Neil is a young at heart, 72 year old male, with arthritic knees. He has been suffering with severe pain bilaterally for seven years. His doctor told him some time ago that his knees need to be replaced but advised him to wait as long as possible. At his late stage in life he is hoping that acupuncture can spare him the surgeons knife. This problem has caused him years of anterior and medial pain with weakness on both legs. The worst pain is usually on the left-hand side. In every other respect Neil is in good health but lately the pain has been affecting his sleep and for this reason he wants a solution to this problem.
Neil is a simple and conservative old sort and up until recently he would never have even considered acupuncture. His daughter had paid for, and arranged, two appointments so he felt obliged to attend.
The first consultation
During the initial discussion about his arthritic knee problem he mentioned that he also had numbness, tingling and often a pain in his feet that he found difficult to describe. Sometimes this odd sensation would cause him to become unsteady and he had started to rely on a walking stick when walking any distance. His feet felt a little cold to the touch and there were some signs of blood stasis. Doctors had informed him that there was no diabetes or other causative factor for this numbness other than his poor circulation, which was just another symptom of his age!
Neil was very curious about this strange form of acupuncture treatment so I explained in detail how effective and rapid the results with abdominal acupuncture could be. I asked Neil if he ever heard of reflexology and then went on to explain that the abdomen can be used to image every part of the body (just as the foot can in reflexology) as well as all of the internal organs. I explained how I expected his pain to change as I was administering the acupuncture and so I went on to describe how he should reference his pain / numbness level in both knees and feet. As he was lying down it was difficult for him to tune into the pain in his knees so I assisted by locating painful points on both medial knees. I pressed these tender points around spleen 10 (Xuehai) and as his face flinched in obvious discomfort. I told him that that was his reference score of 10 out of 10 for that area. I encouraged him to flex his legs in an attempt to aggravate the anterior knee pain. I then got him to use this as his reference score of 10 out of 10 for each knee.
Both of Neil’s feet were feeling numb and so I encouraged him to reference that as a score of 10 out of 10 also. I explained how this was a subjective, real-time score which would give him a real indication of how the acupuncture was working.
The first treatment
Neil's abdomen was particularly cold below the umbilicus and other than that the only real discernible diagnostically relevant thing was the presence of a bubble like ahshi point on the right hand side, approximately 0.3 cun medial and superior to the medial knee point Ab 5, this ahshi represented the tender Sp 10 painful area.
The prescription used was "Bringing Qi Home" Ren 12 (Zhongwan), Ren 10 (Xiawan), Ren 6 (Qihai) & Ren 4 (Guanyuan), Kid 13 (Qixue) bilaterally, “Harmonising the Middle Jiao" St 25 (Tianshu) & Sp 15 (Daheng), with Ab 7 (Qipang) bilaterally in order to move Qi into each leg. This was then followed by stomach 26 (hip pt), Ab 4 (knee) and Ab 6 (ankle) on each side, and stomach 27 (Daju) was chosen in order to move Qi directly into the feet. On the left side I found a small irregularity that I hadn’t noticed before and I used this an ahshi point, the location of this point was midway between Ab 4 (knee) and Ab 5 (medial knee). Upon checking with Neil as to how his pain was on the left knee he declared that the pain was completely gone. I encouraged him to bend that leg in order to both move Qi throughout the leg and also to confirm that his knee was pain free. The treatment focus then moved on to the right side and after needling the small bubble like ahshi point the pain reduced on the sides to 5/10. On re - examination of the abdomen a smaller bubble like ahshi point was located and once this point was needled to the correct depth the reference point score of 10 reduced further down to a level of 2.
I encouraged Neil to bend his right leg a number of times and as he did this he noticed that his feet were feeling warm. He looked a little bit bemused as he told me this stiffness in his feet becoming less apparent as he moved his toes. He mentioned that maybe this was all in his imagination to which I reassured him that this was real and something that I commonly see when using abdominal acupuncture. I decided that this treatment was bearing good results and as there was no obvious ahshi points in the vicinity of the feet on the abdomen, so there was no need to add any more needles.
Fig 1: An illustration of Neil's treatment
When I returned to see Neil after 25 minutes he was still dumbfounded and delighted with the results. The numbness in his feet had turned to warmth and improved flexibility of his toes. His knee pain was completely gone on the left side while the right was much improved by 80%.
The second treatment
I saw Neil two weeks later and he was happy to announce he had been pain-free for five or six days and that his feet were less prone to the numbness and tingling symptoms he had known for years.
After palpating his abdomen I decided that a similar treatment would work well. On this occasion though I decided to drop spleen 15 (Daheng) and once again there was no necessity to use feet points per se, as Stomach 27 (Daju) achieved the desired result. The depth of the needles was kept within the heaven level except for Ren 4 (Guanyuan) and kidney 13 (Qixue) points which went to a depth of 1.25 cun in order to strengthen the kidney essence of this elderly man. The needles moving down the leg became less deep with the ankle points (Ab 6) left at a depth of 0 .2 - 0.3 cun. Then knee points ranged in depth from not 0.2 - 0.4 cun depending on what area of the knee each needle was acting on. Again I encouraged Neil to move both his legs and his feet so that Qi and Blood would move freely through them. After having the needles for a few minutes he once again described how he could feel warm radiating feeling moving down into his feet he declared that he could not believe the change. As there was a degree of blood stasis I changed the depth of the points Ab7 (Qipang) and Ren 6 (Qihai) to 0.75 cun in order to further move blood.
At the end of this treatment Neil left feeling no pain and felt like he would be able to stand on his tippy toes and dance at his leisure.
I saw Neil six weeks later and he delighted in declaring that the knee pain was almost totally gone for about 8-9 days after which time it began to return, but that the intensity had reduced to around 70% of the original pain. His feet had fewer weak moments and the numbness and odd/ painful sensation was improved by approximately 40%.
Neil has been away travelling and is hoping to do more regular acupuncture after Christmas when he has more time!