Guest guest Posted November 11, 2007 Report Share Posted November 11, 2007 Dear colleagues, I would like to ask you if any of you have experience treating alopecia totalis. My patient, a 42 yo female got alopecia areata some three years ago, which came in bouts. In november 2005, her alopecia took a turn for the worse when she took anti-malaria drugs for travelling. She became completely bald in a few weeks time. I have been treating her for several months with herbal formulas boosting yin and blood, and improving blood circulation in the collaterals. I have also done acupuncture on her. The only effect we've got so far is that her eye-lashes have returned, as well as some fur on the face. Additional information would be that she had been taking ant-depressants since 1998, off which she weaned herself with succes some three months ago. Her son is mentally and physically disabled, and her husband has a drinking problem. So she says there's definitely stress in her life, but so far she has managed with the herbal formulas she has been taking. ( At times I added ingredients to course the liver qi and stabilize and calm the mind). She works as an educator, and stopped smoking 6 months ago. She still complains about occasional insomnia (diff. getting to sleep and sleeping through) and overthinking with nervousness. Occasionaly fatigued. Stools are normal but got a bit softer after taking the herbal formulas which included he shou wu. Urine is normal. Sweats easily, but this got a bit better after she stopped using Seroxat. She has cold hands and feet. Perimenstrual dysphoria, blood with clots. Tongue looks fairly normal, a bit elongated. Stasis macules and distended sublingual veins which have gotten better after treatment. Pulse is rather weak. At this point in time I do not know if it is wise to continue her treatment. She feels better than before, is not taking any drugs but her hair is not coming back. I would like to ask if you have any ideas? Thanks a lot, Tom. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2007 Report Share Posted November 11, 2007 Sounds like you have done a great job. I wouldn't worry about the hair. I'm sure she wants it to grow back but it seems you should keep treating her for the other conditions that are actually more complicated and difficult. Doug , " Tom Verhaeghe " <tom.verhaeghe wrote: > > Dear colleagues, > > I would like to ask you if any of you have experience treating alopecia > totalis. > > My patient, a 42 yo female got alopecia areata some three years ago, which > came in bouts. In november 2005, her alopecia took a turn for the worse when > she took anti-malaria drugs for travelling. She became completely bald in a > few weeks time. > I have been treating her for several months with herbal formulas boosting > yin and blood, and improving blood circulation in the collaterals. I have > also done acupuncture on her. > > The only effect we've got so far is that her eye-lashes have returned, as > well as some fur on the face. > > Additional information would be that she had been taking ant-depressants > since 1998, off which she weaned herself with succes some three months ago. > Her son is mentally and physically disabled, and her husband has a drinking > problem. So she says there's definitely stress in her life, but so far she > has managed with the herbal formulas she has been taking. ( At times I added > ingredients to course the liver qi and stabilize and calm the mind). She > works as an educator, and stopped smoking 6 months ago. > > She still complains about occasional insomnia (diff. getting to sleep and > sleeping through) and overthinking with nervousness. Occasionaly fatigued. > Stools are normal but got a bit softer after taking the herbal formulas > which included he shou wu. Urine is normal. Sweats easily, but this got a > bit better after she stopped using Seroxat. She has cold hands and feet. > Perimenstrual dysphoria, blood with clots. > > Tongue looks fairly normal, a bit elongated. Stasis macules and distended > sublingual veins which have gotten better after treatment. Pulse is rather > weak. > > At this point in time I do not know if it is wise to continue her treatment. > She feels better than before, is not taking any drugs but her hair is not > coming back. > > I would like to ask if you have any ideas? > > Thanks a lot, > > Tom. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 Doug (and group), I am not sure I agree. Maybe I am unclear about the specific goals of the patient, but it seems that if she is coming in with a specific complaint I think it your ethical obligation to treat that, unless she (and you) decide otherwise. IMO, we too often just say “treat what you see” and not really understand and focus on the main complaint / disease process. Which brings up a larger question, do we believe that we can just treat just patterns and all diseases will vanish. Sometimes this is true, but clearly not always. This is especially true (and becomes a more complicated question) when patient’s come in with a solid western goal / diagnosis. Sometimes it takes a more advanced understanding, than one may possess. This ties into Kate’s case study. Her patient is coming in for a specific issue, very very low testosterone. If that is what he wants improved then what are the concerns around just treating a pattern (i.e. liver -> sp). Here are possible scenarios to be considered and communicated to the patient: 1) One is not going to treat the testosterone number and just treat “the pattern” and hope for the best, (and is the patient comfortable with that)? 2) The practitioner knows from some research or experience that his pattern (i.e. Lv->Sp) can actually influence testosterone levels. 3) The practitioner decides with the patient that the number (or western disease) is not important (and hence not a goal) and together just strive for optimal health. Otherwise we are walking a fine line. (BTW- I know that Kate in this situation communicated clearly with the patient, so I am not pointing any fingers here, just using the case as a springboard). I would like to hear other’s input on this, because I really think it is a large question. Often, I have patient’s come in with serious problems after seeing a CM practitioner for sometime. There treatment might be something like xiao yao san. Not that this is inherently wrong, and not even that these patient’s might not have had Lv-> Sp, but IMO, many of these cases had nothing to do with the disease process. Many of these patient’s reported feeling much less stress and better sense of well-being, but the disease (or chief complaint) had not improved. One may blame it on bad Dx or Tx, but I think the issue is bigger. I think it has to do with our belief that we just can treat one of a few patterns and everything gets better. The thing that gets me is the approach and communication to the patient. The practitioner (i.e. in the above cases) had led that patient to believe that they were able to treat the disease, by just balancing their liver and spleen. Do others see this as a problem or not so much?? IMO, it is one thing to “strive for optimal health”, but another for treatment of a specific condition. I think CM is fairly good at mapping out what patterns and herbs treat specific diseases. If we do not have the information, we have to be honest to ourselves and the patients. This to me centers on ethical concerns, and I am not really interested in hearing about the possible legal issues. We all know that we cannot i.e. “treat cancer.” On the other side of the coin, I am not suggesting at all that we focus on herbs that just i.e. raise testosterone, I personally prefer a pattern approach. However, knowledge of both the disease process and pattern is imperative for proper treatment. For example, I thought Sharon’s input was extremely helpful, meaning she said that she has seen levels balance out without Kidney yang tonics. But are we to take this to mean that any pattern that we treat can theoretically balance out testosterone levels? Or are there certain one’s that will be successful and certain ones that won’t. I do not have a good answer here… Sharon can you relay which patterns you have actually seen to successfully accomplish the goal of raising testosterone without yang tonics, and have these been verified with lab results? I think we could extend this discussion to acupuncture, type of herbs given etc. I think all of this rests on what the patient actually wants and if the practitioner and patient communicate honestly, then there should be no issues. It seems only be a concern we suggest we can treat a western number (without “proof”) and then are not clear with the patient. Comments? - _____ On Behalf Of Monday, November 12, 2007 12:02 AM Re: alopecia totalis Sounds like you have done a great job. I wouldn't worry about the hair. I'm sure she wants it to grow back but it seems you should keep treating her for the other conditions that are actually more complicated and difficult. Doug @ <%40> , " Tom Verhaeghe " <tom.verhaeghe wrote: > > Dear colleagues, > > I would like to ask you if any of you have experience treating alopecia > totalis. > > My patient, a 42 yo female got alopecia areata some three years ago, which > came in bouts. In november 2005, her alopecia took a turn for the worse when > she took anti-malaria drugs for travelling. She became completely bald in a > few weeks time. > I have been treating her for several months with herbal formulas boosting > yin and blood, and improving blood circulation in the collaterals. I have > also done acupuncture on her. > > The only effect we've got so far is that her eye-lashes have returned, as > well as some fur on the face. > > Additional information would be that she had been taking ant-depressants > since 1998, off which she weaned herself with succes some three months ago. > Her son is mentally and physically disabled, and her husband has a drinking > problem. So she says there's definitely stress in her life, but so far she > has managed with the herbal formulas she has been taking. ( At times I added > ingredients to course the liver qi and stabilize and calm the mind). She > works as an educator, and stopped smoking 6 months ago. > > She still complains about occasional insomnia (diff. getting to sleep and > sleeping through) and overthinking with nervousness. Occasionaly fatigued. > Stools are normal but got a bit softer after taking the herbal formulas > which included he shou wu. Urine is normal. Sweats easily, but this got a > bit better after she stopped using Seroxat. She has cold hands and feet. > Perimenstrual dysphoria, blood with clots. > > Tongue looks fairly normal, a bit elongated. Stasis macules and distended > sublingual veins which have gotten better after treatment. Pulse is rather > weak. > > At this point in time I do not know if it is wise to continue her treatment. > She feels better than before, is not taking any drugs but her hair is not > coming back. > > I would like to ask if you have any ideas? > > Thanks a lot, > > Tom. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 My patient is happy with the progress that we made. However, we have not gotten far with her chief complaint. I have communicated with her from the beginning that this was not going to be an easy task (have her hair grow back). She agreed and wanted to try anyway. She does feel better now, but now I am not sure I have much to offer anymore. I have never treated alopecia universalis before.. My brother-in-law, who is from Hong Kong, had his hair grow back from using a Chinese medical shampoo. He had tried everything for over two years, and finally bought an expensive medical shampoo (several thousand HKD for a few bottles). Now he was just a man in his late twenties losing some scalp hair, so we can't really compare with the patient I am treating now. My brother-in-law still has all his hair now, and is approaching 40. Dyeing his hair black though, just like many modern Chinese men. So although I have often seen mockeries of these magical shampoos in HK comedies, they apparently do exist. Hard to get by though around here.. Tom. , " " wrote: > > Sounds like you have done a great job. I wouldn't worry about the hair. I'm sure she wants > it to grow back but it seems you should keep treating her for the other conditions that are > actually more complicated and difficult. > Doug > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 Jason, Thanks for bringing up a number of issues. Tom had two questions and I was reacting to the first. Should he continue to treat the patient and I say yes, given the number of other problems he seems to have helped with. The second question was any ideas of what more to do to help the hair loss. I'm stumped other than do what he has been doing and hope (pray?) that everything else falls into place. What is the (western) mechanism of the anti-malaria drugs and what would counteract it? Yin tonics? Estrogen? Try to raise testosterone? :-) So does anyone have the knowledge to treat the main complaint? How do we know that Xiao yao isn't the underlying problem? I see more ethics involved in trying to pretend (sorry, my bias) that western mechanisms are treated in the specific way that say, Chen and Chen, implies. On a positive note we had a patient in the Yosan clinic with a classic fright (a gun) that turned her hair white and fell out almost to baldness within a week. That was a year ago, I believe and it took 3 months of formula but it is now growing back to normal color. doug , " " wrote: > > Doug (and group), > > > > I am not sure I agree. Maybe I am unclear about the specific goals of the > patient, but it seems that if she is coming in with a specific complaint I > think it your ethical obligation to treat that, unless she (and you) decide > otherwise. IMO, we too often just say " treat what you see & #65533;and not really > understand and focus on the main complaint / disease process. Which brings > up a larger question, do we believe that we can just treat just patterns and > all diseases will vanish. Sometimes this is true, but clearly not always. > This is especially true (and becomes a more complicated question) when > patient's come in with a solid western goal / diagnosis. Sometimes it takes > a more advanced understanding, than one may possess. > > > > This ties into Kate's case study. Her patient is coming in for a specific > issue, very very low testosterone. If that is what he wants improved then > what are the concerns around just treating a pattern (i.e. liver -> sp). > Here are possible scenarios to be considered and communicated to the > patient: > > > > 1) One is not going to treat the testosterone number and just treat " the > pattern & #65533;and hope for the best, (and is the patient comfortable with that)? > > 2) The practitioner knows from some research or experience that his pattern > (i.e. Lv->Sp) can actually influence testosterone levels. > > 3) The practitioner decides with the patient that the number (or western > disease) is not important (and hence not a goal) and together just strive > for optimal health. > > > > Otherwise we are walking a fine line. (BTW- I know that Kate in this > situation communicated clearly with the patient, so I am not pointing any > fingers here, just using the case as a springboard). > > > > I would like to hear other's input on this, because I really think it is a > large question. Often, I have patient's come in with serious problems after > seeing a CM practitioner for sometime. There treatment might be something > like xiao yao san. Not that this is inherently wrong, and not even that > these patient's might not have had Lv-> Sp, but IMO, many of these cases had > nothing to do with the disease process. Many of these patient's reported > feeling much less stress and better sense of well-being, but the disease (or > chief complaint) had not improved. One may blame it on bad Dx or Tx, but I > think the issue is bigger. I think it has to do with our belief that we just > can treat one of a few patterns and everything gets better. > > > > The thing that gets me is the approach and communication to the patient. The > practitioner (i.e. in the above cases) had led that patient to believe that > they were able to treat the disease, by just balancing their liver and > spleen. Do others see this as a problem or not so much?? IMO, it is one > thing to " strive for optimal health & #65533; but another for treatment of a > specific condition. I think CM is fairly good at mapping out what patterns > and herbs treat specific diseases. If we do not have the information, we > have to be honest to ourselves and the patients. This to me centers on > ethical concerns, and I am not really interested in hearing about the > possible legal issues. We all know that we cannot i.e. " treat cancer. & #65533;> > > > On the other side of the coin, I am not suggesting at all that we focus on > herbs that just i.e. raise testosterone, I personally prefer a pattern > approach. However, knowledge of both the disease process and pattern is > imperative for proper treatment. For example, I thought Sharon's input was > extremely helpful, meaning she said that she has seen levels balance out > without Kidney yang tonics. But are we to take this to mean that any pattern > that we treat can theoretically balance out testosterone levels? Or are > there certain one's that will be successful and certain ones that won't. I > do not have a good answer here & #65533;Sharon can you relay which patterns you have > actually seen to successfully accomplish the goal of raising testosterone > without yang tonics, and have these been verified with lab results? > > > > I think we could extend this discussion to acupuncture, type of herbs given > etc. > > > > I think all of this rests on what the patient actually wants and if the > practitioner and patient communicate honestly, then there should be no > issues. It seems only be a concern we suggest we can treat a western number > (without " proof & #65533; and then are not clear with the patient. > > > > Comments? > > > > - > > > > _____ > > > On Behalf Of > Monday, November 12, 2007 12:02 AM > > Re: alopecia totalis > > > > Sounds like you have done a great job. I wouldn't worry about the hair. I'm > sure she wants > it to grow back but it seems you should keep treating her for the other > conditions that are > actually more complicated and difficult. > Doug > > @ <%40> > , " Tom Verhaeghe " <tom.verhaeghe@> > wrote: > > > > Dear colleagues, > > > > I would like to ask you if any of you have experience treating alopecia > > totalis. > > > > My patient, a 42 yo female got alopecia areata some three years ago, which > > came in bouts. In november 2005, her alopecia took a turn for the worse > when > > she took anti-malaria drugs for travelling. She became completely bald in > a > > few weeks time. > > I have been treating her for several months with herbal formulas boosting > > yin and blood, and improving blood circulation in the collaterals. I have > > also done acupuncture on her. > > > > The only effect we've got so far is that her eye-lashes have returned, as > > well as some fur on the face. > > > > Additional information would be that she had been taking ant-depressants > > since 1998, off which she weaned herself with succes some three months > ago. > > Her son is mentally and physically disabled, and her husband has a > drinking > > problem. So she says there's definitely stress in her life, but so far she > > has managed with the herbal formulas she has been taking. ( At times I > added > > ingredients to course the liver qi and stabilize and calm the mind). She > > works as an educator, and stopped smoking 6 months ago. > > > > She still complains about occasional insomnia (diff. getting to sleep and > > sleeping through) and overthinking with nervousness. Occasionaly fatigued. > > Stools are normal but got a bit softer after taking the herbal formulas > > which included he shou wu. Urine is normal. Sweats easily, but this got a > > bit better after she stopped using Seroxat. She has cold hands and feet. > > Perimenstrual dysphoria, blood with clots. > > > > Tongue looks fairly normal, a bit elongated. Stasis macules and distended > > sublingual veins which have gotten better after treatment. Pulse is rather > > weak. > > > > At this point in time I do not know if it is wise to continue her > treatment. > > She feels better than before, is not taking any drugs but her hair is not > > coming back. > > > > I would like to ask if you have any ideas? > > > > Thanks a lot, > > > > Tom. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 Hi Tom, Is she anorexic? I wonder if that fur is really lanugo. If you've helped to stabilize her shen, nourish her blood and yin, and some hair is growing - sounds like you are going in the right direction, just maybe haven't gone long enough yet. I really had good results with He Shou Wu based products for hair loss patients. Geoff , " Tom Verhaeghe " <tom.verhaeghe wrote: > The only effect we've got so far is that her eye-lashes have returned, as > well as some fur on the face. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2007 Report Share Posted November 13, 2007 Hi Geoff, thank you for your reply. No, she is not anorexic, actually a bit overweight and trying to lose some weight. Would you share with us what he shou wu products you use in your clinic for hair loss? Thanks, Tom. , " G Hudson " <crudo20 wrote: > > Hi Tom, > Is she anorexic? I wonder if that fur is really lanugo. If you've > helped to stabilize her shen, nourish her blood and yin, and some hair > is growing - sounds like you are going in the right direction, just > maybe haven't gone long enough yet. I really had good results with He > Shou Wu based products for hair loss patients. > Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2007 Report Share Posted November 13, 2007 Hi Tom, I used to use Shou Wu Essence from Mayway http://www.mayway.com/store/product.do?productId=305 Ingredients are: Distilled water, Mel (honey), Polygonum multiflorum root, Polygonatum sibiricum rhizome, Rosa laevigata fruit, Cibotium barometz rhizome, Cuscuta chinensis seed, Psoralea corylifolia fruit, Angelica sinensis root, Citrus reticulata peel. - Zheng liu shui, Feng mi, He shou wu, Huang jing, Jin ying zi, Gou ji, Tu si zi, Bu gu zhi, Dang gui, Chen pi. But, alas, no longer available. I am planning on grinding my own until it comes available again hopefully. It also worked very well for other yin xu problems. I tried some of the other capsule based 'fo-ti wan' type formulas but wasn't thrilled with the results - but that's just my experience. I still think you're going in the right direction, but you may consider incorporating some of the strategies from this formula. oh - and I see 'ghost lick syndrome' was already mentioned in a previous post.. Geoff , " Tom Verhaeghe " <tom.verhaeghe wrote: > > Hi Geoff, > > thank you for your reply. No, she is not anorexic, actually a bit > overweight and trying to lose some weight. > Would you share with us what he shou wu products you use in your > clinic for hair loss? > > Thanks, > > Tom. Quote Link to comment Share on other sites More sharing options...
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