case study

[Guest guest]

Bob-

 

 

I attributed his twitching at night to liver wind from yin or blood xu, posibly liver blood not nourishing the tendons, which would also explain the tight tendons in the hands and toes. The twitching has diminished considerably over the last half year. The cold blood stasis diagnosis comes from the bluish tongue and choppy pulse.

 

Thanks for the input on pulses.I do understand that a weak cubit pulse does not necessarily correspond to kidney involvement, and a weak inch pulse doesn't necessarily imply heart or lung involvement. This is the method I was taught, but I'm happy to relearn/change/improve.

 

Beata

[Guest guest]

Bob,

 

Sorry, I forgot to mention that the distended sublingual veins also contributed to my diagnosis of cold blood stasis, along with the bluish tongue and choppy pulse.

 

Thankyou for any insight you can give.

 

Beata

[Guest guest]

Beata,

 

Does the patient still have any tremor? If not, I think you should

consider letting go of wind as part of the pattern discrimination,

unless, of course, there are other s & s indicating the continued

presence of wind.

 

Can you still make a case for the presence of phlegm based on

currently presenting s & s?

 

From the S & s you've given, it doesn't seem you've made a case for

splee-kidney yang vacuity. Am I missing something here? What are the s

& s you collected which add up to spleen-kidney yang vacuity.

 

Based on the tongue, it appears there's some sort of heat in the upper

burner. Vacuity heat seems to fit with the warm hands at night. Since

blood and essence share a common source, this would also fit with the

malnourishment of the sinews.

 

Definitely there is blood stasis, probably having entered the network

vessels. However, I don't think using the concept of " cold blood

stasis " is a good match here. More likely, the CM disease mechanisms

are a combination of liver depression, phlegm obstruction, blood

vacuity failing to nourish the vessels, and enduring disease entering

the network vessels. If blood stasis has entered the network vessels,

then you should consider using some of the bugs and/or tree saps,

i.e., Quan Xie, Wu Gong, Mo Yao, Ru Xiang, etc. The benefits of the

bugs is that they do also search out and track down wind deep-lying

(or hidden, fu) in the channels and vessels.

 

Based on Yan De-xin's dictum that in chronic, enduring diseases there

is always liver depression, I don't doubt there is an element of liver

depression in this case. The patient has to have unfulfilled desires.

 

If slurred speech is the main presenting complaint at this time, then

you might consider choosing a guiding formula under one of the

patterns for " deranged speech. " This is where slurred speech falls as

a disease category in CM. This disease category is covered both in

Philippe Sionneau's The Treatment of Disease in TCM and in my and

James Lake's Chinese Medical Psychiatry.

 

Bottom line, I think you should consider writing a single formula

which addresses the patient's presenting patterns as indicated by his

current s & s, choosing two or three medicinals for each presenting

pattern which are also known to empirically treat his presenting signs

and symptoms. I also would suggest increasing the dosages you are

using if the patient has plateaued and you are not getting any further

forward movement.

 

If you are concomitantly using acupuncture (I forget what you said

about this), consider luo ci (network vessel puncture) for the blood

stasis entering the network vessels. Fine needle (hao zhen)

acupuncture treats the channels (jing) and is not so effective for

treating the network vessels (luo) per se. This often makes the

difference in stubborn, enduring conditions. For further info on

network vessel puncture, see Honora Lee Wolfe's DL program on treating

chronic conditions with acupuncture & moxibustion available from Blue

Poppy.

 

Just some thoughts. Sorry I didn't get back to you yesterday.

 

Good luck and best wishes,

 

Bob

[Guest guest]

Hi Bob-

 

Thanks much for your reply. It is very helpful!

 

I don't think I diagnosed him with spleen and kidney yang vacuity. Perhaps I'm hallucinating again. I believe my diagnosis was liver wind rising due to liver and kidney yin xu, cold blood stasis, and liver blood xu (liver blood not nourishing tendons). Phlegm obstruction makes sense to me, but why no cold blood stasis? I thought a bluish tongue indicated cold, not heat? Liver depression sounds good.

Thankyou for your time and insight on the herbs to consider, I have been treating him with acupuncture twice weekly, and will look into network vessel puncture.

 

Beata

 

 

[Guest guest]

Beata,

 

Maybe it was me that was having an Alzheimer's moment. Sorry if I got

confused.

 

As for cold blood stasis (han xue yu), I'm not sure that I've ever

seen that term in the Chinese literature. There is " stasis heat (yu

re, stasis plus heat) " and there is " cold congelation (han ning). "

Secondly, a pattern is always a pattern of more than one sign or

symptom. So simply a blue tongue is not enough to base a pattern

discrimination on. In addition, I believe (and maybe I'm the one whose

all fermisht), you originally said the tongue was a little red and

bluish. But red plus blue equals purple, no? Of course, it's

impossible to talk about tongue colors unless you both can see the

pulse. That's one of the limitations of a forum such as this.

 

Bob

 

, coastacu@a... wrote:

> Hi Bob-

>

> Thanks much for your reply. It is very helpful!

>

> I don't think I diagnosed him with spleen and kidney yang

vacuity. Perhaps

> I'm hallucinating again. I believe my diagnosis was liver wind

rising due to

> liver and kidney yin xu, cold blood stasis, and liver blood xu

(liver blood

> not nourishing tendons). Phlegm obstruction makes sense to me, but

why no

> cold blood stasis? I thought a bluish tongue indicated cold, not

heat? Liver

> depression sounds good.

>

> Thankyou for your time and insight on the herbs to consider, I

have been

> treating him with acupuncture twice weekly, and will look into

network vessel

> puncture.

>

> Beata

[Guest guest]

Hi, my name is Molly Beverage and I have been practicing acupuncture for a

couple of years in rural Vermont. For a number of months, I have been working

with a woman who has primary lateral sclerosis, and while initially we were both

pleased with the reduction of her symptoms, at this point she seems to be

getting worse fast. Primary lateral sclerosis causes degeneration of the upper

motor neurons (as opposed to amyotropic lateral sclerosis - which affects both

upper and lower motor neurons) and leads to a rocking, stilted gait, poor

balance and slow, slurred speech with trouble swallowing. My client has deep,

slow pulses overall, with the left chi position more xu. Her tongue is light

purple, puffy and scalloped with deep cracks and a thick white dry coat. She is

very cold all the time and cold and anxiety make her symptoms worse. I treat her

with scalp and body points, along with an infrared heat lamp and moxa. I also

put her on herbs, but she is hyperallergenic and has developed

an allergic reaction to all the formulas I have given her.

I would deeply appreciate any and all feedback that anyone has to give me on

this case.

 

 

 

 

Search - Find what you’re looking for faster.

 

 

[Guest guest]

Hi, Molly: My cousins all live in Burlington, and work

in the medical community. Have you tried Kiiko's MS

tx? LV8, KD10, above TH8, and Bafeng? It will at least

help ward off the dizziness that accompanies the PLS.

JG

--- Molly Beverage <mbevera wrote:

> Hi, my name is Molly Beverage and I have been

> practicing acupuncture for a couple of years in

> rural Vermont. For a number of months, I have been

> working with a woman who has primary lateral

> sclerosis, and while initially we were both pleased

> with the reduction of her symptoms, at this point

> she seems to be getting worse fast. Primary lateral

> sclerosis causes degeneration of the upper motor

> neurons (as opposed to amyotropic lateral sclerosis

> - which affects both upper and lower motor neurons)

> and leads to a rocking, stilted gait, poor balance

> and slow, slurred speech with trouble swallowing. My

> client has deep, slow pulses overall, with the left

> chi position more xu. Her tongue is light purple,

> puffy and scalloped with deep cracks and a thick

> white dry coat. She is very cold all the time and

> cold and anxiety make her symptoms worse. I treat

> her with scalp and body points, along with an

> infrared heat lamp and moxa. I also put her on

> herbs, but she is hyperallergenic and has developed

> an allergic reaction to all the formulas I have

> given her.

> I would deeply appreciate any and all feedback that

> anyone has to give me on this case.

>

>

>

>

> Search - Find what you’re looking for faster.

>

> [Non-text portions of this message have been

> removed]

>

>

>

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[Guest guest]

Molly wrote:

 

>Hi, my name is Molly Beverage and I have been practicing acupuncture for a

>couple of years in rural Vermont. For a number of months, I have been

>working with a woman who has primary lateral sclerosis, and while initially

>we were both pleased with the reduction of her symptoms, at this point she

>seems to be getting worse fast. Primary lateral sclerosis causes

>degeneration of the upper motor neurons (as opposed to amyotropic lateral

>sclerosis - which affects both upper and lower motor neurons) and leads to

>a rocking, stilted gait, poor balance and slow, slurred speech with trouble

>swallowing. My client has deep, slow pulses overall, with the left chi

>position more xu. Her tongue is light purple, puffy and scalloped with deep

>cracks and a thick white dry coat. She is very cold all the time and cold

>and anxiety make her symptoms worse. I treat her with scalp and body

>points, along with an infrared heat lamp and moxa. I also put her on herbs,

>but she is hyperallergenic and has developed

> an allergic reaction to all the formulas I have given her.

>I would deeply appreciate any and all feedback that anyone has to give me

>on this case.

___

 

Hi Molly,

Whatever you are doing is clearly making your patient worse. Indiscriminate

use of acupuncture points at this juncture would be unhelpful.

 

I would be happy to help you come to a clearer understanding. I would need a

date of birth for your patient plus a list of any and all physical symptoms.

esp past symptoms like for example when your patient used to get stressed

where / how on the body did it manifest.

 

salvador

 

_______________

Find a cheaper internet access deal - choose one to suit you.

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[Guest guest]

Hi Molly!

 

I use this history form on each patient: (A medical history is required by

law in Florida)

 

Patient: Record Date:

 

Patient Number:

 

What is your major complaint?

How long have you had this condition?

What treatments or remedies have you tried for this condition?

 

 

Have you seen a Western Doctor for this condition? Yes or No.

Have you seen a Chiropractor for this condition? Yes or No.

Have you ever had scarlet fever? Yes or No.

Have you ever had diphtheria? Yes or No.

Have you ever had rheumatic fever? Yes or No.

Have you ever had chronic or frequent colds? Yes or No.

Have you ever had sinusitis? Yes or No.

Have you ever had tuberculosis? Yes or No.

Have you ever had a heart murmur? Yes or No.

Have you ever had a heart attack? Yes or No.

Have you ever had a heart condition? Yes or No.

Have you ever had stomach, liver or intestinal trouble? Yes or No.

Have you ever had gallbladder trouble or gallstones? Yes or No.

Have you ever had jaundice? Yes or No.

Have you ever had a reaction to serum, drug or medicine? Yes or No.

Have you ever had a tumor, growth, cyst or cancer? Yes or No.

Have you ever had piles or rectal disease? Yes or No.

Have you ever had a kidney stone or blood in your urine? Yes or No.

Have you ever had sugar or albumin in your urine? Yes or No.

Have you ever had venereal disease? Yes or No.

Have you ever had any drug or narcotic habit? Yes or No.

Have you ever had an excessive drinking habit? Yes or No.

Have you ever had to wear a neck or back brace? Yes or No.

Have you ever had exposure to tuberculosis? Yes or No.

Have you ever had to wear eyeglasses? Yes or No.

Have you ever had eye trouble? Yes or No.

Have you ever had ear, nose or throat trouble? Yes or No.

 

(female only section)

Have you ever had a pregnancy? Yes or No.

Have you ever had a vaginal discharge? Yes or No.

Have you ever had treatment for female disorder? Yes or No.

Have you ever had painful menstruation? Yes or No.Have you ever had

irregular menstruation? Yes or No.

How old were you when you had your first menstrual period?

What is the interval between your menstrual periods?

How long do your menstrual periods last?

When was your last period?

What is the quantity of your menstrual discharge? Normal, Excessive or Scanty.

Have you ever had or do you now have bloody or other discharge, non menses?

No, Seldom or Frequent.

Have you ever had or do you now have loss of sexual desire? No, Seldom or

Frequent.

(end of female only section)

 

Have you ever had or do you now have shortness of breath? No, Seldom or

Frequent.

Have you ever had or do you now have swollen ankles? No, Seldom or Frequent.

Have you ever had or do you now have high blood pressure? No, Seldom or

Frequent.

Have you ever had or do you now have a rapid heartbeat? No, Seldom or Frequent.

Have you ever had or do you now have dizziness? No, Seldom or Frequent.

Have you ever had or do you now have fainting spells? No, Seldom or Frequent.

Have you ever had or do you now have chest pain or pressure? No, Seldom or

Frequent.

Have you ever had or do you now have leg cramps? No, Seldom or Frequent.

Have you ever had or do you now have a cough? No, Seldom or Frequent.

Have you ever coughed up blood or do you now? No, Seldom or Frequent.

Have you ever had or do you now have hoarseness? No, Seldom or Frequent.

Have you ever had or do you now have sore throats? No, Seldom or Frequent.

Have you ever had or do you now have hay fever? No, Seldom or Frequent.

Have you ever had or do you now have nosebleeds? No, Seldom or Frequent.

Have you ever had or do you now have asthmatic wheezing? No, Seldom or

Frequent.

Have you ever had or do you now have pneumonia? No, Seldom or Frequent.

Have you ever had or do you now have indigestion? No, Seldom or Frequent.

Have you ever had or do you now have abdominal pain or cramps? No, Seldom

or Frequent.

Have you ever had or do you now have constipation? No, Seldom or Frequent.

Have you ever had or do you now have diarrhea? No, Seldom or Frequent.

Have you ever had or do you now have blood in your bowel movement? No,

Seldom or Frequent.

Have you ever had or do you now have a black bowel movement? No, Seldom or

Frequent.

Have you ever had or do you now have increased appetite? No, Seldom or

Frequent.

Have you ever had or do you now have increased thirst? No, Seldom or Frequent.

Have you ever had or do you now have decreased appetite? No, Seldom or

Frequent.

Have you ever had or do you now have nausea and vomiting? No, Seldom or

Frequent.

Have you ever had or do you now have difficulty swallowing? No, Seldom or

Frequent.

Have you ever had or do you now have skin ulceration? No, Seldom or Frequent.

Have you ever had or do you now have itching? No, Seldom or Frequent.

Have you ever had or do you now have a rash? No, Seldom or Frequent.

Have you ever had or do you now have back pain? No, Seldom or Frequent.

Have you ever had or do you now have frequent urination? No, Seldom or

Frequent.

 

(male only section)

Have you ever had or do you now have pain in the testicles? No, Seldom or

Frequent.Have you ever had or do you now have bloody or other discharge

from your penis? No, Seldom or Frequent.

Have you ever had or do you now have loss of sexual potency? No, Seldom or

Frequent.

(end of male only section)

 

Have you ever had or do you now have arthritis? No, Seldom or Frequent.

Have you ever had or do you now have muscle pain or cramps? No, Seldom or

Frequent.

Have you ever had or do you now have painful joints? No, Seldom or Frequent.

Have you ever had or do you now have lameness? No, Seldom or Frequent.

Have you ever had or do you now have backaches? No, Seldom or Frequent.

Have you ever had or do you now have weakness? No, Seldom or Frequent.

Have you ever had or do you now have fever? No, Seldom or Frequent.

Have you ever had or do you now have chills? No, Seldom or Frequent.

Have you ever had or do you now have night sweats? No, Seldom or Frequent.

Have you ever had or do you now have headaches? No, Seldom or Frequent.

Have you ever had or do you now have insomnia? No, Seldom or Frequent.

Have you ever had or do you now have nervousness? No, Seldom or Frequent.

Have you ever had or do you now have irritability? No, Seldom or Frequent.

Have you ever had or do you now have morning tiredness? No, Seldom or Frequent.

Have you ever had or do you now have easy fatigability? No, Seldom or Frequent.

 

Have you ever been refused employment because of your health? Yes or no.

Why were you refused employment because of your health?

 

Have you ever been denied life insurance because of your health?

Why were you refused life insurance because of your health?

 

Have you ever been rejected for or discharged from military service because

of physical, mental or other reasons? Yes or no.

 

Do you smoke? Yes or no.

What do you smoke?

How much do you smoke?

How long have you smoked?

 

Do you have or have you had weight loss recently? Yes or no.

Do you have or have you had weight gain recently? Yes or no.

How much have you lost or gained?

 

Do you have or have you had a memory defect recently? Yes or no.

Do you have or have you had a change in your handwriting recently? Yes or no.

Do you have or have you had difficulty walking in the dark recently? Yes or

no.Do you have or have you had balance problems recently? Yes or no.

Do you have or have you had numbness or tingling in the extremities

recently? Yes or no.

Do you have or have you had hearing loss recently? Yes or no.

Do you have or have you had ringing ears recently? Yes or no.

Do you have or have you had a change in your vision recently ? Yes or no.

Do you have or have you had an ear ache recently? Yes or no.

Do you have or have you had running ears recently? Yes or no.

Do you have or have you had new skin growths recently? Yes or no.

Do you have or have you had a change in the color of your skin recently?

Yes or no.

Do you have or have you had a tendency to bruise easily recently? Yes or no.

Do you have or have you had athlete's foot recently? Yes or no.

Do you have or have you had heat intolerance recently? Yes or no.

Do you have or have you had cold intolerance recently? Yes or no.

Do you have or have you had a change in your shoe or hat size recently? Yes

or no.

Do you have or have you had lymph node enlargement recently? Yes or no.

Do you have or have you had kidney stones recently? Yes or no.

 

Do you have other items of physical fitness you want to mention? Yes or no.

What are the other items of physical fitness you want to mention?

 

Is there a history of tuberculosis in your family? Yes or no.

Who had tuberculosis in your family?

 

Is there a history of diabetes in your family? Yes or no.

Who had diabetes in your family?

 

Is there a history of cancer in your family? Yes or no.

Who had cancer in your family?

 

Is there a history of gout in your family? Yes or no.

Who had gout in your family?

 

Is there a history of heart trouble in your family? Yes or no.

Who had heart trouble in your family?

 

Is there a history of stroke in your family? Yes or no.

Who had a stroke in your family?

 

Is there a history of high blood pressure in your family? Yes or no.

Who had high blood pressure in your family?

 

Is there a history of asthma, hay fever or hives in your family? Yes or no.

Who had asthma, hay fever or hives in your family?

 

Is there a history of glaucoma in your family? Yes or no.

Who had glaucoma in your family?

 

What medications do you currently take?

Have you been hospitalized or treated in the past year for what you would

consider a significant condition? Yes or no.

What was or were the significant condition or conditions you were treated

or hospitalized for?

 

Are there other factors in your physical condition not already covered that

you have questions about? Yes or no.

What are the other factors in your physical condition not already covered

that you have questions about?

 

Please list all operations you may have had, and your age when you had them.

 

(end of the history form)

 

I keep that in mind and then I use this Examination Form:

 

Patient: Record Date:

 

Patient number:

 

 

Observe:

 

Unhealthy complexion. Yes or No. (no spirit)

Withered muscles. Yes or No. (no spirit)

Dark or unclear face color. Yes or No. (no spirit)

Eyes move uncontrollably, show no inner vitality and are not clear. Yes or

No. (no spirit)

Mind is unclear. Yes or No. (no spirit)

Breathing with a readily noticeable sound. Yes or No. (no spirit)

Excess, rapid or jerky movement. Yes or No. (heat, often liver or heart)

Slow or no movement. Yes or No. (deficient cold, usually spleen)

Small movement, continuous fidgeting especially of the legs. Yes or No.

(deficient heat in the kidneys)

Tremors or convulsions. Yes or No. (interior wind of the liver)

Clear moist color (indicates intact Stomach-Qi, Dry lifeless color

indicates exhausted Stomach-Qi)

Green face color (indicates a Liver pattern, interior Cold, pain or

interior Wind) Yes or No.

Red color (may indicate Inflammation, fever or infection)

White (indicates Deficiency, Cold, Blood Deficiency or Yang Deficiency,

Dull-pale-white indicates Blood deficiency, Bright-white color indicates

Yang deficiency)

Black complexion (indicates Cold, pain or Kidney disease, usually

Kidney-Yin deficiency, Moist Black indicates Cold, Dried-up, burned black

color indicates Heat, usually Empty- Heat from Kidney-Yin deficiency)

Yellow (Spleen deficiency, Dampness, or both; Bright orange-yellow,

Damp-Heat more Heat than dampness; Hazy, smoky yellow, Damp-Heat, more

Dampness than Heat; Withered, dried up yellow, Heat in Stomach and Spleen;

Sallow yellow, Stomach and Spleen deficiency;Dull-pale yellow, Cold-Damp in

Stomach and Spleen)

Tall & Slender, hard working " Wood Type " . Yes or No.

Small pointed head, fast moving & small hands " Fire Type " . Yes or No.

Broad, square shoulders, slow and deliberate, strong build, triangular

face, " Metal Type " . Yes or No.

Slightly fat, calm, large head, belly and thighs, wide jaws, " Earth Type " .

Yes or No.

Round face and body with a long spine, slightly lazy, " Water Type " . Yes or No.

Large chest & epigastrium. Yes or No.

Very large upper thighs out of proportion with the rest of the body. Yes or No.

Fat body. Yes or No.

The eyes have glitter and reveal inner vitality. Yes or No.

The eyes move uncontrollably, show no inner vitality and are not clear. Yes

or No.

Clear thin phlegm, cold pattern; dry nasal passage or yellow phlegm, heat

pattern; nose bleeding, extreme heat excess pattern.

5 element ear problem is mainly kidney; tinnitus is yin deficient,

hyperactive fire liver or kidney; crack at the front of the earlobe is

heart.Excess mouth movement, or rapid, jerky,Yang, Full (excess) Hot; lack

of movement, slow movements Yin, Empty (deficient) Cold.

Observe the lips.

Loose teeth, kidney essence deficient.

Observe the gums.

Pale, sallow face, deficient qi & blood; or stagnant qi and congealed

blood; Dark face liver & kidney yin deficient (or stagnant qi and congealed

blood); red face, heat in the blood; puffy (pale, bright), deficient spleen

qi unable to control blood.

Healthy color around wrists and ankles. Yes or No.

Dry and shrivelled around wrists and ankles. Yes or No.

Pale nails. Yes or No.

Blue nails. Yes or No.

Observe the Thenar Eminence.

Non-pitting edema of the lower limbs. Yes or No.

Pitting edema of the lower limbs. Yes or No.

Infant index finger venules:

Tongue color.

Tongue shape.

Tongue coating.

Tongue moisture.

Redness along the channel or channels. Yes or No.

Which channel or channels are red?

White color along the channel or channels. Yes or No.

Which channel or channels are white?

Purple color along the channel or channels. Yes or No.

Which channel or channels are purple?

Purple spots along the channel or channels. Yes or No.

Which channel or channels have purple spots?

Rash along the channel or channels. Yes or No.

Which channel or channels have a rash?

 

Inquire:

 

Fever with aversion to cold. Yes or No. (exterior cold/wind)

Feeling feverish with a slight chilliness. Yes or no. (exterior heat/wind)

Feeling of fever without chills. Yes or no. (heat evil)

Alternating fever and chills. Yes or no. (shao yang stage)

Lowgrade fever worse in the afternoon or only in the afternoon. Yes or no.

(yin deficiency)

Constant lowgrade fever. Yes or no. (qi deficiency)

Fever in the middle of the night. Yes or no. (yin deficiency)

Area of the body that is sweating.

Time of day that there is sweating. (day sweat, yang deficiency; night

sweat, yin deficiency)

Condition of the illness.

Quality of the sweat.

Sudden onset of headache. Yes or no.

Gradual onset of headache. Yes or no.

Time of day when the head aches.

Location of the headache.

Character of the headache pain:

Condition of the patient while having the headache.

Severe giddiness, everything seems to sway, loss of balance. Yes or no.

Slight dizziness with a feeling of heaviness in the head. Yes or no.

Sudden onset of dizziness. Yes or no.

Gradual onset of dizziness. Yes or no.

Slight dizziness, worse when tired. Yes or no.

Pain that is diminished by heat. Yes or no.

Pain that is diminished by cold. Yes or no. (heat)

Pain that is relieved by touch or pressure. Yes or no. (deficient)

Pain that is worsened by touch or pressure. Yes or no. (excess)

Pain that is better after eating. Yes or no. (deficient)

Pain that is worse after eating. Yes or no. (excess)

Pain that is worse in humid weather. Yes or no. (dampness)

Pain with bloating or a sense of fullness. Yes or no. (excess)

Sharp stabbing pain usually in a fixed location. Yes or no. (blood stasis)

Sensation of heaviness. Yes or no. (damp cold, damp heat, qi deficiency or

bi syndrome)

Pain that moves from place to place. Yes or no. (wind)

Slight pain with fatigue. Yes or no. (deficient qi or dampness)

Clear Urine. Yes or no.

Dark Yellow or Reddish Urine. Yes or no.

Scanty urination. Yes or no.

Frequent dark, skanty and painful urination. Yes or no.

Incomplete urination, dribbling or lack of force. Yes or no.

Infrequent, dry hard stool. Yes or no.

Frequent watery or unformed stools. Yes or no.

Urgent diarrhea, especially if yellowish with burning anus. Yes or no.

Stool dry at first, then wet. Yes or no.

Undigested food in the stool. Yes or no.

Thirst, appetite and tastes.

Not able to fall asleep. Yes or no.

Dream disturbed sleep. Yes or no.

Restless sleep with dreams. Yes or no.

Wake up early and not able to fall asleep again. Yes or no.

Always early period. Yes or no.

Always late period. Yes or no.

Sometimes early, sometimes late period. Yes or no.

Heavy menstrual flow. Yes or no.

Scanty period. Yes or no.

Dark red or bright red menstrual blood. Yes or no.

Pale color menstrual blood. Yes or no.

Purple or blackish menstrual blood. Yes or no.

Freshred color menstrual blood. Yes or no.

Congealed menses with clots. Yes or no.

Watery menses. Yes or no.

Turbid menses. Yes or no.

Pain before periods. Yes or no.

Pain during periods. Yes or no.

Pain after periods. Yes or no.

Taking contraceptive pills. Yes or no.

Have had an intrauterine device. Yes or no.

Have had two or more births. Yes or no.

White leucorrhea. Yes or no.

Yellow vaginal discharge. Yes or no.

Green leucorrhea. Yes or no.

Red and white vaginal discharge. Yes or no.

Yellow discharge with pus and blood. Yes or no.

Watery leucorrhea. Yes or no.

Thick leucorrhea. Yes or no.

Is it possible that you are pregnant now? Yes or no.

Change in sinews, such as weak or stiff. Yes or No.

Change in blood vessels, hard & wiry pulse. Yes or No.

Change in the skin, such as flaccid skin. Yes or No.

Change in the bones, such as brittle bones. Yes or No.

Bitter taste is liver problem. Dry mouth is liver, kidney, yin deficiency,

heat. No taste is mucus dampness or spleen.

Throws off the blanket at night. Yes or No. (excess heat maybe liver or heart)

 

Listen & smell:

 

Coarse, strong respiration. Yes or No. (excess)

Weak Respiration, or shortness of breath, weak, low voice, little speech.

Yes or No. (deficiency)

Sudden loss of voice. Yes or No. (usually wind heat)

Chronic loss of voice. Yes or No. (deficiency)

Wheezing. Yes or No. (asthma due to kidney deficiency)

Heavy or sudden, violent cough. Yes or No. (excess)

Dry hacking cough. Yes or No. (heat or dryness)

Weak cough. Yes or No. (deficiency pattern)

Shouting " angry " tone of voice. Yes or No. (wood imbalance or liver

disharmony)

Frequent laughter without reason. Yes or No. (fire imbalance)

Laughing tone of voice. Yes or No. (heart disharmony)

Singing tone of voice. Yes or No. (earth imbalance or spleen disharmony)

Crying. Yes or No. (related to metal, lung deficiency)

Whimpering tone of voice. Yes or No. (lung disharmony)

Very thin and weak voice. Yes or No. (weakness of Lung Qi)

Groaning tone of voice. Yes or No. (imbalance in water or Kidney disharmony)

Loud sounds from the abdomen. Yes or No. (full or excessive pattern)

Weak sounds from the abdomen. Yes or No. (empty or deficient pattern)

Foul, rotten nauseating odor like rotten meat or rotten eggs.Yes or No.

(Kidney or bladder damp heat, or heat in any organ)

Pungent, fishy odor that seems to hurt the nose like bleach odor. Yes or

No. (Cold and Deficiency)

Rancid or goatish, wood; Scorched or burning, fire; Fragrant or perfumed,

earth; Fleshy or rank, metal and Rotten or putrid, water (or heat in any

organ)

 

Palpate:

 

Systolic blood pressure (Optimal <120; Normal <130; High Normal <139; Stage

1, 140 159; Stage 2, 160 179; Stage 3, 180 or more)

Diastolic blood pressure (Optimal <80; Normal <85; High Normal <89; Stage

1, 90 99; Stage 2, 100 109; Stage 3. 100 or more)

Heart rate.

Floating pulse. Yes or no. (weak, deficient yin; strong, interior wind)

Sinking pulse. Yes or No. (yin, internal disharmony or obstruction)

Slow pulse less than 70 beats per minute. Yes or No. (cold or insufficient qi)

Rapid pulse more than 87.5 beats per minute. Yes or No. (heat is

accelerating the movement of blood)

Thin pulse feels like a fine thread but very distinct and clear. Yes or No.

(blood deficiency, often qi deficiency as well)

Big pulse broad and very distinct. Yes or No. (heat in stomach, intestines)

Empty pulse big with no strength, felt at the superficial level. Yes or No.

(deficient qi and blood)

Full pulse big, strong, pounding hard against the fingers at all three

levels. Yes or No. (excess)

Slippery pulse extremely fluid " ballbearing covered with viscous fluid " .

Yes or No. ( yang within yin; pregnant, excess damp or mucus)

Choppy pulse uneven and rough, and sometimes irregular in strength and

fullness. Yes or No. (thin, deficient blood or jing; not thin, congealed blood)

Wiry pulse, taut feeling; strong, rebounds at all levels, hits the fingers

evenly; no fluidity or wave. Yes or no. (stagnation in the body, usually

related to a disharmony that impairs the flowing and spreading functions of

the Liver and Gall Bladder)

Tight pulse strong and seems to bounce from side to side like a taut

rope.Yes or No. (Yang within Yin, Excess, Cold and Stagnation)

Short pulse, does not fill the spaces under the three fingers and is

usually felt in only one position. Yes or No. (often sign of deficient qi)

Long pulse is perceptible beyond the first and third positions. Yes or No.

(if tight and wiry, excess)

Knotted pulse, slow irregular pulse that skips beats irregularly. Yes or

No. (cold obstructing Qi, Blood; Deficient Qi, Blood or Jing. Often a sign

of the Heart not ruling the Blood properly, more interruptions in rhythm,

more severe the condition)

Hurried pulse is a rapid pulse that skips beats irregularly. Yes or No.

(Heat agitating the Qi and Blood)

Intermittent pulse usually skips more beats than the previous two pulses,

but does so in a regular pattern. Yes or No. (Serious Heart disharmony, or

it can signal exhaustion of all organs)

Moderate pulse is the healthy, perfectly balanced pulse normal in depth,

speed, strength and width. Yes or No. (very rare, not necessary for a clean

bill of health)

Flooding pulse surges with the strength of a big pulse to hit the fingers

at all three depths, but leaves the fingers with less strength, like a

receding wave. Yes or No. (Heat has injured the Fluids and Yin)

Minute pulse is extremely fine and soft, but lacks the clarity of the thin

pulse. It is barely perceptible and seems to disappear. Yes or No. (extreme

Deficiency)

Frail pulse is soft, weak and somewhat thin. It is usually felt at the deep

level. It is like an inverted empty pulse. Yes or No. (extreme Deficient Qi

condition)

Soggy pulse is a combination of the thin, empty and floating pulses. It is

extremely soft, less clear than a thin pulse and is perceptible only in the

superficial position. Yes or No. (Deficient Blood or Jing, and sometimes of

Dampness)

Leather pulse is a combination of the wiry and the floating pulses, with

aspects of the empty pulse. It feels like the tight skin on the top of a

drum. Yes or No. (Deficient Blood or Jing)

Hidden pulse is an extreme form of the sinking pulse. Yes or No. (Deficient

Yang if weak. If strong, Deficient Cold obstructing the meridians)

Moving pulse is a combination of the short, tight, slippery and rapid

pulses felt in only one position, incomplete without a head or a tail. Yes

or No. (extreme condition rarely seen, cases of heart palpitation, intense

fright, fever or pain)

Hollow pulse, like the stem of a green onion, solid on the outside but

completely empty, often a floating pulse. Yes or No. (Deficient Blood,

often seen after great loss of Blood)

Scattered pulse, similar to empty pulse, floating, big and weak; larger and

much less distinct than empty pulse, however tends to be felt primarily as

it recedes. Yes or No. (serious Disharmony Kidney Yang is exhausted and is

floating away)

Radial pulse: Left distal (first) Heart; Left central (second) Liver; Left

proximal (third) Kidney Yin; Right distal (first) Lungs; Right central

(second) Spleen; Right proximal (third) Kidney Yang, Mingmen, Life Gate Fire.

 

Flaccidness along the channel or channels. Yes or No.

Which channel or channels are flaccid?

 

Feeling of hardness along the channel or channels. Yes or No.

Which channel or channels are hard?

 

Feeling of cold along the channel or channels. Yes or No

Which channel or channels are cold?

 

Feeling of heat along the channel or channels. Yes or No.

Which channel or channels are hot?

 

Hot at first press then decline. Yes or No. (superficial heat)

Heat increases as felt. Yes or No. (internal heat)

Skin widely hot with no steaming. Yes or No. (general debility)

Cool skin. Yes or No. (yang deficiency)

Cold hands and feet. Yes or No. ( deficient yin, extreme pathogenic cold)

Hot hands and feet. Yes or No. (extreme yang heat)

Hot palms of hot hands. Yes or No. (extreme yang heat)

Hot dorsum of hot hand. Yes or No. (exterior syndrome)

Dry skin. Yes or No. (deficiency of liver blood)

Itchy skin. Yes or No. (wind)

Withered skin. Yes or No. (fluids are exhausted)

 

(end of the examination form)

 

Notice that I have a number of the indications of the various findings in

parentheses. One of these days I will have them all. From there, I open the

form in the word processor, and edit out the ones that don't apply to the

patient. (saving the file under a new name) For your patient, with what you

have given, I would have this as a finding report:

 

Patient: Record Date:

 

Patient number:

 

 

Observe:

 

Excess, rapid or jerky movement. ? (heat, often liver or heart)

Tongue color. Light purple.

Tongue shape. Puffy.

Tongue coating. Thick white with deep cracks.

Tongue moisture. Dry.

 

Inquire:

 

Pain that is diminished by heat. Yes.

 

Listen & smell:

 

 

Palpate:

 

Slow pulse less than 70 beats per minute. Yes. (cold or insufficient qi)

Hidden pulse is an extreme form of the sinking pulse. Yes. (Deficient Yang

if weak. If strong, Deficient Cold obstructing the meridians)

Cool skin. Yes. (yang deficiency)

 

(end of the finding report)

 

I notice that my form does not directly contain some of your findings, so I

am stretching a little to plug in the rocking, stilted gait as excess,

rapid or jerky movement. I wonder if you can see a deep pulse as " hidden " ,

if so we can say " Deficient Yang if weak. If strong, Deficient Cold

obstructing the meridians " .

 

I wonder if you have taken a larger case and have only shared a portion of it?

 

At 05:05 PM 3/2/2004, you wrote:

>Hi, my name is Molly Beverage and I have been practicing acupuncture for a

>couple of years in rural Vermont. For a number of months, I have been

>working with a woman who has primary lateral sclerosis, and while

>initially we were both pleased with the reduction of her symptoms, at this

>point she seems to be getting worse fast. Primary lateral sclerosis

>causes degeneration of the upper motor neurons (as opposed to amyotropic

>lateral sclerosis - which affects both upper and lower motor neurons) and

>leads to a rocking, stilted gait, poor balance and slow, slurred speech

>with trouble swallowing. My client has deep, slow pulses overall, with the

>left chi position more xu. Her tongue is light purple, puffy and scalloped

>with deep cracks and a thick white dry coat. She is very cold all the time

>and cold and anxiety make her symptoms worse. I treat her with scalp and

>body points, along with an infrared heat lamp and moxa. I also put her on

>herbs, but she is hyperallergenic and has developed

> an allergic reaction to all the formulas I have given her.

>I would deeply appreciate any and all feedback that anyone has to give me

>on this case.<snip>

>

 

Regards,

 

Pete