Classical Five-Element Acupuncture Case Study

By Neil R. Gumenick - July 21, 2020
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The patient is a 28-year-old female, single, and employed as a wardrobe consultant in the live entertainment industry. In her initial examination, employing the diagnostic criteria of odor, color, sound, and emotion, she emitted a scorched odor, expressed a lack of red color—ashen-gray skin tone lateral to her eyes—a lack of laughter in the sound of her voice, and a lack of joy, emotionally.

Therefore, I concluded that the Fire element was her primary imbalance. By interacting with this patient in her initial examination, I determined the Officials (organs/functions) of Fire most in need of support were her Heart Protector (pericardium) and Triple Heater (San Jiao).

Treatment Approach and Main Complaints

A patient’s basic diagnostic indicators do not change, except in intensity, according to one’s relative state of balance during the whole of one’s life; thus, one’s primary imbalance does not change to another element. Therefore, except for certain and specific clinical findings (such as energetic blocks), all of a patient’s treatments are directed to support, balance, harmonize and benefit their primary imbalance, addressing the levels of the body, mind, and spirit, according to the unique needs at the time.

Main Complaint: Emotional distress over a recent breakup with a boyfriend. The patient described her state prior to treatment as follows:

“By the time I sat down in the office, I was already in tears. The past three months have been overloaded with change, and I reached a breaking point. Confusion, pain, and an overwhelming lack of control are paralyzing me from accepting the changes I’m facing. I have hardly eaten or slept in two weeks and feel completely drained on all levels. Most important, I feel betrayed by infidelity. I have been searching for new career opportunities and a “fresh start” and now that I am finally getting those opportunities, everything feels wrong. Instead of looking forward, I feel cursed with having to move forward. In reality, I’ve been given exactly the choices I asked for, and now I’m not allowing myself to accept or embrace the any of them. In fact, I am denying these things access to my life and in doing so, causing major disruptions to my well-being.”

When the session began, she further stated, “I’m overcome with guilt, sadness, and a profound sense of loss. I wasn’t up to handling any of this—the infidelity and the pain it caused me and my longtime partner and best friend, choosing which of three amazing job offers in my field to accept, and adjusting to a new city alone.”

Addressing Secondary Complaints

Secondary Complaints: Rashes on left hand, on and off for seven years and inflamed at the time of initial treatment. She had described the history of the skin condition as fluctuating between red, dry, and flaky with deep crevices, or wet and swollen. She had seen 10 different dermatologists over the years. The dermatologic diagnosis was unknown, and although many topical ointments had been prescribed and used, none had been effective. She had lost 20 pounds in the two weeks prior to treatment due to her complete loss of appetite.

Comprehensive Patient Assessment

Significant Medical History: Several fractures of the arm, wrist and fingers in early childhood. At age 16, she had a bad dental infection, following extraction of wisdom teeth. In 2001, she was diagnosed as manic-depressive and was prescribed five antidepressants, which “turned me into a zombie and made me suicidal. I lived two miserable years in a drug-induced fog”. She gained 40 pounds when she stopped taking them.

Additional Systems Review:

Sleep: Describes herself as an “active sleeper.” She awakens frequently, sleepwalks and has very active dreams. She usually wakes feeling tired and like “I’ve been working all night”. In the two weeks prior to this treatment, she reported being unable to sleep.

Appetite: As described above, none in the past two weeks.

Bowels: “I didn’t really eliminate for the last two weeks because I didn’t eat. I’d drink water and kombucha tea.”

Urinary system: Passes water about 6/day, no nocturia, and drinks 3 liters water/day. Has a history of urinary tract infections.

Periods: Since off birth control pills, periods light and short, every 28 days.

Perspiration: Tends to be excessive.

Temperature: Tends to feel alternately very cold or hot.

Medications: None at present.

Pulse Findings and Psychological Insights

Pulse Findings: NOTE: In this system, pulses are palpated and recorded based upon a scale of -3 (indicating maximum hypo-activity) to +3 (indicating maximum hyperactivity) and a check mark indicating “normal,” or how this patient’s pulses would feel if she were fully balanced and healthy in body, mind and spirit, with each organ/function having an appropriate and proper amount of energy. Degrees of hypo or hyper-functioning are recorded in increments of ½. With practice over time and skilled guidance, increments of ¼ also can be detected.

Based on the above scale, in this patient, all 12 pulses were found to be equal but very deficient, registering -2 on all officials.

Impressions of the Patient’s Mind and Spirit: As indicated above, the patient had been carrying a heavy load of guilt, sadness and loss, which, in her own words, was “paralyzing” her. She truly was drained on all levels and primarily drained at the level of spirit. The spirit is what energizes the mind and animates the body. All levels were suffering. Even though she was presented with new opportunities and a “fresh start,” she could muster no joy or enthusiasm at the prospect. She was both weak and stuck. What was most discordant was the profound lack of joy and lack of laughter in her voice, regardless of where the conversation went.

Treatment Details and Patient Response

Given the same situation, other patients might have reacted completely differently, manifesting various emotions. Other patients might have appealed for sympathy, or felt overwrought with fear, utterly unworthy and grief stricken, or frustrated and angry. Thus, the following points chosen are in no way a “formula” for how to treat labels such as depression, guilt, loss, or confusion. For every individual who manifests depression, there are unique needs, which must be addressed. These points were chosen for this particular patient in response to her present unique and individual needs.

Note on the Points: Certain upper kidney-chest points, as well as points on the outer bladder line on the back, Conception and Governor vessel points may be conjoined with points on the primarily imbalanced meridians for addressing needs of the spirit. All points were stimulated with moxibustion and needle. Points are listed in order of treatment.

Governor Vessel (Du) 14: Great Hammer

This point was chosen to break up the stuckness and inertia of all of her officials and get things moving. The point is akin to giving the Officials a “whack” to wake them up and shake things loose, to revitalize and stimulate them to take action and move forward.

Kidney 25: Spirit Storehouse

This point is a reservoir of nourishment specifically for the spirit. Although the patient had spirit, it was nearly empty and utterly exhausted. This point is a deep spiritual spring—a reserve on which to call in hard times, such as what this patient was experiencing. She needed spiritual resolve, but at the time, had very little in the storehouse on which to draw. She was trying, but lacked the will and wherewithal to move forward. With this point, we could both fill the storehouse and grant her access.

Governor Vessel (Du) 12: Body Pillar

The body, mind, and spirit are built around a central pillar, analogous to a tent pole to which all the supporting wires are attached. If the central pillar is weak, cracked, crumbling, leaning to one side, and not well-rooted, the entire structure easily could collapse. Once having given her officials a needed “wake-up call” with the Great Hammer and access to the nearly empty Spirit Storehouse, I chose to strengthen and support her body, mind, and spirit by strengthening and straightening her “pillar”. The patient was very shaky in her resolve and the decisions she had made, easily collapsing into self-doubt and second-guessing what she knew to be right. This point provides “backbone” at all levels.

Three Heater (San Jiao) 5: Outer Frontier Gate

With the following two points, the energy was specifically directed to the Fire meridians. The Three Heater official adjusts our temperature (at all levels) to appropriately harmonize with our environment. This point is a gate, which must open and close appropriately to allow the proper amount of warmth to be expressed. In this patient’s case, she had been intimately involved with her ex-boyfriend. She was struggling with how to adjust to the change in their relationship: how much to give, what the boundaries were, and how to reach a healthy and appropriate balance of feeling and interaction—not too hot, not too cold—to be in perfect sync.

Heart Protector (Pericardium) 6: Inner Frontier Gate

The Heart Protector’s job is exactly what the name implies. It protects the Heart from insult and injury. This patient’s protection had been severely compromised. Her protector had taken a big blow. Her heart was left unprotected and vulnerable. She found it difficult to trust, more so in light of her current situation. She had been deeply hurt. While it may be appropriate for this gate to close entirely, if this gate becomes stuck shut, there is little possibility for warmth and love to enter. Warmth and love are essential for humans to flourish. This point is the gateway to the inner self, from which the Fire can warm all the Officials. When this gate is functioning properly, we know exactly when and how wide to open, whom to let inside and when to close it and keep our distance. Relationships are matters of giving and receiving in appropriate measure.

Post-Treatment Observations and Reflections

Treatment Response

All of the patient’s pulses responded, ending with a reading of -½ (a significant improvement from -2) on all 12 Officials. Her scorched odor substantially diminished, and more red was apparent in her face.

As to her internal state, I quote her own words: “I left the session dry-eyed and laughing. Buoyancy had returned to my heart. I felt blessed with abundance, no longer burdened with pain and indecision. Instead of fearing my options, I was confident there was no wrong answer—I had known all along. The fallout of my treatment was reassurance that I was (and had always been) on the right path, and that I needed to keep going.”

“Neil reminded me that none of us are given anything we cannot handle. I realized that ‘can’t’ and ‘afraid’ are very different, and that, yes, I can and will handle all of it, and choosing to move forward can bring me success, happiness and freedom. I began to sense a dissipation of the guilt and judgment I’d been carrying for two weeks, and the questions I’d let consume me no longer seemed so crippling. We discussed that the mind is like clouds in the sky: no matter the state of their ever-changing existence, blue sky always, and without fail, lies behind them. I imagined the thunderheads I’d been living under for so long. As the moxa burned, I imagined the winds of change blowing the thunderheads away, to reveal what had been there all along.”

“For me, Five Element acupuncture not only affects my physical self in a positive way, but brings a sense of clarity and inner strength more powerful than anything else I’ve experienced. I believe that it works because it’s unlocking or allowing what’s already there to flow freely again; it allows my body and spirit to function in the manner it’s intended.”

“When Neil checked my pulses for the last time that day, I looked out the window and noticed (as if for the first time) the cloudless sky. It was finally time to clear away the clouds and reveal my own blue sky. As soon as I left the appointment, I made a phone call to accept the job that was suddenly so obviously right. I’m also ready to accept that the relationship that had abruptly ended with infidelity had been over long before the incident and that holding on had been hurting both of us. I hope we will find peace in separation, because I sense now it’s time for us to let go.”

The patient reported, at one week post-treatment, that her sleep returned to normal, sleeping seven to ten hours without interruption and waking rested. Her appetite returned to normal, with many of her pre-crisis cravings (such as sweets and caffeine) completely gone. She has been making healthy choices in food, looking at it “as a fresh start”. Her bowels have returned to normal and her rash has disappeared.

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Neil R. Gumenick

Professor Neil R. Gumenick is Founder and Director of the Institute of Classical Five-Element Acupuncture Inc., which offers training to acupuncturists, physicians, and students of Oriental Medicine in this profound system of body/mind/spirit medicine. He has maintained a private practice in Santa Monica, CA, since 1981 and is a professor at Yo San University. Neil holds three degrees and an advanced teaching credential from The College of Traditional Acupuncture (UK), awarded by the late Professor J.R. Worsley. Neil was recipient of the 2007 AAAOM Pioneers and Leaders in Acupuncture and Oriental Medicine Award, and is one of the world’s foremost practitioners, teachers, and writers on the subject of Classical Five-Element Acupuncture.

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