70-year-old man
Reason for consultation
Acute pain in the right hypochondrium.
Clinical history
Two weeks before, the patient caught a cold with cough and fever. After a few days all cold symptoms disappeared. Since yesterday he suddenly started having severe pain in the right hypochondrium (intercostal) accompanied by a burning sensation. The pain is permanent and continuous.
The patient has a history of coronary artery disease and takes medication.
This morning he went to the emergency department and is irritable. He feels heat throughout his body but no fever, cold, palpitations, shortness of breath.
Poor appetite.
Scant and dark urine.
Feels tired, has thirst and drinks large quantities of fluids.
Dry stools.
He has some small red dots distributed along the 4th-5th right intercostal space. Between the dots the skin is healthy (herpes zoster).
Red tongue with a greasy, yellow and thick coating.
Rapid and somewhat superficial pulse.
Diagnosis
Interpretation
Two weeks ago: wind-cold attack in Tai Yang that appears to have resolved. Yesterday suddenly (excess) pain in right hypochondrium with burning on the skin. Pain permanent and continuous. Seems like excess symptom of the Liver channel.
Today he is irritable (LR), heat throughout the body and drinks a lot (great thirst) with scant dark urine and dry stools. There is heat consuming the organic fluids.
Red dots in 5th-6th intercostal.
Red tongue with greasy yellow coating indicates heat. Rapid pulse also indicates heat.
Diagnosis
Wind-cold attack in Tai Yang, which then enters Shao Yang (GB) and damp-heat accumulate in the LR and GB.
Therapeutic principle
- Eliminate heat.
- Calm pain.
- Unblock the channel.
Treatment
If there are many lesions, the skin lesion can be surrounded, with transverse needling (transfixiation). But most people do not have many plaques and it is a consequence of a decrease in defenses. The skin heals itself but the pain must be treated.
To calm pain:
- Hua Tuo Jia Ji of T4 and T6 on the right side. The superior and inferior vertebrae are also treated.
- Add CV-12 or CV-15 (luo), depends on how far the pain radiates forward.
- Very good results with electro stimulation: the negative pole at Hua Tuo Jia Ji and positive in the area where the herpes ends.
- Alternatives to treat the ribs: TE-4 + GB-41 or GB-34 + TE-6.
Eliminate heat and dampness: