Guest guest Posted February 18, 2002 Report Share Posted February 18, 2002 Hi- I recently started treating a 31 year old female with endometriosis and fibroids. She has been trying to conceive for 1 and 1/2 years without success. Her husband is 55 years old and has had his sperm analyzed: it is normal in motility, mobility and count. Sx and Symptoms: Menses: Patient had just started her period the day she came in for first visit. 7 day flow, regular 27 day cycle. Ovulation around day 13. Very painful periods in general, although occasionally less so. Heavy bleeding for 3-4 days then tapers off. Large, quarter sized clots on first day and 2nd day, dime-sized after that. Slightly pink color in beginning, then turning dark red. Brown at the end. Some mucus in blood during first 2 days. Period Pain is reduced by the use of a hot-water bottle on abdomen. PMS: breast tenderness and sad, irritable one day before. Patient has never been pregnant. BC history: patient was on bc pill for 3.5 years prior to trying to conceive. Bleeding and pain were less. Other OB/GYN: frequent yeast infections which began after her laparoscopy in 1996. Rarely had them before that. Attributes in part to high doses of antibiotics she was put on at the time of surgery. She has had one abnormal pap smear in Sept 01, which was normal in December. She has been diagnosed with endometrioisis (cyst on left ovary) and fibroid (on right ovary). Patient gets tired during period. Other: diagnoses with anemia a "few times". Mother and sister also suffer from anemia. She stopped iron pills recently. Sleep: wakes easily, sleeps 8-9 hours. No trouble falling asleep. BT: feels she runs cold. Gets occasional hot flushes in afternoon. Skin: dry Digestion: 1x a day bowel movement, regular, easy digestion, no bloating or gas (patient was embarrased to talk about this, so this may not be the whole story). Thrist: generally very thirsty for warm water, often tea. Drinks alot of water, still thirsty. Emotions: lost her job, low on cash, feels sad which causes her to sleep more than she normally would. Feels guilty easily, and blames herself when things go wrong. Sweat: experienced night sweats last summer, but it was when she was acting in a disturbing holocaust play. DReams: nothing regularly Appetite: craves fat and salt. Frequents McDonalds and likes chocolate cake. Doesn't seem to suffer any obvious ill effects from high fat, high salt diet. Patient is very slim. Gets hungry every 2 hours, eats small amt of veggies and fruit. Tries to eat 1 piece of fruit daily. Energy: gets tired and sad in afternoon. Wants a job to get her energized. HEadaches: gets knots in neck which cause a headache "like a cap" on her head. Gets stomachaches when stressed. Exercise: not a big exerciser at all. Tries to practice yoga 1 x a week. Libido: strong. Pulse: 90 bpm at start, but patient said she "gets nervous when talking about her endometriosis which causes her pulse to increase". I asked why she was nervous, and she said she spent a long time trying to figure out what was wrong with her, and her complaints were often dismissed by doctors, so she is nervous talking to a health care practitioner about her disease. Pulse slowed to 72 bpm by end of treatment. Heart position was thready, Liver pulse weak, Lung pulse deficient, Spleen pulse thin and mingmen weak. Overall weak and thin. Tongue: pale and slightly purplish/dusky overall. Enlarged and puffy with scallops. Dry in center (patient was thirsty even though she had a glass of water upon entering my office). Coat was greasy and white. SLV: distended. Patient has no pain with sex, no bleeding between periods or with bm. I diagnosed this patient with Blood Stasis and Lv Blood deficiency, Qi stasis and Qi deficiency (Kidney and Spleen) and did a gentle first treatment of Sp 6 (moxa, reinforcing), St 36, LI 4 for 10 minutes then UB 18, UB 20, UB 23 and Kd 8 which Jeremy Ross recomends for fear based disorders involving the Kidney. Endometriosis is often thought to be Qi and Blood stasis with an underlying kidney qi def. I think this patient manifests signs of Blood Deficiency also. The question is, which to address first, or whether these can all be attacked simultaneously. I also think there is some qi deficiency and dampness present, which may be almost wholly due to her poor diet. Formula options include Yang He Tang, Shao Fu Zhu Yu Tang and Tong Jin San or some mix therein. I am thinking that it is important to vary the formula depending on where she is in her cycle. My very preliminary thoughts for a formula which I would begin at the end of her bleeding includes herbs that move the stasis with a slight emphasis on tonification, though not to the degree of Yang He Tang: xiao hui xiang 6 g gan jiang 3 g ---these herbs warm and disperse cold. Xiao Hui Xiang also moves Lv Qi. yan hu suo 6 h dang gui 12 g chuan xiong 6 g dan shen 9 mo yao 6 san leng 6 e zhu 6 ---these herbs invigorate blood, stop bleeding, and slightly tonify (dang gui). San Leng and E Zhu might be too strong.... rou gui 3 --warm and tonify yang. I am going to advise her to change her diet to reduce fat and salt, increase leafy greans and fresh vegetables. I am debating about adding Fu Ling to guide out some of the dampness as manifested on the tongue and in the frequent vaginal infections. I might wait on that. I also am thinking about adding more kidney tonics like Lu Jiao Jiao, Bu gu zhi, xian mao--it might be appropriate to add this to her post-menses formula and eliminate them from her pre-menses formula. For her pre-menses formula (before her period), I will likely add some of the qi moving herbs like Wu Yao and some citrus herbs. I think the treatments for the endometrioisis cysts and the fibroids overlap somewhat, but not completely. Currently, I am focused on the endo cysts, and am not addressing the phlegm aspect of the fibroids that much. Would love insight. THanks! Hillary Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2002 Report Share Posted February 27, 2002 In message <e5.13db40f6.29a298c4, acugirlnyc writes >Hi- >I recently started treating a 31 year old female with endometriosis and >fibroids. >Hillary > Dear Hillary - I came across this mailing from last week - and thought it of interest. would you still like some correspondence on this matter? I did not see any other postings referring to it. (My approach to this case would be quite different). Regards Barry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2002 Report Share Posted February 27, 2002 Please resond on this, This is a common problem in the clinic and would like to here more about it. Always like to read about other approaches and ideas. I'm just a lurker here but learn a great deal by reading many of the ideas. bob --- barry <barry wrote: > In message <e5.13db40f6.29a298c4, > acugirlnyc writes > >Hi- > >I recently started treating a 31 year old female > with endometriosis and > >fibroids. > >Hillary > > > Dear Hillary - > I came across this mailing from last week - > and thought it of interest. > would you still like some correspondence on this > matter? > I did not see any other postings referring to it. > (My approach to this case would be quite different). > Regards > Barry > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2002 Report Share Posted February 27, 2002 >I came across this mailing from last week - >and thought it of interest. >would you still like some correspondence on this matter? Please share the information on list as a lot of people want to learn more about it. >I did not see any other postings referring to it. Actually, I've been laying a lot of groundwork with the posts on Blood, Qi, Blood Stasis,etc. I want the list members who are new to TCM to be able to follow what is happening and know how something like this can develop. One thing that struck me was the reference to few digestive system problems. Either the woman is shy about things like that, or, she is ignoring any problems like these because they are so minor-seeming to her (people with multiple health problems tend to do this a lot), or, there is not much Spleen involvement. So if there is Blood Deficiency, how could it come about without Spleen involvement? Kidney Deficiency, and in particular Kidney Yin Deficiency and Kidney Jing Deficiency. But the thin pulse points to Spleen Deficiency also being present. So does the greasy tongue coating. A scalloped tongue (a swollen tongue with indentations from the teeth) usually is a sign of Spleen Qi Deficiency. A swollen, moist tongue also can be a symptom of Kidney Yang Deficiency. People who have been sick a long time with mulitiple problems frequently forget what " normal " is. They mention the more pressing problems when they see a healer, but ignore and fail to mention things which seem minor to them in comparison to what are more pressing problems to them. There are several things which point to Yin Deficiency: " No trouble falling asleep " , " wakes easily " , " gets occasional hot flushes in afternoon " , and strong libido. The night sweats also can point to Yin Deficiency as not every one who acts in a holocaust play gets night sweats as a result. The strong thirst for warm liquids also can be Yin Deficiency. (Center of tongue: Stomach Yin Deficiency?) There may also be Kidney Yang Deficiency. The " feels she runs cold " could be False Cold - True Heat, but it could be Kidney Yang Deficiency. Is the purplish discoloration (Blood Stasis) bluish-purple (Cold) or reddish-purple (Heat)? Excessive sleep can be Yang Deficiency, but 8-9 hours of sleep isn't really excessive. (We're talking 10 or more hours of sleep in a 24-hour period when Kidney Yang Deficiency is present, and wanting to sleep curled up in a fetal position. It took 18 to 20 hours per day for me back when I was the sickest.) " Infertility can be due to Empty conditions such as Blood or Kidney-Essence deficiency, or to full conditions usch as Damp-Heat in the Lower Burner or stasis of Blood in the uterus. " (Maciocia, The Foundations of Chinese Medicine, p. 161.) A thin pulse can indicate Blood Deficiency. It can also indicate Interior Dampness with " severe deficiency of Qi " . (Maciocia, p. 169.) A thin or fine pulse is one which is thinner than normal. A weak pulse points to Deficiency. A weak pulse is one that cannot be felt very easily. It's weak. Weak pulses can be rapid (Heat), normal, or slow (Cold). Blood Stasis (revealed by purple discoloration of tongue) is an Excess problem, but an overall weak pulse points to Deficiency being the predominate problem. Too much or too little of a particular flavor can trigger imbalance in a particular Organ. Salty is the flavor associated with the Kidneys. People who are Kidney Deficient may crave salt. But too much salt also can trigger Kidney imbalance just as too little can. In addition the " salty taste can dry the Blood, and should be avoided in Blood deficiency. (Maciocia, p. 33.) BUT, people with some medical conditions - like Addisons disease, Neurally Mediated Hypotension, etc. - need higher than normal amounts of salt. People with Kidney Yang Deficiency also may eat excessive amounts of salt in an attempt to decrease the excessive urination and as a way of replacing sodium lost through excessive urination. (Note: Licorice, a Qi tonic herb, used to be used to be used to treat Addison's.) Victoria _______________ Join the world’s largest e-mail service with MSN Hotmail. http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2002 Report Share Posted February 28, 2002 thanks for this insight victoria. i will post what i have been doing with her in the next few days. if anyone else has any more insight on endometriosis and my case, please share. if you'd like me to repost the case info, just let me know! Hillary Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2002 Report Share Posted February 28, 2002 In a message dated 2/27/2002 2:47:21 AM Eastern Standard Time, barry writes: In message <e5.13db40f6.29a298c4, acugirlnyc writes >Hi- >I recently started treating a 31 year old female with endometriosis and >fibroids. >Hillary > Dear Hillary - I came across this mailing from last week - and thought it of interest. would you still like some correspondence on this matter? I did not see any other postings referring to it. (My approach to this case would be quite different). Regards Barry Barry- yes! by all means, if you have insight, please share it. I didn't get any responses initially, which I thought odd. But I see her again on friday, and i will let everyone know what formula I ended up using and how it helped. I didn't use the formula I posted to the group---that was very preliminary thinking and i changed its direction quite a bit. hillary Quote Link to comment Share on other sites More sharing options...
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