Guest guest Posted April 21, 2005 Report Share Posted April 21, 2005 Hi, I have a 48 year old patient who has many fibroids that together are the size of a 5 month pregnant woman. The thing that surprises me is that she has no pain! I am wondering if this is a clue to her primary diagnosis. I am thinking that she must have more phlegm than qi and blood stagnation since there is no pain, but the mass is very hard with distinct borders. Any diagnosis/herb/acupuncture ideas would be greatly appreciated, but I am especially interested in knowing why there is no pain, and what that indicates diagnostically. Her tongue is red without much coating---not at all damp looking. Tends to be warmer. However she does have a lack of thirst, which could be damp. Normal stools. Poor sleep--has always had trouble falling and staying asleep. Period every 22 to 28 days, heavy the first couple days then fine. No cramps, no PMS, Headache before period, not sure where on head. Long stringy clots (dampheat?). Emotions even (seems to me like someone who represses her emotions). Pulses are weak and thin. I see some yin deficiency and maybe some dampheat, but not much to explain the fibroids. Thanks for any thoughts, Laura Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2005 Report Share Posted April 22, 2005 Hi, Laura I did not encounter such an advanced fibroids, but I remember that my instructors told me that cyst bigger than 1 cm should be operated on. Good luck Peter Pavolotsky --- heylaurag <heylaurag wrote: Hi, I have a 48 year old patient who has many fibroids that together are the size of a 5 month pregnant woman. The thing that surprises me is that she has no pain! I am wondering if this is a clue to her primary diagnosis. I am thinking that she must have more phlegm than qi and blood stagnation since there is no pain, but the mass is very hard with distinct borders. Any diagnosis/herb/acupuncture ideas would be greatly appreciated, but I am especially interested in knowing why there is no pain, and what that indicates diagnostically. Her tongue is red without much coating---not at all damp looking. Tends to be warmer. However she does have a lack of thirst, which could be damp. Normal stools. Poor sleep--has always had trouble falling and staying asleep. Period every 22 to 28 days, heavy the first couple days then fine. No cramps, no PMS, Headache before period, not sure where on head. Long stringy clots (dampheat?). Emotions even (seems to me like someone who represses her emotions). Pulses are weak and thin. I see some yin deficiency and maybe some dampheat, but not much to explain the fibroids. Thanks for any thoughts, 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, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2005 Report Share Posted April 22, 2005 nel Lei Jing of Zhang Jiebin it is said that if do not have pain it is because blood and qi doesn't flow and being knotted in a 'bag' (i.e. uterus), it is difficult that that medicine could reach it, that's why it is difficult to treat. but in the general abdomen mass, as for your description, it belongs to the blood level, the blood has shape and stay still and those are difficult to break. according to Prince Chang Sang if the mass is in the lower part of the body it would be convenient to moxa points of the category of tianshu, zhangmen, shenshu, qihai, guanyuan, zhongji, shuidao; or to moxa points zhongwan, qimen, zhangmen, pishu, sanjiaoshu and tonggu. this need to be repeatedly. luigi Chinese Medicine , Peter Pavolotsky <peter911cm> wrote: > Hi, Laura > > I did not encounter such an advanced fibroids, but I > remember that my instructors told me that cyst bigger > than 1 cm should be operated on. > Good luck > > Peter Pavolotsky > > > > --- heylaurag <heylaurag@h...> wrote: > > > Hi, I have a 48 year old patient who has many fibroids > that together > are the size of a 5 month pregnant woman. The thing > that surprises me > is that she has no pain! I am wondering if this is a > clue to her > primary diagnosis. I am thinking that she must have > more phlegm than > qi and blood stagnation since there is no pain, but > the mass is very > hard with distinct borders. Any > diagnosis/herb/acupuncture ideas > would be greatly appreciated, but I am especially > interested in > knowing why there is no pain, and what that indicates > diagnostically. > > Her tongue is red without much coating---not at all > damp looking. > Tends to be warmer. However she does have a lack of > thirst, which > could be damp. Normal stools. Poor sleep--has always > had trouble > falling and staying asleep. Period every 22 to 28 > days, heavy the > first couple days then fine. No cramps, no PMS, > Headache before > period, not sure where on head. Long stringy clots > (dampheat?). > Emotions even (seems to me like someone who represses > her emotions). > Pulses are weak and thin. I see some yin deficiency > and maybe some > dampheat, but not much to explain the fibroids. > > Thanks for any thoughts, > > 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, > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2005 Report Share Posted April 23, 2005 It would be a surprise if they did cause pain, for they are basically painless and asymptomatic. Tongue fissure? By my count at pattern 1 there will be some small fissures in the anterior third of tongue, antero-posteriorly positioned, with the axes narrowed towards the front. Further, the tongue should be narrowed to the from so that it seems triangular or apical. While you are looking it can also change shape and becomes ovoid as in normal. Or the i/3 may puff up and lose anchor. Pattern 2, less likely, is a median fissure extending to tip. She should also complain of a dry skin, lack of perspiration, if we are truly fortunate, flat feet or tendency to that. She ought to have a scleral artery injection especially on outer quadrants both or one eye. Face ought to have hues of white and green-blue. There should be the beginnings of a malar flush which presents at 1 PM but actually registers Heat at 3 PM, and lasts till 5 PM and the both flush and Heat fade away. She ought to be a C section or placenta previa child, or a difficult labor or something like that. More data please? Holmes www.acu-free.com 1.888.TCM.CEUS heylaurag wrote: > > Hi, I have a 48 year old patient who has many fibroids that together > are the size of a 5 month pregnant woman. The thing that surprises me > is that she has no pain! I am wondering if this is a clue to her > primary diagnosis. I am thinking that she must have more phlegm than > qi and blood stagnation since there is no pain, but the mass is very > hard with distinct borders. Any diagnosis/herb/acupuncture ideas > would be greatly appreciated, but I am especially interested in > knowing why there is no pain, and what that indicates diagnostically. > > Her tongue is red without much coating---not at all damp looking. > Tends to be warmer. However she does have a lack of thirst, which > could be damp. Normal stools. Poor sleep--has always had trouble > falling and staying asleep. Period every 22 to 28 days, heavy the > first couple days then fine. No cramps, no PMS, Headache before > period, not sure where on head. Long stringy clots (dampheat?). > Emotions even (seems to me like someone who represses her emotions). > Pulses are weak and thin. I see some yin deficiency and maybe some > dampheat, but not much to explain the fibroids. > > Thanks for any thoughts, > > Laura > > > > > > > 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, > > > > ------ > * Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 24, 2005 Report Share Posted April 24, 2005 Laura: Just a few other considerations from my notes (from Chinese teachers). Painless fibroids could be the subserous type, i.e. growing outside of the pelvic cavity & rarely causing sx of irregular bleeding, pain, leucorrhea, etc. There are cultural differences in approaches to surgery, i.e., in the U.S. the usual approach is an hysterectomy, but in China, fibroids are usually treated surgically with myomectomies. Almost ALL fibroids decrease in size and symptoms when the woman passes through menopause, altho sometimes they increase in size just before. Your patient is 48, is she perimenopausal? Some Chinese research shows that fibroids > 4cm are less sensitive to herbs. One of my teachers said that she generally only treats small & intramural myomas with herbs, but that 3 mo. of tx should make a difference in any kind. The differentiations listed in my notes are: 1: Blood Stasis d/t Cold Accumulation sx: pt with small masses, cold sx **Gui Zhi Fu Ling Wan 2: Blood Stasis and Heat sx: abdo mass is hard, XS longterm bleeding, dry mouth, constipation, T red, P wiry & slippery or wiry, slippery & FAST **Da Huang Zhe Chong Wan 3: Blood Stasis with Phlegm sx: XS leucorrhea, chest stuffiness sense. sometimes menses is watery. T coat white & greasy, P wiry & slippery **Shi Xiao San + Xiao Lei Wan --chris Quote Link to comment Share on other sites More sharing options...
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