Sometimes I think we’re in the most humbling of professions. There’s more information than we can possibly master or absorb in a lifetime and then, at every moment of the patient encounter, and all the way through the treatment, we must be ready to be wrong. And then, when we realize we’re wrong, we have to swallow that and go a different way. These days, I just accept that mastery is perpetually out of reach, and yet, even then I’m still staggered at the left turns I sometimes have to make. I had one of these experiences today.
A person I saw only once a year ago and who at the time was drinking hard liquor on a daily basis returned because he was again not well. He described his symptoms all over again and they were much the same—he had severe rebellious Qi (which he called stomach reflux). A year ago I found his pulses racing, flooding, surging. His face was red, especially around the nose. At that time I asked him to remove from his diet: garlic, onion, hot spices including pepper, coffee, chocolate and hard liquor. He responded as many people with reflux do: “But that’s my diet!” and “How can you make food taste interesting without garlic?” I told him (very nicely) that his diet was making him sick and that even if he came in every week, he would not get better if he kept eating all that hyper-heating stuff. (Can’t really call it food.) That day (a year ago) I bled the Stomach Luo point, descended the stomach, and he joined the party and took out everything except some of the liquor. He very quickly improved and soon after that the symptoms disappeared.
I didn’t see him again until today. He asked me to remind him of all the advice, so I happily repeated the list of offenders that can be the principal causes of rebellious Stomach Qi. (He’s says he’s happy, likes his job and is in a happy marriage so at least on the surface there was no apparent rebellion against the outside world, though I wasn’t invited to delve into the impetus for the regular drinking. That would be for another day.) Having laid down the advice I settled down to the pulses. What I found was so fascinating and also confronting. There was no rebellious Stomach pulse. The exaggerated surge there had once been between the middle jiao and the upper jiao was not there at all. In fact, the opposite was true: the upward vector of the Spleen was entirely missing and the stomach was descending strongly. That is, if I pressed into the Spleen pulse and released pressure from the Lung pulse, there was no communication between the two. If I pressed on the Spleen pulse (which was weak) and released pressure from the Kidney pulse, there was a big surge in the Kidneys. Had the Spleen collapsed? And why? I asked him if he had diarrhea? He said yes, he hadn’t had a formed stool for months. Cold hands and feet? Yes, freezing! Heaviness of the limbs? Yes, quite lethargic. Difficulty concentrating? Yes, falling asleep during the day. I asked him was he eating raw food, salads and cold food. Yes. Since he’d been diagnosed with too much heat in the Stomach he’d decided to eat twice daily salads to cool it down. And he had been taking a proton pump inhibitor for the last four months. The PPI had extinguished the Stomach fire, the very qi needed to digest food, and he was eating raw and cold foods, the most difficult foods to digest! It was a perfect storm for a collapsed Spleen. So why did he still experience reflux? Because if the Spleen collapses, the Stomach must rise; they’re on a kind of seesaw. Whatever one does, the other tries to counteract. (Western stats measure low stomach acid type reflux at nearly half of all reflux cases.)
I always, always take the pulses, but if I hadn’t, I would have been stuck in my pre-pulse taking assumptions that the treatment would probably be similar to last year’s. Instead I harmonized Stomach and Spleen and increased Stomach fire with moxa at the points SP-8 (Earth Take Flight), SI-5 (Yang Valley) and SP-7 (Leaking Valley). A Chong first trajectory treatment would also have yielded a great result, and I may choose that in the future if needed for him, but today, with this patient, this simple and direct treatment chose itself.
Artwork: The Rapid Pulse, Ann Cecil-Sterman 2016