Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 Hi Zev and all: Ok, so I've gotten feedback that this is a useful discussion to others besides me, so I am going to type up the details of my ear infection/EPI cases. Hopefully we can all get some ideas from this: 1. Erik: 37 year old lawyer who intially came to me with shoulder and scapula pain. On the second visit January 26 he had developed a sinus/ear infection. He was not interested in herbs, so decided to take antibiotics and come back after he was well. At that time his ears felt clogged and there was pain around the ears (in front of them on the face), Headaches that were frontal, temple, and down towards ears---felt like a cloth around head. Had a mild fever. Swollen glands. Said it started as a cold, but it became worse after he played soccer with his cold. Coughed up some loose white mucus about once a day. Thirst was average. Felt low energy. In general he tends to feel cold more easily than heat--especially toes and fingers (said he might have Raynauds). Drinks wine in the evening, daily coffee (likes the rush). Stools usually formed, some gas. Floaters. Wakes for about 15-20 minutes once a night around 3-4 am. Face flushes easily. When I saw him at the intake he had a very slight coating on the back of his tongue, but otherwise tongue had a slight lack of coating and is short with slight scallops on the sides. There were some red spots on the sides of the tongue. He later told me that at that point he had the cold (which he didn't tell me) and later that week it turned into the sinus/ear infection. Since I did not know he had a cold its possible in my mind that points I did like UB 23 might have made the pathogen stronger. Saw him last week after he had taken two different antibiotics with only slight relief. Weather here has been unusual--spring came early, but then it got cold again just in the past couple weeks. During the time that he has had this he has gone skiing several times and continued to work. Had a slight headache all over head, temples a little more (rated it a " 1 " on level of pain). Some pain on stomach channel of neck/SJ 16 area. Swollen glands. Energy low. Felt a little feverish. Pain in front of ears on the face (no longer in ears as much if at all)---GB 2 area and a little further towards nose around St 6, St 7. Not a lot of phlegm, but some--sometimes clear sometimes " maybe " a little yellow (he wasn't sure). Stools more loose. Eyes stingy, red, hurting as if he had allergies. Face quite flushed. Nose still clear. Feeling stressed about the EPI and also because girlfriend recently broke up with him. Pulses were wiry and rapid. Tongue unremarkable--pretty much the same as before but no coating in back (there had been a very slight coating in the back when I first saw him). Ok, so that's the scoop on Erik. Any feedback would be greatly appreciated. 2. Heather (I'm going to go into less detail here): a 38 year old social worker. Similar presentation as above--started with nasal congestion then became ear pressure. Thinks she also got a second cold from husband in the middle of this--had an itchy throat for a short time and lots of sneezing and watery eyes. Once got ear pressure nose was clear. Headaches that move all around head--but not frontal--more vertex, sides, and especially occipital. Neck pain. Pressure is sometimes felt more in ears, sometimes felt more below ears (SJ 17 area), sometimes in front (GB 2) but not felt on the face as Erik describes. Swollen glands. Heather also recently started medication for hypothyriod. Pulses are thready, lung pulse weak. Tongue has a coating in the back, short, thin central crack to tip, slight lack of coating from middle to front, a dip from about lung area to front. She reports at times a bitter/ " burnt " and sticky taste on back of tongue since she got this EPI. Feels itchy all over. Eyes have been watery--and she does not have allergies. Nose sometimes itchy too, but not congested. A slight feeling of some congestion in throat. I treated her with acupuncture only, and after one treatment she felt better and reported bright yellow phlegm coming down throat. She has since gotten worse again. Acupuncture seems to help, but only temporarily, and she hasn't had that bright yellow phlegm each time. She feels cold, but isn't sure if that is because of her thyroid or because of the EPI. Face flushes easily, but I noticed that in the past before the EPI as well. She has a long history of heart blood deficient insomnia (qi and blood tonifying points and herbs like Ba Zhen Tang help her sleep, but yin tonics seem to make her insomnia worse, strangely enough). 3. Andrea--39 year old psychologist (isn't interesting how similar they all are?---stressed out professionals aged 37 to 39). Mainly has had a slight sore throat that has come and gone with slight ear pressure and fatigue and a headache that is frontal but different from her " normal " headaches-- worse in the morning and the evening--wakes with scratchy throat off and on. Post nasal drip more than normal (but she tends to have this). Itchy skin sometimes, itchy eyes--and doesn't think its allergies (seems different to her). At times sneezing. At times feverish feeling--can alternate between hot and cold. Thirsty. Bitter/bad taste in mouth. Nose NOT congested. A scarf around neck feels good to her with this. Very tired. Vaginal discharge worse (an ongoing problem). I've been seeing her since fall with a host of problems---dampheat related wrist and knee pain (she recently had knee surgery), chronic rhinitus/allergies/asthma, frontal headaches, shoulder pain, and vaginitis. She responds well to whatever we work on, but then there is always a new main complaint before we have resolved the previous one completely. Tongue has a pretty thick yellow coating in the back. Thin central crack. Thready pulses. Whew!!! Ok, let me know if you have ideas for a formula. Diagnostic information would be welcome too. Thanks! 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, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 I remembered one more detail about Heather that I think is interesting. She said that all of her symptoms feel better after she eats. Also, they get worse when she is under pressure/stress at work. At times she has thought that the EPI was gone, and then she has stress and feels it again in her neck,ear, or headache. Chinese Medicine , " heylaurag " <heylaurag@h...> wrote: > > Hi Zev and all: > > Ok, so I've gotten feedback that this is a useful discussion to others > besides me, so I am going to type up the details of my ear > infection/EPI cases. Hopefully we can all get some ideas from this: > > 1. Erik: 37 year old lawyer who intially came to me with shoulder > and scapula pain. On the second visit January 26 he had developed a > sinus/ear infection. He was not interested in herbs, so decided to > take antibiotics and come back after he was well. At that time his > ears felt clogged and there was pain around the ears (in front of them > on the face), Headaches that were frontal, temple, and down towards > ears---felt like a cloth around head. Had a mild fever. Swollen > glands. Said it started as a cold, but it became worse after he > played soccer with his cold. Coughed up some loose white mucus about > once a day. Thirst was average. Felt low energy. > > In general he tends to feel cold more easily than heat--especially > toes and fingers (said he might have Raynauds). Drinks wine in the > evening, daily coffee (likes the rush). Stools usually formed, some > gas. Floaters. Wakes for about 15-20 minutes once a night around 3-4 > am. Face flushes easily. > > When I saw him at the intake he had a very slight coating on the back > of his tongue, but otherwise tongue had a slight lack of coating and > is short with slight scallops on the sides. There were some red spots > on the sides of the tongue. He later told me that at that point he > had the cold (which he didn't tell me) and later that week it turned > into the sinus/ear infection. Since I did not know he had a cold its > possible in my mind that points I did like UB 23 might have made the > pathogen stronger. > > Saw him last week after he had taken two different antibiotics with > only slight relief. Weather here has been unusual--spring came early, > but then it got cold again just in the past couple weeks. During the > time that he has had this he has gone skiing several times and > continued to work. Had a slight headache all over head, temples a > little more (rated it a " 1 " on level of pain). Some pain on stomach > channel of neck/SJ 16 area. Swollen glands. Energy low. Felt a > little feverish. Pain in front of ears on the face (no longer in ears > as much if at all)---GB 2 area and a little further towards nose > around St 6, St 7. Not a lot of phlegm, but some--sometimes clear > sometimes " maybe " a little yellow (he wasn't sure). Stools more loose. > Eyes stingy, red, hurting as if he had allergies. Face quite flushed. > Nose still clear. Feeling stressed about the EPI and also because > girlfriend recently broke up with him. Pulses were wiry and rapid. > Tongue unremarkable--pretty much the same as before but no coating in > back (there had been a very slight coating in the back when I first > saw him). > > Ok, so that's the scoop on Erik. Any feedback would be greatly > appreciated. > > 2. Heather (I'm going to go into less detail here): a 38 year old > social worker. Similar presentation as above--started with nasal > congestion then became ear pressure. Thinks she also got a second cold > from husband in the middle of this--had an itchy throat for a short > time and lots of sneezing and watery eyes. Once got ear pressure nose > was clear. Headaches that move all around head--but not frontal--more > vertex, sides, and especially occipital. Neck pain. Pressure is > sometimes felt more in ears, sometimes felt more below ears (SJ 17 > area), sometimes in front (GB 2) but not felt on the face as Erik > describes. Swollen glands. Heather also recently started medication > for hypothyriod. Pulses are thready, lung pulse weak. Tongue has a > coating in the back, short, thin central crack to tip, slight lack of > coating from middle to front, a dip from about lung area to front. > She reports at times a bitter/ " burnt " and sticky taste on back of > tongue since she got this EPI. Feels itchy all over. Eyes have been > watery--and she does not have allergies. Nose sometimes itchy too, > but not congested. A slight feeling of some congestion in throat. I > treated her with acupuncture only, and after one treatment she felt > better and reported bright yellow phlegm coming down throat. She has > since gotten worse again. Acupuncture seems to help, but only > temporarily, and she hasn't had that bright yellow phlegm each time. > She feels cold, but isn't sure if that is because of her thyroid or > because of the EPI. Face flushes easily, but I noticed that in the > past before the EPI as well. She has a long history of heart blood > deficient insomnia (qi and blood tonifying points and herbs like Ba > Zhen Tang help her sleep, but yin tonics seem to make her insomnia > worse, strangely enough). > > 3. Andrea--39 year old psychologist (isn't interesting how similar > they all are?---stressed out professionals aged 37 to 39). Mainly has > had a slight sore throat that has come and gone with slight ear > pressure and fatigue and a headache that is frontal but different from > her " normal " headaches-- worse in the morning and the evening--wakes > with scratchy throat off and on. Post nasal drip more than normal (but > she tends to have this). Itchy skin sometimes, itchy eyes--and doesn't > think its allergies (seems different to her). At times sneezing. At > times feverish feeling--can alternate between hot and cold. Thirsty. > Bitter/bad taste in mouth. Nose NOT congested. A scarf around neck > feels good to her with this. Very tired. Vaginal discharge worse (an > ongoing problem). I've been seeing her since fall with a host of > problems---dampheat related wrist and knee pain (she recently had knee > surgery), chronic rhinitus/allergies/asthma, frontal headaches, > shoulder pain, and vaginitis. She responds well to whatever we work > on, but then there is always a new main complaint before we have > resolved the previous one completely. Tongue has a pretty thick > yellow coating in the back. Thin central crack. Thready pulses. > > Whew!!! Ok, let me know if you have ideas for a formula. Diagnostic > information would be welcome too. Thanks! > > 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, > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 I am entering the Exquisite Gathering of Herbalists with myself being innocent of the Art. Thus my offerings are on the Altar of Acupuncture which it is hoped shall please the Gods of Alternate Healing. The 2nd gal is almost certainly a HT Deficient - LU Metal Aggressed person, and by all counts has been so for quite some time. This conjecture is based on: " ... Tongue has a coating in the back, short, thin central crack to tip, slight lack of coating from middle to front, a dip from about lung area to front. " And: " ... She has a long history of heart blood deficient insomnia (qi and blood tonifying points and herbs like BaZhen Tang help her sleep, but yin tonics seem to make her insomnia worse, strangely enough). " Which lead naturally enough to: " ... Pulses are thready, lung pulse weak. " " ... a dip from about lung area to front. " And to all the things which have happened to her now and in the past, including the current Invasion problem. Refining the signs: Of all that she presents, the sign most critical is the one of tongue fissure extending to tip. The supporting clue is: The long history of heart blood deficient insomnia. Next: The LU indentation short of the tongue tip. Setting up the 5 E Design: Phase 1: a Deficient HT to begin with, maybe congenital, or acquired from life changes during youth and adulthood, with Emotions as a central player. Phase 2: this settled down to make a home on HT, depleting it's Yin. Phase 3:this in turn began to work on Metal, causing first an LI Flux, which later became ... Phase 4: a LU Yin Deficiency. Phase 5: as extensions one would see an SI Flux, which could become a BL Heat, which could become a DU Heat, which could become a Yang Qiao Flux. These would come and go according to the qi-dynamics of the moment. Some good news in all this glum stuff The hypothyroid may actually be a simple consequence of this Design, and may clear up soon as it is put into its right place. Which is to say that a point in time may arrive where thyroid supplement are being given to someone with no shortfall of natural thyroid hormones. Which is to say unless a close monitoring is kept up one may cause a Hyperthyroid situation; or end up depleting what little natural thyroid has survived. Differential diagnosis: Sort out an Adrenal Cortex Exhaustion. This can result from the basic HT - LU axis, which has graduated to a Water involvement. How to confirm a HT - LU Axis: Look for simpler somatic triggers, and clear these off by remote HT related points. There are lots of these on K pathway in chest on sternocostal track. Ones on L must be more tender than R, the latter signifying more LU that HT, and the former more HT than LU. L LV 14 is classical, and a vague point in between that and the sternal track Others are the Shu in the back, related DU points, the Small Heart on scapula, only the L one, a very tender SI track along scapular border. Therapeutic approach: Tone HT. That's it. And make it a Horary point, and make sure you have triggers to tell you you are doing the right thing. If this is done right, after you have confirmed what is being suggested, and put all the findings through a sieve, so that it is HT- LU as an axis, then a simple toning HT will begin to settle down all the symptoms, the immediate ones as well as the remote ones which have now become chronic and unremarkable. In this kind of work the correct Horary pair of points will work with spectacular results. Dr. Holmes CEUS on DVD www.acu-free.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 I hate to be non-TCMy here but also consider tooth problem. An empacted tooth can cause similar symptoms. Ask when the last time they saw dentist or if any upper molar pain or discomfort. Or just refer them out to a dentist. Bob Linde, AP, RH (AHG) www.acuherbals.com heylaurag <heylaurag wrote: I remembered one more detail about Heather that I think is interesting. She said that all of her symptoms feel better after she eats. Also, they get worse when she is under pressure/stress at work. At times she has thought that the EPI was gone, and then she has stress and feels it again in her neck,ear, or headache. Chinese Medicine , " heylaurag " <heylaurag@h...> wrote: > > Hi Zev and all: > > Ok, so I've gotten feedback that this is a useful discussion to others > besides me, so I am going to type up the details of my ear > infection/EPI cases. Hopefully we can all get some ideas from this: > > 1. Erik: 37 year old lawyer who intially came to me with shoulder > and scapula pain. On the second visit January 26 he had developed a > sinus/ear infection. He was not interested in herbs, so decided to > take antibiotics and come back after he was well. At that time his > ears felt clogged and there was pain around the ears (in front of them > on the face), Headaches that were frontal, temple, and down towards > ears---felt like a cloth around head. Had a mild fever. Swollen > glands. Said it started as a cold, but it became worse after he > played soccer with his cold. Coughed up some loose white mucus about > once a day. Thirst was average. Felt low energy. > > In general he tends to feel cold more easily than heat--especially > toes and fingers (said he might have Raynauds). Drinks wine in the > evening, daily coffee (likes the rush). Stools usually formed, some > gas. Floaters. Wakes for about 15-20 minutes once a night around 3-4 > am. Face flushes easily. > > When I saw him at the intake he had a very slight coating on the back > of his tongue, but otherwise tongue had a slight lack of coating and > is short with slight scallops on the sides. There were some red spots > on the sides of the tongue. He later told me that at that point he > had the cold (which he didn't tell me) and later that week it turned > into the sinus/ear infection. Since I did not know he had a cold its > possible in my mind that points I did like UB 23 might have made the > pathogen stronger. > > Saw him last week after he had taken two different antibiotics with > only slight relief. Weather here has been unusual--spring came early, > but then it got cold again just in the past couple weeks. During the > time that he has had this he has gone skiing several times and > continued to work. Had a slight headache all over head, temples a > little more (rated it a " 1 " on level of pain). Some pain on stomach > channel of neck/SJ 16 area. Swollen glands. Energy low. Felt a > little feverish. Pain in front of ears on the face (no longer in ears > as much if at all)---GB 2 area and a little further towards nose > around St 6, St 7. Not a lot of phlegm, but some--sometimes clear > sometimes " maybe " a little yellow (he wasn't sure). Stools more loose. > Eyes stingy, red, hurting as if he had allergies. Face quite flushed. > Nose still clear. Feeling stressed about the EPI and also because > girlfriend recently broke up with him. Pulses were wiry and rapid. > Tongue unremarkable--pretty much the same as before but no coating in > back (there had been a very slight coating in the back when I first > saw him). > > Ok, so that's the scoop on Erik. Any feedback would be greatly > appreciated. > > 2. Heather (I'm going to go into less detail here): a 38 year old > social worker. Similar presentation as above--started with nasal > congestion then became ear pressure. Thinks she also got a second cold > from husband in the middle of this--had an itchy throat for a short > time and lots of sneezing and watery eyes. Once got ear pressure nose > was clear. Headaches that move all around head--but not frontal--more > vertex, sides, and especially occipital. Neck pain. Pressure is > sometimes felt more in ears, sometimes felt more below ears (SJ 17 > area), sometimes in front (GB 2) but not felt on the face as Erik > describes. Swollen glands. Heather also recently started medication > for hypothyriod. Pulses are thready, lung pulse weak. Tongue has a > coating in the back, short, thin central crack to tip, slight lack of > coating from middle to front, a dip from about lung area to front. > She reports at times a bitter/ " burnt " and sticky taste on back of > tongue since she got this EPI. Feels itchy all over. Eyes have been > watery--and she does not have allergies. Nose sometimes itchy too, > but not congested. A slight feeling of some congestion in throat. I > treated her with acupuncture only, and after one treatment she felt > better and reported bright yellow phlegm coming down throat. She has > since gotten worse again. Acupuncture seems to help, but only > temporarily, and she hasn't had that bright yellow phlegm each time. > She feels cold, but isn't sure if that is because of her thyroid or > because of the EPI. Face flushes easily, but I noticed that in the > past before the EPI as well. She has a long history of heart blood > deficient insomnia (qi and blood tonifying points and herbs like Ba > Zhen Tang help her sleep, but yin tonics seem to make her insomnia > worse, strangely enough). > > 3. Andrea--39 year old psychologist (isn't interesting how similar > they all are?---stressed out professionals aged 37 to 39). Mainly has > had a slight sore throat that has come and gone with slight ear > pressure and fatigue and a headache that is frontal but different from > her " normal " headaches-- worse in the morning and the evening--wakes > with scratchy throat off and on. Post nasal drip more than normal (but > she tends to have this). Itchy skin sometimes, itchy eyes--and doesn't > think its allergies (seems different to her). At times sneezing. At > times feverish feeling--can alternate between hot and cold. Thirsty. > Bitter/bad taste in mouth. Nose NOT congested. A scarf around neck > feels good to her with this. Very tired. Vaginal discharge worse (an > ongoing problem). I've been seeing her since fall with a host of > problems---dampheat related wrist and knee pain (she recently had knee > surgery), chronic rhinitus/allergies/asthma, frontal headaches, > shoulder pain, and vaginitis. She responds well to whatever we work > on, but then there is always a new main complaint before we have > resolved the previous one completely. Tongue has a pretty thick > yellow coating in the back. Thin central crack. Thready pulses. > > Whew!!! Ok, let me know if you have ideas for a formula. Diagnostic > information would be welcome too. Thanks! > > 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, > > > > http://babel.altavista.com/ and adjust accordingly. If you are a TCM academic and wish to discuss TCM with other academics, click on this link Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 heylaurag wrote: > > I remembered one more detail about Heather that I think is > interesting. She said that all of her symptoms feel better after she > eats. Also, they get worse when she is under pressure/stress at work. > At times she has thought that the EPI was gone, and then she has > stress and feels it again in her neck,ear, or headache. > Hi Laura! Really. Consider TMJ problem then. Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 I can see where you all are coming from with the other ideas---Tooth problem and TMJ, and I guess that's a good example of how you just have to know and see the patient to see more clearly because its really clear to me that this is an EPI situation with all of them. Also, I forgot to mention that I got two of these referrals from one of them, so they all know each other. Presumably they had a chance to pass this to each other. I also wondered about adding a yin/blood tonic to one of their formulas because she just recently had her period and she needs something to protect her liver/kidney yin/blood right now. Is there something that I can add without making the pathogen worse? This is Heather that I am concerned about. She took the former formula during her period, and it seems to be helping, but she is definitely showing signs of her liver yin/blood being consumed, which happens easily for her. It seems like when I add something like Xuan Shen or Sheng di Huang in these situations invariably the pathogen gets fed. Laura Chinese Medicine , Pete Theisen <petet@a...> wrote: > heylaurag wrote: > > > > I remembered one more detail about Heather that I think is > > interesting. She said that all of her symptoms feel better after she > > eats. Also, they get worse when she is under pressure/stress at work. > > At times she has thought that the EPI was gone, and then she has > > stress and feels it again in her neck,ear, or headache. > > > Hi Laura! > > Really. Consider TMJ problem then. > > Regards, > > Pete Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.