Guest guest Posted February 10, 2008 Report Share Posted February 10, 2008 Hello all, I have a patient with an interesting condition. I'm not sure if I am approaching it from the right angle. I'd love to hear any & all feedback and suggestions. Thanks! Male, 51 yoa c/c: sores on toes, occurs every Feb. and lasts until around May. Has had this for 10+ years. These sores are painful, itchy, hot, irritated. They begin as small, light red circles about 1cm wide, and after about a week a small lighter center circle emerges (w/red border)- feels like a thorn is in the center. Then it fades away as does the itching/pn/irritation. As some are fading new ones are emerging. These occur on the toes only, no other part of the foot, right side worse than left. His doc has run numerous studies: biopsies, coagulation tests, circulation tests, all are (-). He has even been the subject of a specialty panel which consisted of several experts (mostly dermatologists) in Santa Barbara and no one knew what his condition was. Symptom exacerbated when he had the flu a few weeks ago. In Feb every year, his demands at work are significantly increased. Patient claims that he doesn't feel stressed out, but says his wife would tell me he is very stressed. Patient believes it is connected to the cold weather. These work demands dissipate in spring @ same time sx fade away (and weather warms up). Only source of relief is Predizone which " knocks it right out " for a week or so whereby sx return. Patient does not want to take this medication unless absolutely necessary. other pertinent info: * good energy level, no sig. fatigue or slumps during the day * at bedtime falls asleep easily, but then wakes up @ 2 AM every night, awake for about 2 hours, cannot fall back to sleep. * occasional cold hand & feet, no other significant feelings of hot or cold * no sweating or nightsweats * good appetite, likes to eat, likes all flavors, really likes meat, doesnt eat enough vegetables/fruit. no bloating/nausea/acid reflux/xs gas * 6+ BMs/day. formed, occasionally loose. 3 or 4 BMs in AM before leaving for work. Sometimes urgency. color ranges from black - brown - green. In the early 90's, he had diverticulitis and pouch burst - he had peritonitis, emergency surgery, removed lower portion of colon (sigmoidectomy) * drinks 50 oz water on average/day * urinates less than he drinks. difficulty in starting & stopping flow of urine. urine sometimes dark, no burning or cloudiness. no urgency, occasional dribbling. MD: enlarged prostate. * decreased libido * emotionally upbeat, positive for the most part. can have angry bursts and get short-tempered. doesn't think clearly when angry. * borderline hypertension, borderline type II diabetes. * weekend drinker, goes " overboard with buddies " * eyes strain, red eyes, itching eyes, blurry vision * sores on lips and tongue Pulses - (L) liver is wiry, kidney is wiry ® soft, moderate, less force & tension than L side. SP weakest of all 3 positions. 76 bpm. Tongue - big, puffy. teethmarks, red tip. tongue orangey-red, yellow-brown stain at back third. dx: heat, wind, liver qi stag, liver fire, SP qi weak, damp-heat in lower burner rx: combination of Xiao Feng San + Ba Zheng San +huai niu xi, he huan pi, huang bai, shan yao. (-) hei zi ma, bian xu Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2008 Report Share Posted February 11, 2008 You've obviously got a somewhat complex situation here, but as for the chief complaint, I would encourage you to look in to Si Miao San. It's for damp heat in the legs and feet. On Feb 10, 2008 11:49 PM, CYNTHIA SPLIES <splies wrote: > Hello all, > I have a patient with an interesting condition. I'm not sure if I am > approaching it from the right angle. I'd love to hear any & all > feedback and suggestions. Thanks! > -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2008 Report Share Posted February 11, 2008 Hello Cynthia, Whenever I have a case such as yours, I look for symmetry of the lesions. I have found cases where the sores were located on the same area of both extremities (either arms, hands, legs, feet) In such cases I have ordered a herpes antibody blood test.. Usually if the problem is on both, say feet, and takes place around the same time, more often than not, the problem is of a viral nature located on the spinal segment corresponding to the dermatome enervating that region. Thus cervical for upper extremities and lumbo-sacral for the lower. Best, Fernando , " CYNTHIA SPLIES " <splies wrote: > > Hello all, > I have a patient with an interesting condition. I'm not sure if I am > approaching it from the right angle. I'd love to hear any & all > feedback and suggestions. Thanks! > > Male, 51 yoa > c/c: sores on toes, occurs every Feb. and lasts until around May. Has > had this for 10+ years. These sores are painful, itchy, hot, > irritated. They begin as small, light red circles about 1cm wide, and > after about a week a small lighter center circle emerges (w/red > border)- feels like a thorn is in the center. Then it fades away as > does the itching/pn/irritation. As some are fading new ones are > emerging. These occur on the toes only, no other part of the foot, > right side worse than left. His doc has run numerous studies: > biopsies, coagulation tests, circulation tests, all are (-). He has > even been the subject of a specialty panel which consisted of several > experts (mostly dermatologists) in Santa Barbara and no one knew what > his condition was. > > Symptom exacerbated when he had the flu a few weeks ago. > In Feb every year, his demands at work are significantly increased. > Patient claims that he doesn't feel stressed out, but says his wife > would tell me he is very stressed. Patient believes it is connected > to the cold weather. > These work demands dissipate in spring @ same time sx fade away (and > weather warms up). > > Only source of relief is Predizone which " knocks it right out " for a > week or so whereby sx return. Patient does not want to take this > medication unless absolutely necessary. > > other pertinent info: > * good energy level, no sig. fatigue or slumps during the day > * at bedtime falls asleep easily, but then wakes up @ 2 AM every > night, awake for about 2 hours, cannot fall back to sleep. > * occasional cold hand & feet, no other significant feelings of hot or > cold > * no sweating or nightsweats > * good appetite, likes to eat, likes all flavors, really likes meat, > doesnt eat enough vegetables/fruit. no bloating/nausea/acid reflux/xs gas > * 6+ BMs/day. formed, occasionally loose. 3 or 4 BMs in AM before > leaving for work. Sometimes urgency. color ranges from black - brown > - green. In the early 90's, he had diverticulitis and pouch burst - > he had peritonitis, emergency surgery, removed lower portion of colon > (sigmoidectomy) > * drinks 50 oz water on average/day > * urinates less than he drinks. difficulty in starting & stopping > flow of urine. urine sometimes dark, no burning or cloudiness. no > urgency, occasional dribbling. MD: enlarged prostate. > * decreased libido > * emotionally upbeat, positive for the most part. can have angry > bursts and get short-tempered. doesn't think clearly when angry. > * borderline hypertension, borderline type II diabetes. > * weekend drinker, goes " overboard with buddies " > * eyes strain, red eyes, itching eyes, blurry vision > * sores on lips and tongue > > Pulses - (L) liver is wiry, kidney is wiry ® soft, moderate, less > force & tension than L side. SP weakest of all 3 positions. 76 bpm. > Tongue - big, puffy. teethmarks, red tip. tongue orangey-red, > yellow-brown stain at back third. > > dx: heat, wind, liver qi stag, liver fire, SP qi weak, damp-heat in > lower burner > rx: combination of Xiao Feng San + Ba Zheng San +huai niu xi, he huan > pi, huang bai, shan yao. (-) hei zi ma, bian xu > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2008 Report Share Posted February 11, 2008 Hi Cynthia, Based on the notes you gave us, I would consider your patient having Pompholox eczema. Even though it is rarer for this type of eczema to appear just on the feet, around 10% of sufferers do present this way. The main pathogenesis is that from liver/ Gall bladder damp heat with fire toxin. Basically using a modified long Dan xie gan Tang with the addition of herbs to clear fire toxins like Pu Gong Ying, Zi Hua Di Ding and Lian Qiao. You can add a guide like Mu gua or Nui Xi so as to help the herbs get the the feet. For the spleen I would think of herbs like Bi Xie to help seperate the turbid from the clear External remedy is very important in the acute phases when there is a lot of blistering. I find a soak of Ming Fen, Peng Sha, and Wang Bu Liu Xin to be very effective. They must steam their feet above this utill it is cool enough to soak. Re-use the same mix for about 2 soaks. The soak should help dry up the blisters fairly quickly, helping to relieve itch and inflamation. For the benefit of the group and for your own files to monitor progress, please consider taking photographs. I find this a very useful tool and, like my teacher Mazin Al Khafaji, I photograph all my skin clients. Good luck, Trevor , " CYNTHIA SPLIES " <splies wrote: > > Hello all, > I have a patient with an interesting condition. I'm not sure if I am > approaching it from the right angle. I'd love to hear any & all > feedback and suggestions. Thanks! > > Male, 51 yoa > c/c: sores on toes, occurs every Feb. and lasts until around May. Has > had this for 10+ years. These sores are painful, itchy, hot, > irritated. They begin as small, light red circles about 1cm wide, and > after about a week a small lighter center circle emerges (w/red > border)- feels like a thorn is in the center. Then it fades away as > does the itching/pn/irritation. As some are fading new ones are > emerging. These occur on the toes only, no other part of the foot, > right side worse than left. His doc has run numerous studies: > biopsies, coagulation tests, circulation tests, all are (-). He has > even been the subject of a specialty panel which consisted of several > experts (mostly dermatologists) in Santa Barbara and no one knew what > his condition was. > > Symptom exacerbated when he had the flu a few weeks ago. > In Feb every year, his demands at work are significantly increased. > Patient claims that he doesn't feel stressed out, but says his wife > would tell me he is very stressed. Patient believes it is connected > to the cold weather. > These work demands dissipate in spring @ same time sx fade away (and > weather warms up). > > Only source of relief is Predizone which " knocks it right out " for a > week or so whereby sx return. Patient does not want to take this > medication unless absolutely necessary. > > other pertinent info: > * good energy level, no sig. fatigue or slumps during the day > * at bedtime falls asleep easily, but then wakes up @ 2 AM every > night, awake for about 2 hours, cannot fall back to sleep. > * occasional cold hand & feet, no other significant feelings of hot or > cold > * no sweating or nightsweats > * good appetite, likes to eat, likes all flavors, really likes meat, > doesnt eat enough vegetables/fruit. no bloating/nausea/acid reflux/xs gas > * 6+ BMs/day. formed, occasionally loose. 3 or 4 BMs in AM before > leaving for work. Sometimes urgency. color ranges from black - brown > - green. In the early 90's, he had diverticulitis and pouch burst - > he had peritonitis, emergency surgery, removed lower portion of colon > (sigmoidectomy) > * drinks 50 oz water on average/day > * urinates less than he drinks. difficulty in starting & stopping > flow of urine. urine sometimes dark, no burning or cloudiness. no > urgency, occasional dribbling. MD: enlarged prostate. > * decreased libido > * emotionally upbeat, positive for the most part. can have angry > bursts and get short-tempered. doesn't think clearly when angry. > * borderline hypertension, borderline type II diabetes. > * weekend drinker, goes " overboard with buddies " > * eyes strain, red eyes, itching eyes, blurry vision > * sores on lips and tongue > > Pulses - (L) liver is wiry, kidney is wiry ® soft, moderate, less > force & tension than L side. SP weakest of all 3 positions. 76 bpm. > Tongue - big, puffy. teethmarks, red tip. tongue orangey-red, > yellow-brown stain at back third. > > dx: heat, wind, liver qi stag, liver fire, SP qi weak, damp-heat in > lower burner > rx: combination of Xiao Feng San + Ba Zheng San +huai niu xi, he huan > pi, huang bai, shan yao. (-) hei zi ma, bian xu > Quote Link to comment Share on other sites More sharing options...
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