RFI Yin Deficiency or Damp Heat Tongue? CASE my POV

[Guest guest]

Chinese Traditional Medicine, acugirlnyc@a... wrote:

> 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

 

 

OK, I cant diagnose without seeing a client, but from reading the

case I got following thoughts which I write down to get the MANY

readers to think about the complicated interwoven thing called TCM.

 

Dont take these notes as specific for *this* case but as 'general

teachings':

 

Reading many cases on the web I found out

'Spleen deficiency with dampness' is diagnosed very easily although

there is no dampness and there is only a very mild, I'd say 'regular,

normal' spleen deficiency.

The many masks a Yin deficiency hide in are not clearly explained in

western language books.

 

Smoking (dry-)burns up Yin, damages lungs disseminating functions,

alcohol steam-burns up Yin, damages liver yin and relaxing functions

leading to stagnant qi and fluids.

 

The 'damp-heat' (one should check how much damp/where/how much

heat/where) you treated might be sitting on a deficient liverYin/

(Yang started floating) basis. After eliminating the dampheat one

should be careful to not damage the yin.

Study the formula zhibaidihuangwan.

 

ADD is connected more to the kidney than to the spleen.

 

Longdancao can damage yin with its cold-bitter-purging action. I

suggest you take it yourself for 2 days to feels its 'eradicating'

effects.

Shichangpu uses energy+fluids to make its 'slime-blasting' actions

(warm+acrid leading to dry mouth).

 

Giving Yin tonics might aggravate an existing Qi-blockage (qi blocks

fluid transportation leading to dampness which has nothing to do with

spleen deficiency).

Again:Dont take these notes as specific for *this* case but

as 'general teachings'!

 

How did you treat his nightsweat+yin deficiency?

What about his lung/heart/kidney functions?

What classical formulas is your ecipe based on?

 

Greetings Tay.

[Guest guest]

Thanks, Tay, for summing up a lot of things.

 

I especially want to emphasize this for readers who are new to TCM. (There

are people new to TCM, students, and professionals on the list. I try point

out some of the main concepts for those who are just starting to learn TCM.)

 

>Giving Yin tonics might aggravate an existing Qi-blockage (qi blocks

>fluid transportation leading to dampness which has nothing to do with

>spleen deficiency).

 

One of the main functions of the Spleen is to transform and transport fluids

in the body. The Kidneys and Triple Burner also play important roles in

this. But Dampness can accumulate due to other things. One of these is Qi

Stagnation. Actually, Dampness and Qi Stagnation can be a snow-balling

situation. Dampness can trigger Qi Stagnation and make it worse, and Qi

Stagnation can trigger Dampness and make it worse. Think about the ease that

you can move your arm through air. Then think about the resistance the arm

meets when you try to move it under water. This is sort of like what

Dampness in the body does to Qi. Makes it harder to move.

 

Yin tonics tend to be moistening in nature. Yin cools, calms, and moistens.

The concern is that if the person also has Qi Stagnation problems, adding

that extra moisture of the Yin tonic herbs will worsen the Dampness

accumulation. It can't move because the Qi is not moving. It's like

putting more water into a swamp.

 

Qi Stagnation also is a concern with Qi tonic herbs except in the case of

these herbs what builds up is Qi. Qi is supposed to flow smoothy and evenly

through the body, but can't when there is blockage or Stagnation. Some

parts of the body have too much Qi building up and some parts have too

little. It's not equalized and flowing smoothly. If a person is both Qi

Deficient and has Qi Stagnation problems, tonifying the Qi without

addressing the Stagnation problems is just making the Stagnation problems

worse. The parts of the body that need the smooth Qi flow restored still

aren't getting it, and the Qi is building up behind the " kink " . What

usually results is Heat (like a pressure cooker) though Cold also an result

in areas that are not getting sufficient Qi. (Qi is warming compared to

Yin.)

 

In cases of Qi Deficiency and Yin Deficiency, consider the possibility of Qi

Stagnation and treat along with the Deficiency if present. Do not treat if

it is not present. Treating something which isn't present can cause other

problems.

 

Cold also can cause Qi to Stagnate and Dampness to accumulate. Exterior Cold

can enter the Uterus, the Intestines, and the Stomach directly. In some

(not all) cases where Dampness has accumulated in the lower abdomen, Cold

which has invaded from the Exterior may be the Root. The Cold slows

everything down - including Qi. Fluids accumulate, the Dampness slows Qi

down more and also keeps things Cold down there. The situation snowballs.

It's like rolling a snowball down a hill. Once it gets started, it keeps

gathering more and more snow and getting bigger and bigger the longer it

keeps rolling.

 

Victoria

 

 

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[Guest guest]

>The many masks a Yin deficiency hide in are not clearly explained in

>western language books.

 

Please do more posts on this.

 

Thanks,

Victoria

 

 

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[Guest guest]

>The many masks a Yin deficiency hide in are not clearly explained in

>western language books.

 

Please do more posts on the possible manifestations and etiologies of Yin

Deficiency.

 

Thanks,

Victoria

 

 

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