An 18-year-old female with a robust physique complains of bilateral ankle pain, particularly during the night and when sitting, accompanied by a tingling sensation. She has no history of external injury. Her pulse is soft and weak, notably the pulse at the cun position which is slippery and weak, sinking on deep palpation. When inquired, the patient mentions experiencing dizziness and daily noon headaches located on both sides, three cun lateral to the posterior hairline. The radial pulse is weak and deep, and her tongue appears with dark spots and a slippery coating. She also experiences lower back pain with blood clots, especially on the second day after her menstrual period.
Based on the provided information, it can be inferred that:
Nighttime Ankle Pain: This could be related to the peak of yin and the weakest point of yang during the night, or it could be due to obstruction of the taiyang meridian caused by her sitting posture, resulting in a tingling pain at the external ankle shenmai point.
Noon Headaches: The headaches at noon might result from the impact of deficiency in qi and the lingering presence of dampness obstructing the ascending of clear yang during the time when yang is at its peak. The described sensation of a heavy and congested head along with the dizziness during headaches corresponds to this situation.
Weak Pulse with Lingering Dampness: The soft and weak pulse, along with a tongue displaying dark spots and a slippery coating, indicates a combination of deficiency in qi and lingering dampness.
Back Symptoms: The tense shoulders and neck, as well as the soft and weak sensation in the lower back, indicate cold and contraction in the taiyang meridian.
Considering these factors, it is possible that the issue stems from a failure of the clear yang to ascend and the turbid yin to descend, mainly affecting the taiyang and yangming meridians. It is advisable to consider the following treatment:
- Tonify Left Shenmen and Taichong: These are important acupoints for reinforcing yang qi.
- Harmonize Right Hegu and Gongsun: This will help balance the flow of meridians and promote the circulation of qi and blood.
During acupuncture treatment, it is recommended to leave the needles in place for approximately 10 minutes to observe the potential improvement. However, for ensuring the efficacy of treatment, consultation with a professional Traditional Chinese Medicine practitioner is advised.