Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Greetings everyone, I have an unusual case that I need some help with. I'm hoping someone might have some insights. I have a 34 year old patient who's experienced approximately 18 months of severe emotional stress (situational). As a result, he presented with severe hair & weight loss, lower body edema, cold extremities, aversion to cold, bodily heaviness, facial/eye puffiness, pallor, fatigue/exhaustion, loose stools, poor appetite, apathy/sadness/anxiety. Pulse was weak, deep & thin. Tongue was pale, puffy/scalloped. Over the course of a month, I prescribed Gui Zhi Tang. Then Ba Zhen Wan. Then Gui Fu Li Zhong Tang (modified Li Zhong Wan) Then Zhen Wu Tang (true warrior decoction). Things were steadily improving when I switched to Zhen Wu Tang. It had an immediate & dramatic effect on all symptoms (within a few days). But it also resulted in severe yin deficiency heat symptoms like fever, sore throat, constipation, dryness, & insomnia. Tongue became red w/ a crack, pulse became surging. I switched to a cooling and yin enriching formula and although I've eliminated the overt heat signs, the patient still exhibits dry eyes, mild insomnia, and the tongue still has a left sided red tip. Interestingly, the right guan pulse has remained surging. The problem is that if they avoid yin nourishing herbs for a few days, yin deficiency dryness signs appear. But most of the deficiency signs, including the edema & emotional apathy have also returned. If I attempt to tonify Qi/Blood/Yang, the entire pulse becomes surging, tongue tip becomes very red and other deficiency heat patterns (like insomnia and itching) immediately return. The only thing I can think of is latent heat, cooking off the yin. But other than the surging right guan pulse, there aren't any signs. My sense is that his life circumstances have compromised his capacity for joy and ability to relax (yin). And (perhaps) it's this inability to connect with nourishing feelings that perpetuate his Yin xu. I'm also pretty sure the lack of hope is the predominant cause of his edema/eye puffiness. Any thoughts??? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Maybe you could tell us what your diagnosis was at each stage. The Gui Zhi Tang to start off with is curious to me. doug , " Pete Jones " <tworks2012 wrote: > > Greetings everyone, > > I have an unusual case that I need some help with. I'm hoping > someone might have some insights. > > I have a 34 year old patient who's experienced approximately 18 > months of severe emotional stress (situational). As a result, he > presented with severe hair & weight loss, lower body edema, cold > extremities, aversion to cold, bodily heaviness, facial/eye > puffiness, pallor, fatigue/exhaustion, loose stools, poor appetite, > apathy/sadness/anxiety. > Pulse was weak, deep & thin. > Tongue was pale, puffy/scalloped. > > Over the course of a month, I prescribed Gui Zhi Tang. > Then Ba Zhen Wan. > Then Gui Fu Li Zhong Tang (modified Li Zhong Wan) > Then Zhen Wu Tang (true warrior decoction). > > Things were steadily improving when I switched to Zhen Wu Tang. It > had an immediate & dramatic effect on all symptoms (within a few > days). But it also resulted in severe yin deficiency heat symptoms > like fever, sore throat, constipation, dryness, & insomnia. Tongue > became red w/ a crack, pulse became surging. > > I switched to a cooling and yin enriching formula and although I've > eliminated the overt heat signs, the patient still exhibits dry > eyes, mild insomnia, and the tongue still has a left sided red tip. > Interestingly, the right guan pulse has remained surging. > > The problem is that if they avoid yin nourishing herbs for a few > days, yin deficiency dryness signs appear. But most of the > deficiency signs, including the edema & emotional apathy have also > returned. > > If I attempt to tonify Qi/Blood/Yang, the entire pulse becomes > surging, tongue tip becomes very red and other deficiency heat > patterns (like insomnia and itching) immediately return. > > The only thing I can think of is latent heat, cooking off the yin. > But other than the surging right guan pulse, there aren't any signs. > > My sense is that his life circumstances have compromised his > capacity for joy and ability to relax (yin). And (perhaps) it's this > inability to connect with nourishing feelings that perpetuate his > Yin xu. > I'm also pretty sure the lack of hope is the predominant cause of > his edema/eye puffiness. > > Any thoughts??? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2006 Report Share Posted November 14, 2006 Hi Pete, Here are my thoughts. The pitting edema this patient suffers from is definitively Kidney Yang deficiency. Though there are signs and symptoms that the water accumulation has spread through all three warmers, if you don't address the root of it, the Kidney Yang, there will be no positive effect. You saw how the first formulas were not working. You had the right disease factor to some extent in the formulas: Gui Zhi Tang - Cold Ba Zhen Tang - deficiency Li Zhong Wan - Yang deficiency But, these formulas miss the location of the pathology - the Kidney. So ,when you hit upon Zhen Wu Tang, you got good results. This points to the importance of following Qin Bo-Wei's instructions to make sure your formula addresses the disease factor, location and symptom. Kidney Yang deficiency explains all of her signs and symptoms and is definitive. So, what's the problem? Zhang Jing-Yue describes the tonification of the Kidney Yang is like turning up the fire under a cooking pot. We know from your patient's signs and symptoms, as well as her response to treatment, that this fire does need to be turned up. Zhang also makes it clear that we have to check to make sure that the cooking pot is full when we turn up the fire. If it is not, the symptoms of scorching will develop. Zhen Wu Tang boosts the Kidney Yang in order to transform fluids but it has very little to protect the Yin. If there is any Yin vacuity it will be ecaserbated when the excess fluids are drained and the fire is supplemented. The formula to use is probably Jin Gui Shen Qi Wan. This formula boosts the fire while filling the pot and is not as draining of the fluids. It's important to remember that we don't have to pick between Yin Xu and Yang Xu. We have to see the relationship between the two. Hope this helps, Sharon www.whitepinehealingarts.com Greetings everyone, I have an unusual case that I need some help with. I'm hoping someone might have some insights. I have a 34 year old patient who's experienced approximately 18 months of severe emotional stress (situational). As a result, he presented with severe hair & weight loss, lower body edema, cold extremities, aversion to cold, bodily heaviness, facial/eye puffiness, pallor, fatigue/exhaustion, loose stools, poor appetite, apathy/sadness/anxiety. Pulse was weak, deep & thin. Tongue was pale, puffy/scalloped. Over the course of a month, I prescribed Gui Zhi Tang. Then Ba Zhen Wan. Then Gui Fu Li Zhong Tang (modified Li Zhong Wan) Then Zhen Wu Tang (true warrior decoction). Things were steadily improving when I switched to Zhen Wu Tang. It had an immediate & dramatic effect on all symptoms (within a few days). But it also resulted in severe yin deficiency heat symptoms like fever, sore throat, constipation, dryness, & insomnia. Tongue became red w/ a crack, pulse became surging. I switched to a cooling and yin enriching formula and although I've eliminated the overt heat signs, the patient still exhibits dry eyes, mild insomnia, and the tongue still has a left sided red tip. Interestingly, the right guan pulse has remained surging. The problem is that if they avoid yin nourishing herbs for a few days, yin deficiency dryness signs appear. But most of the deficiency signs, including the edema & emotional apathy have also returned. If I attempt to tonify Qi/Blood/Yang, the entire pulse becomes surging, tongue tip becomes very red and other deficiency heat patterns (like insomnia and itching) immediately return. The only thing I can think of is latent heat, cooking off the yin. But other than the surging right guan pulse, there aren't any signs. My sense is that his life circumstances have compromised his capacity for joy and ability to relax (yin). And (perhaps) it's this inability to connect with nourishing feelings that perpetuate his Yin xu. I'm also pretty sure the lack of hope is the predominant cause of his edema/eye puffiness. Any thoughts??? Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2006 Report Share Posted November 14, 2006 Hello Sharon and Doug & thanks for your replies, Doug, I think Sharons posting follows my diagnosis and rational for choosing the formulas perfectly. Specifically, Gui Zhi Tang for Heart Yang xu. To warm the upper burner, while mildly tonifying Qi & blood, thereby strengthening and diffusing his chest qi. Ba Zhen Wan for the obvious Qi & Blood xu. Li Zhong Wan is a modification of Gui Zhi Tang and tonifies/boosts the middle, rather than the upper. Zhen Wu Tang for water metabolism problems. But (as with many important clinical insights) I only realized that it wasn't strictly a Yang xu water metabolism problem " after the fact " . Now I'm wondering why yin nourishing treatments arent producing lasting effects. Or why he presents with deficiency fire when I tonify him. I've subsequently tried using Ba Zhen Wan, Bu Zhong Yi Qi Tang and Jin Gui Shen Qi Wan. Plus a few other formulas that tonify while cooling. But although they make him feel better, they also seem to flare up his deficiency fire. As Sharon mentioned, it almost seems like the pathological water accumulation actually keeps the deficiency fire in check. As I tonify him, there isn't enough yin to restrain the yang and it flares up (even though its severely depleted). I've used Shi Quan Da Bu Tang and another cooling yin tonic that's very helpful for the deficiency fire but does nothing for his yang & qi xu complaints. Two weeks of using Er Xian Tang had mediocre results. My primary question is whether there's another reason that tonifying formulas might cause immediate & drastic deficiency heat patterns other than the one mentioned??? Thanks, p..... , sharon weizenbaum <sweiz wrote: > > > > Hi Pete, > > Here are my thoughts. The pitting edema this patient suffers from is > definitively Kidney Yang deficiency. Though there are signs and > symptoms that the water accumulation has spread through all three > warmers, if you don't address the root of it, the Kidney Yang, there > will be no positive effect. You saw how the first formulas were not > working. You had the right disease factor to some extent in the > formulas: > Gui Zhi Tang - Cold > Ba Zhen Tang - deficiency > Li Zhong Wan - Yang deficiency > > But, these formulas miss the location of the pathology - the Kidney. > So ,when you hit upon Zhen Wu Tang, you got good results. This > points to the importance of following Qin Bo-Wei's instructions to > make sure your formula addresses the disease factor, location and > symptom. Kidney Yang deficiency explains all of her signs and > symptoms and is definitive. > > So, what's the problem? > > Zhang Jing-Yue describes the tonification of the Kidney Yang is like > turning up the fire under a cooking pot. We know from your patient's > signs and symptoms, as well as her response to treatment, that this > fire does need to be turned up. Zhang also makes it clear that we > have to check to make sure that the cooking pot is full when we turn > up the fire. If it is not, the symptoms of scorching will develop. > > Zhen Wu Tang boosts the Kidney Yang in order to transform fluids but > it has very little to protect the Yin. If there is any Yin vacuity > it will be ecaserbated when the excess fluids are drained and the > fire is supplemented. The formula to use is probably Jin Gui Shen Qi > Wan. This formula boosts the fire while filling the pot and is not > as draining of the fluids. > > It's important to remember that we don't have to pick between Yin Xu > and Yang Xu. We have to see the relationship between the two. > > Hope this helps, > > Sharon > www.whitepinehealingarts.com > > > Greetings everyone, > > I have an unusual case that I need some help with. I'm hoping > someone might have some insights. > > I have a 34 year old patient who's experienced approximately 18 > months of severe emotional stress (situational). As a result, he > presented with severe hair & weight loss, lower body edema, cold > extremities, aversion to cold, bodily heaviness, facial/eye > puffiness, pallor, fatigue/exhaustion, loose stools, poor appetite, > apathy/sadness/anxiety. > Pulse was weak, deep & thin. > Tongue was pale, puffy/scalloped. > > Over the course of a month, I prescribed Gui Zhi Tang. > Then Ba Zhen Wan. > Then Gui Fu Li Zhong Tang (modified Li Zhong Wan) > Then Zhen Wu Tang (true warrior decoction). > > Things were steadily improving when I switched to Zhen Wu Tang. It > had an immediate & dramatic effect on all symptoms (within a few > days). But it also resulted in severe yin deficiency heat symptoms > like fever, sore throat, constipation, dryness, & insomnia. Tongue > became red w/ a crack, pulse became surging. > > I switched to a cooling and yin enriching formula and although I've > eliminated the overt heat signs, the patient still exhibits dry > eyes, mild insomnia, and the tongue still has a left sided red tip. > Interestingly, the right guan pulse has remained surging. > > The problem is that if they avoid yin nourishing herbs for a few > days, yin deficiency dryness signs appear. But most of the > deficiency signs, including the edema & emotional apathy have also > returned. > > If I attempt to tonify Qi/Blood/Yang, the entire pulse becomes > surging, tongue tip becomes very red and other deficiency heat > patterns (like insomnia and itching) immediately return. > > The only thing I can think of is latent heat, cooking off the yin. > But other than the surging right guan pulse, there aren't any signs. > > My sense is that his life circumstances have compromised his > capacity for joy and ability to relax (yin). And (perhaps) it's this > inability to connect with nourishing feelings that perpetuate his > Yin xu. > I'm also pretty sure the lack of hope is the predominant cause of > his edema/eye puffiness. > > Any thoughts??? > > Sharon Weizenbaum > 86 Henry Street > Amherst, MA 01002 > 413-549-4021 > sweiz > www.whitepinehealingarts.com > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2006 Report Share Posted November 21, 2006 Hi Pete, First, it sounds like you don't have a comprehensive diagnosis for this patient and are just trying this and that. You definately know that there is Kidney Fire Xu because of the pitting edema and the Yang tonic formula helped him a lot. The Kidney Yang Xu diagnosis explained all of the other signs and symptoms so I would stick with that. Then there is the question of the deficiency heat. First, it is very important to see that deficiency heat does not necessarily equal yin xu, contrary to what most of us learn in school. There are many examples of heat rising due to Yang, Qi or blood Xu in the case study and classic literature. So, if your diagnosis of Kidney Yang deficiency is correct, which it seems to be, the formula must be modified to root the flaring empty fire while strengthening it. Sharon Hello Sharon and Doug & thanks for your replies, Doug, I think Sharons posting follows my diagnosis and rational for choosing the formulas perfectly. Specifically, Gui Zhi Tang for Heart Yang xu. To warm the upper burner, while mildly tonifying Qi & blood, thereby strengthening and diffusing his chest qi. Ba Zhen Wan for the obvious Qi & Blood xu. Li Zhong Wan is a modification of Gui Zhi Tang and tonifies/boosts the middle, rather than the upper. Zhen Wu Tang for water metabolism problems. But (as with many important clinical insights) I only realized that it wasn't strictly a Yang xu water metabolism problem " after the fact " . Now I'm wondering why yin nourishing treatments arent producing lasting effects. Or why he presents with deficiency fire when I tonify him. I've subsequently tried using Ba Zhen Wan, Bu Zhong Yi Qi Tang and Jin Gui Shen Qi Wan. Plus a few other formulas that tonify while cooling. But although they make him feel better, they also seem to flare up his deficiency fire. As Sharon mentioned, it almost seems like the pathological water accumulation actually keeps the deficiency fire in check. As I tonify him, there isn't enough yin to restrain the yang and it flares up (even though its severely depleted). I've used Shi Quan Da Bu Tang and another cooling yin tonic that's very helpful for the deficiency fire but does nothing for his yang & qi xu complaints. Two weeks of using Er Xian Tang had mediocre results. My primary question is whether there's another reason that tonifying formulas might cause immediate & drastic deficiency heat patterns other than the one mentioned??? Thanks, p..... Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
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