HOT Legz are Back...

[Guest guest]

Speaking of intolerance, my patient with HOT legs is still having problems

with any herbal fx given(causing the HOT LEGS)... I will reintorduce the

case, and hopefully someone has some ideas.

 

1. Chief Complaint: fatigue, sluggishness (chronic)

 

2. Medical History:

2.1 History a Present Illness -- this condition has been

going on for approximately 5 to 10 years. She remembers no specific

instance that triggered this, it's just gradually occurred for almost as

long as she can remember. Rest and reduction of stress helps; and location

is systemic.

2.2. Current Health Status --

-- wakes up tired

-- insomnia (emotionally related -- minded racing, can't let go, wakes up

and cannot fall back sleep)

sleeps 8 hours when good/3-6 when bad -- goes to bed at around 2:00 AM.

(2-3 nights) 12:00-1:00 (the rest).

-- temperature -- cold easily/cold body/especially buttocks and limbs --

although upon palpation of abdomen it was warm.

-- appetite = good (does not eat breakfast and eats dinner around

10:00-11:00), -- has thirst and drinks. no cold drinks craved

-- urination = clear (10+)

-- bowel = good; gets softer when eats bad

-- diet = 2-3 cups of coffee per week -- 2 cups of black tea/day --

occasional meat, primarily whole food diet. craves sugars

-- when she takes medications or herbs she gets hot legs (anterior and

posterior thigh)

-- dry skin (face) especially on upper eyelid

-- hearing loss (diagnosed)

-- she seems slightly foggy and mentally damp

-- complains of stress (due to relationships, work, and other) specifically

affecting sleep

-- recurrent ear infections

 

 

2.3 Menstruation/cycle. Pertinent current biomedical

information.

 

-- menses = regular/3-4 days -- dull pain right at the beginning relieved by

warmth

 

2.4. Past Medical History

-- had a miscarriage 3 years ago

 

2.5. Family Health History

-- nothing of relevance.

 

3. Observation (no analysis here, just objective description)

3.1. Tongue:

body -- pale (although, center looks dusty),

scallops & direct tenderness, has spirit, moderate moisture,. sides slightly

orange.

coat -- very thick yellow slightly greasy and dry in

back,

veins -- n/a

other -- tongue is tender with large red prickles in back and slight red

prickles on sides, tremulous, deviated slightly to the right.

3.2. Facial Complexion -- slightly pale

3.3. Body Shape and Posture -- very petite and slightly

slouched posture; looks xu

3.4. Shen -- there is a slight disturbance which is

evident from her eyes and speech (mumbling) although this speech factor

could be due to her lack of confidence in the English language being a

native German new to the country.

 

4. Listening and Smelling

4.1. Voice -- soft

4.2. Breathing -- quiet

 

 

5. Palpation

5.1. Pulse: 80+, right side much stronger spleen down and

deficient, lung up, heart weak, liver thin, left kidney weak.

5.2 -abdomen -- warm to the touch, tight in the

epigastric (heart-hara), in the liver (hara) area (stomach physiologically)

 

6. Pattern

6.1. -- location = internal

6.2 -- there is excess (phlegm/dampness) with underlying deficiency

6.3 -- there is a mixed hot and cold pattern

6.4. -- Dx: = spleen qi xu leading to dampness/phlegm with liver qi

depression... with underlying jing xu. [Heat from liver depression will of

course agitate heart producing sleep problems.]

 

Treatment: acupuncture seems to work very well, but as mentioned before it

seems that any herbal formula/preparation produces the hot legs. Hot legs

last for 1-2 hours at 5 AM, very hot and cannot sleep. Mentions that the

outside of the leg will feel cool and inside (not necessarily the bone) will

feel hot. (steaming bone?).. any form of medication or even a single herbal

like Echinacea, taken over time, will cause this phenomenon. Usually within

one week the hot legs begin, although with warmer formulas like bu zhong yi

qi tang, it happens much quicker. It seems that some herbal formula should

be able to help her condition and not produces these hot legs.

 

The question is: why? or any suggestions on formulas or approaches that

might work. Originally extracts, tinctures, and pills were used, but raw

herbs have been exclusively used on and off for about six months. Here are

the herbal formulas that have been tried:

 

xiao yao wan - , tincture, extract (previous practitioner) pills. Decoction

+ mods.

liu jun zi tang - pills, decoction.

liu jun zi tang + huang bai

bu zhong yi qi tang - decoction.

er miai san - decoction.

si ni san - decoction.

 

Originally I thought if the spleen was strengthened then the damp/phlegm

would be eliminated and also fend off the liver. Then I got the idea that

the dampness has to be attacked directly, and because of the tongue there

seemed to be an accumulation in the lower burner. Si ni san and & er miao

san were tried last, especially since previous fx.'s were warmer... possibly

aggravating condition, and for it’s simple content… But still did not work.

Nothing too cold can be used because she is so cold on the exterior, and

especially with winter approaching… Any ideas? IF you have any additional

?’s, let me know…

Thanx in advance…

 

-

[Guest guest]

Jason,

 

I would like to throw in my thoughts, be they simple and naive. I am just

finishing my schooling, and bow to the more experienced on this list, but have

had simliar personal problems that we worked on for 4 years with acup and herbs.

Had slight progress along the way, but the major problems persisted. Also had

very sensitive reactions to both herbal and acupuncture due to severe chronic

condition. In the past 6 months, have finally realized major progresses.

Rather than go with the typical herbs treating yin and blood deficiencies (I

know you don't like that word), we finally approached this treating the mental

first--with chai hu. Lo and behold, results.

 

I would look into a formula like Chai Hu Long Gu Mu Li Wan, with it's ability to

stabilize and bind the shen and also draining downward- damp phlegm (ban xia and

fu ling and da huang) while providing some warmth (gui zhi and sheng jiang).

It's amazing how the body will help itself if the sleep ability matches the

needs.

 

Just a thought....

Ruth

 

 

On Thu, 19 October 2000, wrote:

 

>

> Speaking of intolerance, my patient with HOT legs is still having problems

> with any herbal fx given(causing the HOT LEGS)... I will reintorduce the

> case, and hopefully someone has some ideas.

>

>

 

___________

For the most comprehensive Traditional Healthcare information

on the Web, visit http://www.acupuncture.com today!

[Guest guest]

thanx for the input...

 

-

 

>

> ruth elder [ruthelder]

> Friday, October 20, 2000 4:35 AM

>

> Re: HOT Legz are Back...

>

>

> Jason,

>

> I would like to throw in my thoughts, be they simple and naive.

> I am just finishing my schooling, and bow to the more experienced

> on this list, but have had simliar personal problems that we

> worked on for 4 years with acup and herbs. Had slight progress

> along the way, but the major problems persisted. Also had very

> sensitive reactions to both herbal and acupuncture due to severe

> chronic condition. In the past 6 months, have finally realized

> major progresses. Rather than go with the typical herbs treating

> yin and blood deficiencies (I know you don't like that word), we

> finally approached this treating the mental first--with chai hu.

> Lo and behold, results.

>

> I would look into a formula like Chai Hu Long Gu Mu Li Wan, with

> it's ability to stabilize and bind the shen and also draining

> downward- damp phlegm (ban xia and fu ling and da huang) while

> providing some warmth (gui zhi and sheng jiang). It's amazing

> how the body will help itself if the sleep ability matches the needs.

>

> Just a thought....

> Ruth

>

>

> On Thu, 19 October 2000, wrote:

>

> >

> > Speaking of intolerance, my patient with HOT legs is still

> having problems

> > with any herbal fx given(causing the HOT LEGS)... I will reintorduce the

> > case, and hopefully someone has some ideas.

> >

> >

>

> ___________

> For the most comprehensive Traditional Healthcare information

> on the Web, visit http://www.acupuncture.com today!

>

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a

> variety of professional services, including board approved online

> continuing education.

>

>

[Guest guest]

, <@o...>

wrote:

 

> Originally I thought if the spleen was strengthened then the damp/phlegm

> would be eliminated and also fend off the liver. Then I got the idea tha=

t

> the dampness has to be attacked directly, and because of the tongue there=

 

> seemed to be an accumulation in the lower burner. Si ni san and & er miao=

 

> san were tried last, especially since previous fx.'s were warmer... possi=

bly

> aggravating condition, and for it's simple content… But still did not wo=

rk.

> Nothing too cold can be used because she is so cold on the exterior, and

> especially with winter approaching… Any ideas? IF you have any addition=

al

> ?'s, let me know…

> Thanx in advance…

>

Jason

 

You appear to have either supplemented OR dispersed. the condition

seems to show both significant dampheat (tongue coat) and significant

cold xu spleen (at least). In order to be treated successfully in a

longterm chronic case, ALL the mutally engendering pathomechanisms must

be addressed concurrently, not sequentially (as in homeopathy, for

example). While you added huang bai to bu zhong yi qi tang (thus

completing er miao san within that rx), that was clearly not enough

emphasis on dampheat clearage. Also, forgive my pharmacological bias,

but find the typical bulk herb dosing at PCOM to be about half what my

teacher typically used. So you might consider kicking it up a notch.

I use Bensky's dose ranges as daily doses in my rx, while most PCOM

prescribers seem to use these guidelines for pack doses (i.e. for two

days, which cuts daily dose in half).

 

[Guest guest]

In order to be treated successfully in a longterm chronic case, ALL the mutally engendering pathomechanisms must be addressed concurrently, not sequentially (as in homeopathy, for example). While you added huang bai to bu zhong yi qi tang (thus completing er miao san within that rx)

>>>In my experience as well as traditionally, if Excess dampness is significant it should be treated first. If Excess cold damp is treated w/ strong spleen tonics it often transforms to damp heat and lodges deeply. Since most patients with chronic dampness are spleen deficient this is a common issue.

Alon

[Guest guest]

, <alonmarcus@w...> wrote:

 

> >>>In my experience as well as traditionally, if Excess dampness is

significant it should be treated first.

 

when consulting classic texts by zhu dan xi and li dong yuan, longterm

chronic illness with mixed deficency and excess invariably addresses

the entire symptom complex at once, not either/or

 

go to the CHA library and read articles by Bob Flaws that mention

yinfire, gu syndrome or these two authors above for extensive

commentary on this position

[Guest guest]

when consulting classic texts by zhu dan xi and li dong yuan, longterm chronic illness with mixed deficency and excess invariably addresses the entire symptom complex at once, not either/or go to the CHA library and read articles by Bob Flaws that mention yinfire, gu syndrome or these two authors above for extensive commentary on this position>>>>I know about his ideas, many others disagree. I have found that if Dampness is treated first the course is shortened.

alon

[Guest guest]

on 10/26/00 12:02 PM, alonmarcus at alonmarcus wrote:

 

when consulting classic texts by zhu dan xi and li dong yuan, longterm

chronic illness with mixed deficency and excess invariably addresses

the entire symptom complex at once, not either/or

 

go to the CHA library and read articles by Bob Flaws that mention

yinfire, gu syndrome or these two authors above for extensive

commentary on this position

 

>>>>I know about his ideas, many others disagree. I have found that if Dampness is treated first the course is shortened.

alon

 

 

I'd like to know, personally, who the many others are who disagree with Li Dong-yuan and Xu Dan-xi, and how and why they do, on what points and on what evidence.

 

I'd also like to know on what basis you feel that the treatment course is shortened by treating dampness first.

 

Obviously one has to treat dampness, but concurrently one should address the entire pattern as one. . . .I don't think there is any disagreement with this anywhere in CM to my knowledge.

 

 

[Guest guest]

, " " <

zrosenberg@e...> wrote:

 

>

> Obviously one has to treat dampness, but concurrently one should address the

> entire pattern as one. . . .I don't think there is any disagreement with

> this anywhere in CM to my knowledge.

 

Alon

 

I'm with Zev. there is no disagreement amongst scholar-physicians on

this issue. I'm not sure if you are disputing Flaws interpretation or

the existence of this position within the classics. I have read these

classics numerous times and there is no doubt in my mind that flaws

interpretation is correct. In addition, I teach a continuing education

class on this subject and have had about 150 students over the past

year. without exception, they say these ideas have transformed their

herbal practice with regard to difficult chronic cases. In order to

dispute this position, I expect to see citations from classical and/or

modern commentary that present the " other side " . While many may

disagree, they have yet to present evidence to that effect. I think

many folks get confused over the concept of treating acute illness or

acute exacerbations of chronic illness using the method of first

removing excess. I totally agree with this position. However, the

case in question does not fit either of these scenarios. Longterm

chronic cases are addressed by applying the concept of mutual

engenderment of pathology. this is widely evident in both modern and

classical literature and is even alluded to in basic texts like

Fundamentals of CM by ellis, et. al.

 

to illustrate this, consider the simple example that applies well to

this case. Herbs that clear dampheat injure the spleen with their cold

bitter nature. Herbs that drain dampness through urination can reverse

the spleens normal qi dynamic, which is supposed to ascend the pure.

On the other hand, tonics, as you indicate, can promote stagnation of

qi, phlegm, damp and dampheat and increase pathological heat in the

body. the only way to avoid this conundrum is to address both

pathomechanisms simultaneously. To underscore this, it is not

coincidental that the most widely used formula in modern japan for

chronic illness is chai hu gui zhi tang. this formula transforms damp

and phlegm (ban xia), clears heat (huang qin), supplements qi (ren

shen) and uplifts the clear yang (chai hu).

 

 

[Guest guest]

I'd like to know, personally, who the many others are who disagree with Li Dong-yuan and Xu Dan-xi, and how and why they do, on what points and on what evidence. I'd also like to know on what basis you feel that the treatment course is shortened by treating dampness first. Obviously one has to treat dampness, but concurrently one should address the entire pattern as one. . . .I don't think there is any disagreement with this anywhere in CM to my knowledge.>>>Several of my teachers in China would strongly disagree. I had one teacher that was a Shan Han Dr, another that classified him self as coming from the 8 entity tradition, and another that uses the purging method quite often ( per a family tradition). All of them would have strongly disagree. All three would also ridicule practitioners using multiple diagnosis's saying they do not know how to accurately diagnose, and therefor use so many "Chop Sui" formulas. I was often supprised at the effectivenss of the purging Dr, and to quote him "when evil thrives the true is deficient, when evil is purged the true recovers".

alon

 

 

 

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[Guest guest]

Several of my teachers in China would strongly disagree. I had one teacher that was a Shan Han Dr, another that classified him self as coming from the 8 entity tradition, and another that uses the purging method quite often ( per a family tradition). All of them would have strongly disagree. All three would also ridicule practitioners using multiple diagnosis's saying they do not know how to accurately diagnose, and therefor use so many "Chop Sui" formulas. I was often surprised atthe effectiveness of the purging Dr, and to quote him "when evil thrives the true is deficient, when evil is purged the true recovers".

>>>>>>>

>>>P.S In some cases I do combine spleen supplementation when treating Dampness, but I use a neutral herbs.

alon

[Guest guest]

on 10/26/00 6:56 PM, alonmarcus at alonmarcus wrote:

 

 

Several of my teachers in China would strongly disagree. I had one teacher that was a Shan Han Dr, another that classified him self as coming from the 8 entity tradition, and another that uses the purging method quite often ( per a family tradition). All of them would have strongly disagree. All three would also ridicule practitioners using multiple diagnosis's saying they do not know how to accurately diagnose, and therefor use so many " Chop Sui " formulas. I was often surprised atthe effectiveness of the purging Dr, and to quote him " when evil thrives the true is deficient, when evil is purged the true recovers " .

>>>>>>>

>>>P.S In some cases I do combine spleen supplementation when treating Dampness, but I use a neutral herbs.

alon

 

Alon,

I think it would depend on the patient population. . . . until recently, at least, it would seem that mainland Chinese tended to simpler patterns than Westerners. I agree that sometimes an unskilled practitioner may end up all over the map, and miss what is really going on.

Your teacher who used the xia fa method (purging, precipitation) sounds very interesting to me. . . .. it recalls the work of Zhang Zhe-he of the Jin-Yuan dynasty, whose philosophy was the same as your teacher. In fact, I believe your teacher has quoted him directly ('when evil thrives the true is deficient, when evil is purged the true recovers'). However, this is a minority school in modern CM. While many of Zhang Zhe-he's formulas survive, the approach of his contemporaries, Li Dong-yuan and Zhu Dan-xi is much more prevalent.

There are several ways to approach a patient. . . but the point I was making that one should not ignore the entire presentation in a patient and just treat one cluster of symptoms. Thanks for sharing your experience with the group.

 

 

[Guest guest]

There are several ways to approach a patient. . . but the point I was making that one should not ignore the entire presentation in a patient and just treat one cluster of symptoms. Thanks for sharing your experience with the group.>>>I agree, but I think here in the west we tend to emphasis tonification too often.

alon