Ear infections/EPI's

March 20, 2005

Hi Zev and all,

I appreciate the responses and thoughts on these cases. I'm going to

try to open this up to a more general discussion of treating EPI's and

allergies which I hope others will appreciate as well (I've heard

others express frustration with treating EPI's too).

I wound up giving them a formula based on Xiao Chai Hu Tang with some

Ban Lan Gen and additional windheat herbs, and with a little variation

in each case. So far I've heard from one of the three, and she is

getting better already. Zev, your response down below was very

helpful (thank you!)--for one thing it steered me away from Long Dan

Xie Gan Tang and toward Xiao Chai Hu Tang, which seems to be a good

thing. Also, I added a touch of Xi Xin. How much should I add in a

formula to avoid " freezing the evil qi " when using granules? I only

added half a gram. Under what circumstances would Long Dan Xie Gan

Tang be given for an ear infection that has been around awhile?

Since things seem like they might be getting better, I will hold off

on going into detail about each of these patients, but I was wondering

if anyone has any book suggestions for improving my ability to treat

colds/flus?

I have a habit of making things more complicated in my head than they

need to be when I am new to something. I suspect this is the case with

cold/flus, but the challenge is that it seems like the patterns we

studied in school tell us what to do if we catch an EPI in the first

day. Usually I don't see someone until quite awhile later (three

months with one of these patients), and so I know that the approach

should be a little different, but its not real clear to me exactly how

different it should be. Consequently I have not used herbs very often

yet for EPI's in my practice (acupuncture often is enough), but this

bug seems to warrant the use of herbs. So, I am being forced to

learn, which is good.

From what I am understanding, Zev, it sounds like I should stick with

mostly herbs from the diaphoretic category (and generally if its been

around awhile use windheat herbs) and maybe one addition like Ban Lan

Gen unless there are more dramatic symptoms like profuse yellow

phlegm. All three of these patients have swollen glands, but there

isn't any yellow phlegm. There are heat signs, but I guess those are

more windheat/shaoyang heat, right? Two of them have mostly symptoms

in their ears and neck at this point (so the Xiao Chai Hu Tang herbs

will direct to that area), but one also has sinus pressure on the

cheeks in front of the ears (but no phlegm). I wasn't sure what to

add to direct things there--I went with Bai Zhi. Any suggestions? His

nose is clear, so Xin Yi Hua and Cang Er Zi didn't seem right.

I have a patient who is coming in early next week who got a cold on

Friday...so I need to be thinking what to do with him as well. He

said he had lots of mucus, which isn't surprising because he came in

to see me initially with chronic rhinitus. I'm thinking of using Cang

Er Zi Tang plus windheat herbs plus maybe something like Tian Hua Fen

for phlegm and some good ole Ban Lan Gen.

Here's a good general question---why is it that a formula like Yin

Qiao San and Gan Mao Ling are only for early stages, but you still use

similar herbs from the windheat diaphoretic category in a later stage?

Is it generally a good rule of thumb to add Huang Qin/Chai Hu to open

the shaoyang with a later stage cold?

And lastly, I may as well throw in a question about my allergy patient

coming in next week with very itchy eyes (windheat, right?). Within

the windheat formula, should I also add Yu Ping Feng San, or maybe

that's not good during the allergy season? Is Ju Hua the best choice

to direct to the eyes?

Thanks for any and all thoughts and ideas. I am hoping that this is a

useful discussion for others as well---I don't want to take up more

than my share of space on the forum with all these questions, but I

figured others would appreciate this too.

Laura

Chinese Medicine , " "

<zrosenbe@s...> wrote:

> Laura,

> Can you share some pulses and tongues with us? It would help a lot.

>

> A few questions, seeing as this pattern would probably be in the realm

> of warm disease:

>

> 1) What part of the country/world are you? What was the weather like

> when people contracted this evil? What time of year?

>

> 2) Type of fever/heat effusion, worse at what time of day?

>

> 3) Urination: dark, clear, scanty, copious?

>

> 4) Changes in digestion, appetite?

>

> 5) Fatigue?

>

> Unless there is a red tongue, greasy coating, and wiry pulse, I

> wouldn't use long dan xie gan tang. Also, for toxic heat, there

> should be signs of discharge or swelling, such as glandular swelling.

> Also, while a few of the medicinals you listed (zi hua di ding, ban

> lan gen or others) may be useful, be careful of using too many bitter

> cold medicinals as they could 'freeze' the evil qi. Some wind-heat

> dispersing medicinals that are acrid may be useful, and depending on

> damage to yin, yin supplementing medicinals as well such as xuan shen.

>

> We need to narrow down a number of variables here in order to prescribe

> accurately.

>

> Take care,

>

> On Mar 18, 2005, at 1:08 AM, heylaurag wrote:

>

> >

> > Hi All,

> >

> > There is a nasty virus going around here that goes to the ears and

> > sticks around for months seeming to get better and then coming back.

> > I have several patients with varying degrees of this virus. It seems

> > to be a windheat that moves to the ears and becomes toxic heat.

> > Interestingly, none of them have much in the way of phlegm. For the

> > most part their noses are clear. However, there has been neck pain and

> > headaches, and in one case a sore throat. Anyone have any ideas to

> > share on treating this? I'm looking for a base formula to use. I'm

> > thinking about using Long Dan Xie Gan Tang and adding some herbs for

> > toxic heat like Ban Lan Gan, Da Qing Ye, and Zi Hua Di Ding. Then I

> > will add herbs like Ge Gen and Man Jing Zi and Ju Hua for the head and

> > neck.

> >

> > Any ideas? One thing I'm wondering about is whether to add phlegm

> > resolving herbs, and if so, what herbs? It seems that there must be

> > phlegm, but its really not very apparent. I'm thinking it must be a

> > liver/gallbladder phlegmheat thing rather than being in the

> > lungs...does that make sense? If so, what herbs?

> >

> > I'm not particularly advanced at treating colds and flus past the

> > first stage with herbs, so any ideas at all would be greatly

> > appreciated. By the way--its definitely a virus rather than a

> > bacteria as evidenced by the fact that one of them has been on two

> > different antibiotics without clearing it up.

> >

> > Thanks in advance.

> >

> > Laura

> >

> > To translate this message, copy and paste it into this web link

page,

> > http://babel.altavista.com/

> >

> > and

> > adjust accordingly.

> >

> > Messages are the property of the author. Any duplication outside the

> > group requires prior permission from the author.

> >

> > If you are a TCM academic and wish to discuss TCM with other

> > academics,

> >

March 20, 2005

On Mar 19, 2005, at 4:29 PM, heylaurag wrote:

>

> Hi Zev and all,

>

> I appreciate the responses and thoughts on these cases. I'm going to

> try to open this up to a more general discussion of treating EPI's and

> allergies which I hope others will appreciate as well (I've heard

> others express frustration with treating EPI's too).

The reason for the frustration is the lack of training in the essential

theory for treating respiratory infections, i.e. Shang Han Lun 6

channel pattern differentiation and Wen Bing four aspects pattern

differentiation. We need more workshops and post-graduate studies in

these important departments of Chinese internal medicine.

>

> I wound up giving them a formula based on Xiao Chai Hu Tang with some

> Ban Lan Gen and additional windheat herbs, and with a little variation

> in each case. So far I've heard from one of the three, and she is

> getting better already. Zev, your response down below was very

> helpful (thank you!)--for one thing it steered me away from Long Dan

> Xie Gan Tang and toward Xiao Chai Hu Tang, which seems to be a good

> thing. Also, I added a touch of Xi Xin. How much should I add in a

> formula to avoid " freezing the evil qi " when using granules? I only

> added half a gram. Under what circumstances would Long Dan Xie Gan

> Tang be given for an ear infection that has been around awhile?

You can only use xiao chai hu tang if the patient has the pattern of

shao yang disease, a mid-stage pattern with alternating heat and chill,

etc. It doesn't sound like this is what is happening here. Long dan

xie gan tang usually is given for more acute ear infections with

purulent discharge.

>

> Since things seem like they might be getting better, I will hold off

> on going into detail about each of these patients, but I was wondering

> if anyone has any book suggestions for improving my ability to treat

> colds/flus?

Try Liu's Warm Disease text from Eastland Press for one, and Craig

Mitchell's Shang Han Lun. The Maclean " Clinical Handbook of Internal

Medicine " has some nice prescriptions as well you can use as a guide.

>

> I have a habit of making things more complicated in my head than they

> need to be when I am new to something. I suspect this is the case with

> cold/flus, but the challenge is that it seems like the patterns we

> studied in school tell us what to do if we catch an EPI in the first

> day. Usually I don't see someone until quite awhile later (three

> months with one of these patients), and so I know that the approach

> should be a little different, but its not real clear to me exactly how

> different it should be. Consequently I have not used herbs very often

> yet for EPI's in my practice (acupuncture often is enough), but this

> bug seems to warrant the use of herbs. So, I am being forced to

> learn, which is good.

This is a good point. Very often our potential patients will use

western medications first, and we catch them later on. Often times,

the strong medications (steroids, antibiotics, antihistamines) will

complicate the pattern, causing what is called in the Shang Han Lun a

'transmuted pattern'. A transmuted pattern is more entrenched and more

complex than the original wind/cold or wind/heat attack, and requires

more sophisticated prescriptions. This is one of the major threads in

the SHL, and this is why it is so important for us to study this text.

>

> From what I am understanding, Zev, it sounds like I should stick with

> mostly herbs from the diaphoretic category (and generally if its been

> around awhile use windheat herbs) and maybe one addition like Ban Lan

> Gen unless there are more dramatic symptoms like profuse yellow

> phlegm. All three of these patients have swollen glands, but there

> isn't any yellow phlegm. There are heat signs, but I guess those are

> more windheat/shaoyang heat, right? Two of them have mostly symptoms

> in their ears and neck at this point (so the Xiao Chai Hu Tang herbs

> will direct to that area), but one also has sinus pressure on the

> cheeks in front of the ears (but no phlegm). I wasn't sure what to

> add to direct things there--I went with Bai Zhi. Any suggestions? His

> nose is clear, so Xin Yi Hua and Cang Er Zi didn't seem right.

Medicinals such as xuan shen, ban lan gen , ge gen, bo he and niu bang

zi will address the glands and throat area. Of course, you can also

use acupuncture to relieve sinus pressure. I would also consider lian

qiao to clear heat toxin, mai men dong and sha shen to nourish the yin.

>

> I have a patient who is coming in early next week who got a cold on

> Friday...so I need to be thinking what to do with him as well. He

> said he had lots of mucus, which isn't surprising because he came in

> to see me initially with chronic rhinitus. I'm thinking of using Cang

> Er Zi Tang plus windheat herbs plus maybe something like Tian Hua Fen

> for phlegm and some good ole Ban Lan Gen.

It depends if there are actual heat signs such as red tongue, painful

swollen throat and purulent yellow discharge from the nose.

>

> Here's a good general question---why is it that a formula like Yin

> Qiao San and Gan Mao Ling are only for early stages, but you still use

> similar herbs from the windheat diaphoretic category in a later stage?

> Is it generally a good rule of thumb to add Huang Qin/Chai Hu to open

> the shaoyang with a later stage cold?

Yin qiao san can be combined with other medicinals to address other

stages. You still have, it seems, qi aspect heat signs in your

patients, but the lingering evils have damaged the yin. So you combine

qi aspect heat clearing medicinals with yin nourishing medicinals

together.

>

> And lastly, I may as well throw in a question about my allergy patient

> coming in next week with very itchy eyes (windheat, right?). Within

> the windheat formula, should I also add Yu Ping Feng San, or maybe

> that's not good during the allergy season? Is Ju Hua the best choice

> to direct to the eyes?

>

Yu ping feng san can be used later on, after the original condition has

been addressed. Look at pulse, tongue, along with other symptoms and

signs to determine if this is indeed a wind-heat attack or not.

> Thanks for any and all thoughts and ideas. I am hoping that this is a

> useful discussion for others as well---I don't want to take up more

> than my share of space on the forum with all these questions, but I

> figured others would appreciate this too.

>

I think we need more discussions like these on this forum.

Take care,

March 20, 2005

Hi Zev,

I really understand your frustration, and actually predicted that you

would be! Its pretty clear from your posts that you have an

exceptionally sophisticated grasp of the classics and theory. I think

my school was really pretty good in general, but we definitely were

not given a sophisticated education in the classics for treating

EPI's. Like most graduate programs (I have another masters degree in

another field) much of what you learn is dependent on your own

motivation and what you seek to learn to enhance classes. For some

reason many of us (me included) did not focus on learning the Shang

Han Lun and Wen Bing on our own. I honestly did not realize how

important it would be in my practice---in the back of my mind I

thought it was something that wasn't important, perhaps partially

because I am not someone who catches colds/flus very often (I had this

idea that in most cases people just needed to stay home for a couple

days and then its over). Also, the exposure that I DID have to the

classics mentioned seemed as though they didn't really apply to the

current patterns of disease...(I hope I don't get lambasted by anyone

for admitting that!). I had trouble understanding how to apply it to

current patterns, which obviously a more sophisticated study would

have taught me. I would LOVE to find a class that would teach this

stuff in a way I could digest better. I think my respiratory teacher,

who was Chinese, tried to expose us with quotes from the classics, but

his language barrier added to the challenge (I don't mean this to

sound disrespectful, its just a reality that made it harder to learn).

Anyway, I really, REALLY appreciate your willingness to share your

knowledge and thoughts with us. If I can find the time I will go

ahead and write up the cases on here so that we might all learn

something. I did get some help on the formula I gave them from a

former teacher, along with reading your ideas--so that helped.

My school closed within months of when I graduated---so part of my

challenge is that I do not have a " home " to go to for help when I need

it. My class was let loose to practice without the support of our

school available after we graduated.

I'm torn about whether I should be even attempting formulas for EPI's

until I know more. The few times I've tried I actually have gotten

pretty good results--but I talked with others and put a lot of time

and energy into them first.

The allergy patient has a red tongue with a deep central crack and

lack of coating, but with a thicker coating on the back of the tongue.

His pulse can be a little wiry...I don't have the chart here or I'd

go into more detail, (One problem is that I tend to write these posts

at home and my charts are at my clinic). He tends to have a lot of

fatigue, and its been noticeably worse in the morning lately. His

main issue is itchy eyes during allergy seasons (it got warm here for

spring early this year), but he can also have sneezing and runny nose.

He tends to feel cold. With his constitutional yin deficiency, I

wonder about adding yin tonics or if that's not a good idea during the

allergy season (should I want until it is inbetween?).

Thanks for your thoughts,

Laura

Chinese Medicine , " "

<zrosenbe@s...> wrote:

>

> On Mar 19, 2005, at 4:29 PM, heylaurag wrote:

>

> >

> > Hi Zev and all,

> >

> > I appreciate the responses and thoughts on these cases. I'm going to

> > try to open this up to a more general discussion of treating EPI's and

> > allergies which I hope others will appreciate as well (I've heard

> > others express frustration with treating EPI's too).

>

> The reason for the frustration is the lack of training in the essential

> theory for treating respiratory infections, i.e. Shang Han Lun 6

> channel pattern differentiation and Wen Bing four aspects pattern

> differentiation. We need more workshops and post-graduate studies in

> these important departments of Chinese internal medicine.

> >

> > I wound up giving them a formula based on Xiao Chai Hu Tang with some

> > Ban Lan Gen and additional windheat herbs, and with a little variation

> > in each case. So far I've heard from one of the three, and she is

> > getting better already. Zev, your response down below was very

> > helpful (thank you!)--for one thing it steered me away from Long Dan

> > Xie Gan Tang and toward Xiao Chai Hu Tang, which seems to be a good

> > thing. Also, I added a touch of Xi Xin. How much should I add in a

> > formula to avoid " freezing the evil qi " when using granules? I only

> > added half a gram. Under what circumstances would Long Dan Xie Gan

> > Tang be given for an ear infection that has been around awhile?

>

> You can only use xiao chai hu tang if the patient has the pattern of

> shao yang disease, a mid-stage pattern with alternating heat and chill,

> etc. It doesn't sound like this is what is happening here. Long dan

> xie gan tang usually is given for more acute ear infections with

> purulent discharge.

> >

> > Since things seem like they might be getting better, I will hold off

> > on going into detail about each of these patients, but I was wondering

> > if anyone has any book suggestions for improving my ability to treat

> > colds/flus?

>

> Try Liu's Warm Disease text from Eastland Press for one, and Craig

> Mitchell's Shang Han Lun. The Maclean " Clinical Handbook of Internal

> Medicine " has some nice prescriptions as well you can use as a guide.

> >

> > I have a habit of making things more complicated in my head than they

> > need to be when I am new to something. I suspect this is the case with

> > cold/flus, but the challenge is that it seems like the patterns we

> > studied in school tell us what to do if we catch an EPI in the first

> > day. Usually I don't see someone until quite awhile later (three

> > months with one of these patients), and so I know that the approach

> > should be a little different, but its not real clear to me exactly how

> > different it should be. Consequently I have not used herbs very often

> > yet for EPI's in my practice (acupuncture often is enough), but this

> > bug seems to warrant the use of herbs. So, I am being forced to

> > learn, which is good.

>

> This is a good point. Very often our potential patients will use

> western medications first, and we catch them later on. Often times,

> the strong medications (steroids, antibiotics, antihistamines) will

> complicate the pattern, causing what is called in the Shang Han Lun a

> 'transmuted pattern'. A transmuted pattern is more entrenched and more

> complex than the original wind/cold or wind/heat attack, and requires

> more sophisticated prescriptions. This is one of the major threads in

> the SHL, and this is why it is so important for us to study this text.

> >

> > From what I am understanding, Zev, it sounds like I should stick with

> > mostly herbs from the diaphoretic category (and generally if its been

> > around awhile use windheat herbs) and maybe one addition like Ban Lan

> > Gen unless there are more dramatic symptoms like profuse yellow

> > phlegm. All three of these patients have swollen glands, but there

> > isn't any yellow phlegm. There are heat signs, but I guess those are

> > more windheat/shaoyang heat, right? Two of them have mostly symptoms

> > in their ears and neck at this point (so the Xiao Chai Hu Tang herbs

> > will direct to that area), but one also has sinus pressure on the

> > cheeks in front of the ears (but no phlegm). I wasn't sure what to

> > add to direct things there--I went with Bai Zhi. Any suggestions? His

> > nose is clear, so Xin Yi Hua and Cang Er Zi didn't seem right.

>

> Medicinals such as xuan shen, ban lan gen , ge gen, bo he and niu bang

> zi will address the glands and throat area. Of course, you can also

> use acupuncture to relieve sinus pressure. I would also consider lian

> qiao to clear heat toxin, mai men dong and sha shen to nourish the yin.

> >

> > I have a patient who is coming in early next week who got a cold on

> > Friday...so I need to be thinking what to do with him as well. He

> > said he had lots of mucus, which isn't surprising because he came in

> > to see me initially with chronic rhinitus. I'm thinking of using Cang

> > Er Zi Tang plus windheat herbs plus maybe something like Tian Hua Fen

> > for phlegm and some good ole Ban Lan Gen.

>

> It depends if there are actual heat signs such as red tongue, painful

> swollen throat and purulent yellow discharge from the nose.

> >

> > Here's a good general question---why is it that a formula like Yin

> > Qiao San and Gan Mao Ling are only for early stages, but you still use

> > similar herbs from the windheat diaphoretic category in a later stage?

> > Is it generally a good rule of thumb to add Huang Qin/Chai Hu to open

> > the shaoyang with a later stage cold?

>

> Yin qiao san can be combined with other medicinals to address other

> stages. You still have, it seems, qi aspect heat signs in your

> patients, but the lingering evils have damaged the yin. So you combine

> qi aspect heat clearing medicinals with yin nourishing medicinals

> together.

> >

> > And lastly, I may as well throw in a question about my allergy patient

> > coming in next week with very itchy eyes (windheat, right?). Within

> > the windheat formula, should I also add Yu Ping Feng San, or maybe

> > that's not good during the allergy season? Is Ju Hua the best choice

> > to direct to the eyes?

> >

> Yu ping feng san can be used later on, after the original condition has

> been addressed. Look at pulse, tongue, along with other symptoms and

> signs to determine if this is indeed a wind-heat attack or not.

>

> > Thanks for any and all thoughts and ideas. I am hoping that this is a

> > useful discussion for others as well---I don't want to take up more

> > than my share of space on the forum with all these questions, but I

> > figured others would appreciate this too.

> >

> I think we need more discussions like these on this forum.

>

> Take care,

>

March 21, 2005

I am currently studying TCM and formulas, and find the Shang Han Lun and Wen

Bing essential for understanding how diseases enter and progress futher into the

body. In addition, to the formulas that are written in both these texts, the

explanations of the processes of invasion of cold and hot pathogens are very

helpful and interesting. I find that learning herbs and formulas this way also

helps me understand TCM theory in general, and I am very glad that our teachers

refer to these texts and explain the original usages of the formulas, as well as

their current applications

I also enjoy reading these discussions on this forum, so thank you!

Regards,

Joyce Schwartz

-

heylaurag

Chinese Medicine

Sunday, March 20, 2005 10:53 PM

Re: Ear infections/EPI's