Ear infections: update

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Erik called to tell me that his symptoms are better--less pressure

everywhere, but its still there a little. He took the herbs on

Saturday and Sunday--only took them 2 times a day rather than 3 that I

told him. The downside is that he got a bad headache at his temples

both days that he took them. My theory is that it is related to the

Chai Hu being too ascending in action for someone who may have liver

yin deficiency. This brings me back to my question about whether I

can get away with adding a yin tonic without making the pathogen worse...

 

This is the basic formula I gave:

 

Chai Hu, Huang Qin, Tian Hua Fen, Bei Sha Shen, Man Jing Zi, Ban Xia,

Jiang Can (silkworm), Ban Lan Gen, a touch of Xi Xin,

 

To Erik, I added Bai Zhi, to the other two I added Fang Feng, Mu Hu

Die, and Niu Bang Zi.

 

Heather felt better on the formula, but foggy-headed and still

congested in neck a little. She also was getting occipital headaches,

and I wondered if it was yin xu. I added Zhe Bei Mu, and the

foggy-headedness got better, and overall she improved. Then I added

some Sheng Di Huang--we'll see what happens--I'm worried it might

tonify the pathogen.

 

I'm wondering if I should add Zhe Bei Mu (to help with phlegm) to Erik

and Andrea's formula....it seemed to really help with Heathers.

 

Any 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,

>

>