Acu. | Issue #31 | Summer 2021
Lucy, female, 50 years old
Lucy visited my clinic for treatment six weeks after a positive Covid test. Her initial symptoms had been a sore throat, loss of sense of smell and taste, and overwhelming exhaustion. Her lungs had not been affected. Now, although mostly recovered, she still presented with some fatigue, and a mild sore throat which came and went and she couldn’t quite shake off. More worryingly for her, she had in the last few weeks also developed cardiac symptoms: every morning at 5am she was woken up by chest pains, intense heaviness in her chest and the feeling that she couldn’t breathe. The cardiologist diagnosed her as having variant angina and believed this to be linked to long Covid. She was given sublingual nitroglycerin which she took every morning to alleviate the attack as it happened. She otherwise reported her sleep to be good until 5am, no issues with temperature or appetite. She had a history of constipation. Her periods were regular, every 28 days, and noneventful. She reported feeling irritable, as she was tired from lack of sleep in the early morning and worried about her health. Her tongue was pale with a sticky coating at the back, her pulse was wiry. First treatment: The aim of the first treatment was to address the acute cardiac issues with acupuncture, and to expel the lingering pathogen at the shaoyang level, as well as support blood circulation, with herbal treatment. The acupuncture treatment consisted of gentle stimulation of P 4 xi men, the xi-cleft point of the pericardium channel, LU 9 tai yuan, LIV 3 tai chong, REN 17 shan zhong, DU 20 bai hui. Formula 1: Chai hu 12; huang qin 9; ban xia 6; dang shen 15; yuan zhi 9; shi chang pu 9; dan shen 15; hong hua 9; tao ren 12; zhi zi 6; zi su ye 6 This formula was based on Xiao Chai Hu Tang, to expel the lingering pathogen. I added dan shen, hong hua, and tao ren as blood movers; dan shen is particularly indicated for moving blood in the chest. Zi su ye is a light acrid herb to circulate the qi in the chest. Zhi zi is added to vent out the irritability. Second treatment: Feedback a week later was positive. Lucy’s early morning chest pain had consistently lessened and she had not had an angina attack at all the last two mornings, which she was very relieved about. She felt she had finally shaken off the lingering sore throat. Her sleep was however still bothering her. She felt it was restless, and she was still waking up anxiously
at 5am, which I attributed to blood and yin deficiency after her long illness. She had no heat at night or night sweats, no particular dreams. Her constipation was still bothering her. Acupuncture treatment this time was to use the back shu points to deeply nourish her: BL 13 fei shu, BL 15 xin shu, BL 20 pi shu, BL 23 shen shu, KID 3 tai xi, DU 20 bai hui. Lucy benefited from some deep rest during the session and particularly enjoyed the heat lamp. Formula 2: Dang gui 12; bai shao 20; sang shen zi 12; ye jiao teng 25; tian hua fen 12; tao ren 12; xing ren 12; lu gen 9; nu zhen zi 12; han lian cao 12 This formula is primarily a sweet, overall slightly cool formula to build her blood and yin. Seeds are added to moisten the bowel and help with the constipation. Third treatment: Lucy’s feedback from the last session was surprising: while she slept beautifully the night after the acupuncture treatment, her sleep in the subsequent nights had been ‘terrible’. She was exhausted as she felt she had been tossing and turning all night, and then still anxiously waking at 5am. The fact that she had responded so well to the acupuncture but not to the herbs was puzzling, and was an important clue which led me to further question her sleep. While in my previous consultation I had enquired about feelings of heat/ night sweats, I started asking her about feeling cold at night. She indeed informed me that she always slept under two duvets and with cashmere socks – she had always done it and it hadn’t occurred to her to mention it. This led me to believe that, rather than tonifying her yin and cooling her down, which had made her sleep worse, she would benefit from warming up her metabolism. No wonder she enjoyed the heat lamp so much! The acupuncture treatment for this session was a repeat of the previous one as it had been so beneficial for her. Formula 3: Dang gui 12; sang shen zi 12; ye jiao teng 25; tao ren 12; xing ren 12; lu gen 9; nu zhen zi 6; tu si zi 12; gan jiang 6 This is a repeat of the previous sweet, nourishing formula. However I removed bai shao, han lian cao and halved nu zhen zi as these are cooling herbs, and instead added tu si zi which is a yangwarming seed and gan jiang which is
Practice
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very acrid and hot. Follow-ups: The following week Lucy was much more rested. She had still slept with her two duvets and socks, but her sleep had been much deeper. She had only woken once to go to the toilet each night, but had gone straight back to sleep each time.
Discussion
These two cases illustrate how acupuncture and herbal medicine can work together to amplify each other. Having these two separate, but related modalities within one treatment can offer many benefits: combining them allows us to treat different issues in one session, gather more feedback and therefore greatly increase our understanding of the patient’s health, and also allows us to change tack in an informed way if the patient does not respond as expected to current treatment. I hope these two cases inspire acupuncturists who are also practising herbal medicine to look at their treatment plans more pragmatically, and that they are stimulated to think more creatively about the possibilities of their plans as treatment progresses. In the process of sleuthing out what the next step is to return a patient to good health, using the full feedback from these two modalities is invaluable. For acupuncturists thinking of studying herbal medicine, I hope these examples illustrate the reality of clinical practice with herbal medicine, as well as showing how important it is to learn about herbs in a clinical setting as patient responses to formulas are such an important part of the overall treatment. The Register of Chinese Herbal Medicine (RCHM) recommends studying Chinese herbal medicine on accredited courses only, as these courses have a significant number of hours spent in a student clinic where students learn about the reality of practice. BAcC members understand that, although shorter courses are available, only the full BAAB accredited training does justice to the complexity of acupuncture. The same can be said about the practice of Chinese herbal medicine.
