The Unique Acupoint Protocol to Treat Knee Pain of Patient with Thalassemia

she Abstract This unique and newly developed acupoint protocol composed of Yuan-Source and Luo-Connecting acupoints was conducted to the patient with thalassemia for knee pain. Therapeutic effects of acupuncture for the knee pain were observed and rated by the patient on the Wong-Baker Faces Pain Scale from 6 to 2 with the first treatment, the pain did not reoccur, and the patient could fall asleep easily and soundly, which shows this protocol is effective to reduce the pain and deserve attention.


Looking
In ( Figure 1) the information before treatment from Looking indicated pale complexion, the color of the tongue was slightly pale, slight white coating on the Lower Jiao, and a little bit of teeth marks on the left side. The tongue was a little bit swollen with a crack at the tip of the tongue.

Listening
Her voice was a little bit weak and seemed there was phlegm in the chest when questioned,

Asking
The patient responded she felt tired easily, especially in the afternoon, hard to fall asleep, and always slept dream disturbed.

Feeling
Pulse feeling showed wiry, slippery, and thing.

Treatment Plan
"Less needling for the best outcome" is the golden rule for an acupuncture practitioner to follow since this can enable patients to have a better quality of life in a short time [5]. The unique acupoint protocol Reinforcing Yang to Nourish Yin composed of Yuan-Source acupoints and Luo-Connecting acupoints was considered with the following analysis and consideration of her lifestyle. Most importantly, the manipulation of this protocol takes less than three minutes that can save the time and keep the patient from fear. Thing pulse, low voice, and pale complexion showed Blood deficiency equivalent to anemia in the Western medicine. In addition, the pale and swollen tongue and slight white coating on the Lower Jiao and teeth marks on the left side, a crack at the tip of the tongue are the indications of Blood deficiency. Wiry pulse indicated referred to Liver qi stagnation and phlegm is verified with slippery pulse. The overall information reveals that the pattern of this patient is Blood deficiency, which can also result in insomnia, tinnitus, and difficulty in falling asleep.

Results
The patient reported the pain was significantly reduced from 6 to 2 on the scale ten minutes right after the first treatment. The color of the tongue turned redder while the white coating vanished a little as shown in (Figure 1). Before the second treatment started the next day, she said she had a sound sleep, tinnitus was relieved, and the knee pain was almost gone. Most importantly, the knee pain did not reoccur with the two treatments. The patient could fall asleep easily and soundly.

Discussion
Inflammation that can cause pain, redness, swollen joint, joint stiffness, and loss of joint function is a defensive immune response conferred by the host against foreign pathogens [6].
The evidence shows that infected tissues, rheumatic joints, and wounds seem to have lower concentrations of oxygen than healthy tissues [7]. The concept of Ying-Yang in (Figure 2) should deserve attention because it does play a key role to the successful TCM and acupuncture treatments, though is abstract and the unique concept [4]. It is noted in the TCM and acupuncture that Yin referring to materials is the basis of Yang, while Yang is the representations of Zang-Fu organs in exerting Yin [8]. Yin-Yang is incorporated into this acupoint protocol since a disease represents the imbalance  The Five Elements theory indicates that the Liver qi can affect the Spleen qi to ascend and the Stomach qi descend correctly, which has a critical impact on the metabolism and oxygen concentration [9].
From the perspectives of the TCM etiology, pain is result of the imbalance of Yin-Yang and that can be classified into 1) deficiency and 2) excess patterns. Both patterns can be resulted from either stagnated Qi or Blood stasis in the systems of the body, especially Liver qi stagnation [4]. The scientific evidence shows the Liver qi stagnation related symptoms can be interpreted with the biological changes of the auto nerve system that can result in issues of the digestion and depression, the improvement of interleukin-6,decreasing level of the prostaglandin F 1α (PGF1α) levels, increasing level of β-endorphin and the ratio of 6-keto-PGF1α/ thromboxane B 2 (TXB2) [10]. The countering sequence reveals Liver can invade Spleen to cause deficient Spleen qi, which causes Blood deficiency to transport fluid in the body abnormally and finally cause Dampness. Dampness can cause the presentation of white tongue coating and teeth marks, which means that Spleen Yang is damaged and make stagnated fluids to cause Qi stagnation and Blood stasis [4].
Factors like fear, anxiety, depression, and the lack of sleep can affect how severity of the pain [11].The results of this acupoint protocol complies with the scientific studies revealing that poorer sleep is significantly related to higher levels of nighttime pain [12], which can explain why the patient could sleep soundly with the first treatment. The results suggest this acupoint protocol can reinforce Yang for Zang-Fu organs to nourish Ying to retrieve the balance between Ying and Yang. It is also reported that this protocol has been used either for pain management or other health issues in Table 1 with significant results. However, how to understand the mechanism of this protocol with the science-based evidence needs more research in the future since this protocol introduced in this case is totally developed with the limited experiences.