Guest guest Posted March 20, 2003 Report Share Posted March 20, 2003 Hola Herbalistas, I have a patient who's chief complaint is diarrhea. He shows signs of Spleen Qi and Kidney Yang deficiency, with some dampness in the middle Jiao. But he has one sign that kind of stumps me too. He says that when he gets up to go to the bathroom at night, he has a dry mouth and throat about three times per week. It is the next morning in which he can expect a diarrhea day. So this dry mouth and throat serve as some sort of precurser to the diarrhea episodes. The problem doesn't seem to be damp heat. There is no strong odor, no burning anus, no explosive diarrhea, just some yellow mucus on the soft stools, but that is the only sign of heat. Think that's enough for a damp-heat diagnosis? Everything else seems to say cold. -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2003 Report Share Posted March 20, 2003 So this dry mouth and throat serve as some sort of precurser to thediarrhea episodes.>>>Remember that dryness can also be caused by Dampness obstructing clear-yang, weak spleen etc. Not only heat or yin-def, even at night. alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2003 Report Share Posted March 20, 2003 , Al Stone wrote: He says that when he gets up to go to the bathroom at night, he has a dry mouth and throat about three times per week. It is the next morning in which he can expect a diarrhea day. > > So this dry mouth and throat serve as some sort of precurser to the > diarrhea episodes. >>> Al: When doing clinic supervision last weekend I had a similar case. In my patient, as the spleen became more depleted (xu) a small amount of heat was also travelling up the stomach channel toward the mouth creating a similar dryness. So as his spleen, which already suffered from constitutional weakness, becomes weakened by more stress the problem continues. Spleen doesn't raise the clear yang, and stomach doesn't send yangming heat downward. If similar, you should see spleen xu in the deeper portion of the right middle zang pulse, and a small amount of floating heat superficially in the right middle fu position. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2003 Report Share Posted March 21, 2003 , Al Stone <alstone@b...> wrote: > Hola Herbalistas, > > I have a patient who's chief complaint is diarrhea. > > He shows signs of Spleen Qi and Kidney Yang deficiency, with some > dampness in the middle Jiao. > > But he has one sign that kind of stumps me too. He says that when he > gets up to go to the bathroom at night, he has a dry mouth and throat > about three times per week. It is the next morning in which he can > expect a diarrhea day. > > So this dry mouth and throat serve as some sort of precurser to the > diarrhea episodes. > > The problem doesn't seem to be damp heat. There is no strong odor, no > burning anus, no explosive diarrhea, just some yellow mucus on the soft > stools, but that is the only sign of heat. > > Think that's enough for a damp-heat diagnosis? Everything else seems to > say cold. > > -- > Al Stone L.Ac. > Al, THis may or may not be relelvant. Bensky says (F & S?) that loose stools can be caused from yin & xue xu... IS it diarrhea or loose? Furthermore, I am not sure if yin xu can cause diarrhea... I can't think of a pathomechaism... -JAson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2003 Report Share Posted March 21, 2003 The yin xu may be being caused by the diarrhea. I've often had this experience when treating patients with spleen xu plus damp heat UC which has gone on for a long time. In such cases, my teachers in China did routinely supplement yin (with meds such as Mai Dong and Sha Shen) at the same time as eliminating dampness. Bob , " " <@h...> wrote: > , Al Stone <alstone@b...> > wrote: > > > > Hola Herbalistas, > > > > > > > > I have a patient who's chief complaint is diarrhea. > > > > > > > > He shows signs of Spleen Qi and Kidney Yang deficiency, with some > > > > dampness in the middle Jiao. > > > > > > > > But he has one sign that kind of stumps me too. He says that when > he > > > > gets up to go to the bathroom at night, he has a dry mouth and > throat > > > > about three times per week. It is the next morning in which he can > > > > expect a diarrhea day. > > > > > > > > So this dry mouth and throat serve as some sort of precurser to the > > > > diarrhea episodes. > > > > > > > > The problem doesn't seem to be damp heat. There is no strong odor, > no > > > > burning anus, no explosive diarrhea, just some yellow mucus on the > soft > > > > stools, but that is the only sign of heat. > > > > > > > > Think that's enough for a damp-heat diagnosis? Everything else > seems to > > > > say cold. > > > > > > > > -- > > > > Al Stone L.Ac. > > > > > > > > > Al, > > > > > THis may or may not be relelvant. Bensky says (F & S?) that loose > stools can be caused from yin & xue xu... IS it diarrhea or loose? > Furthermore, I am not sure if yin xu can cause diarrhea... I can't > think of a pathomechaism... > > > > > -JAson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2003 Report Share Posted March 21, 2003 At 11:52 AM -0800 3/20/03, Al Stone wrote: I have a patient who's chief complaint is diarrhea. He shows signs of Spleen Qi and Kidney Yang deficiency, with some dampness in the middle Jiao. But he has one sign that kind of stumps me too. He says that when he gets up to go to the bathroom at night, he has a dry mouth and throat about three times per week. It is the next morning in which he can expect a diarrhea day. So this dry mouth and throat serve as some sort of precurser to the diarrhea episodes. The problem doesn't seem to be damp heat. There is no strong odor, no burning anus, no explosive diarrhea, just some yellow mucus on the soft stools, but that is the only sign of heat. Think that's enough for a damp-heat diagnosis? Everything else seems to say cold. -------------- Hey Al, Where's the tongue and pulse (remember the 4 methods)? Have you considered spleen or spleen/stomach yin vacuity? dry mouth and disordered stools fit this diagnosis. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2003 Report Share Posted March 22, 2003 Could it be that kidney yang is failing to raise and separate the fluids, so fluids don't reach the mouth, but they are still someplace (lower burner) where they cause diarrhea. It could be that if his day is particularly stressful and weakens the yang enough, that night would have a dry mouth, an increased need to urinate, and the following day, diarrhea. Par - Rory Kerr Friday, March 21, 2003 6:07 PM Re: yin xu -> diarrhea? At 11:52 AM -0800 3/20/03, Al Stone wrote: I have a patient who's chief complaint is diarrhea.He shows signs of Spleen Qi and Kidney Yang deficiency, with somedampness in the middle Jiao.But he has one sign that kind of stumps me too. He says that when hegets up to go to the bathroom at night, he has a dry mouth and throatabout three times per week. It is the next morning in which he canexpect a diarrhea day.So this dry mouth and throat serve as some sort of precurser to thediarrhea episodes.The problem doesn't seem to be damp heat. There is no strong odor, noburning anus, no explosive diarrhea, just some yellow mucus on the softstools, but that is the only sign of heat.Think that's enough for a damp-heat diagnosis? Everything else seems to say cold. -------------- Hey Al, Where's the tongue and pulse (remember the 4 methods)? Have you considered spleen or spleen/stomach yin vacuity? dry mouth and disordered stools fit this diagnosis. Rory-- 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 March 22, 2003 Report Share Posted March 22, 2003 Al, Is your patient thirsty for warm or cold liquids? There's a discussion of something similar to this under Bu Zhong Yi Qi Tang in Bensky's F & S. -Anne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2003 Report Share Posted March 22, 2003 Al You could interpret this sign from a yang deficient perspective as well. I have seen this seemingly contradictory symptom in yang def. patients before, especially those experiencing diarrhea or urinary frequency, as a result of the failure of fluid metabolism and fluid distribution. Instead of the fluids circulating as they should, they appear to be unevenly distributed, accumulating in the bowel leaving insufficient in the upper body, hence the prodrome of oral dryness before an episode of diarrhea. This uneveness of fluid processing and disribution is a classical feature of yang deficiency. Will Maclean Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2003 Report Share Posted March 22, 2003 Will Maclean wrote: > > Al > > You could interpret this sign from a yang deficient perspective as > well. I have seen this seemingly contradictory symptom in yang def. > patients before, especially those experiencing diarrhea or urinary > frequency, as a result of the failure of fluid metabolism and fluid > distribution. Instead of the fluids circulating as they should, they > appear to be unevenly distributed, accumulating in the bowel leaving > insufficient in the upper body, hence the prodrome of oral dryness > before an episode of diarrhea. This uneveness of fluid processing > and disribution is a classical feature of yang deficiency. Thanks. Something to add for your second edition of the Clinical Handbook Volume 2? Perhaps under the " modifications " heading of the Kidney Yang deficiency portion of diarrhea? And what *would* you add for this condition? -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2003 Report Share Posted March 22, 2003 I agree with Will's perspective on the case. The inefficent distribution of fluids can cause dampness below and dryness in the upper burner. We still need the tongue and pulse diagnosis. On Saturday, March 22, 2003, at 02:08 PM, Will Maclean wrote: > Al > > You could interpret this sign from a yang deficient perspective as > well. I have seen this seemingly contradictory symptom in yang def. > patients before, especially those experiencing diarrhea or urinary > frequency, as a result of the failure of fluid metabolism and fluid > distribution. Instead of the fluids circulating as they should, they > appear to be unevenly distributed, accumulating in the bowel leaving > insufficient in the upper body, hence the prodrome of oral dryness > before an episode of diarrhea. This uneveness of fluid processing > and disribution is a classical feature of yang deficiency. > > Will Maclean > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2003 Report Share Posted March 22, 2003 , Al Stone <alstone@b...> wrote: when he > gets up to go to the bathroom at night, he has a dry mouth and throat > about three times per week. It is the next morning in which he can > expect a diarrhea day. I believe this sx supports Will's hypothesis and Z'ev's agreement. The diarrhea does not cause the dryness sign as the timeline is reversed. If the patient has signs confirming spleen qi and yang xu, then the sinking qi could lead to dry throat preceding diarrhea from fluids failing to rise. I wonder if this happens on days when stress is high or after particular activities or foods. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2003 Report Share Posted March 23, 2003 wrote: > > I agree with Will's perspective on the case. The inefficent > distribution of fluids can cause dampness below and dryness in the > upper burner. > > We still need the tongue and pulse diagnosis. There is a significant coating in the middle portion of the tongue (middle third as opposed to the third toward the throat or the anterior third). He also says that the coating is spread to the edges. For this reason, I am open to what Alon suggested about the middle jiao dampness preventing the fluids from rising to the mouth and throat as well as Will's Kidney Yang deficiency thoughts. I do not have access to this gentleman's pulse as he is somewhere in the deep south. -al. -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2003 Report Share Posted March 23, 2003 wrote: > > , Al Stone <alstone@b...> wrote: > when he > > gets up to go to the bathroom at night, he has a dry mouth and throat > > about three times per week. It is the next morning in which he can > > expect a diarrhea day. > > I believe this sx supports Will's hypothesis and Z'ev's agreement. > The diarrhea does not cause the dryness sign as the timeline is > reversed. If the patient has signs confirming spleen qi and yang xu, > then the sinking qi could lead to dry throat preceding diarrhea from > fluids failing to rise. I wonder if this happens on days when stress > is high or after particular activities or foods. Stress doesn't seem to play a role. However fried chicken eaten recently sent him into a long downward spiral of three days in which he couldn't even go to work due to the diarrhea. -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2003 Report Share Posted March 23, 2003 I wouldn't necessarily add anything...not knowing anything else about your patient I can't make any suggestion, however simply correcting fluid metbolism and whatever is behind its failure should assist fluid distribution. Will Quote Link to comment Share on other sites More sharing options...
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