Case study: Lack of sweat

[Guest guest]

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

appreciate some ideas on. I have looked in a number of books but most talk

about external invasion as the cause and few discuss internal problems

(Fluid Dynamics by Clavey being the exception)

Female 5'7 " 135

CC: 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, chest

and abdomen and small raised red bumps on inside of forearms. In the last

week she will occasionally get rushes of heat travelling up to her head to

the scalp without exertion accompanied by red blotching on neck and chest.

There does not appear to be any temporal pattern. No external invasion at

onset. More thirsty than usual of late. Some nasal congestion on waking

with scant " dusky " phlegm.

 

Patient suffers from mild constipation which appears to be damp in nature

with small,incomplete, difficult, unsatisfactory formed stools. Last week

had what appeared to be the beginning of damp heat clumping in intestines

with burning pain in lower abdomen radiating to sides and back. Some hot

loose stools with rectal itching. On palpation two rock hard areas

resistant to palpation at approx ST 25 and lower descending colon. Resolved

with acupuncture.

 

Skin and hair is dry. Sclera pale. 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.

 

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 to

anyone interested)

 

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. Overall there seems to be more deficiency

than excess. 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. I

added a little Rou Gui on the guess that if the heat rising is due to

deficient yang this would draw it back down(thanks Steve ). I am highly

suspect of this treatment and my real concern is that I don't really

understand enough of the theory behind sweat production and it's pathology

to make a correct diagnosis here. Any ideas or citations of sources on this

problem or sweat theory in general (besides Clavey)would be greatly

appreciated.

 

Rich