A Man Between Heaven and Earth (2018)

 

A sturdy 55-year-old trader who, despite having recently suffered a serious and undeserved professional setback, was describing himself as “an active, full of live, balanced and positive person”, consulted me regarding a case of Sleep Apnea lasting over 10 years. He was able to sleep quite well with the help of a CPAP but a cough (caused by itchness in the pharynx) has started to weaking him up, most nights, after around 5 hours sleep. Some of his other symptoms were chronic: rhinitis, low back pain (triggered by getting up from a sitting position and increased trunk extension), gonalgia (knee pain), hypertension (AHT) and recently – despite been a person that don’t feels much the cold, his hands, feet and nose were getting cold easily.
His body shape expressed an Earth typology. His tongue was rigid and slightly purplish. His radial pulses were Slippery (hua), Slow (chi) and Deep (chen), and they predominated in the Barrier (guan) position.

Since any of the Organs and Viscera (Zangfu), Extraordinary Meridian (Qi Jing Ba Mai) or Energetic levels’s pathology seemed to justify his global ailments, I asked myself what relationship could be among his old symptoms (i.e., pharyngitis, low back pain and gonalgia). The answer came to me by way of roughly scribbling such symptoms in the form of sketches: they all occupied a Man position between Heaven and Earth (that is, in the neck, located between the head-Sky and the trunk-Earth; in the thighs, located between the high-Sky and the low-Earth; and in the knees, located between the hips-Heaven and the feet-Earth).
On the other hand, I wondered what mechanism could have caused the more recent appearance of his hypertension and rhinitis, (expressing both a blockage on the upper part of the body) as well as the cold in his hands, feet and nose (on the periphery areas of the body).

I ventured that they could be the consequence of a Qi blockage in the centre of the body (the Middle Jiao), hindering its free flow between the centre and the periphery. Such central blockage would cause an excess of pressure above because the Qi cannot return to the Centre and would also hinder the regular distribution of heat to the periphery parts of the body (hands, feet and nose). My hypothesis matched well with the pre-eminence of its pulses in the Barrier (guan) position.

Then, I mentally reviewed the acupuncture points that could be related to the symbolism of Man.
I considered BL17 (geshu), Hui point of the diaphragm and blood (Xue); both structure and substance corresponding to Man. The diaphragm, due to its location between the high-Sky and the low-Earth, and the blood-Xue, because it is linked to the Heart- Centre, therefore corresponding to Man (as far as the Qi is associated with Heaven and the Jinye liquids are associated to Earth). But despite the purplish colour of the tongue (revealing stagnant blood), my patient’s symptoms were not included among the clinical indications of BL17. So, continuing with my deductions, the Earth typology of this person and his reserved psychological personality (which is typical of the Taiyin Energetic Level), guided me towards SP4 (gongsun); also related to blood-Xue and the Key Point of Chong Mai, a channel that also evokes Man if we take into account its location between Du Mai and Ren Mai (i.e., the uttermost Yang-Heaven and Yin-Earth vessels), respectively.

I kept pondering now about the 5 Agents (Wuxing), considering the possibility that the professional setback may have off-centered my patient. I ruled out RM14 (juque), Mu point of the Fire Agent (sovereign Fire) and Centre (heliocentric), because the Heart Zang didn’t seem to be involved at all, and because the cold symptoms of this acupoints speak to us about a deep cold – not superficial, as in this case. On the other hand, in the centre (geocentric) of the Wuxing, there are also 2 Mu points that go well with his Earth typology: those of the Spleen (LV13- zhangmen) and Stomach (RM12- zhongwan).

The fullness at the top (hypertension), as far as, it obeys to a non-returning to the depths (typical of the Water Agent), can also manifest a loss of contact with oneself. Although I ruled out GB25 (jingmen), the Kidney Mu point, because its function of setting the Yin in movement was not pathological here, I retained RM3 (zhongji) the Bladder Mu point, because it makes Qi descend and can treat low back pain as well.

At the end, I asked myself, could it be an alteration of the Metal Agent – which favours an autumnal interiorization – related to this man’s apparent lack of mourning in relation to his recent professional failure? ST25 (tianshu), Mu point of the Large Intestine (an organ associated with the Metal Agent), because of its Man position in the body (as it is at the navel level, therefore in between the superior (Heaven) and inferior (Earth) body parts), is an acupoint also capable of unlocking the Centre (the Middle Jiao). Furthermore, the meridian where this point is located (Stomach) belongs to the Earth Agent – precisely the typology of the person we are treating. Finally, I also took into consideration LU1 (zhongfu), the Lung Mu point, which promotes a descent of Qi from the upper part of the body (the Upper Jiao) towards the Centre. The relationship of the Lung meridian with the Metal Agent explains it’s possible association to the feeling of injustice (although apparently unacknowledged, in this case), as well as the reserved attitude that this gentleman keeps maintaining (which is also typical of the Taiyin Energetic Level, where the Lung meridian is located). In addition to clearly favouring the psychological acceptance of a duel (by gathering the energies in the centre) the clinical indications for LU1 (zhongfu) include rhinitis and apnea.

In the first session, I favoured this last option, and practiced the isolated puncture of P1 (zhongfu). The following week, my patient explained that he had slept very well the first few days (without his CPAP). The pharyngeal itchiness had disappeared completely, as well as the lumbar and knee pains. His hands, feet and nose were no longer cold. The blood pressure had lowered, and his pulse no longer predominated in the Guan position.

A little overwhelmed by such clinical response and having (painfully) learned the possibility of relapse in case the stimulation of an effective single point was repeated prematurely, I opted for H3 (taichong) to favour the central distribution of Yin. A week later, his blood pressure was normal. His sleep is more restful, though he still wakes up early needing to go to the toilet. At this point, I associated GB39 (zuanzhong) with SP6 (sanyinjiao). Two weeks later, he defined himself as feeling happy and more active and informed me that his GP has reduced the dosage of the antihypertensive drug that he was taking.

My next attempt, ST25 (tianshu), brought about a reactivation of his apneas. To my consternation, I detected a mocking smile in his countenance, which recalled the image of distrustful rejection described by Paul Couderc, when describing the typology of the candidate patient for P1 (zhongfu). Therefore, I repeated my first point, P1.

A fortnight later, everything was fine. I refrained from treating him, asking him to come back if the symptoms reappeared.
I have since seen him again, but not for the original reason for consultation.