Case Study & Oriental Analysis

Case Study & Oriental Analysis
Below is an example case study aimed at fellow professional shiatsu practioners or students, and I would welcome any feedback anyone has. A simplified version, aimed at people who know little about Shiatsu practice or theory can be viewed here. Please note that personal details have been changed to protect the anonymity of the person involved.

B was a 40 year old single woman. When she came to see me she was working part-time as an IT Consultant and studying part-time. She came to me for 6 treatments over a 3 month period and then moved away from the area.

Reason for Seeking Shiatsu
B had Psoriatic Arthritis.

The Psoriasis started when she was 7 years old, coinciding with a stressful period of her childhood, and changes to her routine. At the start of treatment she had large strips of psoriasis symmetrically on both her elbows and lower legs. Generally, however, the symptoms were much less than they used to be.

The onset of arthritis was in 1981 when she started her first full-time job. She worried a lot about work and could not leave it behind at the end of the day. The arthritis used to be very severe, but peaked around 1992 and is now 90% better than it was. However, her hands, neck and xiphoid process (joint in chest joining the 2 sides of the ribcage) were still badly affected. Her hand joints were very deformed and many virtually immobile. She had a slight lumbar ache which was partly arthritis, and partly an old slipped disk and also neck and shoulder pain, which was the arthritis from the neck radiating down.

Additionally B had a slight Candida imbalance, but was currently exhibiting no real typical symptoms - however, this can be a cause of psoriasis.

Other Presenting Symptoms
Stress exacerbated her medical conditions and caused chest constriction and sweating. She was prone to colds, had dry eyes and suffered very cold extremities - her fingers sometimes would go numb. She was awakening 4/5 times a night and her sleep was dream disturbed.

Observations
B had a slight build; fine, dry, wispy hair; and a pale, dry face. Her movements were extremely stiff and controlled, especially when turning torso/head sideways. Her limbs and the middle of her body generally lacked energy, but she looked 'blocked' around the hips and buttocks. Her shoulders were ‘held’ and forward to protect her chest. B's body language was careful, protective and closed, and her breathing shallow.

Personality
B was outwardly relaxed, but there was an impression of inner tensions, with a guarded, careful manner. She said she had difficulty establishing intimate relationships, which she found frustrating. Some years previously a long-term relationship had ended. She said she easily feels stress, and was quite ‘driven’; she liked a planned organised life and found spontaneity difficult. She said she was generally an angry person and repressed this anger/resentment and had also experienced bouts of depression.

Over the previous 5 years counselling had helped her manage this stress, anger and depression better. For the previous 3 years she had been managing her diet and exercise in a careful manner, to control the arthritis and candida.

Hara Diagnoses over 6 treatments

Jitsu	LI	LI	LI	LU	LV	LV
Kyo	K	TH	TH	SP	TH	TH

Zen Analysis
Using Masanaga's Zen theories, I concluded that B had difficulty relating to the world and adapting; a need which manifested in the frequent Triple Heater kyo diagnoses, i.e. she lacked the Triple Heater's circulation/protection strengths. This showed in her relationship difficulties, her weak immune system, her neck and back pain, her physical inflexibility (especially of the torso), her circulation problems and numbness, and her guarded behaviour. She was unable to be comfortable in the world.

A stressful period during childhood meant she had established excessive boundaries as an outward protection, which masked her inner need to relate to the world comfortably. This manifested in frequent LU/LI diagnoses and with psoriasis as substitute for emotional release. It also manifested in hoarding, depression, a liking for structure, and her closed/protected chest.

Latterly Liver became jitsu, possibly reflecting an investment in a new life she was moving to, i.e. a new phase of her personal evolution. It may well also be a reflection of her deeper symptoms, i.e. her emotional frustration, mood swings, arthritis (lack of flexibility physically) and lack of spontaneity (lack of flexibility emotionally).

Aims
Working with the individual Hara diagnoses my aim was to relax her and gently mobilise her joints (working within her limits and being especially careful of the neck). I also aimed to open her chest and strengthen her breathing to allow the Ki to circulate better and to connect the three burners.

I also aimed to strengthen Water (especially the Kidneys, as root of the body’s energy) and Metal to assist the elimination organs to detoxify body, thus taking the strain off the skin which should help the psoriasis. In 5-Element terms, strengthening Water - the Mother - and Metal - the Controller - of Wood would help to balance any stagnant Wood energy. Smoothing Liver Ki would help her anger and frustration.

Treatments
My treatments focused intensely on her joints, especially in the hands, and I spent a long time working and loosening her finger joints from side to side and projecting energy through the joints. I also did a lot of breathing work with her and always warmed the Kidneys. Of the points I frequently used, the following were the most reactive and beneficial: GB34 (Joints/smooth LV Ki), K3 (Kidneys/Back), TH4-6 (Joints/Arms/Neck/Shoulders), LV3 (Smoothing LV Ki/grounding), SI3 (Joints/Neck/Shoulders).

Number	Comments on day	Treatment
No 1	Energy in arms & thighs depleted, but full in buttocks.	BL, K and LI channels. Gentle stretches. Hara breathing. SI3/TH5/TH6 to relieve neck pain. I recommended she stimulate SI3 and 'unwind' her neck gently.
No 2	After first shiatsu her joints felt ‘stirred-up’ and worsened, but have eased now. On day of treatment the energy in her shoulders/ arms/thighs was depleted; her lower burner looked blocked. She also had a trapped nerve in neck radiating down the left Triple Heater channel.	TH and LI channels. She enjoyed the joint work and rubbing around knees/ankles. Strong connection on GB34. I recommended she stimulate GB34 and rub around her elbows and knees to release stagnation.
No 3	Very relaxed after last treatment - and no adverse after effects. On day of treatment she couldn't move her neck sideways; she thought a dietary 'overindulgence' had caused the C4/5 joint to swell. Normally alcohol would have a very detrimental effect on all her joints, but on this occasion it has only affected her neck & hand joints. She still had a trapped nerve radiating down TH & 4th finger of left hand which felt ‘odd’.	Ampuku, which she found deeply relaxing. LI & TH channels; gentle stretches/shakes to loosen her up. Something ‘clicked’ in neck during LU/LI arm stretch and she felt a big release. She enjoyed the stretching. The neck work left her ‘floaty, released & tingly’. The neck was more mobile afterwards, TH4-6 points were especially reactive. I recommended she stimulate TH5 and do neck circling.
No 4	On day of treatment she said she was very relaxed, ‘well’ and ‘more in touch with her body’. Had just spent 4 days relaxing by the Red Sea. She was 'indulging' on holiday, so her digestion was a bit ‘funny’, but not hugely - much to her surprise. Her neck and 4th finger 'oddness' had improved a lot.	Lung and Spleen channels. Neck work and ampuku. LU1 felt supportive and her chest really opened with this point. I showed her 2 Chi Gong moves to help her mobility and breathing.
No 5	She felt really ‘alive’ for several days after last treatment. On day of treatment the neck pain/inflammation was much better. Her joints were generally better. Energetically her arms were empty and her buttocks full.	Worked TH and LV channels, and stretched GB; dispersal around buttocks. Gentle passive assisted neck stretches. She liked breathing & rib stretching, which opened her chest. Neck stretches substantially increased movement.
No 6	Said she felt really connected, whole and alive after last treatment. On day of treatment her condition was much better, some wrist and neck pain, but her mobility was not too bad.	TH and LV channels; GB stretches. Shoulder/neck work. Both of us felt strong TH connection in arms and torso. At the end she felt relaxed and ‘alive’; wrist/neck felt easier. Recommend: continue Shiatsu, Chi Gong and acupoints.

Progress

several people independently commented to me that her colour had greatly improved;
her neck pain and mobility became much better;
the psoriasis cleared considerably with only a small patch remaining around the GB channel in the calves;
many of her finger joints enjoyed improved mobility;
her sleep was much more settled;
she was partying over last 10 days - prior to going away. Normally this would have had a very detrimental effect, but she only experienced slight pain/swelling the next day and, therefore, she was being tempted to indulge even more! However, I felt that ‘getting-out’ and enjoying herself would strengthen her Metal energy.

Conclusions
B really enjoyed her shiatsu and found it very relaxing.
I feel it proved beneficial, but she needs to continue regular treatments, which hopefully has been possible in her new location. She intended to continue working the recommended points & to try and find a Chi Gong or Tai Chi class.

I would welcome any feedback or ideas anyone wishes to send

See simplified version aimed at non-practitioners
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