Newbie - Chronic fatigue, liver Qi etc - long

[Guest guest]

Hello All,

 

I am new to the list and new to TCM, and diving in and trying to get at

least a working understanding of the principles - I must admit I find it

fascinating.

 

I have two patients - myself, and a horse, both recently started treatment,

myself with a first rate medical herbalist of reknown, and my horse with a

vet practicing TCM.

 

I have great confidence in my herbalist, who is proceeding gently, and my

response to the first few days has been good. In western terms I have

insulin resistance and possibly thyroid-pathway issues, some reactive

hypoglycemia, IBS stuff - doctors no help at all. Been this way for 16

years, when there was some kind of 'acute' incident from which I never

recovered - not viral (as far as we can tell).

 

My concerns are largely over my horse, whos first encounter with TCM does

not seem to be going well at all. I do not have confidence in the vet

concerned, who seems to be of the 'Don't worry yourself you ignorant

layperson, let the all-knowing vet take charge' school.

 

Well, there was clearly some misinterpretation by him of the horse's history

and state, and a lot of what he is reflecting back to me is totally contrary

to what I know to be true of the horse - from his case history, and an

enormous volume of cause and effect observation by me over the years. He has

no western disease, so the western vets are clueless and unable to help, but

thoroughly supportive of my research and genuinely impressed with the

progress I have made in understanding what is going on, getting them some

clinical evidence by working out which bloods need taking, and making

changes to improve his condition. Through my own research I have

established, and got the bloods to confirm, he has a high insulin, high

cortisol, low FT4 (high binding of thyroid hormones therefore 'functional'

hypothyroidism). He tends to reactive relative hypoglycemia , and an

inflammatory/circulatory condition of the feet called laminitis. He does not

have thyroid disease per se, cushings or diabetes. We have tried thyroxine

treatment, but despite a rise in total hormone levels, his FT4 was even more

depressed!

 

He is historically easily mentally and emotionally over-stimulated,

irritable and aggressive, but made extremely anxious by any percieved

environmental 'danger', gets panicky over it. Very sensitive to mild toxins,

any cerebral-acting substances etc. His condiiton is very seasonal, which

may be the change in season or the change in the grass/sugar that

accompanies it. He generally got hyper in spring, totally debilitated in

summer, recovered in autumn, getting quite high again, and was OK in winter.

 

So, anyway, all the vet has mentioned is Liver stagnation and Spleen Qi

deficiency - he seems to have decided he is more 'bored and listless' than

'over-stimulated and exhausted', and is convinced more work is what he needs

when historically the more work he gets the worse he gets to the point of

complete debilitation (though of course he needs a certain amount of

exercise for health, as much as he can take without deterioration) From the

few descriptions I can find his condition seems more like liver fire than

liver stagnation, and I cannot find any references which match spleen

deficiency with his western medical picture.

 

My main problems is that the remedies prescribed make him much worse, and I

cannot get any clarification or explanation from the vet over his poor

response, so fear a mis-diagnosis.

 

He is on:

 

1. Bu Zhong Yi Qi Tang - ginseng and astragalus formula.

I was so concerned that I asked the medical herbalist if there was anything

in the formulas he was getting that might make him too hot, and despite his

reluctance to comment he was obviously concerned when he saw what he was on,

and said the Bu Zhong was indeed pretty heating because of the support

herbs.

 

It gave the horse lots of energy, but with it came a rise in hyperactivity

and anxiety that made him almost uncontrollable out hacking. It started

overnight when he was put on the formula, and left overnight when he was

take off.

 

But in addition to the anxiety, he has become extremely aggressive and

irritable, his hoof inflammation flared up (may have been other factors, but

I am going through a process of elimination) and I have just realised his

eyes have been running for the last few days too.

 

When his feet flared up he was on both remedies, so I withdrew them both,

and within 12 hourse he was a happy, friendly chap again, all the aggression

and anxiety had gone. I treated with anti-inflammatories for 48 hours, and

they settled back to a 'grumbling/recovering' level rather than a flare up

level.

 

I tried both remedies again at half dose, but withdrew the Bu Zhong after my

herbalists comment, and the anxiety left, but the aggression etc remained

for several days more. So I removed that too last night, and again, he is

much happier this morning - his feet even seem better.

 

2. The Liver formula was Chai Hu Qing Gan Tang - bupleurum and rehmannia.

 

Those two main herbs seem to be used for liver fire and stagnation, so I

don't really know what to think - maybe some of the support herbs make the

remedy too powerful for him?

 

I did email the vet to ask if a 'detox' might be releasing toxins into the

system or something, and therefore making him more irritable, but he did not

answer the question - just said more or less 'Your job is to concentrate on

exercise and nutrtition and leave the rest to me'. Don't know if I can cope

with such ego, and it's strange because he seemed such a mild mannered,

centred person in the flesh.

 

So, would you expect to see a big adverse reaction in such a case, or do you

think the vet has made a mistake in differentiation, and therefore the

remedies? I read that the differntiation is judged by the response, so this

seems likely to me, in the absense of an expectation of worsening before

improvement. I have repeated to him my SERIOIUS concern at such a

deterioration without any warning or explanation, but he has not replied as

yet. I have not questioned his diagnosis per se, but I have told him I do

think there is some misunderstanding about whether the horse is

over-stimulated by some endogenous factor or under-stimulated by lack of

external interest, and asked him why the remedies seem to be overheating

every aspect of his condition. I await his reply still.

 

So, what do you all think?

 

Jackie

[Guest guest]

Hi Jackie,

 

Welcome to Chinese Traditional Medicine.

 

> I am new to the list and new to TCM, and diving in and trying to

get at

> least a working understanding of the principles - I must admit I

find it

> fascinating.

 

The earliest posts in the message base will walk you through the

basics of TCM. There also a searcj function in the message area so

you can find specific topics.

 

> My concerns are largely over my horse, whos first encounter with

TCM does

> not seem to be going well at all. I do not have confidence in the

vet

> concerned, who seems to be of the 'Don't worry yourself you ignorant

> layperson, let the all-knowing vet take charge' school.

>

> Well, there was clearly some misinterpretation by him of the

horse's history

> and state, and a lot of what he is reflecting back to me is totally

contrary

> to what I know to be true of the horse - from his case history, and

an

> enormous volume of cause and effect observation by me over the

years.

 

I suspect you already know what needs to be done. When a healer (and

this includes TCM healers) can't or won't answer questions, this is

not a good sign. From what you have said, I am the most concerned

about what the vet is reflecting back to you not matching what you

know to be true of the horse. Sometimes people and animals will

behave differently around different people. This is a possibility.

But sometimes healers will try to " force a square peg into a round

hole " . The healer will decide on something and ignore any evidence

to the contrary. (This is not limited to healers.)

 

> He is historically easily mentally and emotionally over-stimulated,

> irritable and aggressive, but made extremely anxious by any

percieved

> environmental 'danger', gets panicky over it.

 

This suggests Yin Deficiency. Issues of fear suggest Kidney

imbalance. You may want to check one of the earliest posts on Yin

Deficiency.

 

> Very sensitive to mild toxins,

> any cerebral-acting substances etc. His condiiton is very seasonal,

which

> may be the change in season or the change in the grass/sugar that

> accompanies it.

 

It may not be limited to feed available at different times of the

year but a direct function of the effects of weather conditions.

 

Each season has a different Pernicious Evil (Wind (spring), Heat

(summer), Damp (late summer), Dryness (fall), and Cold (winter)

associated with it. The predominate Prenicious Evil may vary

somewhat with locality (for example, areas on the coast tend to be

windy at all times of the year), but in general these hold true.

 

He generally got hyper in spring, totally debilitated in

> summer, recovered in autumn, getting quite high again, and was OK

in winter.

 

The " hyper " in spring suggests Liver imbalance and Wind problems

since spring is the time when Wind is the predominate atmospheric

condition. The Liver is most vulnerable to Wind. (The concept of

Wind includes barometric changes. In some individuals low barometric

pressure will cause tissues in the body to swell slightly. There are

other effects from both Western and TCM standpoints.)

 

You may want to read some of the posts on Liver Yang Rising. In

order for Liver Yang to Rise, Liver Yin has to be Deficient. Since

the Kidneys supply the Yin (and Yang) to the rest of the body, there

often is joint Kidney and Liver Yin Deficiency (though Liver Yin

Deficiency can arise independent of Kidney Yin Deficiency).

 

The being debilitated in summer and winter being the horse's best

season strongly suggests a Heat Disorder. (You may want to read one

of the earliest posts on Hot and Cold.)

 

> So, anyway, all the vet has mentioned is Liver stagnation and

Spleen Qi

> deficiency - he seems to have decided he is more 'bored and

listless' than

> 'over-stimulated and exhausted', and is convinced more work is what

he needs

> when historically the more work he gets the worse he gets to the

point of

> complete debilitation (though of course he needs a certain amount of

> exercise for health, as much as he can take without deterioration)

 

When people or animals are made worse by work or overdoing, this

suggests Qi Deficiency and Spleen Deficiency.

 

>From the

> few descriptions I can find his condition seems more like liver

fire than

> liver stagnation, and I cannot find any references which match

spleen

> deficiency with his western medical picture.

 

They won't necessarily match up. TCM diagnoses are made on the basis

of TCM criteria, not Western diagnoses. In fact, Western-defined

medical conditions often may have several different possible TCM

Roots. This is why 2 people can have the same Western diagnosis but

the TCM treatment will be very different for them. The TCM Roots are

not the same.

 

> But in addition to the anxiety, he has become extremely aggressive

and

> irritable, his hoof inflammation flared up (may have been other

factors, but

> I am going through a process of elimination) and I have just

realised his

> eyes have been running for the last few days too.

 

All of these can be Heat symptoms. Problems with the eyes point to

possible Liver imbalance because the " Liver opens into the eyes " .

 

> 2. The Liver formula was Chai Hu Qing Gan Tang - bupleurum and

rehmannia.

 

Sometimes when Liver herbs (or acupressure/ acupunture) are used,

they can cause the release of a great deal of anger and frustration.

I try to point out to people that this can occur whenever Liver

treatment is used so people can be prepared for it. (Anger is the

emotion most associated with the Liver, and the Liver is most

vulnerable to anger. The Kidneys are most vulnerable to fear, and

Kidney imbalance can prime a person to feel fear.

 

> I did email the vet to ask if a 'detox' might be releasing toxins

into the

> system or something, and therefore making him more irritable, but

he did not

> answer the question - just said more or less 'Your job is to

concentrate on

> exercise and nutrtition and leave the rest to me'.

 

No, these are NOT the only jobs of a member of the healing team. And

patients, parents, owners, etc. ARE members of the healing team.

 

You may also want to do a search on here for cortisol and a Michael

Tierra article on Kidney imbalance.

 

No one can diagnose via email. All I'm suggesting are topics you may

want to reserach further. Let me know if any of them sound like what

is bothering your horse.

 

Is there another TCM vet in your area?

 

Victoria

[Guest guest]

Hi Victoria,

 

> The earliest posts in the message base will walk you through the

> basics of TCM.

 

Oh OK, I'll do that - I checked the file section of the webpage expecting to

find that there, and searched a couple of subjects in messages. I read just

about the whole of a terrific site yesterday - www.TCMbasics.com It gives

much more detail than the silly superficial comsumer sites, and lays out all

the principles in an ordered fashion.

 

> I suspect you already know what needs to be done. When a healer (and

> this includes TCM healers) can't or won't answer questions, this is

> not a good sign. From what you have said, I am the most concerned

> about what the vet is reflecting back to you not matching what you

> know to be true of the horse. Sometimes people and animals will

> behave differently around different people. This is a possibility.

> But sometimes healers will try to " force a square peg into a round

> hole " . The healer will decide on something and ignore any evidence

> to the contrary.

 

Yes, that seems about it - I gave him reams and reams of information

according to the format he requested, but he doesn't seem to have read it,

or at least he hasn't 'heard' it. It is an extremely complex case, but I

have all the data at my finger tips at any given time.

 

> This suggests Yin Deficiency. Issues of fear suggest Kidney

> imbalance. You may want to check one of the earliest posts on Yin

> Deficiency.

 

W'ill do. Does that have to be Yin pertaining to a specific organ, or can it

just be general Yin? Or is it that you identifyYin, and then which

specificYin?

 

I checked through all th Zang-Fu differentials on the TCMbasics site, and

nothing in the kidney section there rang a bell in terms of physical

symptoms. Several spleen and liver sections had a lot of his symptoms, but

always with anorexia, and he has an excess appetite. Only reference for that

I could find was stomach fire.

 

> It may not be limited to feed available at different times of the

> year but a direct function of the effects of weather conditions.

 

Yes I find it hard to separate those two. In general I'd say it's heat that

causes him most problem - he doesn't seem to mind cold weather, though he

hates being allowed to get cold. Damp I'm not sure about - it can be damp at

any time of year in the UK! Wind winds him up and makes him anxious, but

that could be a prey animal whooshy tree thing - he has a phobia about

boogeymen in trees.

 

> The " hyper " in spring suggests Liver imbalance and Wind problems

> since spring is the time when Wind is the predominate atmospheric

> condition. The Liver is most vulnerable to Wind.

 

Interesting.

 

>

> You may want to read some of the posts on Liver Yang Rising. In

> order for Liver Yang to Rise, Liver Yin has to be Deficient. Since

> the Kidneys supply the Yin (and Yang) to the rest of the body, there

> often is joint Kidney and Liver Yin Deficiency

 

Got you, I'll have a look.

>

> The being debilitated in summer and winter being the horse's best

> season strongly suggests a Heat Disorder.

 

(You may want to read one

> of the earliest posts on Hot and Cold.)

 

Right. Going back to the beginning is easy - searching through the whole

archive is a pain!

 

> When people or animals are made worse by work or overdoing, this

> suggests Qi Deficiency and Spleen Deficiency.

 

Does that make spleen qi deficiency - or is that two separate things?

 

> All of these can be Heat symptoms. Problems with the eyes point to

> possible Liver imbalance because the " Liver opens into the eyes " .

 

Exactly, I spotted that yesterday - and feet via a channel? Don't know of a

horses front feet are feet though - they might be hands!

 

> Sometimes when Liver herbs (or acupressure/ acupunture) are used,

> they can cause the release of a great deal of anger and frustration.

> I try to point out to people that this can occur whenever Liver

> treatment is used so people can be prepared for it.

 

Right, so it could be that the remedy has 'hit the spot'?? You think the vet

would warn me or at least explain when I questioned it! If this happens, how

long does it last normally? And is there another way round, by freeing

something up more slowly, or does this have to be 'gone through'?

 

The sad thing is before I found the vet I had gotten as far as trying

Ashwaganda (recommended by my medical herbalist) and an Ayervedic liver

tonic - and the horse was VASTLY improved, became a real happy little bunny.

It's hard to take the contrast - but if I thought it had to be, and was

prepared, I could cope with it short term.

 

 

(Anger is the

> emotion most associated with the Liver, and the Liver is most

> vulnerable to anger. The Kidneys are most vulnerable to fear, and

> Kidney imbalance can prime a person to feel fear.

 

That's the wierd thing - they feel fear before there is anything TO fear

(his mother had the same condition). I think I recall the kidney does cover

the adrenals in TCM, and they are of course produce all the stress hormones

which I know are high in my horse anyway, and possibly the root of the

thyroid and insulin problems. I also asked the vet if a stimulation of the

adrenals by eg ginseng could be why he was being made more anxious/fearful,

but of course he would not answer me. But too much cortisol can precipitate

laminitis, so it was a real worry when his feet flared up. The TCM vet

doubted my word on the possibility of a laminitis recurrance, and just kept

insisting he needed more exercise (if they have laminitis you must not

exercise them - they can actually tear their hooves from the bone). Not

helpful.

 

 

> No, these are NOT the only jobs of a member of the healing team. And

> patients, parents, owners, etc. ARE members of the healing team.

 

Thank you. My western vet feels the same - I really don't know what this

guys problem is, he seems to resent any questioning. It comes with a

'caring' attitude of 'All this worry is not good for you' but nothing is

more worrying that watching your horse get worse without any explanation of

why!

 

> You may also want to do a search on here for cortisol and a Michael

> Tierra article on Kidney imbalance.

 

Ah yes, I've read several of his articles.

 

> No one can diagnose via email. All I'm suggesting are topics you may

> want to reserach further.

 

That's what I need - and access to some information in enough depth.

 

> Is there another TCM vet in your area?

 

I'm pretty sure not - the only well known holistic equine vet uses more

homeopathy. He does do acupuncture, but I tried him years ago and he could

not help the mare at all. He is a bit whacky too - has some ideas that are

contrary to good science.

 

However, if the worst comes to the worst and I could persuade my medical

herbalist to help, my western vet is very happy for him to supply herbs

under his authority. I have no doubt he could select the right ones for a

smooth progress, and would actually LISTEN to me!

 

Thanks a lot, I'll go do my searches and tell you what I find.

 

Jackie

[Guest guest]

Hi Jackie,

 

> W'ill do. Does that have to be Yin pertaining to a specific organ,

or can it

> just be general Yin? Or is it that you identifyYin, and then which

> specificYin?

 

One specific Organ may be Yin Deficient, or it could be general Yin

Deficiency. If the Kidneys are Yin Deficient, a lot of Organs,

perhaps all of them are going to be Yin Deficient because the Kidneys

supply the Yin (and Yang) to the rest of the body. The body will

prioritze based on a number of factors, including genetics. If one

person is Kidney Yin Deficient, her/his body may supply enough Yin to

say the Heart while shorting the Stomach. Another Kidney Yin

Deficient person may supply enough Yin to the Stomach while shorting

the Heart. There is a great deal of variation based on a number of

factors.

 

> symptoms. Several spleen and liver sections had a lot of his

symptoms, but

> always with anorexia, and he has an excess appetite.

 

The lack of appetite usually happens with Spleen Qi Deficiency, but

not always. I am very Spleen Deficient, and I have an excessive

appetite. I never have been able to figure out why. The weird thing

is that very hot herbs will diminish my appetite to normal. I do

tend to substitute eating for rest. I grab something to eat in order

to keep going instead of resting. Bad habit I still haven't broken.

 

> any time of year in the UK! Wind winds him up and makes him

anxious, but

> that could be a prey animal whooshy tree thing - he has a phobia

about

> boogeymen in trees.

 

Many people who are sensitive to Wind also gets anxious, edgy, antsy,

etc. when the wind blows.

 

> > When people or animals are made worse by work or overdoing, this

> > suggests Qi Deficiency and Spleen Deficiency.

>

> Does that make spleen qi deficiency - or is that two separate

things?

 

The Spleen is the number one Organ for Qi production in the body. It

extracts the Qi from the food " rotted and ripened " in the Stomach,

and transports it to the Lungs where it mixes with the Qi extracted

from air by the Lungs. If anything goes wrong with either, Qi

Deficiency can result. But usually it's the Spleen.

 

Standing can harm the Spleen (and Spleen Qi). So can obsessing. The

Spleen is the most vulnerable to Dampness. The Stomach likes

Dampness, but the Spleen hates it. The Spleen also is very

vulnerable to Cold. (The Kidneys are the most vulnerable to Cold.)

Cold can attack Yang. Heat can attack and diminish Yin.

 

> Right, so it could be that the remedy has 'hit the spot'?? You

think the vet

> would warn me or at least explain when I questioned it!

 

The vet may not know about this.

 

> If this happens, how

> long does it last normally? And is there another way round, by

freeing

> something up more slowly, or does this have to be 'gone through'?

 

It varies. Humans usually cut back on the dosage of the herbs. Some

of the acupuncturists on the list may have some other techniques that

work to counter this. Points like Conception Vessel 17? Heart 7?

Pericardium 3 and Pericardium 6?

 

> The sad thing is before I found the vet I had gotten as far as

trying

> Ashwaganda (recommended by my medical herbalist) and an Ayervedic

liver

> tonic - and the horse was VASTLY improved, became a real happy

little bunny.

 

That may be the route to go. Sometimes Ayervedic works best,

sometimes Western establishment, sometimes TCM, sometimes

chiropractic, etc., sometimes a combination.

 

> However, if the worst comes to the worst and I could persuade my

medical

> herbalist to help, my western vet is very happy for him to supply

herbs

> under his authority. I have no doubt he could select the right ones

for a

> smooth progress, and would actually LISTEN to me!

 

This may be a route to go. Just keep in mind that some herbs have

different effects in other animals than in humans. Cats are

notoriously sensitive to a number of things. Does anyone have a list

of herbs that are contrainidicated for animals, particularly for

horses?

 

Victoria

[Guest guest]

> One specific Organ may be Yin Deficient, or it could be general Yin

> Deficiency. If the Kidneys are Yin Deficient, a lot of Organs,

> perhaps all of them are going to be Yin Deficient because the Kidneys

> supply the Yin (and Yang) to the rest of the body. The body will

> prioritze based on a number of factors, including genetics.

 

OK. And I think I have read that TCM starts with where the symptoms are,

rather than the deduced root cause or western findings? Hence it would make

sense to start with Liver and Spleen rather than Kidney?

 

> The lack of appetite usually happens with Spleen Qi Deficiency, but

> not always.

 

Yes it's the exceptions to the rule that makes experience essential.

 

> is that very hot herbs will diminish my appetite to normal. I do

> tend to substitute eating for rest. I grab something to eat in order

> to keep going instead of resting. Bad habit I still haven't broken.

 

Me too.

 

> The Spleen is the number one Organ for Qi production in the body.

 

Right, yes I remember - it is in charge of 'metabolism' of energy, as

opposed to digestion.

>

> Standing can harm the Spleen (and Spleen Qi).

 

Right - hence the insistance on exercise no doubt.

 

> It varies. Humans usually cut back on the dosage of the herbs.

 

Yes I tried this, but it did not work. I have switched back to the

Ayurvedic, and all the symptoms are gone again - even the feet seem to be

settling much faster.

 

> That may be the route to go. Sometimes Ayervedic works best,

> sometimes Western establishment, sometimes TCM, sometimes

> chiropractic, etc., sometimes a combination.

 

Yes I suggested backtracking to the vet, and was told he was studying

Ayurvedic, but he refused to even consider it - just said 'My previous

advice stands' without answering any of my concerns.

 

Still, he has finally replied to my last email apologising for not getting

back to me sooner but saying he wants to give it his full attention and is

therefore going to get back to me in a day or so, and he's sure we can work

it out. That sounds a little better, because I just laid it on the line in

that post, saying 'I need you to listen to me and accept a,b,c,d facts (like

the peg is square!) or we're never going to get anywhere.'

 

> This may be a route to go. Just keep in mind that some herbs have

> different effects in other animals than in humans.

 

That was my reason for searching out the vet. There are a fair number I know

are safe from all the herbal preparations out there for horses, but there

are so many chinese herbs. Also I can't find any reference source for

dosages - horses are very sensitive to some herbs especially chinese,

usually require only a human dose despite their huge size.

 

Thanks, I am feeling somewhat reassured.

 

Jackie