Death from misdiagnosis of heat/cold?

[Guest guest]

> One of the most if not the most critical considerations in TCM is

> Heat/ Cold. It's so critical that getting it wrong can result in death

 

> in extreme cases.

 

Are there documented cases of death from misdiagnosis of heat/cold?

What modalities were being used? Acupuncture? Herbs? Moxa?

 

Jeri

[Guest guest]

Chinese Traditional Medicine , " kurvenal " <kurvenal@a...>

wrote:

> Are there documented cases of death from misdiagnosis of heat/cold?

> What modalities were being used? Acupuncture? Herbs? Moxa?

 

The cases I'm familiar with were herbs.

 

They were all cases where the person was critically sick. One was a

case of childhood leukemia that had reached a crisis stage.

 

Sometimes Heat or Cold will be a standout. Even when part of the body

is too Cold and part too Hot. Other times it won't be that easy to

determine. This is one of those times when knowing possible

etiologies can really help. For example, Heat signs may be present but

the person has had the signs and symptoms of Yang Deficiency

(Deficiency Cold) prior to this. What is happening is that the last

of the Yang is no longer " rooted " and is " floating " at the surface of

the body.

[Guest guest]

> >Are there documented cases of death from misdiagnosis of heat/cold?

> >What modalities were being used? Acupuncture? Herbs? Moxa?

 

> The cases I'm familiar with were herbs.

 

Were these graduates of an accredited TCM school, and

licensed acupuncturists? Anyone can " prescribe " herbs, with

or without any training, which is why I ask.

 

> They were all cases where the person was critically sick.

 

I would think that this makes it less certain that the herbs were

solely at fault, though I certainly agree that it's possible.

 

Jeri

 

 

 

[Guest guest]

Chinese Traditional Medicine , " kurvenal " <kurvenal@a...>

wrote:

> Were these graduates of an accredited TCM school, and

> licensed acupuncturists? Anyone can " prescribe " herbs, with

> or without any training, which is why I ask.

 

They were graduates of accredited TCM schools and experienced.

Sometimes the determination of Hot/Cold is not easy to make, and

even a trained and experienced healer can make a mistake.

>

> > They were all cases where the person was critically sick.

>

> I would think that this makes it less certain that the herbs were

> solely at fault, though I certainly agree that it's possible.

 

They had a turn for the worse after the herbs were administered.

Symptoms worsened instead of lessening.

 

Now, how does a TCM healer lessen the chances of making a critical

mistake? For one thing, be very, very aware of how critical the

Hot/Cold determination can be. When healers are aware that it can be

this critical, they are far less likely to make a mistake.

 

Two, know not only the signs and symptoms of False Cold - True Heat

and False Heat - True Cold, but also the signs and symptoms of a

person having both Heat and Cold in different parts of the body.

 

Three, if possibly, call in someone with more experience.

 

Four, explore treatment strategies that will not aggravate Heat or

Cold. Eventually the Heat or Cold will have to be treated. What

you're doing is strengthening the person in order to better

withstand treatment for Heat or Cold in cases where a determination

is difficult. Also, in the course of treating other things and

strengthening the person, the determination of Heat or Cold may

become clearer.

 

Five, listen to the client and/or carefully monitor. Be prepared to

correct mistakes.

 

Not all TCM imbalances are a matter of Hot/ Cold. For example, Qi

Stagnation of and within itself may not be Hot or Cold (or at least

significantly so) though it can give rise to Heat or Cold.

Especially localized Heat or Cold. For example, Qi Stagnation

resulting from Blood Stasis due to trauma wouldn't have much of a

Hot or Cold component in the beginning. There would be some because

Qi is warming in nature, and wherever Qi was not reaching

sufficiently would tend to be Cold and where Qi builds up because of

blockage would tend to be Hot. But treating this Qi Stagnation

would not have to involve warming or cooling the person. The herbs

or formulas used could have neutral thermal energy and be quite

effective because it's not necessary to warm or cool the person in

order to get the Qi flowing properly in this case.

 

On the other hand, Qi Stagnation due to Cold does have a very strong

Cold component, and the Cold is going to have to be treated before

the Qi will flow properly. Herbs That Move Qi may not be enough by

themselves. Herbs that expel Cold and Herbs that Warm the Exterior

as well as Herbs that Warm the Interior very likely will be needed.

[Guest guest]

Do you happen to know any details of any of these cases?

These could be good learning case studies. What signs/symptoms did the

practioner see that led them to the wrong diagnosis, and what signs/symptoms did

they overlook that would have led them to the correct diagnosis? Do you know

what pulses, tongue, etc. were like?

 

Any possibility that there were interactions with medications and/or other

treatment modalities?

 

At what point did the practioner know that they had misdiagnosed heat/cold? I

assume that by that time, it was too late to correct their mistake, but did they

quickly realize their errors, or was it after the death of the patient? What

signs/symptoms, (other than death), made the practioner aware of the

misdiagnosis?

 

You mentioned that there was a worsening of symptoms after the herbs were taken.

Did the patients die immediately, or was it continued use of the wrong herbs

that led to their deaths?

 

Did the practioner(s) lose his/her license, or is she/he still practicing?

 

Lots of questions, but that's one way to learn. :-) I hope to avoid making the

same mistakes.

 

I happen to have had a discussion with a few other people today on when they

would/wouldn't treat someone. Those who prefer to err on the side of caution

probably would have refused these cases, even though they are very experienced.

(One person was the head of the herb department at a major hospital in China,

another comes from a family where both parents are very successful practioners,

(and were very successful in China as well, I'm told), and from what I've seen,

he's a fantastic practioner as well.) But, when various modalities should or

shouldn't be used is a whole separate topic, and one that can generate a lot of

disagreement.

 

Jeri

 

 

 

 

[Guest guest]

Chinese Traditional Medicine , " kurvenal " <kurvenal@a...>

wrote:

> Do you happen to know any details of any of these cases?

> These could be good learning case studies. What signs/symptoms did

the practioner see that led them to the wrong diagnosis, and what

signs/symptoms did they overlook that would have led them to the

correct diagnosis? Do you know what pulses, tongue, etc. were like?

 

The one that stands out for me is the leukemia case. There was more

than one OMD on the case. The first thought it was a case of severe

inner Heat with Qi and Blood Deficiency, and the second thought it

was a case of True Cold - False Heat with Collapse of Yang and

ShaoYin-stage Deficiency. The first doctor prevailed, and the girl

was treated with very cold herbs that purge Fire and clear Heat

Toxins. Within 2 hours her Cold symptoms became markedly worse, and

she died that night.

 

There were some very marked Heat signs and symptoms. But most were

the very symptons and signs that Maciocia lists under True Cold -

False Heat. She was running a very high fever, but her tongue and

lips were pale. The pulse was Rapid, Floating, and Big. The correct

herbs for True Cold - False Heat with Collapse of Yang include

aconite and dried ginger. These are very Hot herbs and have a very

immediate action, but there were concerns about using these in

regard to the very high temperature she was running (though her legs

felt very cold). I'm wondering where her temperature was taken, and

if this would make a difference in diagnosis in some cases. Does a

temperature taken by mouth always correspond to the same results if

a rectal thermometer is used? They probably do correspond in most

cases, but are there cases where the temperature taken by mouth

indicates fever but were the temperature also taken rectally, would

it too indicate a high fever or indicate a below normal temperature?

I mention this because when Yang or Yin collapse, there is a total

separation between them. In the case of Yang Collapse, the last of

the Yang will " float " to the surface. Because Yang warms, this is

what accounts for the redness on the surface of the skin and the

surface heat. But what's happening in the Interior? The head is

considered part of the Exterior. Taking the temperature by mouth or

by ear may not always reveal what is happening in the Interior

(trunk - Organs) of the body given the tendency of Collapsed Yang

to " float " to the surface of the body and the tendency of Heat to

rise.

 

Collapsed Yang is another way of saying very severe Yang Deficiency.

It's a stage of Yang Deficiency in which the Yang Deficiency gets

corrected, or the person dies. One thing to keep in mind is that

Cold attacks Yang (and the Kidneys which supply Yang to the rest of

the body and the Spleen). If one administers cooling herbs in this

case, what little Yang there is left is going to be decreased

further because Cold attacks Yang.

 

One of the signs of Yang Collapse is very profuse and oily sweat (or

very profuse cold sweating). The profuse cold sweating can be

bodywide, but oily sweat on the forehead is a big danger sign.

Especially if it's like pearls. (Maciocio, The Foundations of

, p. 155.) " Like pearls " means that it's not flowing

like sweat normally does but forming beads. If a person is forming

oily droplets of sweat on the forehead, this is a sign of imminent

death if something is not done immediately. The little girl with

leukemia was sweating profusely, but the account doesn't mention if

it was a cold sweat or if beads of oily sweat formed on the

forehead. (BTW, yellow sweat indicates Damp Heat.)

 

> Any possibility that there were interactions with medications

and/or other treatment modalities?

 

Definitely. Which is why the modern Chinese are working to figure

out the TCM properties of any drugs they use. For example

antibiotics have Cold thermal energy, and the Chinese only use them

when there is Excess Heat. They also are very mindful of the fact

that too vigorous treatment with antibiotics (just like too vigorous

treatment with herbs with Cold energy) during the Yang-stages of the

Six Stages of Cold-Induced Illnesses can actually push a person into

the more serious Yin stages. Remember, part of the diagnosis of the

second doctor was ShaoYin-stage Deficiency.

 

Something else that the Chinese are doing is to work out which herbs

are needed to overcome the side effects and head off potential

problems not only from prescription drugs but from chemotherapy and

radiation therapy. (Sorry I don't know the TCM effects of chemo or

radiation or if either was used on the little girl or what

prescription drugs were administered. BTW, the Chinese are finding

that when it comes to leukemia that a combination of Western

allopathic and TCM works better than either alone. See A Handbook of

Chinese Hematology by Simon Becker for a little more details.)

 

> At what point did the practioner know that they had misdiagnosed

heat/cold?

 

Within two hours.

 

> I assume that by that time, it was too late to correct their

mistake, but did they quickly realize their errors, or was it after

the death of the patient?

 

That info wasn't given.

 

>What signs/symptoms, (other than death), made the practioner aware

of the misdiagnosis?

 

The Cold symptoms got worse, in particular the cold legs. The

coldness also moved further up the legs.

>

> You mentioned that there was a worsening of symptoms after the

herbs were taken.

> Did the patients die immediately, or was it continued use of the

wrong herbs that led to their deaths?

 

My understanding is that one course of herbs was administered. But

they were some very powerful Fire-Purging and Heat Toxin-Releasomg

herbs.

 

> Did the practioner(s) lose his/her license, or is she/he still

practicing?

 

Not known.

 

> Lots of questions, but that's one way to learn. :-) I hope to

avoid making the same mistakes.

 

That part of why this list exists. So people can learn and avoid

the mistakes of others.

>

> I happen to have had a discussion with a few other people today on

when they would/wouldn't treat someone. Those who prefer to err on

the side of caution probably would have refused these cases, even

though they are very experienced.

 

A part of healing is knowing one's limitations. Aside from legal

considerations, all good healers sometimes are going to be faced

with situations in which they are not sure what to do. Do they do

nothing even though they know that death or severe illness is likely

to result if they do nothing? Do they risk a treatment in those

circumstancs? There are no easy answers sometimes. The good healers

worry about situations like this and continue in the field even

though they sometimes face situations like this. And they continue

to learn all they can. The bad healers never worry about things like

this. Professionals need to be able to talk about things like this

with each other. Just like you did with other professionals.

[Guest guest]

Thanks for posting the details of the leukemia case.

Do you know what country this was in? Just curious, since, from

all I hear, there are major differences in how things are handled in

China vs. the US. (I don't have any feel for any other countries.)

 

Hard to say, but if the 2nd doctor was correct in his diagnosis,

it sounds like the girl was close to death at the time of treatment.

While the herbs might have hastened the process slightly,

the girl was in a very critical condition and near death, it sounds like.

 

Did anyone try moxa on salt on CV 8 for her?

 

> Do they do nothing even though they know that death or

> severe illness is likely to result if they do nothing? Do they

> risk a treatment in those circumstancs?

 

Difficult questions, that can probably only be answered when

in the midst of specific situations, with different answers for

different situations.

 

Jeri