strategies

[Guest guest]

, " acupuncture4health " <

acupuncture4health@r...> wrote:

 

> Just a quick note to all students - PLEASE study hard, the real

> world patients are not a straightforward as PCOM clinic - pay a lot

> of attention to herb interactions with pharmaceuticals - so far I've

> seen a dozen patients all with more meds than Walgreens!!!

 

 

Godd advice. But I think you must be a little off your game from all the

transitions. I rarely give endorsements unless they are deserved. It is

important to stay focused. Patients are complex and because of your remote

location, you probably get to see a broader mix. But all patients have a

limited number of patterns that are typically mutually engendering (now this

limit may be 5 or 7 patterns, but it is not 50 or 100). Prioritize the patients

chief complaint and treat that first. Just make sure that your rx does not

worsen other patterns. I do not think it is necessary to treat everything at

the outset (though, IMO, often all mutually engendering patterns have to be

addressed either directly or inidrectly for long term tx). It is just necessary

to treat the branch without worsening the root. This may mean protecting the

qi and blood with bai zhu and gan cao in a patient who is otherwise being

treated for dampheat and blood stasis, for example.

 

In most cases, addressing the branch aggressively will give the most symptom

relief in the shortest time, ensuring further compliance. Once the most acute

sx have been quelled and some of the excess cleared, one can move to more

balanced formulas. It will be easier to write a longterm rx and develop a

longterm acu strategy AFTER the patient has settled down a little bit. Often a

few symptomatic acupuncture treatments W/O herbs is enough to settle the

patient down. And never forget that the continuing presence of strong branch

sx DIRECTLY injurs the root further. The more dampness or vacuity fire

persists, the more damage is accrued to the spleen or kidney yin. While I do

not believe that longterm chronic problems are typically rectified by merely

addressing the branch to free up the root, I also do not believe any harm comes

from judicious and aggressive branch treatment for a short period of time. In

fact, I believe more good comes this strategy. In my experience, balanced

formulas for root and branch are often ineffective at relieving strong acute

branch sx.

 

[Guest guest]

, " "

wrote:

>

> Godd advice. But I think you must be a little off your game from

all the

> transitions. I rarely give endorsements unless they are deserved.

It is

> important to stay focused. Patients are complex and because of

your remote

> location, you probably get to see a broader mix.

 

Certainly, there is an absence of Chinese medicine in the area and

many of the patients coming to see me are particularly desperate

which as you rightly state puts added " self-pressure " on me to

help ...

 

I seem in particular to be attracting some severe Diabetic cases,

severe in as much as they are overlayed with Fibromyalgia, Asthma,

Hypothyroid or Hypertension, Macular Degeneration and Heart Disease.

 

My difficulty is that the western meds that they are taking, together

with the diet they are on are not managing either the blood sugar

levels or their secondary conditions.

 

My activity so far has been to concentrate on calming them with

preliminary acupx to get them past the initial fear of needles and to

gain my own comfort level. However, I hesistate to prescribe herbs

for a couple of reasons.

 

1. Without a baseline control for blood sugar, isn't there a risk

that the herbs could potentially worsen the condition?

 

2. How do the herbs interact with the other meds - should I start

with a low dose and see how they respond - or is this approach a

waste of time.

 

Your comments?

 

Kayte

[Guest guest]

, " acupuncture4health " <

acupuncture4health@r...> wrote:

 

> I seem in particular to be attracting some severe Diabetic cases,

> severe in as much as they are overlayed with Fibromyalgia, Asthma,

> Hypothyroid or Hypertension, Macular Degeneration and Heart Disease.

 

Kayte

 

I think we need an actual case to answer your questions. there are no general

answers. can you give us the details? I would also point out that the tx of

diabetes and the typical complications such as macular degeneration and heart

disease are well detailed in Flaws diabetes book. Hypertension goes with the

territory, too. And hypothyroid may be part of a global endocrine dysfunction

that predisposes to poor fat metabolism, obesity and type 2 DM..

 

I think your concerns about the drug/herb interactions may possibly be

overblown. but we need a real case to assess.

 

[Guest guest]

, " "

wrote:

>> Kayte

>

> I think we need an actual case to answer your questions. there are

no general

> answers. can you give us the details?

- I have Flaws book and am making good progress thru it. You

asked for details so here is what I have - sorry it has taken a

couple of days, but business is picking up...

 

I hope the format works

 

Diabetes Case Study 1

 

61 yr old female, 153 lbs, 5'4 "

• CC Diabetes, diagnosis 1.5 yrs ago – general pains and

stiffness throughout body

• Blood Sugar levels outside normal 175-275 despite Rx. Actose,

Rx Lantis

• 2ndry Complaints –

o Diminished eyesight, diabetic retinopathy/macular

degeneration – Laser surgeries and injections on both eyes, no

improvement in condition, experiences periodic white out effect and

tunneling of vision

o High Blood Pressure Rx Lotinsin – BP on intake 98/49 – supine

o Heart Condition – Rx – Norvask – last EKG clear

o Gastric Surgery – unable to digest meat, rice and many

vegetables

Supplements

• Coral Calcium – osteoporosis

• Ester C

• Aspirin – St Joes for heart

• Simple Greens.

• Prior Surgeries – Stomach lower half removed dt scarring from

long-term ulcer

 

10 Children – 14 pregnancies

Hx of mental and physical abuse

Occupation – personal Attendant to quadriplegic daughter and guardian

for 2 grand-children, 1 ADHD, 1 Touretts

 

1. Energy – not much stamina – after 2 hrs must lay down to

sleep.

2. Sleep – Up 2-3x per night to urinate, falls asleep easily

anytime – up early 5:00Am for chores

3. Temp/Sweat – U Jiao heat, extremities cold, spontaneous sweat

in Am head and neck

4. Appetite/Thirst – Seldom hungry, unable to eat many

vegetables dt high carb content – generally eats 2x per day – keeps

within 65 carbs per day. Thirst – always drinking, would prefer to

drink rather than eat

5. Digestion – gas all the time whether she eats or not.

6. BM's – difficult and urgent, 3x per day, normal color –

urination every 2 hrs during day and 2-3 x at night.

7. HEENT –

a. high pitch ringing, comes and goes during day

b. Sinus problems, post nasal drip, tendency to catch colds

easily, poor sense of smell

8. Menstrual – Menopause was easy – no problems

9. Emotional – Rolls with punches, always positive – been " an

enabler all her life " – abuse and desertion by parents, mental &

physical abuse by spouse – 40+ years

10. Pain – general body pain

 

& #61656; Observation –

o puffiness around eyes, dark shadows, pale complexion and

general weakness

o Tongue, pale, sl yellow coat

& #61656; Palpation –

o Abdominal scar Ren 12 thru ren 7,

o Tender over Spleen on light palpation.

o Pain on palpation at GB 37 (left), Ki 7, Lv 3, Lv 8 and Ki 8

o Pulse – felt like a 16 year old Rx

 

OVERALL DIAGNOSIS

Jing Xu, with St Yin Xu, He Qi Xu & Lv Qi Yu

 

Tx – Tonify Jing, supplement St Yin and He Qi, harmonize liver

 

Acupx – No treatment on initial intake as blood pressure seemed low

and patient seemed tired.

 

& #61656; Patient asked to monitor BP over course of the week.

& #61656; Encouraged to modify diet to more frequent small meals

& #61656; Pt also encouraged to reduce physical lifting of daughter and

look into alternative care options

 

Herbs – No herbs prescribed on intial tx – Thoughts?

Classic Base – Ba Wei Di Huang Wan jia Jian

Eyes, Gou Qi Zi, Ju Hua

Heart – He Huan Pi

St Yin – Shi Hu, Sha Ren

Urination – Fu Pen Zi

 

Concern over patient's ability to digest the herbs – add Shen Qu?

How about the drug herb interaction? – start with low dose and

increase?

 

I look forward to input from the group.

 

Kayte

[Guest guest]

How come you get all the easy cases? ;-)

this is really tough... for me this is where I would start with a patent an=

d work your

way up to teas. I think your hesitancy is correct in terms of herbs. With a=

ll this going

on, especially the gastric problems, to put a thick soup of qi changing her=

bs in this

patient would be too much. Try your base formula as a tincture, patent, wha=

tever and

see what happens. Just my opinion.

doug

 

> Diabetes Case Study 1

>

> 61 yr old female, 153 lbs, 5'4 "

> • CC Diabetes, diagnosis 1.5 yrs ago – general pains and

> stiffness throughout body

> • Blood Sugar levels outside normal 175-275 despite Rx. Actose,

> Rx Lantis

> • 2ndry Complaints –

> o Diminished eyesight, diabetic retinopathy/macular

> degeneration – Laser surgeries and injections on both eyes, no

> improvement in condition, experiences periodic white out effect and

> tunneling of vision

> o High Blood Pressure Rx Lotinsin – BP on intake 98/49 – supine

> o Heart Condition – Rx – Norvask – last EKG clear

> o Gastric Surgery – unable to digest meat, rice and many

> vegetables

> Supplements

> • Coral Calcium – osteoporosis

> • Ester C

> • Aspirin – St Joes for heart

> • Simple Greens.

> • Prior Surgeries – Stomach lower half removed dt scarring from

> long-term ulcer

>

> 10 Children – 14 pregnancies

> Hx of mental and physical abuse

> Occupation – personal Attendant to quadriplegic daughter and guardian

> for 2 grand-children, 1 ADHD, 1 Touretts

>

> 1. Energy – not much stamina – after 2 hrs must lay down to

> sleep.

> 2. Sleep – Up 2-3x per night to urinate, falls asleep easily

> anytime – up early 5:00Am for chores

> 3. Temp/Sweat – U Jiao heat, extremities cold, spontaneous sweat

> in Am head and neck

> 4. Appetite/Thirst – Seldom hungry, unable to eat many

> vegetables dt high carb content – generally eats 2x per day – keeps

> within 65 carbs per day. Thirst – always drinking, would prefer to

> drink rather than eat

> 5. Digestion – gas all the time whether she eats or not.

> 6. BM's – difficult and urgent, 3x per day, normal color –

> urination every 2 hrs during day and 2-3 x at night.

> 7. HEENT –

> a. high pitch ringing, comes and goes during day

> b. Sinus problems, post nasal drip, tendency to catch colds

> easily, poor sense of smell

> 8. Menstrual – Menopause was easy – no problems

> 9. Emotional – Rolls with punches, always positive – been " an

> enabler all her life " – abuse and desertion by parents, mental &

> physical abuse by spouse – 40+ years

> 10. Pain – general body pain

>

> & #61656; Observation –

> o puffiness around eyes, dark shadows, pale complexion and

> general weakness

> o Tongue, pale, sl yellow coat

> & #61656; Palpation –

> o Abdominal scar Ren 12 thru ren 7,

> o Tender over Spleen on light palpation.

> o Pain on palpation at GB 37 (left), Ki 7, Lv 3, Lv 8 and Ki 8

> o Pulse – felt like a 16 year old Rx

>

> OVERALL DIAGNOSIS

> Jing Xu, with St Yin Xu, He Qi Xu & Lv Qi Yu

>

> Tx – Tonify Jing, supplement St Yin and He Qi, harmonize liver

>

> Acupx – No treatment on initial intake as blood pressure seemed low

> and patient seemed tired.

>

> & #61656; Patient asked to monitor BP over course of the week.

> & #61656; Encouraged to modify diet to more frequent small meals

> & #61656; Pt also encouraged to reduce physical lifting of daughter and

> look into alternative care options

>

> Herbs – No herbs prescribed on intial tx – Thoughts?

> Classic Base – Ba Wei Di Huang Wan jia Jian

> Eyes, Gou Qi Zi, Ju Hua

> Heart – He Huan Pi

> St Yin – Shi Hu, Sha Ren

> Urination – Fu Pen Zi

>

> Concern over patient's ability to digest the herbs – add Shen Qu?

> How about the drug herb interaction? – start with low dose and

> increase?

>

> I look forward to input from the group.

>

> Kayte