Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 , Julie Chambers <info@j...> wrote: > 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, There are still a few things I would like to know including: 1. What is the sound of the hiccup: loud and clear, or muffled and deep? 2. Is the hiccup slow and weak or rapid and strong? 3. Is he thirsty or not? Does he have bad breath? It sounds like the white fur should be taken to mean dampness and food stagnation, regardless of whether or not it might be due to drugs. Given the severity of his complaint and the fact that it is a stomach counterflow problem, I would take it seriously. The fact that he says it is not normally there could simply reflect the fact that he does not normally have hiccups. The " stress " he has been under, with the excessive study, could possibly be construed as bringing detriment and damage to the spleen and stomach and not necessarily as a confirmation of primary liver involvement. We sometimes hear the word " stress " and have a knee-jerk response in the direction of liver. We can easily forget that worry and pensiveness damages the spleen. Six months of study and such can bring severe damage to the spleen and stomach. This is not to say that he may not also have liver depression, but perhaps it is a case where the earth should be treated in order to treat the wood, Also four colds in the past year speak to defensive yang vacuity to me. I find it very interesting that the hiccups began in the night the day after graduation. I am not quite sure how to construe this, but I have often seen people " collapse " after completing a big project for which they pushed very hard to complete. The slight heartburn suggests a slight amount of stomach heat, and admittedly often also does present when the liver attacks the stomach and when there is liver-stomach depressed heat. I feel a bit reluctant to make any recommendation in a situation like this, but I am thinking that the thick white fur is the most important piece of information you have given me. For me, it confirms the presence of a repletion evil in the stomach and strongly suggests food stagnation in the stomach duct. I would consider something like the below formula. I would resist the temptation to want to supplement the spleen and stomach until you have tried a more transforming, freeing treatment like this: Shen Qu 15 grams Mai ya 15 Gu Ya 15 Shan Zha 15 Lai Fu Zi 10 Ban Xia 10 Chen Pi 10 Fu Ling 15 Sheng Jiang 3 slices Huang Lian 6 grams Wu Zhu Yu 3 Hou Po 10 Xuan Fu Hua 15 Dai Zhe Shi 15 Zhi Gan Cao 3 Decoct and take one packet per day in two or three divided doses. Another possible strategy, which holds a lot of merit here, is to first purge the patient with xiao cheng qi tang in order to rapidly establish free downbearing. I would only do this if I felt the pulse was strong and the abdomen felt firm, and then follow up with the formula above. In other words, I have to be confident that it is a repletion pattern. I would invite comment from other members. Keep us posted Bob Damone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 Bob Damone said: > > > Julie, > > There are still a few things I would like to know including: > > 1. What is the sound of the hiccup: loud and clear, or muffled and deep? > Loud and clear, almost gasping > 2. Is the hiccup slow and weak or rapid and strong? It was rapid and strong when I saw him -- who knows what it is now, a week later? > > 3. Is he thirsty or not? Does he have bad breath? Some thirst (he attributed it to the Vicodin) and no bad breath. > > It sounds like the white fur should be taken to mean dampness and food > stagnation, regardless of whether or not it might be due to drugs. I don't understand this. If it is from the drugs, why would I assume it would be dampness and food stagnation? I agree with you on clearing the repletion pattern first and even purging...I think he is strong enough to take it. As I have mentioned, I still have not seen him again and do not know if he is still in the hospital or not. I will keep you posted. Thank you all again. Julie 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 <info@j...> wrote: > Bob Damone said: > > > > > Julie, > > > > There are still a few things I would like to know including: > > > > 1. What is the sound of the hiccup: loud and clear, or muffled and deep? > > > Loud and clear, almost gasping > > > 2. Is the hiccup slow and weak or rapid and strong? > > It was rapid and strong when I saw him -- who knows what it is now, a week > later? > > > > 3. Is he thirsty or not? Does he have bad breath? > > Some thirst (he attributed it to the Vicodin) and no bad breath. > > > > > It sounds like the white fur should be taken to mean dampness and food > > stagnation, regardless of whether or not it might be due to drugs. > > I don't understand this. If it is from the drugs, why would I assume it > would be dampness and food stagnation? > > I agree with you on clearing the repletion pattern first and even > purging...I think he is strong enough to take it. > > As I have mentioned, I still have not seen him again and do not know if he > is still in the hospital or not. I will keep you posted. > > Thank you all again. > > Julie Julie, What I mean is that even if the tongue fur is from the drugs (which we cannot be sure of), there IS a greasy white fur that needs to be dealt with. Since it is unclear where it is from, and given the presenting complaint, I would assume it is important for the diagnosis.Also, I just find that it is best to go with the s/s that present instead of trying to second guess which of the m might or might not be due to a medication, or how the patient would be different if they were not taking the medication in question. With the greasy white fur, the most reasonable assumption to me is that there is dampness and food stagnation (perhaps even as a side effect of the drug) in need of " draining " .In my mind, to treat it is wiser than to discount it, even though it is clearly present. I hope you get a chance to treat him again, and that there is nothing seriously wrong with him. Bob Damone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 Here's one more little tidbit to add to our growing bag of hiccup tricks. There was a young man who had had hiccups for 24 days, treated by Nakagami Kinkei (1743-1833). His treatment is described in the book Sen Tetsu Idan, Edited by Yanagiya Sei Itsu (son of Sorei). Nakagami Kinkei was an herbalist, but the herbs he prescribed for the patient made the hiccups worse. He then used a three-edged needle to lightly bleed Lung 11 (Sho Sho), and gave the patient a little cold water to drink. The treatment was successful. The herbal formula is not given. Thanks to Shinjiro Kanazawa for translating from the Japanese text. Linda Lyman, L.Ac. 2602 First Avenue, Suite 103 San Diego CA 92103 619-865-6036 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2003 Report Share Posted June 27, 2003 Dear Bob, and all who helped on the hiccup case: The patient has been released from the hospital, with instructions to intubate himself every 2 hours or so with a tubing that stimulates a strong gagging (actually retching) response, and thereby seems to calm or reset the diaphragm spasm. I only know this second hand and have not seen the patient again. He is coming for more acupuncture in the morning and I will let you know how it goes. Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2003 Report Share Posted June 28, 2003 , Julie Chambers <info@j...> wrote: > Dear Bob, and all who helped on the hiccup case: > > The patient has been released from the hospital, with instructions to > intubate himself every 2 hours or so with a tubing that stimulates a strong > gagging (actually retching) response, and thereby seems to calm or reset the > diaphragm spasm. I only know this second hand and have not seen the patient > again. He is coming for more acupuncture in the morning and I will let you > know how it goes. > > Julie Dear Julie, Good luck with your treatment. I was wondering if you did any ear acupuncture for the diaphragm or the phrenic nerve? Jill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2003 Report Share Posted June 28, 2003 > > Dear Julie, > Good luck with your treatment. I was wondering if you did any ear > acupuncture for the diaphragm or the phrenic nerve? > Jill No, but that is coming next. As for acid levels, Jean Painter, I don't know. Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2003 Report Share Posted June 28, 2003 Hi Julie, Sounds good. So they are doing vigorous vagal nerve stimulation. Same as increased CO2 which is holding the breath. Gagging (retching) is powerful vagal nerve stimulation, far more so than holding the breath. We'll all be interested to hear what the scenario is when you see the patient next. Good luck, and thank you for including us in your work with this patient. In Gratitude, Emmanuel Segmen - Julie Chambers Friday, June 27, 2003 8:51 PM Re: Re: Hiccup Case Dear Bob, and all who helped on the hiccup case:The patient has been released from the hospital, with instructions tointubate himself every 2 hours or so with a tubing that stimulates a stronggagging (actually retching) response, and thereby seems to calm or reset thediaphragm spasm. I only know this second hand and have not seen the patientagain. He is coming for more acupuncture in the morning and I will let youknow how it goes.JulieChinese 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...
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