This period of the case described here takes place over a year. Described here is an abbreviated account of constitutes about 40 acupuncture and herbal treatments.
   S.L. is 45 years old, a former truck driver, now on disability. The Patient came with no acute complaints but listed (obese-mild) diabetes, general fatigue and long term liver cirrhosis. 
   The patient was overweight with dark circles under the eyes, ashen-gray face and passive behavior. He had pronounced difficulty in exhalation. There was also a slightly acrid odor about him. 
He said that his chief complaints started about a year ago.

HISTORY
    S.L was an IV drug user (heroin, methlylamphetamine) for approximately 10 years, 1968-78. He has had both hepatitis B and C 17 years ago. He was diagnosed with liver cirrhosis 10 years ago but only stopped drinking approximately 4 years ago. He is now off of all drugs including coffee, cigarettes, drugs and alcohol. For several years after detox he says that he led a "healthy life-style" : jogging and an off and on vegetarian diet. He earned a living as a long-distance truck driver and it says that it was the long hours of this job that led to the current symptoms. He is very honest about his drug past and his rehabilitation and was receptive to all aspects of the acupuncture.

Western Assessment: Sodium, Potassium, Glucose, BUN, Creatinine, Calcium, Uric Acid, Protein, ALK Phos are all normal. Bilirubin, Globulin, AST/SGOT, ALT/SGPT are all high. Albumin and A/G ratio is low. Test results have not changed significantly over the course of the treatments.

· FIRST INTAKE - DECEMBER, 1994 
DIAGNOSIS:   Xiao Ke, Kidney Yin Deficiency
TONGUE:  red body, red tip, dry yellow coat
PULSE:  deep, slippery, slightly rapid
BODY:  S.L. has lost 40 pounds in the past year since a diagnosis of diabetes but is still 60 pounds over his ideal weight. He had ascites last year and now has pitting edema in his legs and ankles.

BLOOD PRESSURE: 115/70  
BOWEL movement: "good" -once or twice a day
URINATION:  S.L. says he urinates "all day long" : with the color turning from yellow to clear as the day progresses. It is never scanty, painful or urgent urination.
Suffers from impotence.

    The patient says he bleeds seemingly spontaneously from his gums and nose. His doctors have told him that his white blood count/platelets are 50% of normal. His doctors are worried about potential problems from internal bleeding. (Note that there seemed to be no problems with the acupuncture.) S.L has "liver spots" (burst capillaries) on his shoulders and upper arms. Massive bruising from a mugging 3 months ago is still evident on his arms. He has bruise under one eye and a bruise on his arm from a blood test 2 weeks ago is also still evident.

DIET: S.L eats what he feels is a healthy diet of salads, fish and soups. He is constantly thirsty which he feels is a result of the diuretic medication. He eats a lot of raw fruits and fruit juices. He was advised to eat more cooked foods to which he was receptive.

· MEDICATIONS: S.L. is taking 5 mg. Glucotrol (Glipizide) for his diabetes. CURRENT: MEDICAL DIAGNOSIS AND TREATMENT 1995 states that "at least 90% of glipizide is metabolized in the liver to inactive products, and 10% is excreted unchanged in the urine. Gllipize therapy is therefore contraindicated in patients with hepatic or renal impairment, who would therefore be at risk for hypoglycemia..."  The patients last blood sugar level was 150 but this number although low can vary widely depending on what was eaten recently. He says that he needs to take diuretic medications to prevent swelling all over his body.

· TREATMENT has been an ever evolving formula. Formulas at the beginning were targeted towards the diabetes which was seen as a relatively solvable problem. As the acute crisis seemed to be under control, the issues of the cirrhosis were addressed. Acupuncture has been given every week although the patient says that he feels no affect from it. Needling is mainly on the front, although back shu points are given about once every 3 weeks. More than most patients he is very aware of when Qi has been obtained and is more than willing to give comments about needling technique. Needling can be relatively aggressive. 

TREATMENTS
 
· December, 1994
pts: LI  4
 LU 7   w/ K6- opens the Directing vessel, descending Lung Qi and Kidney grasping
 KI 6    Yin Qiao Mai
 Sp 3
 Sp 6
 St. 2
Yi Shu - pancreas point 1.5 lateral to T8 

    
· FORMULAS:  
tonify Qi and Yin, clear heat, regulate St/Sp
bring clear energy up - take Stomach energy down

DEC. 21, 1994

Shi Hu  clear heat, nourish body fluids,  moisten Lung, Yin def heat 
Mai Men Dong Moisten Lung, nourish body fluids, Lu Yin deficiency, 
Tian Hua Feng diabetes, skin lesions, clear heat, nourish body fluids 
Ge Gen  clear heat, quench thirst, raise spleen Yang
Mu Li  LV, KI - liver/spleen enlargement, peptic ulcer
Gou Qi Zi diabetes, yin deficiency, benefit  Jing
Ju Hua  soothe liver, brighten eyes
Jin Yin Hua cool blood, stop dysentary, sweet cold
Dang Sheng generate body fluids, SP/LU anemia
 

The formulas are based on a diagnosis of SP QI DEF, YIN DEF and LUNG QI DEF. Herbs to deal directly with the ascites to strongly purge the water are unwise to use here because their strong actions may lead to death.
 

· 1-18-95 all measurements in grams
Shi Hu (15), Mai Men Dong (15), Tian Hua Fen (12), Ge Gen (12), Mu Li (15), Gou Qi Zi (10), Ju Hua (10), Jin Yin Hua (10), Dang Shen (10), Sheng Di (10), Fu Ling (10), Mu Dan Pi (15), Shan Yao (15), Wu Wei Zi (7), Zhi Ke (6), Huang Qi  (9)

4-5 -95
Patient's tongue is redder and he complains of bleeding gums. Also any food causes digestion problems. 
Treatment principles: Clear St/Li Heat And Stagnation

Dang Shen, Bai Zhu, Cang Zhu, Zhi Shi, Da Fu Pi, Bai He, Wu Yao, Fu Ling, Ze Xie, Jin Yin Hua, Huang Qin, Tian Hua Fen, Ge Gen
ADDITIONS  4-18- 95
Huang Qi, Zhi Mu, Shan Yao.

 
September 26, 1995
patient is "feeling pretty good" - better with rest, getting some exercise, anger is better, weight has been going up and down depending on the laysix diuretic.
Pulse: left- slippery, right: thready
Tongue: looking good, slightly red in front, slight yellow in back
UB 15. UB13, UB 18, Yi Shu, UB23, UB 20, 21, 17

ADDITIONS  9/26/95
Yin Chen, Da Zao

· OCTOBER 24, 1995
Bai Zhu, Cang Shu, Zhi Shi, Da Fu Pi, Fu Ling, Ze Xie, Tian Hua Fen, Ge Gen, Huang Qi, Bei Sha Shen, Ban Xia, Huang Qin, Zhi Gan Cao, Zhi Mu, Dan Shen, Yin Chen, Ren Shen   
 
· OCTOBER 31,1995
"feels about the same" - face color is better, lethargic  B.P.,128/70
PTS: K3, Sj 5, St 36, Liv 14, Sp 3, Lu 7, GB 41, Sp 6, Ren 17, Liv 3

· NOVEMBER 28, 1995
 has energy only 1 or two days a week, diarrhea comes and goes "happens all of the sudden" - watery & gas. No night sweats, bloating or hot/cold sensations. PULSE is slippery, weak and slightly thready. TONGUE: fairly clear, with teeth marks and slight (dry) yellow coat.
 ASSESSMENT: Sp Qi Def, Yin Def, Lung Qi Def
 POINTS: St. 36, Lu 7, Sp 6, K 3, Sp 3, Liver 3, Ren 6, St. 25, Ren 12, Du 20
 
 
· CURRENT: - 4/96
Over the course of the year the patient's condition has improved to a point but has plateau-ed. It may be pointed out that when a patient has such a disease even a stable state may constitute some sort of  success. 
A year later the signs of a gray/bronze facial color, a very low voice, acrid/ammonia odor and pitting edema in his legs are gone. He still has ascites and all other signs and symptoms of hepto-cirhosis. He now has a very clear if large tongue. He still bleeds on occasion from the mouth. Despite complaints of low energy he works part-time, volunteers at a drug counseling center and has enrolled in a 3 year college program for drug counseling to which he goes to classes 2 times a week.
    The main challenges for practionener has been addressing his periodic depression and energy level. Despite our urgings he is resistance to take up a modest exercise routine, either of walking or tai-qi. In many ways this reminds him of when he was running several miles a day and to think of such slow exercise program depresses him. At the same time he freely admits he feels much better than a year ago.
 
 Conclusion: This is obviously a complex case that depends as much on the patient' s ability and willingness to adhere to a life-time of diet and life-style awareness. One would like to see a "cure" that would restore the patient to full health more appropriate to his mid-40's age. This as yet as not has happened. Undiscussed in the above is the appreciation and calm that the patient has taken towards his treatment and condition respectively. In other words this is a patient that is a joy to work with.
 
Acupuncture cannot undo much of the past damage that S.L. has done to his body and there is little that can do to reverse his liver cirrhosis. However I feel that because of his past drug rehabilitation and his open attitude towards acupuncture and herbs I am very hopeful towards the future health of S.L.