Guest guest Posted November 8, 2007 Report Share Posted November 8, 2007 Hi Kate, Seems like, if nothing else, you have all your ducks in a row. Nothing wrong with that. I think that you might want to present the following options to your patient: 1. does he want to feel better or does he want his testosterone levels lifted? Honestly it is entirely possible that his libido issues derive from his marital strife. One way in which you can determine this is to ask him if he notices pretty girls who aren't his wife. In other words, is his libido simulated outside of the marriage? If so, perhaps it isn't so much a testosterone deficiency and more something along the qi and blood stagnation that you've observed. 2. If the outcome measurement is his sense of wellness or " feeling better " , I'd default to treating what you see as you have begun doing. If the outcome measurement is his testosterone levels, then you are perhaps correct in adding some Kidney yang tonics. 3. Another avenue you may consider is selling him on the Liver/Spleen issues as the cause of his testosterone deficiency. Post natal nourishes prenatal and all that. I think that middle-aged guys who've long attached their sexuality to their sense of self can be quite surprised to discover how much the emotions can effect their libido. This may not have been too big of a deal earlier in life, but as we men age, feelings matter more and more. Are you feeling me? -al. On Nov 8, 2007 12:52 PM, kbnls <kbnls wrote: > > Hi everyone, > > I have a 47 year old male patient who has a chief complaint of low > testosterone, along with high stress, poor digestion, and decreasing > libido. My main dilemma is whether to use herbs which have been shown > to increase testosterone – (testosterone often being a reflection of > KD yang in both CM terms and pharmaceutical research), even though he > doesn't present with much KD deficiency. -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2007 Report Share Posted November 8, 2007 Hi kate, Bai Ji Li, tribulus, is a good herb to boost testosterone and course the liver Qi as well. The 5 seed decoction is also good and is not overly warming. I usually add Bai JI li to it, as well She Chuang Zi and Chong Wei Zi. I have seen good result in clinic. Many clients come back to me saying things like " I feel like a walking hormone " or " I feel like a teenager again! " Good luck Trevor www.acubalance.ca , " kbnls " <kbnls wrote: > > Hi everyone, > > I have a 47 year old male patient who has a chief complaint of low > testosterone, along with high stress, poor digestion, and decreasing > libido. My main dilemma is whether to use herbs which have been shown > to increase testosterone – (testosterone often being a reflection of > KD yang in both CM terms and pharmaceutical research), even though he > doesn't present with much KD deficiency. > > Details of the case are below. > > His testosterone levels were 500 ng/dl in 6/07, 200 in 8/07 and 100 in > 10/07. > > His stress is somewhat related to his work but mostly his marriage, as > his wife is finding herself and trying to decide whether she wants to > be married anymore; they have 2 children. He says feels that stress > could be the root of all his physical problems. He is in both > individual and marriage counseling. Despite the risks, he wants > testosterone supplementmentation but his therapist convinced him to > try Chinese medicine fist. He feels increasingly fatigued and > depressed, and states that he would rather live 10 more good years > feeling good through testosterone supplementation than 30 years the > way he feels now. > > His digestive symptoms are a feeling of fullness and bloating after he > eats ( " food just sits there " ) for 1 year, regardless of what he eats, > and 2 or more loose bowel movements throughout the day. He states that > his appetite is still good, and he is trying to eat smaller, more > frequent meals, but it hasn't seemed to help. He has always previously > had strong digestion. > > His libido decline concerns him, as he has always defined himself to > some degree through sex. He acknowledges that the decline may be due > in part to his wife's rejection of him for the past 6 months, as well > as the declining testosterone. > > Otherwise, he rates his overall energy at 7/10 (down from his previous > 10/10). He has a stocky muscular build and runs daily for exercise, > and gets increasingly irritable and anxious if he doesn't exercise. He > feels hot overall, but has noticed his feet occasionally getting cold > lately. He is thirsty for cold water and doesn't drink much caffeine, > although when he does, it occasionally gives him a temporal headache. > He sleeps well, occasionally waking briefly around 4 am. He urinates > 6-8 x/ day (neither particularly scanty nor profuse amounts), and > doesn't get up at night to pee. He has had 2-3 concussions and some > previous musculoskeletal complaints (post-accident hip pain). He has > gained a little weight since his testosterone has been declining. > > His tongue is red/ dusky with a red tip, and a thick, slightly dry and > slightly turbid white coat, and distended purple sublingual veins. His > pulse is wiry, slightly slippery and moderately slow. > > I have only seen him once, and am first addressing his digestion, > working on a diagnosis of Liver overacting on Spleen, leading to food > stagnation and dampness. I gave him a modified bulk chai hu shu gan > wan (chai hu 6, bai shao 9, zhi ke 9, zhi gan cao 6, shan zha 6, ji > nei jin 6, yu jin 6, chen pi 6, xiang fu 6, bai zhu 9, pei lan 6) over > 2 days, and patent bao he wan to use as needed. > > Ultimately he wants his testosterone levels to go back up. Clearly > there is some SP xu here, and possibly an argument for some KD yang xu > as well, but I hesitate to give him a bunch of hot herbs (yin yang > huo, ba ji tian, etc.) just to boost his testosterone. > > Please forgive the long post. I am a new practitioner, and any advice/ > experience would be appreciated. > > Thanks, > Kate > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2007 Report Share Posted November 8, 2007 Al - I totally feel ya; thanks for the input. Trevor - Thanks for your input as well. Bai ji li seems to be a great idea. Is the " 5 seed decoction " you are referring to the tao ren, xing ren, bai zi ren, song zi ren, yu li ren, chen pi formula associated with ma zi ren wan in Bensky? My concern is that while using the idea of seeds to mildly tonify the yang is good, they might exacerbate his already loose stools. And to rephrase my question for everyone: has anyone seen treating a Liver-Spleen pattern actually raise testosterone levels? Thanks again, Kate , " Trevor Erikson " <trevor_erikson wrote: > > Hi kate, > > Bai Ji Li, tribulus, is a good herb to boost testosterone and course the liver Qi as well. > The 5 seed decoction is also good and is not overly warming. > I usually add Bai JI li to it, as well She Chuang Zi and Chong Wei Zi. > I have seen good result in clinic. Many clients come back to me saying things like " I feel > like a walking hormone " or " I feel like a teenager again! " > > Good luck > Trevor > www.acubalance.ca > > , " kbnls " <kbnls@> wrote: > > > > Hi everyone, > > > > I have a 47 year old male patient who has a chief complaint of low > > testosterone, along with high stress, poor digestion, and decreasing > > libido. My main dilemma is whether to use herbs which have been shown > > to increase testosterone – (testosterone often being a reflection of > > KD yang in both CM terms and pharmaceutical research), even though he > > doesn't present with much KD deficiency. > > > > Details of the case are below. > > > > His testosterone levels were 500 ng/dl in 6/07, 200 in 8/07 and 100 in > > 10/07. > > > > His stress is somewhat related to his work but mostly his marriage, as > > his wife is finding herself and trying to decide whether she wants to > > be married anymore; they have 2 children. He says feels that stress > > could be the root of all his physical problems. He is in both > > individual and marriage counseling. Despite the risks, he wants > > testosterone supplementmentation but his therapist convinced him to > > try Chinese medicine fist. He feels increasingly fatigued and > > depressed, and states that he would rather live 10 more good years > > feeling good through testosterone supplementation than 30 years the > > way he feels now. > > > > His digestive symptoms are a feeling of fullness and bloating after he > > eats ( " food just sits there " ) for 1 year, regardless of what he eats, > > and 2 or more loose bowel movements throughout the day. He states that > > his appetite is still good, and he is trying to eat smaller, more > > frequent meals, but it hasn't seemed to help. He has always previously > > had strong digestion. > > > > His libido decline concerns him, as he has always defined himself to > > some degree through sex. He acknowledges that the decline may be due > > in part to his wife's rejection of him for the past 6 months, as well > > as the declining testosterone. > > > > Otherwise, he rates his overall energy at 7/10 (down from his previous > > 10/10). He has a stocky muscular build and runs daily for exercise, > > and gets increasingly irritable and anxious if he doesn't exercise. He > > feels hot overall, but has noticed his feet occasionally getting cold > > lately. He is thirsty for cold water and doesn't drink much caffeine, > > although when he does, it occasionally gives him a temporal headache. > > He sleeps well, occasionally waking briefly around 4 am. He urinates > > 6-8 x/ day (neither particularly scanty nor profuse amounts), and > > doesn't get up at night to pee. He has had 2-3 concussions and some > > previous musculoskeletal complaints (post-accident hip pain). He has > > gained a little weight since his testosterone has been declining. > > > > His tongue is red/ dusky with a red tip, and a thick, slightly dry and > > slightly turbid white coat, and distended purple sublingual veins. His > > pulse is wiry, slightly slippery and moderately slow. > > > > I have only seen him once, and am first addressing his digestion, > > working on a diagnosis of Liver overacting on Spleen, leading to food > > stagnation and dampness. I gave him a modified bulk chai hu shu gan > > wan (chai hu 6, bai shao 9, zhi ke 9, zhi gan cao 6, shan zha 6, ji > > nei jin 6, yu jin 6, chen pi 6, xiang fu 6, bai zhu 9, pei lan 6) over > > 2 days, and patent bao he wan to use as needed. > > > > Ultimately he wants his testosterone levels to go back up. Clearly > > there is some SP xu here, and possibly an argument for some KD yang xu > > as well, but I hesitate to give him a bunch of hot herbs (yin yang > > huo, ba ji tian, etc.) just to boost his testosterone. > > > > Please forgive the long post. I am a new practitioner, and any advice/ > > experience would be appreciated. > > > > Thanks, > > Kate > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2007 Report Share Posted November 9, 2007 The five seeds decocion I am referring to is Wu Zi Yan Zong Wan, Five Seeds Developing the Ancestors Pill: Lycium, Cuscutta, Schissandra, Semen Plantaganis, and Fructus Rubrus. Good luck, Trevor , " kbnls " <kbnls wrote: > > Al - I totally feel ya; thanks for the input. > > Trevor - Thanks for your input as well. Bai ji li seems to be a great > idea. Is the " 5 seed decoction " you are referring to the tao ren, xing > ren, bai zi ren, song zi ren, yu li ren, chen pi formula associated > with ma zi ren wan in Bensky? My concern is that while using the idea > of seeds to mildly tonify the yang is good, they might exacerbate his > already loose stools. > > And to rephrase my question for everyone: has anyone seen treating a > Liver-Spleen pattern actually raise testosterone levels? > > Thanks again, > Kate > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2007 Report Share Posted November 9, 2007 Kate - I would have to go out on a limb here - but couples with marital strife often don't have a healthy sex life. I may have missed it, but how often are they having relations? Maybe someone here more knowledgeable in endocrinology might know, but my strong suspicion is that testosterone production will follow sexual stimulation. If the ming men isn't being stirred with a regular sex life, then I believe testosterone production isn't needed and the levels will fall off. If you're comfortable, you can ask the patient about frequency of sexual relations (with wife or alone!). Considering your presentation, it sounds like the strife is the root, and the Qi Zhi is the branch. Treating the Qi Zhi might also help with their therapy though, so best of luck there! If there's the food stagnation also, how about looking at Yue Ju Wan? I have often found that 'Liver qi stagnation' patients that female patients normally do great with something like Xiao Yao Wan, and men do not do so well, but Yue Ju Wan might be more sucessful. Geoff , " kbnls " <kbnls wrote: > > Al - I totally feel ya; thanks for the input. > > Trevor - Thanks for your input as well. Bai ji li seems to be a great > idea. Is the " 5 seed decoction " you are referring to the tao ren, xing > ren, bai zi ren, song zi ren, yu li ren, chen pi formula associated > with ma zi ren wan in Bensky? My concern is that while using the idea > of seeds to mildly tonify the yang is good, they might exacerbate his > already loose stools. > > And to rephrase my question for everyone: has anyone seen treating a > Liver-Spleen pattern actually raise testosterone levels? > > Thanks again, > Kate Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2007 Report Share Posted November 10, 2007 Thanks again for all the input. The patient came in again yesterday after 4 days/ 2 bags of the original formula. He initially reported " no change, " but upon inquiry said that he had been feeling emotionally less stressed, was having less bloating, and was less concerned about his libido. His tongue coat was also remarkably less thick. I like the ban xia xie xin tang idea, but I am afraid that I don't understand the formula well enough to feel confident using it in this case. The mixed excess/ deficiency pattern it treats matches to some degree, but very few of the associated S/S that I learned are present. For example, he has no abdominal/ epigastric pain, just bloating/ fullness, and no borborygmus. Ren 8 is moderately tender with deep pressure, and Ren 12 is less so. He has no nausea, just loose bowel movements 2-3 x/ day. His appetite is good, despite the fullness after eating. Do those of you with more experience feel that the S/S are less relevant as long as the pattern matches? Also, can anyone explain if / how this formula addresses the Liver component? If not, wouldn't significantly modifying the formula to address the Liver turn it into a completely different formula anyway? I changed his formula yesterday before I saw your responses and we are going to check in again on Monday. I'll try to take everything that has been said into consideration, and I'll keep you all up to date. best wishes, and thanks again, Kate Quote Link to comment Share on other sites More sharing options...
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