Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 OK, here is the hiccup case: Male, age 31, just graduated from college after a very stressful final quarter -- he basically did nothing but study for the past six months. Very very stressful. The day after graduation, in the middle of the night, he began hiccupping. He had eaten nothing unusual that day, only a chicken burrito. He had been in good health other than catching more colds in this past year, maybe four. He is of average height and build, maybe a tad over his ideal weight and a little bit out of shape. He claims to tend towards a hot constitution, and sometimes has extra earwax. Urine is clear, bowel movements are normal, there are no digestive complaints, other than some slight heartburn with this hiccup condition. Sleep is normally good, but very disturned with this problem. He has a wife and a 2-year old daughter. His demeanor is calm and focused, and he appears to be above average in intelligence. He says he is very frustrated, who wouldn't be? But he is not normally a frustrated or angry person. Since the hiccups started, they have been constant, about every 6 seconds, with no let up in 7 days (this was almost a week ago -- so now the hiccups have been constant for 12 days). He has had a CT scan of his head, chest and abdomen (all negative). He has tried Thorazine, Reglan and Vicodin with virtually no relief. The Vicodin calms down the hiccups a tiny bit, but he is against taking it. Earl Grey tea has also been minimally effective in calming down the hiccups (the bergamot oil in it may act like Chen Pi?), but nothing else. Sleep is disturbed, but eating is OK. His hiccups are a little better with eating. He has never had this condition before, and has no other significant medical history. His pulses were evenly balanced, right to left, and did not (to me) exhibit any unusual characteristics. Not rapid, not wiry, just normal. His tongue, though, looked compromised by drugs; that is, it had a thick white coating, dry, which to me looked like a drug-affected coating. The coating obscured the tongue body, but it did look purplish underneath. You may ask: why do I assume the tongue coating was caused by the drugs? He said it was not normally there, and it did look to me like other drug-induced tongue coatings I have seen. Since using Vicodin, he also has a dry mouth and tongue. My pattern diagnosis was liver qi stagnation invading the stomach, and rebellious qi of the stomach. There was only a minimal hint of stomach heat. No sign of stomach yin vacuity. I base this diagnosis on the fact that the several months preceding the onset of the hiccups were fraught with stress, and the purple tongue body I was able to glimpse. I used acupressure over UB 2 (Zanzhu) with no relief, then acupuncture at the same point, plus P 6 (Neiguan), Ren 12 (Zhongwan), Stomach 36 (Zusanli), Extra point Yintang, LI 4 (Hegu) and Liver 3 (Taichong). I did not give him an herbal formula, but I did give him a bag of Chen Pi to decoct. I do not know if he tried it or not. After the acupuncture treatment, he felt relaxed and relieved in general, but the hiccups were unchanged. The day after the treatment, he was suffering so much he went to the Emergency Room and was admitted to the hospital. He has been in the hospital for 2-3 days now, and every drug given to him has been unsuccessful. More imaging studies were done (a fluoroscope of the diaphragm) and I do not know the results. Another interesting clue: he did not feel much on the acupuncture points, not the needling, nor the stimulation. He wondered why he didn't feel the needles more...I stimulated each one strongly until he finally felt something. But he had a very high pain tolerance. Maybe it was because he was so distracted and focused on the discomfort of the hiccups. This is where things stand up to date. Julie - " Bob Damone " <bdamone Thursday, June 26, 2003 8:37 PM Re: More on hiccups > > If you have a complete intake on him, can you post it again? What is the pattern > diagnosis for his case? Has he tried to consistently take a focused and well- > designed herbal prescription yet? If so, what have you tried giving him? > > There are several patterns to look for including stomach repletion or vacuity > cold, upward counterflow of stomach fire, depression and stagnation of the qi > dynamic, and stomach yin vacuity. Of course, in any of these patterns, the main > issue is loss of harmoniuous downbearing of stomach qi. > > Can we get more details and then proceed in an orderly fashion to a possible > treatment while he pursues biomedical evaluation to rule out something > serious? > > > Glad to help, > > Bob Damone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 , Julie Chambers wrote: > His pulses were evenly balanced, right to left, and did not (to me) exhibit any unusual characteristics. Not rapid, not wiry, just normal. >>> Julie: Examine his lung pulse again at the organ depth and see if it doesn't reverse during the hiccup. Then examine what quality changes occur during that moment; not only in the lung position but on both sides of the diaphragm (check both L and R sides). One simple technique to try--if you already haven't yet--is to strongly pinch the point at the outside corner of the nail of the middle finger (on both sides). It's a reflex point for the diaphragm. It can help the diaphragm relax since it's associated to the pericardium. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 James wrote:> > > Julie: > > Examine his lung pulse again at the organ depth and see if it > doesn't reverse during the hiccup. Then examine what quality changes > occur during that moment; not only in the lung position but on both > sides of the diaphragm (check both L and R sides). OK, and what if it does (reverse during the hiccup)? > > One simple technique to try--if you already haven't yet--is to > strongly pinch the point at the outside corner of the nail of the > middle finger (on both sides). It's a reflex point for the > diaphragm. It can help the diaphragm relax since it's associated to > the pericardium. I have not tried this. Many people suggested SJ 17, which I tried and also recommended to him to try on his own...it clearly didn't help. I have not heard from them since yesterday morning, and he may still be in the hospital. Thanks again to all who wrote. Julie > > > Jim Ramholz > > > > > > 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 June 27, 2003 Report Share Posted June 27, 2003 , Julie Chambers wrote: > > Examine his lung pulse again at the organ depth and see if it > > doesn't reverse during the hiccup. Then examine what quality changes occur during that moment; not only in the lung position but on both sides of the diaphragm (check both L and R sides). > > OK, and what if it does (reverse during the hiccup)? >>> Julie: The pulse will reverse during a hiccup. If you have the sensitivity to detect it clearly, you should be able to see where the tension is around the diaphragm (the boundary between distal and middle position on both sides). Depending on the qualities (wiry from liver, etc.) you should be able to see what movements or blockages are involved in the hiccup pattern. For example, I have one patient who had hiccups and pinching the extra point at the outside corner of the middle nail would relieve it for only several hours. It turned out that he had an infection in the diaphragm area that was continually irritating it. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 Julie, Have his stomach acid levels been checked? It is possible that he is hypochordyric. Jean Painter - Julie Chambers Thursday, June 26, 2003 7:42 PM Case presentation on hiccups OK, here is the hiccup case:Male, age 31, just graduated from college after a very stressful finalquarter -- he basically did nothing but study for the past six months. Veryvery stressful. The day after graduation, in the middle of the night, hebegan hiccupping. He had eaten nothing unusual that day, only a chickenburrito. He had been in good health other than catching more colds in thispast year, maybe four. He is of average height and build, maybe a tad overhis ideal weight and a little bit out of shape. He claims to tend towards ahot constitution, and sometimes has extra earwax. Urine is clear, bowelmovements are normal, there are no digestive complaints, other than someslight heartburn with this hiccup condition. Sleep is normally good, butvery disturned with this problem. He has a wife and a 2-year old daughter.His demeanor is calm and focused, and he appears to be above average inintelligence. He says he is very frustrated, who wouldn't be? But he is notnormally a frustrated or angry person. Since the hiccups started, they havebeen constant, about every 6 seconds, with no let up in 7 days (this wasalmost a week ago -- so now the hiccups have been constant for 12 days).He has had a CT scan of his head, chest and abdomen (all negative). He hastried Thorazine, Reglan and Vicodin with virtually no relief. The Vicodincalms down the hiccups a tiny bit, but he is against taking it. Earl Greytea has also been minimally effective in calming down the hiccups (thebergamot oil in it may act like Chen Pi?), but nothing else.Sleep is disturbed, but eating is OK. His hiccups are a little better witheating.He has never had this condition before, and has no other significant medicalhistory.His pulses were evenly balanced, right to left, and did not (to me) exhibitany unusual characteristics. Not rapid, not wiry, just normal. His tongue,though, looked compromised by drugs; that is, it had a thick white coating,dry, which to me looked like a drug-affected coating. The coating obscuredthe tongue body, but it did look purplish underneath. You may ask: why do Iassume the tongue coating was caused by the drugs? He said it was notnormally there, and it did look to me like other drug-induced tonguecoatings I have seen. Since using Vicodin, he also has a dry mouth andtongue.My pattern diagnosis was liver qi stagnation invading the stomach, andrebellious qi of the stomach. There was only a minimal hint of stomach heat.No sign of stomach yin vacuity. I base this diagnosis on the fact that theseveral months preceding the onset of the hiccups were fraught with stress,and the purple tongue body I was able to glimpse.I used acupressure over UB 2 (Zanzhu) with no relief, then acupuncture atthe same point, plus P 6 (Neiguan), Ren 12 (Zhongwan), Stomach 36 (Zusanli),Extra point Yintang, LI 4 (Hegu) and Liver 3 (Taichong).I did not give him an herbal formula, but I did give him a bag of Chen Pi todecoct. I do not know if he tried it or not.After the acupuncture treatment, he felt relaxed and relieved in general,but the hiccups were unchanged. The day after the treatment, he wassuffering so much he went to the Emergency Room and was admitted to thehospital. He has been in the hospital for 2-3 days now, and every drug givento him has been unsuccessful. More imaging studies were done (a fluoroscopeof the diaphragm) and I do not know the results.Another interesting clue: he did not feel much on the acupuncture points,not the needling, nor the stimulation. He wondered why he didn't feel theneedles more...I stimulated each one strongly until he finally feltsomething. But he had a very high pain tolerance. Maybe it was because hewas so distracted and focused on the discomfort of the hiccups.This is where things stand up to date.Julie-"Bob Damone" <bdamoneThursday, June 26, 2003 8:37 PM Re: More on hiccups>> If you have a complete intake on him, can you post it again? What is thepattern> diagnosis for his case? Has he tried to consistently take a focused andwell-> designed herbal prescription yet? If so, what have you tried giving him?>> There are several patterns to look for including stomach repletion orvacuity> cold, upward counterflow of stomach fire, depression and stagnation of theqi> dynamic, and stomach yin vacuity. Of course, in any of these patterns, themain> issue is loss of harmoniuous downbearing of stomach qi.>> Can we get more details and then proceed in an orderly fashion to apossible> treatment while he pursues biomedical evaluation to rule out something> serious?>>> Glad to help,>> Bob DamoneChinese 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 June 27, 2003 Report Share Posted June 27, 2003 Dear James, > > The pulse will reverse during a hiccup. If you have the sensitivity > to detect it clearly, you should be able to see where the tension is > around the diaphragm (the boundary between distal and middle > position on both sides). Depending on the qualities (wiry from > liver, etc.) you should be able to see what movements or blockages > are involved in the hiccup pattern. Well, I wish you were here because I certainly don't have that kind of pulse-taking skill. I still have not seen the patient again since he was hospitalized, and he may still be in the hospital. Thanjk you and everyone for their advice. Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 Jim - are you using Shen/Hammer system here or is this method also part of Dang Han? Will If you have the sensitivity to detect it clearly, you should be able to see where the tension is around the diaphragm (the boundary between distal and middle position on both sides). William R. Morris, OMD Secretary, AAOM Dean of Clinical Education Emperor's College of TOM 310-453-8383 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2003 Report Share Posted June 28, 2003 , WMorris116@A... wrote: > Jim - are you using Shen/Hammer system here or is this method also part of Dong Han? >>> Will: This is from the Dong Han system. I don't know enough about Shen/Hammer to practice it. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
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