Guest guest Posted January 17, 2007 Report Share Posted January 17, 2007 Hello all, I am trying to decipher diagnosis and treatment of a patient and could use some input. 50 year old female. Main complaint : chronic upper body pain, it's exhausting. Very tight toward the end of the day, buzzing and burning in her upper back muscles. Recently had an MRI, which showed some arthritis and bone spurs. It also showed chronic sinus infection, with which she was never symptomatic, and her doctor prescribed 2 rounds of antibiotics. Secondary complaint: multifocal myoclonus, diagnosed by western MD. (involuntary spasms, mostly in her shoulder blades, upper back, neck, arms, occasionally affecting her legs (especially left hip.) Rx: Klonopin and neurontin (used for siezure disorders.) They help for a while. Spasms for several years but have been getting worse over the last 2 years. She describes the neck spasms as Tourretes-like. Chronic insomnia, takes Ambien. Wakes up in a panic, heart pounding. Or she falls asleep easily, wakes an hour later with a busy mind. She went through a sleep study and was diagnosed with moderate sleep apnea. High reflux, voice gets raw and gravelly. She had an endoscopy, which showed a stomach full of bile. Her valves seemed ok. Possibly slow transit in stomach with back-flow of bile. The MD's could not giver her a cause for the bile reflux. She takes Prevacid and Pepsin daily (which is for stomach acid) and says she has very few occurrences now. Hypochondrial pain and tenderness around liver and solar plexus, which comes and goes. She is cold, especially icy feet, regardless of climate. I am not a pulse expert, but both sides feel deficient, sl. slow, with both kidney pulses deep. Her tongue is swollen, red, peeled edges, thick white coat in the center, and a red tip. She takes Cozaar for high blood pressure which seems to be under control. Hx: neck injuries as a child, 3 rear-end auto accident years ago Uterine prolapse in 2004, with a complete hysterectomy. There was so much tissue from 2 C-sections in 1979 & 81, that one ovary was buried in scar tissue. Care-taking mother who has survived ovarian cancer, double mastectomy, non hodgkins lymphoma, and melanoma. These cause worry and fear Very depressed afterwards, had hot flashes, and was prescribed an estrogen patch. She is still angry about the hysterectomy, but feels without it she would live in fear of ovarian cancer. Chronic insomnia, and takes Ambien. Wakes up in a panic, heart pounding. Or she falls asleep easily, wakes an hour later with a busy mind. She went through a sleep study and was diagnosed with moderate sleep apnea. I'm thinking Liver/Heart yin/blood deficiency, Yang rising, and liver wind causing spasms, high blood pressure. Liver /GB Qi Stagnation, Not sure if the coldness and icy feet is a Kidney Yang/Qi deficiency or Liver Qi Constraint issue. Seems complex. Any ideas? She started coming to Tai Chi class, and will take patent formulas. Formula ideas: Tian Ma Gou Teng Yin, Si Ni San, Xiao Yao Wan, Suan Zao Ren Tang???? Chinese Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2007 Report Share Posted January 17, 2007 On 1/17/07, Chinese Medicine <> wrote: > She is cold, especially icy feet, regardless of climate. I am not a > pulse expert, but both sides feel deficient, sl. slow, with both > kidney pulses deep. Her tongue is swollen, red, peeled edges, thick > white coat in the center, and a red tip. > Deep Kidney pulses aren't too strange. It is their nature to sink. Floating upper jiao pulses are okay for the same reason, it is their nature. The deficiency in the pulse I think is important, though. At least it puts us on to the map of what to do. A red tongue says heat, I'm guessing deficiency because of the chronic aspects here. Thick coating in the center is probably related to her stomach problems. Either food stagnation and/or Liver attacking Stomach. Probably with some turbid dampness thrown in too. With everything that is going on and all the drugs that she's taking, its really hard to start to unravel anything too specific, especially with premade remedies. I would consider Jue Yu Wan for all the stagnations and heat. Jia Wei Xiao Yao Wan might make sense too since the tongue is redder than normal. Clearly, there is Liver wind, heat, and stagnations happening here. Which angle is going to unravel everything else is well beyond my ability to assess her. I would however just consider doubling the dosage that is printed on the label so you can be sure she's getting a decent dosage. -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2007 Report Share Posted January 17, 2007 Hi Wendy, I think you're on the right track with nourishing kidney and liver yin and blood, and downbearing yang and wind, but but the burning pain, you should also consider some herbs specifically for clearing heat. It also sounds like she needs to mobilize and free up the muscles in her upper back and neck - has she tried any bodywork? Interesting case study. Let us know how it goes. Chinese Medicine <> wrote: Hello all, I am trying to decipher diagnosis and treatment of a patient and could use some input. 50 year old female. Main complaint : chronic upper body pain, it's exhausting. Very tight toward the end of the day, buzzing and burning in her upper back muscles. Recently had an MRI, which showed some arthritis and bone spurs. It also showed chronic sinus infection, with which she was never symptomatic, and her doctor prescribed 2 rounds of antibiotics. Secondary complaint: multifocal myoclonus, diagnosed by western MD. (involuntary spasms, mostly in her shoulder blades, upper back, neck, arms, occasionally affecting her legs (especially left hip.) Rx: Klonopin and neurontin (used for siezure disorders.) They help for a while. Spasms for several years but have been getting worse over the last 2 years. She describes the neck spasms as Tourretes-like. Chronic insomnia, takes Ambien. Wakes up in a panic, heart pounding. Or she falls asleep easily, wakes an hour later with a busy mind. She went through a sleep study and was diagnosed with moderate sleep apnea. High reflux, voice gets raw and gravelly. She had an endoscopy, which showed a stomach full of bile. Her valves seemed ok. Possibly slow transit in stomach with back-flow of bile. The MD's could not giver her a cause for the bile reflux. She takes Prevacid and Pepsin daily (which is for stomach acid) and says she has very few occurrences now. Hypochondrial pain and tenderness around liver and solar plexus, which comes and goes. She is cold, especially icy feet, regardless of climate. I am not a pulse expert, but both sides feel deficient, sl. slow, with both kidney pulses deep. Her tongue is swollen, red, peeled edges, thick white coat in the center, and a red tip. She takes Cozaar for high blood pressure which seems to be under control. Hx: neck injuries as a child, 3 rear-end auto accident years ago Uterine prolapse in 2004, with a complete hysterectomy. There was so much tissue from 2 C-sections in 1979 & 81, that one ovary was buried in scar tissue. Care-taking mother who has survived ovarian cancer, double mastectomy, non hodgkins lymphoma, and melanoma. These cause worry and fear Very depressed afterwards, had hot flashes, and was prescribed an estrogen patch. She is still angry about the hysterectomy, but feels without it she would live in fear of ovarian cancer. Chronic insomnia, and takes Ambien. Wakes up in a panic, heart pounding. Or she falls asleep easily, wakes an hour later with a busy mind. She went through a sleep study and was diagnosed with moderate sleep apnea. I'm thinking Liver/Heart yin/blood deficiency, Yang rising, and liver wind causing spasms, high blood pressure. Liver /GB Qi Stagnation, Not sure if the coldness and icy feet is a Kidney Yang/Qi deficiency or Liver Qi Constraint issue. Seems complex. Any ideas? She started coming to Tai Chi class, and will take patent formulas. Formula ideas: Tian Ma Gou Teng Yin, Si Ni San, Xiao Yao Wan, Suan Zao Ren Tang???? Chinese Medicine Quote Link to comment Share on other sites More sharing options...
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