Name: Blanca G.
Age: 32
Reason for consultation: Asthma

Antecedents: nothing relevant to the case.
Parents: The mother had several vascular brain incidents with almost total recovery. The father has a large history of conditions with Diabetes Mellitus., psoriasis, hypertension, tachycardia, rheumatic arthritis and the last year impotence. There are precedents of Diabetes in this part of the family.
Appearence: Slender woman,especially the legs, happy expression, strong look, very energetic.
History: Her asthma started when she was 24 years old related to a situation of high tension due to the bankruptcy of her father’s company.
The treatment she was receiving consisted of puffs of Ventolin and Prednizon during more than three years.
After those three years she looked for help abroad. A French specialist changed her medication to: Terbasnin, Terbutalinsulfathe and Pulmicord.

Asthma is a broncheo spasm that produces a restriction of air followed by a swelling in the mucus producing lining of the lungs. The cramp in the bronchus produces a difficulty in breathing out leading to an accumulation of mucus.

T.O.M. differntiates asthma between: Xiao; hissing, sibilant and Chuan: lack of breath.
The accumulation of ‘Tan’ which means: phlegm is a RESULT of asthma not the cause of the broncheo spasm. Would the asthma be caused by phlegm one would expect in diagnose a swollen tongue with a thick white layer, but that is normally not the case.
To differentiate :the Chuan condition improves when Tan is eliminated but Xiao hides in the lungs and comes out in bursts. It is the retention of ‘wind’ in the body. That is why diagnose by X-rays is not accurate because the phlegm only accumulates after several years.

‘Early onset asthma’ that starts during childhood is many times wrongly diagnosed because its first symptom is eczema. The treatment of this with cortisone, ‘pushes’ the asthma inside, worsening the condition.
The asthma that starts in adolescence, normally does not produce skin problems in the first stage.
The retention of ‘wind’ is normally due to a weak defensive energy (Wei Qi) and weakness of the energy of the lungs and the kidneys.
It is the kidneys who have to ‘recieve’ the life energy or: ‘Qi’. The tract of the kidney meridian makes it (picture) clear how the kidneys are related to the power of breathing in.
That is why traumas during birth and the ’first breath’ can have such a big influence on the development of asthma. The natural course of the birth process is of big importance because it ‘starts’ the whole organism and establishes the connection between the lungs and the kidneys.
That is why there is higher occurrence uof asthma under children born by caesarian.
Another aspect is the prematural cutting of the umbilical cord that inhibits the entrance of Immunoglobuline G (an important factor in our immunity system) in the newborn. This may weaken our defensive energy and can become an extra factor in the development of asthma.
The role of the kidneys is also shown by the fact that many woman who suffer from asthma see an important improvement during their pregnancy.

Pulse: tense, especially in the upper region, floating.
Tongue: normal tongue body and colour, little bit red at the point.
There is a feeling of coldness in the body, lack of air, oppression in the thorax, white mucus, frequent headaches and irritability especially in confrontations with authoritarian men.
Diagnose: Cold wind invasion in the lungs with a base of ‘wood insulting metal’. The overcharged energy of the liver inhibits the functioning of the lungs.
The cold wind has invaded the layer of the ‘Wei Qi’ (defensive energy) of the lungs and inhibits the dispersing and descending function of the lungs causing the lack of air and producing cough.

Treatment: Liberating the exterior, restore the descending and dispersing energy of the lungs , expels cold wind. Added to this is: Tonify the defensive energy of the kidneys and the lungs and harmonise the ‘Shen’ (mind).

Used points: Feng Men (bladder 12), Fei Shu (bladder 13), Lieque (lungs 7), Kongzu (lungs 6), Dingchuan (extra), Shen Men (heart 7), Fengchi (Gallbladder 20) and Jianjing (Gallbladder 21).

Feng Men and Fei Shu were first treated with cupping to liberate the exterior and establish the dispersing and descending function of the lungs. After that they were needled and direct moxa to expels the cold.
Lieque liberates the exterior , expulses cold wind  and helps the descending function of the lungs by opening Ren Mai (The sea of Yin).
Kongzui is a powerful accumulation point that is used in acute asthma.
Dingchuan (half a chun next to Dazhui, Du mai 14), is used in acute lack of breath.
Shen Men harmonises the Shen and calms the mind.
Fengchi and Jianjing disperse wind and by relaxing the trapezius muscle help the descending function of the lungs.

This was combined with Bioenergetic exercises to strengthen ‘Grounding’. These produce strong vibrations in the legs to open the channels and gave spectacular results.
This was followed by ‘pushing hands’ exercises (Qi Kung) to harmonise respiration with movement.

The emotional therapy helped to confront her self with the demanding pressure of the father and the competitive relationship with the mother.
Therapy made it  obvious how the inhibition of emotions in the development of her character had produced a stagnation of the liver energy that led to ‘wood insulting metal’.

After an improvement in her condition we changed to a treatment concentrated on liberating the chest and the flow of the energy of the liver (Qi Ji).
Gonsun (spleen 4) opens Chong mai meridian that connects with the uterus, essence of woman.
Neiguan (pericard 6) reduces the tension in the chest.
Shen men (heart 7), calms the mind.
Tai Chong (liver 3) regulates the flow of the liver energy.
This treatment produced immediate improvement of her state of mind.

After this phase we moved to a more structural treatment.
Shen Shu (bladder 23), Zhishi (bladder 52), Guanyuan (Ren mai 4), Huangshu  (kidney 6) and Fi Shu (bladder 13) to tonify the defensive energy of kidneys and lungs.
Lieque (lung 7), Chize (lung 5) and Shanzhong (Ren mai 17) to liberate the chest and reestablish the descending function of the lungs.
Shentin (du mai 24) and Shen Men (heart 7) to harmonise the mind.
Zu San Li (stomach 36) and Fenglong (stomach 40) to stimulate bloodproduction and dissolve phlegm.

Her asthma has virtually disappeared.

Name: Marja M.
Date of birth: 8/11/50.
Reason for consultation: Pain in the right knee.

Clinical background: nothing relevant to the case
Finnish lady, widowed,  with a robust constitution, with a happy character, outgoing, sporty history, with a history of pain in the knees during the last ten years.
Last year she had a knee protests implant in the left leg for lack of cartilage and unbearable pain.
The operation has been a succes with successful recovery.
For reasons of compensation during the recovery, but probably already before the operation, the pain has passed to the right knee.

The last ten years, after the death of her husband, she has stopped to practice sport and subsequently has gained weight. Around 40 kilos. One thinks about a state of anxiety.
She is mother of two daughters , already grown up, with one (of 28) with a large and severe history of bulimia and anorexia, now in successful recovery.
Complexion: pink with a flushed face, shining eyes, tendency to sweat with a slow and painful mobility.
Palpation shows serious tension in the shoulder and neck area as well in the lumbar region.
Pulse is fast and big, but empty and slipping as well, tense as well in the liver area as in the heart zone. Indicating an emptiness of yin of the kidneys and the liver with a condition of heat combined with ‘dampness’ (tan).
The tongue is red without cover even redder in the sides and the tip.

The syndrome of ‘Bi’ from Traditional Oriental Medicine means: Painful Obstruction Syndrome has its cause in the invasion of cold humid ‘wind’. In the case of invasion of wind one sees painful inhibition of movement in the muscles and articulations moving from one articulation to the other. Combined with ‘dampness’ it gives way to swelling in one articulation with the feeling of numbness and heaviness, made worse by humid climatological circumstances.
Combined with cold it produces acute pain with limitation of mobility, normally only on one side.
The combination of wind with ‘dampness’ and cold can on a long turn produce, as in the case of this lady a situation of ‘Bi’ syndrome with heat.
Especially when there is a background of emptiness of ‘yin’ (‘cool’ substance, interior, liquids, nutrition) it gives rise to intense pain combined with heat in the articulations, painful at though, swelling, redness and limitation of mobility.
Diagnostic in this case is heat combined with ‘humidity’, but the main pathological factor is ‘dampness’.
On the long term this situation of heat humidity will develop into ‘Bi’ syndrome in the bones.
If this process will go on during a long period of time it will produce local blood stasis that will produce muscular atrophy, swelling and bone deformation, a extreme form of what is called ‘Phlegm’ in TOM.
In every case of ‘Bi’ syndrome one has to consider that the three invasive factors (wind, cold and humidity) are at the base of the problem.
The other important factor to consider is  that the invasion of what T.O.M. calls pernicious energies (wind, cold, dampness) is related to a weakness off the kidney energy  and the Du Mai or governor function/meridian who is seen as the ‘backbone’ of the bodily functions (Du Mai is considered ‘The sea of Yang energy, related to the nervous system and all bodily activity) and together with the kidney energy  stands as the basis of ‘Wei Qi’ or defensive energy, meaning the immunity to penetrating pernicious energies.
In this case any treatment should be combined with an effort to lose weight.

Treatment: mobilise Qi-Xue (energy and blood), expulse heat-dampness, tonify Qi and Yin of the kidneys and liver, strengthen Du Mai, calm anxiety and ease the pain.

The first step was to put her on a diet. Her knees literary could not handle her lack of movement and her weight. Also she had to start moving, therefor she bought a static bike to start exercising at home.
According to T.O.M., internal dampness is  related to a malfunctioning of the spleen-pancreas function. Therefore elimination of blood sugar rising food was required. The diet that should be most helpful in this case is the Paleo-diet, the diet that Fred Flintstone was eating before the cultivation of grains and pulses etc. No carbohydrates, only food that originally was not cultivated. Meat, fish, shellfish, algae,  ‘wild’ green leafs like salad, spinach, broccoli, asparagus etc. mushrooms, fruit, nuts etc. No lactic products.

She has a house in the ‘Costa Brava’ in Spain, with a swimming pool that she had to use more often to tonify her muscles without stressing the knee-joints and gradually bring up her pulsations as a ‘light’ cardio.
Shiatsu treatment and Qi-Kung exercises should complement her whole program to liberate her muscular tension and induce deeper breathing, strengthening her Du Mai, kidney and ‘Wei Qi’  or defensive energy.
She started a program to specifically tonify her quadriceps and adductors to give more stability to the knees and alleviate the pain.

Used acupuncture points:

To Tonify Du Mai: Ming Men (Du Mai 4), and Da Zhui (D.M. 14)
Basic points to strengthen bones and bone marrow: Da Shu (Bladder 11), Xuang Zong (Gallbladder 39).
For Damp-Heat: Quchi (Large intestine 11), Fenglong (stomach 40), Xiangu (St. 43), Hegu (L.I. 4), Yinlingquang (Spleen-Pancreas 9). San Yin Jiao (S.-P. 6), Pi Shu (Bladder 20), Zhongwan (Ren Mai 12) Shui Fen ( R.M. 9) and Xing Jian (Liver 2).
To eliminate blood stasis: Xue Hai (S.P. 10), Ge Shu (B. 17), Nei Guan (Pericardium 6).
To strengthen Liver and Kidneys: Shen Shu (B. 23), Taixi (Kidney 3), Fu Liu (K. 7), Gan Shu (B. 18), Ququan (liver 8), Guan Yuan (Ren Mai/conception vessel 4), Yanglingquan (G.B. 34), Zu San Li (s. 36), San Yin jiao (S.-P-6)
To calm anxiety: Tai Chong (L.3), with Nei Guan (P. 6), Shen Men (Heart 7) with Tan Zhong (R.M. 17) and Pa Hui (D.M. 20)
To calm the pain: distant points: Shangqiu (S.-P- 5) and Qiuxu (G.B. 40)
local points: Yinlinquan (S.-P. 9), Yanglinquan (G.B. 34) Zu San Li (S.36), Xiguan (L. 7), Weizhong (B. 40) and extra points Xiyan (the ‘eyes of the knee of which the exterior corresponds to Du Bi (S. 35).
To calm anxiety auricular acupuncture was used. Points used: Shen Men, Thyroid and Para-renals.
To help clean the liver and blood western herb combination was used with: Cardo Mariano, Artichoke, Gentianum.

In 12 sessions her mobility improved significantly, pain still persists but at a much more manageable level (At home she already walked without crutches, outside with one, ‘just to feel more secure’). Although the goal is to lose 25% of her weight in two years, she has not been strict on this part until now.

She is on the waiting-list for another knee prosthesis operation but the surgeon has told her that she might avoid the need for it.