Teresa’s Case Study (2) | He Looked Deficient — So Why Didn’t I Treat Him as Deficient?

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

This was a young American man in his twenties who mainly worked with computers.

He had been feeling very fatigued for a long time. His whole body felt tight, especially around the neck, shoulders, back, lower back and hips. He also often experienced cold hands and feet, especially when the weather became colder, rainy or changeable.

He had travelled from the United States to Australia and New Zealand partly to take a break from work and give his body time to recover. He hoped that travel, rest and some Chinese medicine treatment would help him feel stronger before returning to work.

While in Australia, he had already received two acupuncture treatments.

When he arrived in New Zealand, he had originally planned to continue travelling. But after one or two treatments with me in Auckland, he felt a noticeable change and believed the treatment direction suited him.

So instead of immediately continuing his trip, he chose to stay in Auckland and use the time for treatment and recovery.

Over about two weeks, he received approximately three treatments per week, for a total of seven sessions.

He Looked “Deficient”, but My First Thought Was Not to Tonify

From a TCM perspective, his symptoms could easily suggest deficiency.

He was tired, low in energy, easily fatigued and often cold in his hands and feet.

But after examining him, I did not think deficiency alone explained the whole picture.

His neck, shoulders, entire back, lower back and hip muscles were all markedly tight. Many areas did not feel soft or weak. Instead, they felt tense and hard, with clear muscle knots and widespread muscle and fascial tension.

That made me look at his fatigue and cold extremities from another angle.

“Not Enough Qi” and “Qi That Cannot Move” Are Not the Same

In TCM, Qi deficiency and Qi stagnation can sometimes produce similar symptoms.

A person with Qi deficiency may feel tired, weak, cold and low in energy.

In simple terms, Qi deficiency can be understood as:

There is not enough usable energy available.

Qi stagnation is different.

The body may still have strength, but that strength is not moving, distributing or being used properly.

The patient may still feel tired, weak and cold, and may even feel “deficient”, but the problem is not always that something is missing.

Sometimes:

It is there, but it is not moving properly.

A simple way to explain it is:

Qi deficiency is like running out of fuel. Qi stagnation is like having fuel in the tank, but not being able to deliver it properly.

In this patient, I was more inclined toward the second pattern.

His long hours of computer work and sitting, together with widespread tension and hard areas through the neck, shoulders, back, lower back and hips, made me consider Qi stagnation and stasis rather than simple deficiency alone.

Different Patterns Can Require Opposite Treatment Directions

If the main pattern is deficiency, treatment generally leans toward tonifying.

But if the main problem is stagnation and stasis, the direction changes. Treatment may need to focus more on moving Qi, promoting circulation within the TCM framework, releasing tension and clearing stagnation.

This is why pattern differentiation matters.

If someone is genuinely weak and deficient, using an overly draining treatment may make them feel even more tired.

But if the main problem is stagnation, appropriate moving and releasing treatment may actually make the patient feel lighter, warmer and more energised.

So the key question in this case was not simply:

“Does he look deficient?”

It was:

“Is he truly lacking energy, or does he still have energy that is not moving and being used properly?”

So I Did Not Focus the Treatment on Tonifying

Based on the examination and TCM differentiation, I focused more on releasing stagnation and improving movement rather than simply tonifying.

I used sliding cupping along the back, including the Du Mai and Bladder channel regions. After treatment, the back showed a clear red reaction.

The purpose was to help release long-standing muscle and fascial tension and, from a TCM perspective, support freer movement of Qi and Blood.

I also used superficial pricking and bleeding in selected tense areas around the hips, neck, shoulders and back.

Some areas were then treated with cupping for around ten minutes.

From a TCM perspective, these are more dispersing and moving methods rather than tonifying methods.

I did not choose them because the patient was tired. I chose them because his examination suggested that stagnation was an important part of his presentation.

His Response Supported the Original Clinical Reasoning

After treatment, he gradually noticed some clear changes.

He said his whole body felt much lighter.

His hands and feet, which had often felt cold, became warmer.

His fatigue reduced, and as that improved, he felt that his energy was coming back.

For me, this response was meaningful.

If his main problem had been a strong deficiency pattern, repeated treatment using moving and dispersing methods might have made him feel more exhausted.

But that was not what happened.

Instead, he felt lighter, warmer and less fatigued, and his overall condition improved.

That response further supported my initial decision not to treat him simply as Qi deficient.

Later, He Left This Google Review

After treatment, the patient left a short review on our clinic’s Google page:

“Very good with lots of experience. My circulation improved after and I feel better.”

The phrase “my circulation improved” reflects the patient’s own experience. It is not a medical measurement or a diagnosis of improved blood circulation.

But it matched what he had originally described: cold hands and feet, fatigue and a feeling that his body was not “circulating” properly.

After treatment, he felt warmer, lighter and generally better.

That patient-reported change also matched the treatment direction I had chosen from the beginning.

What This Case Made Me Think About

What makes this case worth sharing is not cupping, bleeding therapy or any single technique.

The most important point is:

Different TCM patterns can produce similar symptoms, but the treatment direction may be completely different.

A person who looks tired, cold and low in energy is not always simply “deficient”.

If we only look at the surface symptoms, it is easy to think about tonifying.

But when examination also shows widespread muscle and fascial tension, hard knots and long-standing physical tightness, the clinical picture may be different.

In this patient, the sequence was quite clear:

fatigue, cold extremities and widespread tightness → examination suggesting stagnation → treatment aimed at moving and releasing → the body felt lighter and warmer → the patient later wrote:

“My circulation improved after and I feel better.”

For me, the real value of this case is this:

Pattern differentiation guides the treatment direction, and the patient’s actual response then helps us reassess whether that reasoning was appropriate.

That is what makes this case worth recording.