26 Recurrent Infections Main complaints: Multiple recurrent colds over the last year. On a number of occasions the colds worsened and developed into bronchitis. On two occasions the bronchitis progressed into pneumonia, one episode of which led to her being hospitalized. She had to take many rounds of antibiotics over the last year because of the episodes of bronchitis and pneumonia. Along with the colds she had some problems with ear infections as well, but this was less of a problem than the continuous cycle of catching colds. At the time she presented, Mary was recovering from a cold that had started several days before; she had a congested nose and mild cough. History: Until 1 year previously she did not have too many health problems. But over the last year she had been more tired and showing signs of emotional distress. Her appetite, sleep, and bowel movements were regular and all right. Her mother was a student of mine and had recently learned shonishin from me, which made her think to bring her daughter for treatment. While discussing her daughter’s problems the following history emerged: Mary’s mother worked and studied full-time. Two years before, while a student and working she was found to have breast cancer. After starting treatment for the breast cancer her husband could not cope and left her. Now she was a single working mother who also was finishing her studies, and in remission from cancer. It seemed to me that probably Mary’s problems were related to the difficulties that her mother had been having. Her mother was struggling a lot with her own problems and when Mary started becoming sick was increasingly frustrated about being unable to do anything to help her. This probably created a cycle feeding the downward spiral in Mary’s health. Treatment strategy: Apply the basic non-pattern-based root treatment and teach the mother to do the treatment daily at home. Treatment: Tapping was applied with a herabari on the GV-12 area, GV-22, and occipital areas. Stroking was applied with an enshin down the back, arms, legs, and abdomen. Press-spheres were retained on GV-12 and left BL-13 (hard knot). The mother was taught to carefully apply the treatment daily at home. Second visit—1 week later Mary had fully recovered from the cold and had nothing else to report. The mother was applying treatment daily in the evening before putting Mary to bed, which Mary enjoyed. Treatment: Tapping was applied with a herabari on the GV-12, GV-22, and occipital areas. Stroking was applied with an enshin down the back, arms, legs, and abdomen. A press-sphere was retained on GV-12. After a further discussion about the home treatment the mother agreed to come back with Mary if symptoms started returning. Follow-up: Five-and-a-half months later Mary had not had a single episode of catching cold. At 1 year, she had had one episode of a mild cold, from which she recovered quickly. She was doing well, was full of energy and very happy. Reflection: I felt application of the principle of Nan Jing (Classic of Difficulties) Chapter 69: “For vacuity supplement the mother” was very important. It was highly likely that the psychosocial circumstances of Mary’s home life contributed to and probably triggered the problems she was having: the illness of her mother, her and her mother’s abandonment by the father, her mother’s hard-working habits and determination to keep going no matter what. Treating Mary alone would be helpful. But more helpful was to have the treatment given daily by her mother. Not only would treatment be more frequent, it would give mother and child more close contact together, it would help the mother relieve her own feelings regarding her health, her husband’s departure, and her inability to help her child stay well. As the mother felt better this would be picked up by Mary and help Mary feel more secure in herself too. It worked well, I think. Case 1 illustrates how a healthy child under stressful circumstances can respond with developing an illness. The next case shows how those illness patterns are part of a longer-standing issue to do with constitutional tendencies. When the constitutional tendency underlies the illness, it may be necessary to give attention specifically to trying to affect the constitution. This is discussed in Chapter 25 “Weak Constitution.” In the following case we can see that despite a history of chronic problems that easily recurred, a little focused treatment was able to trigger big changes quite well. The additional measures that can be needed to address weak constitution problems were unnecessary, as were treatment approaches (such as okyu/direct moxa) to help stimulate the immune system to deal with the recurrent infections. Main complaints: He caught cold easily and had recurrent colds and ear infections, with continuously swollen lymph nodes in the neck. History: He had taken many rounds of antibiotics in the past. He was hospitalized 16 months before with a streptococcus infection in the lymph nodes of the neck accompanying a bad ear infection, and has had swollen lymph nodes in the neck since then. He had problems with chronic loose stools, diarrhea, and vomiting. These symptoms improved after elimination of wheat gluten from the diet following identification of a gluten allergy. His mother had many problems as a child, with chronic swollen lymph nodes in the neck. At age 19 she was diagnosed with sarcoidosis of the lungs. The mother was thus worried that her son may have the same problem or similar tendencies. Mood good, sleep good, all other systems unremarkable. Diagnosis: Lung vacuity with liver repletion pattern (based on the symptoms and findings on the abdomen and pulses). Treatment: Tapping was applied with a herabari over the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left BL-58 drained. Press-spheres were left on GV-12 and CV-12. Second visit—7 days later The week was unremarkable, with not much to report. Treatment: Tapping was applied using a herabari on the head, occipital and neck regions, GV-12 area, around the ears and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left BL-58 drained. Press-spheres were left on GV-12, CV-12. I taught the mother how to do home treatment, with light tapping (around the ears, neck, and GV-12 regions) and light stroking down the back, abdomen, arms, and legs. Third visit—6 days later He was doing well. The home treatment went well with nothing much to report. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left BL-58 drained. Press-spheres were left on GV-12 and CV-6. Fourth visit—8 days later He had had a slight cold, from which he recovered quickly, and he was generally doing well. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, LI-6 drained. Press-spheres were left on GV-12 and TB-17. Fifth visit—3 weeks later Over the last few days the lymph nodes had been a little larger (but without ear infection). He had had some problems with cough and mild headache symptoms. Otherwise he was quite well. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3 drained. Press-spheres were left on GV-12, bilateral TB-17. Sixth visit—19 days later He had had some mild digestive symptoms (loose stools, abdominal pain) over the previous week. He had started with an ear infection but it cleared up without developing much, and he was still coughing a little. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and left TB-5, SI-7 drained. Press-spheres were left on GV-12, bilateral TB-17. Seventh visit—23 days later The lymph nodes were smaller, but still a little swollen below the left ear; he had some problems with headaches. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left TB-5, SI-7 drained. Press-spheres were left on GV-12, and behind the neck point on the back of the right ear. Eighth visit—19 days later He was doing generally better; the cough was very mild and occasional, the lymph nodes less swollen. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, ST-12, GV-12 areas, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left BL-58 drained. Press-spheres were left on GV-12, behind TB-17 bilaterally. Ninth visit—15 days later He was doing well and the lymph nodes were much less swollen. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3 drained. Press-spheres were left on GV-12 and to a stiff point below the left ear. Tenth visit—5 weeks later He was doing very well, the lymph nodes were barely palpable, and he had been able to eat a wider variety of foods, including wheat products, without reaction. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and left BL-58 drained. A press-sphere was left on GV-12. Eleventh visit—4 weeks later Nothing to report. He was doing well and was free of any symptoms. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3 drained. A press-sphere was left on GV-12. Twelfth visit—24 days later He was doing very well. He had had a cold on holiday but with no consequences such as lymph node swelling or ear infection. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3 drained. A press-sphere was left on GV-12. Thirteenth visit—2 months later He was doing well, but had a lot of mosquito bites. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9, SP-3 and right LR-3 were supplemented. A press-sphere was left on GV-12. Fourteenth visit—6 weeks later He was doing well, but reported some stiffness around the left jaw. Treatment: Tapping was applied using a herabari on the head, occipital, and neck regions, GV-12 area, around the ears, and on the abdomen, back, arms, and legs. Stroking with an enshin was applied on the abdomen, down the back, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented and right LR-3, left BL-58 drained. A press-sphere was left on GV-12. After this Tom came for treatment if any problems developed, but the chronic problem he had of recurrent infections disappeared with treatment. Strengthen the body so as to be able to resist problems better. If needed, apply techniques to try to enhance the immune system (such as okyu/direct moxa). Give the parent tools for applying some treatment at home, such as the basic home treatment method; this can be helpful because often with children who have recurrent infections, the parent(s) are quite stressed, tired, feeling frustrated, and even a bit overwhelmed. Most cases of recurrent infections show as lung vacuity pattern. This can be as part of a lung weak constitution. Some children with recurrent infections also have ancillary problems of ear infections; these cases are also often lung vacuity pattern. If a child has been taking a lot of medications for the infections one can, on occasion, see the pattern change. It is possible that the kidney or liver vacuity pattern now starts showing. On very young children, where pulse and abdominal findings are not clear, treat the lung vacuity pattern, but on children with more history and who will allow you to examine the pulse and abdomen, you can differentiate more precisely and may end up with, for example, kidney or liver vacuity pattern. For the kidney a key sign will be the tendency to have cool or cold feet. For the liver pattern there will probably be sleep disturbance or behavioral issues. Usually we supplement LU-9 and SP-3 to treat the lung vacuity. But if there are more acute symptoms, it could be helpful to modify this point selection. Nan Jing Chapter 68 gives useful hints for this (see Chapter 10). For cough or alternating fever and chills, try the jing-river points, LU-8 and SP-5. Expanding on this, if the cold has just started the jing-river points may be preferable to the usual points. If perchance the child is brought in to you with a fever, better to use the ying-spring points (LU-10, SP-2), which are indicated for body heat (fevers). With the older child on whom you are able to read the pulses better, it is quite likely that you will find pathological repletion in one or more yang channels, in which case treat what you find (see Case 2 above). Some children who have this tendency to recurrent infections will show a weakness of all the yang channels. In such a condition the pulse will be deep and weak. Whether it is possible to read the pulse or not, there will be other signs that are usually quite clear. When you touch the skin of the child, it tends to feel slightly looser, softer than on other children. The skin can feel as though it has lost its springiness and luster. You often also see a more weakened appearance of the child as well. In such a case, after supplementing the acupoints for the primary vacuity pattern (such as LU-9, SP-3), also supplement either ST-36 or TB-4. These points can be very helpful to strengthen the yang channels when they are all weak.1 Touch the points and choose the weak, soft, empty feeling points for treatment. The points could be done bilaterally or you may, for example, choose left TB-4 and right ST-36 based on palpation. For this kind of child it can be useful to also use chinetsukyu/warm moxa technique—see below. __________________ 1 This comes from my Toyohari teachers. So long as there are no concurrent skin problems, apply the core non-pattern-based root treatment using light stroking down the arms, legs, abdomen, chest, back, with tapping around GV-12. However, some children with recurrent infections have concurrent skin problems. This makes it more difficult deciding how to apply some simple treatment at home, as a light tapping is usually indicated. An alternative approach is to hold a teishin so that the rounded tip is still within the finger and thumb of the left hand. Then lightly glide the oshide (supporting hand—see Chapter 10) with teishin held stable within it in the following pattern: down the large intestine channel on the arms, down the stomach channel on the abdomen and legs, down the bladder channel on the back and legs.2 __________________ 2 This treatment model comes from my teacher Toshio Yanagishita. Fig. 26.1 Stroking: • Down the arms (yang channels) • Down the legs (stomach and bladder channels) • Down the back (bladder channel) • Down the abdomen (stomach channel) • Across the chest Tapping: • Occipital area: 10 times • Behind the ear: 10 times each • Above the ear: 10 times each • Below the ear: 10 times each • GV-12 area: 10 to 20 times • LI-4: five to 10 times each • ST-12 area: five times each • GV-20 area: 10 times • Across the shoulders: 10 to 20 times Additional tapping can be applied around LU-1, on the chest around CV-17, the interscapular region around GV-12, the shoulders, and the supraclavicular fossa region if the child has very congested lungs and/or is coughing. If there is also nasal infection or congestion, tap around GB-20, GV-22 to GV-23, and LI-4. For ear-related symptoms, tap above, behind, and below the ears (see Fig. 26.1). The most important treatment for children with recurrent infections is the root treatment, both pattern and non-pattern-based. If the problem proves stubborn or resistant, okyu/direct moxa is probably the best method for stimulating the immune system of the child. However, it is, as discussed elsewhere, not always easy to apply this method, thus we tend to apply other techniques first in addition to the root treatment and use the moxa if still not working. It is common to leave press-spheres on points like GV-12 and BL-13. If there is a lot of lymphatic congestion below the ears (usually seen when the ears also become infected after catching cold), it can be helpful to leave press-spheres at the harder, more painful points, often around or below TB-17. For children with cough, palpate and treat the “stop coughing” points on the elbows near LU-5. On some children when the lungs are congested, a strong reaction will show around the asthma shu point; it is good to treat this point for the lungs. If the symptoms prove stubborn or resistant, increase the dose by using the new Pyonex press-tack needles. The intra-dermal needles are used if the symptoms persist after increasing the dose of treatment with press-tack needles. Additionally, for the child who has a tendency toward lung weak constitution and has a problem of recurrent infections, it can be helpful to treat related back shu points, such as treating BL-13 on one side and BL-20 on the other. Press-spheres can be used, but if the child is older or symptoms more stubborn, the 0.6-mm Pyonex press-tack needles can be used. If the child has secondary liver-related symptoms such as sleep or behavioral problems, it can be helpful to leave a press-sphere on the point on the ear behind shen men. If the child has very stiff shoulders, which is a symptom of the lung vacuity pattern, and the stiffness does not change much with the pattern-based root treatment and the non-pattern-based root treatment that includes light tapping of the shoulders, needling may be required. It can be helpful to lightly insert needles to one or two of the most reactive acupoints on the stiff shoulders, such as GB-21, TB-15, SI-14. The needling should be shallow (2–3 mm) and needles not retained for very long. Palpate the area around GB-20 for the child with recurrent infections, chronically congested nose or nasal infection if these symptoms have not responded to treatment. If it is stiff here use either the retained needling or in and out needling method to treat the stiff reactions. On the older child (3 years and older) for the same stubborn symptoms of the nose, palpate around GV-22 to GV-23 for a spongy, painful reaction. If present, apply retained needling on the reactive point, angled towards the nose. For the child with additional problems of ear infections, if there are strong reactions in the region below the affected ear(s) around TB-17, and the problems have not been resistant so far to treatment, you can apply light needling to this reaction to speed up the process of change. Sometimes a reaction is found around GB-12 rather than TB-17, in which case needle this. If the child with the problem of recurrent infections, which is a typical lung vacuity sign, also has concurrent liver symptoms such as behavioral problems, or sleep disturbance, treat related acupoints. If tapping LI-4 and the stiff region around GB-20 has not yet helped, use in and out needling to LI-4 and either in and out or retained needling to the reaction around GB-20. If the responses are too slow developing, or the child requires a more urgent treatment, okyu/direct moxa can be applied at GV-12. But, as explained in Chapter 13, this can be difficult to do, both for the parent and the child. It is not usual to do this immediately, but rather, later in the treatment series. Because of the effects of this moxibustion technique, the desired biological changes will start regardless of where you apply the moxa. We choose GV-12 first because it has a reputation as being good for all pediatric conditions, second because there is a history of applying moxa to this point to prevent infections, and third because it is easier to do moxa on as few points as possible. Choosing a midline point on the back is much easier than bilateral points elsewhere. When you start applying moxa to this acupoint, use the “80%” method at first (see Chapter 13), let it get hot then take it off. When the child is more used to the technique you can let it burn down more. In more severe or acute cases you may choose to let the moxa burn down further to get the stronger treatment effects. This is a technique we do not use often on children and only on older children who you are confident will stay still long enough. The technique is used as a soft supplementation method (see Chapter 13) for children who show weakness of all the yang channels. In such a case use a cone of moxa on GV-14. Make sure that the cone is removed before the child feels any heat. The stronger supplementation effect comes just before the patient starts to become aware of some vague feeling of warmth. Thus, use this for the child who shows softness and loss of springiness of the skin with overall weak deep pulses (see above). If there is chronic congestion in the lungs it is often helpful to apply cupping over the interscapular region to help break up the congestion. It depends on the age, strength, and dose requirements of the child as to how to apply the cupping—see Chapter 14 for ideas about these dose adjustments. On some children there is a lot of lymphatic congestion in the neck. One finds chronically swollen lymph nodes in the neck, below the ears. If after applying other treatment methods to try to help with this the change is insufficient one can try light bloodletting of either LI-1 or LU-11: both are helpful for this kind of problem. LI-1 is better selected in more acute circumstances. Some children with the lung constitutional weakness and recurrent infections show vascular spiders on the upper back in the space between the scapulae and from the levels of GV-14 down to GV-11. If you see this, first try applying light (usually brief) cupping to help improve the blood stasis—light cupping is recommended because one will often notice that the skin in this area is thin, a sign of lung vacuity, and lesser dosage of treatment is indicated. If the improvements are not enough, then one can start to carefully apply vascular spider bloodletting on the area. Since the skin is usually thin here, apply only the stabbing and squeezing method, rather than the cupping method. See Chapter 15 and also Japanese Acupuncture: A Clinical Guide, Chapter 10 (Birch and Ida 1998, pp. 218–229). It can be important to test for and eliminate as needed cow’s milk products. The cow’s milk products (milk, cheese, cream, yoghurt) may need to be eliminated while the child recovers, but can be consumed again later when the child is stronger and has broken the cycle of recurrent infections. Sugar intake can also contribute to the problem, thus it can also be important to control this. To strengthen the body and give parents tools for treatment, teach a simple form of the core non-pattern-based root treatment as soon as you can (usually not on the first visit). This most often includes light stroking (especially with a silver spoon rather than a stainless-steel spoon) and some minimal targeted tapping such as GV-12 (almost all cases) and LU-1, in the area below the ears, and so on. For ear involvement, the tapping is done above, behind, and below the ears. For nasal involvement the tapping is done on LI-4 and over the occipital region. For cough, tap over the inter-scapular region, maybe LU-1. Case 3 Main complaints: He caught cold easily, seven times in the last 6 months. Often he had high fevers with each cold. His nose was chronically stuffy, his lungs congested throughout most of this time. History: The last week he had had a bad cold with high fever for 2 days. He seemed to slowly recover from each cold and then quickly start another. His nose was stuffy so that he had to breathe with his mouth open all the time, which at night caused dryness and irritation of the mouth and throat. He was delivered by suction method resulting in a mild head trauma, affecting his left side, which is slightly less well developed than the right. Despite this, he was a relatively well-developed and full-bodied (slightly replete type) child. He tended to have loose stools and some abdominal bloating. All other systems were unremarkable. His parents were very busy and the family lived a distance from the clinic, making regular weekly treatments difficult. Diagnosis: The lung and spleen areas on the abdomen showed a reaction, the lung and spleen pulses were weak, and the liver pulse hard. Diagnosis was lung vacuity pattern with probable repletion of the liver. Treatment: Tapping was applied using a herabari on the abdomen, back, arms, and legs, GV-22, GV-20, GV-12, and occipital area. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Press-spheres were retained on GV-12 and left BL-13 (a palpable knot was found here). The parents were instructed to test for sensitivity to cow’s milk products. Second visit—8 days later He was doing well, no cold and no fever, not much to report. Treatment: Tapping was applied using a herabari on the abdomen, chest, arms, and legs, GV-22, GV-20, GV-12, around the ears, and over the occipital area. Using an enshin, stroking was applied down the back. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Press-spheres were retained on GV-12 and bilateral BL-15. The parents were instructed to do home therapy daily, stroking down the back, tapping arms, legs, chest, GV-22, GV-12, occipital area. Third visit—6 weeks later Home treatment had been pretty consistent and gone well. He was clearly better without cow’s milk and was using a soy-based replacement. Other than an infection of the left eye, he had generally been OK, without any colds, was able to breathe through his nose more, and had fewer problems with loose stools and abdominal bloating. But a recent test showed he had a slightly low white blood cell count, which the parents were quite concerned about. Treatment: Tapping was applied using a herabari on GV-22, GV-12, LI-4, around the ears and over the occipital area. Using a teishin, very light stroking was applied down the back, abdomen, arms (large intestine channel), legs (stomach and bladder channels), chest, neck, and shoulders. Using a teishin, left LU-9, SP-3, and right ST-36 were supplemented. Press-spheres were retained on GV-12 and CV-12. The parents were instructed to continue daily home treatment. Fourth visit—6 weeks later He started kindergarten and immediately had some digestive problems (loose stools and bloating). Generally he was better, with no colds and the nasal congestion better. He had a mild rash while traveling, but was recovered. On this visit he had a mild runny nose and some congestion in the lungs. Treatment: Tapping was applied using a herabari on GV-22, GV-12, LI-4, ST-36, around ST-12, and over the occipital area. Using an enshin, stroking was applied down the back, abdomen, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained, and left TB-4 supplemented. Press-spheres were retained on GV-12 and bilateral asthma shu points. Fifth visit—13 days later He had caught cold 4 days earlier. He had nasal congestion, mild fever, coughing, congestion in the lungs, and a mild skin rash on the right cheek. Treatment: Tapping was applied using a herabari on GV-22, GV-12, over the occipital area, arms, legs, back, and abdomen. Using a teishin, left LU-9, SP-3, and right LR-3 were supplemented. Cupping was applied over the interscapular region. Press-spheres were retained on bilateral asthma shu points and nasal bi tong points. His nose and lungs were generally better, but he was having some problems with abdominal pain and gas. The night before, he had had a mild fever with cough and evidenced some congestion in the lungs. He was very slightly warm to the touch, but had no fever. Treatment: Tapping was applied using a herabari on GV-22, abdomen, back, arms, legs, chest, around the ears, and over the occipital area. Using an enshin, stroking was applied down the back, abdomen, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Pyonex press-tack needles (0.6 mm) were applied to bilateral asthma shu points. A press-sphere was placed on the left “stop coughing” elbow point. Seventh visit—13 days later He was good for 2 days after the last visit then developed a cold, which turned into bronchitis, and an ear infection. He had fully recovered from these and was generally doing well. Treatment: Tapping was applied using a herabari on GV-22, GV-12, abdomen, back, arms, legs, chest, around ST-12, and over the occipital area. Using an enshin, stroking was applied down the back, abdomen, arms, and legs. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Small press-tack needles (0.6 mm) were applied to bilateral asthma shu points Eighth visit—6 weeks later He had been good since the last visit, but a few days previously had a bad cold, with strong coughing. He was still coughing. Treatment: Tapping was applied using a herabari on the head, abdomen, back, arms, legs, and chest. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Cupping was applied over the interscapular region. Pyonex press-tack needles (0.6 mm) were retained on bilateral BL-13. Press-spheres were placed on the left “stop coughing” elbow point and bilateral LU-1. Ninth visit—22 days later He had generally been good, but with some sleep disturbance the last few nights, crying at night, waking around 2 a.m., and not falling asleep easily. He had also had some irregularity of bowel movements over these few days. Treatment: Needles were inserted and retained at bilateral GB-20. Tapping was applied using a herabari on the head, abdomen, back, arms, legs, and chest. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Cupping was applied over the interscapular region and around the navel. Press-spheres were retained on GV-12 and bilateral ST-25. Tenth visit—20 days later He had been good, no lung and nasal symptoms, but some irritability and waking at night. Treatment: Needles were inserted and retained at bilateral GB-20. Tapping was applied using a herabari on the head, occipital area, abdomen, back, arms, and legs. Using an enshin, stroking was applied down the back, arms, legs, and abdomen. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Cupping was applied over the interscapular region. Press-spheres were retained on GV-12 and bilateral ST-25. Eleventh visit—27 days later He had been pretty good this last month. Some signs of irritability, a little coughing with some loose stools over the last few days. Treatment: Needles were inserted and retained at bilateral GB-20. Tapping was applied using a herabari on the head, abdomen, back, arms, legs, chest, around ST-12, and over the occipital area. Using an enshin, stroking was applied down the arms, legs, and back. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Cupping was applied over the interscapular region. Press-spheres were retained on GV-12 and bilateral ST-25. Twelfth visit—22 days later He had been doing well, no complaints. It was decided to stop treatment at this time since the main reasons for coming, the repeated infections, had clearly stopped and his digestive problems were much better. The parents agreed to continue applying some home treatment and call for an appointment if Eric had any recurrence of these problems. Treatment: Needles were inserted and retained at bilateral GB-20. Tapping was applied using a herabari on the head, abdomen, back, arms, legs, chest, around ST-12, and over the occipital area. Using an enshin, stroking was applied down the arms, legs, and back. Using a teishin, left LU-9 and SP-3 were supplemented, right LR-3 drained. Cupping was applied over the interscapular region and around the navel. Approximately 1 year later I was in contact with his parents who reported that he no longer had any problem with catching colds, lung, or nasal congestion. These problems had not recurred since the treatment. Reflection: I had worried that we might need to apply okyu to try to kick-start his immune system, especially after we heard about the low white blood cell count, but without the moxa and with regular home treatment, Eric did very well. He had a clear lung weak type constitutional tendency (see Chapter 25 “Weak Constitution”), which shows with allergic sensitivities and tendency to repeated infections. Probably it would have been useful to apply cupping earlier than I did. It is also interesting that as his lung weak tendency improved he showed less of the symptoms associated with the pattern (lung, nose, and digestive). The associated repletion of the liver showed up as sleep disturbance, irritability, and more crying kanmushisho-type symptoms (see Chapter 21). I changed the treatment approach once I recognized this, hence the needling of GB-20 and the refocusing of the core treatment pattern. Such a change is usually a good sign, though the parents do not always see it as such. Changing a chronically weak constitutional tendency so that it triggers fewer of the associated symptoms can take time; not only do those gradually improve, but secondary problems emerge as being of more concern. We see this tendency in many adult patients when they stop talking about the symptoms that brought them for treatment and instead talk a lot about other problems that they had before, but which they had barely mentioned in passing.
Recurrent Respiratory Tract Infections
General Approach for Patients with Recurrent Infections
Most Likely Pattern-based Root Diagnosis
Typical Non-pattern-based Root Treatment
Recommendations for Symptomatic Treatment
Press-spheres (Ryu), Press-tack Needles (Empishin), and Intra-dermal Needles (Hinaishin)
Needling
Okyu—Direct Moxa
Chinetsukyu—Warm Moxa
Cupping
Bloodletting
Other Considerations
Dietary
Home Treatment
Further Case Histories
Eric, Boy Age 18 Months
