27 Improving Vitality There are two classes of patients on whom the primary focus of treatment is to “improve vitality.” In the first there are no symptoms for you to treat, since you are providing auxiliary therapy to help the patient receive strong Western medical therapy such as surgery, chemotherapy, and so on. Here you are trying to strengthen and balance the overall condition of the patient before or during those therapies to improve resilience and ability to recover. In the second, you are faced with a patient who is in such a poor condition, usually with multiple chronic debilitating problems, that it makes no sense to focus on treating symptoms. Instead, the best approach is to provide general support by strengthening and balancing the overall condition of the patient, which can allow the patient to start improving more naturally from some of the problems they are plagued with. At the beginning of Chapter 17, I described the three-, four- and five-level models for understanding and thinking about what you are trying to do. Taking the basic five-level model, you are primarily trying to strengthen the third level (vitality) rather than focus on techniques to trigger symptom improvements in level 1 (functional-structural systems level). As is discussed there, it is usually advantageous to target both the overall qi (yuan qi/zheng qi/sheng qi) with the core non-pattern-based root treatment and to balance the channel system using the pattern-based Meridian Therapy treatments. Chapter 25 “Weak Constitution” further discusses the treatment of the weak constitution. What is described there is often helpful when thinking about how one applies this general “improving vitality” treatment approach. There will be an overlap of your treatment approaches. In the treatment of the constitutionally weak patient, if the results are not good enough, we saw that we increase the dose of treatment to try to stimulate more of the changes you are seeking, with, for example, use of direct moxa at specific acupoints. In the current case, that of “improving vitality,” the general treatment of the non-pattern-based and pattern-based approaches are used, but not the stronger stimulation methods. I have found on both children and adults that for patients on whom you need to take this approach, the best results come from avoiding more stimulating, symptom-targeting approaches and to focus on only the channels and vitality. This is reinforced by the teachings of my Toyohari Meridian Therapy teachers such as Toshio Yanagishita. The following case is of a very ill little boy who, without surgical and other drastic medical interventions, would have died long before. I was called in to help him recover from the next major surgery that was planned. Main complaints: He had been hospitalized for the last 3 months with severe gastrointestinal disturbance. He had chaotic peristalsis in the GI tract causing fecal matter to pass back up through the intestine to the stomach and out through the nose and mouth. This is life-threatening. To deal with this problem he had a tube placed through his abdominal wall around left ST-26 to drain his small intestine. He had a tube placed down his throat to drain his stomach. He had enemas twice daily to clear out his colon. The name of the diagnosis of this problem is chronic intestinal pseudo-obstruction syndrome. It is very rare. Life expectancy is very poor. He was not able to eat solid food and was fed through a tube (a “portacath”) in the right thoracic region. History: By the age of 1 year his parents figured out that his gastrointestinal system was abnormal, and the problem was first diagnosed. Since that time he had spent about half his life in hospital. He had multiple abdominal surgeries to investigate and try to remedy the problem, including surgeries for obstructed bowel. He had continuous medical interventions with multiple tests for over 4 years. He could not eat normally. His teeth were abnormal and in poor condition. At this stage, eating solid matter only increased the amount of material drained out into the stomach and small intestine drainage bags. One measure of how well he was doing was the amount of fecal matter drained out of the stomach. He spent most of his time sitting in bed. As a result, he had developed problems of hip dysplasia and could not walk normally or well. He also had very stiff and, at times, painful back muscles. It was decided that probably the best thing to try next was a colostomy surgery to disconnect the small and large intestine and to install an external drainage bag. He was on the waiting list for this surgery. It was decided to try acupuncture before he had the surgery to help prepare him for it. His mother was staying with him at the hospital, which was very disruptive to family life. He had had so many medical interventions that he reacted with fear in the presence of a new therapist. This is normal in a small child with his medical history. For the first visit, a case-worker from the hospital assisted with explaining and helping through the various stages and methods of the diagnosis and treatment. He showed an especially strong fear reaction when hands approached the region of his mouth, again considered normal given the number of times that he had been orally intubated. Assessment: Besides being fearful as described, he was in a generally good mood. He had a strong clear voice. His face was slightly swollen and round, probably as a result of medications such as prednisone that he was taking. Sitting on the bed he had no problem playing and moving around, except to make sure that he did not pull on any of the tubes to which he was attached. He sat with very splayed legs as a result of the hip problems. His skin was a slightly dull white. Once the case worker had explained what was going on it was possible to get him to strip down to his underwear. Abdominal diagnosis was not possible because of the numerous tubes and scars on the abdominal and thoracic walls. The muscles of his arms were very stiff, the muscles on his back were stiff and jumpy on palpation, the shoulders and neck regions were also very stiff. The pulses were difficult to take as he would not stay still for very long, but the quality was overall slightly sinking and weak. Pulse rate was difficult to assess because of his repeated movements. The heart (first left deep) pulse, the spleen (second right deep) pulse, and the ming men/pericardium (third right deep) pulse were weak. Diagnosis: In Japanese Meridian Therapy, he had a spleen vacuity pattern. He was not, as one might expect, in an advanced state of vacuity. The yang channels were probably all slightly weak. It was decided to target the treatment to apply supplementation techniques for the spleen vacuity pattern and possibly the yang channels, and to apply techniques to try to release some of the tightness of the muscles. As it was the first visit and it was possible to schedule the next visit the next day at the hospital, it was decided to apply a simple low dose of treatment. Treatment: Using a teishin, supplementation was applied to left SP-3 and then left PC-7. The pulses were rechecked, and it was noted that the kidney (third left deep) pulse was relatively weak. Supplementation was then applied to right KI-3 using the teishin. The pulses were then rechecked. It was not clear whether or how to select any draining techniques on the yang channels, and there remained a slight weakness of the yang channels. Thus, supplementation was applied to bilateral TB-4 and then ST-36 using the teishin. Using a herabari, light, rhythmic tapping was applied over the back of the neck and over the tops of the shoulders. Press-spheres were placed at GV-12 and bilateral ST-36. Next visit—1 week later There was no significant change. There had been no word yet about when the surgery might take place, and since it would be almost a week before the third treatment, it was decided to try to increase the dose of treatment. Diagnosis: He showed the same spleen vacuity pattern and but was obviously more relaxed with the treatment. Treatment: Using the teishin, supplementation techniques were applied to left SP-3, left PC-7, right KI-3, and bilateral TB-4. Using the herabari, light, rhythmic tapping was applied over the neck, naso regions, arms, and back. An enshin was lightly stroked down the back. Intra-dermal needles were placed at bilateral ST-36 with instructions to replace them the next day with press-spheres. John’s mother was also given appropriate tools to use and was taught how to apply the light, rhythmic tapping over the back, arms, legs, and neck, with recommendations to do this daily for a few minutes. He had had a lot of intestinal gas and pain the day of the treatment with increased counterflow of food and draining of matter from the stomach bag. This improved the next day. It was discussed further and was decided that while it could happen at any time, there was a high suspicion that the intradermal needles were possibly the cause. It was decided not to use them again. He was also scheduled for the surgery the next day, thus the treatment was principally to help him prepare for and recover from the surgery. Diagnosis: Spleen vacuity pattern. It was also decided that the counterflow symptoms recommended the use of the he-sea points for the root treatment. It was also decided to use the extraordinary vessels in order to affect the abdomen. Treatment: A small copper disc was placed on left KI-6 with a small zinc disc on left LU-7.1 These were retained for approximately 2 minutes. The pulse filled out and John became visibly relaxed. __________________ 1 This treatment method comes from the Toyohari tradition. See Fukushima (1991: 243–251). Supplementation was applied using the teishin to left SP-9, PC-3, then to right KI-3 and TB-4 on both sides. Light, rhythmic tapping was applied on the arms, legs, neck, and back using the herabari. An enshin was stroked lightly down the arms, legs, and back. Press-spheres were applied to left and right ST-36. The parents agreed to call to set up the next appointment. John usually spent 2 or more weeks recovering in bed following any abdominal surgery, during which time he was not very active and quieter. Next visit—9 days later John had recovered remarkably well and quickly from the surgery. Instead of lying in bed quietly for 2 weeks, he was up playing after only 2 days! He was quite active at this visit. Since the surgery, the stomach drainage had decreased slightly, but not significantly. The parents had been trying to postpone this surgery for years. Now that they had decided to go ahead with the surgery they found themselves torn about what to do with the acupuncture. On the one hand, they could see that it had done something for John. On the other hand, it was very important to see what the surgery could do for him. As a result of this they decided to discontinue the acupuncture, so that this would be the last visit. Since it was obvious from the outset that John’s parents were confronted with life-and-death situations not infrequently, and that they were under enormous personal strain, it was decided at that time to agree with their wishes without debate, and to ask them only to call if it may ever be appropriate in the future. Treatment: The spleen vacuity pattern showed. Supplementation was applied using the teishin to left SP-3, left PC-7, right KI-3. Draining technique was applied to left BL-58 and supplementation to right TB-4 and ST-36. Light, rhythmic tapping was applied over the arms, legs, neck, back, and shoulders using the herabari. Press-spheres were applied to ST-36 on both sides. Next visit—17 months later John’s parents called out of the blue asking for more acupuncture treatments. John, who was now 7, had recovered well from the surgery and had been able to go home for a while. But 4 months before calling he had to be readmitted with acute abdominal pain resulting from an obstructed small intestine. He required emergency surgery, from which he spent over 2 weeks recovering. Ten weeks later he required further emergency surgery for a similar problem, from which he also spent weeks recovering. The professor in charge of his case had found during the last surgery that John’s colon was completely abnormal and after consultation with international experts had decided that the best course of action was to completely remove the colon. Since John also had a tube down his throat to the stomach and a tube through the abdominal wall into the jejunum, it was decided to replace these at the same time. John was also on parenteral feeding with a tube directly into the small intestine. These surgeries were planned for 10 days later and John’s parents remembered that he had recovered well after the acupuncture the previous year, thus they called to see if acupuncture could be used to prepare him for surgery and help with the post-surgical recovery. Two more appointments were scheduled before the surgery. Diagnosis: Despite having been in hospital for the last 4 months and having major surgeries during that time he looked quite well. His voice was strong, he had grown, and he was both more active and more mature. He had daily schooling at the hospital. His flesh was full and strong, but the muscles were still very tight. On inquiring about his walking, the parents discussed how John was also scheduled for a brain CAT scan to see if there was any abnormality of the brain that might be causing the muscle spasticity. Abdominal diagnosis was not possible. Using a teishin, supplementation was applied to left LI-4 as a method of confirming the pulse diagnosis. The pulse diagnosis showed a spleen vacuity pattern. Treatment: Supplementation was applied to left SP-3, left PC-7 and right KI-3 using the teishin. Draining technique was then applied to left SI-7, right LI-6, and supplementation to ST-36 on both sides. Using the teishin, super light stroking (sanshin) was applied down the large intestine and stomach channels on the arms. Using an enshin, very light stroking was also applied down the backs of the arms and legs and down the back. Light, rhythmic tapping was applied on the head and over the areas ST-36 to ST-37. Next visit—1 week later Two days before, his portacath feeding tube mechanism had mechanically failed. This required that he have emergency minor surgery to replace the tube. Following such minor surgeries with general anesthetic John would spend at least a couple of days recovering. He was out of bed playing 2 hours after the surgery! Treatment: Supplementation was applied using the teishin on left SP-3, left PC-7, right KI-3, ST-36 on both sides, with draining technique on left SI-7. The sanshin-style super light stroking was applied down the large intestine and stomach channels. Light stroking down the back was applied using an enshin. Light, rhythmic tapping was applied over the head, neck, and shoulders using the herabari. Press-spheres were applied to ST-36 on both sides. Next visit—2 days later, 1 day before the surgery John was doing well and was ready for the surgery. Treatment: Identical to the previous session, except that SI-7 was not drained and a press-sphere was also added to GV-12. Next visit—15 days later, and just before I was to leave for Japan to study John had recovered amazingly well from the surgery. The surgery had gone well so that he now had no colon left. It was expected that he would be in intensive care after the surgery for 3–4 days. He was out in 20 hours! It was expected that he would be laid flat on his back in bed for 2 weeks. He was sitting and playing in 3 days! This was the first time that even the surgeon was wondering about the acupuncture. John was still on pain medication and still had postsurgical pain, but was doing very well. He was quite active and had no difficulties getting around. The CAT scans of his brain had come back negative. It had been decided to start pediatric physical therapy as soon as he was able. The parents stated their intention to try and get John home as soon as possible, as it was a very big burden at present to have him stay in hospital because one of them had to stay with him at all times. Treatment: The same treatment as the last was applied with the addition of draining technique to left SI-7, right TB-5. Next visit—4 weeks later John was doing well. He had an infection at the surgical scar, which was successfully treated with antibiotics. The parents were trying to get him home with home help, but there was currently a shortage of home help available, delaying his departure from the hospital. His pain was much better and he was using NSAIDs (non-steroidal anti-inflammatory drugs). Treatment: He seemed to show a lung vacuity pattern. Consequently, using the teishin supplementation was applied to left LU-9 and SP-3, with draining technique to right LR-3, right TB-5. Supplementation was applied to ST-36 on both sides. The stroking and light, rhythmic tapping was the same as the last session. Press-spheres were left on ST-36 on both sides and right BL-18. Next visit—5 weeks later He was at home for the first time in 6 months. He had home help during the day. He was able to run around for a few hours during the day but needed to be hooked up to various feeding and draining tubes by the evening. He was generally doing quite well. He had some abdominal pain and still used the NSAIDs as necessary. Treatment: He had the usual spleen vacuity pattern. Supplementation was applied using the teishin to left SP-3, left PC-7, right KI-3, draining technique to right LI-6. The light stroking and tapping was applied as usual. Press-spheres were placed on bilateral ST-36 and right BL-18. Next visit—15 days later John had experienced a slow increase of abdominal pain over the last week and had to go back on the stomach drain. He was having some headaches and was cranky and irritable. His parents were very distressed as this usually presaged a return to the hospital. They had been discussing what to do as there were no clear next steps for John. They had made a choice not to return to the hospital for any further intervention. The strain on John and everyone else was too much and they could no longer see what the future might bring. They were both clearly very distressed. They had had to live with this possibility for 6 years. No further discussion was made. They wanted to discontinue the acupuncture treatment after this visit. Treatment: He showed the lung vacuity pattern again. Supplementation was applied using the teishin to left LU-9, left SP-3, draining techniques to right LR-3 and left BL-58. The light stroking and tapping techniques were applied as usual. Press-spheres were applied to bilateral ST-36 and to GV-3, GV-12. Follow-up: Seven months later John was still at home and doing very well. He was going by bus to school each day. He had recovered from the acute flare-up at the time of the last acupuncture treatment and had not needed to be hospitalized since then. He was living the closest to a normal life he had ever done.
