the tongue and the treatment of latent pathogens

[Guest guest]

Hi everybody,

 

A couple of weeks ago, I submitted a case of a woman who has had emphysema

and fatigue as the result of working in a sick building. Her tongue to start

was dusky, with a thin greasy grey coating. My herbal formula followed the

example of Heiko in his sick building case, in that it's focus was

addressing the damp pathogen and less strongly addressing other patterns

presenting. After having a weeks worth of herbs and an another acupuncture

treatment she came back to me saying that she was feeling so much better-

less fatigue, better digestion, clearer thinking, no headaches, better

breathing. The only difficulty she was having is that she is beginning a

cycle of insomnia that she regularly has- hard to all with early waking,

tossing and turning but not a busy mind.

Her tongue coating now is much thicker and greasier and more moist; also,

there is a yellow/brown patch of coat on the right edge only.

How do I interpret this new tongue presentation? She's feeling so much

better but is this tongue saying that I am doing something that is not her

best interest in the long run?

 

Thanks,

 

Kristin

 

 

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[Guest guest]

Kristin

 

Usually if a tongue coat becomes thicker it indicates the pathogen is

becoming stronger, I have read over your original symptom

picture........what herbs did you prescibe exactly .......the we can

have a look at what they may be doing.

 

Heiko

[Guest guest]

Hi Heiko,

 

I prescribed the following formula in the form of concentrated granules at a

total of 10 grams a day(approximately 50grams of raw equivalent). After the

name is the proportion.

Ban xia, 6

Bai zhu, 6

Jie geng, 3

Fu ling, 5

Zhi shi, 3

Ze xie, 3

Gan cao, 3

Huang bai, 5

Mu xiang, 4

Pei lan, 5

Man jing zi, 5

Gua luo pi, 5

Yu jin,5

Tai zi shen, 6

Chuan xiong, 5

Yi mu cao, 5

Mai men dong, 5

Rou gui, 1

4 sp, 2x/day

Acupuncture wise, what I had done was bled Lung11 and a divergent treatment-

Lung/LI and Liver/GB. She actually said that she had felt better since the

acupuncture treatment except the digestive upset she was having resolved

throughout the week. This is a problem when working with multiple

modalities. Is the pathogen getting stronger now or is it just moving out of

latency and into more superficial layers? But if it were moving into more

superficial layers then I would think that she wouldn't be feeling so great.

I don't see how these herbs could make a damp pathogen that much worse.

For me this case brings up the issue of what the tongue is really showing

us. Her tongue at first didn't show that much dampness when her symptoms

did. And now that I have treated her for a damp pathogen, the tongue shows

more dampness than anything.

Thanks for your time.

 

Kristin

 

-

Heiko Lade <heiko

 

Saturday, May 05, 2001 3:12 AM

Re: the tongue and the treatment of latent

pathogens

 

 

> Kristin

>

> Usually if a tongue coat becomes thicker it indicates the pathogen is

> becoming stronger, I have read over your original symptom

> picture........what herbs did you prescibe exactly .......the we can

> have a look at what they may be doing.

>

> Heiko

>

>

>

> 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]

Kristin,

 

> For me this case brings up the issue of what the tongue is really

showing

> us. Her tongue at first didn't show that much dampness when her

symptoms

> did. And now that I have treated her for a damp pathogen, the

tongue shows

> more dampness than anything.

> Thanks for your time.

>

> Kristin

 

First, I want to make it clear that my

comments here do not concern the particular

case you've described. But I wanted to

respond to the question you raised, as

I think it's an important one.

 

You ask, " What does the tongue really show us? "

 

But it seems to me that what you are struggling

with is how, in the face of an anomaly, to assemble

a coherent overall picture of the patient's pattern

that will provide you with an understanding of the

pathomechanisms and, at this phase particularly,

with the prognosis after treatment.

 

It seems, if I can characterize it in the following

way, that you are faced with what seems to you

to be an anomaly of a patient responding one

way with a tongue reponding another. Is that

a fair description?

 

If it is, I can pass on advice I got many

years ago working in the clinic at the hospital

of the CDUTCM when I questioned several of my

teachers about such anomalous presentations.

 

To sum it up, the point was made to me that

Chinese medical diagnosis is based on a set

of theories that are used by selecting those

that permit a clearer view of the patient

by assembling the information represented

in the patient's signs and symptoms into

recognizable patterns. From time to time

such anomalies do appear, and we observe

one sign or symptom that does not accord

with others. Sometimes a situation like

this can be extensively anomalous.

 

In some cases such anomalies appear in

critical stages of a disease, making it

extremely important that doctors understand

their meaning and, more importantly what to do

about them.

 

Furthermore, the appearance of such anomalies

can be the result of a range of causes that

is extensive enough to make it more or less

impossible to comment on a particular case

without being able to see the patient.

 

The important issue, I believe, how do we

deal with clinical anomalies? Is it the

doctor's perception? Is it a critical sign

of an underlying pathology? Is it an instance

of a so-called false pattern? Something else

entirely?

 

In general, theories in Chinese medicine are

fitted to the patient and not the other way

round. But the fit is seldom perfect and

one of skills of clinical expertise is knowing

the significance of those things that don't

fit the picture.

 

By the way, the next issue of CAOM will include

an article by Prof. Yan Shi Lin of CDUTCM on

anomalies in cold and heat patterns

which discusses all of this in some detail, for

those interested in taking a closer look.

 

Ken

[Guest guest]

Kristin

In your original notes you said "

Hi everybody,

 

 

 

I have a new case that confounds me more than usual.

 

56 y.o female

 

 

 

Chief complaints: 4 years ago she started working in an old courthouse

that had a leaky roof and animals rotting in the insulation.

At this time she was working 2 jobs and raising 3 kids as a single mom.

Soon after she started getting migraines, fatigued and

respiratory distress that culminated in a “pneumonia like “ illness(2

years ago) that she doesn’t feel that she has recovered from.

The following complaints date from this illness.

 

Fatigue- She says that she is unrested on waking even after

sleeping 10-14 hours. She has started to fall asleep without

any warning during yoga classes and sit down events. However, she

works out 5 times a week aerobically and with

weights for 45 minutes. These work outs leave her temporarily more

tired but feeling better overall.

Headaches: no more migraines. Headaches are frontal, occipital or

involve the whole head. They will be every day for a

few weeks then stop for a few weeks. Headaches are throbbing in

nature, always involve photosensitivity, and

occasionally involve mild nausea. No auras. No redness to the face

or eyes during headaches.

Left sided back pain located below the scapula. Was sharp when

started during illness. Now it is a constant dull pain.

Not affected by breathing. Limits left arm reaching forward. Chest

xrays/MRI are negative except for “black spot” left

over from sarcoidosis.

 

 

 

Systems overview

 

Respiratory: Diagnosed with sarcoidosis at age 27- hasn’t had any

relapses. Now diagnosed with emphysema and copd. Since

the illness 2 years ago has had shortness of breath constantly, which

when it gets severe creates chest pain that can radiate

down left arm and up to her jaw- this happens 2 x week. EKGs show no

problems with her heart. Her breathing during the

interview sounded labored. When this happens she uses an albuterol

inhaler. She uses flovent and serevent daily. Wheezes on

damp days. Barely ever coughs. Has stuffy nose in the morning but no

nasal discharge or sinus problems. Has always had a

poor sense of smell.

 

GI:Gets acid reflux when is having a bad breathing day. Eats 3 meals but

is never hungry in the morning. Bowel movements

come every other day- they are sometimes sticky. Has frequent

flatulence. Eats lots of salads.

 

Sleep: Has weeks where she sleeps well and then weeks where she has a

hard time falling and a hard time staying. Doesn’t

wake to urinate.

 

Gyn: Went through menopause 3 years ago. Up until then she had 28 day

cycles with no problems. Did have a fibroid.

 

General: Very dry scaly skin.

 

Occasional low back pain with long periods of standing.

 

Gets “fevers” in cycles that last for weeks. When they happen the fevers

happen in the late morning, the early afternoon and in

the middle of the night. The fevers last for ½ hour and involve her

whole body feeling hot without any up flushing feeling. She

can sweat profusely when they happen at night.

 

Since the illness, she has a hard time concentrating. Feels like her

head is in a fog and that she can’t retain new material.

 

She comes across as a feisty woman.

 

 

 

Tongue: slightly swollen overall, slightly more swollen on the left side

front; purplish with slightly orange sides; mild red pts at the

tip; thin yellow coating, thicker in the back; a deep crack on the left

side anterior 1/3rd, smaller cracks on the right side anterior

1/3; underneath- thin purple veins to the tip with little varicosities

over the whole underneath surface "

 

Thin yellow and thicker at the back............there is heat and damp

and also in the lower jiao.

 

You used rou gui in your formula , I presume because of deepness in the

chi position , to supplement the kidneys. However rou gui is HOT .And

its use here is premature I believe ,and is aggravating the damp and

heat, you can boost the kidney later after expelling the pathogen. Also

the mai dong may not be neccesary at this moment. Remember it is a bit

cold and containdicated with congested fluids (in this case damp) , even

though your case has damp and heat there are spleen xu signs and mai

dong may be a bit greasy .Tai zi shen is neutral but there is a latent

pathogen and perhaps lay off on the qi and blood tonics for a while in

case you are feeding the pathogen.

 

I believe you can have a latent damp /heat pathogen and not necessarily

have to have a thick greasy tongue coat .In much the same way that there

could be blood stasis without a purple tongue , hesitant pulse or

stabbing pain.

 

Hope this helps

 

Heiko

[Guest guest]

Thanks Ken for your feedback.

Well said. Judging the significance of anomalies hopefully improves with

clinical experience. I look forward to the article in CAOM.

 

Heiko,

Thanks for your feedback. I added mai men dong- probably too much- to the

formula to prevent the formula from being too drying especially in light of

the deep tongue crack in the anterior 1/3rd of her tongue. Tai zi shen was

in there with the same idea in mind- probably overkill. At the same time it

is surprising that a relatively small amount of these 2 herbs- a total of

55g of the 2 combined over a week- could produce such a dramatic change in

her tongue without any digestive or damp symtoms getting exacerbated. This

week I prescribed her the same formula without the mai men dong, so we will

see what happens.

Thanks again,

 

Kristin

 

-

Heiko Lade <heiko

 

Saturday, May 05, 2001 10:51 PM

Re: the tongue and the treatment of latent

pathogens

 

 

> Kristin

> In your original notes you said "

> Hi everybody,

>

>

>

> I have a new case that confounds me more than usual.

>

> 56 y.o female

>

>

>

> Chief complaints: 4 years ago she started working in an old courthouse

> that had a leaky roof and animals rotting in the insulation.

> At this time she was working 2 jobs and raising 3 kids as a single mom.

> Soon after she started getting migraines, fatigued and

> respiratory distress that culminated in a " pneumonia like " illness(2

> years ago) that she doesn't feel that she has recovered from.

> The following complaints date from this illness.

>

> Fatigue- She says that she is unrested on waking even after

> sleeping 10-14 hours. She has started to fall asleep without

> any warning during yoga classes and sit down events. However, she

> works out 5 times a week aerobically and with

> weights for 45 minutes. These work outs leave her temporarily more

> tired but feeling better overall.

> Headaches: no more migraines. Headaches are frontal, occipital or

> involve the whole head. They will be every day for a

> few weeks then stop for a few weeks. Headaches are throbbing in

> nature, always involve photosensitivity, and

> occasionally involve mild nausea. No auras. No redness to the face

> or eyes during headaches.

> Left sided back pain located below the scapula. Was sharp when

> started during illness. Now it is a constant dull pain.

> Not affected by breathing. Limits left arm reaching forward. Chest

> xrays/MRI are negative except for " black spot " left

> over from sarcoidosis.

>

>

>

> Systems overview

>

> Respiratory: Diagnosed with sarcoidosis at age 27- hasn't had any

> relapses. Now diagnosed with emphysema and copd. Since

> the illness 2 years ago has had shortness of breath constantly, which

> when it gets severe creates chest pain that can radiate

> down left arm and up to her jaw- this happens 2 x week. EKGs show no

> problems with her heart. Her breathing during the

> interview sounded labored. When this happens she uses an albuterol

> inhaler. She uses flovent and serevent daily. Wheezes on

> damp days. Barely ever coughs. Has stuffy nose in the morning but no

> nasal discharge or sinus problems. Has always had a

> poor sense of smell.

>

> GI:Gets acid reflux when is having a bad breathing day. Eats 3 meals but

> is never hungry in the morning. Bowel movements

> come every other day- they are sometimes sticky. Has frequent

> flatulence. Eats lots of salads.

>

> Sleep: Has weeks where she sleeps well and then weeks where she has a

> hard time falling and a hard time staying. Doesn't

> wake to urinate.

>

> Gyn: Went through menopause 3 years ago. Up until then she had 28 day

> cycles with no problems. Did have a fibroid.

>

> General: Very dry scaly skin.

>

> Occasional low back pain with long periods of standing.

>

> Gets " fevers " in cycles that last for weeks. When they happen the fevers

> happen in the late morning, the early afternoon and in

> the middle of the night. The fevers last for ½ hour and involve her

> whole body feeling hot without any up flushing feeling. She

> can sweat profusely when they happen at night.

>

> Since the illness, she has a hard time concentrating. Feels like her

> head is in a fog and that she can't retain new material.

>

> She comes across as a feisty woman.

>

>

>

> Tongue: slightly swollen overall, slightly more swollen on the left side

> front; purplish with slightly orange sides; mild red pts at the

> tip; thin yellow coating, thicker in the back; a deep crack on the left

> side anterior 1/3rd, smaller cracks on the right side anterior

> 1/3; underneath- thin purple veins to the tip with little varicosities

> over the whole underneath surface "

>

> Thin yellow and thicker at the back............there is heat and damp

> and also in the lower jiao.

>

> You used rou gui in your formula , I presume because of deepness in the

> chi position , to supplement the kidneys. However rou gui is HOT .And

> its use here is premature I believe ,and is aggravating the damp and

> heat, you can boost the kidney later after expelling the pathogen. Also

> the mai dong may not be neccesary at this moment. Remember it is a bit

> cold and containdicated with congested fluids (in this case damp) , even

> though your case has damp and heat there are spleen xu signs and mai

> dong may be a bit greasy .Tai zi shen is neutral but there is a latent

> pathogen and perhaps lay off on the qi and blood tonics for a while in

> case you are feeding the pathogen.

>

> I believe you can have a latent damp /heat pathogen and not necessarily

> have to have a thick greasy tongue coat .In much the same way that there

> could be blood stasis without a purple tongue , hesitant pulse or

> stabbing pain.

>

> Hope this helps

>

> Heiko

>

>

>

>

> 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.

>

>

>

>