Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 There is a interesting case study outlining treatment of a deathly case of Nephrotic syndrome coupled with utter Qi exhaustion in Wei Li's, " Clinical Nephrology in . " A 7 year old boy had been diagnosed with nephrotic syndrome and chronic renal failure. HE was hospitalized and given hormone therapy and other drugs for two months without any improvement.The doctors informed the family that he may die very soon. The parents then took the boy to see Dr. Pei. The boy was extremely fatigued and suffered total lassitude of the spirit. His face was pale and his whole body edematous. His testicles were severely swollen and his abdomen was as a drum. The boy had great difficulty urinating and could only dribble a bit when he was able to go. His tongue was swollen and pale with a very wet and slimy fur. His pulse was fine and faint. Dr. Pei concluded that the boy was sufffering utter qi exhaustion and with no qi transformation the water could not be transformed and instead accumulated as water swelling. Prognosis was not considered good. Dr. Pei prescribed Sheng di 50g Tu fu ling 30g Hei Da Dou 30g Da Zao 7 pcs Mu li 30g After a few days his urine became disinhibited and his edema was reduced. He had more vitality and the puls became stronger. Dr. Pei added ba ji tian 15g huang bai 15g Ze xie 18g. In the next week his urine ouput increased dramatically. His water swelling was much reduced and his testicles were almost a normal size. His turn turned normal with a thin white fur and his pulse was stronger. Dr. Pei modified the formula again with unstated modifications and after three months all of his symptoms vanished. What makes this case study peculiar to me is the observed divergence between the diagnosis and the treatment strategy. Qi exhaustion and water retention are treated through nourishing yin and disinhibiting urination. It's obvious that Dr. Pei acknowledged the immediacy of disinhibiting urination in such a case and he seems to be aiming at generating " water " and opening the dams. However, the stated pathomechanisms involved seem to rely on a lack of qi transformation in principle and the tongue is pale and swollen with a thick coat, not red and dry. The other obvious signs of Qi vacuity include utter lethargy and a faint pulse. I would of thought herbs like huang qi would of been key " sovereign " candidates for such a treatment. It supplements Qi and treats water swelling. In discriminating amongst patterns would many choose a similar treatment strategy as the one given in this case study?? Any thoughts? perplexed, matthew Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 , " facteau8 " <facteau8> wrote: > > I would of thought herbs like huang qi would of been > key " sovereign " candidates for such a treatment. It supplements Qi > and treats water swelling. In discriminating amongst patterns would > many choose a similar treatment strategy as the one given in this > case study?? Any thoughts? > perplexed, > matthew It did seem that the repletion conditions took precident, particulary because they would give symptomatic relief to a person who was supposed to die soon. If your patient is going to die soon, symptomatic relief might be better than supplementation. Also, there were 3 months of treatments with herbs that were not listed, so it is quite possible that supplementation may have become the focus. It is not clear in the case study that you provided. Brian C. Allen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 , " bcataiji " <bcaom@c...> wrote: > > It did seem that the repletion conditions took precident, particulary > because they would give symptomatic relief to a person who was > supposed to die soon. If your patient is going to die soon, > symptomatic relief might be better than supplementation. > > Also, there were 3 months of treatments with herbs that were not > listed, so it is quite possible that supplementation may have become > the focus. It is not clear in the case study that you provided. Good points. But the point to me is that the symptom of utter exhaustion was relieved largely without addressing qi vacuity directly unless one thinks da zao did it. I agree that the unknown followup may have included large amounts of tonics, but this example still makes the case for a sequential approach to treatment rather than a simultanaeous one. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 , " bcataiji " <bcaom@c...> wrote: > , " facteau8 " <facteau8> > wrote: > > > > I would of thought herbs like huang qi would of been > > key " sovereign " candidates for such a treatment. It supplements Qi > > and treats water swelling. In discriminating amongst patterns would > > many choose a similar treatment strategy as the one given in this > > case study?? Any thoughts? > > perplexed, > > matthew > > It did seem that the repletion conditions took precident, particulary > because they would give symptomatic relief to a person who was > supposed to die soon. If your patient is going to die soon, > symptomatic relief might be better than supplementation. Well, yes of course symptomatic relief is crucial in this case, but my point is that the treatment principles of nourishing yin, clearing heat and disinhibiting urination were chosen in this case. I would of thought based on the tongue and pulse as well as the symptoms that the treatment principle would have been primarily too supplement the qi and powerfully disinhibit urination. Wei li states in the beginning of the chapter on nephrotic syndrome that all cases present with cold dampness(possibly transforming into damp heat) and that there may be a Qi or qi/yang dual vacuity. The Diagnosis was Qi exhaustion. > > Also, there were 3 months of treatments with herbs that were not > listed, so it is quite possible that supplementation may have become > the focus. It is not clear in the case study that you provided. Yes, perhaps this is when supplementation was used. But isn't using 50g of sheng di supplementing in cases of drum-distention and such? > > Brian C. Allen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 Matt, Good case study.. this illustrates an important point.. and BTW there are many many others like this... let us look at something, though. The difference between zang-fu and SHL style of thinking. zang-fu focus mostly on physiology and making sure the organs are working properly... SHL style on the other hand is very much concerned about getting a pathogen out of the body. Even in chronic conditions a SHL approach will use i.e. MHT too eliminate a lingering pathogen to restore balance. Not try to increase physiological function. 2 very different and valid approaches.. If one looks at SHL style case studies one will see fatigue etc treated many times without any supplementation, because the focus is too eliminate something. Where someone like BOB who loves li dong yuan will be concerned with restoring physiological function and want to tonify the spleen... I think some of us forget there are many ways to approach such issues. - , " facteau8 " <facteau8> wrote: > > There is a interesting case study outlining treatment of a deathly > case of Nephrotic syndrome coupled with utter Qi exhaustion in Wei > Li's, " Clinical Nephrology in . " > A 7 year old boy had been diagnosed with nephrotic syndrome and > chronic renal failure. HE was hospitalized and given hormone therapy > and other drugs for two months without any improvement.The doctors > informed the family that he may die very soon. The parents then took > the boy to see Dr. Pei. The boy was extremely fatigued and suffered > total lassitude of the spirit. His face was pale and his whole body > edematous. His testicles were severely swollen and his abdomen was > as a drum. The boy had great difficulty urinating and could only > dribble a bit when he was able to go. His tongue was swollen and > pale with a very wet and slimy fur. His pulse was fine and faint. > Dr. Pei concluded that the boy was sufffering utter qi exhaustion and > with no qi transformation the water could not be transformed and > instead accumulated as water swelling. Prognosis was not considered > good. > Dr. Pei prescribed > Sheng di 50g > Tu fu ling 30g > Hei Da Dou 30g > Da Zao 7 pcs > Mu li 30g > > After a few days his urine became disinhibited and his edema was > reduced. He had more vitality and the puls became stronger. > Dr. Pei added ba ji tian 15g huang bai 15g Ze xie 18g. In the next > week his urine ouput increased dramatically. His water swelling was > much reduced and his testicles were almost a normal size. His turn > turned normal with a thin white fur and his pulse was stronger. > Dr. Pei modified the formula again with unstated modifications and > after three months all of his symptoms vanished. > > What makes this case study peculiar to me is the observed > divergence between the diagnosis and the treatment strategy. Qi > exhaustion and water retention are treated through nourishing yin and > disinhibiting urination. It's obvious that Dr. Pei acknowledged the > immediacy of disinhibiting urination in such a case and he seems to > be aiming at generating " water " and opening the dams. However, the > stated pathomechanisms involved seem to rely on a lack of qi > transformation in principle and the tongue is pale and swollen with a > thick coat, not red and dry. The other obvious signs of Qi vacuity > include utter lethargy and a faint pulse. > I would of thought herbs like huang qi would of been > key " sovereign " candidates for such a treatment. It supplements Qi > and treats water swelling. In discriminating amongst patterns would > many choose a similar treatment strategy as the one given in this > case study?? Any thoughts? > perplexed, > matthew Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 , " bcataiji " <bcaom@c...> wrote: > > It did seem that the repletion conditions took precident, particulary > because they would give symptomatic relief to a person who was > supposed to die soon. If your patient is going to die soon, > symptomatic relief might be better than supplementation. > > Also, there were 3 months of treatments with herbs that were not > listed, so it is quite possible that supplementation may have become > the focus. It is not clear in the case study that you provided. > > Brian C. Allen B, IMO, it is bad practice to second guess case studies, you will miss the point. And because of the nature of case studies especially pre- modern (as Todd just noted) there is always going to be stuff left out... More important is to try to learn from what is written and get the lesson that is being presented. -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2004 Report Share Posted January 9, 2004 , " " <@h...> wrote: it is bad practice to second guess case studies, you will miss > the point. More important is to try to learn from what is written and > get the lesson that is being presented. I think you have to do both. You have to look at the case itself, but much like one would critique a research study by asking questions about followup issues, I think that question is also valid here. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 10, 2004 Report Share Posted January 10, 2004 , " " wrote: > , " " <@h...> > wrote: > > it is bad practice to second guess case studies, you will miss > > the point. More important is to try to learn from what is written and > > get the lesson that is being presented. > > > > I think you have to do both. You have to look at the case itself, but much like one > would critique a research study by asking questions about followup issues, I think > that question is also valid here. > I think you are right to a certain extent.. It is always nice to ask further questions, but to a certain extent it is moot, because one can never know the unknown. It is real easy to say, well (in that case study) they had fatigue and obviously they would have a better formula if they supplemented qi, but then you never learn anything. You are stuck in your own box. It is really hard to criticize a case study when you are not there. IMO, they are there for the lesson. Except it and open the mind… It has actually taken me a long time to get that point, and I still struggle with it… Although many of the case studies, some of the best, have multiple visits, and mistakes are obvious and present to demonstrate the aspects of the lesson. These are easier to criticize, but again I think if one fixates on looking to variables that are not mentioned then one can easily miss the idea. What if… What happened then… etc etc. I find pointless. - Quote Link to comment Share on other sites More sharing options...
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