Digest Number 1061

July 21, 2002

Frances,

Sat, 20 Jul 2002 22:24:56 -0400

Frances Gander <fgander

Re: black tongues

I am posting the following case for your comments. I am wondering about

the black streak on her tongue, the floating sensations, and tingling in

her legs which were not present during the time I have been seeing her.

Any herbal combinations come to mind? Thank you for your thoughts.

Do you have a treatment strategy

in mind? I'm always reluctant to

speculate about cases that I have

not seen with my own eyes and touched

with my own hands, and in this case

I'm additionally confused because

you seem to be asking for help

clarifying the signs and symptoms

and for herbal combinations.

Do you seek to follow a symptom-relief

approach with the case? Or are you

interested in treating the root?

If it's the latter, then before

coming to conclusion as to which

ingredients to combine, it seems

to me that you should focus on

what the combination is intended

to accomplish.

Frances

Woman, 54 years old. Normal menses, no clots or irregularities until she

went through menopause process 4-6 years ago.

Then what? The timing here is

not clear to me. Did her symptoms

begin to appear subsequent to menopause?

Married for 31 years.

Issues with her married/sexual life?

Social worker in a state mental hospital center.

She does what? Talking therapy?

Is she talking to mental patients

all day long?

Vegetarian.

What does she eat? How is her

digestion? metabolism? elimination?

How is her skin tone? Complexion? Are

her eyes bright or dull?

Normal

weight.

What is normal weight?

I noted a black streak, for the first time, on the root of her tongue.

In the basic theory textbook that is

widely used in the colleges and universities

of TCM it associates black tongue coating

with epidemic diseases, giving the example

of cholera. Black tongue bodies are associated

with cold, although this can be misleading

as when one sees the disease in the clinic

the cold has often turn heat, manifesting

in high fever. I saw a case last year of

a virulent flu. Dead of winter in Beijing.

Black tongue. And lots of dampness accumulating

in the upper jiao. Since this thread is

all about black tongues.

It was vertical, about 3/4 " wide. The fur was dry and deep horizontal

cracks in the body. Red edges and tip. Previously, her tongue had been

more wet, thin white coat, and the red edges and tip.

Pulses: excess in left proximal position, all others thin, deep,

thready and deficient. Previously, could tend to be rolling, but faint.

If I understand you correctly, you're

saying her kidney pulse is excess.

Can you elaborate on what you mean,

i.e., on what you felt?

New symptoms:

What is the interval here that has

elapsed since you previously treated

her and the present? And what happened

during that time? You mention her long

walk. Did she have any injuries, pains,

sensations, changes, etc. after that

walk?

Most recently, legs feel " tingly, heavy, and loose, like

there's nothing inside. " The tingling occurs more in the a.m. A few

weeks ago she had sensations of 'trembling inside' and 'floating' which

have now subsided. She is concerned that this is pre-seizure

symptomatology, as in her teens she had epileptic seizures.

And how long has it been since her

long walk?

None since

then and on medication: dilantin 100 mg TID and celontin 300 mg TID.

She's been on these meds at these

doses since her teens?

Recent extensive lab tests she requested because of the above symptoms

had no abnormal findings.

Previously, she came to me with a diagnosis of clinical depression and

was on effexor. She may have been on the brink of perimenopause at that

time, though her periods were still regular.

So you saw her 4-6 years ago? She was hospitalized at 16

for depression.

How was she treated?

There was a history of sexual abuse by a brother from

ages 6-13. She came out of the depression during treatment with

acupuncture, moxa, and herbs, little by little over a course of about

two years, until she has maintained consistently bright spirits, or I

would say a normal mood with some ups and down but never into the depths

of depression. She also studies taiji with me.

I was just rereading Prof. Cheng's

Thirteen Treatises book, and in the

chapter on Benefiting the Internal

Organs, there are some valuable

insights into the potential of

taiji as a method of addressing

cases such as this one. " Only if

you sink the ch'i to the tan t'ien

will the result of exercise be

different....when the ch'i sinks

to the tan t'ien the internal organs

can relax and move, and open and close,

with each breath. "

In May or June she walked 60 miles, for which she raised more than

$5,000 for breast cancer research.

I would suggest a thorough palpatory

examination of her whole body. I

suspect that she injured her ligaments

and other connective tissue during

this process and that this subsequently

injured the qi4 of the liver and gall

bladder. But this is a mere speculation

on my part and would need to be confirmed

and addressed only if discovered to

align with her actual condition.

She threw herself into training and

completed the walk. It was a very inspiring experience for her, but I

wonder if this experience has consumed her yin, in addition to her very

stressful job.

Sounds like her yin1 has suffered

mightily.

If you want to continue to discuss

the case, I'm very interested to

learn more about it.

Thanks,

Ken

July 28, 2002

yulong wrote:

Frances,

Sat, 20 Jul 2002 22:24:56 -0400

Frances Gander <fgander

Re: black tongues

I am posting the following case for your comments. I am wondering

about

the black streak on her tongue, the floating sensations, and tingling

in

her legs which were not present during the time I have been seeing

her.

Any herbal combinations come to mind? Thank you for your

thoughts.

Do you have a treatment strategy

in mind? I'm always reluctant to

speculate about cases that I have

not seen with my own eyes and touched

with my own hands, and in this case

I'm additionally confused because

you seem to be asking for help

clarifying the signs and symptoms

and for herbal combinations.

Do you seek to follow a symptom-relief

approach with the case? Or are you

interested in treating the root?

If it's the latter, then before

coming to conclusion as to which

ingredients to combine, it seems

to me that you should focus on

what the combination is intended

to accomplish.

Ken,

I am asking for help in understanding her

black tongue, trembly feeling in her legs and all over may mean in connection

with her other signs and symptoms. These are what I wish to focus

on; the rest I give for background. Of course, both she and I seek to know

more about the source of her troublesome symptoms. I missed most

of the earlier posts on black tongues.

Frances

Woman, 54 years old. Normal menses, no clots or irregularities until

she

went through menopause process 4-6 years ago.

Then what? The timing here is

not clear to me. Did her symptoms

begin to appear subsequent to menopause?

Sorry for the indistinct

time-line. I will try to straighten that out. Her symptoms

(black tongue and shakiness) have just appeared since one month ago, about

1 1/2 months after her 60-mile walk for breast cancer. Her depression recurred

or became exacerbated during menopause and was treated with herbs and acupuncture,

'96-'98. That is o.k. now.

Married for 31 years.

Issues with her married/sexual life?

None, other than lack of libido which she

has experienced increasingly since menopause. She does not seem motivated

to change that, and I always ask about it. She seems resigned to

it as natural for this stage of her life. I don't agree, but this

is about her.

Social worker in a state mental hospital center.

She does what? Talking therapy?

Is she talking to mental patients

all day long?

Her duties are more case management since

this is a state facility. There is not time to talk with patients, other

than gathering specific information. Also many of the patients

are in for short-term treatment of addictions and/or psychotic episodes.

Vegetarian.

What does she eat? How is her

digestion? metabolism? elimination?

How is her skin tone? Complexion? Are

her eyes bright or dull?

In summer, she eats a lot of fresh vegetables

and fruit from her garden. The vegetables are often cooked in soup.

There is no bloating or gas. By most standards, she is constipated in that

she only moves her bowels about every 2nd or 3rd day. Always been

that way. Stool is formed, moist, and no straining. I always

ask, though. However, in the last month her eyes are less bright than before,

and complexion is more pale (but not gray or dull). She exhibits signs

of exhaustion.

Normal

weight.

What is normal weight?

5'4", 130 lbs.

I noted a black streak, for the first time, on the root of her tongue.

In the basic theory textbook that is

widely used in the colleges and universities

of TCM it associates black tongue coating

with epidemic diseases, giving the example

of cholera. Black tongue bodies are associated

with cold, although this can be misleading

as when one sees the disease in the clinic

the cold has often turn heat, manifesting

in high fever. I saw a case last year of

a virulent flu. Dead of winter in Beijing.

Black tongue. And lots of dampness accumulating

in the upper jiao. Since this thread is

all about black tongues.

It was vertical, about 3/4" wide. The fur was dry and deep horizontal

cracks in the body. Red edges and tip. Previously, her tongue

had been

more wet, thin white coat, and the red edges and tip.

Pulses: excess in left proximal position, all others thin,

deep,

thready and deficient. Previously, could tend to be rolling, but

faint.

If I understand you correctly, you're

saying her kidney pulse is excess.

Can you elaborate on what you mean,

i.e., on what you felt?

I mean her heart and small intestine pulse

was excess in relation to all the others, something that has not shown

up before. The movement seemed mostly on the surface, but oogled around

like two b-b's.

New symptoms:

What is the interval here that has

elapsed since you previously treated

her and the present? And what happened

during that time? You mention her long

walk. Did she have any injuries, pains,

sensations, changes, etc. after that

walk?

She has been in my care about 6 years.

When she first came in in '96 she sought help with a diagnosed 'clinical

depression.' I saw her about once a week until she started to feel better,

then every other week, then monthly. I have seen her monthly for

the past several years, occasionally treating her for low back pain or

spasming in her l. trapezius (probably from the telephone). Along

with acupuncture and taiji, here's the basic herb formula that helped her

regain her zest for life: ba ji tian, gou qi zi, shu di huang, yin

yang huo, he shou wu, bu gu zhi, mu dan pi, suan zao ren, huang bai, dan

shen, mai men dong, wu wei zi, yuan zhi. This was in concentrate

form. In the past 2-3 years, she feels that tian wang bu xin wan

is helpful, along with taiji, in staying emotionally balanced.

Most recently, legs feel "tingly, heavy, and loose, like

there's nothing inside." The tingling occurs more in the

a.m. A few

weeks ago she had sensations of 'trembling inside' and 'floating'

which

have now subsided. She is concerned that this is pre-seizure

symptomatology, as in her teens she had epileptic seizures.

And how long has it been since her

long walk?

About two months.

None (seizures) since

then and on medication: dilantin 100 mg TID and celontin 300 mg

TID.

She's been on these meds at these

doses since her teens?

The dosage of celontin is lower now

and she doesn't take dilantin any more. Her neurologist says this

is minimal 'seizure protection.'

Recent extensive lab tests she requested because of the above symptoms

had no abnormal findings.

Previously, she came to me with a diagnosis of clinical depression

and

was on effexor. She may have been on the brink of perimenopause

at that

time, though her periods were still regular.

So you saw her 4-6 years ago? She was hospitalized at

16

for depression.

How was she treated?

I'm assuming you're asking about the depression.

She was treated with psychotherapy, including about 12 years in psychoanalysis.

Probably drugs, too, but I don't know which ones other than the most recent

one which was effexor. She became disillusioned with talk therapy and quit

it. I mentioned how I treated her during this depression which recurred

in menopause above.

There was a history of sexual abuse by a brother from

ages 6-13. She came out of the depression during treatment with

acupuncture, moxa, and herbs, little by little over a course of

about

two years, until she has maintained consistently bright spirits,

or I

would say a normal mood with some ups and down but never into the

depths

of depression. She also studies taiji with me.

I was just rereading Prof. Cheng's

Thirteen Treatises book, and in the

chapter on Benefiting the Internal

Organs, there are some valuable

insights into the potential of

taiji as a method of addressing

cases such as this one. "Only if

you sink the ch'i to the tan t'ien

will the result of exercise be

different....when the ch'i sinks

to the tan t'ien the internal organs

can relax and move, and open and close,

with each breath."

She is really good at sinking her qi, but

being exhausted, she doesn't feel like practicing taiji She comes

home, eats dinner, sits around for a while, then goes to bed. She

has to be to work at 7 a.m.

In May or June she walked 60 miles, for which she raised more than

$5,000 for breast cancer research.

I would suggest a thorough palpatory

examination of her whole body. I

suspect that she injured her ligaments

and other connective tissue during

this process and that this subsequently

injured the qi4 of the liver and gall

bladder. But this is a mere speculation

on my part and would need to be confirmed

and addressed only if discovered to

align with her actual condition.

I will palpate her body thoroughly Friday

when she comes in. Your speculation about the tendon and ligament injury,

etc. makes a certain amount of sense. I will check it out.

She threw herself into training and

completed the walk. It was a very inspiring experience for her,

but I

wonder if this experience has consumed her yin, in addition to

her very

stressful job.

Sounds like her yin1 has suffered

mightily.

Yes indeed.

If you want to continue to discuss

the case, I'm very interested to

learn more about it.

Thanks,

Ken

Thank you, Ken. I hope others will

be stimulated to put in their ideas or ask further questions. It's

quite labor intensive to get into these cases, so one always hopes it leads

to better understanding for more than two people.

Frances

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate academics

specializing in Chinese Herbal Medicine, provides a variety of professional

services, including board approved online continuing education.

February 22, 2003

I have had good success using magnets in conjunction with my chiropractor. I used to work with horses all the time. Continually grooming them for sales and shows. After a while my hand became so irritated that I could not sleep at night. I went to the chiropractor and he helped after some sessions. I now wear a small magnetic wrap and/or a far infrared wrap and my hand feels great.

Nick Skias