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Advice needed


#1

Hi, greetings from Singapore! I would greatly appreciate if someone could read my post and help me with the questions I have at the end of the post. Apologies for the long post!

Symptoms:

  • Dull knotty-kind of tightness in the entire abdomen region. Upon palpation, I feel the muscle actually twitching/jumping, namely above the navel. When the tightness gets worse at times, massaging it could cause me to burp, which would relieve the discomfort temporarily.
  • Increased muscle tone (feels ropey) in neck muscles namely the scalenes, SCM, and suboccipital muscles. However, what’s funny is my neck’s range of motion is fine. I am able to turn my neck left, right, up and down pain-free.
  • 24/7 dizziness-kind tension feeling in the head. Intensity: 3/10 – bearable but annoying. I would not go so far to call it a headache, as there’s no pain. The closest description I can think of: you know that feeling when you try on a new pair of glasses for the first time? Yes, that’s the feeling. I attribute this to the neck tension (I'm not sure though).
  • Along with the neck muscles, it seems the general muscle tone in other parts of my body has increased too, e.g. pectoralis, forearm, and bicep. Calves feel tight too.
  • Words to describe my current state of thought/emotion: frustrated (because of this problem), unable to unwind completely, trying to stay optimistic, can’t wait to get well (as I have lots of things I want to do).
  • An overall dip in energy levels. I have no problems falling asleep at night, but don’t feel particularly rested when I wake up in the morning.
  • Do not have any issues with coffee in the past (not that I drank a lot of it). However, recently I realized it made me edgy.
  • Decreased libido, yet have occasional instances of nocturnal emissions despite not having dreams.

How did these symptoms above come about?

This may sound bizarre, but the aforementioned symptoms appeared after this one-off incident. In April 2012, I visited a pain management doctor for a one-year long right Quadratus Lumborum (QL) pain, caused by hurting myself doing some exercise. I was given a trigger point (TrP) injection and medicines. The injection proved effective; the pain went down significantly but not completely. I was busy preparing for my university exams during this period so I did not take the medicines as they would cause drowsiness.

A month later, after my exams ended, I went for a follow-up visit. The doctor warned that the second injection would not be as effective as the first and told me to take the medicines if the injection did not help. The injection did not help so I started taking the medicines as told. Looking back, I think this was where the problem began. I started becoming lethargic, sleepy all day, and perspired a lot. The side effects were affecting me but were not helping my flank pain. After taking the medicines for ten days, out of curiosity, I looked them: Alprazolam, Trazodone, and Cymbalta up on Wikipedia and was alarmed when I found out they were antidepressants. Then in hindsight, I think I did something stupid: in my bid to get these drugs out of my system quickly, I drank lots of green tea and used the dry sauna.

Two days later, at around 9pm, I suddenly experienced a pounding heartbeat that continued all the way to 4am before I decided to make my way to the nearby hospital’s emergency department. The doctor there put me on a drip, ran tests on me but could not find anything wrong (my heart beat was measured to be normal from the beginning in spite of my complaints of a racing heartbeat) and suggested two possibilities: ‘anxiety’ and ‘hypokalaemia due to use of sauna’ in the report. I was discharged at noon and during my stay, I was given a tranquilizer jab twice.

For the next few days to a week, I found myself in some kind of emotional wreck. I felt empty, depressed and harboured suicidal thoughts. It was the first time in my entire life I felt as such and I constantly had to rationalise to prevent myself from doing something stupid. When the depression and suicidal thoughts eventually went away (never came back), those abovementioned symptoms, in particular the neck tension and dizziness came about.

Till today, I still can’t figure out why I felt that way. I had just graduated and was looking forward to a long vacation before stepping into the workforce. No more project deadlines to meet, no more exams to prepare; life couldn’t be much better. I’ve gone through more stressful periods in my life without any problems, e.g. conscripted military service from 19 to 21 years old, participated in military parades, and played chess competitively in college.

Treatments/people whom I have tried/seen:

Western medicine

  • Pain Management: Saw two different ones. The first was the one mentioned earlier. He wanted to prescribe another drug. I refused and never saw him again. The second one gave me TrP injections into my trapezius and neck, but they didn’t help.
  • Orthopaedic: Did cervical spine MRI. Result: minor disk degeneration. The orthopaedic says findings are unrelated to symptoms, so did the neurologist.
  • Neurologist: Did brain MRI and Nerve Conduction Study (NCS). Both tests results were normal.
  • Subsequently, I was referred to the physiotherapy department.

Physiotherapy

  • All I did was stretching, no different from what I can do on my own.

Chiropractic

  • Saw two different ones. They did the typical neck and back adjustments; didn’t feel any difference. Went 5 sessions in total.

Myofascial TrP dry needling

  • Different from TCM acupuncture, the therapist does not simply leave the needle in the skin. She would move it arouns to try and elicit a “jump” response.
  • I spent the bulk of my time here; did about 15 to 20 sessions in total. Initially, I thought the muscle tension was nothing more than myofascial TrP. Thus, this was one of the first treatments I tried. At first, it did help to get rid of some TrP in my upper trapezius. Neither the therapist nor I were able to find anymore TrP, but the muscle tension is still there.

Massage

  • The therapist was skilled, but my muscles just wouldn’t relax. He was the one who pointed out that my neck’s range of motion is fine, but it’s holding a lot of tension. He too was unable to find anymore TrP.

TCM acupuncture

  • I did 4 sessions in total, once a week. I don’t remember seeing any noticeable difference, like the muscle fibres in my neck feeling less ropey.

Wet cupping

  • Similar to bloodletting, the Muslims also practiced wet cupping. They call it ‘Hijama’.
  • Done only once a month, I did about 8 sessions in total. In addition to the back and neck, I also shaved my head bald to do cupping on the head. The therapist would typically cup 15 to 20 points, including the head. One of the head points is GV20 (always had a lot dark red blood). While wet cupping did not really help with my current problem, it got rid of my right QL pain for good.

Questions:

  1. Based on my symptoms, from a TCM standpoint, what could be my problem?
  2. Based on my symptoms, do you think I should be doing wet cupping? I’m still doing it on a monthly/fort-monthly basis. I always see dark red blood in the cups so I assume it’s good to do it.
  3. I have always believed in the adage, ‘insanity is doing something over and over again, and expecting a different result.’ Nonetheless, I am not seeking a one-time miracle cure, but I would need to see improvement after each treatment. Does this adage apply to acupuncture, especially for a problem like mine? Do you think I quit my acupuncture treatments prematurely? If yes, how many sessions should I try before deciding if it works/does not work?
  4. Do you think the way in which I presented my case to the physician may have influenced the way he treated me? As you can see, I wrote a lot above. I did not verbally convey everything I wrote above; just the major complaints, namely the neck tension and dizziness.

Thanks,

Lock


#2

Questions:

Based on my symptoms, from a TCM standpoint, what could be my problem?

-- From a pure tcm standpoint you haven&#39t provided the right information to offer a TCM diagnosis besides liver qi stagnation likely (stress) and localized blood and qi stagnation in the upper part of the body.



Based on my symptoms, do you think I should be doing wet cupping?

-- I don&#39t think I would ever let anyone, every for any reason cup my head. I think you should see a fully trained acupuncturist who also does &#39dry&#39 cupping and tuina (Chinese Medical Massage) and give them 7-10 treatments before you judge the efficacy of what you have going on. Someone who also practices herbal medicine would be preferable.

I’m still doing it on a monthly/fort-monthly basis. I always see dark red blood in the cups so I assume it’s good to do it.

I have always believed in the adage, ‘insanity is doing something over and over again, and expecting a different result.’ Nonetheless, I am not seeking a one-time miracle cure, but I would need to see improvement after each treatment. Does this adage apply to acupuncture, especially for a problem like mine? Do you think I quit my acupuncture treatments prematurely? If yes, how many sessions should I try before deciding if it works/does not work?

--See above. Also you may or may not see improvement each treatment. After a few you should get some kind of consistent result in most cases.

Do you think the way in which I presented my case to the physician may have influenced the way he treated me?

You better believe it. But they generally get distracted by broad systemic problems that don&#39t have an isolated cause.

As you can see, I wrote a lot above. I did not verbally convey everything I wrote above; just the major complaints, namely the neck tension and dizziness.


#3

Chad,

Thanks for the really quick reply!

From a pure tcm standpoint you haven&#39t provided the right information to offer a TCM diagnosis besides liver qi stagnation likely (stress) and localized blood and qi stagnation in the upper part of the body.

Wow, I think I have pretty much listed out all the symptoms I have. Apart from a tongue and pulse diagnosis (which is quite impossible here), what additional information do you need?

I think you should see a fully trained acupuncturist who also does &#39dry&#39 cupping and tuina (Chinese Medical Massage) and give them 7-10 treatments before you judge the efficacy of what you have going on.

The acupuncturist who I saw 4 times did do dry cupping on me. Okay, thanks for providing me with a guideline; I guess I had quit my treatments prematurely.

You better believe it. But they generally get distracted by broad systemic problems that don&#39t have an isolated cause.

Does “it” refer to TCM acupuncture or are you agreeing with my statement that the way in which I presented my case to the physician would have influenced the way he treated me?

Thanks,

Lock


#4

You don&#39t mention diet, but some of your symptoms seem to indicate you may be dehydrated. Esp since symptoms started with two dehydrating things: green tea and dry sauna. Bleeding cupping can also aggravate possible LR Blood deficiency due to Blood stagnation. You may want to add berries, beets and plenty of protein to your diet. Please also try drinking 8 large glasses of pure water per day and see if there is any difference. You are getting a lot of different kinds of treatments, and your body appreciate some simplicity and consistency.


#5

I totally agree with "dear addie" about the hydrating being number 1. Please consider drinking lots of plain water. Skip the tea for right now. Also avoid coffee (dehydrating, qi-dispersing) and any alcohol (burdening).

From your history, the possible pathomechanisms that I see are (and please note, this does not necessarily apply to you, but this is how Chinese Medicine can explain what you have experienced. Please seek the expert opinion of someone who can work with you individually):

1 / the initial injury to the QL, if due to trauma sustained during physical exercise, could create local qi & Blood stagnation. Not sure what the doctor injected, but would assume, if it alleviated the pain, that it could disperse some qi and Blood, both locally and systemically.

2 / taking antidepressants will quickly cash in a lot of one&#39s root qi (kidney qi, the stuff you&#39re born with, the stuff that&#39s harder to replace when you use it up). So doing that for any length of time can continue to deplete qi. The presense of signs such as lethargy & heavy perspiration points to qi deficiency, including a destabilization of the wei (externally protecting) qi.

3 / going OFF antidepressants (specifically benzodiapines & SSRIs) is not something to be done quickly. No wonder you were feeling so emotionally down afterwards. Chemically, and also via Oriental Medicine&#39s view of how intense emotions lead to stagnation, going off antidepressants will lead to a less smooth flow of qi, hence qi stagnation & possibly even some Blood stasis.

4 / green tea is bitter, energetically cold, and an anti-diuretic. It will do a pretty good job of ridding body of some unwanted heat, but also of WANTED and unwanted fluids. The sauna might offset a bit of the cold injested from the tea, but it&#39s ALSO going to deplete you of fluids by making you sweat. The sauna heat is also going to further interact with & possibly harrass the unstable wei qi. So now you&#39re looking at a combination of qi depletion (from 2 & 3), and fluid depletion all taking a toll on the Blood.

5 / finishing up a long course of study, and going from a life that is filled with structure (deadlines, external pressures) to a life that has a lot of flexible, open-ended time is going to lead to a certain stress or stagnation associated with "too many choices". It seems to me a perfect time for pathology to arise, because suddenly there is room for it.

Your current symptoms I would suggest indicate depletion of the material aspect of your body: fluids and blood (which can follow the trajectory of chronically dispersing and stagnating qi). This would lead to an upflowing of yang (heat, upward energy) because there isn&#39t enough yin (cool, material rooting) to hold it down, which explains headache and strange dizzy-ish feeling sensations.

In general, it seems to me that its quite possible you are trying to do too much to eradicate "the problem" when really what you need most is to create an environment where the body can rebalance and reconnect with itself. Let go of your want-to-dos right now (you will have a time later to take them on when they are not presenting an impediment to your getting better). Drink water. Find one practitioner you want to work with (I wouldn&#39t do chiropractic, acupuncture, massage, physiotherapy, etc. all at once — that&#39s totally going to blow out your qi). Perhaps do some simple daily movements of yoga (sun salutes, gentle, 10 minutes max daily) or tai chi. Also spend 10 minutes sitting with your eyes closed in meditation, to give the Body time to integrate all that is going on around you.

Adapting a quietness should enable qi & fluids (Blood) to fill up and move again harmoniously, thereby nourishing your muscles and tendons.


#6

In my initial post, under Symptoms I wrote, ‘I feel the [mid-upper abdominal] muscle actually twitching/jumping.’ However, I think the twitching/jumping could be nothing more than abdominal pulse. To confirm my suspicions, I checked my pulse in two different locations. I placed my fingers on the neck and abdomen simultaneously and realised both areas (pulses) were beating in tandem.

I figured out that the nervous energy/”butterflies in my stomach” is why I feel my abdominal muscles twitching. As I started getting in tune with my body, I think all my other symptoms (i.e. tension in the other muscle groups mentioned above) can be traced to that nervous energy in my stomach. Additionally, at random occasions when I become antsy/edgy for no good reason, previously I would begin to panic as I don’t know what’s wrong with me. However, ever since I figured out that those butterflies in my tummy are the culprit, I do not freak out anymore. It’s like I know where the problem is and I have things under control.

Right now, I have that “butterflies in my tummy” feeling constantly, 24/7. Though I have more or less learnt to cope with it/ignore it, it’s annoying and I want to get rid of it.

Anxiety/fear/stress can manifest itself in many symptoms. Different people display different symptoms. As far as TCM goes, is there a different diagnosis for different symptoms? If so, what could be the diagnosis for someone like me whose chief complaint is feeling “butterflies in his tummy” all the time? Still Liver Qi stagnation?


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