Herbal Help Needed Low Back Pain Case

[Guest guest]

Hi All. I would greatly appreciate herbal advice for the following

case.

 

I have a 43 y/o male patient that I have been treating with

acupuncture for low back pain. He has been responding well to the

acupuncture and I would like to to add herbs but I don't know what

to prescribe. Maybe I need some help seeing the forest thru the

trees

 

He has a long history of back pain beginning in 1987 with a disc

herniation that required a laminectomy at L4. In 2003 he reinjured

his back and required a second laminectomy at L5. In 2005 he

reinjured his back and sufferred another herniation at L5/S1. He

and his surgeon want to avoid another surgery. He has been

diagnosed with degenerative disc disease and disc protrusions from

L3 to L5.

 

He has dull achy pain along the GV, UB and GB meridians of both

sides. He has a lump of scar tissue at the R UB 23 area that feels

like phlem congestion. And numbness in his R foot along the SP and

ST meridians. Pain is worse with activity and changes in weather.

Better with rest and heat. His feet are cold and have been cold

since injuring his back. Seems straight forward: wind damp cold bi

with Ki Qi/Yang deficiency also Qi and Blood stagnation.

 

Here is where I get confused. He is a smoker and tends to get a

sore and hoarse voice when he talks. He has high blood pressure

which is controlled by medication. He is highly irritible and prone

to outbursts of anger for which he takes Paxil and Wellbutrin . He

has gout in his foot which is controlled by medication, but he will

flare up if he stops taking it. He is also just over 90 days sober

and possibly still in the detoxification phase- he has times when

his body is very shakey and his hands tremble. He has bad teeth-

upper and lower dentures. He is prone to HSV 1 infections at the

corners of his lips(occur when stressed) and infections of his eye

lid (generally due to rubbing it when he is stressed)

 

His tongue is candy apple red, no coat, center crack, short and

trembling. Tongue is possibly a little puffy. Pulses are generally

rapid wiry and slippery on the left. With the Liver pulse being

weaker at the deeper level. The right pulses are generally rapid and

slippery, the Spleen position is deficient. Ki pulses are deep and

weak. Some days Ki Yin is stronger than Ki Yang and other days it

is reversed. If his eye lid is infected then the pulses change of

course and they tend to become more wiry and superficial.

 

He also takes Kava and Valerian to help relax (self prescribed).

 

From the above symptoms my diagnosis would be Liver Kidney Yin

deficiency with Liver Yang rising and internal wind.

 

I don't know how much his meds change his tongue and pulse-I think

he may have LJ dampheat (gout) and also possibly some phlem (he is

about 35lbs overweight, scar tissue, foot numbness)

 

I'm thinking of Tian Ma Gou Teng Yin modified for him. I'm not sure

of how to modify it or if it is the correct formula.

 

He has been responding well to acupuncture. He no longer walks with

a limp, he has stopped taking Soma and Vicodin for pain and now

relies on Bextra for pain management. He feels that his pain now is

more related to disc problems. He has been counseled in dietary

changes to reduce inflammation.

 

I could really use help in formulating a formula for him. Thanks

Denise

[Guest guest]

does the central crack extend to involve tip of tongue?

 

say something about color changes on face?

 

holmes

 

mountainwarp wrote:

 

> Hi All. I would greatly appreciate herbal advice for the following

> case.

>

> I have a 43 y/o male patient that I have been treating with

> acupuncture for low back pain. He has been responding well to the

> acupuncture and I would like to to add herbs but I don't know what

> to prescribe. Maybe I need some help seeing the forest thru the

> trees

>

> He has a long history of back pain beginning in 1987 with a disc

> herniation that required a laminectomy at L4. In 2003 he reinjured

> his back and required a second laminectomy at L5. In 2005 he

> reinjured his back and sufferred another herniation at L5/S1. He

> and his surgeon want to avoid another surgery. He has been

> diagnosed with degenerative disc disease and disc protrusions from

> L3 to L5.

>

> He has dull achy pain along the GV, UB and GB meridians of both

> sides. He has a lump of scar tissue at the R UB 23 area that feels

> like phlem congestion. And numbness in his R foot along the SP and

> ST meridians. Pain is worse with activity and changes in weather.

> Better with rest and heat. His feet are cold and have been cold

> since injuring his back. Seems straight forward: wind damp cold bi

> with Ki Qi/Yang deficiency also Qi and Blood stagnation.

>

> Here is where I get confused. He is a smoker and tends to get a

> sore and hoarse voice when he talks. He has high blood pressure

> which is controlled by medication. He is highly irritible and prone

> to outbursts of anger for which he takes Paxil and Wellbutrin . He

> has gout in his foot which is controlled by medication, but he will

> flare up if he stops taking it. He is also just over 90 days sober

> and possibly still in the detoxification phase- he has times when

> his body is very shakey and his hands tremble. He has bad teeth-

> upper and lower dentures. He is prone to HSV 1 infections at the

> corners of his lips(occur when stressed) and infections of his eye

> lid (generally due to rubbing it when he is stressed)

>

> His tongue is candy apple red, no coat, center crack, short and

> trembling. Tongue is possibly a little puffy. Pulses are generally

> rapid wiry and slippery on the left. With the Liver pulse being

> weaker at the deeper level. The right pulses are generally rapid and

> slippery, the Spleen position is deficient. Ki pulses are deep and

> weak. Some days Ki Yin is stronger than Ki Yang and other days it

> is reversed. If his eye lid is infected then the pulses change of

> course and they tend to become more wiry and superficial.

>

> He also takes Kava and Valerian to help relax (self prescribed).

>

> >From the above symptoms my diagnosis would be Liver Kidney Yin

> deficiency with Liver Yang rising and internal wind.

>

> I don't know how much his meds change his tongue and pulse-I think

> he may have LJ dampheat (gout) and also possibly some phlem (he is

> about 35lbs overweight, scar tissue, foot numbness)

>

> I'm thinking of Tian Ma Gou Teng Yin modified for him. I'm not sure

> of how to modify it or if it is the correct formula.

>

> He has been responding well to acupuncture. He no longer walks with

> a limp, he has stopped taking Soma and Vicodin for pain and now

> relies on Bextra for pain management. He feels that his pain now is

> more related to disc problems. He has been counseled in dietary

> changes to reduce inflammation.

>

> I could really use help in formulating a formula for him. Thanks

> Denise

>

>

>

>

>

>

>

 

 

 

 

[Guest guest]

central crack does not extend to tip. I can't remember exact facial

colors. Maybe yellowish complexion with slightly red cheeks. D.

 

Chinese Medicine , dkakobad

<dkaikobad@c...> wrote:

> does the central crack extend to involve tip of tongue?

>

> say something about color changes on face?

>

> holmes

>

> mountainwarp wrote:

>

> > Hi All. I would greatly appreciate herbal advice for the

following

> > case.

> >

> > I have a 43 y/o male patient that I have been treating with

> > acupuncture for low back pain. He has been responding well to

the

> > acupuncture and I would like to to add herbs but I don't know

what

> > to prescribe. Maybe I need some help seeing the forest thru the

> > trees

> >

> > He has a long history of back pain beginning in 1987 with a disc

> > herniation that required a laminectomy at L4. In 2003 he

reinjured

> > his back and required a second laminectomy at L5. In 2005 he

> > reinjured his back and sufferred another herniation at L5/S1. He

> > and his surgeon want to avoid another surgery. He has been

> > diagnosed with degenerative disc disease and disc protrusions

from

> > L3 to L5.

> >

> > He has dull achy pain along the GV, UB and GB meridians of both

> > sides. He has a lump of scar tissue at the R UB 23 area that

feels

> > like phlem congestion. And numbness in his R foot along the SP

and

> > ST meridians. Pain is worse with activity and changes in

weather.

> > Better with rest and heat. His feet are cold and have been cold

> > since injuring his back. Seems straight forward: wind damp

cold bi

> > with Ki Qi/Yang deficiency also Qi and Blood stagnation.

> >

> > Here is where I get confused. He is a smoker and tends to get a

> > sore and hoarse voice when he talks. He has high blood pressure

> > which is controlled by medication. He is highly irritible and

prone

> > to outbursts of anger for which he takes Paxil and Wellbutrin .

He

> > has gout in his foot which is controlled by medication, but he

will

> > flare up if he stops taking it. He is also just over 90 days

sober

> > and possibly still in the detoxification phase- he has times when

> > his body is very shakey and his hands tremble. He has bad teeth-

> > upper and lower dentures. He is prone to HSV 1 infections at the

> > corners of his lips(occur when stressed) and infections of his

eye

> > lid (generally due to rubbing it when he is stressed)

> >

> > His tongue is candy apple red, no coat, center crack, short and

> > trembling. Tongue is possibly a little puffy. Pulses are

generally

> > rapid wiry and slippery on the left. With the Liver pulse being

> > weaker at the deeper level. The right pulses are generally rapid

and

> > slippery, the Spleen position is deficient. Ki pulses are deep

and

> > weak. Some days Ki Yin is stronger than Ki Yang and other days

it

> > is reversed. If his eye lid is infected then the pulses change of

> > course and they tend to become more wiry and superficial.

> >

> > He also takes Kava and Valerian to help relax (self prescribed).

> >

> > >From the above symptoms my diagnosis would be Liver Kidney Yin

> > deficiency with Liver Yang rising and internal wind.

> >

> > I don't know how much his meds change his tongue and pulse-I

think

> > he may have LJ dampheat (gout) and also possibly some phlem (he

is

> > about 35lbs overweight, scar tissue, foot numbness)

> >

> > I'm thinking of Tian Ma Gou Teng Yin modified for him. I'm not

sure

> > of how to modify it or if it is the correct formula.

> >

> > He has been responding well to acupuncture. He no longer walks

with

> > a limp, he has stopped taking Soma and Vicodin for pain and now

> > relies on Bextra for pain management. He feels that his pain now

is

> > more related to disc problems. He has been counseled in dietary

> > changes to reduce inflammation.

> >

> > I could really use help in formulating a formula for him. Thanks

> > Denise

> >

> >

> >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

I have had very good results suggesting MSM with Glucosamine. I tell my clients

that they can get these at very low cost from Puritan's Pride or Wal-Mart.

 

Dr. Joseph Monticello

 

mountainwarp <twoocean39 wrote:

central crack does not extend to tip. I can't remember exact facial

colors. Maybe yellowish complexion with slightly red cheeks. D.

 

Chinese Medicine , dkakobad

<dkaikobad@c...> wrote:

> does the central crack extend to involve tip of tongue?

>

> say something about color changes on face?

>

> holmes

>

> mountainwarp wrote:

>

> > Hi All. I would greatly appreciate herbal advice for the

following

> > case.

> >

> > I have a 43 y/o male patient that I have been treating with

> > acupuncture for low back pain. He has been responding well to

the

> > acupuncture and I would like to to add herbs but I don't know

what

> > to prescribe. Maybe I need some help seeing the forest thru the

> > trees

> >

> > He has a long history of back pain beginning in 1987 with a disc

> > herniation that required a laminectomy at L4. In 2003 he

reinjured

> > his back and required a second laminectomy at L5. In 2005 he

> > reinjured his back and sufferred another herniation at L5/S1. He

> > and his surgeon want to avoid another surgery. He has been

> > diagnosed with degenerative disc disease and disc protrusions

from

> > L3 to L5.

> >

> > He has dull achy pain along the GV, UB and GB meridians of both

> > sides. He has a lump of scar tissue at the R UB 23 area that

feels

> > like phlem congestion. And numbness in his R foot along the SP

and

> > ST meridians. Pain is worse with activity and changes in

weather.

> > Better with rest and heat. His feet are cold and have been cold

> > since injuring his back. Seems straight forward: wind damp

cold bi

> > with Ki Qi/Yang deficiency also Qi and Blood stagnation.

> >

> > Here is where I get confused. He is a smoker and tends to get a

> > sore and hoarse voice when he talks. He has high blood pressure

> > which is controlled by medication. He is highly irritible and

prone

> > to outbursts of anger for which he takes Paxil and Wellbutrin .

He

> > has gout in his foot which is controlled by medication, but he

will

> > flare up if he stops taking it. He is also just over 90 days

sober

> > and possibly still in the detoxification phase- he has times when

> > his body is very shakey and his hands tremble. He has bad teeth-

> > upper and lower dentures. He is prone to HSV 1 infections at the

> > corners of his lips(occur when stressed) and infections of his

eye

> > lid (generally due to rubbing it when he is stressed)

> >

> > His tongue is candy apple red, no coat, center crack, short and

> > trembling. Tongue is possibly a little puffy. Pulses are

generally

> > rapid wiry and slippery on the left. With the Liver pulse being

> > weaker at the deeper level. The right pulses are generally rapid

and

> > slippery, the Spleen position is deficient. Ki pulses are deep

and

> > weak. Some days Ki Yin is stronger than Ki Yang and other days

it

> > is reversed. If his eye lid is infected then the pulses change of

> > course and they tend to become more wiry and superficial.

> >

> > He also takes Kava and Valerian to help relax (self prescribed).

> >

> > >From the above symptoms my diagnosis would be Liver Kidney Yin

> > deficiency with Liver Yang rising and internal wind.

> >

> > I don't know how much his meds change his tongue and pulse-I

think

> > he may have LJ dampheat (gout) and also possibly some phlem (he

is

> > about 35lbs overweight, scar tissue, foot numbness)

> >

> > I'm thinking of Tian Ma Gou Teng Yin modified for him. I'm not

sure

> > of how to modify it or if it is the correct formula.

> >

> > He has been responding well to acupuncture. He no longer walks

with

> > a limp, he has stopped taking Soma and Vicodin for pain and now

> > relies on Bextra for pain management. He feels that his pain now

is

> > more related to disc problems. He has been counseled in dietary

> > changes to reduce inflammation.

> >

> > I could really use help in formulating a formula for him. Thanks

> > Denise

> >

> >

> >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

Hi Denise

 

> From the above symptoms my diagnosis would be Liver Kidney Yin

> deficiency with Liver Yang rising and internal wind. I don't know how

> much his meds change his tongue and pulse-I think he may have LJ

> dampheat (gout) and also possibly some phlegm (he is about 35lbs

> overweight, scar tissue, foot numbness)

 

Apart from any herbal Tx that you may decide, consider AP once/week

for 3-4 weeks. See:

http://www.yinyanghouse.com/chinesetheory/organdisharmony-KD.html

http://www.yinyanghouse.com/chinesetheory/etiology-menopause.html

http://www.yinyanghouse.com/chinesetheory/etiology-pms.html#lvkdyindef

 

LV/KI Yin Deficiency: Signs & Symptoms: More common in

perimenopausal women. Slight breast distention, irritability, sore back

a/or knees, dizziness, blurred vision, dry eyes a/or throat, heat in the 5

palms. Tongue: Red w/no coat Pulse: Floating, empty

 

Treatment Principle: Tonify LV Yin Tonify KI Yin Harmonize LV

 

Treatment Points (Maciocia):

LV08 - harmonize LV, tonify Blood & Yin

CV04 - tonify KI Yin

SP06 - tonify Yin

LV03 - harmonize LV, tonify Blood & Yin

Could add KI03 or KI06 - tonify KI Yin.

Could add the Shu points - BL18, BL23.

 

If the scar tissue has sensitive points, consider Neural Therapy with

intradermal blebs of 0.25% local anaesthetic at the sensitive Pts.

 

Also consider " Wind (Feng) Points " :

GB20 (or BL10);

BL12;

SI12,

GV16,

GB31;

TH17;

Bafeng (Eight Winds; on foot-dorsum, 4 points on each foot between

distal heads metatarsals 1-2 (LV02), 2-3 (ST44), 3-4 (NL02), 4-5

(GB43));

Fengguan (Wind Pass) at palm, at centre of proximal crease of finger

2);

Changfeng (Intestinal Wind; 1' lat to L2-L3 space, 0.5' med to BL23);

Fengyan (Wind's Cliff/Eye?; 0.5' ant to point midway from GV15 to inf

edge of earlobe, level with inf edge of mastoid process);

 

For gout, add LV03 + GB34 +/- BL18 or BL19.

 

For Phlegm, add ST40 (the " Banxia-Pinellia Pt " )

 

 

Best regards,

 

 

Tel: (H): +353-(0) or (M): +353-(0)

 

 

 

 

Ireland.

Tel: (W): +353-(0) or (M): +353-(0)

 

 

 

" Man who says it can't be done should not interrupt man doing it " -

Chinese Proverb