Need help on case--Vaginal Discharge-please read

[Guest guest]

Warning: this is a long email with a case history in it.

 

Hi!

i posted information on this a while back but got no responses, so maybe it

didnt get through, or maybe I needed to post more information.

 

Anyway, I have been treating a 35 year old female for 5 months for a chief

complaint of " frequent yeast infections " . At her first visit, patient complained

of frequent " yeast " infections of approximately 6-9x a year. Since giving birth

in March of 2001, she felt that the frequency had increased.

 

I have been seeing this patient, as I said for 5 months. She has had improvement

in the sense that the frequency of vaginal infections has lessened but the

severity has not. These infections are characterized by 1-4 days of vaginal

redness and slight itchiness with no discharge, which then progresses to much

more severe, hot, extremely itchy, red vulva with white cottage cheese discharge

(in some instances, however, there is no discharge at all, just severe redness,

itchiness and burning). The patient says she wakes at night with the pain. Often

the patient will try to go without Western meds for a few days, doing yoghurt

douches, etc but in the end she often resorts to Monistat 7 day and Diflucan for

3-4 days because she can no longer bear the discomfort and pain. Even on these

western meds, it will often take 2 more weeks to resolve itself.

 

Anyway, since she has been seeing me, I have approached her from a couple of

different angles, with some limited success. Before i get into which formulas i

have used, i will give you her other sx.

 

Muscular: stiffness and not alot of flexibility despite 2 years of yoga

practice.

 

Sleep: solid, 6-8 hours a night, no trouble falling asleep or staying asleep.

 

thirst: prefers cool water, drinks 1-2 liters a day. Drinks because she's

" supposed to " but lately has been more thirsty.

 

Eyes adn ears; occasional tinnitus, also gets floaters in her eyes every couple

weeks.

 

body temp: (subjective) runs hot, but more recently has stated that in the night

she gets colder and likes covers. She ran cold before giving birth. Now she says

she " finds it hard to cool down " after slight movement, which makes her

inordinately warm.

 

bowels and digestion:2 soft but formed stools a day. No indigestion, a lot of

gas, no belching, no stomach pain. Patient has struggled to lose weight since

having child in March. about 40-50 pounds overweight. Gained 65 lbs during

pregnancy. In the last 2 months, has been following the Zone diet, with no to

low sugar, low carbs, few refined foods. Small amount of alcohol.

 

Exercise: works out 2-3 times a week, yoga and running.

 

Sweats: no night sweats, no unusual sweats otherwise.

 

Emotions: good, happy person. Fatigue since birth of child, but has nannies so

can sleep usually. Both parents died when she was 20, father was drug abuser.

Was divorced 4 years ago, remarried and is happy in current relationship.

 

Menses: was on pill for years prior to conception. Went off pill for 4 months

and used condom, then stoped all b/c and got pregnant within 2 months. She got

her period back 3 months following birht of child. Lost alot of blood (more than

normal) during childbirth. Gets slight PMS with irritability. She is back on BC

pills and last month did not bleed at the end of the packet of pills (is taking

pregnancy test just to be sure). Has had slight midcycle spotting since resuming

pills. Vaginal lubrication was insufficient following birth but feels it is

more normal now. Menstrual blood has slight clots, starts off brown and then

becomes brighter red. Short (3 days) on pill.

 

Headaches: gets occasional headaches midcycle, quite bad, behind temples. also

can get them around menses but not often.

 

Energy: mid afternoon slump. Feels she could always use some more sleep.

 

Tongue: bright red, slight to no coat, large red petechiae on tip, especially

when in middle of a yeast infection, dip in the lung to spleen area, thin and

pointy.

 

Pulse 68 bpm/ Deep in all positions. Mingmen is very deep and thin, spleen is

deep and slightly wiry, lung is less deep than spleen and kidney. Liver is deep

and soft, and then switches to deep and wiry. kidney yin pulse is deep and thin.

Left is stronger than right, but not much, *This is her pulse and tongue as of

the last visit, where she was in the midst of a TERRIBLE yeast infection and had

resorted to monistat on day 10.

 

During yeast infections, I supplement her internal formula with an external

douche. She believes (as do I ) that the douche is not that effective:

ku shen

huang bai

she chuang zi

jin yin hua

tu fu ling

bai bu

di fu zi

bai tou weng

 

For a while, the internal formuala during the infections was along the same

track as the external formula, and had such herbs as yi yi ren, huang bai, pu

gong ying, zi hua di ding, zhi zi, ku shen and niu xi. Her diagnosis during

these outbreaks is toxic heat in the lower jiao.

 

When she is not in the midst of an infection, my thinking, until this most

recent outbreak, has been that she has Liver and Kidney Yin Deficiency with

perhaps some Sp deficiency. Also I am beginning to think that there is Blood

Heat involved also. I have been treating her for 2 months with a raw formula

consisting of the following, with some variations in dosage and herbs. As of

last week, I requested that she increase the amount to what amounts to about 100

grams a day in decoction form

 

sheng di 15

shan zhu yu 12

shan yao 12

fu ling 9

ze xie 9

mu dan pi 9

zhi mu 9

huang bai 6

dang gui 12

bai shao 9

I actually am beginning to wonder if this is deficiency or excess heat. I think

that the liver and kidney yin deficiency is intimately linked with some blood

heat, although she has no other blood heat signs besides the pattern of her

vaginitis/infections and her tongue and her body temp during the day. Perhaps

what's going on here is heat entering the nutritive level. Etiologically

speaking, my sense is that the blood loss during pregnancy further exacerbated a

constitutional yin deficiency, leading to vacuity heat. Of course, this is just

a theory. Her tongue is definitely red, and there is very little coat, even when

in the midst of heavy discharge. Her pulse is definitely deep, and it's not

simply due to the fact that she is overweight (her wrists are actually quite

thin). But her pulse is not fast. She doesnt have night heat or night sweats.

She does not have the typical " yin deficiency " body (although while doing a home

visit recently, I caught site of a photo of her pre-pregnancy and she was much

thinn

er), her skin is not dry, she has no difficulty sleeping nor any anxiety or

palpitations She does state that when she gets irritable, which she does during

a vaginal outbreak, her face gets flushed and 'hot feeling " .

 

So i guess my first step is to go back to the basics and ask " is this excess or

deficiency " ? There are definitely elements of both, but I wonder if the heat

itself is excess or deficiency. My thinking at this moment is that Yin

deficiency led to blood heat or nutritive level heat, which is derived from

deficiency but manifests as excess (correct me if I am wrong here).

 

Would love to hear back. I want to write her formula Friday or Saturday, so

please ask any follow up questions-I will check my email tonight.

Thank you so much!

Hillary

[Guest guest]

Hi,Hillary,

 

I will provide some opinions if you are not so rush.

I am busy today.Maybe tomorrow (in Taiwan time).

I didn't read it yet.

 

Jean

 

 

=====

 

 

--------------------------------

< ¨C¤Ñ³£ ©_¼¯ > www..tw

[Guest guest]

Hillary-

 

Have her try an alternate form of contraception. The pill is notorious

for inducing chronic yeast infections with significant damage to the

vaginal walls and external vulva.

 

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

" Man is always worse than most people suspect, but also generally better

than most people dream. " --Reinhold Niebuhr

 

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[Guest guest]

At 1:09 AM -0500 11/2/01, Karen S Vaughan wrote:

>Have her try an alternate form of contraception. The pill is notorious

>for inducing chronic yeast infections with significant damage to the

>vaginal walls and external vulva.

--

 

Karen, I'd love to have a good reference for this. Do you have one?

 

Rory

--

[Guest guest]

Hi,Hillary,

 

Here comes suggestion.

 

These infections are characterized by 1-4 days of

vaginal redness and slight itchiness with no

discharge, which then progresses to much more severe,

hot, extremely itchy, red vulva with white cottage

cheese discharge

 

spleen dampness cost this,according to TCM theory.

 

why she doing (yoghurt douches) this?

Could white cottage cheese discharge are=same type

yeast?

 

 

 

 

Muscular: stiffness and not alot of flexibility

despite 2 years of yoga practice.

Sleep: solid, 6-8 hours a night, no trouble falling

asleep or staying asleep.

thirst: prefers cool water, drinks 1-2 liters a day.

Drinks because she's " supposed to " but lately has been

more thirsty.

 

health condition is not bad.Slightly stomach yin

insufficency.

 

Eyes adn ears; occasional tinnitus, also gets floaters

in her eyes every couple weeks.

(slightly blood insufficency)

 

bowels and digestion:2 soft but formed stools a day.

No indigestion,(normal)

 

a lot of gas(splenn dampness)

 

no belching, no stomach pain. Patient has struggled to

lose weight since having child in March. about 40-50

pounds overweight. Gained 65 lbs during pregnancy. In

the last 2 months

(over weight but healty)

 

, has been following the Zone diet(what is this?),

with no to low sugar, low carbs, few refined foods.

Small amount of alcohol.

 

Exercise: works out 2-3 times a week, yoga and

running.

(not bad)

Sweats: no night sweats, no unusual sweats otherwise.

(good)

 

Emotions: good, happy person. Fatigue since birth of

child, but has nannies so can sleep usually. Both

parents died when she was 20, father was drug abuser.

Was divorced 4 years ago, remarried and is happy in

current relationship.

(good)

 

Menses: was on pill for years prior to conception.

Went off pill for 4 months and used condom, then

stoped all b/c and got pregnant within 2 months. She

got her period back 3 months following birht of child.

Lost alot of blood (more than normal) during

childbirth. Gets slight PMS with irritability. She is

back on BC pills and last month did not bleed at the

end of the packet of pills (is taking pregnancy test

just to be sure). Has had slight midcycle spotting

since resuming pills. Vaginal lubrication was

insufficient following birth but feels it is more

normal now.

(normal)

 

Menstrual blood has slight clots, starts off brown and

then becomes brighter red. Short (3 days) on pill.

(almost normal)

 

Headaches: gets occasional headaches midcycle, quite

bad, behind temples. also can get them around menses

but not often.(slightly problem)

 

Energy: mid afternoon slump. Feels she could always

use some more sleep. (symdrome fit the formula I will

provide below)

 

Tongue: bright red, slight to no coat, large red

petechiae on tip, especially when in middle of a yeast

infection, dip in the lung to spleen area, thin and

pointy.(spleen dampness affect lung slightly)

 

Pulse 68 bpm/ Deep in all positions.(fat people's

pulse deep sometimes)

 

Mingmen is very deep and thin(normal,very very

slightly

insufficiency) spleen is deep and slightly

wiry(slightly liver-spleen-bu-he),

lung is less deep than spleen and kidney(normal).

Liver is deep and soft(slightly blood not enough),

and then switches to deep and wiry(normal liver

pulse). kidney yin pulse is deep and thin(normal as

above mentioned). Left is stronger than right, but not

much(normal),

 

>has been that she has Liver and Kidney Yin Deficiency

with perhaps some Sp deficiency.

 

According to TCM theory,this patient is spleen

dampness cost Bai(white discharge)-Di ,and it is not

yellow-Di yet.Therefore, zhi mu, huang bai is not

needed.

 

Wan-Di-Tang(Fu-qing-zhe gynecology)

 

bai2 zhu2 30g soil stir-fry

shan yao4 30g stir-fry

bai2 shao3 15g wine stir-fry

ren2 sen2 6g

Che-qianw zi 9g wine stir-fry

cang zhu2 9g

Gan cao3 3g

Chen2-pi 2g

Hei-jie4-sui4 2g

Cai2-hu2 2g

 

Dose is cite from textbook;you might add some herbs or

change dosage for increase blood and others.

 

>Thank you so much!

Hillary

 

you are always welcome!!Haa!

 

Jean

 

 

 

=====

 

 

--------------------------------

< ¨C¤Ñ³£ ©_¼¯ > www..tw

[Guest guest]

Thank you for suggesting that she try other forms of b/c. I have suggested it to

her, but she is not interested in other forms. Do you have any literature that I

might access that substantiates this connection? If I could show her this, it

might help.

 

thanks

[Guest guest]

Hillary-

 

I'll try to find some references. The mechanism is that the pill changes

the normal acidic pH of the vagina, making it more hospitable to yeast

(and less hospitable to the intravaginal lactobacillus cultures she has

been trying to introduce.)

 

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

" Man is always worse than most people suspect, but also generally better

than most people dream. " --Reinhold Niebuhr

 

______________

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[Guest guest]

Julia Chang's website contains information about birth control pills and

their effects. I offer it with reservations, as I do not know how

to verify her information. Still, I have found any information on

this topic hard to come by and would appreciate hearing about other sources.

http://jchang/#Topics

Karen S Vaughan wrote:

Hillary-

I'll try to find some references. The mechanism is that the

pill changes

the normal acidic pH of the vagina, making it more hospitable to

yeast

(and less hospitable to the intravaginal lactobacillus cultures

she has

been trying to introduce.)

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

"Man is always worse than most people suspect, but also generally

better

than most people dream."--Reinhold Niebuhr

______________

GET INTERNET ACCESS FROM JUNO!

Juno offers FREE or PREMIUM Internet access for less!

Join Juno today! For your FREE software, visit:

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Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate academics

specializing in Chinese Herbal Medicine, provides a variety of professional

services, including board approved online continuing education.

 

 

[Guest guest]

I don't have a current copy of it, but there is a book updated every two

years, Contraceptive Technology Update. The main editor is Robert Hatcher,

MD. It's a great resource for all the most current information on

effectiveness of contraceptive techniques, their user failure rates, etc. It

also includes mechanisms of action and side effects. I am pretty sure you'd

find the information regarding the effect of oral contraception on the

vaginal pH and how it can result in yeast infections. This book would be

most easily located in a university library.

 

As an aside, a second problem with oral contraceptives is that they alter

the way a woman absorbs and metabolizes B vitamins, which is why depression

is often listed as a side effect of OCs. The " in the know " physicians will

often recommend a good B complex vitamin in conjunction with OCs, but the

sad truth is that most physicians don't even recognize this fact when

prescribing. This is information that we as TCM practitioners are in a good

place to share with our patients who have been prescribed OCs and have no

idea why they're so down.

 

Jeff

 

 

>Karen S Vaughan <creationsgarden

>

>

>Re: Need help on case--Vaginal

>Discharge-please read

>Sun, 4 Nov 2001 20:02:21 -0500

>

>Hillary-

>

>I'll try to find some references. The mechanism is that the pill changes

>the normal acidic pH of the vagina, making it more hospitable to yeast

>(and less hospitable to the intravaginal lactobacillus cultures she has

>been trying to introduce.)

>

>Karen Vaughan

>CreationsGarden

>***************************************

>Email advice is not a substitute for medical treatment.

> " Man is always worse than most people suspect, but also generally better

>than most people dream. " --Reinhold Niebuhr

>

>______________

>GET INTERNET ACCESS FROM JUNO!

>Juno offers FREE or PREMIUM Internet access for less!

>Join Juno today! For your FREE software, visit:

>http://dl.www.juno.com/get/web/.

 

 

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[Guest guest]

Francis-

 

I didn't see information on BC pills on her site, and I read through the

articles on endometriosis, infertility and the liver. Which article?

 

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

" Man is always worse than most people suspect, but also generally better

than most people dream. " --Reinhold Niebuhr

 

______________

GET INTERNET ACCESS FROM JUNO!

Juno offers FREE or PREMIUM Internet access for less!

Join Juno today! For your FREE software, visit:

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[Guest guest]

She may have changed her website articles. I last read it a year

ago. But what do you think of her information?

Frances

Karen S Vaughan wrote:

Francis-

I didn't see information on BC pills on her site, and I read through

the

articles on endometriosis, infertility and the liver. Which

article?

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

"Man is always worse than most people suspect, but also generally

better

than most people dream."--Reinhold Niebuhr

______________

GET INTERNET ACCESS FROM JUNO!

Juno offers FREE or PREMIUM Internet access for less!

Join Juno today! For your FREE software, visit:

http://dl.www.juno.com/get/web/.

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.