plugged submaxillary salivary gland

[Guest guest]

Patient is a 57 yrs. old male retired from a stressfull job. Has high

blood pressure and his kidney function is at about 50%. Suffers from

insomnia, BPH, constipation. He describes himself as obssesive about

work,is easily angered and irritable. Other complaints are cold

hands and feet, nocturia, and constipation. Pulse is deep, deficient

especilly in the third position. Tongue is red, cracked with a thin

white coat which is thicker and sticky all around the sides.

Patient is seeking treatment for a plugged (right side) submaxillary

gland. One month of treatment by his M.D. which included 3 weeks

course of antibiotics to prevent infection has not been

succesfull.Patient would like to avoid surgery which has been

suggested as a last resort. One first acu treatment which included

Sj 17, Si 17, Li4, St 40, Liv 3 Mouth, Parotid gland on the ear and

local needling with e-stim has not offered relief. What would be an

appropriate herbal strategy to his condition?

[Guest guest]

, caron@o... wrote:

..

> Patient is seeking treatment for a plugged (right side) submaxillary

> gland.

 

Hi Christian

 

What is the patient experiencing with this condition, pain, swelling,

etc. Since submaxiallary glands are not part of TCM and this condition

is rare, I doubt there is much in the literature under this heading.

However, with the chief complaint from the patient's perspective, as

opposed to the medical dx, we might be able to identify a traditional

chinese disease category that is similar.

 

[Guest guest]

, " " <@i...>

wrote:

> , caron@o... wrote:

> .

> > Patient is seeking treatment for a plugged (right side)

submaxillary

> > gland.

> main complaint is swelling and discomfort on the right side under

the maxilla while eating. The swelling and discomfort lessens after

an hour or two following food intake. It has been difficult to find

any mention on how to go about treating a plugged salivary gland. I

am not sure if treating based on the TCM diagnosis would be enough or

there are any tried and true modalities that could be used to obtain

relief for the patient.

[Guest guest]

, " Cristian Aron " <caron@o...>

wrote:

 

> > main complaint is swelling and discomfort on the right side under

> the maxilla while eating. The swelling and discomfort lessens after

> an hour or two following food intake.

 

is the pain internal or external; in other words, would you call it a

pain in the mouth or pain in the face or pain in the jaw, perhaps

 

todd

[Guest guest]

, " Cristian Aron " <caron@o...>

wrote:

 

 

> > main complaint is swelling and discomfort on the right side under

> the maxilla while eating. The swelling and discomfort lessens after

> an hour or two following food intake.

 

I can't find any disease categories in either sionneau or wiseman that

match this presentation. It seems that there is local excess, as it is

aggravated by eating. there seems to be liver yang rising, as well as

kidney xu, probably yin and yang, but more yin xu. Also some damp or

dampheat could be related to BPH. Are you sure tongue coat is white? I

think chronic internal cold damp is a rare presentation, as it usually

transforms to heat, except in the most yang xu patients. I also find

that dirty or off white tongue coats, signifying some heat

transformation, are often mistaken for white coats. Plus the tongue

body and the liver yang rising sx would suggest there is internal heat.

If damp is present, it may hinder free flow of yang, thus leading to

cold hands and feet (see Clavey).

 

Liver yang rising is often rooted in liver qi depression, which can

also lead to stoppage, swelling and discomfort due to phlegm

stagnation, qi stagnation and blood stasis. Are there purple veins

under the tongue body? Yin xu can congeal fluids promoting inhibition

of flows. Liver yang rising with yin xu underneath often leads to head

symptoms as yang rises uncontrolled. I guess the most telling sign is

the red tongue body in an older xu patient, which indicates rising xu

heat. Some combination of settling yang, nourishing yin, moving stasis

and clearing heat seem indicated. A formula that addresses these

principles is tian ma gou teng yin. this rx is used for liver yang

rising, but I have NEVER seen it used for this type of condition.

However, it also addresses a yang xu component with duzhong, which may

be the source of cold, a factor in BPH and certainly quite possible due

to age.

 

Liver yang rising often drafts phlegm upwards, which could be a factor,

as well. If the blocked gland is actually palpable as a lump, perhaps

it could be addressed locally as either a node or scrofula, in which

case it may also indicate a component of phlegm heat, which may be

amenable to treatment by the addition of herbs like xuan shen, xia ku

cao, bei mu, mu li and jiang can, all of which would also be good for

liver yang rising, too. I would worry, given the presentation, that

merely aromatically opening the orifices or drying phlegm might be

problematic, as these could exacerbate ascendant yang and heat. though

you didn't indicate it, it would seem to follow that blocked salivary

gland would mean decreased saliva,another yin xu sign. Despite this

being unorthodox and essentially a new use for tian ma gou teng yin, I

might try this. It does underscore the diffculty in treating such

cases without access to the TCM case study literature. You might also

check to see if Blue Poppy has any research reports on this topic and

definitely wait for others to chime in before just taking my musings

into clinic.