Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 Group: I have a woman in her late 40's I am just started seeing with main c/o headaches occuring for two days each menstrual cycle. Stabbing headache behind the eyes is the only complaint and is consistantly occuring at ovulation. Her cycle is otherwise unremarkable. It occurred to me that she has mild blood stasis in the Chong which causes Liver Qi to get stuck leading to the H/A. Once the flow in the Chong gets moving the symptoms subside. I cannot find this eitiology in any of my books and my gynocology knowledge is somewhat limited. Can someone confirm that this would make sense either theoretically or emperically? Thanks, Michael Buyze Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 Michael: This type of headache pattern is not uncommon. It sounds like her headache is caused by liver qi movement from the organ upward along the internal part of the channel which overlays the Chong mai (it is also the typeical pathway for headaches occuring at the vertex). You should be able to see this in the pulse, during the headache, as a strong movement from the organ depth upward to the sensory line (the dividing line between the qi and blood depths). Jim Ramholz , mbuyze@h... wrote: > Group: > > I have a woman in her late 40's I am just started seeing with main > c/o headaches occuring for two days each menstrual cycle. Stabbing > headache behind the eyes is the only complaint and is consistantly > occuring at ovulation. Her cycle is otherwise unremarkable. > > It occurred to me that she has mild blood stasis in the Chong which > causes Liver Qi to get stuck leading to the H/A. Once the flow in the > Chong gets moving the symptoms subside. > > I cannot find this eitiology in any of my books and my gynocology > knowledge is somewhat limited. Can someone confirm that this would > make sense either theoretically or emperically? > > > Thanks, > > Michael Buyze Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 Michael, Ovulation is a cusp dividing the yin (hypothermal) from the yang (hyperthermal) portions of the cycle. According to a number of modern Chinese gynecologists, such as Xia Gui-cheng and the late Ni Yi-tian, yin reaches its maximum at midcycle and, therefore, transforms into yang. However, for this transformation to occur, the qi mechanism must be freely flowing (tong1) and uninhibited (li4). The free flow and disinhibition of the qi mechanism is dependent upon the coursing and discharging of the liver. Therefore, it is not uncommon at midcycle to see symptoms of liver depression and/or blood stasis (as in, for instance, mittelschmerz). Because the woman's headache is stabbing in nature and fixed in location, I agree that it is probably due to blood stasis, at least in part. However, because the woman is in her late 40s, I strongly suspect that that is not the only disease mechanism at work. At this age, it is not uncommon to find a liver-spleen disharmony giving rise to a qi and blood vacuity which has evolved into a concomitant liver-kidney vacuity (yin, yang, or yin and yang). Further, such liver-kidney vacuity is commonly complicated by either vacuity heat or ascendant liver yang hyperactivity (even at the same time there is yang vacuity above). Then, depending on the patient's body type, diet, and lifestyle, there may also be phlegm, dampness, and turbidity. Therefore, I think you need to give a much fuller description of this woman's signs and symptoms before we can say what actually is going on here. While I think we can say there is blood stasis, I also feel sure there are a number of other disease mechanisms which explain and have led to this blood stasis. In my experience, to treat such multi-pattern perimenopausal headaches successfully, it is necessary to treat the entire constellation of disease mechanisms. For instance, liver depression is caused and aggravated by blood, yin, and yang vacuities (the liver can only perform its functions of coursing and discharging if it A) obtains sufficient blood to nourish and emoliate it, sufficient yin to enrich and moisten it, and sufficient yang to warm and steam it), while blood stasis is caused and aggravated by qi stagnation, qi vacuity, blood vacuity, cold, and heat. The qi moves the blood. If the qi either is stagnant or lacks the power to stir or move the blood, then the blood won't move, while the blood nourishes the heart and vessels. If the heart and vessels do not obtain sufficient blood to nourish them, then they cannot do their function of moving or stirring the blood. Cold's nature is constricting and contracting, while heat may stew the juices. Thus either cold or heat may congeal the blood and cause stasis. If such other disease mechanisms exist and are causing or contributing to the engenderment of blood stasis, then simply quickening the blood and transforming or dispelling stasis will not achieve a perfectly satisfactory result. I would also be careful of how and how much you use the concept of the chong mai in this case. If you are treating with acupuncture and you mention the chong mai because you want to use points associated with the chong mai, that is one thing. However, if you are planning on using internally administered Chinese medicinals, then you should keep in mind that the perimenopausal pattern of chong and ren disharmony (chong ren bu he) is really only a shorthand for indicating a more complex pattern of spleen-liver-kidney vacuity complicated by heat or hyperactivity and typically qi stagnation if not stasis. In my experience as a CM gynecologist, it is better to spell out all these patterns one by one so that one can then list all the necessary treatment principles and, therefore, include all the necessary medicinals. If one uses such a step-by-step methodology, it helps insure hitting the mark. The methodology itself funnels you to the appropriate treatment plan. If one uses a shorthand, such as chong ren bu he, without understanding the more complex scenario for which this abbreviation stands, then one is liable to miss one or more aspects of the overall situation. At least that's my experience as a clinician and a teacher. In any case, if you'd like to present a fuller description of this patient's presenting signs and symptoms, I would be happy to help you problem-solve this case, as, no doubt, so would a number of other rs to this list. Bob , mbuyze@h... wrote: > Group: > > I have a woman in her late 40's I am just started seeing with main > c/o headaches occuring for two days each menstrual cycle. Stabbing > headache behind the eyes is the only complaint and is consistantly > occuring at ovulation. Her cycle is otherwise unremarkable. > > It occurred to me that she has mild blood stasis in the Chong which > causes Liver Qi to get stuck leading to the H/A. Once the flow in the > Chong gets moving the symptoms subside. > > I cannot find this eitiology in any of my books and my gynocology > knowledge is somewhat limited. Can someone confirm that this would > make sense either theoretically or emperically? > > > Thanks, > > Michael Buyze Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 Bob can you explain how you prioritize the formula in a situation such as this, especially dosage Thanks Alon - pemachophel2001 Wednesday, October 31, 2001 2:02 PM Re: Headache Case Michael,Ovulation is a cusp dividing the yin (hypothermal) from the yang (hyperthermal) portions of the cycle. According to a number of modern Chinese gynecologists, such as Xia Gui-cheng and the late Ni Yi-tian, yin reaches its maximum at midcycle and, therefore, transforms into yang. However, for this transformation to occur, the qi mechanism must be freely flowing (tong1) and uninhibited (li4). The free flow and disinhibition of the qi mechanism is dependent upon the coursing and discharging of the liver. Therefore, it is not uncommon at midcycle to see symptoms of liver depression and/or blood stasis (as in, for instance, mittelschmerz).Because the woman's headache is stabbing in nature and fixed in location, I agree that it is probably due to blood stasis, at least in part. However, because the woman is in her late 40s, I strongly suspect that that is not the only disease mechanism at work. At this age, it is not uncommon to find a liver-spleen disharmony giving rise to a qi and blood vacuity which has evolved into a concomitant liver-kidney vacuity (yin, yang, or yin and yang). Further, such liver-kidney vacuity is commonly complicated by either vacuity heat or ascendant liver yang hyperactivity (even at the same time there is yang vacuity above). Then, depending on the patient's body type, diet, and lifestyle, there may also be phlegm, dampness, and turbidity.Therefore, I think you need to give a much fuller description of this woman's signs and symptoms before we can say what actually is going on here. While I think we can say there is blood stasis, I also feel sure there are a number of other disease mechanisms which explain and have led to this blood stasis. In my experience, to treat such multi-pattern perimenopausal headaches successfully, it is necessary to treat the entire constellation of disease mechanisms. For instance, liver depression is caused and aggravated by blood, yin, and yang vacuities (the liver can only perform its functions of coursing and discharging if it A) obtains sufficient blood to nourish and emoliate it, sufficient yin to enrich and moisten it, and sufficient yang to warm and steam it), while blood stasis is caused and aggravated by qi stagnation, qi vacuity, blood vacuity, cold, and heat. The qi moves the blood. If the qi either is stagnant or lacks the power to stir or move the blood, then the blood won't move, while the blood nourishes the heart and vessels. If the heart and vessels do not obtain sufficient blood to nourish them, then they cannot do their function of moving or stirring the blood. Cold's nature is constricting and contracting, while heat may stew the juices. Thus either cold or heat may congeal the blood and cause stasis. If such other disease mechanisms exist and are causing or contributing to the engenderment of blood stasis, then simply quickening the blood and transforming or dispelling stasis will not achieve a perfectly satisfactory result.I would also be careful of how and how much you use the concept of the chong mai in this case. If you are treating with acupuncture and you mention the chong mai because you want to use points associated with the chong mai, that is one thing. However, if you are planning on using internally administered Chinese medicinals, then you should keep in mind that the perimenopausal pattern of chong and ren disharmony (chong ren bu he) is really only a shorthand for indicating a more complex pattern of spleen-liver-kidney vacuity complicated by heat or hyperactivity and typically qi stagnation if not stasis. In my experience as a CM gynecologist, it is better to spell out all these patterns one by one so that one can then list all the necessary treatment principles and, therefore, include all the necessary medicinals. If one uses such a step-by-step methodology, it helps insure hitting the mark. The methodology itself funnels you to theappropriate treatment plan. If one uses a shorthand, such as chong ren bu he, without understanding the more complex scenario for which this abbreviation stands, then one is liable to miss one or more aspects of the overall situation. At least that's my experience as a clinician and a teacher.In any case, if you'd like to present a fuller description of this patient's presenting signs and symptoms, I would be happy to help you problem-solve this case, as, no doubt, so would a number of other rs to this list.Bob, mbuyze@h... wrote:> Group:> > I have a woman in her late 40's I am just started seeing with main > c/o headaches occuring for two days each menstrual cycle. Stabbing > headache behind the eyes is the only complaint and is consistantly > occuring at ovulation. Her cycle is otherwise unremarkable.> > It occurred to me that she has mild blood stasis in the Chong which > causes Liver Qi to get stuck leading to the H/A. Once the flow in the > Chong gets moving the symptoms subside.> > I cannot find this eitiology in any of my books and my gynocology > knowledge is somewhat limited. Can someone confirm that this would > make sense either theoretically or emperically?> > > Thanks, > > Michael BuyzeChinese 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 October 31, 2001 Report Share Posted October 31, 2001 Hi,Michael, Could you provide this case as an case report,like Hillary and Julie did. Tho more information you provide,the more advice will come. Jean ===== -------------------------------- < ¨C¤Ñ³£ ©_¼¯ > www..tw Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2001 Report Share Posted November 1, 2001 Alon, First, I would write the patterns in the order of predominance. Then I would write the treatment principles for each of the patterns in exactly the same order. Next, I would pick the guiding formula from whatever category was indicated by the first set of treatment principles. Therefore, if the first treatment principles were to nourish the liver (yang gan) and invigorate the kidneys (qiang shen), then I would pick a formula from the yang-supplementing (bu yang) category (since most yang supplements nourish liver blood as well as invigorate kidney yang, e.g. Xian Mao, Xian Ling Pi). In that case, I may be starting out with Er Xian Tang (Two Immortals Decoction). Next I would modify the formula by subtracting any medicinals in that are not warranted. For instance, if there was no vacuity heat, and I was starting with Er Xian Tang, then I would take out Zhi Mu and Huang Bai. Then I would begin adding medicinals for each of the other treatment principles. As a for instance, if there was concomitant spleen qi vacuity, in order to fortify the spleen and supplement the qi, I might add Huang Qi and Dang Shen. If there was concomitant liver depression transforming heat, in order to course the liver, clear heat, and resolve depression, I might add Chai Hu and Huang Qin. If there was concomitant blood stasis, in order to quicken the blood and dispel stasis, I might add Chuan Xiong and Hong Hua, etc. In general, I would typically choose two medicinals working in tandem for each subsidiary treatment principle. When possible, I would also choose medicinals which would accomplish more than a single treatment principles when possible to economize the number of meds in the Rx. Since I have yet to read a more complete presentation of the patient's signs and symptoms, these examples are only hypothetical. At the moment, my response to Michael was merely based on my own clinical experience as a gynecological specialist. If Michael can provide enough of the right signs and symptoms for me to feel reasonably confident about the pattern discrimination, I'd be happy to write an actual formula as an example of my practice. Bob , " ALON MARCUS " <alonmarcus@w...> wrote: > Bob can you explain how you prioritize the formula in a situation such as this, especially dosage > Thanks Alon > - > pemachophel2001 > > Wednesday, October 31, 2001 2:02 PM > Re: Headache Case > > > Michael, > > Ovulation is a cusp dividing the yin (hypothermal) from the yang > (hyperthermal) portions of the cycle. According to a number of modern > Chinese gynecologists, such as Xia Gui-cheng and the late Ni Yi-tian, > yin reaches its maximum at midcycle and, therefore, transforms into > yang. However, for this transformation to occur, the qi mechanism must > be freely flowing (tong1) and uninhibited (li4). The free flow and > disinhibition of the qi mechanism is dependent upon the coursing and > discharging of the liver. Therefore, it is not uncommon at midcycle to > see symptoms of liver depression and/or blood stasis (as in, for > instance, mittelschmerz). > > Because the woman's headache is stabbing in nature and fixed in > location, I agree that it is probably due to blood stasis, at least in > part. However, because the woman is in her late 40s, I strongly > suspect that that is not the only disease mechanism at work. At this > age, it is not uncommon to find a liver-spleen disharmony giving rise > to a qi and blood vacuity which has evolved into a concomitant > liver-kidney vacuity (yin, yang, or yin and yang). Further, such > liver-kidney vacuity is commonly complicated by either vacuity heat or > ascendant liver yang hyperactivity (even at the same time there is > yang vacuity above). Then, depending on the patient's body type, diet, > and lifestyle, there may also be phlegm, dampness, and turbidity. > > Therefore, I think you need to give a much fuller description of this > woman's signs and symptoms before we can say what actually is going > on here. While I think we can say there is blood stasis, I also feel > sure there are a number of other disease mechanisms which explain and > have led to this blood stasis. In my experience, to treat such > multi-pattern perimenopausal headaches successfully, it is necessary > to treat the entire constellation of disease mechanisms. For instance, > liver depression is caused and aggravated by blood, yin, and yang > vacuities (the liver can only perform its functions of coursing and > discharging if it A) obtains sufficient blood to nourish and emoliate > it, sufficient yin to enrich and moisten it, and sufficient yang to > warm and steam it), while blood stasis is caused and aggravated by qi > stagnation, qi vacuity, blood vacuity, cold, and heat. The qi moves > the blood. If the qi either is stagnant or lacks the power to stir > or move the blood, then the blood won't move, while the blood > nourishes the heart and vessels. If the heart and vessels do not > obtain sufficient blood to nourish them, then they cannot do their > function of moving or stirring the blood. Cold's nature is > constricting and contracting, while heat may stew the juices. Thus > either cold or heat may congeal the blood and cause stasis. If such > other disease mechanisms exist and are causing or contributing to the > engenderment of blood stasis, then simply quickening the blood and > transforming or dispelling stasis will not achieve a perfectly > satisfactory result. > > I would also be careful of how and how much you use the concept of the > chong mai in this case. If you are treating with acupuncture and you > mention the chong mai because you want to use points associated with > the chong mai, that is one thing. However, if you are planning on > using internally administered Chinese medicinals, then you should keep > in mind that the perimenopausal pattern of chong and ren disharmony > (chong ren bu he) is really only a shorthand for indicating a more > complex pattern of spleen-liver-kidney vacuity complicated by heat or > hyperactivity and typically qi stagnation if not stasis. In my > experience as a CM gynecologist, it is better to spell out all these > patterns one by one so that one can then list all the necessary > treatment principles and, therefore, include all the necessary > medicinals. If one uses such a step-by-step methodology, it helps > insure hitting the mark. The methodology itself funnels you to the > appropriate treatment plan. If one uses a shorthand, such as chong ren > bu he, without understanding the more complex scenario for which this > abbreviation stands, then one is liable to miss one or more aspects of > the overall situation. At least that's my experience as a clinician > and a teacher. > > In any case, if you'd like to present a fuller description of this > patient's presenting signs and symptoms, I would be happy to help you > problem-solve this case, as, no doubt, so would a number of other > rs to this list. > > Bob > > , mbuyze@h... wrote: > > Group: > > > > I have a woman in her late 40's I am just started seeing with main > > c/o headaches occuring for two days each menstrual cycle. Stabbing > > headache behind the eyes is the only complaint and is consistantly > > occuring at ovulation. Her cycle is otherwise unremarkable. > > > > It occurred to me that she has mild blood stasis in the Chong which > > causes Liver Qi to get stuck leading to the H/A. Once the flow in > the > > Chong gets moving the symptoms subside. > > > > I cannot find this eitiology in any of my books and my gynocology > > knowledge is somewhat limited. Can someone confirm that this would > > make sense either theoretically or emperically? > > > > > > Thanks, > > > > Michael Buyze > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2001 Report Share Posted November 1, 2001 Thanks Bob What about dose?. If you feel for example that the pattern is mostly Liv yin def with K yin yang def and heat and choose something like Er Xian Tang. And your assumption is that the Sp symptoms are 1. sp def due to K yang def. 2. sp def due to wood invading earth, probably due to qi stagnation secondary to liver yin/blood def, how do you manage the dosage of the sp herbs. I am trying to see if there is a difference in taking Yin fire approach and what I see as normal formula alteration. Also thinking of a typical patient what would be the maximum treatment principles you would combine and how due you prioritize the formula. Thanks Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 James, Bob, Alon, Jean and group: Thanks for the reply, sorry for the slight delay in getting additional information to you. Details follow: PATIENT: 47 y.o. female MAJOR COMPLAINT: Recurring Headaches related to ovulatory aspect of menstrual cycle HISTORY OF PRESET ILLNESS: Headaches began 3 years ago and have been recurring regularly at about day 14 of her cycle and consistently lasting for 2 days keeping her from her normal ADLs. The headache is typically a stabbing pain behind her eyes. Accompanying symptoms include achiness in the neck, shoulders, and upper back. She also gets chills, indigestion, insomnia (primarily due to pain), low back pain, and is unable to concentrate. These symptoms seem to be triggered by ovulation, which she feels as a heaviness in her mid- section with downward movement. She has seen her physician regarding these headaches. She was tested for menopause at that time and assured that she is still pre-menopausal. She was given no other explanation for her symptoms. She has cold hands and feet much of the time and feels cold in general. ADDITIONAL COMPLAINTS: None OTHER MEDICIAL HISTORY: Her record indicates an ancient history of minor anxiety in the past for which she saw another acupuncturist in this office, but this was not discussed. MEDICATIONS: Rx: None; OTC: None; Vitamins/Supplements: Multi vitamin, B-complex (on occasion), Vitamin C, Vitamin E, Calcium, and Aloe Vera ALLERGIES: Penicillin, Sulfa DIETARY HABITS: No special diet, she eats 3 meals per day with 4 servings of fruits & vegetables and 6 glasses of filtered water. She eats in restaurants 1-2 times per week. She eats red meat once per week, poultry twice per week, and fish once per week. She reports her current weight to be 138 lbs. This is her highest adult weight. Her lowest adult weight was 115 lbs. at age 20. She has no history of dieting. DIGESTION & ELIMINATION: She experiences bloating mid-cycle as described above and the couple days before the onset of menstruation. She stools less than once per day, about 5 times per week. Stool is soft-formed. She develops constipation about once per month and has no diarrhea or urination problems. SLEEP: She sleeps about 7.5 hours per night and reports no difficulty falling asleep with occasional difficulty staying asleep. She does not get up to urinate at night. She rates the overall quality of her sleep as 8 (0-10 scale), feeling best mid-morning and worst in the late evening. LIFESTYLE: She is the manager of a stockroom at a state university and also does massage on a part-time basis. She does not use tobacco and rarely uses alcohol, as she does not tolerate it well. She drinks 2 cups of coffee per day. She walks regularly and also does either yoga or qi gong. OB/GYN: Para 3, Gravida 3, she continues to have regular menstrual periods. Menses is dark in color with clots. She denies cramping, but does complain of irritability and bloating in the last couple days before the onset of menses. She has had some minimal menopausal symptoms, which she does not detail. She is not on hormone replacement or birth control pills. EXAMINATION: Well-developed, well-nourished white female appearing approximately her stated age in no apparent distress. Tongue is slightly bluish in color with a thick white coat that is moist overall and slimy towards the back. Pulse is rapid at 120 bpm, thin and tight. Thanks in advance for the assistance. The above reflects the information I routinely collect via health hx questionaire and intitial interview. If my information is deficient in any area, I would appreaciate that feedback also. Bob: regarding your comment about the chong mai. Yes, intially I am thinking more in acupuncture terms. My herb work to date has been classic formulas with additions. I am just getting into subtractions and building formulas using single herbs, so this is a learning experience for me. Thanks again, Michael Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 Alon, My response to you (and to Micheal originally) was not necessarily based on yin fire theory. What I described is simply the methodology I learned in my fang ji xue class (formulas & prescriptions) at the Shanghai College of as taught by Dr. Chen Wei and what I learned in clinical practice from Dr. Yu Min at the Yue Yang Chinese Medical Hospital. While it does segue nicely with Li-Zhu yin fire theory, it is not necessary to use that theory to come to the conclusions I came to. It is simply a question of studying the Chinese gynecfological literature and parsing the patterns I regularly see in women of this age. In all your communications to this list on yin fire, there seems, to me, to be misunderstanding on how I use this theory. To explain that takes me at least 90 minutes (and often three hours). So I cannot do that in this forum. If you really want to know what I think about this topic and how I use this theory in clinical practice, you might want to take one of my classes on it. As for dosages, that's impossible to talk about without a live patient in front of us. So far, and until Michael gives us a more detailed description of his patient, we are talking completely in the realm of hypothesis. However, I can say that basically I accept 9-10g per day per medicinal as the standard of care in contemporary professional Chinese medicine. Dosages of individual medicinals above or below that benchmark are determined by 1) the role they play in the formula, 2) the severity of the condition they are attempting to address, 3) the chronicity of the condition (e.g. whether the condition is acute or chronic), and 4) the standard dosages of specific medicinals. For instance, Xi Xin and Sha Ren are usually dosed less than 9g, while Pu Gong Ying and Bai Jiang Cao are usually dosed more than 9g due to their specific properties. As I have offered before, if Michael chooses to present his case in detail, I am willing to write a sample Rx, including dosages, for that case AS AN EXAMPLE OF MY PRACTICE (not as something I think Michael should then prescribe to his patient, since, without seeing the patient, we are, necessarily talking in the realm of theory). As for the relationship of the liver and spleen and spleen and kidneys, that is also a large topic, and one that I also normally take 90 minutes to three hours to discuss. That being said, the relationship between the liver and spleen is a " chicken and egg " one. There are two statements of fact that help explain this situation: 1) " If the liver is diseased, first treat the spleen. " 2) " Liver disease IS spleen disease. " These two statements (the first from the Nei Jing) imply that, in real life and like cockroaches, if there is one, there is more than one. These two patterns rarely, in my experience, exist independently in females. This is so in women due to the fact that, " [in] women, the main [thing is] the blood. " Women lose and/or consume more blood than men due to menstruation, gestation, and lactation. Since the spleen is the main viscus in the engenderment and transformation of the blood, this makes spleen vacuity more common in women than in men, all other things being equal. Further, the liver can only control its function of coursing and discharge if it obtains sufficient blood to nourish it. If it does not control that function, it becomes depressed. Then liver wood, which is replete with qi (even though vacuous of blood) attacks and checks spleen earth. This then creates a mutually reinforcing loop. In some particular women, it is my experience that we can identify the disease cause, such as emotional stress causing liver depression or eating sweets causing spleen vacuity. However, in most cases involving middle-aged Western women, these disease causes and mechanisms responsible for a liver-spleen diahramony are so mutually engendering that it is impossilbe to say which came first, nor is it particulaly important to do so in terms of remedial treatment. As for the relationship of spleen qi vacuity to kidney yang vacuity in a 49 year old women, this is more quickly explained. The Nei Jing says that, in women, blood production declines at 35 due to a decline in the yang ming, which, in this particular instance, does not just mean the stomach but includes the spleen, since the stomach per se does not engender the blood. (In other words, in this particular case, the yang ming stands for the spleen-stomach, not just the stomach.) Since the former and latter heavens are mutually rooted, it is spleen vacuity which begins or worsens in the mid 30s which " reaches " or evolves into a dual spleen-kidney yang vacuity in many women by the late 40s. This is not just theory. One sees this in clinical practice, both in China and the U.S. (and, I would add from my personal experience, in India, Nepal, the U.K., Western Europe, Australia, New Zealand, and Israel), on a daily basis. Capisce? Bob , <alonmarcus@w...> wrote: > Thanks Bob > What about dose?. If you feel for example that the pattern is mostly Liv yin def with K yin yang def and heat and choose something like Er Xian Tang. And your assumption is that the Sp symptoms are 1. sp def due to K yang def. 2. sp def due to wood invading earth, probably due to qi stagnation secondary to liver yin/blood def, how do you manage the dosage of the sp herbs. I am trying to see if there is a difference in taking Yin fire approach and what I see as normal formula alteration. > Also thinking of a typical patient what would be the maximum treatment principles you would combine and how due you prioritize the formula. > Thanks Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 Michael, Thanks for providing more detail about your case. From my estimation, you've provided enough new detail to say some things pretty conclusively. However, I think there are also some grey areas which I would want clarified if this were my patient. What I think we can say conclusively is that there is 1) a liver-spleen disharmony as evidenced by the irritability, " tight " pulse (which I bet I would identify as xian mai, stringlike or bowstring), abdominal symptoms, cold hands and feet, and defecatory pattern. Also, having more energy in the A.M. and feeling worse (fatigued?) in the evening also suggests spleen vacuity. I think we need you to ask some more questions here about fatigue and energy level. 2)Given the patient's age, it looks likely that this liver-spleen disharmony has evolved into a spleen-kidney yang vacuity, as evidenced by the chills and general coldness and low back pain. However, to pin this down, at least in my mind, we need to know if A) the patient wears socks to bed at night (at least in winter), and B) there has been a decrease in her libido. Positive answers to these two questions or even only B would indicate, at least to me, not just a spleen vacuity but a spleen-kidney yang vacuity. 3) I think we also know for sure that there is blood stasis, as evidenced by the fixed pain, stabbing pain, purple tongue, and dark, clotty menstruate. 4) If the pulse is truly 120bpm, then there is some kind of heat. The main candidates would be depressive heat, vacuity heat, phlegm heat, and/or damp heat. Given the age, fine pulse, and the tendency towards matitudinal insomnia, it looks likely there is a liver blood and possibly a kidney yin vacuity. To conclusively pin this down, you would need to ask some more questions. In particular, we need to know exactly what she means by minimal perimenopausal symptoms. Hot flashes? Night sweats? Night sweats would go a long way to confirming yin vacuity with vacuity heat. What is not quite clear is the meaning of the tongues sings you've recorded. They might indicate there is damp heat in the lower burner. I know the fur is not yellow. However, the fur does not need to be yellow if damp heat is due to spleen vacuity, and damp heat often becomes bound with stasis and stagnation (i.e., blood stasis and liver depression qi stagnation). However, these tongue signs may also be pointing to phlegm, dampness, and turbidity. In any case, we need to further clarify the role of any phlegm, dampness, and turbidity in this case. This is important since phlegm, blood stasis, and yin vacuity are all mutually engendering. I think you also need to ask more questions about the previous Chinese medical pattern discrimination and treatment for anxiety. What exactly did the patient mean by anxiety? As you can see from James Lake's and my Chinese Medical Psychiatry, anxiety may be due to heart-gallbladder qi timidity (really meaning a liver-spleen-stomach disharmony resulting in the engenderment of phlegm and the nonconstruction and malnourishment of the heart spirit), a simple heart-spleen dual vacuity, a kidney vacuity, and/or some sort of heat evils harassing the heart spirit. Knowing the patient's previous diagnosis and what the treatment was that sucessfully treated her condition might further clarify her overall constellation of patterns. For instance, is there a heart qi and blood vacuity? Is there phlegm? Is that what the tongue fur is indicating. So I'm going to throw the ball back in your court, Michael, to see if you can requestion the patient and get further clarity on these issues. If so, I'm still willing to write that sample Rx. As it happens, I do think this case is an example of a yin fire scenario. In this case, I think the upper back, neck, and shoulder tension are a good example of yin fire or yang qi (Li would say lifegate fire) being shifted from the heart to the hand and foot tai yang channels and the du as described by Li and Zhu. In my personal clinical experience, simply addressing this kind of upper back, neck, and shoulder tension (with acupuncture) as counterflow qi shifted from the liver to the shao yang does not get adequate treatment results. If we were to accept, Li-Zhu theory on this type of upper back, neck, and shoulder tension, then, in terms of acupuncture, we would need to treat the chong mai. However, I have written at length on this elsewhere (viz. Free Articles, www.bluepoppy.com & /or www.chinesemedicalpsychiatry.com). You can also read about this disease mechanism in Blue Poppy Press translations of the Pi Wei Lun, Ge Zhi Yu Lun, and Dan Xi Xin Fa Zhi Yao. Although we're not quite there yet, I do believe, from my point of view, that we are closing in. Bob , mbuyze@h... wrote: > James, Bob, Alon, Jean and group: > > Thanks for the reply, sorry for the slight delay in getting > additional information to you. Details follow: > > PATIENT: 47 y.o. female > MAJOR COMPLAINT: Recurring Headaches related to ovulatory aspect of > menstrual cycle > HISTORY OF PRESET ILLNESS: Headaches began 3 years ago and have been > recurring regularly at about day 14 of her cycle and consistently > lasting for 2 days keeping her from her normal ADLs. The headache is > typically a stabbing pain behind her eyes. Accompanying symptoms > include achiness in the neck, shoulders, and upper back. She also > gets chills, indigestion, insomnia (primarily due to pain), low back > pain, and is unable to concentrate. These symptoms seem to be > triggered by ovulation, which she feels as a heaviness in her mid- > section with downward movement. She has seen her physician regarding > these headaches. She was tested for menopause at that time and > assured that she is still pre-menopausal. She was given no other > explanation for her symptoms. She has cold hands and feet much of the > time and feels cold in general. > ADDITIONAL COMPLAINTS: None > OTHER MEDICIAL HISTORY: Her record indicates an ancient history of > minor anxiety in the past for which she saw another acupuncturist in > this office, but this was not discussed. > MEDICATIONS: Rx: None; OTC: None; Vitamins/Supplements: Multi > vitamin, B-complex (on occasion), Vitamin C, Vitamin E, Calcium, and > Aloe Vera > ALLERGIES: Penicillin, Sulfa > DIETARY HABITS: No special diet, she eats 3 meals per day with 4 > servings of fruits & vegetables and 6 glasses of filtered water. She > eats in restaurants 1-2 times per week. She eats red meat once per > week, poultry twice per week, and fish once per week. She reports her > current weight to be 138 lbs. This is her highest adult weight. Her > lowest adult weight was 115 lbs. at age 20. She has no history of > dieting. > DIGESTION & ELIMINATION: She experiences bloating mid-cycle as > described above and the couple days before the onset of menstruation. > She stools less than once per day, about 5 times per week. Stool is > soft-formed. She develops constipation about once per month and has > no diarrhea or urination problems. > SLEEP: She sleeps about 7.5 hours per night and reports no difficulty > falling asleep with occasional difficulty staying asleep. She does > not get up to urinate at night. She rates the overall quality of her > sleep as 8 (0-10 scale), feeling best mid-morning and worst in the > late evening. > LIFESTYLE: She is the manager of a stockroom at a state university > and also does massage on a part-time basis. She does not use tobacco > and rarely uses alcohol, as she does not tolerate it well. She drinks > 2 cups of coffee per day. She walks regularly and also does either > yoga or qi gong. > OB/GYN: Para 3, Gravida 3, she continues to have regular menstrual > periods. Menses is dark in color with clots. She denies cramping, but > does complain of irritability and bloating in the last couple days > before the onset of menses. She has had some minimal menopausal > symptoms, which she does not detail. She is not on hormone > replacement or birth control pills. > EXAMINATION: Well-developed, well-nourished white female appearing > approximately her stated age in no apparent distress. Tongue is > slightly bluish in color with a thick white coat that is moist > overall and slimy towards the back. Pulse is rapid at 120 bpm, thin > and tight. > > > Thanks in advance for the assistance. The above reflects the > information I routinely collect via health hx questionaire and > intitial interview. If my information is deficient in any area, I > would appreaciate that feedback also. > > Bob: regarding your comment about the chong mai. Yes, intially I am > thinking more in acupuncture terms. My herb work to date has been > classic formulas with additions. I am just getting into subtractions > and building formulas using single herbs, so this is a learning > experience for me. > > Thanks again, > > Michael Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 Bob My response to you (and to Micheal originally) was not necessarily based on yin fire theory. >>>>Can you try to do it from the Yin fire perspective? I am intrested in hearing and learning more Otherwise I understand all the other mechanisims you discribe and they are standerd TCM theory with the addition of understanding of manstrual cycle from WM TCM combined theory. However, in most cases involving middle-aged Western women, these disease causes and mechanisms responsible for a liver-spleen diahramony are so mutually engendering that it is impossilbe to say which came first, nor is it particulaly important to do so in terms of remedial treatment >>>>>Here I think one does have to prioritize since in patinets with primary Liver stag using formulas like shao yao san or using herbs like bai zhu, dang shen often result in increased liver stagnation transformative heat. While using herbs like fu ling, san yao, lian zi are tolerated well. And second if Liv is truely the major issues some patient do well with just treating the liver, at least in dis-eases. If pathology is more severe then i agree often the two have to be treated at the same time Alon - pemachophel2001 Friday, November 02, 2001 7:49 AM Re: Headache Case Alon,My response to you (and to Micheal originally) was not necessarily based on yin fire theory. What I described is simply the methodology I learned in my fang ji xue class (formulas & prescriptions) at the Shanghai College of as taught by Dr. Chen Wei and what I learned in clinical practice from Dr. Yu Min at the Yue Yang Chinese Medical Hospital. While it does segue nicely with Li-Zhu yin fire theory, it is not necessary to use that theory to come to the conclusions I came to. It is simply a question of studying the Chinese gynecfological literature and parsing the patterns I regularly see in women of this age. In all your communications to this list on yin fire, there seems, to me, to be misunderstanding on how I use this theory. To explain that takes me at least 90 minutes (and often three hours). So I cannot do that in this forum. If you really want to know what I think about this topic and how I use this theory in clinical practice, you might want to take one of my classes on it.As for dosages, that's impossible to talk about without a live patient in front of us. So far, and until Michael gives us a more detailed description of his patient, we are talking completely in the realm of hypothesis. However, I can say that basically I accept 9-10g per day per medicinal as the standard of care in contemporary professional Chinese medicine. Dosages of individual medicinals above or below that benchmark are determined by 1) the role they play in the formula, 2) the severity of the condition they are attempting to address, 3) the chronicity of the condition (e.g. whether the condition is acute or chronic), and 4) the standard dosages of specific medicinals. For instance, Xi Xin and Sha Ren are usually dosed less than 9g, while Pu Gong Ying and Bai Jiang Cao are usually dosed more than 9g due to their specific properties. As I have offered before, if Michael chooses to present his case in detail, I am willing to write a sample Rx, including dosages, for that case AS AN EXAMPLE OF MY PRACTICE (not as something I think Michael should then prescribe to his patient, since, without seeing the patient, we are, necessarily talking in the realm of theory).As for the relationship of the liver and spleen and spleen and kidneys, that is also a large topic, and one that I also normally take 90 minutes to three hours to discuss. That being said, the relationship between the liver and spleen is a "chicken and egg" one. There are two statements of fact that help explain this situation: 1) "If the liver is diseased, first treat the spleen." 2) "Liver disease IS spleen disease." These two statements (the first from the Nei Jing) imply that, in real life and like cockroaches, if there is one, there is more than one. These two patterns rarely, in my experience, exist independently in females. This is so in women due to the fact that, "[in] women, the main [thing is] the blood." Women lose and/or consume more blood than men due to menstruation, gestation, and lactation. Since the spleen is the main viscus in the engenderment and transformation of the blood, this makes spleen vacuity more common in women than in men, all other things being equal. Further, the liver can only control its function of coursing and discharge if it obtains sufficient blood to nourish it. If it does not control that function, it becomes depressed. Then liver wood, which is replete with qi (even though vacuous of blood) attacks and checks spleen earth. This then creates a mutually reinforcing loop. In some particular women, it is my experience that we can identify the disease cause, such as emotional stress causing liver depression or eating sweets causing spleen vacuity. However, in most cases involving middle-aged Western women, these disease causes and mechanisms responsible for a liver-spleen diahramony are so mutually engendering that it is impossilbe to say which came first, nor is it particulaly important to do so in terms of remedial treatment.As for the relationship of spleen qi vacuity to kidney yang vacuity in a 49 year old women, this is more quickly explained. The Nei Jing says that, in women, blood production declines at 35 due to a decline in the yang ming, which, in this particular instance, does not just mean the stomach but includes the spleen, since the stomach per se does not engender the blood. (In other words, in this particular case, the yang ming stands for the spleen-stomach, not just the stomach.) Since the former and latter heavens are mutually rooted, it is spleen vacuity which begins or worsens in the mid 30s which "reaches" or evolves into a dual spleen-kidney yang vacuity in many women by the late 40s. This is not just theory. One sees this in clinical practice, both in China and the U.S. (and, I would add from my personal experience, in India, Nepal, the U.K., Western Europe, Australia, New Zealand, and Israel), on a daily basis.Capisce?Bob , <alonmarcus@w...> wrote:> Thanks Bob> What about dose?. If you feel for example that the pattern is mostly Liv yin def with K yin yang def and heat and choose something like Er Xian Tang. And your assumption is that the Sp symptoms are 1. sp def due to K yang def. 2. sp def due to wood invading earth, probably due to qi stagnation secondary to liver yin/blood def, how do you manage the dosage of the sp herbs. I am trying to see if there is a difference in taking Yin fire approach and what I see as normal formula alteration. > Also thinking of a typical patient what would be the maximum treatment principles you would combine and how due you prioritize the formula.> Thanks AlonChinese 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 November 2, 2001 Report Share Posted November 2, 2001 Alon, I agree that one must prioritize the patterns, but the patterns (zheng) are different from the disease causes (bing yin) which I do not think you need to absolutely determine. Nor is the relative importance of the pattern necessarily dependent on the order in which its disease mechanisms were put into play. In other words, precedence in time does not necessarily indicate severity of the disease mechanisms. A disease mechanism which was created secondarily may, in many cases, be more severe than the original disease mechanism that gave rise to it. Otherwise I agree that if liver depression is the main pattern/disease mechanism, too greatly supplementing the spleen may cause problems. Bob , " ALON MARCUS " <alonmarcus@w...> wrote: > Bob > My response to you (and to Micheal originally) was not necessarily > based on yin fire theory. > >>>>Can you try to do it from the Yin fire perspective? I am intrested in hearing and learning more > > Otherwise I understand all the other mechanisims you discribe and they are standerd TCM theory with the addition of understanding of manstrual cycle from WM TCM combined theory. > > > However, in most cases involving middle-aged Western > women, these disease causes and mechanisms responsible for a > liver-spleen diahramony are so mutually engendering that it is > impossilbe to say which came first, nor is it particulaly important to > do so in terms of remedial treatment > >>>>>Here I think one does have to prioritize since in patinets with primary Liver stag using formulas like shao yao san or using herbs like bai zhu, dang shen often result in increased liver stagnation transformative heat. While using herbs like fu ling, san yao, lian zi are tolerated well. And second if Liv is truely the major issues some patient do well with just treating the liver, at least in dis-eases. If pathology is more severe then i agree often the two have to be treated at the same time > Alon > > - > pemachophel2001 > > Friday, November 02, 2001 7:49 AM > Re: Headache Case > > > Alon, > > My response to you (and to Micheal originally) was not necessarily > based on yin fire theory. What I described is simply the methodology I > learned in my fang ji xue class (formulas & prescriptions) at the > Shanghai College of as taught by Dr. Chen Wei and > what I learned in clinical practice from Dr. Yu Min at the Yue Yang > Chinese Medical Hospital. While it does segue nicely with Li-Zhu yin > fire theory, it is not necessary to use that theory to come to the > conclusions I came to. It is simply a question of studying the > Chinese gynecfological literature and parsing the patterns I regularly > see in women of this age. In all your communications to this list on > yin fire, there seems, to me, to be misunderstanding on how I use this > theory. To explain that takes me at least 90 minutes (and often three > hours). So I cannot do that in this forum. If you really want to know > what I think about this topic and how I use this theory in clinical > practice, you might want to take one of my classes on it. > > As for dosages, that's impossible to talk about without a live patient > in front of us. So far, and until Michael gives us a more detailed > description of his patient, we are talking completely in the realm of > hypothesis. However, I can say that basically I accept 9-10g per day > per medicinal as the standard of care in contemporary professional > Chinese medicine. Dosages of individual medicinals above or below that > benchmark are determined by 1) the role they play in the formula, 2) > the severity of the condition they are attempting to address, 3) the > chronicity of the condition (e.g. whether the condition is acute or > chronic), and 4) the standard dosages of specific medicinals. For > instance, Xi Xin and Sha Ren are usually dosed less than 9g, while Pu > Gong Ying and Bai Jiang Cao are usually dosed more than 9g due to > their specific properties. As I have offered before, if Michael > chooses to present his case in detail, I am willing to write a sample > Rx, including dosages, for that case AS AN EXAMPLE OF MY PRACTICE > (not as something I think Michael should then prescribe to his > patient, since, without seeing the patient, we are, necessarily > talking in the realm of theory). > > As for the relationship of the liver and spleen and spleen and > kidneys, that is also a large topic, and one that I also normally take > 90 minutes to three hours to discuss. That being said, the > relationship between the liver and spleen is a " chicken and egg " one. > There are two statements of fact that help explain this situation: 1) > " If the liver is diseased, first treat the spleen. " 2) " Liver disease > IS spleen disease. " These two statements (the first from the Nei Jing) > imply that, in real life and like cockroaches, if there is one, there > is more than one. These two patterns rarely, in my experience, exist > independently in females. This is so in women due to the fact that, > " [in] women, the main [thing is] the blood. " Women lose and/or consume > more blood than men due to menstruation, gestation, and lactation. > Since the spleen is the main viscus in the engenderment and > transformation of the blood, this makes spleen vacuity more common in > women than in men, all other things being equal. Further, the liver > can only control its function of coursing and discharge if it obtains > sufficient blood to nourish it. If it does not control that function, > it becomes depressed. Then liver wood, which is replete with qi (even > though vacuous of blood) attacks and checks spleen earth. This then > creates a mutually reinforcing loop. In some particular women, it is > my experience that we can identify the disease cause, such as > emotional stress causing liver depression or eating sweets causing > spleen vacuity. However, in most cases involving middle-aged Western > women, these disease causes and mechanisms responsible for a > liver-spleen diahramony are so mutually engendering that it is > impossilbe to say which came first, nor is it particulaly important to > do so in terms of remedial treatment. > > As for the relationship of spleen qi vacuity to kidney yang vacuity in > a 49 year old women, this is more quickly explained. The Nei Jing says > that, in women, blood production declines at 35 due to a decline in > the yang ming, which, in this particular instance, does not just mean > the stomach but includes the spleen, since the stomach per se does not > engender the blood. (In other words, in this particular case, the yang > ming stands for the spleen-stomach, not just the stomach.) Since the > former and latter heavens are mutually rooted, it is spleen vacuity > which begins or worsens in the mid 30s which " reaches " or evolves into > a dual spleen-kidney yang vacuity in many women by the late 40s. This > is not just theory. One sees this in clinical practice, both in China > and the U.S. (and, I would add from my personal experience, in India, > Nepal, the U.K., Western Europe, Australia, New Zealand, and Israel), > on a daily basis. > > Capisce? > > Bob > > , <alonmarcus@w...> wrote: > > Thanks Bob > > What about dose?. If you feel for example that the pattern is mostly > Liv yin def with K yin yang def and heat and choose something like Er > Xian Tang. And your assumption is that the Sp symptoms are 1. sp def > due to K yang def. 2. sp def due to wood invading earth, probably due > to qi stagnation secondary to liver yin/blood def, how do you manage > the dosage of the sp herbs. I am trying to see if there is a > difference in taking Yin fire approach and what I see as normal > formula alteration. > > Also thinking of a typical patient what would be the maximum > treatment principles you would combine and how due you prioritize the > formula. > > Thanks Alon > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 Bob, Agreed - pemachophel2001 Friday, November 02, 2001 11:56 AM Re: Headache Case Alon,I agree that one must prioritize the patterns, but the patterns (zheng) are different from the disease causes (bing yin) which I do not think you need to absolutely determine. Nor is the relative importance of the pattern necessarily dependent on the order in which its disease mechanisms were put into play. In other words, precedence in time does not necessarily indicate severity of the disease mechanisms. A disease mechanism which was created secondarily may, in many cases, be more severe than the original disease mechanism that gave rise to it. Otherwise I agree that if liver depression is the main pattern/disease mechanism, too greatly supplementing the spleen may cause problems. Bob, "ALON MARCUS" <alonmarcus@w...> wrote:> Bob> My response to you (and to Micheal originally) was not necessarily > based on yin fire theory.> >>>>Can you try to do it from the Yin fire perspective? I am intrested in hearing and learning more> > Otherwise I understand all the other mechanisims you discribe and they are standerd TCM theory with the addition of understanding of manstrual cycle from WM TCM combined theory.> > > However, in most cases involving middle-aged Western > women, these disease causes and mechanisms responsible for a > liver-spleen diahramony are so mutually engendering that it is > impossilbe to say which came first, nor is it particulaly important to > do so in terms of remedial treatment> >>>>>Here I think one does have to prioritize since in patinets with primary Liver stag using formulas like shao yao san or using herbs like bai zhu, dang shen often result in increased liver stagnation transformative heat. While using herbs like fu ling, san yao, lian zi are tolerated well. And second if Liv is truely the major issues some patient do well with just treating the liver, at least in dis-eases. If pathology is more severe then i agree often the two have to be treated at the same time> Alon> > - > pemachophel2001 > > Friday, November 02, 2001 7:49 AM> Re: Headache Case> > > Alon,> > My response to you (and to Micheal originally) was not necessarily > based on yin fire theory. What I described is simply the methodology I > learned in my fang ji xue class (formulas & prescriptions) at the > Shanghai College of as taught by Dr. Chen Wei and > what I learned in clinical practice from Dr. Yu Min at the Yue Yang > Chinese Medical Hospital. While it does segue nicely with Li-Zhu yin > fire theory, it is not necessary to use that theory to come to the > conclusions I came to. It is simply a question of studying the > Chinese gynecfological literature and parsing the patterns I regularly > see in women of this age. In all your communications to this list on > yin fire, there seems, to me, to be misunderstanding on how I use this > theory. To explain that takes me at least 90 minutes (and often three > hours). So I cannot do that in this forum. If you really want to know > what I think about this topic and how I use this theory in clinical > practice, you might want to take one of my classes on it.> > As for dosages, that's impossible to talk about without a live patient > in front of us. So far, and until Michael gives us a more detailed > description of his patient, we are talking completely in the realm of > hypothesis. However, I can say that basically I accept 9-10g per day > per medicinal as the standard of care in contemporary professional > Chinese medicine. Dosages of individual medicinals above or below that > benchmark are determined by 1) the role they play in the formula, 2) > the severity of the condition they are attempting to address, 3) the > chronicity of the condition (e.g. whether the condition is acute or > chronic), and 4) the standard dosages of specific medicinals. For > instance, Xi Xin and Sha Ren are usually dosed less than 9g, while Pu > Gong Ying and Bai Jiang Cao are usually dosed more than 9g due to > their specific properties. As I have offered before, if Michael > chooses to present his case in detail, I am willing to write a sample > Rx, including dosages, for that case AS AN EXAMPLE OF MY PRACTICE > (not as something I think Michael should then prescribe to his > patient, since, without seeing the patient, we are, necessarily > talking in the realm of theory).> > As for the relationship of the liver and spleen and spleen and > kidneys, that is also a large topic, and one that I also normally take > 90 minutes to three hours to discuss. That being said, the > relationship between the liver and spleen is a "chicken and egg" one. > There are two statements of fact that help explain this situation: 1) > "If the liver is diseased, first treat the spleen." 2) "Liver disease > IS spleen disease." These two statements (the first from the Nei Jing) > imply that, in real life and like cockroaches, if there is one, there > is more than one. These two patterns rarely, in my experience, exist > independently in females. This is so in women due to the fact that, > "[in] women, the main [thing is] the blood." Women lose and/or consume > more blood than men due to menstruation, gestation, and lactation. > Since the spleen is the main viscus in the engenderment and > transformation of the blood, this makes spleen vacuity more common in > women than in men, all other things being equal. Further, the liver > can only control its function of coursing and discharge if it obtains > sufficient blood to nourish it. If it does not control that function, > it becomes depressed. Then liver wood, which is replete with qi (even > though vacuous of blood) attacks and checks spleen earth. This then > creates a mutually reinforcing loop. In some particular women, it is > my experience that we can identify the disease cause, such as > emotional stress causing liver depression or eating sweets causing > spleen vacuity. However, in most cases involving middle-aged Western > women, these disease causes and mechanisms responsible for a > liver-spleen diahramony are so mutually engendering that it is > impossilbe to say which came first, nor is it particulaly important to > do so in terms of remedial treatment.> > As for the relationship of spleen qi vacuity to kidney yang vacuity in > a 49 year old women, this is more quickly explained. The Nei Jing says > that, in women, blood production declines at 35 due to a decline in > the yang ming, which, in this particular instance, does not just mean > the stomach but includes the spleen, since the stomach per se does not > engender the blood. (In other words, in this particular case, the yang > ming stands for the spleen-stomach, not just the stomach.) Since the > former and latter heavens are mutually rooted, it is spleen vacuity > which begins or worsens in the mid 30s which "reaches" or evolves into > a dual spleen-kidney yang vacuity in many women by the late 40s. This > is not just theory. One sees this in clinical practice, both in China > and the U.S. (and, I would add from my personal experience, in India, > Nepal, the U.K., Western Europe, Australia, New Zealand, and Israel), > on a daily basis.> > Capisce?> > Bob > > , <alonmarcus@w...> wrote:> > Thanks Bob> > What about dose?. If you feel for example that the pattern is mostly > Liv yin def with K yin yang def and heat and choose something like Er > Xian Tang. And your assumption is that the Sp symptoms are 1. sp def > due to K yang def. 2. sp def due to wood invading earth, probably due > to qi stagnation secondary to liver yin/blood def, how do you manage > the dosage of the sp herbs. I am trying to see if there is a > difference in taking Yin fire approach and what I see as normal > formula alteration. > > Also thinking of a typical patient what would be the maximum > treatment principles you would combine and how due you prioritize the > formula.> > Thanks Alon> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 STRONG LINK DETECTED BETWEEN LOW BONE MASS AND VERBAL MEMORY IMPAIRMENTResearchers have uncovered a strong link between low bone mineraldensity and verbal memory impairment in a cross-sectional study of 4304elderly subjects.http://orthopedics.medscape.com/44572.rhtml?srcmp=orth-110201<a href="http://orthopedics.medscape.com/44572.rhtml?srcmp=orth-110201">Read it Here</a>>>>Another nice TCM correlation, So we now have correlation with hearing loss and memory Alon - pemachophel2001 Friday, November 02, 2001 8:35 AM Re: Headache Case Michael,Thanks for providing more detail about your case. From my estimation, you've provided enough new detail to say some things pretty conclusively. However, I think there are also some grey areas which I would want clarified if this were my patient. What I think we can say conclusively is that there is 1) a liver-spleen disharmony as evidenced by the irritability, "tight" pulse (which I bet I would identify as xian mai, stringlike or bowstring), abdominal symptoms, cold hands and feet, and defecatory pattern. Also, having more energy in the A.M. and feeling worse (fatigued?) in the evening also suggests spleen vacuity. I think we need you to ask some more questions here about fatigue and energy level. 2)Given the patient's age, it looks likely that this liver-spleen disharmony has evolved into a spleen-kidney yang vacuity, as evidenced by the chills and general coldness and low back pain. However, to pin this down, at least in my mind, we need to know if A) the patient wears socks to bed at night (at least in winter), and B) there has been a decrease in her libido. Positive answers to these two questions or even only B would indicate, at least to me, not just a spleen vacuity but a spleen-kidney yang vacuity. 3) I think we also know for sure that there is blood stasis, as evidenced by the fixed pain, stabbing pain, purple tongue, and dark, clotty menstruate. 4) If the pulse is truly 120bpm, then there is some kind of heat. The main candidates would be depressive heat, vacuity heat, phlegm heat, and/or damp heat. Given the age, fine pulse, and the tendency towards matitudinal insomnia, it looks likely there is a liver blood and possibly a kidney yin vacuity. To conclusively pin this down, you would need to ask some more questions. In particular, we need to know exactly what she means by minimal perimenopausal symptoms. Hot flashes? Night sweats? Night sweats would go a long way to confirming yin vacuity with vacuity heat.What is not quite clear is the meaning of the tongues sings you've recorded. They might indicate there is damp heat in the lower burner. I know the fur is not yellow. However, the fur does not need to be yellow if damp heat is due to spleen vacuity, and damp heat often becomes bound with stasis and stagnation (i.e., blood stasis and liver depression qi stagnation). However, these tongue signs may also be pointing to phlegm, dampness, and turbidity. In any case, we need to further clarify the role of any phlegm, dampness, and turbidity in this case. This is important since phlegm, blood stasis, and yin vacuity are all mutually engendering.I think you also need to ask more questions about the previous Chinese medical pattern discrimination and treatment for anxiety. What exactly did the patient mean by anxiety? As you can see from James Lake's and my Chinese Medical Psychiatry, anxiety may be due to heart-gallbladder qi timidity (really meaning a liver-spleen-stomach disharmony resulting in the engenderment of phlegm and the nonconstruction and malnourishment of the heart spirit), a simple heart-spleen dual vacuity, a kidney vacuity, and/or some sort of heat evils harassing the heart spirit. Knowing the patient's previous diagnosis and what the treatment was that sucessfully treated her condition might further clarify her overall constellation of patterns. For instance, is there a heart qi and blood vacuity? Is there phlegm? Is that what the tongue fur is indicating.So I'm going to throw the ball back in your court, Michael, to see if you can requestion the patient and get further clarity on these issues. If so, I'm still willing to write that sample Rx.As it happens, I do think this case is an example of a yin fire scenario. In this case, I think the upper back, neck, and shoulder tension are a good example of yin fire or yang qi (Li would say lifegate fire) being shifted from the heart to the hand and foot tai yang channels and the du as described by Li and Zhu. In my personal clinical experience, simply addressing this kind of upper back, neck, and shoulder tension (with acupuncture) as counterflow qi shifted from the liver to the shao yang does not get adequate treatment results. If we were to accept, Li-Zhu theory on this type of upper back, neck, and shoulder tension, then, in terms of acupuncture, we would need to treat the chong mai. However, I have written at length on this elsewhere (viz. Free Articles, www.bluepoppy.com & /or www.chinesemedicalpsychiatry.com). You can also read about this disease mechanism in Blue Poppy Press translations of the Pi Wei Lun, Ge Zhi Yu Lun, and Dan Xi Xin Fa Zhi Yao.Although we're not quite there yet, I do believe, from my point of view, that we are closing in.Bob , mbuyze@h... wrote:> James, Bob, Alon, Jean and group:> > Thanks for the reply, sorry for the slight delay in getting > additional information to you. Details follow:> > PATIENT: 47 y.o. female> MAJOR COMPLAINT: Recurring Headaches related to ovulatory aspect of > menstrual cycle> HISTORY OF PRESET ILLNESS: Headaches began 3 years ago and have been > recurring regularly at about day 14 of her cycle and consistently > lasting for 2 days keeping her from her normal ADLs. The headache is > typically a stabbing pain behind her eyes. Accompanying symptoms > include achiness in the neck, shoulders, and upper back. She also > gets chills, indigestion, insomnia (primarily due to pain), low back > pain, and is unable to concentrate. These symptoms seem to be > triggered by ovulation, which she feels as a heaviness in her mid-> section with downward movement. She has seen her physician regarding > these headaches. She was tested for menopause at that time and > assured that she is still pre-menopausal. She was given no other > explanation for her symptoms. She has cold hands and feet much of the > time and feels cold in general.> ADDITIONAL COMPLAINTS: None> OTHER MEDICIAL HISTORY: Her record indicates an ancient history of > minor anxiety in the past for which she saw another acupuncturist in > this office, but this was not discussed. > MEDICATIONS: Rx: None; OTC: None; Vitamins/Supplements: Multi > vitamin, B-complex (on occasion), Vitamin C, Vitamin E, Calcium, and > Aloe Vera> ALLERGIES: Penicillin, Sulfa> DIETARY HABITS: No special diet, she eats 3 meals per day with 4 > servings of fruits & vegetables and 6 glasses of filtered water. She > eats in restaurants 1-2 times per week. She eats red meat once per > week, poultry twice per week, and fish once per week. She reports her > current weight to be 138 lbs. This is her highest adult weight. Her > lowest adult weight was 115 lbs. at age 20. She has no history of > dieting.> DIGESTION & ELIMINATION: She experiences bloating mid-cycle as > described above and the couple days before the onset of menstruation. > She stools less than once per day, about 5 times per week. Stool is > soft-formed. She develops constipation about once per month and has > no diarrhea or urination problems.> SLEEP: She sleeps about 7.5 hours per night and reports no difficulty > falling asleep with occasional difficulty staying asleep. She does > not get up to urinate at night. She rates the overall quality of her > sleep as 8 (0-10 scale), feeling best mid-morning and worst in the > late evening.> LIFESTYLE: She is the manager of a stockroom at a state university > and also does massage on a part-time basis. She does not use tobacco > and rarely uses alcohol, as she does not tolerate it well. She drinks > 2 cups of coffee per day. She walks regularly and also does either > yoga or qi gong.> OB/GYN: Para 3, Gravida 3, she continues to have regular menstrual > periods. Menses is dark in color with clots. She denies cramping, but > does complain of irritability and bloating in the last couple days > before the onset of menses. She has had some minimal menopausal > symptoms, which she does not detail. She is not on hormone > replacement or birth control pills.> EXAMINATION: Well-developed, well-nourished white female appearing > approximately her stated age in no apparent distress. Tongue is > slightly bluish in color with a thick white coat that is moist > overall and slimy towards the back. Pulse is rapid at 120 bpm, thin > and tight.> > > Thanks in advance for the assistance. The above reflects the > information I routinely collect via health hx questionaire and > intitial interview. If my information is deficient in any area, I > would appreaciate that feedback also.> > Bob: regarding your comment about the chong mai. Yes, intially I am > thinking more in acupuncture terms. My herb work to date has been > classic formulas with additions. I am just getting into subtractions > and building formulas using single herbs, so this is a learning > experience for me.> > Thanks again,> > MichaelChinese 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 November 2, 2001 Report Share Posted November 2, 2001 , pemachophel2001 wrote: > Michael, > > Thanks for providing more detail about your case. From my > estimation, you've provided enough new detail to say some things > pretty conclusively. However, I think there are also some grey areas > which I would want clarified if this were my patient. > I will be seeing this patient for acupuncture on Wednesday. If I can get the info before then I will, otherwise I will get it then. In particular I will determine the Kidney Yang issue with socks to bed and decreased libido questions, have her better describe her fatigue and energy level, and get at the Yin vacuity/vacuity heat with a better description of her menopausal symptoms. As far as the anxiety treatment. She did not bring this up. It only came to my attention after she had left. Unfortunately, my predecessor at this particular clinic did not find it necessary to document his assessments and treatment plans, only the acupuncture points used ...illegibly at that! So we there won't be any hints from his work. > 4) If the pulse is truly 120bpm, then there is some kind of heat. While I don't have alot of experience in TCM, I do in counting pulses (from 13 years in exercise physiology). Indeed it was 120. My thoughts were that this may be a temporary anomaly due to nervousness as she was about to have her first acupuncture treatment from me. I will reassess that also when I see her again. (How do you view this type of response with regard to nervousness? Is it a pathological indicator if it only occurs the one time when she was nervous?) Bob, you also made a point about yin fire, it must have been in the post to Alon, because I cannot find it here. Anyway, I found it interesting that she had a strong facial flushing reaction to the acupuncture treatment almost immediately upon insertion of the needles. This included significant redness in the cheeks and she reported feeling a strong sense of heat rising to her face. I will post the additional info as soon as I have it. Thanks again, Michael Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2001 Report Share Posted November 3, 2001 While I don't have alot of experience in TCM, I do in counting pulses (from 13 years in exercise physiology). Indeed it was 120. >>>significant qi blood deficiency can also cause a fast pulse regardless of heat. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2001 Report Share Posted November 3, 2001 Hi,Michael, I have to applogize first.Because the information you provide didn't follow the four steps of TCM, so,I can't provide clear suggestion. In WM view,I suggest your patient do EKG and Thiroid and oval exam.Did she get hypertension? Her heart bit rate is not normal.Maybe heart disease or others. In TCM view,your patient seems got something about liver yin and heart yin extremely insufficency.and maybe plus kindey yin,too.The blood and Qi problem and blood gain more. I guess.I need more clear information in TCM way. Jean ===== -------------------------------- < ¨C¤Ñ³£ ©_¼¯ > www..tw Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 Bob: Below are the questions you asked and the information I obtained at her most recent acupuncture session. , pemachophel2001 wrote: >I think we need you to ask some more questions here about fatigue and energy level. She feels tired as the day goes on. She doesn't really like her job (storeroom manager at a state university), but the pay and benefits preclude her from leaving. She also practices massage on a part-time basis. She finds this work very fulfilling, but doesn't believe she would be able to make a living at it at this time. She works 40 hours per week in the storeroom during the school year and very part-time in the summers. She also has 3 teenage children and a husband who works long hours requiring to take on the majority of responsibility for managing the household. >2)Given the patient's age, it looks likely that this liver-spleen > disharmony has evolved into a spleen-kidney yang vacuity, as evidenced by the chills and general coldness and low back pain. >However, to pin > this down, at least in my mind, we need to know if A) the patient > wears socks to bed at night (at least in winter), and B) there has > been a decrease in her libido. Response: She does not wear socks to bed. She has noticed a decrease in her sex drive in the past few years. She further noted that the first acupuncture treatment seemed to stimulate her sex drive a bit. >Positive answers to these two questions > or even only B would indicate, at least to me, not just a spleen > vacuity but a spleen-kidney yang vacuity. > > 3) I think we also know for sure that there is blood stasis, as > evidenced by the fixed pain, stabbing pain, purple tongue, and dark, > clotty menstruate. > > 4) If the pulse is truly 120bpm, then there is some kind of heat. The > main candidates would be depressive heat, vacuity heat, phlegm heat, > and/or damp heat. Given the age, fine pulse, and the tendency towards > matitudinal insomnia, it looks likely there is a liver blood and > possibly a kidney yin vacuity. To conclusively pin this down, you > would need to ask some more questions. In particular, we need to know > exactly what she means by minimal perimenopausal symptoms. Hot > flashes? Night sweats? Night sweats would go a long way to confirming > yin vacuity with vacuity heat. > Response: Her pulse was 120 again today. She stated that it gets fast when she is nervous, which she denied being today. She describes her " perimenopausal symptoms " as inconsistencies in her menstrual bleeding (e.g. heavy, then light or stop, then heavy). She also notes more clotting. She denies hot flashes or night sweats. She does have episodes of feeling warm at night w/o sweat, just the urge to throw off all the bed covers, but these are rather infrequent occurring once every couple months. > What is not quite clear is the meaning of the tongues sings > you've recorded. They might indicate there is damp heat in the lower > burner. I know the fur is not yellow. However, the fur does not need > to be yellow if damp heat is due to spleen vacuity, and damp heat > often becomes bound with stasis and stagnation (i.e., blood stasis and > liver depression qi stagnation). However, these tongue signs may > also be pointing to phlegm, dampness, and turbidity. In any case, we > need to further clarify the role of any phlegm, dampness, and > turbidity in this case. This is important since phlegm, blood stasis, > and yin vacuity are all mutually engendering. > > I think you also need to ask more questions about the previous Chinese > medical pattern discrimination and treatment for anxiety. What > exactly did the patient mean by anxiety? Response: As I indicated in a seperate response, the acupuncturist who treated her really didn't document a diagnosis or treatment plan and his hand wrinting on the treatment he performed is mostly illegible. Based on her recollection, the anxiety occurred 4 years ago and was her 2nd bout with anxiety/depression. (The first bout occurred earlier, she sought western treatment and found it to be totally unsatisfactory. Therefore she opted to persue alternatives in this 2nd bout.) She was diagnosed with restless leg syndrome at this time and recalls sensations of heat, especially in the lower half of her body. She also developed significant low back pain at this time which resolved only to recur recently. The anxiety she felt was debilitating and interfered with her normal functioning for more than a year. She refers to this time as " dark nights of the soul " . She eventually overcame this with meditation, yoga, qi gong and counseling. As you can see from > James Lake's and my Chinese Medical Psychiatry, anxiety may be due to > heart-gallbladder qi timidity (really meaning a liver-spleen- stomach > disharmony resulting in the engenderment of phlegm and the > nonconstruction and malnourishment of the heart spirit), a simple > heart-spleen dual vacuity, a kidney vacuity, and/or some sort of heat > evils harassing the heart spirit. Knowing the patient's previous > diagnosis and what the treatment was that sucessfully treated her > condition might further clarify her overall constellation of patterns. > For instance, is there a heart qi and blood vacuity? Is there phlegm? > Is that what the tongue fur is indicating. > > So I'm going to throw the ball back in your court, Michael, to see if > you can requestion the patient and get further clarity on these > issues. If so, I'm still willing to write that sample Rx. > > As it happens, I do think this case is an example of a yin fire > scenario. In this case, I think the upper back, neck, and shoulder > tension are a good example of yin fire or yang qi (Li would say > lifegate fire) being shifted from the heart to the hand and foot tai > yang channels and the du as described by Li and Zhu. In my personal > clinical experience, simply addressing this kind of upper back, neck, > and shoulder tension (with acupuncture) as counterflow qi shifted from > the liver to the shao yang does not get adequate treatment results. If > we were to accept, Li-Zhu theory on this type of upper back, neck, and > shoulder tension, then, in terms of acupuncture, we would need to > treat the chong mai. However, I have written at length on this > elsewhere (viz. Free Articles, www.bluepoppy.com & /or > www.chinesemedicalpsychiatry.com). You can also read about this > disease mechanism in Blue Poppy Press translations of the Pi Wei Lun, > Ge Zhi Yu Lun, and Dan Xi Xin Fa Zhi Yao. > > Although we're not quite there yet, I do believe, from my point of > view, that we are closing in. > > Bob Response: In discussing heat sensation with her, she stated that she is usually cold, but there are times when heat just seems to break through and she gets very warm. Thanks again for your assitance. I look forward to your response. Michael Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2001 Report Share Posted November 8, 2001 Michael, I wish I could say that you've filled in the blanks to the point where I'd be willing to write a sample Rx. Unfortunately, I don't think we're there yet. As I frequently tell people, Chinese medicine is " village medicine " as opposed to long distance medicine. To do a pattern discrimination, there's no substitute for seeing the patient live. Given the patient's age, sex, decreased libido, and her general cold symptoms, I still suspect there is an element of kidney yang vacuity beyond the obvious spleen qi vacuity. I also feel confident there is heat here as well, but I don't think you've aksed either enough or the right questions to elucidate exactly what kind of heat we're talking about. I would say it's either vacuity or damp heat or a combination of both, which is not unusual. The persistent heat of damp heat can damage and consume yin, while the dampness of damp heat binds up fluids in an evil form, preventing them from playing their righteous role of enriching and moistening. In any case, I don't feel comfortable making suggestions about this woman's treatment given the current grey areas of her pattern discrimination. As a kind of aside, Alon remarked that one could have a rapid pulse due to qi vacuity without heat. According to Li-Zhu yin fire theory, if the spleen becomes vacuous and weak, the central qi may fail downward to the lower burner where it becomes depressed. If this depression transforms heat, then there is yin fire. So from this point of view, there is heat when there is a rapid pulse due to qi vacuity -- depressive heat. That being said, I do not think that's the kind of heat you're dealing with here. Good luck and best wishes, Bob , mbuyze@h... wrote: > Bob: > > Below are the questions you asked and the information I obtained at > her most recent acupuncture session. > > , pemachophel2001 wrote: > >I think we need you to ask some more questions here about fatigue > and energy level. > > She feels tired as the day goes on. She doesn't really like her job > (storeroom manager at a state university), but the pay and benefits > preclude her from leaving. She also practices massage on a part-time > basis. She finds this work very fulfilling, but doesn't believe she > would be able to make a living at it at this time. She works 40 hours > per week in the storeroom during the school year and very part-time > in the summers. She also has 3 teenage children and a husband who > works long hours requiring to take on the majority of responsibility > for managing the household. > > > > >2)Given the patient's age, it looks likely that this liver-spleen > > disharmony has evolved into a spleen-kidney yang vacuity, as > evidenced by the chills and general coldness and low back pain. > >However, to pin > > this down, at least in my mind, we need to know if A) the patient > > wears socks to bed at night (at least in winter), and B) there has > > been a decrease in her libido. > > Response: She does not wear socks to bed. She has noticed a decrease > in her sex drive in the past few years. She further noted that the > first acupuncture treatment seemed to stimulate her sex drive a bit. > > >Positive answers to these two questions > > or even only B would indicate, at least to me, not just a spleen > > vacuity but a spleen-kidney yang vacuity. > > > > 3) I think we also know for sure that there is blood stasis, as > > evidenced by the fixed pain, stabbing pain, purple tongue, and > dark, > > clotty menstruate. > > > > 4) If the pulse is truly 120bpm, then there is some kind of heat. > The > > main candidates would be depressive heat, vacuity heat, phlegm > heat, > > and/or damp heat. Given the age, fine pulse, and the tendency > towards > > matitudinal insomnia, it looks likely there is a liver blood and > > possibly a kidney yin vacuity. To conclusively pin this down, you > > would need to ask some more questions. In particular, we need to > know > > exactly what she means by minimal perimenopausal symptoms. Hot > > flashes? Night sweats? Night sweats would go a long way to > confirming > > yin vacuity with vacuity heat. > > > Response: Her pulse was 120 again today. She stated that it gets fast > when she is nervous, which she denied being today. She describes > her " perimenopausal symptoms " as inconsistencies in her menstrual > bleeding (e.g. heavy, then light or stop, then heavy). She also notes > more clotting. She denies hot flashes or night sweats. She does have > episodes of feeling warm at night w/o sweat, just the urge to throw > off all the bed covers, but these are rather infrequent occurring > once every couple months. > > > What is not quite clear is the meaning of the tongues sings > > you've recorded. They might indicate there is damp heat in the > lower > > burner. I know the fur is not yellow. However, the fur does not > need > > to be yellow if damp heat is due to spleen vacuity, and damp heat > > often becomes bound with stasis and stagnation (i.e., blood stasis > and > > liver depression qi stagnation). However, these tongue signs may > > also be pointing to phlegm, dampness, and turbidity. In any case, > we > > need to further clarify the role of any phlegm, dampness, and > > turbidity in this case. This is important since phlegm, blood > stasis, > > and yin vacuity are all mutually engendering. > > > > I think you also need to ask more questions about the previous > Chinese > > medical pattern discrimination and treatment for anxiety. What > > exactly did the patient mean by anxiety? > > Response: As I indicated in a seperate response, the acupuncturist > who treated her really didn't document a diagnosis or treatment plan > and his hand wrinting on the treatment he performed is mostly > illegible. Based on her recollection, the anxiety occurred 4 years > ago and was her 2nd bout with anxiety/depression. (The first bout > occurred earlier, she sought western treatment and found it to be > totally unsatisfactory. Therefore she opted to persue alternatives in > this 2nd bout.) She was diagnosed with restless leg syndrome at this > time and recalls sensations of heat, especially in the lower half of > her body. She also developed significant low back pain at this time > which resolved only to recur recently. The anxiety she felt was > debilitating and interfered with her normal functioning for more than > a year. She refers to this time as " dark nights of the soul " . She > eventually overcame this with meditation, yoga, qi gong and > counseling. > > As you can see from > > James Lake's and my Chinese Medical Psychiatry, anxiety may be due > to > > heart-gallbladder qi timidity (really meaning a liver-spleen- > stomach > > disharmony resulting in the engenderment of phlegm and the > > nonconstruction and malnourishment of the heart spirit), a simple > > heart-spleen dual vacuity, a kidney vacuity, and/or some sort of > heat > > evils harassing the heart spirit. Knowing the patient's previous > > diagnosis and what the treatment was that sucessfully treated her > > condition might further clarify her overall constellation of > patterns. > > For instance, is there a heart qi and blood vacuity? Is there > phlegm? > > Is that what the tongue fur is indicating. > > > > So I'm going to throw the ball back in your court, Michael, to see > if > > you can requestion the patient and get further clarity on these > > issues. If so, I'm still willing to write that sample Rx. > > > > As it happens, I do think this case is an example of a yin fire > > scenario. In this case, I think the upper back, neck, and shoulder > > tension are a good example of yin fire or yang qi (Li would say > > lifegate fire) being shifted from the heart to the hand and foot > tai > > yang channels and the du as described by Li and Zhu. In my personal > > clinical experience, simply addressing this kind of upper back, > neck, > > and shoulder tension (with acupuncture) as counterflow qi shifted > from > > the liver to the shao yang does not get adequate treatment results. > If > > we were to accept, Li-Zhu theory on this type of upper back, neck, > and > > shoulder tension, then, in terms of acupuncture, we would need to > > treat the chong mai. However, I have written at length on this > > elsewhere (viz. Free Articles, www.bluepoppy.com & /or > > www.chinesemedicalpsychiatry.com). You can also read about this > > disease mechanism in Blue Poppy Press translations of the Pi Wei > Lun, > > Ge Zhi Yu Lun, and Dan Xi Xin Fa Zhi Yao. > > > > Although we're not quite there yet, I do believe, from my point of > > view, that we are closing in. > > > > Bob > > Response: In discussing heat sensation with her, she stated that she > is usually cold, but there are times when heat just seems to break > through and she gets very warm. > > Thanks again for your assitance. I look forward to your response. > > Michael Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2001 Report Share Posted November 9, 2001 Hi,Michael, I have to applogize first. I don't know should I provide you advice or not because you didn't follow the four steps doagnosis. Therefore,I don't know if my suggestion for her is good or bad, for both you and her. She seems over stressed,and because the time she suffer for the stress took a while,therefore,she got a very similar symptoms(much more heavier) as mine. 1.her blood yin is extreme not enough,this cause her liver yang go up(gan-yan-shan-kan) ,she got eyes area pain and heart bits faster.I also wonder she got anemia,not enough blood and liver yang goes up make her heart bits very fast. Liver has connected with eyes. 2.her age is near stop mens.Woman period problem always connected with liver yin and kidney yin. According to my experiences,TCM doctor in Taiwan suggest this type patient should use Gia-wei-shao-Yao-san(very useful for relax the anxilty and stress,and liver depression,Shao-yao means be happy in chinese),add liver yin and clean liver waste which might cause heart bit fast or hypertention. ) and Leo-wei-di-hung-won(tonic her kindney yin).I had these formulae for more than two years to recover my over stress symptoms. and I might add few long-dan-xie-gan-tang to reduce her liver yang goes up. Also,she have to reduce her stress if it is possible. Do more and more deep consider before you use these formulae. Jean ===== -------------------------------- < ¨C¤Ñ³£ ©_¼¯ > www..tw Quote Link to comment Share on other sites More sharing options...
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