Thanks for the reply, my client has been getting twice weekly treatments for 4 weeks. She is a fit 43 years old active woman, doing swimming, running and pole dancing, she is a massage therapist of 20 years experience, she has recently stopped pole dancing because of the pain. The pain started about 10 years ago,(it has not been ongoing) she thinks from carrying numerous buckets of water to give to horses, 30-40 buckets of water twice daily, I told her then to buy a long hose pipe which she subsequently did.
I have seen her on and off over the years and am treating this case mainly as a channel problem, there is an ongoing lung xu and liver stagnation, tongue body colour is good with very slight purple to orange sides, shallow toothmarks, thin white coating, small crack in the right lung position that comes and goes, pulse at the moment is slightly floating in the liver, heart and small intestine positions, (she has a head cold at the moment) and small and hard in the kidney position. she is prone to her lung qi dropping characterised by a very weak breathless voice, this often co incides with a drop in blood sugar, she gets breathless on slight exertion, like climbing the stairs and her skin gets a bit clammy/sweaty. She does not like acupuncture and can start to hyperventilate if daqi is even slightly strong. I use a 1-5 pain scale with 1 being no pain, hers is generally at a 3, managable but irritating, she has been using NSAIDS and Kerol 50mg with no relief, she has not had any cortizone injections, the pain is only there when she goes to pick something up or when she exrtends her arm. Heat helps very short term, as in a few hours. The acupuncture has helped alleviate the pain for a few days each time but never completely and it always comes back to a 3.
The principal of treatment for this instance has been to clear and invigorate the channels and move stagnation and cold.
Distal points have been hegu LI 4, yangxi LI5 and Pianli LI6, 3 consecutive points boost the effectivness of themselves, also they are all for elbow problems and pianli is the lu point which would help her lung qi xu. Zusanli St36 and yanglingquan GB34 yangming and shaoyang points, also yanglingquan is emperical point for sinews.
sj10 tianjing relaxes the sinews and regulates zhong qi and helps liver qi stagnation (tongue and prior treatments) chize Lu5 is needled deep as an ashi point, also combined with kongzui Lu6 and an ashi point midpoint of the two, Quchi Li11relieves bi syndrom, local. Shousanli Li10, invigorates the channel, moves stagnation, bi. I have alternated these two points on each treatment, quchi left arm, shousanli right arm, next treatment quchi right arm and shousanli left arm. Quyangwei with moxa. Obviously I needle the distal points 1st with fairly vigorous stimulation fi possible, then I needle the local, ashi and conductor points,they will be left in for 40 minutes. I don;t use all of these point on every treatment, they would be the more common ones, her records are kept in the clinic, I am at home at the moment.
I hope this helps you help me