Case study: Lack of sweat

[Guest guest]

Rich, I would orient my research towards the wen bing. See if there you can find a solution- does she have any other symptoms that would warrent you treating her with a warm exterior dispersing formula?

question on history to see if this is a latent warm pathogen or a cold pathogen that has transformed into heat and is trapped in the body.

Eti

Rich Blitstein <richblit wrote:

I have a lack of sweat case in clinic which I find rather baffling and wouldappreciate some ideas on. I have looked in a number of books but most talkabout external invasion as the cause and few discuss internal problems(Fluid Dynamics by Clavey being the exception)Female 5'7" 135CC: Lack of sweat since July 2002. At times when there should be sweating,i.e. during exercise, she will get red blotching with itching in neck, chestand abdomen and small raised red bumps on inside of forearms. In the lastweek she will occasionally get rushes of heat travelling up to her head tothe scalp without exertion accompanied by red blotching on neck and chest.There does not appear to be any temporal pattern. No external invasion atonset. More thirsty than usual of late. Some nasal congestion on wakingwith scant "dusky" phlegm.Patient suffers from mild constipation which appears to be damp in naturewith small,incomplete, difficult, unsatisfactory formed stools. Last weekhad what appeared to be the beginning of damp heat clumping in intestineswith burning pain in lower abdomen radiating to sides and back. Some hotloose stools with rectal itching. On palpation two rock hard areasresistant to palpation at approx ST 25 and lower descending colon. Resolvedwith acupuncture.Skin and hair is dry. Sclera pale. Tends to get redness below nostrils andaround mouth.Pulse: Extremely deep and weak both sides only detectable in upper jiaowhere it feels thin and thready but normal speed.Tongue: Body: Thick, swollen,pale purple, mild scalloping, Red dots at tip.Coat: Turbid, thicker in LJ. (I have a picture which I could email toanyone interested)Due to the damp heat clumping last week I was ready to give her a San RenTang type formula but there just didn't seem to be enough damp heat tojustify such a move this week. Overall there seems to be more deficiencythan excess. On the advice of my advisor I gave a a modified Gui Zhi Tangwith increased Bai Shao to protect the Jing/Wei, Huang Qi and Dang Gui. Hethought the lack of sweat was to due Jing/Wei,blood and qi deficiency. Iadded a little Rou Gui on the guess that if the heat rising is due todeficient yang this would draw it back down(thanks Steve ). I am highlysuspect of this treatment and my real concern is that I don't reallyunderstand enough of the theory behind sweat production and it's pathologyto make a correct diagnosis here. Any ideas or citations of sources on thisproblem or sweat theory in general (besides Clavey)would be greatlyappreciated.RichChinese 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]

, Eti Domb <etidomb>

wrote:

>>

> Tongue: Body: (I have a picture which I could email to

> anyone interested)

 

you could upload this picture to the files section at

 

/files

 

[Guest guest]

, " Rich Blitstein " <richblit@r...>

wrote:

few discuss internal problems

> (Fluid Dynamics by Clavey being the exception)

 

and what does he say?

 

 

> Female 5'7 " 135

> CC: Lack of sweat since July 2002.

 

given the recent onset, it does seem it might be related to an

unresolved pathogen in the exterior. My wen bing book by Liu

lists dampness without heat as a possible cause of this. Dan

Bensky presented several case studies at a symposium a few

years back on using gui zhi tang variations for absent sweating.

>

> Patient suffers from mild constipation which appears to be

damp in nature

> with small,incomplete, difficult, unsatisfactory formed stools.

 

why do you call this damp constipation?

>

> Skin and hair is dry. Sclera pale.

 

sounds like it might be some blood xu and that could also

account for the small difficult stools. I wonder if the lack of sweat

is due to fluid vacuity??

 

Tends to get redness below nostrils and

> around mouth.

>

> Pulse: Extremely deep and weak both sides only detectable in

upper jiao

> where it feels thin and thready but normal speed.

 

pulse strongly suggests qi vacuity

>

> Tongue: Body: Thick, swollen,pale purple, mild scalloping,

Red dots at tip.

> Coat: Turbid, thicker in LJ.

 

tongue suggest dampness and spleen vacuity perhaps

 

>

> Due to the damp heat clumping last week I was ready to give

her a San Ren

> Tang type formula but there just didn't seem to be enough

damp heat to

> justify such a move this week.

 

I agree that the heat signs are weak except when the rash

appears, but that may be due to damp transforming to heat at

that moment. It also may be due to lack of fluids that generates

heat during exercise.

 

Overall there seems to be more deficiency

> than excess.

 

I agree

 

On the advice of my advisor I gave a a modified Gui Zhi Tang

> with increased Bai Shao to protect the Jing/Wei, Huang Qi and

Dang Gui. He

> thought the lack of sweat was to due Jing/Wei,blood and qi

deficiency.

 

this may have been a good call. how did it work? It addresses a

pattern of vacuity with perhaps unresolved exterior. But first

answer these two questions:

 

 

Was the onset sudden or gradual?

 

did it follow on the heels of any type of acute illness or blood

loss?

 

[Guest guest]

Rich

 

I guess in a nutshell, it must be something blocking the wei or

inadequate production or circulation of ying.

 

, " " <@i...>

wrote:

> , " Rich Blitstein " <richblit@r...>

> wrote:

> few discuss internal problems

> > (Fluid Dynamics by Clavey being the exception)

>

> and what does he say?

[Guest guest]

Rich:

 

Have you already ruled out any medications that cause hypohidrosis---

anticholinergics, antihistamines, antiparkinsonian drugs,

butyrophenones, monoamine oxidase (MAO) inhibitors, phenothiazines,

thioxanthenes, or tricyclics?

 

 

Jim Ramholz

 

 

 

 

 

In , " Rich Blitstein " <richblit@r...> wrote:

> I have a lack of sweat case in clinic which I find rather baffling

and would appreciate some ideas on.

[Guest guest]

In CLavey's book he discusses the work of a Dr Gong who (pg 51) lists a SPL- KID yang deficiency as one pattern for a lack of sweat. He ascribes the lack of sweat to a ying/wei deficiency due to the SPL transformation and transportation def and the Kidney's lack of steaming the fluids. This appears to be a pretty good fit for this patient. The formula is:

Huang Qi 30g

Dang Shen 10

Bai Zhu 10

Shu DI 10

Shan Zhu YU 10

Rou Cong Rong 10

Ba Ji Tian 10

Gui Zhi 10

Bai Shao 10

Chi Shao 10

Dan Shen 10

Tao Ren 10

Hong Hua 10

Chai Hu 3

Sheng MA 3

Gan Cao 3

Sheng Jiang 2 slices

 

The Blood movers are to" open and harmonize the blocked nutritive qi and regulate the distribution of protective qi"

In this case I would boost the blood tonics and lighten up the blood movers due to the deficiencies present and the fact that patient has history of blood deficient dizziness increasing Bai Shao to 20 and adding Dang Gui 20 and moving the blood movers back to 5-7.

I should know on Tuesday what the effect of the modified Gui Zhi Tang was. Thanks Todd for the note on Bensky's lecture --I remember hearing it on tape and will go back and listen to it again.

I called her stools damp because they weren't dry or hard enough to be blood def constipation and from the description not qi def either. The overall feeling of insatisfaction combined with her acute damp heat last week makes me think it is damp which due to stagnation and the addition of extra damp heat (ETOH) created the clumping. Along this line I was wondering if you think the Rou Cong Rong in the above formula is enough to stop her getting hot in the lower jiao again or do I need to add something. I would like a directional like Zhi Shi but was advised this is too draining but I think in the context of the formula in a small dose it should be ok. What's your opinion or another idea?

 

Rich

 

[Guest guest]

Patient is not on any pharmaceuticals. Good idea though

Along this line check this article out all:

http://www.nytimes.com/2002/10/20/magazine/20DIAGNOSIS.html

 

Rich

 

James Ramholz [jramholz]Monday, October 21, 2002 4:05 AM Subject: Re: Case study: Lack of sweatRich:Have you already ruled out any medications that cause hypohidrosis---anticholinergics, antihistamines, antiparkinsonian drugs, butyrophenones, monoamine oxidase (MAO) inhibitors, phenothiazines, thioxanthenes, or tricyclics?Jim RamholzIn , "Rich Blitstein" <richblit@r...> wrote:> I have a lack of sweat case in clinic which I find rather baffling and would appreciate some ideas on. 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]

, " Rich Blitstein " <richblit@r...>

wrote:

He ascribes the

> lack of sweat to a ying/wei deficiency due to the SPL

transformation and

> transportation def and the Kidney's lack of steaming the fluids.

This appears to be a pretty good fit for this patient.

: It does, though there may also be some damp blockage

 

> I called her stools damp because they weren't dry or hard

enough to be blood

> def constipation and from the description not qi def either.

 

were they pasty? does she get adequate fiber in her diet?

 

Along this line I was wondering if you

> think the Rou Cong Rong in the above formula is enough to

stop her getting

> hot in the lower jiao again or do I need to add something.

 

rou cong rong is a warm herb. and quite moistening. It is not

appropriate when pronounced dampness or heat are present. If

you are correct that dampness is at the root of her constipation,

then transforming dampness and regulating qi is the strategy

that should be used.

 

I would like a

> directional like Zhi Shi but was advised this is too draining but I

think in

> the context of the formula in a small dose it should be ok.

 

I think it is safe for short term use and it seems like a good

choice to me. I know plenty of people who use da haung when I

would only use zhi shi and others who never purge, so this is a

matter of opinion

[Guest guest]

, " Rich Blitstein " <richblit@r...>

wrote:

 

from bu zhong yi qi tang - I can see this with the tongue and

pulse:

> Huang Qi 30g

> Dang Shen 10

> Bai Zhu 10

> Chai Hu 3

> Sheng MA 3

> Gan Cao 3

 

modified for yin yang vacuity - these may be too rich if damp is

present:

> Shu DI 10

> Shan Zhu YU 10

> Rou Cong Rong 10

> Ba Ji Tian 10

 

harmonize ying and wei (makes sense but does the emphasis

need to be on opening the surface or nourishing ying?):

> Gui Zhi 10

> Bai Shao 10

> Sheng Jiang 2 slices

 

 

move blood (this already seems like a lot of blood moving with

minimal s/s of this pattern present in your patient and I am big

fan of the blood moving method):

> Chi Shao 10

> Dan Shen 10

> Hong Hua 10

> Tao Ren 10

 

I wonder if sweating can be induced. what if she takes a large

dose of bo he before exercise. she should only do this after a

nourishing meal to provide ying. if it is some trapped pathogen,

this might do it.

 

[Guest guest]

How about adding the damp drainers in Liu Wei Di Huang? That's a

nourishing formula and it's half damp drainers.

 

> Re: Case study: Lack of sweat

>

> In CLavey's book he discusses the work of a Dr Gong who (pg

> 51) lists a SPL- KID yang deficiency as one pattern for a

> lack of sweat. He ascribes the lack of sweat to a ying/wei

> deficiency due to the SPL transformation and transportation

> def and the Kidney's lack of steaming the fluids. This

> appears to be a pretty good fit for this patient. The

> formula is: Huang Qi 30g Dang Shen 10 Bai Zhu 10 Shu DI 10

> Shan Zhu YU 10 Rou Cong Rong 10 Ba Ji Tian 10 Gui Zhi 10 Bai

> Shao 10 Chi Shao 10 Dan Shen 10 Tao Ren 10 Hong Hua 10 Chai

> Hu 3 Sheng MA 3 Gan Cao 3 Sheng Jiang 2 slices

>

.....

> the Rou Cong Rong in the above formula is enough to stop her

> getting hot in the lower jiao again or do I need to add

> something. I would like a directional like Zhi Shi but was

> advised this is too draining but I think in the context of

> the formula in a small dose it should be ok. What's your

> opinion or another idea?