RFI Yin Deficiency or Damp Heat Tongue? CASE

March 21, 2002

I have a patient with the following workup (I will try to keep it to the point):

Male, 34 years old, originially presenting with a main complaint of chronic sugar addiction, along with milder coffee addiction. Patient is not overweight, and is in fact in remarkably good muscular shape--he is a yoga instructor.

BT: tends to run warm to hot. Face is objectively reddish.

Sweat: very occasional night sweats, sweats excessively (ie more than others) in yoga class.

Eyes: gets red eyes and styes about 1x a month.

Thirst: thirsty but without desire to drink. Likes room temp beverages.

Sleep: sleeps fitfully when he knows he has to be up early (about 2x a week he gets up at 6 am) Other days his sleep is less restless but not perfect. No trouble falling asleep.

Diet: Sugar addiction. Craves sweets, cheese, caffeine (only 1-2 cups a day). Has made only moderate headway in improving his diet.

Addiction: under acupuncture care, quit smoking 4 months ago. Recovering alcoholic.

Digestion: can tend to be bloated and gassy, although this has also improved substantially under acupuncture and herb care. Stools on the softer side 1-3 x a day.

No pain with BM.

Urine:nothing unusual

Skin: has moderate to severe reddish sores on his upper legs, buttock and groin area (although the groin area has improved dramatically with treatment). Some of te sores have whitish pus inside. A couple of sores also lie where his waistband hits. The sores cover areas where his yoga shorts sit, and I suggested that he switch detergent to a natural milder sort. Also strongly suggested a lukewarm shower immediately following each yoga class (he practices for 2 hours daily and had not been taking showers right away). Learned at his most recent visit that he wears his yoga shorts more than once, even though he sweats excessively, adn suggested he use a fresh pair. The sores can get dry and itchy, but are mostly just red and sometimes fluid filled.

Mental: foggy thinking, diagnosed with ADD.

Patient has a history of herpes outbreaks. but has not experienced this in many months.

Pulse: wiry in all positions, weaker in Spleen position. 57-62 bpm.

Tongue: This is the interesting point. He stopped seeing me for 1 and 1/2 months over the holidays (and his sugar addiction got much worse over this time) and his tongue upon his return to my office had developed a red peeled and cracked area in the Stomach Spleen area. The rest of the tongue is red, and there is greasy coating on the Lv/GB areas and in the lower jiao area.

I have been treating this patient for 4-5 months, more on than off. I have diagnosed him usually with Damp Heat in Liver/GB, Spleen Qi Vacuity with Dampness. The peeled area of the tongue has really caught my attention. I remember reading somewhere that Damp Heat, over time, can cause a peeled tongue, but cannot locate where I read this. Could the heat be consuming the yin fluids of the stomach. But his night sweats and other yin deficiency signs have if anything gottne better witTh treatment, adn I don't want to burden his system with any clogging yin tonics if damp-heat is the main issue. I put some Shi Hu or Sha Shen in his formula, which is not particularly clogging.

He is on a formula consisting of spleen tonics, some fu ling, shi chang pu, Huang Bai (which has really helped the fungus on his toes, which is almost gone), ku shen or some closely functioning herb for damp skin lesions, and shi hu or sha shen.At times, the formula includes Niu Xi and Long Dan Cao. He has used external washes which don't do a whole lot of good. The sudden and severe reapperance of the upper leg and butt sores have me a bit perplexed--although he did miss 5 days of his formula last week.

Any insight into the tongue or other issues would be appreciated.

Hillary