unrelenting conditons

[Guest guest]

Hi, hope one may procide insight into a case I am having difficulty

with. 54 y.o. male 5'8' complains of

1) Upper Jiao: asthma with difficulty inhaling, breathing, diagnosed

with COPD, taking antiinflammatory beclovent, ventrolin, worse on

exertion. Sweating is frequent, areas include chest, legs (not the

palms & soles), awakes with soaked T-shirt. Breathing not affected by

the weather. Nasal mucosa was physically damaged, per ENT, therefore

blood supply damaged, pt has dryness of the mouth, throat & nose with

thick turbid saliva and phlegm, white in color, so viscous that when

spit into the sink drain it does not wash away easily.

Patient reprots lack of energy especially in evening, and feeling s

of

iriitablity and being easily p.o.ed in general.

 

2) MJ: bloating, distention, explosive gas, loose bowels, food

particles in bowels, smelly stools, symptoms worse with intake of milk

avoids caffine, meat, alcohol and cheese. Red dish cheeks and

warm to the touch. These symoptoms do go away after taking chia hu

shu

gan wan.

 

3) LJ: urinary frequent and urgency yet flow is scanty with

difficulty

expelling urine long voidance time needed before flow is initiated),

and in addition feelings of not totally expelling urine from the

bladder in one sitting. Nighttime uriation 3X. low libido inability

to

maintain erections.

 

Spinal stenosis at L3-L4 worse with upright sitting and walking. pain

is 4/5. No radiculopathy , intense pain.

 

Pulses: 70 BPM, slippery and wiry on right. Left cun: thin, deep,

slippery in middle and lower positions.

 

My diagnosis centered around Concurrent excess and deficiency

syndrome:

Kidney failing to grasp lung Qi

 

Liver invading Stomach with concurrent damp heatsinking into the

lower

burner obstrucitng yuan qi of the KIdneys

 

Blood stasis in the lower back

 

 

How do we account for the turbid phlegm in the lungs (kidney Xu ,

Spleen Lung production storehouse of phlegm relaitonship)

 

 

More importantly treatmentformuals which ahve fialed are

 

 

1) chai hu Shu gan wan & ma xing shi gan tan & ZHi sou san

 

2) Bie xie fne Qin Yin modified

bie cxie 10

yuan zhi 10

xian lian pi 10

chuan niu xi 10

bai shao 10

chai hu 10

tu si zi 10

du zhong 10

gui zhi 10

huang bai 10

 

3) Er chen tang modified for nasal congestion

chen pi 10

fu ling 10

mai men dong 10

dang shen 10

mai ya 10

cang zhu 10

chuan xiong 10

ban xia bai zhu tian ma san 30 grams

 

 

4) Where am I now? This is my current line of thinking and I am stuck!

 

Clavey in Fluid and Ohysiology page 88 talks about inhibited

urination

2 patterns are pertinentto this man's case.

1) Internal obstruction by Damp-Heat versus

 

2) Qi blockage Damp obstruction causing difficult urination

 

Because of digestive complaints I want to side with Qi Blockage Damp

obstruction etc. However his forulas Ba Zhen tang & Wei Ling tang (a

combo of Ping wei san and wu ling san) do not address the turbid

phlegm in the lung issue!

 

can anyone lend some guidance ?

 

Sincerely,

 

josh

[Guest guest]

Josh, please spell check and visually check your documents before posting! It

will make it much easier for people to respond.

 

Julie

[Guest guest]

Josh

I am wondering if the sweating at night is some kind of damp obstruction as

opposed to yin xu (because no sweat on hands /feet) and may want to try

that first .The connection with lungs and urine may help the the nocturia,ie

w/o using astringents etc .Maybe something like qing qi hua tan wan.

 

 

 

There is xs above and deficiency below so I thought of a formula like

su zi jiang qi tang .On its own it may be too hot because of rou gui so you

would have to try it with a few cooling herbs huang bai etc

 

Alternatively you may want to just approach the earth and treat all the

digestive stuff but along the lines of damp heat distressing spleen as

opposed to liver attacks earth.Treat that first and see what is left.

 

Either way ,sounds complicated and am interested what others have to say.

 

Heiko Lade

Registered Acupuncturist / Chinese Herbalist

2 Jenkins St.

Green Island, Dunedin

New Zealand

Tel: (03) 488 4086, Fax: (03) 488 4012

http://www.lade.com/heiko

Email: heiko

[Guest guest]

Ok, I'll take a crack at this.

1) check to make sure that the beclovent and ventrolin do not have a side effect

of dry mouth (or the sweating or the impotence). If so, you can still treat the

symptoms, but it skews, in my opinion, some of our zang-fu assumptions regarding

them.

 

2) we know that the Chai hu Shu gan Wan worked for digestive problems (but later

you said it failed?) .

 

3) You wrote: Because of digestive complaints I want to side with Qi Blockage

Damp obstruction etc.

 

I agree. You have so many middle jiao problems I am also seeing more spleen Qi

creating damp. this could account for both the upper and lower symptoms. Did you

mention a tongue pattern? this is obviously important for this diagnosis.

 

4) you said that some formulas " didn't work " . How long had you tried them? I am

co-supervising a case of sarcoidosis (maybe not technically COPD but a severe

lung disfunction with plenty of sputum, asthma etc) where the woman has been

taking raw herbs for 7 months now. She still

is on oxygen, she is slowly getting better. I wish it would resolve quicker but

that's how it is going.

 

5) in terms of case management, I would continue with the spleen issues (er chen

tang with cang zhu, ban xia, chen pi), obviously, there is going to be some

Kidney Xu but that can be a minor part of your formula (su zi, some du zhong),

open up the lung qi, (hou po, gua lou pi).

Bring Qi down with Bai qian, Qian Hu. If heat then, Huang qin, Zhi Mu... etc...

 

6) The sweating and urination sound like " qi mechanisms " that will resolve (or

can be more directly addressed) once the core issues are worked on.

 

Remember, I can only imagine your patient and build a formula around my idea of

his condition. So basically I think you are on the right track, I just think

about the time frame and your and his expectations for results.

 

tells us what happens.

 

> Hi, hope one may procide insight into a case I am having difficulty

> with. 54 y.o. male 5'8' complains of

> 1) Upper Jiao: asthma with difficulty inhaling, breathing, diagnosed

> with COPD, taking antiinflammatory beclovent, ventrolin, worse on

> exertion. Sweating is frequent, areas include chest, legs (not the

> palms & soles), awakes with soaked T-shirt. Breathing not affected by

> the weather. Nasal mucosa was physically damaged, per ENT, therefore

> blood supply damaged, pt has dryness of the mouth, throat & nose with

> thick turbid saliva and phlegm, white in color, so viscous that when

> spit into the sink drain it does not wash away easily.

> Patient reprots lack of energy especially in evening, and feeling s

> of

> iriitablity and being easily p.o.ed in general.