Guest guest Posted June 26, 2004 Report Share Posted June 26, 2004 Hello all, I am hoping someone can give me some herbal guidance on a patient. 59 y.o. female with burning acid reflux for 3-4 years. She has a sensation of phlegm coming up her throat to the point of choking throughout the day. Endoscopy revealed nothing to indicate stricture, ulceration or herniation. Several weeks ago, she had a kidney stone that presented with no previous symptoms, but caused acute pain radiating from back to abdomen, vomiting and hematuria for 12 hours. After she passed the stone, she again had no symptoms, no burning urination, bleeding, cloudy urine, nothing. She always experiences frequent urination, despite not drinking sufficient water. Other health complaints include: chronic upper tooth infection, hypochondrial pain, hair loss, dry skin, weight gain, extreme fatigue (her thyroid levels are non-conclusive...). T: pale, slightly scalloped, slightly dry thin white coat, small center line cracks. P: almost completely imperceptible on both sides, however when I can barely feel it, it is between 90-110 BPM. On a side acupuncture note, on two occasions, once while I was an intern and again last week, she has experienced whole body shaking after having LIV 14-LU 1 needled, and LIV 3-LI 4 (these were done on separate occasions). She claims that she had a similar response to " an injection " she had as a child, which induced uncontrollable shaking. She " always has to feel like (she) is in control, " so this is most disconcerting. Herbally, I have tried to address the plumpit Qi to no avail with Ban Xia Huo Po T, then tried to quell the ST fire/phlegm with Wen Dan Tang, then addressed Liver overacting on SP with Xiao Yao San, and have only had moderate success. While she was seeing me regularly whilst an intern, we eliminated the acid reflux completely, but now it is back due to a 2 month hiatus in treatments. I know that I need to nourish her blood & yin but am afraid of adding fuel to the fire. (whew!) I know this is a long post, but I am really concerned about doing the best thing for her. Any suggestions are VERY appreciated! Thanks, Melanie ===== New and Improved Mail - Send 10MB messages! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2004 Report Share Posted June 26, 2004 Hi Melanie, This is definitely a complicated patient. There is alot going on with her. The history of kidney stones, hair loss, chronic tooth infection, and frequent urination cause me to want to look more closely at her kidneys; yin and yang. Throat stricture can be plum pit qi, or stomach yin xu rising up into the throat. The dry skin and hair point to blood vacuity, and the hypochondriac pain suggests liver constraint. It may be more of a liver-kidney yin and blood vacuity picture with an overlay of wood-earth disharmony. It looks to me like you might need to simultaneously clear heat and nourish yin. Yi Guan Jian (Linking Decoction) addresses kidney-liver yin xu with liver constraint; you can add some herbs to nourish stomach yin (Mai Men Dong comes to mind) and also to clear heat (Huang Lian for stomach fire), and address the kidney yang xu (if that's what her frequent urination is due to) down the road. What is being done for the chronic tooth infection? As this is an excess, I would find addressing this a top priority, then clearing heat and moving stagnation, and then nourishing yin and yang, in that order, but I would also try to address as many of these things simultaneously as possible - some with herbs, some with acumoxa. I'd be more specific, but I feel I'd have to see her to make more concrete recommendations. Let us know what you do and how it works. " Melanie Morris Katin, L.Ac. " <mmkatin wrote: Hello all, I am hoping someone can give me some herbal guidance on a patient. 59 y.o. female with burning acid reflux for 3-4 years. She has a sensation of phlegm coming up her throat to the point of choking throughout the day. Endoscopy revealed nothing to indicate stricture, ulceration or herniation. Several weeks ago, she had a kidney stone that presented with no previous symptoms, but caused acute pain radiating from back to abdomen, vomiting and hematuria for 12 hours. After she passed the stone, she again had no symptoms, no burning urination, bleeding, cloudy urine, nothing. She always experiences frequent urination, despite not drinking sufficient water. Other health complaints include: chronic upper tooth infection, hypochondrial pain, hair loss, dry skin, weight gain, extreme fatigue (her thyroid levels are non-conclusive...). T: pale, slightly scalloped, slightly dry thin white coat, small center line cracks. P: almost completely imperceptible on both sides, however when I can barely feel it, it is between 90-110 BPM. On a side acupuncture note, on two occasions, once while I was an intern and again last week, she has experienced whole body shaking after having LIV 14-LU 1 needled, and LIV 3-LI 4 (these were done on separate occasions). She claims that she had a similar response to " an injection " she had as a child, which induced uncontrollable shaking. She " always has to feel like (she) is in control, " so this is most disconcerting. Herbally, I have tried to address the plumpit Qi to no avail with Ban Xia Huo Po T, then tried to quell the ST fire/phlegm with Wen Dan Tang, then addressed Liver overacting on SP with Xiao Yao San, and have only had moderate success. While she was seeing me regularly whilst an intern, we eliminated the acid reflux completely, but now it is back due to a 2 month hiatus in treatments. I know that I need to nourish her blood & yin but am afraid of adding fuel to the fire. (whew!) I know this is a long post, but I am really concerned about doing the best thing for her. Any suggestions are VERY appreciated! Thanks, Melanie ===== New and Improved Mail - Send 10MB messages! Chinese Herbal Medicine offers various professional services, including board approved continuing education classes, an annual conference and a free discussion forum in Chinese Herbal Medicine. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2004 Report Share Posted June 27, 2004 From the symptoms you've listed, I can spot at least a half dozen patterns: Qi and Blood Defic, Liver Qi Stagn, Liver Invading St/Sp?, Spleen Dampness/Phlegm, Kidney Qi Defic... If tongue is pale without any yellow TCOAT, and fissures in center, this is more likely some St Yin Deficiency rather than Excess-Fire, especially with weak pulses. Obviously a complicated case, your formulas seem in right ballpark, and whenever this happens to me, I always do a thorough dietary/environmental/occupational history. In most cases, some horrific things will show up that need to be addressed. A chronic tooth infection can often result in systemic problems. Infected root canals, combinations of different dental metals in mouth, etc. might also be factors. Also check: heavy metals (mineral imbalance, kidney stones), organic solvent toxicity, poor diet. If these things are factors, herbs will generally have only minimal effects without other measures. ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org > " Melanie Morris Katin, L.Ac. " <mmkatin >acid reflux, KD stones > >Hello all, >I am hoping someone can give me some herbal guidance >on a patient. >59 y.o. female with burning acid reflux for 3-4 years. >She has a sensation of phlegm coming up her throat to >the point of choking throughout the day. Endoscopy >revealed nothing to indicate stricture, ulceration or >herniation. Several weeks ago, she had a kidney stone >that presented with no previous symptoms, but caused >acute pain radiating from back to abdomen, vomiting >and hematuria for 12 hours. After she passed the >stone, she again had no symptoms, no burning >urination, bleeding, cloudy urine, nothing. She always >experiences frequent urination, despite not drinking >sufficient water. >Other health complaints include: chronic upper tooth >infection, hypochondrial pain, hair loss, dry skin, >weight gain, extreme fatigue (her thyroid levels are >non-conclusive...). T: pale, slightly scalloped, >slightly dry thin white coat, small center line >cracks. P: almost completely imperceptible on both >sides, however when I can barely feel it, it is >between 90-110 BPM. >On a side acupuncture note, on two occasions, once >while I was an intern and again last week, she has >experienced whole body shaking after having LIV 14-LU >1 needled, and LIV 3-LI 4 (these were done on separate >occasions). She claims that she had a similar response >to " an injection " she had as a child, which induced >uncontrollable shaking. She " always has to feel like >(she) is in control, " so this is most disconcerting. > >Herbally, I have tried to address the plumpit Qi to no >avail with Ban Xia Huo Po T, then tried to quell the >ST fire/phlegm with Wen Dan Tang, then addressed Liver >overacting on SP with Xiao Yao San, and have only had >moderate success. While she was seeing me regularly >whilst an intern, we eliminated the acid reflux >completely, but now it is back due to a 2 month hiatus >in treatments. I know that I need to nourish her blood > & yin but am afraid of adding fuel to the fire. >(whew!) I know this is a long post, but I am really >concerned about doing the best thing for her. Any >suggestions are VERY appreciated! >Thanks, >Melanie ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org Quote Link to comment Share on other sites More sharing options...
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