Guest guest Posted July 22, 2001 Report Share Posted July 22, 2001 A woman came to me after having fallen and hit her head on the bathtub. This was three months after the fall and she had been heavily medicated the entire three months. She said her pain was 10 on a 10 scale, sharp, stabbing and excruciating. She also presented as qi, yang and blood xu. she is 65 and weighs over 200 pounds. prescribed (2 day packs of raw herbs for 2 weeks) mo yao 18 ru xiang 18 chuan xiong 18 xu duan 24 huang qi 24 dan gui 18 niu xi 18 hong hua 18 tao ren 18 Pain was 65% gone after three days and 85% gone after two weeks. Discontinued herbs and pt. improved till sx were gone over next two weeks based on telephone followup. Ironic note: A student asked one of the chinese teachers at PCOM about herb dosage and she said Americans were overly conservative and this inhibited their results. the student then said, so Todd is right about this? The chinese teacher who also orders herbs for the pharmacy said, no, Todd uses too high a dose. I have to order too often because of him. He needs to lower his dose because it costs the school too much. so clinically speaking, my dose is correct, but economically problematic. Needless to say, I took this admonition with all the import it deserved. -- Chinese Herbs VOICE: (858) 946-0070 FAX: (858) 946 0067 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 Todd It is very interesting case. What is your diagnosis? Blood stagnation? You gave her blood moving herbs, is it not a little bit dangerous? Because it is probably some kind of hematoma in the head? Yuri Todd Sun, 22 Jul 2001 10:37:42 -0700 pain from injury A woman came to me after having fallen and hit her head on the bathtub. This was three months after the fall and she had been heavily medicated the entire three months. She said her pain was 10 on a 10 scale, sharp, stabbing and excruciating. She also presented as qi, yang and blood xu. she is 65 and weighs over 200 pounds. prescribed (2 day packs of raw herbs for 2 weeks) mo yao 18 ru xiang 18 chuan xiong 18 xu duan 24 huang qi 24 dan gui 18 niu xi 18 hong hua 18 tao ren 18 Pain was 65% gone after three days and 85% gone after two weeks. Discontinued herbs and pt. improved till sx were gone over next two weeks based on telephone followup. _________________________ Visit http://www.visto.com. Find out how companies are linking mobile users to the enterprise with Visto. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 Obviously the formula worked, so my question is purely academic. In class, we were only given a superficial picture of how herbs in the invigorate blood category are used. According to that picture, Yan Hu Suo is the " number one pain reliever " in the materia medica - so I would expect to see it in a formula that treats pain which rates a 10 on a scale of 1 to 10. What I'd like to know is if there's a particular reason why it would be inappropriate for the case you described. Is it a matter of choosing mo yao and ru xiang because of their ability to promote healing in conjunction with stopping pain - and adding yan hu suo would be overkill? Is it related to the length of time you nticipated the patient would be taking the formula and yan hu suo may cause abdominal cramping and other problems if taken for two weeks? Is it because of the Yang xu in the case - would yan hu suo be too intense - or simply isn't necessary thanks to the high dosage of xu duan? I'm always wary when a lecture presents one herb as the end-all and be-all of a certain therapy - " always use yan hu suo when pain is severe. " Presented this way, students make notes in bold and remember only this aspect of the herb. As for the " economically problematic " nature of your prescribing habits in the PCOM clinic - I wonder if they have weighed the cost of reordering herbs more frequently against the positive impact of having patients who experience real success in such a short time frame. I'd say that kind of advertising is worth the investment of an extra bag of chai hu from time to time. Laurie , wrote: > She said her pain was 10 on a 10 scale, sharp, > stabbing and excruciating. She also presented as qi, yang and blood > xu. she is 65 and weighs over 200 pounds. > > prescribed (2 day packs of raw herbs for 2 weeks) > > mo yao 18 > ru xiang 18 > chuan xiong 18 > xu duan 24 > huang qi 24 > dan gui 18 > niu xi 18 > hong hua 18 > tao ren 18 > > Pain was 65% gone after three days and 85% gone after two weeks. > Discontinued herbs and pt. improved till sx were gone over next two > weeks based on telephone followup. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 on 7/23/01 1:35 PM, tgperez at tgperez wrote: I was taught that the dose of herbs should be about one oz of raw material daily- 28 gms, which is roughly 9 qian. I make large bags that last a week and they weigh in around 6-8 oz. Occasionally they are larger. your formula works out to just over 6 oz. given that it's a short formula, I'd say you're right on target. not too hi, not too low. Cara >> prescribed (2 day packs of raw herbs for 2 weeks) >> >> mo yao 18 >> ru xiang 18 >> chuan xiong 18 >> xu duan 24 >> huang qi 24 >> dan gui 18 >> niu xi 18 >> hong hua 18 >> tao ren 18 >]\\ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 Cara I appreciate your support, but that formula is a two day dose as written. It weighed about 85 grams per day or about three ounces per day, well over a pound per week. I was actually taught to go considerably higher in many cases. The dose ranges I used are the upper end of those in bensky's materia medica and representative of most chinese research and case studies I have seen (perhaps even a little low). , Cara Frank <herbbabe@e...> wrote: > > I was taught that the dose of herbs should be about one oz of raw material > daily- 28 gms, which is roughly 9 qian. I make large bags that last a week > and they weigh in around 6-8 oz. Occasionally they are larger. your formula > works out to just over 6 oz. given that it's a short formula, I'd say you're > right on target. not too hi, not too low. > > Cara > > >> prescribed (2 day packs of raw herbs for 2 weeks) > >> > >> mo yao 18 > >> ru xiang 18 > >> chuan xiong 18 > >> xu duan 24 > >> huang qi 24 > >> dan gui 18 > >> niu xi 18 > >> hong hua 18 > >> tao ren 18 > >]\\ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 , " yuri ovchinikov " <yuriovi@v...> wrote: > It is very interesting case. What is your diagnosis? Blood stagnation? You gave her blood moving herbs, is it not a little bit dangerous? Because it is probably some kind of hematoma in the head? > Yuri she had an mri and CT scan befoe I saw her. They found nothing wrong with her. Yes, I diagnosed her severe pain from injury as blood stasis. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2001 Report Share Posted July 23, 2001 , tgperez@e... wrote: > > I'm always wary when a lecture presents one herb as the end-all and > be-all of a certain therapy - " always use yan hu suo when pain is > severe. " Presented this way, students make notes in bold and > remember only this aspect of the herb. I don't use it that often actually. Mostly for shan qi and dysmenorrhea. But it certainly would not have been contraindicated and perhaps even indicated. I don't have a real good reason. Maybe I should use it more. > > As for the " economically problematic " nature of your prescribing > habits in the PCOM clinic - I wonder if they have weighed the cost > of reordering herbs more frequently against the positive impact of > having patients who experience real success in such a short time > frame. I'd say that kind of advertising is worth the investment of > an extra bag of chai hu from time to time. > I couldn't agree more. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2001 Report Share Posted July 24, 2001 Did you write the formula in qian or gms? I think I assumed gms. which would make it about 3 times lighter- hence 6 oz. Frankly, cost is a big issue. So- can you acheive the same clinical results using less herbs? you could prabaly scale down the rx by 25% w/ no sacrifice in resluts. Cara > Cara > > I appreciate your support, but that formula is a two day dose as > written. It weighed about 85 grams per day or about three ounces per > day, well over a pound per week. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2001 Report Share Posted July 25, 2001 I would expect to see it in a formula that treats pain which rates a 10 on a scale of 1 to 10. >>>Anybody that walks into a clinic and says that she has a 10 out of 10 scale is questionable in my mind Alon - tgperez Monday, July 23, 2001 10:35 AM Re: pain from injury Obviously the formula worked, so my question is purely academic. In class, we were only given a superficial picture of how herbs inthe invigorate blood category are used. According to that picture,Yan Hu Suo is the "number one pain reliever" in the materia medica -so I would expect to see it in a formula that treats pain which rates a 10 on a scale of 1 to 10. What I'd like to know is if there's a particular reason why it would be inappropriate for the case you described. Is it a matter of choosing mo yao and ru xiang because of their ability to promote healing in conjunction with stopping pain - and adding yan hu suo would be overkill? Is it related to the length of time younticipated the patient would be taking the formula and yan hu suo may cause abdominal cramping and other problems if taken for two weeks? Is it because of the Yang xu in the case - would yan hu suo be too intense - or simply isn't necessary thanks to the high dosage of xu duan? I'm always wary when a lecture presents one herb as the end-all and be-all of a certain therapy - "always use yan hu suo when pain is severe." Presented this way, students make notes in bold andremember only this aspect of the herb. As for the "economically problematic" nature of your prescribing habits in the PCOM clinic - I wonder if they have weighed the cost of reordering herbs more frequently against the positive impact ofhaving patients who experience real success in such a short time frame. I'd say that kind of advertising is worth the investment of an extra bag of chai hu from time to time.Laurie, wrote:> She said her pain was 10 on a 10 scale, sharp,> stabbing and excruciating. She also presented as qi, yang and blood> xu. she is 65 and weighs over 200 pounds.> > prescribed (2 day packs of raw herbs for 2 weeks)> > mo yao 18> ru xiang 18> chuan xiong 18> xu duan 24> huang qi 24> dan gui 18> niu xi 18> hong hua 18> tao ren 18> > Pain was 65% gone after three days and 85% gone after two weeks.> Discontinued herbs and pt. improved till sx were gone over next two> weeks based on telephone followup.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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2001 Report Share Posted July 31, 2001 , " Alon Marcus " <alonmarcus@w...> wrote: > I would expect to see it in a formula that treats pain which > rates a 10 on a scale of 1 to 10. > > >>>Anybody that walks into a clinic and says that she has a 10 out of 10 scale is questionable in my mind > Alon I consider 10 of 10 to a qualitative description, not quantitative. It signifies extreme severity in the patient's opinion, pain that was not relieved by medication or physical therapy. I have also seen patients pick the most extreme point of pain rating on a visual analog scale that was properly administred. But I still don't find this quantitative. It is subjective to me until a test is developed to quantify some biochemical change correlated with pain. But to say that that a patient reporting 10 of 10 is questionable. I don't even know what that means. that she didn't say it? that its not meaningful? or her perception doesn't really add up to 10? I don't how to evaluate that part. So I'll have to accept the patient's perception. Now does this mean I think the patient got relief from the medicine and not placebo effect? Could she have been a malingerer? I have no idea. The scientist in me wants to now what happened. the healer just cares that the patient is better? She continues to remain well with no further acupuncture or herbs for about a month. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2001 Report Share Posted July 31, 2001 In a message dated 7/31/01 6:32:45 AM Pacific Daylight Time, tcm2 writes: << However I do find relative number scales useful. I ask pain patients to consider the pain they've come in with as a '10' and rate their improvement against it. >> I like to ask the patient to consider 10 being " the worst pain they have had with THIS condition " -- if 10 is the number they came in with but yesterday it was much worse, then what was yesterday's number? Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2001 Report Share Posted July 31, 2001 I've always had a problem with that number scale. It is not possible for someone to empathize with pain they've never had and rate their own discomfort against it. However I do find relative number scales useful. I ask pain patients to consider the pain they've come in with as a '10' and rate their improvement against it. Thus, if they come in telling me that their pain is now a '7' I reframe that back at them and ask, " so things are about 30% better? " This gives them another opportunity to consider their scoring. Mark Reese > > I consider 10 of 10 to a qualitative description, not quantitative. It > signifies extreme severity in the patient's opinion, pain that was not > relieved by medication or physical therapy. I have also seen patients > pick the most extreme point of pain rating on a visual analog scale > that was properly administred. But I still don't find this > quantitative. It is subjective to me until a test is developed to > quantify some biochemical change correlated with pain. But to say that > that a patient reporting 10 of 10 is questionable. I don't even know > what that means. that she didn't say it? that its not meaningful? or > her perception doesn't really add up to 10? I don't how to evaluate > that part. So I'll have to accept the patient's perception. Now does > this mean I think the patient got relief from the medicine and not > placebo effect? Could she have been a malingerer? I have no idea. > The scientist in me wants to now what happened. the healer just cares > that the patient is better? She continues to remain well with no > further acupuncture or herbs for about a month. > > > > > > 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. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2001 Report Share Posted July 31, 2001 If you look at studies on VAS and MPI as well as other studies you find that these scales are quite informative and a patients with a 10 out of 10 score almost universally come with some personality traits that have much to do with hysteria etc Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2001 Report Share Posted July 31, 2001 I've always had a problem with that number scale >>>These are actually very good but must be administered correctly Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2001 Report Share Posted August 1, 2001 > alonmarcus wrote: > > If you look at studies on VAS and MPI as well as other studies you > find that these scales are quite informative and a patients with a 10 > out of 10 score almost universally come with some personality traits > that have much to do with hysteria etc Heart fire patients tend to have BIG problems with REALLY VIVID esperiences even though it may be just cut finger, they'll describe the issue as BLEEDING TO DEATH. Here's a unique 20th century aside: I tend to read frequent all-caps words in a sentence as an expression of heart fire. All caps in a sentence includes what you see above. -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 --- wrote: > > Al Stone <alstone > Re: Re: pain from injury > > Here's a unique 20th century aside: I tend to read > frequent all-caps > words in a sentence as an expression of heart fire. > All caps in a > sentence includes what you see above. > > -- Give them some coptis and crank a big needle into P8, that'll make 'em think twice before they hit that cap lock key..... ===== Robert Hayden, L.Ac. http://jabinet.net Make international calls for as low as $.04/minute with Messenger http://phonecard./ Quote Link to comment Share on other sites More sharing options...
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