NESA Actions & Effects I Instructor: Meredith St. John, Lic.Ac.

Exercise for practicing indications of the points and developing point prescriptions Musculoskeletal disorders: 1. Your patient is a 35-year-old woman who complains of neck pain following an automobile accident 1 year ago, in which her head struck the windshield. The pain is focused in the occiput, muscles lateral to her cervical vertebrae, and her upper back, restricting movement of flexion and extension as well as rotation side to side. At the time of the original injury, her pain was 8-9/10, and now its 3-4/10. Previous treatment: physical therapy, Advil. This diagnosis is local Qi/Blood Stagnation following trauma. The treatment strategy is move local Qi/Blood to relieve pain. Please list a pool of points for her, including both local and distal, on the affected channels.

2. Your patient is a 48-year-old woman who complains of low back pain in the area of BL 25 on the right side, with pain radiating down the posterior aspect of her leg. The pain first occurred 5 days ago after lifting boxes while she was moving. She has been treated twice by her chiropractor, and has used ice and Ibuprofen.Severity is about 4-5/10, is worse while mdriving and better when lying down, and has already reduced by 2 points. This diagnosis is local Qi Stagnation following trauma. The treatment strategy is move local Qi Stagnation to relieve pain. Please list a pool of points for her, including both local and distal, on the affected channels.

Exterior conditions 3. Your patient is a 21-year-old woman who complains of a cold for the past few days with fever and sore throat. It started with a splitting headache. Her nose is runny. She has been able to continue working in spite of her cold. She has no cough. Shes not blowing any yellow or green mucus out of her nose. Her appetite is fine. Her tongue is normal. Her pulse is floating and rapid. This diagnosis is Exterior Wind Heat. The treatment strategy is Release the exterior & clear heat. Pool of points:

4. Your patient from the previous question returns a week later, and her cold has gotten much worse, affecting her lungs. Now she has a severe cough, productive of sticky, yellow mucus. Her fever went away for a few days, and then came back. Her tongue is pale red with a thick, yellow coat. Her pulse is full, slippery and rapid. This diagnosis is Lung Heat and Phlegm. Treatment strategy is clear heat from LU and transform phlegm.

5. Your patient is a 30-year-old woman with a head cold that started 2 days ago with pain and stiffness in the back of her head and neck. She thinks she became chilled from over-exposure to air conditioning in her office. She has an occipital headache and some body aches. She has no fever, no sore throat, and only a slight cough. Her tongue is normal. Her pulse is floating & tight. This diagnosis is Exterior Wind Cold. Treatment strategy is release the exterior and scatter cold.

Internal Conditions 6. Your patient is qi-deficient after a serious illness. His pulse is weak, especially on the right side. His tongue is pale. He is tired, has no appetite, and has loose BMs. He sweats without exertion. Tonify Qi by choosing points by their indications, especially on LU, SP, and ST, and the relevant shu points.

7. Your patient is a 63-year-old woman with chronic diarrhea. She has multiple loose stools daily, loosely formed but not watery, without itching or unusual odor. She is fatigued. She has little appetite and is often nauseous. Her tongue is pale with a thick white coat. Her pulse is slippery and weak. Diagnosis: SP Qi deficiency with dampness. (also called Damp Cold Spleen) Treatment strategy: Tonify SP Qi and rid damp. Use points that accomplish the treatment strategy and especially direct the effects of the treatment to the intestines. Use a source/luo combination. Pool of points:

8. Your blood-deficient patient is anxious and depressed. She has a pale complexion and dry skin. Her menstrual flow is scanty and only lasts 3 days. Her tongue is pale and thin. Her pulse is choppy and fine. Tonify Blood and calm her spirit. Use channels that support Blood production. Use mu & shu combination.

9. Your patient is a 50-year-old woman who complains of symptoms of menopause. Her last menstrual period (LMP) was over a year ago. She has hot flashes during the day and drenching nightsweats at night, waking her up several times. She is tired and a little agitated. Her cheeks are flushed, as are the palms of her hands. Her urine is dark and concentrated. Her stools are dry and hard. Her tongue is red with little coat. Her pulse is thin and rapid. Her diagnosis is Yin Deficiency with Empty Heat. Pool of points: Clear empty heat & reduce nightsweats : tonify yin: Float the boat:

10. Your patient is a 70-year-old man who complains of feeling cold. His belly, back, and extremities feel cold and are cold to your touch. He has little appetite. You identify pitting edema in his lower extremities. His urine is pale, copious, and frequent. Watery diarrhea awakens him in the early morning. His tongue is pale, swollen, and wet. His pulse is deep & weak. This is yang deficiency. Tonify yang. Pool of points: