chronic phlegmy throat since the flu

[Guest guest]

I'd appreciate some assistance with this case:

 

female, 61 y.o. married with 5-1/2 y.o. adopted daughter

WM dx: hypertension, high cholesterol

MC: clear phlegm in nasopharynx causing constant clearing of throat;

not aware of phlegm in her sinuses or chest, just back of throat.

Phlegm started Oct 2006 after a bad flu " that never went away. " The

phlegm part never went away.

Other symptoms: occasional insomnia, HAs, not much menopausal

nightsweats anymore. Thirst? not really. She had laryngitis when

acacia bloomed in November. No reflux.

 

P: empty, slight floating. (I'm not skilled enough to discern more

specifics.)

 

T: sl dry, small cracks middle and tip, normal pale red

 

My TCM dx: LV & K yin xu, yang rising. (But I don't understand the

mechanism for the phlegm with this diagnosis.)

 

Her M.D.'s changed her blood pressure meds and finally took her off

them completely and there was no change in phlegm. They've given her

many symptomatic meds: benadryl, sudafed, loratadine.... She was skin

tested with an allergist--all negative. She's put covers on her

mattress, pillow....

 

2-3 weeks in Arizona (twice) didn't have any effect on her symptom.

 

Her adopted daughter has always been 'very phlegmy' and has asthma.

 

I've given her 5 acupuncture treatments over 5 weeks with little

effect. Interesting that I cannot obtain any de Qi sensation, even at

points like LI4 and ST36! I have suspected an environmental trigger,

in the air or her diet. Interesting about her daughter. If it were

local environmental I'd have thought it would at least improve in

Arizona. I considered laundry detergent, makeup.... She's disinclined

to change any of these things. I suspect a 'latent pathogen' since it

began after the flu but am not knowledgeable about such treatments.

I'd like to consider herbs at this point. Any suggestions?

 

thank you,

Marian

[Guest guest]

I have treated similar problems with the simple Rx- Ban Xia Hou Po

Tang. It usually works quite well with chronic issues dealing with the

throat. You can modify it based on other signs and symptoms or just

try it as is.

 

Trevor

 

, " Marian Blum, L.Ac., DNBAO "

<chinesemed wrote:

>

> I'd appreciate some assistance with this case:

>

> female, 61 y.o. married with 5-1/2 y.o. adopted daughter

> WM dx: hypertension, high cholesterol

> MC: clear phlegm in nasopharynx causing constant clearing of throat;

> not aware of phlegm in her sinuses or chest, just back of throat.

> Phlegm started Oct 2006 after a bad flu " that never went away. " The

> phlegm part never went away.

> Other symptoms: occasional insomnia, HAs, not much menopausal

> nightsweats anymore. Thirst? not really. She had laryngitis when

> acacia bloomed in November. No reflux.

>

> P: empty, slight floating. (I'm not skilled enough to discern more

> specifics.)

>

> T: sl dry, small cracks middle and tip, normal pale red

>

> My TCM dx: LV & K yin xu, yang rising. (But I don't understand the

> mechanism for the phlegm with this diagnosis.)

>

> Her M.D.'s changed her blood pressure meds and finally took her off

> them completely and there was no change in phlegm. They've given her

> many symptomatic meds: benadryl, sudafed, loratadine.... She was skin

> tested with an allergist--all negative. She's put covers on her

> mattress, pillow....

>

> 2-3 weeks in Arizona (twice) didn't have any effect on her symptom.

>

> Her adopted daughter has always been 'very phlegmy' and has asthma.

>

> I've given her 5 acupuncture treatments over 5 weeks with little

> effect. Interesting that I cannot obtain any de Qi sensation, even at

> points like LI4 and ST36! I have suspected an environmental trigger,

> in the air or her diet. Interesting about her daughter. If it were

> local environmental I'd have thought it would at least improve in

> Arizona. I considered laundry detergent, makeup.... She's disinclined

> to change any of these things. I suspect a 'latent pathogen' since it

> began after the flu but am not knowledgeable about such treatments.

> I'd like to consider herbs at this point. Any suggestions?

>

> thank you,

> Marian

>

[Guest guest]

Marian,

When a couple of us were studying in the hospital in Hangzhou, we spent

several weeks with an herbalist who specialized in hypertension. As is common,

as an MD she was able to prescribe drugs as well as herbs and she really knew

the line where either herbs, drugs, or both was going to be the appropriate

therapy for one of her patients. One of the insights she shared was that phlegm

was always a component of hypertension and treatment for phlegm was essential to

resolution of this condition along with other presenting patterns. We observed

her write many variations on Tian Ma Gou Teng Yin the almost always had some

resolve phlegm and/or spleen supplementing herbs in them. So, in writing a

custom prescription for your patient you might consider formulating with this in

mind.

I would also consider looking at dietary triggers including not just key

players such as dairy, but other culprits in devitalizing the spleen such as raw

foods.

 

Two plants that are abundant locally near you that I use a lot are

Eriodyction californica and Grindelia stricta which are excellent at resolving

phlegm that is difficult to expectorate. There are a couple great monographs of

these plants in 's book if you don't have it yet, it is a great

resource for illuminating the uses of a lot of things growing around you Marian.

 

Best regards,

Benjamin Zappin

www.fiveflavorsherbs.com

 

p.s. - If anyone lives in So. California we are offering a CEU trip for L.Ac.'s

this weekend (March 21, 22) in Anza Borrego studying the medicinal uses,

harvesting, and preparation of the local flora. (831) 239 6900 for details.

 

 

: chinesemed: Mon, 17

Mar 2008 03:32:03 +0000 chronic phlegmy throat since the flu

 

 

 

 

I'd appreciate some assistance with this case:female, 61 y.o. married with 5-1/2

y.o. adopted daughterWM dx: hypertension, high cholesterolMC: clear phlegm in

nasopharynx causing constant clearing of throat; not aware of phlegm in her

sinuses or chest, just back of throat. Phlegm started Oct 2006 after a bad flu

" that never went away. " The phlegm part never went away.Other symptoms:

occasional insomnia, HAs, not much menopausal nightsweats anymore. Thirst? not

really. She had laryngitis when acacia bloomed in November. No reflux.P: empty,

slight floating. (I'm not skilled enough to discern more specifics.)T: sl dry,

small cracks middle and tip, normal pale redMy TCM dx: LV & K yin xu, yang

rising. (But I don't understand the mechanism for the phlegm with this

diagnosis.)Her M.D.'s changed her blood pressure meds and finally took her off

them completely and there was no change in phlegm. They've given her many

symptomatic meds: benadryl, sudafed, loratadine.... She was skin tested with an

allergist--all negative. She's put covers on her mattress, pillow....2-3 weeks

in Arizona (twice) didn't have any effect on her symptom.Her adopted daughter

has always been 'very phlegmy' and has asthma.I've given her 5 acupuncture

treatments over 5 weeks with little effect. Interesting that I cannot obtain any

de Qi sensation, even at points like LI4 and ST36! I have suspected an

environmental trigger, in the air or her diet. Interesting about her daughter.

If it were local environmental I'd have thought it would at least improve in

Arizona. I considered laundry detergent, makeup.... She's disinclined to change

any of these things. I suspect a 'latent pathogen' since it began after the flu

but am not knowledgeable about such treatments. I'd like to consider herbs at

this point. Any suggestions?thank you,Marian

 

 

 

 

 

 

_______________

Shed those extra pounds with MSN and The Biggest Loser!

http://biggestloser.msn.com/

 

 

[Guest guest]

Thanks Ben. I'll take your suggestions into consideration.

Marian

 

, ben zappin <btz23

wrote:

>

>

> Marian,

> When a couple of us were studying in the hospital in

Hangzhou, we spent several weeks with an herbalist who specialized in

hypertension. As is common, as an MD she was able to prescribe

drugs as well as herbs and she really knew the line where either

herbs, drugs, or both was going to be the appropriate therapy for one

of her patients. One of the insights she shared was that phlegm was

always a component of hypertension and treatment for phlegm was

essential to resolution of this condition along with other presenting

patterns. We observed her write many variations on Tian Ma Gou Teng

Yin the almost always had some resolve phlegm and/or spleen

supplementing herbs in them. So, in writing a custom prescription for

your patient you might consider formulating with this in mind.

> I would also consider looking at dietary triggers including

not just key players such as dairy, but other culprits in

devitalizing the spleen such as raw foods.

>

> Two plants that are abundant locally near you that I use a

lot are Eriodyction californica and Grindelia stricta which are

excellent at resolving phlegm that is difficult to expectorate. There

are a couple great monographs of these plants in 's book

if you don't have it yet, it is a great resource for illuminating the

uses of a lot of things growing around you Marian.

>

> Best regards,

> Benjamin Zappin

> www.fiveflavorsherbs.com

>

> p.s. - If anyone lives in So. California we are offering a CEU trip

for L.Ac.'s this weekend (March 21, 22) in Anza Borrego studying the

medicinal uses, harvesting, and preparation of the local flora. (831)

239 6900 for details.

>

>

[Guest guest]

Thank you, Trevor. I'm often baffled when I see one long-term, perhaps

constitutional, pattern supported by P & T but also a new symptom that

doesn't seem to fit and isn't reflected in the signs. I'll consider

treating for qi stag with BSHPT. It's always good to hear of others'

success before embarking on a new approach.

 

Marian

 

, " Trevor Erikson "

<trevor_erikson wrote:

>

> I have treated similar problems with the simple Rx- Ban Xia Hou Po

> Tang. It usually works quite well with chronic issues dealing with the

> throat. You can modify it based on other signs and symptoms or just

> try it as is.

>

> Trevor

[Guest guest]

Hi Marian,

 

Your description of pulse would indicate to me that there has been an

exterior attack that has not completely resolved as yet contributing to this

symptomology.

 

One of my favorite " sequela " formulas for similar sx that haven't resolved

since onset of an exterior attack is Zhi Sou San. Granted, cough is not one

of her complaints, but the constant collection of phlegm in the throat and

post-nasal drainage would make me at least consider the possible pattern

fit. ZSS is a relatively neutral formula, although slightly more suited for

w-c in it's unmodified state, which makes it easy to modify for specific

presentations (e.g., add more phlegm resolving, chest opening, heat

clearing, etc., as appropriate per case).

 

My other suggestion is to consider that there could be a lingering low-grade

sinus infection that is causing the constant drainage. The sinus congestion

could be deeper than the more superficial frontal/maxillary area and

something the patient is not necessarily aware of...you mentioned she had

HA's but didn't mention a location/quality or if there was a connection at

all to onset of cc so perhaps the two aren't related. However, the constant

post-nasal drip is coming from somewhere. Resolve exterior, transform

phlegm, open orifices....think about a modification of Cang Er San, perhaps

in combo w/ ZSS if warranted? Or perhaps w/ simple Er Chen?

 

As a home-care recommendation - I highly recommend the use of a neti pot for

nasosinus lavage. It's easy to do and can help keep the collection of phlegm

reduced until the situation is resolved. Especially good to use if you

suspect allergy component.

 

Unless and until I felt the exterior was resolved, I wouldn't be trying to

address the underlying zang fu dx (or western dx for that matter) that you

mentioned otherwise you run the risk of dragging the pathogen deeper into

the body. As for acupuncture, I would stick to (mostly) upper body points

for the same reason, using a channel based approach. LU8, 6 & 5 is a good

combo (al la Master Tong style) along with Si Ma San and perhaps even Xie

San Huang (these points are along the ST and SP channels respectively) or

maybe just ST41/40, and of course good ole LI18-->Bi Tong for suspected

sinus and perhaps Shui Jin/Shui Tong.

 

The meds you listed as we know are all about symptom suppression and could

therefore have dragged it deeper in as well. What I like about trying the

exterior resolving approach is that you should know pretty quickly whether

you're on the right path. The exterior will either resolve and the sx begin

to improve/go away or there will be no significant change. But if you've

been working on this for 5 weeks with no improvement...seems to me it's

worth a shot at this point.

 

Joy

________

Joy Keller, LAc, Dipl.OM

Board Certified in Acupuncture & Oriental Medicine

Ramona Acupuncture & Oriental Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupuncture.com

 

 

On Sun, Mar 16, 2008 at 8:32 PM, Marian Blum, L.Ac., DNBAO <

chinesemed wrote:

 

> I'd appreciate some assistance with this case:

>

>