tcm herbs & prednisone?

[Guest guest]

Hello,

 

This is my first time using this chatline - what a great idea!

I have a question for the group and welcome any responses. I am currently

seeing a patient who has been recently diagnosed with polymyalgia rheumatica

and has been taking 25 mg of prednisone daily for the past 2 monthes to help

manage her back pain, which is quite severe. My patient is 53 yrs old and

has a long history of Spleen and Kidney deficiency. I feel that prescribing

tcm herbs is important for helping build these systems in her body but am

unsure how they might interact with the prednisone.

 

Her case history is as follows:

 

cheif complaint - Urinary Strangury

-freq bladder infections started in early 20's, initially with no

pain, just urgency

-in early 30's diagnosed with interstitial cystitis, sympoms of

freq and pain then, on antibiotics for 2 yrs to manage cysts on

bladder but symptoms remained the same

-symptoms got worse with menopause (menses stopped 3 yrs ago)

-hystorectomy 2 yrs ago due to prolapse of uterus, and discomfort

with urination has been unbearable since

-spasm/burning pain in lower ab after urination (esp am)

-flow stops and starts, feels better with warmth

-no bacterial count

-no bearing down sensation

-urinate every 2 hrs during day/every 3-4 hrs @ night

-pain so intense and constant during early 2001 that she felt

suicidal

-multiple installations of Zilocaine, Cystistat and

hydro-distention have reduced pain to being managable but no

change in freq. (no longer suicidal)

 

low back pain -sudden onset in sept 2001

-woke up with intense ache in low back

-legs felt frozen and had to lift legs out of bed due to

pain, esp left side, radiating pain down back of legs

-intially had other symptoms of tidar fever, dry cough

with expectoration 1x daily of thick yellow mucous/blood,

and night sweats but these symptoms are no longer present

with prednisone

-hospitalized in mid Oct/01 for testing and was diagnosed

with polymyalgia rheumatica and given 30mg/day prednisone

-symptoms have improved with prednisone but cannot drop

below 25mg without pain intensifying

-sensation of loose tendons/instability in SI joint esp

left side

 

digestion - slow, feels full, reduced appetite

BM - alternate constipation and loose stools

energy - very low, fatigued

sleep - disrupted freq. by urination, otherwise ok

skin,hair,nails,ENT - ok

headaches, dizziness - ok

complexion - very pale, lifeless

body temp - always cold

emotions - more stable now, has some sense of hope

my impressions - she comes across of very dreary/heavy and is very soft

spoken

tongue - large teethmarks, pale body, moist clear coat

red tip with bumps and raw looking @ LU/H area

pulse - generally weak and soft feeling (sorry I'm not more specific,

my pulse taking is not great)

 

 

I have been doing acupuncture with her over the past 3 weeks and feel

confident with that, but am wondering about herbs. I generally work with

patents for patient compliance but can use powders to customize if needed.

The formulas i have been considering are:

 

Seperate Clear and Turbid - Three Treasures herb line

(modified Bi Xie Fen Qing Yin)

-bi xie, wu yao, yi zhi ren, shi chang pu, fu ling, gan

cao, huang qi, che qian zi, qu mai, bai shao, ba ji tian

 

OR

 

Wu Bi Shao Yao Wan - powdered

-shan yao, rou cong rong, tu si zi, ba ji tian, du zhong

shu di huang, shan zhu yu, niu xi, wu wei zi, chi shi zhi

ze xie, fu shen

 

Let me know if you have any thoughts on this case in regards to herbs,

especially if you have any insight/experience with prescribing herbs in

combination with predisone. My email address is tcmsteph

 

Thank you,

Stephanie Curran

 

 

 

 

 

 

 

 

 

 

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