Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 Steve: Here are some therapeutic options. Best of luck to you and your patient. Will According to Professor Ming Dingjie: When the lesion is in the kidney, Warm the Yang, Expel Wind, and Benefit the Kidney. Xien Ling Pi is the base formula for this: Aconite carmichaeli (Zhi Chuan Wu), Lycopodium clavatum (Shen Jin Cao), Scrophularia ningpoensis (Xuan Shen), Glycyrrhiza uralensis (Gan Cao), Cinnamomi cassia Ramulus (Gui Zhi), Atractylodes alba (Bai Zhu), Astragalus membranaceus(Huang Qi), Coicis lachryma-jobi (Yi Yi Ren), Achyranthes bidentatae (Niu Xi),Chaenomeles lagenaria (Mu Gua). Modification for Yang Deficiency:subtract Scrophularia ningpoensis (Xuan Shen). Add Achyranthes bidentatae (NiuXi), Cistanches salsa (Rou Cong Rong), Eucommia ulmoidis (Du Zhong), Aconitecarmichaeli (Fu Zi). Modification for Yin Deficiency:increase Scrophularia ningpoensis (Xuan Shen) and add Rehmannia glutinosae Raw(Sheng Di Huang). Proteinuria: add Astragalusmembranaceus (Huang Qi), Atractylodes alba (Bai Zhu), Zea mays (Yu Mi Shu),Coicis lachryma-jobi Radix (Yi Yi Ren Gen), and Blackbeans. Elevated BUN: Add Achyranthes bidentatae (Niu Xi),Chaenomeles lagenariae (Mu Gua). From studies in the practical Surgery of published in the OHAI Journal (Hsu HY. OHAI Bulletin. March1982; 7(2); 34-40Mic) 1.For Spleen-Kidney Yang Deficiency useEucommia and Rehmannia Formula (You Gui Wan) as general treatment. A specificformula used contains Curculiginis orchioides (Xian Mao) 15g, Epimediumsagittatum (Yin Yang Huo) 15g, Cuscuta chinensis (Tu Si Zi) 15g, Cynomoriumcoccineum (Suo Yang) 9g, Atractylodes alba (Bai Zhu) 9g, Codonopsis pilosula(Dang Shen) 9g, Smilax glabra (Tu Fu Ling) 30g, Glycerrhizae uralensis (GanCao) 6g, Antelopis cornu (Ling Yang Jiao) 3g. Goat horn is a possiblereplacement for antelope. 2.For yin deficient internal heat useRehmannia glutinosae (Shou Di Huang) 18g, Scrophularia ningpoensis (Xuan Shen)12g, Ophiopogon japonicus (Mai Men Dong) 12g, Peonia alba (Bai Shao) 9g,Testudinis plastrum (Gui Ban) 18g, Lycium chinensis (Gou Qi Zi) 15g,Anemarrhena asphodeloides (Zhi Mu) 9g, Phellodendron amurense (Huang Bai) 9g,Smilax glabra (Tu Fu Ling) 30g, Rubus parvifolius (Ci Bo) 15g, Glycyrrhizaeuralensis (Gan Cao) 3g. 3.For Excess Toxic Heat use Rehmanniaglutinosae Fresh (Sheng Di Huang) 30g, Peonia alba (Bai Shao) 12g, Moutanradicis (Mu Dan Pi) 9g, Gypsum fibrosum (Shi Gao) 30g, Anemarrhenaasphodeloides (Zhi Mu) 9g, Isatis tinctoris (Ban Lan Gen) 9g, Lithospermumerythrorhizon (Zi Cao) 9g, Glycerrhizae uralensis (Gan Cao) 3g. For severe aching of the joints, addPolygoni cuspidatum (Hu Chang) 15g and Clematis chinensis (Wei Ling Xian) 12g. For purpura, add Ecliptae prostratae(Han Lian Cao) 15g. As is true for most clinicalsituations, treat what you find. Patients have had remarkable improvement usingsimple patent Yin Tonics when appropriately indicated. In a message dated 1/14/02 5:12:11 AM Pacific Standard Time, skinner writes: I have a case of a woman 30 years old with systemic lupus. She has had a spleenectomy about a year and a half ago. She recently had her fourth child and is now having a lupus flare. Aches and pains and Nephritis. She is currently taken qualine( sp? an antimalarial), prednisone, and another immune suppressive drug. I feel a yin tonic based on rehmannia six would be helpful and a change in diet. But I have no experience(still a student)with lupus and would like some advice from the experts. Any advice will be greatly appreciated. Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 Rory - Thank you for clarifying this critical point.....Will I suggest in a complex and serious case such as this you ask a clinical supervisor to confirm your pattern ID Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 I have a case of a woman 30 years old with systemic lupus. She has had a spleenectomy about a year and a half ago. She recently had her fourth child and is now having a lupus flare. Aches and pains and Nephritis. She is currently taken qualine( sp? an antimalarial), prednisone, and another immune suppressive drug. I feel a yin tonic based on rehmannia six would be helpful and a change in diet. But I have no experience(still a student)with lupus and would like some advice from the experts. Any advice will be greatly appreciated. Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 Hi Steve, I am by far no expert, however could you please give more description... like whats going on with the Tongue & Pulse. Also how is her sleep, and digestion? Is she sensitive to light? How long has she been on immuosuppressants and predisone? How often does she get flare up? How is she emotionally? Thanks, Teresa - " Stephen Skinner " <skinner Monday, January 14, 2002 5:08 AM lupus nephritis > I have a case of a woman 30 years old with systemic lupus. > She has had a spleenectomy about a year and a half ago. > She recently had her fourth child and is now having a lupus flare. Aches and pains and > Nephritis. She is currently taken qualine( sp? an antimalarial), prednisone, and another > immune suppressive drug. I feel a yin tonic based on rehmannia six would be helpful and > a change in diet. But I have no experience(still a student)with lupus and would like some > advice from the experts. Any advice will be greatly appreciated. > Steve > > > > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 Steve, before anyone on this list should answer your question we will need a pattern differentiation for your patient. Either you should provide the data for us to do it, or you should tell us what it is. If the latter, you should provide us with a list of prominent symptoms/problems (other than those you've mentioned) and the tongue and pulse. I suggest in a complex and serious case such as this you ask a clinical supervisor to confirm your pattern ID (that should happen anyway). Rory >I have a case of a woman 30 years old with systemic lupus. >She has had a spleenectomy about a year and a half ago. >She recently had her fourth child and is now having a lupus flare. >Aches and pains and >Nephritis. She is currently taken qualine( sp? an antimalarial), >prednisone, and another >immune suppressive drug. I feel a yin tonic based on rehmannia six >would be helpful and >a change in diet. But I have no experience(still a student)with >lupus and would like some >advice from the experts. Any advice will be greatly appreciated. >Steve -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2002 Report Share Posted January 14, 2002 Along with the need for pattern diagnosis, I see a major red flag here: the immunosuppressive medication. We need to know which one. There may be a problem of interaction of Chinese and Western medicinals, so be cautious before giving herbs to this patient. While there are protocols for treating patients on steroidal drugs such as prednisone, it is much more hairy for drugs such as cyclosporine, as Chinese medical treatment may neutralize the immunoosuppressive effect. While there are few if any studies on this, my clinical experience is that this is possible. I will not treat any patient with organ transplants or taking immunosuppressive drugs to cripple the immune response, when this is considered a main clinical goal from the biomedical point of view. On Monday, January 14, 2002, at 05:08 AM, Stephen Skinner wrote: > I have a case of a woman 30 years old with systemic lupus. > She has had a spleenectomy about a year and a half ago. > She recently had her fourth child and is now having a lupus flare. > Aches and pains and > Nephritis. She is currently taken qualine( sp? an antimalarial), > prednisone, and another > immune suppressive drug. I feel a yin tonic based on rehmannia six > would be helpful and > a change in diet. But I have no experience(still a student)with lupus > and would like some > advice from the experts. Any advice will be greatly appreciated. > Steve > > > > > > Chinese Herbal Medicine, a voluntary organization of licensed > healthcare practitioners, matriculated students and postgraduate > academics specializing in Chinese Herbal Medicine, provides a variety > of professional services, including board approved online continuing > education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2002 Report Share Posted January 17, 2002 , " " <zrosenbe@s...> wrote: > Along with the need for pattern diagnosis, I see a major red flag here: > > the immunosuppressive medication. > > We need to know which one. > > There may be a problem of interaction of Chinese and Western medicinals, > so be cautious before giving herbs to this patient. While there are > protocols for treating patients on steroidal drugs such as prednisone, > it is much more hairy for drugs such as cyclosporine, as Chinese medical > treatment may neutralize the immunoosuppressive effect. While there > are few if any studies on this, my clinical experience is that this is > possible. I will not treat any patient with organ transplants or taking > immunosuppressive drugs to cripple the immune response, when this is > considered a main clinical goal from the biomedical point of view. > Z'ev I am interested in the clinical experience you mention as well as theoretical reasoning regarding immunosupressants and Chinese medicinals. Given that such as cyclosporine is very interactive, for instance with grapefruit and St Johns Wort,certainly it would seem possible to neutralize its effect with Chinese herbs but despite this there might be some great benefits of joint WM CM treatment. My particular interest is that I have a transplanted kidney myself and have prehaps treated more than a usual number of kidney patients. In situations where there is little to lose, such as deteriorating Nephrotic syndrome or a failing transplant,its my observation that it is possible to use a wide range of herbs according to pattern differentiation with some advantage and without seeming to negate the immunosuppressant therapy. I know that that your terminology of a crippled immune response wasnt meant to be technically analysed but it isnt an accurate description of effect, particularly of the selective drugs, and it would be a shame to turn ones back on what might be a rewarding if difficult area where many mechanisms are at work. Prehaps herbal treatment will largely wait on biomedical analsis but I think that there is some room for cautious treating in deteriorating situations,in situations where one wants to reduce the side effects of the corticosteroid component of combined therapy, in cases where regular creatinine checks are available and prehaps post transplant,with an eye to preventing chronic rejection or the renewal of the original disease if autoimmune. Just to be clear about the query you were replying to it would seem to me to be inappropriate for a student to treat someone on such medication. Despite the enormous number of Chinese language journal articles on kidney disease, some including steroids, I have not seen any on integrated treatment with selective immunosuppressants so all thoughts and experience would be appreciated. Simon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2002 Report Share Posted January 18, 2002 Dear Simon, Your points are well taken. Part of my response was based on the fact that this was a student treating a patient with a transplant and using immunosuppressive medication, without giving a pattern diagnosis, pulse or tongue images or the name of the medication. It seems that many students and practitioners are way over their heads with the complexity and depth of many patients' disorders, leading to a lunging forward into the case without adequate preparation. While there is much material, both in Chinese and English, on combined Chinese-Western treatment when patients are on steroidal drugs, there is, as you point out, a lack of material on such immunosuppressents as cyclosporine. I also realize that immunosuppressent medications used in organ transplants do have some selectivity, and that there may be a possibility of using both systems together. At the present time, I have no protocols available, therefore I don't treat transplant patients as a rule. I am planning to do some research on cyclosporine, and will get back to you and the group on it soon. I do treat many patients on steroids, and have success in helping patients get off of these medications. I will also get input from some of my own teachers, and plug that in as well. My own experience that stands out was an early one, 1984. I had a young woman in her late 20's who had a kidney transplant, using prednisone and cyclosporine. She came to me with the hope of losing weight, and overcoming such symptoms as moon face. I gave her liu wei di huang wan, and treated her with acupuncture and moxa, points on the kidney and liver channels primarily. She had two treatments. After each treatment, she developed a fever and night sweating. After this reaction, I sent her to a physician for a blood test that confirmed that the treatment was interfering with the medications, causing a mild rejection response and fever. Since that time, I have avoided these clinical situations. I also do not treat dialysis patients, as my work has not been very effective, and it is difficult to give herbal medicines when there is the possibility of flushing them out via the machine, or concentrating mineral salts in the kidneys. However, I do have on-going cases of care of two or three patients who were candidates for dialysis because of low kidney function, and they have maintained with Chinese medical treatment. One has been stable for seven years since having been recommended dialysis seven years ago (she was born with one kidney). I have been looking over, slowly, a Chinese text: Shi yong zhong yi shen bing xue/Complete Study of Chinese Medical Treatment of Kidney Disease " . Miki Shima turned me on to it. You might find this book interesting. On Thursday, January 17, 2002, at 02:53 PM, dallaskinguk wrote: > > Z'ev > > I am interested in the clinical experience you mention as well as > theoretical reasoning regarding immunosupressants and Chinese > medicinals. Given that such as cyclosporine is very interactive, for > instance with grapefruit and St Johns Wort,certainly it would seem > possible to neutralize its effect with Chinese herbs but despite this > there might be some great benefits of joint WM CM treatment. My > particular interest is that I have a transplanted kidney myself and > have prehaps treated more than a usual number of kidney patients. In > situations where there is little to lose, such as deteriorating > Nephrotic syndrome or a failing transplant,its my observation that it > is possible to use a wide range of herbs according to pattern > differentiation with some advantage and without seeming to negate the > immunosuppressant therapy. > I know that that your terminology of a crippled immune response > wasnt meant to be technically analysed but it isnt an accurate > description of effect, particularly of the selective drugs, and it > would be a shame to turn ones back on what might be a rewarding if > difficult area where many mechanisms are at work. Prehaps herbal > treatment will largely wait on biomedical analsis but I think that > there is some room for cautious treating in deteriorating > situations,in situations where one wants to reduce the side effects > of the corticosteroid component of combined therapy, in cases where > regular creatinine checks are available and prehaps post > transplant,with an eye to preventing chronic rejection or the renewal > of the original disease if autoimmune. > Just to be clear about the query you were replying to it would seem > to me to be inappropriate for a student to treat someone on such > medication. > Despite the enormous number of Chinese language journal articles on > kidney disease, some including steroids, I have not seen any on > integrated treatment with selective immunosuppressants so all > thoughts and experience would be appreciated. > > Simon > > > > > > > Chinese Herbal Medicine, a voluntary organization of licensed > healthcare practitioners, matriculated students and postgraduate > academics specializing in Chinese Herbal Medicine, provides a variety > of professional services, including board approved online continuing > education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2002 Report Share Posted January 21, 2002 Dear Z'ev Absolutely I take the point of your original cautionary response. However, just to pursue your case example for its own interest, I think that one could not say definately that what was going on here was rejection, especially 'mild' rejection. What will have been measured in the blood was a slight raise in creatinine but this could have been due to three things; normal variations in level, my limited experience leads me to wonder whether a variety of immune stimuli can produce this temporarily, readings over time would be needed; Second and third, the normal dilemma with raised creatinine post transplant of knowing whether it is due to rejection- the immunosuppression is not enough- or nephrotoxicity -the immunosuppression is too much. Only a biopsy is confirmatory. Presumably herbs could play their part in both sides of this as the cases of St Johns Wort and grapefruit might suggest. As to the fever response, in the right individual I think that can apply in all cases, from a Chinese medicine point of view I think that the drugs may exacerbate heat producing patterns. Of course the formula had to be liu wei di huang wan! Though I have found it OK so far. It is interesting that the reaction arose directly to acumoxa treatment. As an example of sensitivity to moxa,I had a patient, not on immunosuppression , who had IgA Nephropaphy- early stage lu and ki yin vacuity- who after late day treatments in a moxa filled room would develop night sweats and kidney pain followed by trace haematuria. Thank you for the promise of future info and the book reference, I will also make a slow attempt. Simon In , " " <zrosenbe@s...> wrote: > Dear Simon, > Your points are well taken. Part of my response was based on the > fact that this was a student treating a patient with a transplant and > using immunosuppressive medication, without giving a pattern diagnosis, > pulse or tongue images or the name of the medication. > > It seems that many students and practitioners are way over their > heads with the complexity and depth of many patients' disorders, leading > to a lunging forward into the case without adequate preparation. > > While there is much material, both in Chinese and English, on > combined Chinese-Western treatment when patients are on steroidal drugs, > there is, as you point out, a lack of material on such > immunosuppressents as cyclosporine. I also realize that > immunosuppressent medications used in organ transplants do have some > selectivity, and that there may be a possibility of using both systems > together. At the present time, I have no protocols available, therefore > I don't treat transplant patients as a rule. I am planning to do some > research on cyclosporine, and will get back to you and the group on it > soon. I do treat many patients on steroids, and have success in helping > patients get off of these medications. > > I will also get input from some of my own teachers, and plug that in as > well. > > My own experience that stands out was an early one, 1984. I had a young > woman in her late 20's who had a kidney transplant, using prednisone and > cyclosporine. She came to me with the hope of losing weight, and > overcoming such symptoms as moon face. I gave her liu wei di huang wan, > and treated her with acupuncture and moxa, points on the kidney and > liver channels primarily. She had two treatments. After each > treatment, she developed a fever and night sweating. After this > reaction, I sent her to a physician for a blood test that confirmed that > the treatment was interfering with the medications, causing a mild > rejection response and fever. Since that time, I have avoided these > clinical situations. I also do not treat dialysis patients, as my work > has not been very effective, and it is difficult to give herbal > medicines when there is the possibility of flushing them out via the > machine, or concentrating mineral salts in the kidneys. > > However, I do have on-going cases of care of two or three patients who > were candidates for dialysis because of low kidney function, and they > have maintained with Chinese medical treatment. One has been stable for > seven years since having been recommended dialysis seven years ago (she > was born with one kidney). > > I have been looking over, slowly, a Chinese text: Shi yong zhong yi > shen bing xue/Complete Study of Chinese Medical Treatment of Kidney > Disease " . Miki Shima turned me on to it. You might find this book > interesting. > > > > > > > Chinese Herbal Medicine, a voluntary organization of licensed > > healthcare practitioners, matriculated students and postgraduate > > academics specializing in Chinese Herbal Medicine, provides a variety > > of professional services, including board approved online continuing > > education. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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