Guest guest Posted March 31, 2003 Report Share Posted March 31, 2003 This case makes me think of Todd' s posts on the value of clinical experience. I've never seen anything like this before, and hope I'm not misreading the tongue and the pulse. Last week I saw a 67 year old woman whose chief complaint was lower back pain. She's had metal rods put in but those have not helped. She was all wrapped up, and said she was cold all the time. Her legas are weak and give way. She had urinary incontinence, and is on Ventalin, so I assume she has asthma as well, although I didn't get to ask her. So I assumed this was Kidney Yang xu with invasion of cold damp. She treats herself with moist heat three times a day Question 1-wouldn't the moist heat then increase the damp. She says she feels like she is sitting in cold water, so I think there is damp there. Then things got more complicated. Her right pulse is weak tight, slippery, with no kidney pulse. She has a history of hemorraghes with surgery and childbirth. Her left pulse was tight and wiry. I haven't felt a pulse from extreme cold before, so I didn't know if it was that kind of tight. I call some pulses tight anyway. It was also choppy and deep. She has had a tremor since 1962, and became emotionally unstable when I asked her if her teen years had been stressful. I had to calm her down. She also has migraines. So I'm thinking she has some liver wind, although I saw in Sionneau that body trembling can occur from Kid Y deficiency too. Her emotions increased the tremor. What really threw me off was the tongue. It was blackish, and the tb was grey. But the coat was thick and cracked, with slimy green sides. According to one tongue book, green means heat in the Yand Ming organ. Turns out she smokes 20 cigarrettes a day, drinks 4 to 5 cups decaff coffee, and takes oral morphine. Not suprisingly, she gets so constipated that in her desperation, she will take Milk of Magnesia and give herself terrible stomach cramps. I think she basically takes laxatives every day, and sometimes asks for enemas. She said she had received five one evening with no effect. When she does have stool, it is very hard. She is also constantly thirsty, for warm drinks, and sometimes has hot hands and feet. She also grinds her teeth. She has also had bladder carcinoma. Right now she has something in her kidney, but they think it is a cyst, not a tumor, although hard to be sure without a biopsy. I know a black tc can also be cold, but I thought that she might have heat in the Yang Ming organs, from long term constipation. I told her husband I would have to treat her constipation before I could help her much. Question 2-Is it safe to use moxa with all that heat? I would like to moxa DU4, because they are suspicious of acupuncture, and just want help for the back pain. Question 3-Is it possible that somehow, with the Yang deficiency being that marked, that it causes heat. I'm thinking of how the extremes turn into eachother. I can't articulate this well, but I think you all know what I'm saying. Question 4- Here is the powdered herb formula I gave her, based on Da Cheng Qi Tang Da Huang 9g Zhi shi 6g Hou po 6g Da fu Pi 6g Shi Gao 3g Bai Shao 5g Gan cao 5g Sheng jiang 5g Mu Xiang 6g Ru Cong Rong 5g Huo ma ren 6g 3 scoops 3x day By the way, Ken and Robert and Zev-I respect your opinions, but truthfully, I would rather have had an experienced practioner in there with me than 10 Chinese textbooks that I could read in Chinese TIA, Gabrielle Miss Biomed Jr (I'm teasing. Thanks for your explanations) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2003 Report Share Posted April 1, 2003 , " gabriellemathieu " <gabriellemathieu> wrote: > > > Question 2-Is it safe to use moxa with all that heat? I would like > to moxa DU4, because they are suspicious of acupuncture, and > just want help for the back pain. > rh She doesn't seem to have a lot of heat signs, unless I'm missin something she seems more cold, so IMO moxa would be fine. Then again, I use moxibustion on everybody, even in Miami. > Question 3-Is it possible that somehow, with the Yang deficiency > being that marked, that it causes heat. I'm thinking of how the > extremes turn into eachother. I can't articulate this well, but I think > you all know what I'm saying. rh Seems likely what heat signs she has are secondary to stagnation. > > Question 4- > Here is the powdered herb formula I gave her, based on Da > Cheng Qi Tang > > Da Huang 9g > Zhi shi 6g > Hou po 6g > Da fu Pi 6g > Shi Gao 3g > Bai Shao 5g > Gan cao 5g > Sheng jiang 5g > Mu Xiang 6g > Ru Cong Rong 5g > Huo ma ren 6g > > 3 scoops 3x day > rh Looks similar to Maziren wan. Scratching my head about the Shigao? Do you have a tx principle you're following? > By the way, Ken and Robert and Zev-I respect your opinions, but > truthfully, I would rather have had an experienced practioner in > there with me than 10 Chinese textbooks that I could read in > Chinese > rh Who wouldn't? Even people who read Chinese would rather have a teacher than a book. > TIA, Gabrielle > Miss Biomed Jr (I'm teasing. Thanks for your explanations) Robert Mr flaky artist Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2003 Report Share Posted April 1, 2003 Gabrielle, Is the 'thick and cracked' tongue coat dry? I assume so if it's cracked. I don't think in this example the Yang Xu is leading to Yin Xu, but it seems to make better sense that the heat in the yangming is burning up the yin & jin ye. I don't know what the energetics of morphine are except that it can cause constipation due to a decrease in peristalsis. Is she using the morphiene for the lower back pain? Does defication relieve her back pain? Do you have a complete medication list? I'm concerned about your modified Da Cheng Qi formula though. It doesn't look too strong, but you might want to try something a little more mild first. I remember a story about one of my supervisors using Da Cheng Qi tang for an elderly patient, and the patient couldn't get out of bed for a week. Geoff > __________ > > " gabriellemathieu " <gabriellemathieu > Difficult case-advice welcome > > > What really threw me off was the tongue. It was blackish, and the > tb was grey. But the coat was thick and cracked, with slimy green > sides. According to one tongue book, green means heat in the > Yand Ming organ. Turns out she smokes 20 cigarrettes a day, > drinks 4 to 5 cups decaff coffee, and takes oral morphine. Not > suprisingly, she gets so constipated that in her desperation, she > will take Milk of Magnesia and give herself terrible stomach > cramps. I think she basically takes laxatives every day, and > sometimes asks for enemas. She said she had received five > one evening with no effect. When she does have stool, it is very > hard. She is also constantly thirsty, for warm drinks, and > sometimes has hot hands and feet. She also grinds her teeth. > > She has also had bladder carcinoma. > Right now she has something in her kidney, but they think it is a > cyst, not a tumor, although hard to be sure without a biopsy. > > I know a black tc can also be cold, but I thought that she might > have heat in the Yang Ming organs, from long term constipation. > I told her husband I would have to treat her constipation before I > could help her much. > > Question 2-Is it safe to use moxa with all that heat? I would like > to moxa DU4, because they are suspicious of acupuncture, and > just want help for the back pain. > > Question 3-Is it possible that somehow, with the Yang deficiency > being that marked, that it causes heat. I'm thinking of how the > extremes turn into eachother. I can't articulate this well, > but I think > you all know what I'm saying. > > Question 4- > Here is the powdered herb formula I gave her, based on Da > Cheng Qi Tang > > Da Huang 9g > Zhi shi 6g > Hou po 6g > Da fu Pi 6g > Shi Gao 3g > Bai Shao 5g > Gan cao 5g > Sheng jiang 5g > Mu Xiang 6g > Ru Cong Rong 5g > Huo ma ren 6g > > 3 scoops 3x day > > By the way, Ken and Robert and Zev-I respect your opinions, but > truthfully, I would rather have had an experienced practioner in > there with me than 10 Chinese textbooks that I could read in > Chinese > > TIA, Gabrielle > Miss Biomed Jr (I'm teasing. Thanks for your explanations) Quote Link to comment Share on other sites More sharing options...
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