times and he says the treatments have “changed his life”. I used a lot of TCM methodologies as Im still learning Classical but interestingly I ended up being more guided by intuition and used a lot of points I don’t normally use. I later discovered (after listening to Jeffrey Yuen’s Ghost Point lecture) that I was using a lot of Ghost Points (which I was never taught). I’ve also used Gua Sha on his back shu points and he used to come up massively red, especially on BL47. But they are much improved.

I think he would benefit from a Luo treatment but I’m concerned about him being on blood thinners. Would a 7 star needle with a dabble of pin point blood be enough? And if massage is contraindicated, is a 7 star needle too risky? I don’t want him to throw a clot! His leg has much improved using Jing Well points and others. It is far less hot, less swollen, less discoloured. But it is still painful- all the time.

My other question is parainsomnia and insomnia. I’m not making any headway with this. Is this a luo issue or 8 extra? It’s definitely Hun and Po kind of stuff, yes? A separation of Hun and Po? He sometimes wakes and is unable to move- like a paralysis- for a brief time (which he finds terrifying). Again, a lack of connection between Hun and Po????

My pulse taking has gone out the window. His pulses started out rapid and surging and are no longer. I had never felt pulses dynamically, just pressed them. So, to be perfectly honest, I’m not sure what I’m feeling anymore. But they are fuller in the Guan position. I’ve got a lot of catching up to do!

I look forward to learning with everyone here. And thank everyone for their contributions.

xx Liz

[Ann Cecil-Sterman]

Hello Liz,
Thank you for sharing your case. And congratulations on taking on the learning of the classical art.
Two things are important here. Firstly, bleeding a luo point actually treats the underlying condition. The thinners are treating the symptom (clot). Bleeding the luo point regulates the blood so that it is less likely to clot in thee first place. When a patient is on thinners, bleed no more than one point at a time and after the blood changes color, press on the point until it has completely stopped before moving to another point. As you’re doing that you are focused on the reversal of the pathology, not what you think might go wrong.
The second important thing is that it’s very important that you don’t formulate treatments because on labels and diagnoses. Parasomnia and insomnia have myriad causes and you can’t determine the cause from a diagnosis. So is it the Hun? Is it blood deficiency? Is it Yin deficiency? Is the heart not speaking to the kidneys? Is the Shen not anchored? And so on. And you’re right: pulse taking is key in diagnosis. Perhaps instead of the divergent class in London, you might be better served by the pulse class in Poland. (I’m may do one in New York in February, tbd.) But you seem to be on a roll. Maybe Cal or Hung might organize a study group for the pulses in London. Anyway, the western diagnoses are broad terms that catch so many possible causes. I would certainly be starting with the Liver Luo here. And I think you would find yourself in divergent territory eventually, since the opposite leg responded. But stay simple. When you’re introducing yourself to this complex powerful medicine, stay simple. Just do luos in one session and let the patient have reflective time on the table with no talking but sit with him. I think you will find the LR luo treats the sleep issues more than you think. Find the deficiencies (thin, weak) pulses and nourish that medium. Stay simple is the main message here, Liz. Welcome here and feel free to ask more.
Ann

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