Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Hi folks, I would appreciate help with this case. I have treated him 14 times and had some positive results but he is starting to despair that his esophagus will ever heal. I have tried TCM treatments (Spleen deficiency with damp, Liver stagnation), Kiiko style (blood stagnation in the abdomen) and Dr. So’s treatment for esophageal stricture. 37 year old male scientist. Body type is tall and thin. Diagnosed with mild gastritis and esophageal inflammation resulting from GERD. Doctor says he has “pre-Barretts” esophagus. Main complaint: Burning pain that moves around in his abdomen and epigastrium. The most consistent pain is around CV 15; the area feels itchy and gets irritated every time he eats. Sometimes the pain radiates around the left side of the ribs and to the back. He also feels like food is pushing upward against his esophagus when he lies down. Walking helps. Symptoms are worst between 1-6pm and better at night. Symptoms range between .5-2 out of 10 (10 is worst). Symptoms began 10 years ago but have been worse since January. He has a history of working late hours and eating large meals. Now he has restricted his diet, cutting out acidic and spicy food, and is only eating mashed food to alleviate the esophageal irritation. He lost 15 lbs since January but has recently been able to put a few lbs back on. Other symptoms: High stress over job and health, irritable, short tempered, hard to let things go. Cough with white mucus in the morning and after big meals. Arthritis in knees. Small purple spider veins along ribs. Tongue: Very swollen, slightly purple, white thick greasy coat Pulse: Thin and wiry, right side Kidney position weak. Sometimes Lung and/or Spleen positions are also weak. Left Kidney sometimes feels slippery. Symptoms that have gone away during the course of treatment: Pulling sensation at armpits, groin, and neck, swollen sensation in head, loose stool with undigested food, tendency to feel chilled. _______________ Catch suspicious messages before you open them—with Windows Live Hotmail. http://imagine-windowslive.com/hotmail/?locale=en-us & ocid=TXT_TAGHM_migration_HM\ _mini_protection_0507 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Hello: I would go onto the DogtorJ.com website to see the diet advice from Dr. John Symes, a veterinarian whom has Crohn's disease himself. He has GERD diet recommendations.He also has natural ways to treat epilepsy.This is not TCM persee, but it definetly is Food Therapy.Today's processed foods contribute to the symtoms.If the client had EFT done, this also does come from TCM and the psychopsomatic disease cycle.Your work will allow him to be able to get to and through the other changes that must take place. Sincerely, Patricia Jordan DVM,CVA,CTCVM & Herbology " Emily Konstan " <emilylists Chinese Medicine Chinese Medicine help requested, GERD case Fri, 18 May 2007 19:06:30 -0400 Hi folks, _______________ Catch suspicious messages before you open them—with Windows Live Hotmail. http://imagine-windowslive.com/hotmail/?locale=en-us & ocid=TXT_TAGHM_migration_HM\ _mini_protection_0507 Subscribe to the fee online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Chinese Medicine , " Emily Konstan " <emilylists wrote: > > Hi folks, > > I would appreciate help with this case. I have treated him 14 times and had > some positive results but he is starting to despair that his esophagus will > ever heal. Are you trained with herbs? It seems like Bao He Wan with additions to strengthen might help.(Additions since his pulse is thin and not slippery, and he himself is thin as well and has lost weight) I've been adding Jiao Gu Lan to some of my formulas to supplement. He Ge Ye is also good for blockage sensation in the esophagus. Duan Mu LI might help with the burning if he has too much acid. He might also have burning from too little stomach acid though, so be careful. This formula would be appropriate if he has a sensation of undigested food. It treats only the stagnations, not the root of the problem. If the food is blocked from descending it would be appropriate. For REN 15 pain, oketsu is not used. Try Sp 6 or Sp 9 and see if that relieves the pain, and check the pericardium channel as well, for Kiiko's PC treatment. Regards, Gabrielle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2007 Report Share Posted May 20, 2007 Emily, I am a Five Element acupuncturist and this guy's situation sounds like Wood controlling Earth...have you discussed anger issues with him? I sense a lot of irritation in bodymindspirit. I'd also recommend/teach him how to meditate, and to use this to find out what is at the heart of the problem. He apparently " can't stomach " whatever is bugging him. If it's worse between 1-6 pm, you're looking at Small Intestine, Bladder, and Kidney time. This could mean that since Wood is overcontrolling Earth, Earth also controls Water, which has collapsed. On a more mundane level, what happens to him in the afternoon? Is he at work, interacting with people he dislikes? Or doing projects he detests? What is rubbing him the wrong way? I have a feeling some lifestyle changes may be in order for him. Certainly, treating Earth within Wood (i.e., Liv 3) could be important. Although I imagine you've already treated the Four Gates....Liv 5 might be helpful because it is " Insect Ditch " , and it sure sounds as if he is in an insect ditch! If you'd like more suggestions along the Five Element perspective, feel free to contact me offline. Good luck! Donna Greenberg Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2007 Report Share Posted May 20, 2007 Hi Emily, I have some questions that may assist in making suggestions for your patient- How frequently have you been treating him with acupuncture? Is he taking any herbs? Medication? Antacids? Are you treating the area around CV-15? Have you tried treating the corresponding area on his back? In addition to Spleen Qi vacuity and Liver Qi Stagnation, it sounds like he also has rebellious Stomach Qi. Have you treated him for this? The purple spider veins indicate not only Qi Stagnation, but also Blood Stagnation. Does he have any trouble digesting fats? Is his diet high in fatty, fried or rich foods? Does he have a history of gallbladder disease? Does he have any signs or symptoms of heat or cold? Based on the info below, I would treat him for food stagnation and rebellious stomach qi, with liver qi and blood stagnation and underlying spleen qi vacuity. I would make recommendations for a low-fat diet of simple, well-cooked foods (lots of veggies, small amounts of grains and lean proteins, low fat, no spice or acids). I would also recommend that he practice eating in a relaxed environment and manner - this will likely be a significant life change for him - and to have several very small meals per day, chew his food well before swallowing, and maybe even learn to meditate before eating. Or take a short, relaxed walk before eating, to get his qi moving. I have seen a number of patients with symptoms that are similar to your patients'. I always look at backing the liver (wood) from invading the spleen and stomach (earth) first, then strengthening earth imbalances second. I would also work on calming the shen, and clearing any heat that may be present. Points that have been useful for my patients include Liv-14, Liv-13, GB-24, GB-25, Ren-12, ST-44, Liv-2, and Liv-3. I also often do ah-shi needling along the lower edge of the ribcage if that area is tender, threading the area shallowly from the midline towards the gallbladder channel. Other points I select depend on other signs and symptoms of the patient. I would definitely treat Ren-15 on your patient, since it bothers him so much. I would also look at the pressure symptom he has in his esophagus, and ask questions that may help you ferret out whether he also has plum pit qi. Ban Xia Hou Po Tang, the formula for that, may ease may of his symptoms and the underlying causes as well, with the exception of blood stagnation. You may want to look at a variation of Xue Fu Zhu Yu Tang for that, with herbs that would place greater emphasis on the stomach than the chest. Good luck. Sounds like an interesting case that you can help alot. You may need to see him a couple of times a week to make a big change, though, and then reduce your frequency. Emily Konstan <emilylists wrote: Hi folks, I would appreciate help with this case. I have treated him 14 times and had some positive results but he is starting to despair that his esophagus will ever heal. I have tried TCM treatments (Spleen deficiency with damp, Liver stagnation), Kiiko style (blood stagnation in the abdomen) and Dr. So’s treatment for esophageal stricture. 37 year old male scientist. Body type is tall and thin. Diagnosed with mild gastritis and esophageal inflammation resulting from GERD. Doctor says he has “pre-Barretts” esophagus. Main complaint: Burning pain that moves around in his abdomen and epigastrium. The most consistent pain is around CV 15; the area feels itchy and gets irritated every time he eats. Sometimes the pain radiates around the left side of the ribs and to the back. He also feels like food is pushing upward against his esophagus when he lies down. Walking helps. Symptoms are worst between 1-6pm and better at night. Symptoms range between .5-2 out of 10 (10 is worst). Symptoms began 10 years ago but have been worse since January. He has a history of working late hours and eating large meals. Now he has restricted his diet, cutting out acidic and spicy food, and is only eating mashed food to alleviate the esophageal irritation. He lost 15 lbs since January but has recently been able to put a few lbs back on. Other symptoms: High stress over job and health, irritable, short tempered, hard to let things go. Cough with white mucus in the morning and after big meals. Arthritis in knees. Small purple spider veins along ribs. Tongue: Very swollen, slightly purple, white thick greasy coat Pulse: Thin and wiry, right side Kidney position weak. Sometimes Lung and/or Spleen positions are also weak. Left Kidney sometimes feels slippery. Symptoms that have gone away during the course of treatment: Pulling sensation at armpits, groin, and neck, swollen sensation in head, loose stool with undigested food, tendency to feel chilled. _______________ Catch suspicious messages before you open them—with Windows Live Hotmail. http://imagine-windowslive.com/hotmail/?locale=en-us & ocid=TXT_TAGHM_migration_HM\ _mini_protection_0507 Subscribe to the fee online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2007 Report Share Posted May 20, 2007 Hi Andrea, Thanks to you and everyone else who shared their thoughts. To answer your questions: How frequently have you been treating him with acupuncture? I see him twice a week, usually Tuesday and Saturday. Is he taking any herbs? Medication? Antacids? He is on prescription ranitidine and carafate. My colleague gave him homeopathics and I am trying to convince him to take Chinese herbs, but he is worried that it will aggravate his symptoms. He also likes to self-medicate with probiotics, licorice, and other supplements (I don't have his file in front of me to give more specifics.) Are you treating the area around CV-15? Have you tried treating the corresponding area on his back? I have treated CV 15 and 14, also BL 15 and 17 and the huatos of BL 15-18. Right now he does not want back treatments because he says he feels pressure on his esophagus, even if I treat him sitting up. In addition to Spleen Qi vacuity and Liver Qi Stagnation, it sounds like he also has rebellious Stomach Qi. Have you treated him for this? The purple spider veins indicate not only Qi Stagnation, but also Blood Stagnation. I think I have tried most of the usual suspects for rebellious ST Qi-- ST 43/44, LV 14, GB 24, CV 17/22, GB 21. I also tried bleeding the spider veins but he did not respond well to that treatment. Interestingly, he does not have any pressure pain on the abdomen, just the vague burning that moves from place to place. Does he have any trouble digesting fats? Is his diet high in fatty, fried or rich foods? Does he have a history of gallbladder disease? No problems with this that I know of. His diet right now is mostly mashed veggies, oatmeal, rice, and a Boost shake. I sent him to a nutritionist who wanted him to add more fiber, but he says that irritates his esophagus. He has been pretty good about eating smaller portions and not drinking with his meals Does he have any signs or symptoms of heat or cold? For heat sx, just the burning pain and maybe the irritability. He had been feeling chilled easily, but he says that has gone away. I had been doing mostly straight TCM style based on his patterns, but I found the Dr. So treatment and we have been sticking with that for the past 5 visits. It is: LI 4, LU 7 and 9, ST 36 and 44, GB 21, CV 22, 12, 13, moxa CV 16 and 17, BL 15 and 17 with needle and moxa (of course, we are skipping the back treatment right now). The points pretty much fit his pattern (although I'm not sure why choose the LU 7/9) , and it seems to be helping. At his request, the second half of the treatment I focus on relaxation-- I take out all the needles except LI 4, and add LV 3, PC 6, yintang, and pressballs at shenmen. He is a very worried guy and I am constantly encouraging him to stay optimistic. This week he seems pretty happy and says that he is " stable. " He is willing to come for 5 more treatments, so I am hoping he will notice enough change and decide to continue with treatments. Again, thanks to everyone for your help. Emily ----Original Message Follows---- < Chinese Medicine Chinese Medicine Re: help requested, GERD case Sun, 20 May 2007 09:17:30 -0700 (PDT) Hi Emily, I have some questions that may assist in making suggestions for your patient- How frequently have you been treating him with acupuncture? Is he taking any herbs? Medication? Antacids? Are you treating the area around CV-15? Have you tried treating the corresponding area on his back? In addition to Spleen Qi vacuity and Liver Qi Stagnation, it sounds like he also has rebellious Stomach Qi. Have you treated him for this? The purple spider veins indicate not only Qi Stagnation, but also Blood Stagnation. Does he have any trouble digesting fats? Is his diet high in fatty, fried or rich foods? Does he have a history of gallbladder disease? Does he have any signs or symptoms of heat or cold? Based on the info below, I would treat him for food stagnation and rebellious stomach qi, with liver qi and blood stagnation and underlying spleen qi vacuity. I would make recommendations for a low-fat diet of simple, well-cooked foods (lots of veggies, small amounts of grains and lean proteins, low fat, no spice or acids). I would also recommend that he practice eating in a relaxed environment and manner - this will likely be a significant life change for him - and to have several very small meals per day, chew his food well before swallowing, and maybe even learn to meditate before eating. Or take a short, relaxed walk before eating, to get his qi moving. I have seen a number of patients with symptoms that are similar to your patients'. I always look at backing the liver (wood) from invading the spleen and stomach (earth) first, then strengthening earth imbalances second. I would also work on calming the shen, and clearing any heat that may be present. Points that have been useful for my patients include Liv-14, Liv-13, GB-24, GB-25, Ren-12, ST-44, Liv-2, and Liv-3. I also often do ah-shi needling along the lower edge of the ribcage if that area is tender, threading the area shallowly from the midline towards the gallbladder channel. Other points I select depend on other signs and symptoms of the patient. I would definitely treat Ren-15 on your patient, since it bothers him so much. I would also look at the pressure symptom he has in his esophagus, and ask questions that may help you ferret out whether he also has plum pit qi. Ban Xia Hou Po Tang, the formula for that, may ease may of his symptoms and the underlying causes as well, with the exception of blood stagnation. You may want to look at a variation of Xue Fu Zhu Yu Tang for that, with herbs that would place greater emphasis on the stomach than the chest. Good luck. Sounds like an interesting case that you can help alot. You may need to see him a couple of times a week to make a big change, though, and then reduce your frequency. _______________ Catch suspicious messages before you open them—with Windows Live Hotmail. http://imagine-windowslive.com/hotmail/?locale=en-us & ocid=TXT_TAGHM_migration_HM\ _mini_protection_0507 Quote Link to comment Share on other sites More sharing options...
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