“Chinese medicine are known to have a holistic view on the patient and to NOT treat symptoms. Making our diagnostic approach our advantage. We are supposed to focus on the origin of the problems in the patient, treat the root cause and ignore the symptoms. This is a case analysis that goes straight to the root. All Chinese medicine should be like this. Enjoy.”
Nils Volden
A Complete Case Analysis
By Professor Nils E. Volden, University of Chinese Psychology
Case: SG102 – 2012/05
- Presentation of indicators
Gender: Male
Age: 43 years
Lives: Mexico city (10 years), but born in the provinces of Guerrero/ Oaxaca, Xochistlahuaca.
Ethnicity: Hispanic, belongs to the Amuzgo people
Social status: Married, 25 years, wife live in hometown
Children: 2 (Boy 17 years and girl 14 years)
Highest Education: Junior High school
Occupation: Employed in a shop named “Wal-Mart” as a normal worker
Main problem:
Neck pain, almost every day. The pain radiates up on the right side of the head; stops over the right eye.
General symptoms of the physical body:
- Palpitations when under pressure. Sometimes when he come home from work.
- Insomnia recently due to pain in the neck
- Tendency to flush when embarrassed or tired
- Have a digestion problem, constipation, for a long time. When defecating the stools are formed like small balls.
- Have a little gastritis when eating chili or excess of oily food
- Before he had asthma, but the last years it has been the neck that has given problems.
- Asthma were connected to stress, and now it is the neck that is difficult
- Tendency to eczema, red and dry. Comes during stressing periods at home
- Urinate 5 times a day
- Pain in the neck and in the back of the head. The pain radiates to the side of the head. It is possible to say that Upper trapezius is the main problem. More at right side.
- Last year have been a little more muscular cramps than normal
- Tic in the right eye, from time to time
General symptoms of the mental aspects:
- Feel irritated and a little angry, but do not know why
- Is very good in remembering things and was good at school
- Repeats others, copies and is correct to the letter
- Find rules and follows them, Follows rules or confirmative
- Does things that is pre-learned, but will not improvise
- Life is filled with properness and the right activities
- Rationalization
- Withdrawal
Physical gathered indicators:
Palpation:
Pulse: Rapid and string taut
Reflexes: Normal
Visually:
General: No damages or anything special to remark
Tongue: Red tip and movement of the tongue body
Eye: Good reflex and nothing special with the liquid inside
Throat: Is not inflamed and structures looks normal
Ear: Normal
Nose: A little inflamed. Probably due to cleaning.
Auditory:
Lung: Small sound of squeeze
Heart: Good rhythm and nothing out of normal
Tests:
Height: 174.5 cm
Weight: 74.3 kg
BMI 24.4 BMI
BP: 123/67-87
BMB: 24 BMB
Temperature: 36.7°C
SPO2: 95
BGL: 113 (3 hours after eating)
BFI: 36%
LDL: 256 mg/dl
RMR: 1614 Kcal
BMR: 1657 Kcal or adjusted for age 1343 Kcal
Vo2max: 28
He bring no further test results to the clinic
More information
Medication: Paracetamol 500mg tablets to make the pain go down. Often the pills do not help
Surgery: No
Trains: Football when he was young, but nothing after getting children.
Hobbies: No
Social life: Only some friends from secondary school
Marriage: Is in a separation process
Tobacco: Do not smoke
Alcohol: Drink alcohol in Party’s, but only moderate
Drugs: Do not use drugs
Food: Eats three times a day. Drinks 1,5 liters of Coca-cola a day
Ongoing treatment: No
Deep Analysis (A)
To analyze this type of extensive cases we have to be structured. First we over-analyze everything to get to know the patient. Then we start to shorten down the information, and in the end we will start searching for the solution or diagnosis. That is why every aspect will be analyzed separated before we put the findings together. An analysis like this has to have a form of brainstorming or a quest for possibilities. This process will be colored by subjectivity, but it is formed to include many different aspects to be as objectively as possible. In the end of the analysis we have to look into the correctness of our partial analysis. The more creatively and objective we gather the information the more chances for a correct analysis.
Gender: Male
A: Yang compared to female.
Age: 43 years
A: According to San Shi jian (the three time periods) he is in a phase of Yi wang (living the past in the period 40-47 years). This second cycle is more Yin charged than the first one. Making his thinking become more negative charged about the past and possible a little more conservative. He is also in a Yin charged Wood period (40-47 years). Meaning, Yin Wood Yi wang: he is in a more passive negative phase related to the past and possible a little more changing and impulsive than before.
Lives: Mexico City (10 years), but born in the provinces of Guerrero/ Oaxaca, Xochistlahuaca.
A: He is an indigenous person living in a country of great contrasts. The rich is rich and the poor is poor. The government can be seen as unstable. The narco war kills thousands of people every year. The education system is regarded as a disaster in the provinces. It is strong cultural differences between city-dwellers and people from the countryside, but also between white and dark, mestizo and indigenous people. Indigenous people start to work at an earlier age and finish later than the rest of the population. They receive a lower salary and have a poor health services and poor living conditions. The difference between indigenous and mestizo are floating, 80% is classified as mestizo (racially mixed). Genetically in his region the average person are 52% European, 37% Amerindian and 11% African. In practical terms about 55% is regarded as being of more pure indigenous ancestry. Making the patient originating in a group that is less fortunate, and that faces many problems like racism and inequality. Most likely he moved to the City to start working.
Ethnicity: Hispanic, belongs to the Amuzgo people
A: This group origin from the coast area of Oaxaca. Historically this people have migrated to their region due to problems where they lived. In old times the Amuzgos rebelled against the Aztecs. The population of the Amuzgos was 20,000 persons in 1522 and went down to 200 in 1582. Around the 1750s many African slaves (Later to be named as Afro-Mexicans) escaped to their territories. Making them have to move away from the coast. Most of the population does not have road access; making them relatively isolated from the world. Men marry at the age of 17 years and girls at 15 years. Marriages are arranged by the family. Men have to work and provide while the woman stay at home (63%). Recently many have started to migrate to cities and to USA. Men often work in construction and women as housemaids. The persons that move out to work send money home to their family. The region where the Amuzgos live is normally considered as very poor. They lack electricity, water and drainage. Most houses are made of adobe and cement is rarely used. The kitchen has a fireplace to prepare food. The majority is illiterate and just a few manage to complete Secondary School. They belive in spirits in the nature, and health are connected to the spirits and bad actions, and not to physical issues. Resulting in that this people uses spiritual healers, shamans, witches and household natural medicine.
Social status: Married, 25 years, wife live in hometown
A: Have a found a life partner. He has been married since 18 years old. Have lived separated from the wife for 10 years, but continues married. It is common for people from the provinces to live separated from their wife for periods. In vacations or similar they tend to go home to visit, but most likely he send money to provide for his wife.
Children: 2 (Boy 17 years and girl 14 years)
A: Meaning that he waited 8 years before he got his first child with his wife. One of the reasons for that might be that he had a very young wife. Or he did not want children in the beginning. Any how it is strange that he did not get children before. The children most likely live with the wife. Meaning, he sees his children one or two times a year. The children are now in an age where they soon have to marry; making him obligated by traditions to find a proper partner to his children.
Highest Education: Junior High school
A: He has very little education.
Occupation: Works at “Wal-Mart” as a normal worker
A: Wal-mart is the largest private employer in Mexico. The business is not known for good salaries. In Mexico this is one of the best jobs you can get without having High school. He have a job here most likely because it is the best he can get.
Main problem:
Neck pain, almost every day. The pain radiates up on the right side of the head; stops over the right eye.
A: Neck is connected to Tai yang skin region. General pain might be seen as an obstruction of channels and collaterals. Another way of naming pain is through the word Bi syndrome. We do not know anything special about the pain more than it moves and is not constant. Moving is wind, the same goes for something that comes and goes. We also get information about this pain are the place the movement stops, something that might indicate an afflicted meridian. We find that the gall bladder meridian correspond with the movement of the pain. Giving us the possibility to say that the man have an obstruction of the qi circulation in the gall bladder meridian. Further on we might say that the uni-laterality in the symptom complex might indicate a problem with a divergent meridian. Since we only have indicator from one divergent meridian we might assume this is the Gallbladder divergent meridian that is afflicted in its qi circulation. The qi that circulates in the divergent meridians are the psychic qi. That gives us information that this might be a mentally based problem. Going back to Taiyang skin region; it is common to say that this is one of the first defenses are we use when put under pressure. For example, when a person is not comfortable with something he might get palpitations, tension in the neck and flush. Gallbladder is internal externally connected to the Zang organ liver and thereby to wind. Wind is commonly said to be one of the main indicators of the Liver. An initial conclusion might be an obstruction of psychic qi in the Gallbladder divergent meridian converting into wind.
General symptoms (S) of the physical body:
S: Palpitations when under pressure sometimes when he comes home from work.
A: Palpitations are connected to the Heart Zang. It is an active process that goes on and there by a Yang process. Most likely we find that this in deficient conditions or Xu. Because true excess or Shi conditions in the Heart occurs under infections. It is normal to name palpitations as a Heart yin xu. This problem occurs when put under pressure; giving us a lead to connect palpitations to a mental variable. This gives us two likely possibilities. The first is an obstruction of the Heart qi due to pressure with followed by palpitations. The other possibility is a symptom from the organic part of a divergent meridian. All divergent meridians pass through their own organ and their coupled organ before passing through the heart. We also know that the problem occurs when he comes home from work and not any other place in the world. Giving us a clue that he problem has some relation to his home. Not knowing the conditions at home we cannot speculate in reasons, but we might connect this to something psychologically. Since it is not likely that this is a physically problem connected to the home of him. In Chinese psychology this is connected to an increased activity in the mental aspect of Hun. Further on it is common to say this is a symptom that occurs when Hun mirror itself in Po. The Po will make physical symptoms of the elevated mental activity. The mirroring will create physical problems like palpitations. When we find this type of symptoms we know that this is connected to the divergent meridians and its organic trajectory. An initial conclusion might be a heart yin xu and a problem with a divergent meridian organic part.
S: Insomnia recently due to pain in the neck
A: Insomnia is a problem with the sleep. Within Chinese medicine this is one of the master symptoms of the heart. Since this is an active stage we can classify it as a yang state. We got two possibilities excess and deficiency. An Excess state might be connected to an immediate problem with sleeping due to a sort of trauma or similar, but normally insomnia is connected to a deficiency problem or a xu state. Of course insomnia is yang by nature and the person will experience it as a yang state, but that does not mean that this is an excess state. The difference is that in deficiency we find that the person is tired but cannot sleep, and an excess state will be more of an external problem like influenza, mania or a deficiency from another place in the body creating a false excess state. Then we find out that the person have this insomnia due to pain in the neck. Pain is a bi syndrome or an obstruction of channels and collaterals. Let us see it like an obstruction. When qi is obstruction we find that the body loses its normal potential. For example the possibility of sleeping might become interrupted. In that case it is not a heart yin xu that is the base for the insomnia, but an obstruction of cannels and collaterals. That the problem has occurred recently does not tell more than that it is not chronically. Perhaps it might indicate a shi state, but the indication is very vague. An initial conclusion might be an obstruction of channels and collaterals giving a heart yin xu.
S: Tendency to flush when embarrassed or tired
A: A tendency is nothing more than an indicator in an analysis, but even though just being a tendency it is a great opportunity to map indicators in a person. Flushing is normally connected to the Zang organ Heart. It is a yang state by nature. Flushing comes rapidly and goes rapidly. This cannot be connected to a deficiency state. Normally we say that flushing (not red face!) is a shi state. This distinct state of shi is almost all the time an obstruction of channels and collaterals. We also know that embarrassment is an emotion that comes suddenly and goes suddenly. This is psychic qi becoming wild. The wild psychic qi will create a sudden change in the circulation of qi and thereby create an obstruction of channels and collaterals. This obstruction might be seen as a shi state, but are in real life a false shi state. The flushing also occurs when the person is tired. When a person is tired we find that he lack qi. In this case this means that when the person lack qi or is in a qi xu state he more easy develop a heart yin xu. How is it possible to have a symptom that in one occasion is a heart yang shi and in the other a heart yin xu? The reason is that this is an indicator and not a symptom. When emotions play with him, psychic qi get wild and an obstruction of channels and collaterals creates a state of false heart yang shi. When he is tired he lack qi and the heart develops a heart yang xu state. An initial conclusion might be a vulnerable heart Zang that is common in people that have a Chen constitution or Heart constitution if you want.
S: Have a digestion problem, constipation, for a long time. When defecating the stools are formed like small balls.
A: Digestion problems are connected to the Zang organ spleen within Chinese medicine. Constipation comes in many forms. Normally constipation is connected to poor movement in the colon or excessive absorption of liquid in the Fu organ large intestine. Sometime to avoid discussion about internal specifications people often use the diagnostic name damp heat in middle Jiao or internal heat among others. This is not very exact and do not help when making a good diagnosis. It is needed with more information. We know that the person have suffered with this digestive problem for a long time. A long time indicates a chronically problem or often a xu state. The only way to have a xu state in the Spleen and constipation is a spleen yin xu. That is a heat state in the digestive system that consumes the liquid. The dryness in the stools makes them difficult to come out; constipation. In some textbooks this might be called a state of heat damp in middle Jiao. Then we get the information of the distinct form of the stools. The ball form of the stools is so distinct that it requires its own explication. This is really normal stools regarding liquids. By that the previous analysis is invalid. This is rather pressure on the stools that forms them as small balls. The organ that gives the ball formed stools is the Fu organ large intestine. This is a yang state in this organ. Since it is chronically it is a Xu state and therefore a large intestine yin xu. It is not incorrect to state that a spleen yin xu will include a large intestine yin xu, but as you might understand less correct. There is a huge but here. If you have a large intestine yin xu that will not only indicate that a person got contractions in the muscular walls in the intestine, but also that the person reabsorb more liquid in the intestine wall. That is why we need to start thinking about what muscular activity in the large intestine is connected to. In Chinese medicine we find that muscular activity and – movement is related to the Zang organ liver. Liver is therefore related to the formation of the ball shape of the stools and the constipation due to the tension in the large intestine. Since this is an obstruction of the normal activities of the large intestine we might consider the qi in the liver not circulating like normal. The qi is stagnated in a type of spasm in the large intestine. This stagnation is often named as liver qi stagnation. We have no further information to continue the analysis at this point. An initial conclusion might be a liver qi stagnation creating a large intestine yin xu.
S: Have a little gastritis when eating chili or excess of oily food
A: Gastritis is an inflammation of the gastro intestinal tract or in Chinese medicine we name this as a yang state in the Zang organ spleen. In some literature we might find gastritis named as heat damp in the middle Jiao. Depending on the duration we might name it as a yin xu or a yang shi. We do not know the duration directly here, but we know that it is a little and it comes after eating chili or excess of oily food. This might indicate that it is connected to eating habits and thereby to be seen as a result of external stimuli. Chili is yang in nature and oily food damp in nature. Gastritis is therefore a type of heat damp or fire damp if you want. For sure the person has reasons to have gastritis and for sure it comes from the food, but it is just a little and the person does not become sick. This might indicate a weakness in the digestive system or a middle Jiao qi xu; something that makes the person more receptive to problems of this nature. An initial conclusion might be a middle Jiao qi xu.
S: Before he had asthma, but the last years it has been the neck that has given problems.
A: This is information about a state that occurred before. It tells that before he had lung yin xu state or lung qi stagnation. We do not know the exact problem he had just that it was the lung and that it was a yang state. We also hear in this statement that it is the neck that is his problem now. That tells us that the lung problem was a real problem before, but not anymore! He does not specify the nature of the neck problem, but we might assume that it is an indication of change of the pathology pattern in the person from lung to neck. An initial conclusion might be that this is of informational value only.
S: Asthma were connected to stress, and now it is the neck that is difficult
A: This is in a way an extension of the previous symptom. Here we learn that the asthma were stress related. Asthma is related to the Zang organ lung. It is a yang state. We might divide into two different types of asthma. The first one is a yang deficiency state in the lung or a lung yin xu. The other one are a yang excess state in the lung or a lung yang shi. Of course it is possible to name asthma as a heat damp in upper Jiao or wind heat in the Lung. Some even might name asthma as liver qi stagnation due to the contractive nature in the bronchia’s. He mentioned that the asthma was connected to stress. This indicates that an increased activity in Hun, makes Hun mirror itself in Po. Po is the mental aspect of the Zang organ lung. Often we find this Po-lung mirroring in an initial phase of an increased activity in Hun. We do not know why he had an increased activity in Hun, but we do know that it provoked the lung to develop asthma. Stress creates the psychic qi circulate different. If we have an indication of a mirroring this have to have the precursor of something that increased the activity of Hun. We do not know what in this symptom complex. We do know that before it was asthma and now it is neck problems; indicating that the basis to everything is based in something mental or stress. An initial conclusion might be that this is an indication of an increased activity in Hun that before gave an obstruction of lung qi and now a general obstruction of qi in channels and collaterals.
S: Tendency to eczema, red and dry. Comes during stressing periods at home
A: Eczema indicates a problem in the skin. The skin within Chinese medicine is related to the Zang organ lung. The redness indicates that the person have a heat situation that most likely are a yin xu. The dryness indicates that the person is lacking water. Water within Chinese medicine are connected to Jin ye. What he lacks is the Jin, the clear and delicate liquid. Since the related organ is the lung we will have a lung yin xu or a lung Jin xu situation. It is not common to use the term lung Jin xu. That is why we categorize this problem to a lung yin xu. Again, some would perhaps use the term heat dryness in upper Jiao or a Fire in lung. An initial conclusion might be that this is a lung yin xu
S: Urinate 5 times a day
A: Urination is connected to the kidney and the urinary bladder. Kidney if it is a urine quantity problem and urinary bladder if it is a problem with getting the urine out properly. This man urinates 5 times per day; this frequency might be an indicator of much urination. Let us assume that this is urination and not quick visits with just drops of urine that would indicate a problem with the prostate or a urinary infection. A lot of urine is a sign from the kidney. The kidney is the organ that filters water and waste out of the blood. First 180 liters of water is filtered out of the blood per day. This is a relatively passive process. The active process is the reabsorption of 178.5 liters of the water to the blood. This reabsorption is normally entitled as the activity of kidney yang. If a person has a kidney yang xu situation in the body we find that the kidney does not reabsorb what it should; giving us more urine than normal. This person has more urine than normal. An initial conclusion might be that this person has a kidney yang xu.
S: Pain in the neck and in the back of the head. The pain radiates to the side of the head. It is possible to say that Upper trapezius is the main problem. More at right side.
A: We have analyzed the pain before, but now we have another more information that the Upper trapezius is the main problem. As we know pain in itself is a Bi syndrome something that indicates that the person have pain and nothing more. To find out more we need more information. The specification of the muscular group helps us to tell something important. In Chinese medicine it is common to connect muscular problems to the Tendino muscular meridians (TMM). The TMM gives us three candidates to the three yang muscular groups of the hand: the Hand-Taiyang (Small intestine), Hand- Shaoyang (San jiao) and Hand-Yangming (Large intestine). All three of them might be connected to the upper trapezius. The best way to separate the different TMMs is through the movements. Problems lifting hand forward with a lateral twist is connected to the Hand- Yangming. Problems stretching out the hand and out to the side is connected to the Hand-Shaoyang. Problems with making a circular movement with the hand in front of the chest and out to the side is connected to the Hand-Taiyang. For persons that think that headache on the side of the head is Shaoyang headache they are correct, but here we speak about Foot-Shaoyang. The patient here has other muscular groups involved than the classical Shaoyang TMMs. Unfortunately we do not know the inhibited muscular movement, but another indicator is the radiation of the pain to the side of the head. That indicator is the reliever for us. It excludes two of the TMMs and leaves us with the Hand-Taiyang. Hand-Taiyang is connected to the small intestine meridian that is internal external connected to the heart meridian. Then comes the 100 dollar question what does a TMM problem indicate. Well, practically we often say that the TMMs are the place where Qi and Xue (blood) circulate. In a more practical language we better connect the TMM with the circulation or Wei qi in the body, our defense system. A TMM are more superficial and connected to the exterior of the body. Often we say that the internal connection to this channel is of a superficial nature, just as its location. Problems with the TMMs often originate in external pathogens like cold, wind damp, heat or trauma. Rarely, we might find internal organs as the origin to TMM problems. In the information we got no information about traumas. We know that uni-laterallity is common for TMM problems as well as for divergent meridians. Let is dwell a little with the Wei qi. Wei qi is our defense qi in our body; think blood out to our cells. A strong wei qi and the person does not get sick. A weak wei qi and the person get sick more easily. In stress periods of the life the person will consume more wei qi than normal making him prone to disease. Hand-Taiyang offers us three important aspects: It is connected to the internal external organ to the Zang organ heart. It is a Taiyang connected TMM. It is connected to wei qi. Since we have no records for trauma or pathogenic factors penetrating the body we might assume that the problem is connected to something else. The mist likely reason is 抗压 Kang ya or stress makes Wei qi (the defense) become weak. A weakness occurs where the person have a pre-disposition to get problems. Here it happened in the Hand-Taiyang or the Large intestine; connecting this pre-disposition to the Large intestine and the Heart. The large intestine is the yang organ of the fire element. Making its prime symptoms yang related. Like we have discussed before a yang state in the large intestine gives constipation of muscular cramps in the rectum; with the result small ball shaped stools. Taiyang as a defense mechanism is also of interest for us. The taiyang region of the body is the back of the neck and the trapezius region. If a person has problems related to Kang ya we often find this region tenser than others. Who have not ever been tense between the shoulder blades? Kang ya are often due to a high activity in Hun. An initial conclusion might be that this person has an elevated activity in Hun that activates the Taiyang defense mechanism leading to an obstruction of the qi circulation in the Hand-Taiyang tendino muscular region.
S: Last year have been a little more muscular cramps than normal
A: This is a time indicator that tells us that the problem has increased more this year. The problem existed also last year, but is worse this year. The problem is cramps. Cramps are contractions in the muscles. Cramps are a movement or wind in Chinese medicine. Muscular movements are connected to the Zang organ liver. If a person has muscular cramps it indicates that the qi in the liver does not circulate in a good manner. The qi is from time to time stagnated. An initial conclusion might be that the person has a liver qi stagnation or liver wind.
S: Tic in the right eye, from time to time
A: This is a symptom that indicates that the person has involuntary movements in one eye. One eye indicates a uni-laterality that is often connected to divergent meridians and thereby the circulation of the psychic qi in the body. The muscular movement is related to the liver and often a liver qi stagnation or liver wind. The liver Zang are connected to its mental aspect Hun. This symptom indicates an elevated activity in Hun leading to mirroring in Po. Muscular tics are created by this mental process, but the source is the liver. An initial conclusion might be that the person has a liver qi stagnation transforming to liver wind due to an increased activity in Hun.
General symptoms of the mental aspects:
S: Feel irritated and a little angry, but do not know why
A: Irritation and angriness are two classical symptoms from the Zang organ liver. It indicates a yang state in the liver. A yang state might be connected to yin xu, qi stagnation, wind, yang shi, fire or heat damp. The key symptom here is irritation. Irritation is an emotion that does not last for long time. That limits the different types of diagnosis that is possible. We end up with a qi stagnation that occasionally transforms into wind. Since this organ is the liver, we get a liver qi stagnation transforming into wind. A liver qi stagnation are the state of mind that occur when a person have an increased activity in Hun that passes the line of tolerance. An initial conclusion might be that this person has an elevated activity in Hun making a liver qi stagnation transforming into wind.
S: Is very good in remembering things and was good at school
A: This is a symptom that is more descriptive than an indicator of an error in the body. The personality that is good in remembering things are the Chen personality. They are like a computer, everything typed in stays. Often we find Chen personalities like straight A students. An initial conclusion might be that this person is a Chen personality.
S: Repeats others, copies and is correct to the letter
A: This is also a symptom that is more descriptive than an indicator of an error in the body. The personality that repeats others are the Chen personality. Everything that is fed into a Chen mind, can and will be repeated in the proper occasions. Stories, jokes and other elements are repeated. For example you yell a joke to a Chen personality. Some minutes later he will retell your joke. It does not matter that you are present or that you are one of the listeners. He copies how people dress, speak and live. He is a real copycat. When it comes to correctness he is super correct. He speaks with the right words, sounds and expressions. The only problem is the moments where he lacks proper information. Then he simply copy other persons ways of behaving; something that might feel strange when you discover that a person is copying you in front of you. Another problem is when he copies the wrong people. Do never forget the computer metaphor “Bullshit in = bullshit out!”. An initial conclusion might be that this person is a Chen personality.
S: Find rules and follows them, Follows rules or confirmative
A: This is also a symptom that is more descriptive than an indicator of an error in the body. The personalities that searches for rules and follows them are the Chen personality. This is people that are “rulers”. A Ruler is a person that follows rules no matter how stupid they might be. Since they do not invent a single rule we find them very confirmative and predictable. If you are supposed to wear a red shirt they will wear red. If you say jump they will jump. If they does not know what is the rules they will use a lot of energy to find them. Of course in that very process they might go wrong and in a way invent rules that did not exist. Meaning that they misunderstood something, but they do not know it. The misunderstanding becomes the guiding rule for them. An initial conclusion might be that this person is a Chen personality.
S: Does things that is pre-learned, but will not improvise
A: This is also a symptom that is more descriptive than an indicator of an error in the body. The personality that stays connected to the pre-learned are the Chen personality. When you are programmed to follow rules you will not improvise. Like a robot you will walk where you are told to. The important aspect here are the place the person learned the things. Was it at church, at university, the street or the crazy father that taught you how to behave? All depends. Chen personalities do not change things. They only live out the copy to the maximum. An initial conclusion might be that this person is a Chen personality.
S: Life is filled with properness and the right activities
A: This is also a symptom that is more descriptive than an indicator of an error in the body. The personality that is super proper is the Chen personality. All depending of the person copied and the activities observed we might get the most proper or improper person in the world. Take the habits from where you are might describe some of the essence of the Chen personality. An initial conclusion might be that this person is a Chen personality.
S: Rationalization
A: Rationalization is within Chinese psychology named 合理化 Hei li hua. This is a defense technique that involves that the person convinces himself that nothing wrong has been done. For example if a person destroy a glass and convinces himself that it was the wind that made the piece of wood hit the window, and not his hand accidently touching the wood. Hei li hua is a way to make excuses for things. The convincing process might involve fast reasoning and is connected to 阴大人 Yin Da ren defense techniques or Yin adult defense techniques. This is the third level defense mechanism. At this level the person uses yin techniques that give short time advantages. The basic idea is to survive in the moment. This defense technique is commonly used by Chen personalities. An initial conclusion might be that this person uses Hei li hua (realization) a Yin Da ren defense technique because he is a Chen personality.
S: Withdrawal
A: Withdrawal is within Chinese psychology named 退避三舍 Tu bi san she. This is a defense technique that involves that the person removes himself from situations that provokes uncomfortable feelings. This removing might be a separation physical from a place or only a mentally separation. For example a person can be present, but disconnected from the actual situation. In other words the person has withdrawn himself into his own world. The social withdrawal can be seen as a self-induced isolation or seclusion. The roots for this behavior can be many, but often we find deliberate choice and direct consequences from previous actions. Tu bi san she is a idiom that literary means “To retreat three days march”. This means that you give way in the face of superior strength, or a strategic withdrawal. You retire for later coming back stronger. The withdrawal will include a separation from uncomfortable and is connected to 阴大人 Yin Da ren defense techniques or Yin adult defense techniques. This is the third level defense mechanism. At this level the person uses yin techniques that give short time advantages. The basic idea is to survive in the moment. This defense technique is commonly used by Chen personalities. An initial conclusion might be that this person uses Yu bi san she (Withdrawal) a Yin Da ren defense technique because he is a Chen personality.
Physical gathered indicators:
Palpation:
S: Pulse: Rapid and string taut
A: A rapid pulse is called Shu mai in Chinese medicine, meaning that the heart has more than five beats per respiration cycle. Shu mai indicates that it is yang in the body. This is normally manifested as different forms of heat or fire. We do not know if it is yang excess (yang shi) or a yin deficiency (yin xu). If we have to give a tentative conclusion it is more likely that this is a yin xu. The reason is that a yang shi would more likely give Shi mai or a pulse of excess type. Here we only have Shu mai (rapid) and string taut (Xuan mai). Xuan mai is normally associated with problems in the Zang organ liver, phlegm retention and pain syndromes. The analysis shows us that this person having heat problems and something with the liver. What we find is the heat and the liver problem. The liver problem might be connected to a liver yin xu or liver qi stagnation. The person does not have a Deep pulse (Chen mai) that indicates deficiency (xu) and internal diseases. Meaning that he has enough xue (blood) and the body is strong. Giving us an understanding for that this person suffers from liver qi stagnation. The heat cannot be connected to anything else that an accumulation of internal heat in the body due to the qi stagnation. As we know that qi stagnation will most frequently have a heat nature in the body. An initial conclusion might be that this person has a liver qi stagnation and heat.
S: Reflexes: Normal
A: This indicates that the qi circulates normal inside the meridians.
Visually:
S: General: No damages or anything special to remark
A: This indicates that no obvious trauma has occurred.
S: Tongue: Red tip and movement of the tongue body
A: A red tip of the tongue proper indicates that the upper Jiao have heat. Most common is the heat in the Zang organ heart. The reason to this red tip is a fast pulse makes the blood circulate faster than normal in the tongue. The tongue fills up with an excess of blood. The drainage of the tongue cannot keep up with the filling of blood. Makin red blood cells accumulate in the tip of the tongue making this an indication of a heart yin xu. A completely red tongue proper will be connected to heart fire or fire in general. Fire is more a type of fever. Movement of the tongue is connected to the fact that it is a muscle. The liver dominates the movements of the muscles. In the moment a person have an excess of movement we call this wind, but if we want to analyze more profound it is common to say that this movement is liver wind. It is normal to manifest movement of the tongue when you have a lot of pressure. In that way it is possible to say that an increased activity in hun makes a liver qi stagnation transforming into liver wind. An initial conclusion might be that this person has an increased activity in Hun creating a liver qi stagnation causing a heart yin xu and wind.
S: Eye: Good reflex and nothing special with the liquid inside
A: This indicates that qi circulates normal inside the eyes.
S: Throat: Is not inflamed and structures looks normal
A: This indicates that qi circulates normal inside the throat.
S: Ear: Normal
A: This indicates that the qi circulates normal inside the ears.
S: Nose: A little inflamed. Probably due to cleaning.
A: When the ear is a little inflamed it indicates heat. Ears are related to the Zang organ kidney within Chinese medicine. Something that normally would have given rice to a kidney yin xu or a kidney yang shi analysis, but here it is a remark that this is probably due to cleaning. Making this problem in the ear connected to an external trauma and nothing organic. An initial conclusion might be that this person has suffered a minor trauma in the ear.
Auditory:
S: Lung: Small sound of squeeze
A: Sound from the lung is a lung symptom. This sound is like a small squeeze. This indicates that a tightness in the lung. Tightness comes from a contraction in the lung; meaning that this is an activity, a yang situation. It exist two types of yang situations in the lung yin xu and yang shi. Yang shi is normally due to an exogenous pathogenic factor (EPF). If it is an EPF it needed to be a high sound. This sound is low and by that we have a yin xu state in the lung. Of course it is possible to have a heat damp or phlegm damp in the lung. An initial conclusion might be that this person has a lung yin xu.
S: Heart: Good rhythm and nothing out of normal
A: This indicates that the qi circulates normal inside the heart.
Tests:
S: Height: 174.5 cm
A: This is of information value only.
S: Weight: 74.3 kg
A: This is of information value only.
S: BMI 24.4 BMI
A: This indicates that his Body mass index is within normal.
S: BP: 123/67-87
A: This indicates that his blood pressure is acceptable close to normal. Perhaps some would say that the systolic pressure passes into the category pre-hypertension. I feel that is to over diagnose.
S: BMB: 24 BMB
A: This indicates that the person has an elevated stress indicator. Up to 5 is normal. 5-15 indicates a stressor. 16-30 indicates a feeling of crawling in the body feeling. More than 30 will constitute an organic problem due to stress; like high blood pressure. An elevated number might also indicate hyperthyroidism. This man got 24 BMB. That means that he feels a strange alien feeling in the body. He is stressed or in other words he got an elevated activity in Hun. An initial conclusion might be that this person has an elevated activity in Hun.
S: Temperature: 36.7°C
A: This is of information about a normal body temperature.
S: SPO2: 95
A: This is a measurement of the saturation of peripheral oxygen taken 2500 m over sea level. At sea level the normal level is 95-100%, but in these heights it is normal to see 92-94% as normal. This is a measurement of the percentage of the oxygen being carried by the red blood cell in the blood. The result of a standard SPO2 test is of indicative value since a proper blood test is needed for the exact value. This patient has 95% saturation, and that is perfect.
S: BGL: 113 mg/dl (3 hours after eating)
A: This is a measurement of glucose in the blood. This is not the optimal measurement, but it gives us an indicator of the quantity of glucose in the blood. If taken properly a person needs to have less than 100 mg/ dl after 7 hours or under 140 mg/dl after 2 hours. Here the person has 113 mg/dl after 3 hours. We might estimate that the person had under 140 mg/dl one hour before, making this glucose level acceptable.
S: BFI: 36%
A: This is a measurement of the fat level in the body. He has 36% fat in his body or 26,8 kg of pure fat. Less than 15% is normal, making this person having 21% of excess fat or 15,6 kg of excess fat. An initial conclusion might be that this person has obesity and need to lose weight.
S: LDL: 256 mg/dl
A: This is a measurement of the Low density lipoproteins (LDL) in the blood. The normal value is about 100 mg/dl, but often the normal range is set to 60-180 mg/dl. This is the dangerous cholesterol in the blood, and he got 2,5 times more than recommendable. It is important to understand what cholesterol is before judging anything. 80% of our cholesterol is made in our liver; it does not come only from food. For example to stop eating eggs have only a marginal effect. Cholesterol is positive in many regards it makes vitamin D, is necessary for the nerve endings and the brain. 50% of the brain marrows weight is cholesterol. Cholesterol is important when making many hormones. If we reduce the amount of cholesterol we get many collateral problems. Medication (Statines) against cholesterol gives no change in the mortality rate. Of course elevated levels with cholesterol are not healthy; it increased amount of coronary disease. Diet (more fibers, green, fish oils and less sugar) is often regarded as the best way to reduce elevated cholesterol values. Research has shown that the liver converts sugar to LDL; making one of the biggest sources to elevated levels of LDL being sugar. An initial conclusion might be that this person has an increased production of LDL perhaps due to elevated sugar intake.
S: RMR: 1614 Kcal
A: This is the Resting metabolic rate of the person. That is the quantity of calories needed for this person if he is sleeping/ resting 24 hours. This is of information value only.
S: BMR: 1657 Kcal or adjusted for age 1343 Kcal
A: This is the Basic metabolic rate of the person. That is the quantity of calories needed for this person if he maintains his basic activities. Adjusted is the BMR that corresponds to his age and activity level. This is of information value only.
S: Vo2max: 28 (Poor)
A: This is the maximal oxygen consumption or uptake capacity in the body during incremental exercise or “Volume oxygen maximum”. This patient has 28 in Vo2max something that is rated as poor. A poor rating will normally constitute a weak person or a zong qi xu situation.
More information
S: Medication: Paracetamol 500mg tablets to make the pain go down. Often the pills do not help
A: This informs us about a use of a medication. Regular use of paracetamol might be fatal; slowly the body is filling up with this chemical substance. In USA, 56.000 persons visit emergency departments due to paracetamol overdose every year. 26.000 persons are hospitalized due to over dose of paracetamol every year in USA and minimum 450 persons die of it every year. But it is suggested that 16.000 persons die every year of gastrointestinal bleeding due to paracetamol, aspirin and NSIDs in the USA. If paracetamol does not help you should change chemical substance; an increased quantity will not increase the effect. The effect goes through a protein connected to TRPA1 nerve cells. This is of information value only.
S: Surgery: No
A: This is of information value only.
S: Trains: Football when he was young, but nothing after getting children.
A: This tells us that he live a passive life.
S: Hobbies: No
A: This is of information value only.
S: Social life: Only some friends from secondary school
A: This tells us that he have just a few friends and not made many friends after growing up. He finished secondary school about 30 years before. During the years that have passed he has not connected to other people. This might be because he did not have the need or he lacked the ability to make friends. Of course we also have the possibility that people do not want to become his friends.
S: Marriage: Is in a separation process
A: This tells us that he is in a process of separating from his wife. We do not know the reason or who initiated this process. We neither know who supports this process or not. Perhaps all his family and friends say it is correct or perhaps not. Was it the distance who finished the marriage or was it fidelity. Everything is speculations, and should stay like speculations until we know better. An initial conclusion might be that this person has an important mental moment that might fill Hun.
S: Tobacco: Do not smoke
A: This is of information value only.
S: Alcohol: Drink alcohol in Party’s, but only moderate
A: This is of information value only.
S: Drugs: Do not use drugs
A: This is of information value only.
S: Food: Eats three times a day. Drinks 1.5 liters of Coca-cola a day
A: The eating pattern is totally normal in Mexico. He drinks a lot of Coca-Cola. This is approximately 360 grams of sugar or 15 tablespoons of granulated sugar every day. Sugar might cause diabetes and elevated cholesterol (LDL) levels. An initial conclusion might be that this person has an important mental moment that might fill Hun.
S: Ongoing treatment: No
A: This is of information value only.
Final analysis
It is many ways to analyze a case. Let us try to make some sense out of this case.
43 years ago a man were born in a province of Mexico. He became a part of the indigenous Amuzgo people. This is a group of people that lives very primitive. He managed to finish secondary school; that is regarded as a high education among the Amuzgos. Until he become 18 years old he lived with his parents and worked in his village. Then his parents arrange him to marry a woman. They lasted 8 years before their first child arrived; in total they got two children. 10 years ago, he moved to Mexico City; leaving his family, his friends and in his village. He only visits them one to two times a year. He got a low paid job in the city, but without studies it is the best he can get. Still after 10 years in Mexico City he has not acquired any friend. His only friends are those from his time at secondary school 30 years before. Today he is in the separation process from his wife. Separation is on “the Holmes and Rahe stress scale” regarded as the second most stressful event for an adult (only death of spouse is rated worse). For sure this person has some issues regarding to his separation from his family, ongoing divorce, no friends, being indigenous in the City, living far away from the two children, separated from both his family and his friends from the village, poor education and being culturally different from the others where he live.
The man has a normal BMI, but his BFI is elevated; meaning that he has an excess of fat, but deficiency of muscles. This indicates that he have a profound imbalance between fat and muscles. This is normal among men with small arms and legs, and with a huge belly; the classical Chen personality body. It is one habit that stands out, that is his heavy drinking of Coca-Cola (normal among poor people). An elevated intake of sugars causes the liver to transform sugars to cholesterol (LDL). In this patient we find this connection to LDL to be plausible. His rather lazy lifestyle without hobbies have made him fat (damp) and given him a poor stamina or qi xu (poor Vo2max level). This gives us an idea about why he lacks Zong qi and – feels tired.
When presenting himself in the clinic he manifested on the pulse that indicates liver qi stagnation. On the tongue he manifested the same, liver qi stagnation. Liver qi stagnation is often regarded as the result of an elevated activity in the mental aspect of Hun; indicating that something is on a mental level. When revising his lungs sounds that indicated tightness could be heard. This tightness might be connected to a lung yin xu state. It is both possible and plausible to say that tightness in the lungs is caused by an elevated activity in Hun transforming into liver qi stagnation. The liver qi stagnation causes an obstruction of the qi in the lung and thereby tightness sound. His BMB is also elevated to a degree where it indicates without a doubt elevated activity in Hun.
Mentally the man feels agitated something that is one of the main signs of an elevated activity in Hun. He is also characterized as a Chen personality through common indicators like good memory, conformity, repeating others and correctness. Often we use a metaphor describing the Chen personality; a computer. It remembers everything, but it cannot see right from wrong; creating a lot of problems in moments of elevated activity in Hun. Because is his reactions proper when considering the issues he has. We know that he manifest two classical symptoms from the third defense levels Yin Da ren (Yin adult defense) for Chen personalities, Hei li hua (rationalization) and Tu bi san she (withdrawal). Showing us that he feel the need to defend himself against something. These defense techniques are of an educated level and of a low pace. The defense is of an adult defense level. According to San shi jian (The three time periods) he is a yin charged Yi wang (past focus). Making him analyze things based on a negative past. When he thinks and acts he will be thinking something like “everything was bad before”. Since his decisions are based on a negative past and his Chen personality, we might predict his interpretation of most issues in a historical light and with a negative undertone. Issues make his Hun increase its activity. This increased activity in Hun will create problems related to liver qi stagnation as for example the ball shaped stools, and a tension that over time weakens the middle Jiao qi and gives a delicate digestion. Historically his problems were centered to the lung, but recently we find a shift in the pathology towards an obstruction of channels and collaterals. For us this is an indication of a shift from “a personality created co-cycle attacks” (heart overacts lung) to “Hun mirroring in Po related problems”. This shift occurs when the Hun activity becomes so high that it mirrors itself into Po.
Po will make physical symptoms based on the elevated mental activity. The symptoms often manifests in the personality, skin, divergent meridians, lung and related organs. Since he is a Chen personality we will get some symptoms related to heart Zang; like Palpitations (H yin xu), insomnia (H yin xu) and flushing (H yin xu). Of course the symptomology will be inter-tangled with other aspects. For example; symptoms like palpitations might also be connected to the organic part of the divergent meridians; making a symptom to be both a heart yin xu and a divergent meridian organic part problem. The skin problem, eczema, is related to the mirroring into Po and the reflection into the lung as a lung yin xu and the relation between Po and the lung. It is also possible to connect all emotionally related skin problems to Po, our corporal soul. An elevated activity in Hun will activate the Taiyang defense mechanism (heat and tension in the upper back) leading to an obstruction of the qi circulation in the Hand-Taiyang tendino muscular meridian (large intestine). Do not forget that Hand-Taiyang tendino muscular meridian is internal external related to the heart.
When presented a case like this we need to understand the power of the personality. This patient is a Chen personality. A Chen personality will when in difficulties send out less of its product fron the heart. The heart send yang to the kidney; making a kidney yang xu develop (frequent urination). The Heart does not send sufficient yin to the lung; making a lung yin xu develop (astma and eczema). The heart does not send sufficient yang to the spleen; making a spleen yang xu develop (gastritis and ball shaped stools; both externally caused). Further on the heart does not send sufficient yang to the liver; making a liver yang xu develops (muscular problems like cramps and tics). The pains related to the neck and the back of the head are related to Kang ya (stress). In Chinese medicine we find Kang ya connected to a high activity in Hun.
We start to understand that the root to the problems in this patient is connected to an elevated activity in Hun. That mean that we have to look closer into the mental model or 动脑筋 Dong nao jin. Bu zi jue (unconsious) 忆 Yi (the mental aspect of the zang organ spleen) gathers 资讯 Zi xun or information from the senses and transmits them to 魂 Hun (the mental aspect of the zang organ liver). This gives us two different possibilities of Hun stimulation. First we have the quantity of new inputs and then we have content of the inputs. In this case we do not have any indicators of any extra difficult Yi input. Based on the incoming information from Yi Hun will start to lay 打算 Da suan or plans. The plans will be many and creative. An active Hun will create more plans than a passive. Here we do not have any information that indicates that a hyperactive Hun is the problem. We got indicators that we got a high activity in Hun and nothing more. After the planning process Hun sends the plans to 神 Shen (the mental aspect of the zang organ heart). Shen will immediately send the plans to 智 zhi (the mental aspect of the zang organ kidney). Zhi is going to connect the plan to previous experiences through using 长期音记忆 Chang qi yin ji yi, the long-term memory. Here we know that he according to San shi jian (The three time periods) is in a yin charged Yi wang (past focus). This makes him select information in Zhi that is negatively charged; a negative past focus. Chinese psychology assumes that the memory is 动态存储器 Dong tai cun chu qi or dynamic. This indicates that the flow of Zi xun (information) is constant and ever changing. It never stops it just changes. Yin Yi wang constitutes for a shift toward negative and past information; it has never worked before statements. Then Zi xun will be sent back to Shen from Zhi. In Shen we find 析毫剖厘 Xi hao po li, a prosess of deep analyzis of Zi xun. If Shen effectuates a Fan si (rethinking) the plan circulates back to Hun. Hun will then do a new creative process with the base in the actual resent plan from Shen. The rethought plans will occupy space in the mind. Normally the plans that are sent for rethinking are connected to some type of personal dilemma.
Slowly the person starts accumulating processes until the capacity to process more information or plans are full. At this very point in time we see that the activity in Hun increases. Often this is exactly where we see the shift from “a personality created co-cycle attacks” (for example heart overacts lung) to “Hun mirroring in Po related problems”. This shift occurs when the Hun activity becomes so high that it mirrors itself into Po. We also find changes in the selected defense techniques in this very moment normally a person changes from third to fourth level defense technique; this patient still only manifest third level. This increase in activity is called hyperactivity of yang in Hun or over-activity in Hun.
In the moment the activity in Hun passes the line of tolerance the activity in Hun will mirror itself in 魄 Po. This is called Hun is mirroring in Po, and the mirroring is sometimes called 鑒 Jian. Po will reflect Hun qi and manifest itself in physical problems. In other words, the increased mental activity in Hun will be converted into physical problems. Normally, Po only mirrors hyperactivities in Hun that passes the level of tolerance, but it exist exceptions. If Po is very sensitive it might mirror normal activity in Hun. Here we have no indication of a hypersensitive Po. A hypersensitive Hun might increase its own activity without any special reason and as a result Po will mirror Hun. We have no reason to believe that this patient have a hypersensitive Hun. Hun mirroring itself into Po is a safety measure for the mind. It prevents the mind to get an extraordinary high mental activity, and a possible mental disease. If the problem is not in Po or in Hun, what is the problem? The problem is rooted in his issues, his problems and how he analyses them.
The main issues are as mentioned before the separation from his family, ongoing divorce, no friends, being indigenous in the City, living far away from the two children, separated from both his family and his friends from the village, poor education and being culturally different from the others where he live. Combine this with a Chen personality and a yin charged Yi wang (past focus). He is a person that is practically obsessive with details and correctness. Trapped by his personality he will focus like he is predisposed to and following do what he has to do. He married when his parents told him to, moved to the city to earn more when he got children and when he went to school he studied to the maximum level in his town (secondary school). In short he has arranged his life perfectly as a Chen personality is supposed to. Now after 10 years away he is in the process of divorcing. We do not know why, but we do know that he does not have any friends, he lives far away from everybody and he is a low status person in the city. It is plausible to assume that these issues are filling Hun with work. In pressured times the personality seems to take some control of the way a person think making this patient start thinking like an extreme Chen colored by Yin Yi wang. Inside the mind of the patient he uses old information in a negative manner. Making the problems seem bigger! We do not know details regarding his problems. It is possible that it is real problems he has to deal with, but it is also possible that it is just a maximation of a crisis and the solution that he comes up with is really the problem. Let us think is the problem the problem, or the solution the problem. For 10 years he has lived like this, or more correctly all his life he has lived like this. Why does this problem come today? Why haven’t he protested before? The solution he presents creates drastically changes in his life and not mentioning his family. Perhaps this is a momentary change of course or is it a permanent decision. This is a calm person that is good in what he is doing. He is humble and his parents have before commanded parts of his life. He is in a life fase where it is easy to adjust toward a negative direction. If a negative solution should occur it had to be now. This does not mean that the solution he selected is bad or good. Just that he suffers due to this situation he is in. Perhaps it is better to cancel the solution or just continue to the bitter end; no matter the consequences! Do not forget that a Chen personality do not change much by themself. To make a drastical change in life it is needed to have an external person to advice the Chen personality. We know that the Chen personality here DO NOT have any close friend that could have taken this task of advisory. That leaves us with the feeling of that he is in a life fase. That gives us two options: One, support him to change the life. Two, send him home to his town to adjust his proper issues.
Diagnosis:
Elevated activity in Hun
Treatment principle:
Reduce the activity in Hun through promoting the free flow of psychic qi in the liver – and gallbladder divergent meridian, organic part.
Acupuncturepoints:
Dadun, Liver 1: Ting point liver divergent meridian
Tongziliao, Gallbladder 1: Central reunion point liver divergent meridian
Renying, Stomach 9: Window to heaven point, helps psychic qi to reach the mind.
Tianfu, Lung 3: Window to heaven point. Change the communication from internal to external.
Baihui, Du20: Regulates the mind
All points where possible bilateral puncture.
Stimulation is neutral.
Retention of needles: 45 minutes.
What happened?
He received in total two treatments. After the second treatment I sent him home, and he returned after one month back to Mexico City as a new person. He does not want to divorce any more. He just wants to support his children and his wife. Possible in a few months they will join him here. His physical problems don’t exist anymore. He is for the moment cured. We just have to wait and see what happens when he have to face problems in the future.
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