Chapter III/28.
Written by Dr Szilard Hamvas (chapters are translated from my book published in Hungarian)
From the Nails to the entire Person – Case Study
Subtitle: Getting rid of the invisible corset
Magdolna C., 50 years old
1.) Anamnesis, main complaints
She came to our surgery complaining about her nail. She hurt her big toenail which has since become crumbly and is not growing back normally. I told her that nobody had ever been to see me because of a nail problem, so I was at a loss as to what to say about its chances of healing. Nails grow very slowly, so I did not want to get her hopes up in vain. Although, I added, I had seen cases when during the treatment of other complaints diseased nails had also healed. If she had any other problems needing treatment, let us start with those. According to the approach of Traditional Chinese Medicine we treat the entire person; if the rest of his problems are improving presumably his nails will improve too. We agreed on this.
She is a single, well-educated woman. She enjoys her work but her relationship with her colleagues is less harmonious. As a result of her upbringing she does not tolerate it easily if her “territory” is disturbed. Her mother did not love her husband and she interfered with her only child’s life in a controlling way. Magdolna does not have a good relationship with her mother to this day. Formerly she was a heavy smoker with 50-60 cigarettes a day, but she stopped smoking a few years ago.
2.) Complaints and symptoms
-
Crumbly nail on the right big toe
Her nails are generally brittle
Irregular bowel movements. At times her bowel movements are entirely liquid, yellowish colour. At other times her bowel movements are perfectly normal. Psychological stress deteriorates the consistency of the stool.
Undigested food also occurs in the stool.
She craves lots of liquid but doesn’t like it cold.
Throbbing headache around the forehead, mostly triggered by frustration.
From time to time music like tinnitus
Menopause at the age of 44
If she has a chance to do it, she vents her anger by yelling
She does not take it lightly if someone meddles with her “territory”
If she is tense, she wakes up at 2am
Recurring dream motive: wanting to meet expectations
Anger towards her mother
Pulse: right: ruo, Yang Kidney: xu.
Left: xi, hua.
Tongue: reddish edge of the tongue.
Mild tooth imprints.
Table 28/1
2.) Diagnostic analysis of complaints and symptoms
-
Crumbly nail on the right big toe
Liver Blood Deficiency
Her nails are generally brittle
Liver Blood Deficiency
Irregular bowel movements. At times her bowel movements are entirely liquid, yellowish colour. At other times her bowel movements are perfectly normal. Psychological stress deteriorates the consistency of the stool.
Liver Qi Stagnation, Liver attacks the Spleen
Undigested food also occurs in the stool.
Spleen-Kidney Yang Qi deficiency
She craves lots of liquid but doesn’t like it cold.
Stomach Heat and Spleen Yang Qi deficiency simultaneously
Throbbing headache around the forehead, mostly triggered by frustration.
Liver attacks the Stomach, Heat rises up along the Meridian
From time to time music like tinnitus
Kidney deficiency, Liver Yang Rising
Menopause at the age of 44
Kidney Jing exhaustion
If she has a chance to do it, she vents her anger by yelling
Liver Fire
She does not take it lightly if someone meddles with her “territory”
Psychologically she is characterised by Liver Yang dominance
If she is tense, she wakes up at 2am
It is the hour of the Liver. Liver Yang Excess.
Recurring dream motive: wanting to meet expectations
Gall bladder Qi deficiency
Anger towards her mother
Liver Qi stagnation
Pulse: right: ruo, Yang Kidney: xu.
Left: xi, hua.
Spleen and Kidney Yang Qi deficiency
Tongue: reddish edge of the tongue.
Mild tooth imprints.
Liver Fire or Liver Yan Rising
Spleen Qi deficiency
Table 28/2
4.) Differential diagnosis, etiopathogenesis:
Almost all her symptoms relate to the Wood element. (According to Traditional Chinese Medicine nails are extensions of the Tendons, and as such are linked to the Liver.)
At the same time two instances of in-phase Yin and Yang separation can be recognised. One is within the Earth element, indirectly also linked to the Liver. This is due to the Liver Qi Stagnation – the Liver cannot adequately perform the harmonisation of the Spleen-Stomach. The other Yin and Yang separation appears within the Wood element, but only intra-psychically. The desire to meet expectations, which manifests in her dreams, points to deficient Qi in the Gall-Bladder, fragile self-esteem. Her strong outer defences such as the fierce protection of her “territory” suggest uncertainty within. (The very fierce protection of territory indicates that she needs strong external defence because internally she is very vulnerable. This may have come about as a result of his mother’s controlling behaviour.)
The symptoms of the Kidney deficiency are negligible and are probably the signs of the reducing Kidney Qi and Jing, which in any case happens with advancing age.
So the root of the problems is Liver Qi Stagnation. The stagnating Liver brings about disharmony between the Spleen and the Stomach, the consequence of which is Stomach Heat and Spleen Qi deficiency. Prolonged Spleen Qi Deficiency causes Blood deficiency. In a Blood deficient environment the Liver Qi Stagnation easily flows into Liver Yang Rising, but it is probable that at times pure Excess of Liver Fire also develops.
She used to smoke very intensively, and this also points to Liver Qi Stagnation. Smokers, when smoking inhale the air deeply even if they do not do this at any other time. Deep breathing generates a strong Qi flow, and releases Qi stagnation. (That’s why everybody keeps sighing when they are very stressed.) Smokers release Qi stagnation with the help of the breathing technique they use during smoking.
5.) Therapeutic aims:
-
Release Liver Qi Stagnation, pacify Rising Liver Yang and Liver Fire
Harmonise Stomach, eliminate Stomach Heat
Strengthen Spleen Yang Qi
Nourish Blood
Strengthen Kidney
Harmonise digestion
Nourish nail
Table 28/3
6.) Therapeutic aims and possible acupuncture points:
-
Release Liver Qi Stagnation, pacify Rising Liver Yang and Liver Fire
G41-TE5, Liv14, Liv3, Liv2,
P6, G34, G21, B18
Harmonise Stomach, eliminate Stomach Heat
Cv12, B21, St44 (-)
Sp6 (+)
Strengthen Spleen Yang Qi
Sp3, St36, Cv6, Cv12, Gv20, B20 (+)
Nourish Blood
Sp6, Liv8, B20, B23 (+)
Strengthen Kidney
K3, Cv4, B23 (+)
Harmonise digestion
St25, Cv6, Cv12, Liv13, St36
Nourish nail
G34, Liv8, Sp1, Liv1
Table 28/4.
Note to the acupuncture points shown in Table 28/4:
G34: Hui Point of Tendons
Liv8: Water point of the Liver Meridian, Liver meridian’s Mother point, He (= Sea) point, it strengthens the energies of the Liver Yin, it nourishes the Liver Blood.
G41-TE5: it opens the Dai Mai Extra meridian, thus harmonising the Liver Qi, it pacifies the Liver Yang and the Liver Fire. It also clears the Dampness and Heat in the Liver and Gall bladder meridians, as well as in the Gall bladder and in the Urogenital system. Besides, it regulates the Dai Mai meridian, which joins together all the vertically running meridians on the torso.
Liv13: Mu Point of Spleen. It is especially used for treating the Spleen, if Spleen-Liver disharmony stands in the background of her Spleen disease.
G21: pacifies Rising Liver Yang.
7/a.) The first phase of the realised therapy step by step
Point collection used at the first treatment:
-
Harmonise Liver
Liv3, P6
G21, B18
Harmonize Middle Burner, tonify Spleen
St36
B20
Harmonise Shen
ExHN3
Harmonise digestion
(St36), St25
Nourish and regulate nail
Liv8, G34
Table 28/5
Result after the first treatment: No headaches for a week. Her bowel movements had been entirely in order for three days.
Other complaints: She got the flu. Her lower back hurt (this signals the weakness and vulnerability of the Kidney). Her gums are inflamed (Yang Ming Fire).
Second treatment, therapy adjustment:
L14 (-): Partly because of External Wind invasion, partly because of her inflamed gums.
Gv14: Because of the External Wind invasion.
In order to support Spleen Sp3 (+), to tonify Kidney B23 and Gv4(+) were added to point collection.
Result after second treatment: She had eaten something that affected her digestion. There is mucus in the stool. (The symptom itself signals Damp-Phlegm-Stagnation, and points to the vulnerability of the Spleen.
She had stopped having headaches until this day, but today she felt a strong throbbing headache spreading from her forehead to the back of her neck. (Yang Rising in the Gall-bladder meridian.) Her lower back is better. Her gums returned to normal.
She tells me of a symptom, about which she had forgotten until the relief from this symptom made her aware of it. She felt a belt-like tightening around her waist. Usually she felt an unpleasant saturation, and had difficulty in taking a deep breath. This tightness has now eased. (The symptom is the result of the Liver Qi Stagnation, which has an effect on the Liver Qi flow and also on the Lung Qi flow. The “belt” is probably related to the Dai Mai = Belt Channel. As I have mentioned above, harmonising the Belt Channel will harmonise the Liver Qi.)
Third treatment, adjustment in therapy: instead of P6 selecting G41-TE5. Discontinuing Sp3. Discontinuing Gv4-Gv14 at the back. Adding G20 and G21 to the prescription.
Point collection applied during the third treatment:
-
Harmonise Liver
Liv3, G41-TE5
G20, G21, B18
Harmonise Middle Burner, tonify Spleen
St36
B20
Tonify Kidney, nourish Blood
Liv8
(B20), B23
Harmonise Shen
ExHN3
Harmonise digestion
(St36), St25
Nourish and regulate nail
Liv8, G34
Table 28/6
Note to the acupuncture points listed in Table 28/6:
G41 (on the right hand side) – TE5 (on the left hand side). The opening of the Dai Mai harmonises the Liver Qi and of course also the circulation of the Dai Mai meridian (Belt Channel) itself.
G20-G21: Subdue Rising Liver Yang
Result after the third treatment: In the past whenever there was a change in the weather, a new weather front or a storm, she stuffed herself with painkillers to deal with the headaches. She no longer has headaches although she constantly feels as if a headache is just about to come on. Her bowel movements are in order. The belt-like tightening has entirely stopped.
Fourth treatment: therapy unchanged.
Result after the fourth therapy: she reports the improvement of a further, so far unmentioned symptom. Her feet used to be so hot that she had to cool them down in cold water. Since she has been coming to our surgery she has had no need to cool her feet. (The burning of the soles and palms as the so called “5 Heart Heat” is a symptom that points to deficient Yin.)
Tiny white dots appear on her big toe. As if she had very tiny blisters under her skin. (Damp Heat? Pus?)
Fifth treatment, adjustment to therapy: Because of Yin deficiency I thought that the most important thing to do was nourish the Yin, so I opened the Ren Mai Extra meridian instead of opening the Dai Mai meridian. In order to subdue the Liver Yang I inserted the needle into the Liv2 and P7 points. I complemented these with the St44 point, because the upward flow of Stomach Heat and Rising Liver Yang strengthen each other. (On the one hand P7 helps the functioning of Liv2, because the Liver Meridian is on the same energy level as the Pericardium Meridian, as both are Jue Yin meridians. On the other hand it prevents the Liver Yang taking a further step towards the Heart.)
Point collection applied during the fifth treatment:
-
Harmonise Liver
Liv2, P7 (-)
G20, G21, B18
Eliminate Stomach Heat
St44 (-)
Harmonise Middle Burner, tonify Spleen
St36
B20
Tonify Kidney, nourish Yin
Lu7-K6 (+)
B23
Harmonise digestion
(St36), St25
Nourish and regulate nail
Liv8, G34
Table 28/7
Result after the fifth treatment: on the whole, without complaints.
Sixth treatment: unchanged therapy.
Result after the sixth treatment: Her state of health is up and down. When her diarrhoea gets better her haemorrhoids return. She often has mild headaches, but she does not need to take any medicines. Her forehead and her region of ExHN5 are especially sensitive.
Both the diarrhoea and the haemorrhoids point to the weakness of the Spleen Qi. In reality I think that these symptoms are related to the Liver Qi Stagnation. Liver Qi Stagnation causes the bowel movements to be uneven: at times she has diarrhoea, at other times constipation. The constipation causes the problem of haemorrhoids. The headache is also related to the Liver Qi Stagnation in the region of the Gall bladder and the Stomach meridians. Reducing St44 and Liv2 points and tonifying the Yin prevents developing Stomach Fire and Liver Yang Rising, but the system probably needs a stronger Qi Stagnation release.
Seventh treatment, adjustment in therapy: In order to harmonise the Liver I return to opening of the Dai Mai meridian. Because of her nail I use two local points now (Liv1 and Sp1). Because of her haemorrhoids I apply Gv20 and B58 points. To nourish the Yin and the Blood, I also add Sp6 to the point collection.
Point collection applied during the seventh treatment:
-
Harmonise Liver
G41-TE5 (-)
G20, G21, B18
Eliminate Stomach Heat
St44 (-)
Harmonise Middle Burner, tonify Spleen, strengthen Central Qi
St36, Cv6, Cv12, Gv20
B20
Tonify Kidney, nourish Blood
Sp6 (+)
B23
Harmonise Shen
ExHN3
Local point of headache
ExHN5
Harmonise digestion
(St36), St25
Treat haemorrhoids
(B20), B58, Gv20
Nourish and regulate nail
Liv1, Sp1,
(Sp6) Liv8, G34.
Table 28/8
Note to the acupuncture points listed in Table 28/8:
Gv20 is most effectively promoting the rising of the Central Spleen Qi, if we use moxa, but keeping in mind that the Liver Yang Rising could be provoked by moxa therapy, I set this aside.
Results after the seventh treatment: She had not had strong headaches needing medication since the third treatment. Her haemorrhoids had not been bleeding. She observed that without the anxiety that her haemorrhoids would bleed, her bowel movements became normal. She had experienced continuous and mild improvement on every area. She said, “I improve as much as I allow myself improve.” According to her own admission the spectacular improvements of the first few weeks made her frightened!
7/b.) Summary of the subsequent therapy:
I continued the treatment more or less as above. After the haemorrhoid problems had gone, I left out point B58. At times K3 was included in the prescription, and then I left it out. Because of the diarrhoea I used moxa on point St36, when the Liver Yang had already diminished to such an extent that I did not have to be afraid of the headaches recurring.
After the sixth treatment I treated her fortnightly until the fifteenth treatment. After this we met every three weeks and after the twentieth treatment once a month.
At the seventeenth treatment she told me that she had noticed that her floating ribs started to move outwards, returning to the plane of the other ribs and with this her chest started to expand. About 20 years ago her floating ribs started to turn inward, caused her to feel as if a corset was tightening her body. At around this time she became frightened of dying by suffocation.
Her nail had improved a lot – a healthier nail started to grow replacing the crumbly one – but I was not satisfied with the result, also the small red spots kept reappearing at tip of her big toe. I directed her to a dermatologist, who grew a fungal and bacterial culture and started a targeted antibiotic treatment.
At the moment she attends the surgery every 4-8 weeks. Her nails are now completely healed. Her digestion is sometimes better sometimes worse. In all other areas she is complaint free.
8.) Lessons to be learnt:
Even with thorough questioning some symptoms that may carry important information can be left out. At the same time patients do not consider some symptoms to be a complaint, because they have been there for such a long time, that they learned to live with them. The patient only becomes aware of these as they subside, and the acupuncturist only learns about them when they cease. I found it interesting how many hidden issues can be present in the background of a seemingly insignificant problem. Furthermore it is surprising that acupuncture can also remedy abnormalities that belong to the category of physique, such as the inverted floating ribs!
