Female, 29 years old

Clinical history

The patient has a history of low back pain for 2 years. The pain is accompanied by cold and heaviness and is aggravated by weather changes especially in cold weather and improves with heat.

For 2 days she has had a slight fever and fear of cold. The low back pain has become very strong again. The pain is located on the right side, from BL-26 to BL-21. The pain is acute, limiting flexion and rotation movements. At the same time, she has great pain in the right shoulder blade that radiates to the nape (SI-14, 15 13 12 ID).

She also has: abdominal distension with nausea and loss of appetite, excessive salivation and bland taste in the mouth. The urine is clear and scant. The stools are pasty.

The tongue is pink with a seborrheic white coating.

The pulse is somewhat superficial and tense.

Diagnosis

Tendinomuscular blockage of Tai Yang, cold reaching Tai Yin.

+ Latent base of emptiness, Bladder meridian V in deficit for two years.

Two days ago meridian problem, no Zang Fu involved. Pain sensitive to cold and dampness that improves with heat. Local problem. There is predisposition to blood-energy emptiness problem of V, but nothing more.

Bladder fears cold. But if the meridian is in equilibrium nothing feels bad. If weather change produces pain it means your vital energy, of the meridian or of the whole is weakened. When vital energy is good, external energy cannot overcome you. The external becomes pathogenic when you cannot adapt to that energy. Same with emotions, they are necessary, not bad, but when they exceed your capacity of adaptation is when they become pathogenic.

Cold that causes low back pain, it's Bladder meridian. There are no general symptoms that lead us to emptiness of R, B etc.

Two days ago attack of cold, attack of Tai Yang initially, which with the poorly defended Bladder meridian problem extends rapidly to Bladder tendinomuscular. It's in the V zone, not in the center of the spine. At the same time ID lying is also affected. Tai Yang affected, V and ID. By intensity and blockage we see it's tendinomuscular.

There is fear of cold, tense pulse from pain, from cold that compresses and tenses as well.

Cold can affect Tai Yang and also Tai Yin: pasty stools, abdominal distension, excessive salivation (only these last few days, not long-term emptiness), there is no transport transformation, then there is dampness, thick coating, pasty stools, V loses its Yang, does not transform, does not propel, then scant and clearer urine from cold.

Being a very blocking, acute and recent pain, it would hardly be a curious meridian. If it were it would be more structural, deeper, with more complicated symptoms.

Treatment

Release from disabling pain.

On the other hand, strengthen Tai Yang (lumbar + cold) and Tai Yin, the two entry gates are weak.

Also boost her Yang, because she is sensitive to cold, could reach Tai Yin (I can treat R or B to boost her vital energy).

All needles with moxa.

• BL-60 her system is cold, give warmth to this meridian, it's a King point, it's fire, and it's also a great nape point. Bilateral. + BL-10 to activate the two branches of V.
• SI-3 + BL-62 would be a great combination in this case, to treat and release Tai Yang. I could place only on the right side, which is the affected one.
• GV-14 + GV-4 to mobilize and raise Yang, they are two very potent points. High and low part. (moxa)
• Ashi points (hot needle).

If I remove the cold far from her body, Tai Yin would improve, but we can add from the other side ST-36 and CV-12.

All V points and GV-14 release the surface.

Van Nghi would propose BL-67 (Jing), she doesn't see utility in it, it doesn't give result. She treats with Ashi points (as classical texts say).

In acupuncture you must palpate and know how to find living points, the dead ones don't work. Acupuncture is dynamic, it's working with a complex living system. Academic education teaches theory, not the essence.