Guest guest Posted September 12, 2009 Report Share Posted September 12, 2009 I have a 33 year old female patient that has presented with, roughly, a 10 year history of profuse sweating from her hands and feet that has been worsening in severity. When she perceives that she is sweating, she becomes anxious, and sweats that much more. Blue Poppy had a research study on diabetic hyperhydrosis on their website (Thanks, Bob!) I diagnosed her primarily with Sp Qi Def/Vacuity, and focused on tonifying qi and astringing. Anyway, I mostly went with the BP formula with a few changes. I ordered a vacuum packed decoction from Kamwo in NYC. She noticed some improvement. They do pao zhi at Kamwo and so, I was wondering if anyone had any input on what would improve this formula. Additions/Subtractions ( I was thinking of adding Sheng Ma, or maybe trying Ma Huang Gen, pulling out mai men dong, shan yao).what pao zhi would be applicable etc (I don't have any clinical experience doing pao zhi). Here is the formula, dosages of raw herbs are in grams. Huang Qi 30 Dang Shen20 Fu Xiao Mai15 Fang Feng15 Bai Zhu15 Mai Men Dong15 Shan Yao15 Fu Ling15 Da Zao15 Bai Shao15 Wu Wei Zi15 Suan Zao Ren15 Anyway, not a great case study, I know, but there it is. Thanks, Sean Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2009 Report Share Posted September 13, 2009 Thank you for sharing your case study here and I think it is benefical to all of us to learn about your experiences. You are on the right track about the treatment methods and the formula should work as you said. However, it is difficult to suggest further modifications because I can not see a clear picture about pattern identification. 1) no data of the condition of tongue, pulses, urination, and stool are provided 2) why you use Suan Zao Ren15 in the first place 3) how many dosages the patient had had Overall, it seems to me the dosage is a bit heavy for local American patients. Pao zhi does not play such an important role here, though preferred for seeds such as Suan Zao Ren. Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 14, 2009 Report Share Posted September 14, 2009 Hi Dr. Sung, Thanks for your reply. Her tongue had a small body, slightly swollen and red, and quivered slightly. I found her weakest pulses to be her K yang and Sp, and they were generally bowstring overall. She was very anxious when she came to see me, and she was sweating from her hands and feet quite profusely. At that first visit we did acupuncture and she soaked the sheets at the area of her hands and feet. I had scheduled her initially thinking that I would primarily treat her with herbs, and seeing how she responded confirmed that for me. I decided not to do anymore acupuncture with her. She didn't report anything remarkable with her urination and bowel movements on questioning. She has only had five days of that herbal formula. I put the Suan Zao Ren in because of its ability to calm the spirit, and stop sweating. I stuck with the high doses because I was looking for a strong action. I had a friend in school with this condition that didn't seem to get resolution. I don't remember what herbs they tried, but I know it can be very difficult to treat overall. Initially, I was going to just do a modification of Bu Zhong YI Qi Tang, but then I saw that formula on the Blue Poppy site and thought it seemed more applicable. I see that the price has increased $10 for the formula that I had previously listed. She may not want to continue the raw herbs because of the price increase. I would then try granules. Thanks again, any comments will be appreciated. Sean Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2009 Report Share Posted September 15, 2009 Hi Sean, you should stick with granules, it is more economical and you can precribe on weekly basis. Qi and blood cannot be engendered overnight so more time is necessary. My suggestions for modifications for your case. You have a base formula of Jade Barrier Powder Huang Qi 20g Fang Feng 10g Bai Zhu 10g Fu Xiao Mai 15g or ma huang gen 10g Mai Men Dong 10g Wu Wei Zi 8g add sha shen 15-20g (address stomach/spleen yin and tonify qi) shan zhu yu 10g (address the kidney yin deficiency) Dang Shen is too warm here; substitute it with sha shen that can tonify qi and nourish yin simultaneously; I will not pick Suan Zao Ren as the patient did not address sleeplessness issue. Just my thoughts and hope that helps. Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2009 Report Share Posted September 15, 2009 Hi Sean Please remember that there are always two sides to every problem, ie excess and deficiency, or a combination of the two. The excessive sweating that you mentioned is often times due to Damp heat, particularly in the lv/ Gb channels, and may be treated quite well with Long Dan Xie Gan Tang modifications. I have treated several cases like this quite successfully. Does your patient have any skin rashes? Trevor , " Sean Doherty " <sean wrote: > > Hi Dr. Sung, > > Thanks for your reply. > > Her tongue had a small body, slightly swollen and red, and quivered > slightly. I found her weakest pulses to be her K yang and Sp, and they were > generally bowstring overall. She was very anxious when she came to see me, > and she was sweating from her hands and feet quite profusely. At that first > visit we did acupuncture and she soaked the sheets at the area of her hands > and feet. I had scheduled her initially thinking that I would primarily > treat her with herbs, and seeing how she responded confirmed that for me. I > decided not to do anymore acupuncture with her. She didn't report anything > remarkable with her urination and bowel movements on questioning. > > > > She has only had five days of that herbal formula. I put the Suan Zao Ren > in because of its ability to calm the spirit, and stop sweating. > > I stuck with the high doses because I was looking for a strong action. I > had a friend in school with this condition that didn't seem to get > resolution. I don't remember what herbs they tried, but I know it can be > very difficult to treat overall. > > Initially, I was going to just do a modification of Bu Zhong YI Qi Tang, but > then I saw that formula on the Blue Poppy site and thought it seemed more > applicable. > > > > I see that the price has increased $10 for the formula that I had previously > listed. She may not want to continue the raw herbs because of the price > increase. I would then try granules. > > > > Thanks again, any comments will be appreciated. > > > > Sean > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2009 Report Share Posted September 16, 2009 Thanks Dr. Sung and Trevor for your comments. Much appreciated. I will keep your thoughts in mind, Trevor. She doesn't have any skin rashes. How old were the patients you treated? What was the course of treatment? Did it resolve completely or do they continue to take herbs? What form of herbs did you give them? She ran out of that first formula and was anxious to take more, because she realized how much it had been helping. I already ordered her a couple weeks more of the formula, after which I told her we would switch to granules.mostly because of the cost issue. I will reassess then. I have been trying to get away from working with the granules myself, because the powder that goes into the air when I mix a formula irritates my sinuses ( I use KPC, I don't have problems with environmental allergies, but when I make a formula it is often a problem). There are options for having the granule formulas made, but the price isn't that much better than having the decoctions vacuum packed. Consequently, I had moved to doing more with standard capsule formulas, (mostly Blue Poppy), but ran into the typical problems with not being able to customize for certain conditions, or a cost issue again when giving two formulas at the same time. I need a fume hood, or I suppose I could put in an exhaust fan at my work station. I have thought of tinctures, but don't really want to make the investment in a whole tincture pharmacy. I think it is easier though, in many ways, to just send off the prescription and not futz with mixing the formulas myself. Anyway, I am getting far afield from my original query. If not informative, I am sure some will find it funny Thanks, Sean On Behalf Of trevor_erikson Tuesday, September 15, 2009 9:48 PM Re: Hyperhydrosis Hi Sean Please remember that there are always two sides to every problem, ie excess and deficiency, or a combination of the two. The excessive sweating that you mentioned is often times due to Damp heat, particularly in the lv/ Gb channels, and may be treated quite well with Long Dan Xie Gan Tang modifications. I have treated several cases like this quite successfully. Does your patient have any skin rashes? Trevor <%40> , " Sean Doherty " <sean wrote: > > Hi Dr. Sung, > > Thanks for your reply. > > Her tongue had a small body, slightly swollen and red, and quivered > slightly. I found her weakest pulses to be her K yang and Sp, and they were > generally bowstring overall. She was very anxious when she came to see me, > and she was sweating from her hands and feet quite profusely. At that first > visit we did acupuncture and she soaked the sheets at the area of her hands > and feet. I had scheduled her initially thinking that I would primarily > treat her with herbs, and seeing how she responded confirmed that for me. I > decided not to do anymore acupuncture with her. She didn't report anything > remarkable with her urination and bowel movements on questioning. > > > > She has only had five days of that herbal formula. I put the Suan Zao Ren > in because of its ability to calm the spirit, and stop sweating. > > I stuck with the high doses because I was looking for a strong action. I > had a friend in school with this condition that didn't seem to get > resolution. I don't remember what herbs they tried, but I know it can be > very difficult to treat overall. > > Initially, I was going to just do a modification of Bu Zhong YI Qi Tang, but > then I saw that formula on the Blue Poppy site and thought it seemed more > applicable. > > > > I see that the price has increased $10 for the formula that I had previously > listed. She may not want to continue the raw herbs because of the price > increase. I would then try granules. > > > > Thanks again, any comments will be appreciated. > > > > Sean > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2009 Report Share Posted September 16, 2009 The last patient I treated with this condition was about 34 years of age. He had suffered with hyperhydrosis for many years. It was triggered with nervousness, but was always present. Through this he developed pompholox eczema on his hands and a fungal infection mixed with pitted keratylosis on his feet (very smelly!!) His condition improved, meaning the sweating ceased, within 3 weeks on a modified long dan xie gan tang. The skin conditions associated with it cleared completely within 2 months. He is not with me now, but when he was discharged he was very stable. I used E Feng granules with him, which are vacuum packed by individual herb. No powder mixing needed. Just hand out the appropriate amount of packets. I was just trying to present another view :-) Trevor , " Sean Doherty " <sean wrote: > > Thanks Dr. Sung and Trevor for your comments. Much appreciated. > > > > I will keep your thoughts in mind, Trevor. She doesn't have any skin > rashes. How old were the patients you treated? What was the course of > treatment? Did it resolve completely or do they continue to take herbs? > What form of herbs did you give them? > > > > She ran out of that first formula and was anxious to take more, because she > realized how much it had been helping. I already ordered her a couple weeks > more of the formula, after which I told her we would switch to > granules.mostly because of the cost issue. I will reassess then. > > > > I have been trying to get away from working with the granules myself, > because the powder that goes into the air when I mix a formula irritates my > sinuses ( I use KPC, I don't have problems with environmental allergies, but > when I make a formula it is often a problem). There are options for having > the granule formulas made, but the price isn't that much better than having > the decoctions vacuum packed. Consequently, I had moved to doing more with > standard capsule formulas, (mostly Blue Poppy), but ran into the typical > problems with not being able to customize for certain conditions, or a cost > issue again when giving two formulas at the same time. I need a fume hood, > or I suppose I could put in an exhaust fan at my work station. I have > thought of tinctures, but don't really want to make the investment in a > whole tincture pharmacy. I think it is easier though, in many ways, to > just send off the prescription and not futz with mixing the formulas myself. > Anyway, I am getting far afield from my original query. If not informative, > I am sure some will find it funny > > > > Thanks, > > Sean > > > > > On Behalf Of trevor_erikson > Tuesday, September 15, 2009 9:48 PM > > Re: Hyperhydrosis > > > > > > Hi Sean > > Please remember that there are always two sides to every problem, ie excess > and deficiency, or a combination of the two. The excessive sweating that you > mentioned is often times due to Damp heat, particularly in the lv/ Gb > channels, and may be treated quite well with Long Dan Xie Gan Tang > modifications. I have treated several cases like this quite successfully. > > Does your patient have any skin rashes? > > Trevor > > > <%40> , " Sean Doherty " <sean@> > wrote: > > > > Hi Dr. Sung, > > > > Thanks for your reply. > > > > Her tongue had a small body, slightly swollen and red, and quivered > > slightly. I found her weakest pulses to be her K yang and Sp, and they > were > > generally bowstring overall. She was very anxious when she came to see me, > > and she was sweating from her hands and feet quite profusely. At that > first > > visit we did acupuncture and she soaked the sheets at the area of her > hands > > and feet. I had scheduled her initially thinking that I would primarily > > treat her with herbs, and seeing how she responded confirmed that for me. > I > > decided not to do anymore acupuncture with her. She didn't report anything > > remarkable with her urination and bowel movements on questioning. > > > > > > > > She has only had five days of that herbal formula. I put the Suan Zao Ren > > in because of its ability to calm the spirit, and stop sweating. > > > > I stuck with the high doses because I was looking for a strong action. I > > had a friend in school with this condition that didn't seem to get > > resolution. I don't remember what herbs they tried, but I know it can be > > very difficult to treat overall. > > > > Initially, I was going to just do a modification of Bu Zhong YI Qi Tang, > but > > then I saw that formula on the Blue Poppy site and thought it seemed more > > applicable. > > > > > > > > I see that the price has increased $10 for the formula that I had > previously > > listed. She may not want to continue the raw herbs because of the price > > increase. I would then try granules. > > > > > > > > Thanks again, any comments will be appreciated. > > > > > > > > Sean > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2009 Report Share Posted September 16, 2009 Oh, I appreciate your perspective, and glad to hear of your clinical success. Sorry to have trundled off into my herb dilemma. I know of E Feng. I have resisted trying them out because of the delay in ordering from California. Often takes forever to get stuff, but I just might have to reconsider. Best, Sean On Behalf Of trevor_erikson Wednesday, September 16, 2009 3:27 PM Re: Hyperhydrosis The last patient I treated with this condition was about 34 years of age. He had suffered with hyperhydrosis for many years. It was triggered with nervousness, but was always present. Through this he developed pompholox eczema on his hands and a fungal infection mixed with pitted keratylosis on his feet (very smelly!!) His condition improved, meaning the sweating ceased, within 3 weeks on a modified long dan xie gan tang. The skin conditions associated with it cleared completely within 2 months. He is not with me now, but when he was discharged he was very stable. I used E Feng granules with him, which are vacuum packed by individual herb. No powder mixing needed. Just hand out the appropriate amount of packets. I was just trying to present another view :-) Trevor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2009 Report Share Posted September 17, 2009 I had used vaccum packed grandule a few times when I was in Toronto (it is not common here in Hong Kong). It has one drawback that makes me hesitant using it again. It was sanjiao brand (999) packed granule and they are packed in standard (normal) dosage. I cannot get the exact weight I want as some of the herbs I used will not match their standard dose. Very often my patients need to use only half a pack and the whole thing get messy. Besides, it is not green. I would precribe on weekly basis and sometimes by month. It is a headache for patients to cut all these packs. May be it is just my problem. I like to use 8g, 12g, 15g, something like that. I wonder what about E feng package? Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
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