Guest guest Posted July 9, 2004 Report Share Posted July 9, 2004 Here's a puzzler: 48 y.o female Patient with hx of endometriosis, excruciating (though regular) periods, pain both preceding and during. Hx. of sexual abuse. Light smoker. Tends toward cold, both core and extremities, even in summer, though gets night sweats. I have been treating her with AP and Craniosacral therapy with great results for musculoskeletal and menstrual pain. DX: 1) KD Yang Def. 2) Blood stagnation in lower warmer 3) Cold in uterus 4) Liver Qi stagnation 5) Heart Blood deficiency 6) Sp Qi deficiency. The issue: I have tried giving her herbs, unsuccessfully. First I tried moving Liver Qi, mildly moving blood, and building Blood & Yin. Went with Health Concerns' " Women's Balance " (Dan Zhi Xiao Yao San) and Jia Jian Ding Xin Wan ( " Calm Spirit " - also includes enzymes for stress and digestion). Combination caused gas and constipation, so switched her to a warmer formula than Dan Zhi Xiao Yao San, one with Gotu Kola substituted for Chai Hu ( " Heavenly Water " ). This also produced gas, and less constipation, but still difficult BM's. Decided to work on building blood by building up a possibly deficient SP, so replaced Ding Xin Wan with Gui Pi Tang (Shen Gem from Health Concerns). She took two pills, and vomited, then experienced lasting lower right quadrant discomfort for two weeks. Reevaluated, decided to go after the cold in the lower warmer. Also postulated that she might be sensitive to the binders in the tablets, so switched to tincture. Went with K'an " Women's Journey " , or Jia Jian Wen Jing Tang: (Mu Li Oyster Shell 12.3% E Jiao (A Jiao) Gelatin 8.3% Mu Dan Pi (Su) Moutan 8.3% Mai Men Dong Ophiopogon 8.3% Bai Shao Peony (White) 8.3% Dang Gui (Shen) Tangkuei 8.3% Sheng Jiang Ginger (Fresh) 5.6% Wu Zhu Yu Evodia Fruit 5.6% Gui Zhi Cinnamon Twigs 5.6% Xian Mao Curculigo 4.2% Sheng Di Huang Rehmannia (Fresh) 4.2% Gan Cao Licorice 4.2% Zhi Mu Anemarrhena 4.2% Ren Shen Ginseng 4.2% Ba Ji Tian Morinda 4.2% Huang Bai (Chuan) Phellodendron Bark 4.2% She took 8 drops 3x/day (minimum dosage, per manufacturer), and for five days she wasn't warmer, but FREEZING COLD! I can't get my head around how a formula with evodia, ginger, morinda, curculigo, ginseng, and cinnamon could cool her off, and not warm her. I have contacted the distributor - maybe the batch is bad (mislabled, wrong ratio, etc). But is there a TCM (or other) explanation? Given her other " opposite " reactions (Qi-moving herbs made her gassy and constipated, SP building and middle-Qi moving made her vomit and her intestines spasm, and a heavily warming formula made her freeze), could there be some kind of psychoemotional/spiritual blockage to herbal substances? I do extremely mild acupuncture with her, meridian-style with Seirin #1's, and she has a " spiritual journey " each time. Any thoughts? Benjamin B. Hawes M.A.O.M., Lic. Ac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2004 Report Share Posted July 10, 2004 Hi, Benjiman, Have you tried clearing up her digestive system? How is her food absorption? Perhaps addressing this first may help. Constipation can be not wanting to let go of something (sexual abuse is very difficult to treat, even if the pt thinks it's in the past and been dealt with already). Food for thought, Pam Price > Here's a puzzler: > > 48 y.o female Patient with hx of endometriosis, excruciating (though > regular) periods, pain both preceding and during. Hx. of sexual abuse. Light > smoker. Tends toward cold, both core and extremities, even in summer, though > gets night sweats. I have been treating her with AP and Craniosacral therapy > with great results for musculoskeletal and menstrual pain. DX: 1) KD Yang > Def. 2) Blood stagnation in lower warmer 3) Cold in uterus 4) Liver Qi > stagnation 5) Heart Blood deficiency 6) Sp Qi deficiency. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2004 Report Share Posted July 10, 2004 Just a thought. Have you considered Si Ni San, perhaps with modifications? Perhaps she's experiencing so much stagnation that she's unable to perfuse the extremities? Regards, Shanna Chinese Medicine , " Benjamin Hawes " <ben_laura@n...> wrote: > Here's a puzzler: > > 48 y.o female Patient with hx of endometriosis, excruciating (though > regular) periods, pain both preceding and during. Hx. of sexual abuse. Light > smoker. Tends toward cold, both core and extremities, even in summer, though > gets night sweats. I have been treating her with AP and Craniosacral therapy > with great results for musculoskeletal and menstrual pain. DX: 1) KD Yang > Def. 2) Blood stagnation in lower warmer 3) Cold in uterus 4) Liver Qi > stagnation 5) Heart Blood deficiency 6) Sp Qi deficiency. > > The issue: I have tried giving her herbs, unsuccessfully. First I tried > moving Liver Qi, mildly moving blood, and building Blood & Yin. Went with > Health Concerns' " Women's Balance " (Dan Zhi Xiao Yao San) and Jia Jian Ding > Xin Wan ( " Calm Spirit " - also includes enzymes for stress and digestion). > Combination caused gas and constipation, so switched her to a warmer formula > than Dan Zhi Xiao Yao San, one with Gotu Kola substituted for Chai Hu > ( " Heavenly Water " ). This also produced gas, and less constipation, but still > difficult BM's. Decided to work on building blood by building up a possibly > deficient SP, so replaced Ding Xin Wan with Gui Pi Tang (Shen Gem from > Health Concerns). She took two pills, and vomited, then experienced lasting > lower right quadrant discomfort for two weeks. > Reevaluated, decided to go after the cold in the lower warmer. Also > postulated that she might be sensitive to the binders in the tablets, so > switched to tincture. Went with K'an " Women's Journey " , or Jia Jian Wen Jing > Tang: > (Mu Li Oyster Shell 12.3% > E Jiao (A Jiao) Gelatin 8.3% > Mu Dan Pi (Su) Moutan 8.3% > Mai Men Dong Ophiopogon 8.3% > Bai Shao Peony (White) 8.3% > Dang Gui (Shen) Tangkuei 8.3% > Sheng Jiang Ginger (Fresh) 5.6% > Wu Zhu Yu Evodia Fruit 5.6% > Gui Zhi Cinnamon Twigs 5.6% > Xian Mao Curculigo 4.2% > Sheng Di Huang Rehmannia (Fresh) 4.2% > Gan Cao Licorice 4.2% > Zhi Mu Anemarrhena 4.2% > Ren Shen Ginseng 4.2% > Ba Ji Tian Morinda 4.2% > Huang Bai (Chuan) Phellodendron Bark 4.2% > > She took 8 drops 3x/day (minimum dosage, per manufacturer), and for five > days she wasn't warmer, but FREEZING COLD! > I can't get my head around how a formula with evodia, ginger, morinda, > curculigo, ginseng, and cinnamon could cool her off, and not warm her. > I have contacted the distributor - maybe the batch is bad (mislabled, wrong > ratio, etc). But is there a TCM (or other) explanation? Given her other > " opposite " reactions (Qi-moving herbs made her gassy and constipated, SP > building and middle-Qi moving made her vomit and her intestines spasm, and a > heavily warming formula made her freeze), could there be some kind of > psychoemotional/spiritual blockage to herbal substances? I do extremely mild > acupuncture with her, meridian-style with Seirin #1's, and she has a > " spiritual journey " each time. > > Any thoughts? > > Benjamin B. Hawes M.A.O.M., Lic. Ac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2004 Report Share Posted July 11, 2004 Hi, I've seen a situation like this, and circulating the lung qi seemed to be the key to warming her up. She also had been a smoker, and I thought that had something to do with it. There seems to be a combination of insubstantial phlegm with lung dryness and both qi deficiency and stagnation, so you have to be sure and use herbs that are not drying. Consider adding Bai Bu or Xing Ren or Zi Wan to the formula. That's what did the trick for her. Laura Chinese Medicine , " shannahickle " <shannahickle> wrote: > Just a thought. Have you considered Si Ni San, perhaps with > modifications? Perhaps she's experiencing so much stagnation that > she's unable to perfuse the extremities? > > Regards, Shanna > > Chinese Medicine , " Benjamin > Hawes " <ben_laura@n...> wrote: > > Here's a puzzler: > > > > 48 y.o female Patient with hx of endometriosis, excruciating > (though > > regular) periods, pain both preceding and during. Hx. of sexual > abuse. Light > > smoker. Tends toward cold, both core and extremities, even in > summer, though > > gets night sweats. I have been treating her with AP and > Craniosacral therapy > > with great results for musculoskeletal and menstrual pain. DX: 1) > KD Yang > > Def. 2) Blood stagnation in lower warmer 3) Cold in uterus 4) > Liver Qi > > stagnation 5) Heart Blood deficiency 6) Sp Qi deficiency. > > > > The issue: I have tried giving her herbs, unsuccessfully. First I > tried > > moving Liver Qi, mildly moving blood, and building Blood & Yin. > Went with > > Health Concerns' " Women's Balance " (Dan Zhi Xiao Yao San) and Jia > Jian Ding > > Xin Wan ( " Calm Spirit " - also includes enzymes for stress and > digestion). > > Combination caused gas and constipation, so switched her to a > warmer formula > > than Dan Zhi Xiao Yao San, one with Gotu Kola substituted for Chai > Hu > > ( " Heavenly Water " ). This also produced gas, and less constipation, > but still > > difficult BM's. Decided to work on building blood by building up a > possibly > > deficient SP, so replaced Ding Xin Wan with Gui Pi Tang (Shen Gem > from > > Health Concerns). She took two pills, and vomited, then > experienced lasting > > lower right quadrant discomfort for two weeks. > > Reevaluated, decided to go after the cold in the lower warmer. Also > > postulated that she might be sensitive to the binders in the > tablets, so > > switched to tincture. Went with K'an " Women's Journey " , or Jia > Jian Wen Jing > > Tang: > > (Mu Li Oyster Shell 12.3% > > E Jiao (A Jiao) Gelatin 8.3% > > Mu Dan Pi (Su) Moutan 8.3% > > Mai Men Dong Ophiopogon 8.3% > > Bai Shao Peony (White) 8.3% > > Dang Gui (Shen) Tangkuei 8.3% > > Sheng Jiang Ginger (Fresh) 5.6% > > Wu Zhu Yu Evodia Fruit 5.6% > > Gui Zhi Cinnamon Twigs 5.6% > > Xian Mao Curculigo 4.2% > > Sheng Di Huang Rehmannia (Fresh) 4.2% > > Gan Cao Licorice 4.2% > > Zhi Mu Anemarrhena 4.2% > > Ren Shen Ginseng 4.2% > > Ba Ji Tian Morinda 4.2% > > Huang Bai (Chuan) Phellodendron Bark 4.2% > > > > She took 8 drops 3x/day (minimum dosage, per manufacturer), and > for five > > days she wasn't warmer, but FREEZING COLD! > > I can't get my head around how a formula with evodia, ginger, > morinda, > > curculigo, ginseng, and cinnamon could cool her off, and not warm > her. > > I have contacted the distributor - maybe the batch is bad > (mislabled, wrong > > ratio, etc). But is there a TCM (or other) explanation? Given her > other > > " opposite " reactions (Qi-moving herbs made her gassy and > constipated, SP > > building and middle-Qi moving made her vomit and her intestines > spasm, and a > > heavily warming formula made her freeze), could there be some kind > of > > psychoemotional/spiritual blockage to herbal substances? I do > extremely mild > > acupuncture with her, meridian-style with Seirin #1's, and she has > a > > " spiritual journey " each time. > > > > Any thoughts? > > > > Benjamin B. Hawes M.A.O.M., Lic. Ac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2004 Report Share Posted July 12, 2004 Benjamin, I think there two issues here. One is the accuracy of the content information on the labels/inserts. Because you are not using raw herbs, you have to rely on the accuracy of the information that is provided on the label or inserts to ascertain the contents in the herb. I believe that the information provided on the label is reliable for the most part, but the reality can vary. For instance, the formula you provided below could have much greater percentage of Mai Meng Dong and smaller percentage than reported for the warmer herbs. Labels are always the same, but the herbal contents can vary from one lot to another depending on how consistently quality control is carried out in the production facility. Nevertheless, if you give the same batches of herbs (with the same lot number) to other patients and they reacted with the treatment effect that you expected, it is more likely that the problem lies with the patient. You might want to ask her what kind of liquid (hot or cold) did she drink to taker her prescription. The second issue here is the patient. I had a wonderful female patient who came in with a hip injury from a fall. She, like your patient, is extremely cold physically from the core to the extremities. I remember giving her Jing Kuei Shen Qi Wan to treat her frequent urination problem, and it took a month and a half of continuous consumption before the pills took effect. After that, it was great and her urination problem was under control. What I have learned from her is that when you encounter a patient like her, you have to think warm thoughts. I was using needles to treat her, but I was only getting minimal results (meaning slightly better than placebo) at best. Then, out of frustration and much contemplation (in calm), I decided to replace all needles with moxa, which means where I would normally use the needles I burn moxa instead. From that point on, the treatment effects starts to improve dramatically, and I was getting the results I wanted for her. I was happy. She was happy. Everybody was happy. Given the cold nature of her body, she might be extremely sensitive to cold herbs as I suspect the that vomiting, the gas, and constipation, etc., are all reactions to herbs that are cold. In her case, raw herbs may actually be better for you, because you would have control of the contents. Your prescriptions and diagnosis are very good. The only suggestion I have would be to minimize or eliminate any content that is cold or slightly cold from your herbal formula prescription and see if she still reacts the same way. Hope this rambling helps. Sincerely, Ming Benjamin Hawes <ben_laura wrote: Here's a puzzler: 48 y.o female Patient with hx of endometriosis, excruciating (though regular) periods, pain both preceding and during. Hx. of sexual abuse. Light smoker. Tends toward cold, both core and extremities, even in summer, though gets night sweats. I have been treating her with AP and Craniosacral therapy with great results for musculoskeletal and menstrual pain. DX: 1) KD Yang Def. 2) Blood stagnation in lower warmer 3) Cold in uterus 4) Liver Qi stagnation 5) Heart Blood deficiency 6) Sp Qi deficiency. The issue: I have tried giving her herbs, unsuccessfully. First I tried moving Liver Qi, mildly moving blood, and building Blood & Yin. Went with Health Concerns' " Women's Balance " (Dan Zhi Xiao Yao San) and Jia Jian Ding Xin Wan ( " Calm Spirit " - also includes enzymes for stress and digestion). Combination caused gas and constipation, so switched her to a warmer formula than Dan Zhi Xiao Yao San, one with Gotu Kola substituted for Chai Hu ( " Heavenly Water " ). This also produced gas, and less constipation, but still difficult BM's. Decided to work on building blood by building up a possibly deficient SP, so replaced Ding Xin Wan with Gui Pi Tang (Shen Gem from Health Concerns). She took two pills, and vomited, then experienced lasting lower right quadrant discomfort for two weeks. Reevaluated, decided to go after the cold in the lower warmer. Also postulated that she might be sensitive to the binders in the tablets, so switched to tincture. Went with K'an " Women's Journey " , or Jia Jian Wen Jing Tang: (Mu Li Oyster Shell 12.3% E Jiao (A Jiao) Gelatin 8.3% Mu Dan Pi (Su) Moutan 8.3% Mai Men Dong Ophiopogon 8.3% Bai Shao Peony (White) 8.3% Dang Gui (Shen) Tangkuei 8.3% Sheng Jiang Ginger (Fresh) 5.6% Wu Zhu Yu Evodia Fruit 5.6% Gui Zhi Cinnamon Twigs 5.6% Xian Mao Curculigo 4.2% Sheng Di Huang Rehmannia (Fresh) 4.2% Gan Cao Licorice 4.2% Zhi Mu Anemarrhena 4.2% Ren Shen Ginseng 4.2% Ba Ji Tian Morinda 4.2% Huang Bai (Chuan) Phellodendron Bark 4.2% She took 8 drops 3x/day (minimum dosage, per manufacturer), and for five days she wasn't warmer, but FREEZING COLD! I can't get my head around how a formula with evodia, ginger, morinda, curculigo, ginseng, and cinnamon could cool her off, and not warm her. I have contacted the distributor - maybe the batch is bad (mislabled, wrong ratio, etc). But is there a TCM (or other) explanation? Given her other " opposite " reactions (Qi-moving herbs made her gassy and constipated, SP building and middle-Qi moving made her vomit and her intestines spasm, and a heavily warming formula made her freeze), could there be some kind of psychoemotional/spiritual blockage to herbal substances? I do extremely mild acupuncture with her, meridian-style with Seirin #1's, and she has a " spiritual journey " each time. Any thoughts? Benjamin B. Hawes M.A.O.M., Lic. Ac. Membership requires that you do not post any commerical, swear, religious, spam messages,flame another member or swear. http://babel.altavista.com/ and adjust accordingly. If you , it takes a few days for the messages to stop being delivered. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2004 Report Share Posted July 12, 2004 Hi, can I give my two pennies here? > Benjamin Hawes <ben_laura wrote: > DX: 1) KD Yang > Def. 2) Blood stagnation in lower warmer 3) Cold in > uterus 4) Liver Qi > stagnation 5) Heart Blood deficiency 6) Sp Qi > deficiency. I might view her dx from the info provided as follows: 1) K Yang Deficiency 2) Qi Deficiency 3) K Yin Deficiency 4) Blood STASIS in the lower warmer / Liver merid. (due to cold? congestion? deficiency?) etc > (Mu Li Oyster Shell 12.3% > E Jiao (A Jiao) Gelatin 8.3% > Mu Dan Pi (Su) Moutan 8.3% > Mai Men Dong Ophiopogon 8.3% > Bai Shao Peony (White) 8.3% > Dang Gui (Shen) Tangkuei 8.3% > Sheng Jiang Ginger (Fresh) 5.6% > Wu Zhu Yu Evodia Fruit 5.6% > Gui Zhi Cinnamon Twigs 5.6% > Xian Mao Curculigo 4.2% > Sheng Di Huang Rehmannia (Fresh) 4.2% > Gan Cao Licorice 4.2% > Zhi Mu Anemarrhena 4.2% > Ren Shen Ginseng 4.2% > Ba Ji Tian Morinda 4.2% > Huang Bai (Chuan) Phellodendron Bark 4.2% The overall impression I'm getting as well as my clinical experience suggest that the Mu Li is a major problem for her, with the sheng di huang coming in second. The Mai Dong and Zhi Mu I would also delete. I might try Shu Di instead of Sheng Di. > days she wasn't warmer, but FREEZING COLD! Mu Li and maybe Sheng Di as well. Remember the Heart fire is closely connected to the Kidney yang. Put one out, put the other out. > " opposite " reactions (Qi-moving herbs made her gassy > and constipated, SP > building and middle-Qi moving made her vomit and her > intestines spasm, My idea here is the secondary dx of Qi deficiency from my pov. I would tend to not move qi around since that will consume qi. In cases like hers I've used used acupuncture / moxa / TDP lamp (boost k yang, boost qi, boost yin) to start, for at least 1 month, then I start with a very low dose of zhi bai (hollow heat / yin deficiency). I stay away from all cold herbs, _especially those that pacify the heart_. I'm looking up the Gui Pi tang from health concerns that you mentioned ... AAAAAAAAAAAAA that formula has Dan Shen / salvia in it!!! Bitter and Cold!!! Invigorates blood and breaks blood stasis! So anyway, in terms of my diagnosis, that woudl eb a problem. I'd be interested in a fuller picture of her Heart function, see if any of what I've said adds up. My final advice, and the only one I'll stand by is that with patients who are very weak, I very slowly build them up with acupuncture, making the important changes to their diet (remove damaging foods), and then I very carefully start them on a very basic _classical_ formula. Something for yang, yin, blood, you know? I don't do any complicated energetic stuff with them, that means no formulas that have complex energetic movements to them. Straightforward and basic seems to work for me. I deal with a lot of geriatric cases and it's just to complicated. I try to get a really good idea of what the roots are, and then treat that gently and simply. I hope this helps and makes sense. Ask if you have any questions. Bye! Hugo _________ALL-NEW Messenger - sooooo many all-new ways to express yourself http://uk.messenger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2004 Report Share Posted July 13, 2004 >Message: 3 >Mon, 12 Jul 2004 10:04:32 -0700 (PDT) > " Ming H. Lee " <aceqihealer >Re: Opposite reactions to herbs >I think there two issues here. One is the accuracy of the content information on the labels/inserts. >.Given the cold nature of her body, she might be extremely sensitive to cold herbs as I suspect the that vomiting, the >gas, and constipation, etc., are all reactions to herbs that are cold. In her case, raw herbs may actually be better for >you, because you would have control of the contents. Your prescriptions and diagnosis are very good. The only >suggestion I have would be to minimize or eliminate any content that is cold or slightly cold from your herbal formula >prescription and see if she still reacts the same way. I am assuming for the point of argument that the percentages the manufacturer gives are accurate. They use HPLC testing, etc. to insure consistency. The potency of the herbs batch to batch could be an issue, but the same could be said of raw herbs. She only drinks warm liquids, so that plays no part. However, looking back at the patent formula, it does seem to be much colder than the original Wen Jing Tang - the ratios are nearly reversed! I don't know why a manufacturer - under the direction of Ted Kaptchuk, no less! - would take a warming formula and turn it into a potentially cooling formula. It seems irresponsible, especially since they don't list percentages on their packaging (Crane Herbs, a distributor, provided that info). > (Mu Li Oyster Shell 12.3% > E Jiao (A Jiao) Gelatin 8.3% > Mu Dan Pi (Su) Moutan 8.3% > Mai Men Dong Ophiopogon 8.3% > Bai Shao Peony (White) 8.3% > Dang Gui (Shen) Tangkuei 8.3% > Sheng Jiang Ginger (Fresh) 5.6% > Wu Zhu Yu Evodia Fruit 5.6% > Gui Zhi Cinnamon Twigs 5.6% > Xian Mao Curculigo 4.2% > Sheng Di Huang Rehmannia (Fresh) 4.2% > Gan Cao Licorice 4.2% > Zhi Mu Anemarrhena 4.2% > Ren Shen Ginseng 4.2% > Ba Ji Tian Morinda 4.2% > Huang Bai (Chuan) Phellodendron Bark 4.2% >Message: 4 > Mon, 12 Jul 2004 19:58:40 +0100 (BST) > Hugo Ramiro <subincor >Re: Opposite reactions to herbs > The overall impression I'm getting as well as my >clinical experience suggest that the Mu Li is a major >problem for her, with the sheng di huang coming in >second. The Mai Dong and Zhi Mu I would also delete. I >might try Shu Di instead of Sheng Di. >Mu Li and maybe Sheng Di as well. > Remember the Heart fire is closely connected to the >Kidney yang. Put one out, put the other out. >I'm looking up the Gui Pi tang from health concerns >that you mentioned ... >AAAAAAAAAAAAA that formula has Dan Shen / salvia in >it!!! Bitter and Cold!!! Invigorates blood and breaks >blood stasis! > So anyway, in terms of my diagnosis, that woudl eb a >problem. You both have pointed out how theory and practice may differ widely when employing patent medicines, especially with hypersensitive patients. Like the Wen Jing Tang, Gui Pi Tang should be a nourishing, overall warm formula, but the manufacturer added moving, cooling herbs and transformed it into a different formula. A lesson for me in reading the fine print and not assuming a formula listing itself with a particular name actually reflects the original formula. Unfortunately, because of cost (I practice 4.5 hours from the closest city among skeptical ranchers and farmers), I don't work with raw herbs / custom powders. But I'll be sure to select the patents more carefully (i.e. companies like Mayway, which do traditional, but GMP, formulas). I think, then, that maybe this case is relatively simple, but the formulas, as chosen, were incorrect, and this patient's reactions to the mismatch were more dramatic than most. I am grateful for such discriminating patients - they teach me so much. Benjamin Hawes, MAOM, Lic. Ac., CORTEZ FAMILY ACUPUNCTURE 1430 E. Main Street, Suite #4 Cortez, CO 81321 (970) 565-0230 Quote Link to comment Share on other sites More sharing options...
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