Hello! I have often found the posts on this site helpful. I am two years into my clinical practice and I am seeking a little early intervention in a new case that I have no previous experience with.
I have a male aged 32, highly motivated professional (own company) presenting with "slight, intermittent, dull pain around liver area" graded 1-2/10 pain level.
The only trigger he is sure is linked is stress, as it got worse recently during a stressful period. Whether there were other factors (eg diet, alcohol, sleep, exercise) coinciding with this stressful period is unclear but he doesn't recall any change other that stress. He believes that it is not worse after eating certain foods, so there doesn't appear to be a gallbladder issue.
Investigations have revealed a slightly fatty liver and he is pending an appointment with a specialist , predicted to be in October. Elevated liver enzymes. He believes that he has a normal fatty liver for a 32 year old, and that stress is the major cause, and he is hoping that acupuncture can address this and that the liver may resolve itself.
HX sinusitis (successfully treated by an experienced Chinese acupuncturist many years ago) and post nasal drip.
HX brain haemorrhage following a head trauma, resolved.
Takes lysine for cold sores.
General information and symptoms:
Stress, irritability, vivid dreams and hypochondriac pain were the highest scoring on his intake form. He said his dreams were really very vivid, but don't bother him as they are not emotionally difficult dreams, generally pleasant and he doesn't wake tired.
High sex drive, forgetful, craving salty food, restless/agitated, over-thinking, fatigue after eating and loose stools scored slightly lower.
Finally a little neck and shoulder tension, sighing, low back pain scored the lowest and no other symptoms were disclosed.
He exercises in a gym 3-4 times per week, drinks sparingly and is now off for lent, doesn't smoke, reads and plays music to relax, and takes sailing trips.
His energy is 8/10 and his diet is healthy although he admitted to eating a pastry the night before.
I took his pulse later when he was resting and it was slightly rapid but not out of normal range and slightly wiry, but for a new patient they can be slightly nervous and with pre-existing Liver Qi Stagnation it's not suprising. I'm not great at pulse diagnosis beyind this. He doesn't experience any palpiations or feel any particular awareness of his pulse.
His tongue surprisingly was more deficient. Quivering, small, wet, a bit flaccid with toothmarks and the colour normal. He said it would make sense for him to be somewhat tired or run down despite his energy generally appearing good.
Shen appeared good, good sense of humour, the appearance of being very confident and chatty in the way that business people often behave.
He is overweight although doesn't seem concerned with this, as he has habitually exercised and was quite critical of people who don't take exercise.
So what can I say. There is a mixed excess/deficiency pattern. Some Sp Qi xu which presumably could be due to the volume of work and overthinking and there is Liver Qi Stagnation, both could contributed to fluids eventually condensing to phlegm accumulating. We've got post-nasal drip, excess weight and fatty liver.
So for his first treatment I aimed to sooth the Liver, calm the mind and tonify SP Qi and resolve phlegm. Long term I am hoping that focussing on the Liver and Spleen will prevent accumulation of phlegm.
I've done one treatment so far, using calming points and soothing points yintang, 4-gates, HT-7. Tonified RN-6, St-36 Sp6, reduced St-40, Liver-13 and Liver-14. These last two I only did on the right but please correct me if I am wrong, I just applied my logic at the time.
I'm not a herbalist so I am treating with acupuncture alone.
Grateful for any contribution from someone with experience with this pattern and if the treatment goal is reasonable and realistic. Any particular diet advice welcome too.