Case Study: “Front Wheel of Life” for Digestive Issues

 “The Front Wheel of Life” is the name given to a specific set of acupuncture points used on the abdomen: Ren 12, Ren 6, Ren 4, bilateral ST 25, and left ST 21. While Ren 4 was not utilized in this particular case study, I am still choosing to call it the Front Wheel of Life. These particular points act powerfully on the digestive system.

Ren 12 is the Front Mu(1) point of the Stomach, the influential point of the yang organs, and the crossing point of the conception vessel with the San Jiao, Small Intestine, and Stomach channels. Ren 12 is located “north” of the navel. Ren 6 is located “south” of the umbilicus and is called QÌHǍI in Chinese which translates into “Sea of Qi”. This point is an incredibly important point for fostering yuan (original) qi, tonifiying qi, and regulating qi, especially of the yang organs such as the Stomach and Intestines. The bilateral Stomach 25 points can be visualized as the “east” and “west”  points with the navel in the center. Stomach 25 is the Front Mu point of the Large Intestine and is used for all types of digestive disorders as it functions to regulate the Spleen, Stomach, Intestines, Qi, and Blood as well as resolve dampness and damp heat. It can also eliminate stagnation. Finally, left Stomach 21 is referred to as the “crank on the wheel” as it is the last needle inserted in the series and it is important to tonify this point as part of the overall treatment. Stomach 21 is located lateral to Ren 12. It regulates qi, alleviates pain, harmonizes the middle jiao, transforms stagnation, raises the qi, and stops diarrhea. It is particularly important for treating epigastric pain, abdominal distention, vomiting, poor appetite, borborygmus, slippery diarrhea, and undigested food in the stool. One can quickly see how combining these five points can be a powerful point prescription for treating chronic digestive issues. This month’s blog presents a case study that covers 15 months of treating a patient with this point prescription. 

1. Front Mu points are the acupuncture points on the front of the body where the qi of the yin and yang organs gathers and concentrates on the anterior surface of the body. The majority of these points are located along the conception channel (Ren). 

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56 yo AFAB (pronouns: She/Her) patient was one of my first patients as a pre-intern at the Academy of Chinese Culture and Health Sciences in the Fall of 2020. She chose to only be treated by me until she left the country in mid-February 2022 of my final semester at ACCHS in Oakland, CA. 

Initial Chief Complaint: Lumbar and right hip pain accompanied by bilateral shoulder pain, attributed to long work hours at a desk for approximately 2.5 months 

Medical History: 

Lower back pain tended to occur when tired. Backache was really bad on the morning of the initial intake, rated at an 8 on a scale of 1 to 10, 10 being the highest. Relief was brought on by heat and ibuprofen. The pain was exacerbated by prolonged sitting at her desk. 

The patient also reported a history of severe diverticulitis which required two surgeries. This condition caused her GI tract to feel irritated after eating until she is able to pass a bowel movement and often the bowel movement will be "pebbly" & would only feel completely passed when she took Metamucil. The patient reported that Metamucil was "a flush"; took it daily, but her stomach reacted inconsistently. The patient wanted to have something else that helped her empty her bowels as citrus flavors upset her stomach: she experienced nausea when she would take it in the morning, but in the evening she would throw it up. 

    The patient also revealed biomedical diagnoses of pre-diabetes. hypothyroidism, uterine fibroids (that resulted in a partial hysterectomy), and a large ovarian cyst. 

Treatment Progression:

    While the chief complaint initially was lower back pain, the focus of her treatments became more fixated overtime on the middle jiao stagnation leading to her varied chronic illnesses: metabolic syndrome/pre-diabetes as well as digestion and motility issues, with a goal of having the patient be able to evacuate bowels fully on her own. 

The primary diagnosis throughout her 26 treatments was Kidney and Spleen Qi deficiency engendering middle jiao qi stagnation and damp accumulation. As such, the treatment principles were to tonify Kidney and Spleen Qi, move Qi, and transform damp-phlegm. 

        The acupuncture approach changed over time, especially depending on who was my shift supervisor. Some supervisors would allow me to use as many needles as necessary to treat what I was seeing that day; others would only allow for 9 needles max. Regardless of this variable, I would assert that the cornerstone acupuncture prescription utilized was the front wheel of life e.g. bilateral ST 25 (16/26 treatments, 62%), Ren 6 (17/26 treatments, 65%), Ren 12(19/26 treatments, 73%), L ST 21(14/26 treatments, 54%). Most notably, during the Fall 2021 semester, my shift supervisor would not approve of me using these points altogether. It was during this time that the patient reported a setback in her ability to pass fully formed bowel movements as well as to empty more fully. I was able to return to utilizing this full point prescription in the Spring of 2022 and the patient noticed an immediate benefit. 23% of the treatments I swapped bilateral ST 25 for KD 16. While the patient didn’t always report that she noticed a difference with this treatment (versus the usual front wheel of life), the patient would often note that digestion function was greatly improved - bloating totally diminished, bowels easier to pass as well as feeling better overall in her body. Ultimately I decided to stick with the front wheel of life without using KD 16 in order to better track the changes being observed while minimizing confounding variables. 

Final Reflections 

   On the patient’s last appointment, 02/11/2022, I asked her how she felt her health had changed over the course of 15 months of treatment. She rated her improvement as an 8/10, with 10 being the best improvement possible. In her own words: “I didn’t feel stable when I first started but now I do. I went from needing weekly treatments to being able to come in every other week. My gut has much more balance to it now and I trust it more as a result. I wasn’t able to incorporate good health changes before receiving acupuncture treatments but now I have been able to enter a really good self-care routine as a result of the treatments”. 

    I would add the following observations of what changed for this patient over the 15 months: 

• Spleen Qi deficiency with dampness and middle jiao qi stagnation/deficiency

  • thick, slightly swollen tongue changed to be more narrow, less swollen with fewer teeth marks; undigested food in stool ceased to be a complaint, damp-phlegm signs diminished such as downward-bearing sensation in the bladder was resolved by the last session, fully formed non-sticky bowel movements more often than not, more energy overall, limbs feeling less heavy. 

• Liver qi stagnation insulting spleen/stomach  (wood overacting on earth)

  • Abdominal distension and pain were almost fully resolved by the last treatment as the patient no longer experienced these symptoms in an exacerbated way;  alternation of constipation and loose stools, stools sometimes dry and in small pieces -> patient had reached the point where the bowels no longer alternated in this fashion and had many more days of fully formed, non-sticky, whole bowel movements than not. Replete left guan changed to being less replete, more even with the right guan when compared.

• Stomach heat

  • Thirst, sour regurgitation/vomiting soon after eating was mostly eliminated by the last treatment. Certain meats could still trigger this response such as chicken or beef but the symptoms were vastly improved from when she first began treatment. 

• Damp Bi

  • pain shifting locations throughout the back and hips were mostly resolved by the third month of treatment. She can still experience a flare-up now and again if she sits too much for work without making sure she moves and changes position, however it is overall vastly improved since her first visit. 

• Kidney Yin and Yang deficiency

  • Cold feet, lower backache, night sweats, decreased libido, red tongue with dry coat -> lower backache is gone with the caveat that she must change positions throughout the day as she works her desk job. The patient no longer complained of cold feet by the last treatment. Night sweats were resolved fairly early on. While the patient mentioned the decreased libido at the beginning, we never revisited the subject so I cannot report whether or not this improved as it was more of a side note than a chief complaint. The tongue was markedly less red, pinker as it should be, and a balanced, moist coat that had repopulated the upper jiao portion of the tongue with the exception of the very tip of the tongue by the last treatment. 

 In summation, I believe that this patient’s treatment helped move them closer to their goal of being able to fully pass a bowel movement on their own in large part because of the use of this point prescription.