Guest guest Posted May 23, 2007 Report Share Posted May 23, 2007 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 with epigastric/stomach pain, dx age 7. Genetic mutation of cystic fibrosis, 2 younger paternal cousins now found to also have mutation. Pain is supraumbilical area, dull, diffuse, extreme, occ radiates around back. Worse with pressure, not with rebound, no change with hot or cold application, but better with intake of cold during attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT because it would help pain, just that it felt good. " History of approximately annual hospitalizations lasting 5-7 days for px control. Is in pain mgmt program. Pancreas currently scarred and shrinking. Since approximately at the onset puberty/menses age 13, pain worse, more frequent attacks lasting longer, more difficult to control, higher on pain scale. MDs said puberty/hormones will either lessen or exacerbate. More frequent hospitalizations in last 2 years with longer duration, missing a lot of school and has quit all athletics and activities. Desires pain control and decrease in frequency of attacks. Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, freckled body. cold feet and hands, does not feel generally cold or hot (but mother claims she seems cold and is frequently sweatered). Catches colds easily and frequently. Fatigued most days, very fatigued on days of pain, now occurring twice weekly, each with additional day of residual pain. During attacks, can only get from bed to couch but rarely complains. Reports generally happy and outgoing (mother concurs) but quiet during attacks. Hypotensive. Cycles unremarkable. Poor appetite overall and worse with pain attacks, gets full quickly. no bloating, no gas. BMs hard but long and formed QOD, q3 days, probably due to meds, not particularly odorous. Dry skin, tends towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas from meds. Belly warm to touch. Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but she thinks that's because she enjoys the " comfort " of lots of blankets (not because she's cold). No known correlation of emotions or events that trigger episodes, spontaneous. Tongue wide, red, slight white coat towards rear, no coat anterior, slightly redder tip. Very slightly scalloped and shiny edges. Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl wiry in liver. Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl anti-spasmodic, benadryl for itching from the meds, and a couple of other pain meds she didn't bring with her when the pain worsens. I have a couple of ideas for formulas, but I am a bit confounded by exact diagnosis, possibly due to how meds are changing her diagnostic signs. Seems to have a Lung-Spleen constitution (?) and yin is damaged, but overall, pulse seems to indicate some damp/heat (or is this the meds?), while tongue more yin xu heat. Is this liver- gallbladder/stomach-spleen? I was considering a variation of Dan Shen Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. Would a short-term of Long Dan Xie Gan T be worth considering despite no extraordinary damp signs or is she not hot enough? Short term Da Chai Hu Tang modified for px? I am considering giving a formula for acute attacks while using a nourishing one between. Overall, I'm a bit confounded as to which direction to go and acknowledge that I may be way off with my initial thoughts. Hoping for feedback, Vickii Gervais, LM, LAc Wild Harmony Wellness Center San Diego CA 92115 619.286.2888 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2007 Report Share Posted May 23, 2007 Yes, very difficult case and a good presenstation on your part. To me, I would look more toward Stomach/Spleen and Liver Yin Xu. This is based on the early onset, probably not an aquired lifestyle excess condition, and the genetic components. There is also diffuse pain. The popsicles probably just mask-freeze the pain and don't indicate a heat condition. You also seem to allude to Yin Xu over all. I would suggest you look at Yi Guan Jian. The Chuan Lian Zi is the only herb for pain but it tends to work well for digestive issues especially aroung the liver-gallbladder-pancreas axis. Doug , " vickiimidwife " <vickiimidwife wrote: > > Overall, I'm a bit confounded as to which direction to go and > acknowledge that I may be way off with my initial thoughts. > > 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 > with epigastric/stomach pain, dx age 7. Genetic mutation of cystic > fibrosis, 2 younger paternal cousins now found to also have mutation. > > Pain is supraumbilical area, dull, diffuse, extreme, occ radiates > around back. Worse with pressure, not with rebound, no change with > hot or cold application, but better with intake of cold during > attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT > because it would help pain, just that it felt good. " > > History of approximately annual hospitalizations lasting 5-7 days for > px control. Is in pain mgmt program. Pancreas currently scarred and > shrinking. Since approximately at the onset puberty/menses age 13, > pain worse, more frequent attacks lasting longer, more difficult to > control, higher on pain scale. MDs said puberty/hormones will either > lessen or exacerbate. More frequent hospitalizations in last 2 years > with longer duration, missing a lot of school and has quit all > athletics and activities. Desires pain control and decrease in > frequency of attacks. > > Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, > freckled body. cold feet and hands, does not feel generally cold or > hot (but mother claims she seems cold and is frequently sweatered). > Catches colds easily and frequently. Fatigued most days, very > fatigued on days of pain, now occurring twice weekly, each with > additional day of residual pain. During attacks, can only get from > bed to couch but rarely complains. Reports generally happy and > outgoing (mother concurs) but quiet during attacks. Hypotensive. > > Cycles unremarkable. > > Poor appetite overall and worse with pain attacks, gets full quickly. > no bloating, no gas. BMs hard but long and formed QOD, q3 days, > probably due to meds, not particularly odorous. Dry skin, tends > towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas > from meds. Belly warm to touch. > > Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but > she thinks that's because she enjoys the " comfort " of lots of > blankets (not because she's cold). > > No known correlation of emotions or events that trigger episodes, > spontaneous. > > Tongue wide, red, slight white coat towards rear, no coat anterior, > slightly redder tip. Very slightly scalloped and shiny edges. > Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl > wiry in liver. > > Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl > anti-spasmodic, benadryl for itching from the meds, and a couple of > other pain meds she didn't bring with her when the pain worsens. > > I have a couple of ideas for formulas, but I am a bit confounded by > exact diagnosis, possibly due to how meds are changing her diagnostic > signs. Seems to have a Lung-Spleen constitution (?) and yin is > damaged, but overall, pulse seems to indicate some damp/heat (or is > this the meds?), while tongue more yin xu heat. Is this liver- > gallbladder/stomach-spleen? I was considering a variation of Dan Shen > Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. > Would a short-term of Long Dan Xie Gan T be worth considering despite > no extraordinary damp signs or is she not hot enough? Short term Da > Chai Hu Tang? > > Vickii Gervais, LM, LAc > Wild Harmony Wellness Center > San Diego CA 92115 > 619.286.2888 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2007 Report Share Posted May 24, 2007 With chronic disease, there is usually also a component of blood stagnation. You might look at adding Yu Jin and Yan Hu Suo to the formula, since they both address abdominal pain and blood stagnation. wrote: Yes, very difficult case and a good presenstation on your part. To me, I would look more toward Stomach/Spleen and Liver Yin Xu. This is based on the early onset, probably not an aquired lifestyle excess condition, and the genetic components. There is also diffuse pain. The popsicles probably just mask-freeze the pain and don't indicate a heat condition. You also seem to allude to Yin Xu over all. I would suggest you look at Yi Guan Jian. The Chuan Lian Zi is the only herb for pain but it tends to work well for digestive issues especially aroung the liver-gallbladder-pancreas axis. Doug , " vickiimidwife " <vickiimidwife wrote: > > Overall, I'm a bit confounded as to which direction to go and > acknowledge that I may be way off with my initial thoughts. > > 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 > with epigastric/stomach pain, dx age 7. Genetic mutation of cystic > fibrosis, 2 younger paternal cousins now found to also have mutation. > > Pain is supraumbilical area, dull, diffuse, extreme, occ radiates > around back. Worse with pressure, not with rebound, no change with > hot or cold application, but better with intake of cold during > attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT > because it would help pain, just that it felt good. " > > History of approximately annual hospitalizations lasting 5-7 days for > px control. Is in pain mgmt program. Pancreas currently scarred and > shrinking. Since approximately at the onset puberty/menses age 13, > pain worse, more frequent attacks lasting longer, more difficult to > control, higher on pain scale. MDs said puberty/hormones will either > lessen or exacerbate. More frequent hospitalizations in last 2 years > with longer duration, missing a lot of school and has quit all > athletics and activities. Desires pain control and decrease in > frequency of attacks. > > Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, > freckled body. cold feet and hands, does not feel generally cold or > hot (but mother claims she seems cold and is frequently sweatered). > Catches colds easily and frequently. Fatigued most days, very > fatigued on days of pain, now occurring twice weekly, each with > additional day of residual pain. During attacks, can only get from > bed to couch but rarely complains. Reports generally happy and > outgoing (mother concurs) but quiet during attacks. Hypotensive. > > Cycles unremarkable. > > Poor appetite overall and worse with pain attacks, gets full quickly. > no bloating, no gas. BMs hard but long and formed QOD, q3 days, > probably due to meds, not particularly odorous. Dry skin, tends > towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas > from meds. Belly warm to touch. > > Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but > she thinks that's because she enjoys the " comfort " of lots of > blankets (not because she's cold). > > No known correlation of emotions or events that trigger episodes, > spontaneous. > > Tongue wide, red, slight white coat towards rear, no coat anterior, > slightly redder tip. Very slightly scalloped and shiny edges. > Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl > wiry in liver. > > Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl > anti-spasmodic, benadryl for itching from the meds, and a couple of > other pain meds she didn't bring with her when the pain worsens. > > I have a couple of ideas for formulas, but I am a bit confounded by > exact diagnosis, possibly due to how meds are changing her diagnostic > signs. Seems to have a Lung-Spleen constitution (?) and yin is > damaged, but overall, pulse seems to indicate some damp/heat (or is > this the meds?), while tongue more yin xu heat. Is this liver- > gallbladder/stomach-spleen? I was considering a variation of Dan Shen > Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. > Would a short-term of Long Dan Xie Gan T be worth considering despite > no extraordinary damp signs or is she not hot enough? Short term Da > Chai Hu Tang? > > Vickii Gervais, LM, LAc > Wild Harmony Wellness Center > San Diego CA 92115 > 619.286.2888 > Finding fabulous fares is fun. Let FareChase search your favorite travel sites to find flight and hotel bargains. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2007 Report Share Posted May 24, 2007 Any relationship to her menstrual cycle? Popsicles might not have anything to do with cold, but could just be the analgesic effect of sugar water. Does she exercise? I wouldn't rule out simple Qi Zhi - the relationship to her cycle and effect of exercise might help you eliminate this possibility. Geoff , " " wrote: > > Yes, very difficult case and a good presenstation on your part. To me, > I would look more toward Stomach/Spleen and Liver Yin Xu. This is > based on the early onset, probably not an aquired lifestyle excess > condition, and the genetic components. There is also diffuse pain. The > popsicles probably just mask-freeze the pain and don't indicate a heat Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 Hi Vikii, I think it is important to clarify your diagnosis before giving a formula. All the formulas you mentioned are just guesses at this point. I have a couple of questions regarding your excellent intake information. First, when you say " no coat anterior " does this mean it is peeled or just that there is no pathological coat? Also, you said that the sides are shiny. Are they shiny red or are there any fissures on the sides? This would make a lot of difference to me. Assuming that the sides are shiny red and that the anterior is peeled (lacking any coat) here is what I would think in terms of diagnosis: First, you know heat because cool makes it better, red tongue. You know that there is Yin vacuity of the Spleen and Stomach because of the peeled anterior combined with the digestive symptoms and the red shiny sides of the tongue. So, then, some of the heat is vacuity heat. But, her tongue is large and red so some of the heat is excess heat (depressive) I would never diagnose dampheat based soley on a slippery rapid pulse - I do not see any Liver involvement - stress does not make it worse. Maybe Liver Yin Xu with the red shiny sides. So, I would diagnose Spleen and Stomach Yin vacuity which can explain all of her signs and symptoms. The Yin is important for the flow of Qi and food in the digestion as it keeps things soft and moist. Pain is always stagnation and Yin deficiency in the digestion can easily cause stagnation. The stagnation can explain the depressive heat aspect to this. night sweats, dry skin, dry stool, dry hair. Even the cold hands and feet since the Yin is needed to help the Yang spread to the extremities. There is some dampness - we know because her tongue is large - but there are no symptoms of dampness or obvious signs of accumulated water. The slightly thicker moss on the rear of the tongue is normal. To me this means just that the pathological heat is steaming up fluids and creating some swelling. Parching or draining damp would not be right. It's also not right to use pungent herbs to open Qi stasis as these would further damage the Yin. Using a very bitter draining formula like Long Dan Xie Gan Tang would also be contraindicated imo. So, I would say that you need to moisten the Yin of her Spleen and Stomach. It seems key to moisten her stool and have your method encourage daily bowel movements. Obviously this is key for any stasis. Clearing the stasis should clear the depressive Qi but you will also need to clear empty heat in her Spleen and Stomach. Stopping pain should be by emolliating rather than pungently opening. You can imagine that this CF has caused her digestive tract to become dry and brittle so your methods should moisten and soften. The methods you suggested, though they are thinking about stopping pain, they are not addressing the real reason for the pain and I think would make her worse. Since it is a genetic chromosomal issue she will probably use the herbs to help her manage this for the rest of her life. Here is what I would suggest: (modified Yi Wei Tang) Xuan Shen 15 Mai Men Dong 15 Sheng Di Huang 15 Gan Cao 12 Bai Shao 15 Xi Yang Shen 12 Zhi Mu 12 Sha Shen 12 Dang Gui 12 Chi Shao 9 Good luck! Sharon Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 Hi Vikii, I think it is important to clarify your diagnosis before giving a formula. All the formulas you mentioned are just guesses at this point. I have a couple of questions regarding your excellent intake information. First, when you say " no coat anterior " does this mean it is peeled or just that there is no pathological coat? Also, you said that the sides are shiny. Are they shiny red or are there any fissures on the sides? This would make a lot of difference to me. Assuming that the sides are shiny red and that the anterior is peeled (lacking any coat) here is what I would think in terms of diagnosis: First, you know heat because cool makes it better, red tongue. You know that there is Yin vacuity of the Spleen and Stomach because of the peeled anterior combined with the digestive symptoms and the red shiny sides of the tongue. So, then, some of the heat is vacuity heat. But, her tongue is large and red so some of the heat is excess heat (depressive) I would never diagnose dampheat based soley on a slippery rapid pulse - I do not see any Liver involvement - stress does not make it worse. So, I would diagnose Spleen and Stomach Yin vacuity which can explain all of her signs and symptoms. The Yin is important for the flow of Qi and food in the digestion as it keeps things soft and moist. Pain is always stagnation and Yin deficiency in the digestion can easily cause stagnation. The stagnation can explain the depressive heat aspect to this. night sweats, dry skin, dry stool, dry hair. Even the cold hands and feet since the Yin is needed to help the Yang spread to the extremities. There is some dampness - we know because her tongue is large - but there are no symptoms of dampness or obvious signs of accumulated water. The slightly thicker moss on the rear of the tongue is normal. To me this means just that the pathological heat is steaming up fluids and creating some swelling. Parching or draining damp would not be right. It's also not right to use pungent herbs to open Qi stasis as these would further damage the Yin. Using a very bitter draining formula like Long Dan Xie Gan Tang would also be contraindicated imo. So, I would say that you need to moisten the Yin of her Spleen and Stomach. It seems key to moisten her stool and have your method encourage daily bowel movements. Obviously this is key for any stasis. Clearing the stasis should clear the depressive Qi but you will also need to clear empty heat in her Spleen and Stomach. Stopping pain should be by emolliating rather than pungently opening. You can imagine that this CF has caused her digestive tract to become dry and brittle so your methods should moisten and soften. The methods you suggested, though they are thinking about stopping pain, they are not addressing the real reason for the pain and I think would make her worse. Since it is a genetic chromosomal issue she will probably use the herbs to help her manage this for the rest of her life. Here is what I would suggest: (modified Yi Wei Tang) Xuan Shen 15 Mai Men Dong 15 Sheng Di Huang 15 Gan Cao 12 Bai Shao 15 Xi Yang Shen 12 Zhi Mu 12 Sha Shen 12 Dang Gui 12 Chi Shao 9 Good luck! Sharon 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 with epigastric/stomach pain, dx age 7. Genetic mutation of cystic fibrosis, 2 younger paternal cousins now found to also have mutation. Pain is supraumbilical area, dull, diffuse, extreme, occ radiates around back. Worse with pressure, not with rebound, no change with hot or cold application, but better with intake of cold during attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT because it would help pain, just that it felt good. " History of approximately annual hospitalizations lasting 5-7 days for px control. Is in pain mgmt program. Pancreas currently scarred and shrinking. Since approximately at the onset puberty/menses age 13, pain worse, more frequent attacks lasting longer, more difficult to control, higher on pain scale. MDs said puberty/hormones will either lessen or exacerbate. More frequent hospitalizations in last 2 years with longer duration, missing a lot of school and has quit all athletics and activities. Desires pain control and decrease in frequency of attacks. Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, freckled body. cold feet and hands, does not feel generally cold or hot (but mother claims she seems cold and is frequently sweatered). Catches colds easily and frequently. Fatigued most days, very fatigued on days of pain, now occurring twice weekly, each with additional day of residual pain. During attacks, can only get from bed to couch but rarely complains. Reports generally happy and outgoing (mother concurs) but quiet during attacks. Hypotensive. Cycles unremarkable. Poor appetite overall and worse with pain attacks, gets full quickly. no bloating, no gas. BMs hard but long and formed QOD, q3 days, probably due to meds, not particularly odorous. Dry skin, tends towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas from meds. Belly warm to touch. Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but she thinks that's because she enjoys the " comfort " of lots of blankets (not because she's cold). No known correlation of emotions or events that trigger episodes, spontaneous. Tongue wide, red, slight white coat towards rear, no coat anterior, slightly redder tip. Very slightly scalloped and shiny edges. Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl wiry in liver. Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl anti-spasmodic, benadryl for itching from the meds, and a couple of other pain meds she didn't bring with her when the pain worsens. I have a couple of ideas for formulas, but I am a bit confounded by exact diagnosis, possibly due to how meds are changing her diagnostic signs. Seems to have a Lung-Spleen constitution (?) and yin is damaged, but overall, pulse seems to indicate some damp/heat (or is this the meds?), while tongue more yin xu heat. Is this liver- gallbladder/stomach-spleen? I was considering a variation of Dan Shen Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. Would a short-term of Long Dan Xie Gan T be worth considering despite no extraordinary damp signs or is she not hot enough? Short term Da Chai Hu Tang modified for px? I am considering giving a formula for acute attacks while using a nourishing one between. Overall, I'm a bit confounded as to which direction to go and acknowledge that I may be way off with my initial thoughts. Hoping for feedback, Vickii Gervais, LM, LAc Wild Harmony Wellness Center San Diego CA 92115 619.286.2888 Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 Sharon, Overall I agree with your diagnosis, but I also see the need to supplement the qi of the spleen more. Why not include a bit of bai zhu and/or fu ling, and/or bai bian dou to aid the spleen qi and prevent cloying? Or even huang qi, which doesn't damage the yin fluids? Most prescriptions I've studied to supplement spleen yin at least mildly supplement spleen qi. On May 25, 2007, at 2:58 AM, sharon weizenbaum wrote: > > Here is what I would suggest: (modified Yi Wei Tang) > > Xuan Shen 15 > Mai Men Dong 15 > Sheng Di Huang 15 > Gan Cao 12 > Bai Shao 15 > Xi Yang Shen 12 > Zhi Mu 12 > Sha Shen 12 > Dang Gui 12 > Chi Shao 9 > > Good luck! > > Sharon > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2007 Report Share Posted May 27, 2007 Thank you Sharon & Z'ev. That does help narrow it down more, and I agree that I had trouble with the formula direction because I didn't feel solid about a diagnosis. Anterior coat is peeled, sides of tongue are shiny as in mirror-like. No fissures on sides. I'm glad you had the impression of " no real damp heat " as that was not a comfortable thought to me. I didn't feel her pulse matched the rest of her well, but again, she is on a lot of meds. So in terms of recommending yi wei tang, is the thought that nourishing yin will be enough to ultimately cause a decrease in pain? What about during pain attacks--no particular change and hope that the pain decreases soon enough? I've requested she call me during a pain attack so that I can treat her 3x in that week. I like Z'ev's idea of boosting the spleen more as she is extraordinarily fatigued, and I think that huang qi will also help in preventing the frequent external attacks she gets. Thank you, Vickii Gervais, LM, LAc Chinese Medicine , sharon weizenbaum <sweiz wrote: > > Hi Vikii, > > > I think it is important to clarify your diagnosis before giving a > formula. All the formulas you mentioned are just guesses at this > point. I have a couple of questions regarding your excellent intake > information. First, when you say " no coat anterior " does this mean > it is peeled or just that there is no pathological coat? Also, you > said that the sides are shiny. Are they shiny red or are there any > fissures on the sides? This would make a lot of difference to me. > > Assuming that the sides are shiny red and that the anterior is peeled > (lacking any coat) here is what I would think in terms of diagnosis: > > First, you know heat because cool makes it better, red tongue. > > You know that there is Yin vacuity of the Spleen and Stomach because > of the peeled anterior combined with the digestive symptoms and the > red shiny sides of the tongue. So, then, some of the heat is vacuity > heat. But, her tongue is large and red so some of the heat is excess > heat (depressive) > > I would never diagnose dampheat based soley on a slippery rapid pulse - > > I do not see any Liver involvement - stress does not make it worse. > > So, I would diagnose Spleen and Stomach Yin vacuity which can explain > all of her signs and symptoms. The Yin is important for the flow of > Qi and food in the digestion as it keeps things soft and moist. Pain > is always stagnation and Yin deficiency in the digestion can easily > cause stagnation. The stagnation can explain the depressive heat > aspect to this. > > night sweats, dry skin, dry stool, dry hair. Even the cold hands and > feet since the Yin is needed to help the Yang spread to the extremities. > > There is some dampness - we know because her tongue is large - but > there are no symptoms of dampness or obvious signs of accumulated > water. The slightly thicker moss on the rear of the tongue is > normal. To me this means just that the pathological heat is > steaming up fluids and creating some swelling. Parching or draining > damp would not be right. It's also not right to use pungent herbs to > open Qi stasis as these would further damage the Yin. Using a very > bitter draining formula like Long Dan Xie Gan Tang would also be > contraindicated imo. > > So, I would say that you need to moisten the Yin of her Spleen and > Stomach. It seems key to moisten her stool and have your method > encourage daily bowel movements. Obviously this is key for any > stasis. Clearing the stasis should clear the depressive Qi but you > will also need to clear empty heat in her Spleen and Stomach. > Stopping pain should be by emolliating rather than pungently opening. > > You can imagine that this CF has caused her digestive tract to become > dry and brittle so your methods should moisten and soften. The > methods you suggested, though they are thinking about stopping pain, > they are not addressing the real reason for the pain and I think > would make her worse. > > Since it is a genetic chromosomal issue she will probably use the > herbs to help her manage this for the rest of her life. > > Here is what I would suggest: (modified Yi Wei Tang) > > Xuan Shen 15 > Mai Men Dong 15 > Sheng Di Huang 15 > Gan Cao 12 > Bai Shao 15 > Xi Yang Shen 12 > Zhi Mu 12 > Sha Shen 12 > Dang Gui 12 > Chi Shao 9 > > Good luck! > > Sharon > > > > > 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 > with epigastric/stomach pain, dx age 7. Genetic mutation of cystic > fibrosis, 2 younger paternal cousins now found to also have mutation. > > Pain is supraumbilical area, dull, diffuse, extreme, occ radiates > around back. Worse with pressure, not with rebound, no change with > hot or cold application, but better with intake of cold during > attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT > because it would help pain, just that it felt good. " > > History of approximately annual hospitalizations lasting 5-7 days for > px control. Is in pain mgmt program. Pancreas currently scarred and > shrinking. Since approximately at the onset puberty/menses age 13, > pain worse, more frequent attacks lasting longer, more difficult to > control, higher on pain scale. MDs said puberty/hormones will either > lessen or exacerbate. More frequent hospitalizations in last 2 years > with longer duration, missing a lot of school and has quit all > athletics and activities. Desires pain control and decrease in > frequency of attacks. > > Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, > freckled body. cold feet and hands, does not feel generally cold or > hot (but mother claims she seems cold and is frequently sweatered). > Catches colds easily and frequently. Fatigued most days, very > fatigued on days of pain, now occurring twice weekly, each with > additional day of residual pain. During attacks, can only get from > bed to couch but rarely complains. Reports generally happy and > outgoing (mother concurs) but quiet during attacks. Hypotensive. > > Cycles unremarkable. > > Poor appetite overall and worse with pain attacks, gets full quickly. > no bloating, no gas. BMs hard but long and formed QOD, q3 days, > probably due to meds, not particularly odorous. Dry skin, tends > towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas > from meds. Belly warm to touch. > > Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but > she thinks that's because she enjoys the " comfort " of lots of > blankets (not because she's cold). > > No known correlation of emotions or events that trigger episodes, > spontaneous. > > Tongue wide, red, slight white coat towards rear, no coat anterior, > slightly redder tip. Very slightly scalloped and shiny edges. > Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl > wiry in liver. > > Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl > anti-spasmodic, benadryl for itching from the meds, and a couple of > other pain meds she didn't bring with her when the pain worsens. > > I have a couple of ideas for formulas, but I am a bit confounded by > exact diagnosis, possibly due to how meds are changing her diagnostic > signs. Seems to have a Lung-Spleen constitution (?) and yin is > damaged, but overall, pulse seems to indicate some damp/heat (or is > this the meds?), while tongue more yin xu heat. Is this liver- > gallbladder/stomach-spleen? I was considering a variation of Dan Shen > Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. > Would a short-term of Long Dan Xie Gan T be worth considering despite > no extraordinary damp signs or is she not hot enough? Short term Da > Chai Hu Tang modified for px? I am considering giving a formula for > acute attacks while using a nourishing one between. Overall, I'm a > bit confounded as to which direction to go and acknowledge that I may > be way off with my initial thoughts. > > Hoping for feedback, > > Vickii Gervais, LM, LAc > Wild Harmony Wellness Center > San Diego CA 92115 > 619.286.2888 > > > Sharon Weizenbaum > 86 Henry Street > Amherst, MA 01002 > 413-549-4021 > sweiz > www.whitepinehealingarts.com > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2007 Report Share Posted May 27, 2007 Vickii Can you keep us informed on treatments and outcomes thanks - sharon weizenbaum Chinese Medicine Friday, May 25, 2007 2:58 AM Re:chronic pancreatitis: 15 yo Hi Vikii, I think it is important to clarify your diagnosis before giving a formula. All the formulas you mentioned are just guesses at this point. I have a couple of questions regarding your excellent intake information. First, when you say " no coat anterior " does this mean it is peeled or just that there is no pathological coat? Also, you said that the sides are shiny. Are they shiny red or are there any fissures on the sides? This would make a lot of difference to me. Assuming that the sides are shiny red and that the anterior is peeled (lacking any coat) here is what I would think in terms of diagnosis: First, you know heat because cool makes it better, red tongue. You know that there is Yin vacuity of the Spleen and Stomach because of the peeled anterior combined with the digestive symptoms and the red shiny sides of the tongue. So, then, some of the heat is vacuity heat. But, her tongue is large and red so some of the heat is excess heat (depressive) I would never diagnose dampheat based soley on a slippery rapid pulse - I do not see any Liver involvement - stress does not make it worse. So, I would diagnose Spleen and Stomach Yin vacuity which can explain all of her signs and symptoms. The Yin is important for the flow of Qi and food in the digestion as it keeps things soft and moist. Pain is always stagnation and Yin deficiency in the digestion can easily cause stagnation. The stagnation can explain the depressive heat aspect to this. night sweats, dry skin, dry stool, dry hair. Even the cold hands and feet since the Yin is needed to help the Yang spread to the extremities. There is some dampness - we know because her tongue is large - but there are no symptoms of dampness or obvious signs of accumulated water. The slightly thicker moss on the rear of the tongue is normal. To me this means just that the pathological heat is steaming up fluids and creating some swelling. Parching or draining damp would not be right. It's also not right to use pungent herbs to open Qi stasis as these would further damage the Yin. Using a very bitter draining formula like Long Dan Xie Gan Tang would also be contraindicated imo. So, I would say that you need to moisten the Yin of her Spleen and Stomach. It seems key to moisten her stool and have your method encourage daily bowel movements. Obviously this is key for any stasis. Clearing the stasis should clear the depressive Qi but you will also need to clear empty heat in her Spleen and Stomach. Stopping pain should be by emolliating rather than pungently opening. You can imagine that this CF has caused her digestive tract to become dry and brittle so your methods should moisten and soften. The methods you suggested, though they are thinking about stopping pain, they are not addressing the real reason for the pain and I think would make her worse. Since it is a genetic chromosomal issue she will probably use the herbs to help her manage this for the rest of her life. Here is what I would suggest: (modified Yi Wei Tang) Xuan Shen 15 Mai Men Dong 15 Sheng Di Huang 15 Gan Cao 12 Bai Shao 15 Xi Yang Shen 12 Zhi Mu 12 Sha Shen 12 Dang Gui 12 Chi Shao 9 Good luck! Sharon 15 y o female NP. Med dx genetic chronic pancreatitis. Onset age 4 with epigastric/stomach pain, dx age 7. Genetic mutation of cystic fibrosis, 2 younger paternal cousins now found to also have mutation. Pain is supraumbilical area, dull, diffuse, extreme, occ radiates around back. Worse with pressure, not with rebound, no change with hot or cold application, but better with intake of cold during attacks, eg popsicles. Desired hot pack to abdomen during tx but " NOT because it would help pain, just that it felt good. " History of approximately annual hospitalizations lasting 5-7 days for px control. Is in pain mgmt program. Pancreas currently scarred and shrinking. Since approximately at the onset puberty/menses age 13, pain worse, more frequent attacks lasting longer, more difficult to control, higher on pain scale. MDs said puberty/hormones will either lessen or exacerbate. More frequent hospitalizations in last 2 years with longer duration, missing a lot of school and has quit all athletics and activities. Desires pain control and decrease in frequency of attacks. Appears quiet, well-mannered, well-spoken but not shy. Slightly pale, freckled body. cold feet and hands, does not feel generally cold or hot (but mother claims she seems cold and is frequently sweatered). Catches colds easily and frequently. Fatigued most days, very fatigued on days of pain, now occurring twice weekly, each with additional day of residual pain. During attacks, can only get from bed to couch but rarely complains. Reports generally happy and outgoing (mother concurs) but quiet during attacks. Hypotensive. Cycles unremarkable. Poor appetite overall and worse with pain attacks, gets full quickly. no bloating, no gas. BMs hard but long and formed QOD, q3 days, probably due to meds, not particularly odorous. Dry skin, tends towards eczema, dry hair. Thirst & ur nl. No vomiting, nausea occas from meds. Belly warm to touch. Sleep disturbed 2x nightly from px. Vivid dreams. Night sweats, but she thinks that's because she enjoys the " comfort " of lots of blankets (not because she's cold). No known correlation of emotions or events that trigger episodes, spontaneous. Tongue wide, red, slight white coat towards rear, no coat anterior, slightly redder tip. Very slightly scalloped and shiny edges. Pulse deep, rapid, slippery, fuller than I expected to find, thin/sl wiry in liver. Complicated by daily meds: pancreatic enzymes, ultram for px, bentyl anti-spasmodic, benadryl for itching from the meds, and a couple of other pain meds she didn't bring with her when the pain worsens. I have a couple of ideas for formulas, but I am a bit confounded by exact diagnosis, possibly due to how meds are changing her diagnostic signs. Seems to have a Lung-Spleen constitution (?) and yin is damaged, but overall, pulse seems to indicate some damp/heat (or is this the meds?), while tongue more yin xu heat. Is this liver- gallbladder/stomach-spleen? I was considering a variation of Dan Shen Yin or Qing Yi Tang or Chai Hu Shu Gan Tang as part of her formula. Would a short-term of Long Dan Xie Gan T be worth considering despite no extraordinary damp signs or is she not hot enough? Short term Da Chai Hu Tang modified for px? I am considering giving a formula for acute attacks while using a nourishing one between. Overall, I'm a bit confounded as to which direction to go and acknowledge that I may be way off with my initial thoughts. Hoping for feedback, Vickii Gervais, LM, LAc Wild Harmony Wellness Center San Diego CA 92115 619.286.2888 Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2007 Report Share Posted May 30, 2007 Hi Vickie, Good question about how to treat the pain when it gets bad. I think Andrea's suggestion combined with Doug's - use Yan Hu Suo and Chuan Lian Zi. These are cooling qi and blood regulators and help stop pain. But also, I would think that acupuncture could be very helpful as well. I also agree with Z'ev about the Spleen Qi but I might use Tai Zi Shen instead of Bai Zhu since it's less drying and I'd be a bit cautious with Bai Bian Dou not to bind up the stool. Do let us know, Sharon Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2007 Report Share Posted May 30, 2007 Hi Vickie, Good question about how to treat the pain when it gets bad. I think Andrea's suggestion combined with Doug's - use Yan Hu Suo and Chuan Lian Zi. These are cooling qi and blood regulators and help stop pain. But also, I would think that acupuncture could be very helpful as well. I also agree with Z'ev about the Spleen Qi but I might use Tai Zi Shen instead of Bai Zhu since it's less drying and I'd be a bit cautious with Bai Bian Dou not to bind up the stool. Do let us know, Sharon Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
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