Treatments: Cases and decisions

Kidney yin deficiency with small-hours insomnia and dryness. What principle and what timeframe?

1. Drain the fire, two sessions
2. Nourish Kidney yin and clear deficiency heat, over months, with review at one month
3. Tonify yang for energy, a few weeks

Acute low back pain since yesterday from cold and damp, in an otherwise strong patient. Plan?

1. Expel cold and damp and unblock the channel, with two or three sessions this same week
2. Tonify the Kidney for three months
3. Wait and see if it resolves by itself

Is this plan well framed or does it need redoing?

• «Move the Liver qi; review at four sessions»Well framedNeeds redoing
• «Tonify and drain at once with equal intensity»Well framedNeeds redoing
• «Warm the Kidney yang; three months, watching night urination»Well framedNeeds redoing
• «Strengthen the patient's general energy»Well framedNeeds redoing
• «Apply moxa because the patient likes it»Well framedNeeds redoing
• «Clear bladder damp-heat; two sessions this week and review»Well framedNeeds redoing

Menstrual pain with dark clots that eases once they pass, plus abdominal coldness. Build the principle.

After the first session the patient reports intense fatigue for two days and then improvement. How do you adjust?

1. Change nothing: the reaction shows it is working
2. Stop the treatment
3. Lower the intensity and the number of points next session, and raise it again if tolerated

Order the review of a treatment that is going slowly.

1. Check whether the patient is doing what was agreed outside the clinic↑↓
2. Check whether any minor sign has actually moved↑↓
3. Check whether the pattern is still the same↑↓
4. Check whether the principle really answers that pattern↑↓
5. Change the route or the dose, or consider referral↑↓