An example of individualizing treatment

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In Dr. Maciocia's last newsletter there was a question about post-viral fatigue

syndrome in the case of a woman who suffers from ME (the British term for

CFIDS). The patient's symptoms are " very tired, severe muscle fatigue and ache

(especially on her back), difficulty sitting, heavy limbs, poor concentration, a

constant feeling of fullness in the epigastric area " (center, upper abdomen)

" and on the right side of the abdomen, bitter taste, sore throat, insomnia,

scanty dark urine and shivers. Her pulse was Full, tense and the Kidney

position was Weak. Her tongue has teeth marks on the sides, is a little bit

swollen and the coating is thin-white. "

 

Dr. Maciocia diagnosed " Damp-Heat in the Middle Burner and muscles against a

background of Spleen and Kidney deficiency. " He recommended resolving the

Damp-Heat first.

 

Note that this is an individualized treatment plan for this person in the here

and now. A week, two weeks, or more from the start of this treatment, the

emphasis may need to be shifted to treating the Kidney and Spleen Deficiency.

Eventually these will have to be addressed.

 

Note that there are some outstanding indicators of Heat in part of the body -

the scanty dark urine, the sore throat, and in this case the bitter taste,

shivers, and insomnia. The other symptoms tell Dr. Maciocia that it's Damp Heat

(Heat With a Dampness component). Her tongue tissue is not pale so in this case

it makes sense to treat the Damp Heat component first.

 

Beginning treatment would have been different if the tongue had been pale, if

the woman felt very cold all the time and couldn't warm up, if she suffered from

needing to sleep all the time instead of insomnia, and if the urine had been

clear and copious. This would point to a fairly severe Kidney Yang Deficiency

and/or Spleen Yang Deficiency that probably would need to be addressed first.

The Damp Heat problems would be addressed later as this woman would be hurt by

anything that cooled her down and slowed down her metabolism still more. TCM

treatments are monitored and changed as the need arises.

 

How did Dr. Maciocia know that the pressing Heat problem is Damp Heat? The

woman's tongue is a bit swollen and has teeth marks on the sides. These are

signs of Dampness problems. So is the " heavy limbs " . (Note: Many PWCs/ PWMEs

will describe their limbs as feeling heavy or feeling like they're encased in

cement or weights. This is a sign of Dampness problems in anyone, not just PWCs

though it does tend to be severe in PWCs. Magnesium is a non-TCM treatment that

often will relieve this sensation as well as other symptoms in many PWCs, but

eventually the underlying problem with Dampness and what gave rise to the

Dampness are going to need to be addressed. Magnesium also plays some critical

roles in the immune function.)

 

Part of what the TCM-defined Spleen does it to move fluids in the body and to

make sure that each part of the body has the proper amount of fluid. When you

see a swollen tongue - especially one with teeth marks, this often is a sign

that the Spleen is Deficient. However, the Kidneys also play a role in fluid

management, and Kidney Deficiency also can cause the tongue to be swollen and

Dampness to accumulate in the body (in spite of the person having to go to

urinate a lot and the urine being clear-colored).

 

In this case there are signs of both Kidney and Spleen Deficiency. Whenever you

see mention of back pain ( " severe muscle fatigue and ache (ESPECICALLY ON HER

BACK) " , suspect Kidney imbalance. Also if the person complains of weak, achy

knees.

 

Both Spleen Deficiency and Kidney Deficiency can result in severe fatigue. If

it's Spleen Yang Deficiency and/or Kidney Yang Deficiency, this is the severest

of fatigue. The weak pulse in the Kidney position futher points to Kidney

Deficiency.

 

But, another reason why Dr. Maciocia recommends putting the emphasis on treating

the Damp Heat first instead of addressing the Spleen and Kidney Deficiency

problems is that the overall quality of the pulse is Full. A Full or Strong

pulse points to an Excess problem. A Weak pulse (as in the Kidney position in

this case) usually is associated with Deficiency. In this case the overall

pulse quality is Full (Excess), so in this case the emphasis is placed on

clearing the Excess (Damp Heat) first. If the woman's pulse overall had been say

Slow and Weak, the emphasis may have been placed on correcting the Deficiency

first.

 

A tense pulse can be a sign of prolonged pain or a tendency toward pain,

" especially when associated with Cold " . (Wicke, vol. 1, p. 337)

A symptom of Yang Deficiency is the person feels cold and has problems warming

up.)

 

The general rule of thumb is to treat Excess before Deficiency. However, there

are exceptions to this general rule. Sometimes the Deficiency will need to be

treated first. Sometimes both the Deficiency (Emptiness) and the Excess

(Fullness) will need to be treated at the same time. TCM is individualized in

the here and now.

 

I know that some of this is going to sound a bit overwhelming to readers new to

TCM. Keep in mind I've been at this for some time, so I can rattle these things

off. The main ideas to learn in the beginning are: If the tongue is swollen -

especially if there's teeth marks, suspect Dampness, Dampness accumulation often

is caused by Spleen and/or Kidney imbalance, if the person complains of a weak

and painful back suspect Kidney involvement, if the person complains of

heavy-feeling limbs than suspect Dampness problems, a Full pulse usually

indicates an Excess condition, and a Weak pulse usually indicates a Deficiency

condition.

 

Victoria

 

 

 

 

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