Guest guest Posted October 25, 2007 Report Share Posted October 25, 2007 Hello colleagues, I have a case that I could use some feedback on. 51 y/o Female Tingling, pressure, crawling sensations (no pain) on the top front half (forehead to vertex) of scalp and on face, right side more than left, down to SI 18 on R side. Primary site and most intense point is R UB 7. Patient can activate symptoms by pressing on it. Sometimes it feels like a tight band around the head. Symptoms stronger when stressed, but can also be intense when relaxed. Scalp is somewhat sore and sensitive to light touch. It is soothed by massage but will comes back minutes later. Symptoms improve when lying on right side while going to sleep. Initial onset in 2000, for 3 months while studying for a science board exam. The symptoms disappeared completely the day before the exam and did not return for 1.5 years. Present continuously for the past 6 years, varying in intensity throughout the day and over a cycle of several weeks. It can be very strong for a few weeks. Initially on right side, feeling like someone was digging fingers into her head. Now it is echoed on the left. Tingling on the right cheek is especially strong during sitting meditation, or lying on her back (in tub or w/acupuncture.) Patient has tried acupuncture, osteopathy (diagnosed muscle tension in neck squeezing nerves), chiropractic, neurologist (said the nerve pattern theory didn't make sense. Maybe it was a type of migraine. Rx Magnesium, Vit. B 6, neurontin which didn't really help). She had a brain MRI which was negative. Tongue: pale, thin white coat, dry center crack, reddish tip with red dots. Pulse: L side wiry, tight R slippery Patient has history of breast rash, red, oozing, and itchy, especially before periods. Periods clotty, dark, crampy, migraine headaches since 8 y/o, insomnia. Has had psycho-therapy for 20 years to deal with anger and frustration. Practices Tai Chi for last 10 years which has helped to calm and relax her, deal with emotions, and help her lighten-up a lot, but is stubborn about relaxing her back and lengthening her spine, especially through her thoracic vertebrae. In the last 5 years she has started to make art and has blossomed in that direction, and her mood has become much less frustrated. She has taken 1/4 mg. dexamethasone (cortisone) for the past 20 years due to an imbalance. I have treated her in the past for the breast rash, and a few times unsuccessfully for the tingling. She has seen all the chiropractor, osteopath, nuerologist, another few acupuncturists (including Dr. Zhu scalp acupuncturist) since then and no one has been able to help. If you have any ideas, please help. Thanks. Chinese Medicine Chinese Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 25, 2007 Report Share Posted October 25, 2007 Hi Wendy, You may not remember me- I'm also FBI alumni(1997), and friend of Jeff Chapman and Galen Williams. Long time no see... My teacher says that such sensations on the scalp are usually due to blood and yin deficiency, and it looks like your patient might fit this pattern given the tongue description, the wiry pulse on the left also possibly indicating liver yin/blood xu with yang rising. If sx's worsen with fatigue and/or at night that would also point towards this dx. Looks like some blood stagnation as well, given the menstruation. I hesitate to recommend herbs without seeing a patient, but maybe can consider Da Huang Zhe Chong Wan, beginning 7-10 days before the menstruation is due and continued until the menstruation is done, then tonify for 2 weeks after the menstruation is finished (maybe Ren Shen Bie Jia Jian Wan or whatever looks appropriate) then again use Da Huang Zhe Chong as desribed above. Maybe continue like this for a few months to remove the blood stagnation and rebuild the deficient qi, blood and yin. My teacher, and now I, often use this or similar protocols to remove blood stagnation and rebuild deficient qi, blood, yin, etc. Remember, Da Huang Zhe Chong Wan is found in Jin Gui Yao Lue's chapter on Xu Lao(vacuity taxation), and is based on the principle Yi Tong Wei Bu, which means to use " through " in order to supplement. Tong/through, in the case of this rx is moving blood and transforming blood stagnation. Getting rid of the stagnation in this case is a form of tonification, and allows for " normal " tonification to take place later. One cannot straight tonify such a patient without first removing whatever stagnations are present first. Not sure if this really fits your patient, but some things to consider. If you can let us know what you've tried in the past and with what results, maybe we can come up with some more and better ideas. Best wishes, Greg Chinese Medicine , Chinese Medicine <> wrote: > > Hello colleagues, > > I have a case that I could use some feedback on. > > 51 y/o Female > Tingling, pressure, crawling sensations (no pain) on the top front > half (forehead to vertex) of scalp and on face, right side more than > left, down to SI 18 on R side. Primary site and most intense point is > R UB 7. Patient can activate symptoms by pressing on it. Sometimes it > feels like a tight band around the head. Symptoms stronger when > stressed, but can also be intense when relaxed. Scalp is somewhat > sore and sensitive to light touch. It is soothed by massage but will > comes back minutes later. Symptoms improve when lying on right side > while going to sleep. > > Initial onset in 2000, for 3 months while studying for a science > board exam. The symptoms disappeared completely the day before the > exam and did not return for 1.5 years. Present continuously for the > past 6 years, varying in intensity throughout the day and over a > cycle of several weeks. It can be very strong for a few weeks. > Initially on right side, feeling like someone was digging fingers > into her head. Now it is echoed on the left. Tingling on the right > cheek is especially strong during sitting meditation, or lying on her > back (in tub or w/acupuncture.) > > Patient has tried acupuncture, osteopathy (diagnosed muscle tension > in neck squeezing nerves), chiropractic, neurologist (said the nerve > pattern theory didn't make sense. Maybe it was a type of migraine. Rx > Magnesium, Vit. B 6, neurontin which didn't really help). She had a > brain MRI which was negative. > > Tongue: pale, thin white coat, dry center crack, reddish tip with red > dots. > Pulse: L side wiry, tight R slippery > > Patient has history of breast rash, red, oozing, and itchy, > especially before periods. Periods clotty, dark, crampy, migraine > headaches since 8 y/o, insomnia. Has had psycho-therapy for 20 years > to deal with anger and frustration. Practices Tai Chi for last 10 > years which has helped to calm and relax her, deal with emotions, and > help her lighten-up a lot, but is stubborn about relaxing her back > and lengthening her spine, especially through her thoracic vertebrae. > In the last 5 years she has started to make art and has blossomed in > that direction, and her mood has become much less frustrated. She has > taken 1/4 mg. dexamethasone (cortisone) for the past 20 years due to > an imbalance. > > I have treated her in the past for the breast rash, and a few times > unsuccessfully for the tingling. She has seen all the chiropractor, > osteopath, nuerologist, another few acupuncturists (including Dr. > Zhu scalp acupuncturist) since then and no one has been able to help. > > If you have any ideas, please help. Thanks. > > Chinese Medicine > > > > > > > Chinese Medicine > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 25, 2007 Report Share Posted October 25, 2007 Hi Wendy, Considering the number of investigations she has undergone and practitioners she has seen you can pretty much rule out physical/nerve problems and the like. The style of acupuncture that i practice would still require that i take the whole case and i would advise you to do so also, regardless of what the patient sees as important. if you have already done this i don't mean to teach you to suck eggs! From what you have said though i would be treating/looking for SP, Liver and phlegm involvement. Tingling elsewhere normally points to blood Xu, Damp-heat (rarely) or phlegm. the tight frontal headache points to spleen/damp as does the breast rash with some liver involvement. My guess is if you treat these things (if they are present) it will take time but will clear. LI4,ST40,BL6o, might be useful. Is there any chance this is local invasion that has stayed on long term? You said better for pressure though, this points to Deficiency of maybe blood. Thats about all the help i can be but with a full case history it might be more enlightening. Thanks Dan Chinese Medicine , Chinese Medicine <> wrote: > > Hello colleagues, > > I have a case that I could use some feedback on. > > 51 y/o Female > Tingling, pressure, crawling sensations (no pain) on the top front > half (forehead to vertex) of scalp and on face, right side more than > left, down to SI 18 on R side. Primary site and most intense point is > R UB 7. Patient can activate symptoms by pressing on it. Sometimes it > feels like a tight band around the head. Symptoms stronger when > stressed, but can also be intense when relaxed. Scalp is somewhat > sore and sensitive to light touch. It is soothed by massage but will > comes back minutes later. Symptoms improve when lying on right side > while going to sleep. > > Initial onset in 2000, for 3 months while studying for a science > board exam. The symptoms disappeared completely the day before the > exam and did not return for 1.5 years. Present continuously for the > past 6 years, varying in intensity throughout the day and over a > cycle of several weeks. It can be very strong for a few weeks. > Initially on right side, feeling like someone was digging fingers > into her head. Now it is echoed on the left. Tingling on the right > cheek is especially strong during sitting meditation, or lying on her > back (in tub or w/acupuncture.) > > Patient has tried acupuncture, osteopathy (diagnosed muscle tension > in neck squeezing nerves), chiropractic, neurologist (said the nerve > pattern theory didn't make sense. Maybe it was a type of migraine. Rx > Magnesium, Vit. B 6, neurontin which didn't really help). She had a > brain MRI which was negative. > > Tongue: pale, thin white coat, dry center crack, reddish tip with red > dots. > Pulse: L side wiry, tight R slippery > > Patient has history of breast rash, red, oozing, and itchy, > especially before periods. Periods clotty, dark, crampy, migraine > headaches since 8 y/o, insomnia. Has had psycho-therapy for 20 years > to deal with anger and frustration. Practices Tai Chi for last 10 > years which has helped to calm and relax her, deal with emotions, and > help her lighten-up a lot, but is stubborn about relaxing her back > and lengthening her spine, especially through her thoracic vertebrae. > In the last 5 years she has started to make art and has blossomed in > that direction, and her mood has become much less frustrated. She has > taken 1/4 mg. dexamethasone (cortisone) for the past 20 years due to > an imbalance. > > I have treated her in the past for the breast rash, and a few times > unsuccessfully for the tingling. She has seen all the chiropractor, > osteopath, nuerologist, another few acupuncturists (including Dr. > Zhu scalp acupuncturist) since then and no one has been able to help. > > If you have any ideas, please help. Thanks. > > Chinese Medicine > > > > > > > Chinese Medicine > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 25, 2007 Report Share Posted October 25, 2007 Hi Wendy, I second the idea that you might need to do quite a bit of tonification before that numbness / tingling improves. You might want to ignroe the main complaint entirely for now, and get a clear idea of the rest of her pattern and treat that. I would also be interested to know some details about the initial onset, beyond that she was studying for exams - weather, season, diet unusual at that time etc. Hugo _________ Messenger - NEW crystal clear PC to PC calling worldwide with voicemail http://uk.messenger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 2007 Report Share Posted October 26, 2007 Good point- phlegm may also be part of the picture. There's a saying in Chinese, Tan Yu Tong Yuan- Phlegm and Blood Stagnation are from the same source. You mentioned a thin white coat- is it sticky or greasy or tight at all? That would also point towards phlegm. How about bowel movements, appetite, digestion, sleep and dreams, menstruation starts easily the first day or not, tinnitus, dizziness? More info would be helpful. Best, Greg Chinese Medicine , " corotcm " <corotcm wrote: > > > Hi Wendy, > Considering the number of investigations she has undergone and > practitioners she has seen you can pretty much rule out physical/nerve > problems and the like. > The style of acupuncture that i practice would still require that i > take the whole case and i would advise you to do so also, regardless > of what the patient sees as important. if you have already done this i > don't mean to teach you to suck eggs! > From what you have said though i would be treating/looking for SP, > Liver and phlegm involvement. Tingling elsewhere normally points to > blood Xu, Damp-heat (rarely) or phlegm. the tight frontal headache > points to spleen/damp as does the breast rash with some liver involvement. > My guess is if you treat these things (if they are present) it will > take time but will clear. LI4,ST40,BL6o, might be useful. Is there any > chance this is local invasion that has stayed on long term? You said > better for pressure though, this points to Deficiency of maybe blood. > Thats about all the help i can be but with a full case history it > might be more enlightening. > Thanks Dan > > > Chinese Medicine , Chinese Medicine > <wballen@> wrote: > > > > Hello colleagues, > > > > I have a case that I could use some feedback on. > > > > 51 y/o Female > > Tingling, pressure, crawling sensations (no pain) on the top front > > half (forehead to vertex) of scalp and on face, right side more than > > left, down to SI 18 on R side. Primary site and most intense point is > > R UB 7. Patient can activate symptoms by pressing on it. Sometimes it > > feels like a tight band around the head. Symptoms stronger when > > stressed, but can also be intense when relaxed. Scalp is somewhat > > sore and sensitive to light touch. It is soothed by massage but will > > comes back minutes later. Symptoms improve when lying on right side > > while going to sleep. > > > > Initial onset in 2000, for 3 months while studying for a science > > board exam. The symptoms disappeared completely the day before the > > exam and did not return for 1.5 years. Present continuously for the > > past 6 years, varying in intensity throughout the day and over a > > cycle of several weeks. It can be very strong for a few weeks. > > Initially on right side, feeling like someone was digging fingers > > into her head. Now it is echoed on the left. Tingling on the right > > cheek is especially strong during sitting meditation, or lying on her > > back (in tub or w/acupuncture.) > > > > Patient has tried acupuncture, osteopathy (diagnosed muscle tension > > in neck squeezing nerves), chiropractic, neurologist (said the nerve > > pattern theory didn't make sense. Maybe it was a type of migraine. Rx > > Magnesium, Vit. B 6, neurontin which didn't really help). She had a > > brain MRI which was negative. > > > > Tongue: pale, thin white coat, dry center crack, reddish tip with red > > dots. > > Pulse: L side wiry, tight R slippery > > > > Patient has history of breast rash, red, oozing, and itchy, > > especially before periods. Periods clotty, dark, crampy, migraine > > headaches since 8 y/o, insomnia. Has had psycho-therapy for 20 years > > to deal with anger and frustration. Practices Tai Chi for last 10 > > years which has helped to calm and relax her, deal with emotions, and > > help her lighten-up a lot, but is stubborn about relaxing her back > > and lengthening her spine, especially through her thoracic vertebrae. > > In the last 5 years she has started to make art and has blossomed in > > that direction, and her mood has become much less frustrated. She has > > taken 1/4 mg. dexamethasone (cortisone) for the past 20 years due to > > an imbalance. > > > > I have treated her in the past for the breast rash, and a few times > > unsuccessfully for the tingling. She has seen all the chiropractor, > > osteopath, nuerologist, another few acupuncturists (including Dr. > > Zhu scalp acupuncturist) since then and no one has been able to help. > > > > If you have any ideas, please help. Thanks. > > > > Chinese Medicine > > wballen@ > > > > > > > > > > > > Chinese Medicine > > wballen@ > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2007 Report Share Posted November 2, 2007 Hi Greg, Dan, Hugo, Andrea, Linda, and Artemis, Thanks so much for all your responses and insight. I have been waiting to see my patient again to further query and asses the situation. She came in last week with an external wind invasion, so we dealt with that. I did a more detailed intake at the time, and found that most of her symptoms do fall into an underlying Liver blood and yin deficiency causing blood stagnation, yang rising, or contributing to internal wind. I have treated her for that with acupuncture, slightly relieving the head symptoms for the day following treatment, but think herbs taken consistently will really be helpful. I liked the idea from Greg re: " the principle Yi Tong Wei Bu, which means to use " through " in order to supplement. Tong/through, in the case of this rx is moving blood and transforming blood stagnation. Getting rid of the stagnation in this case is a form of tonification, and allows for " normal " tonification to take place later. " I am going to treat her with a combination of blood moving and blood/yin/liver nourishing formulas and some and hope that addresses the rising yang and or wind problems also. I'll let you know what happens. Thanks again, Chinese Medicine P.S. Hi Greg. It's been 10 years! Hope you are well and happy. Thanks for your input. Quote Link to comment Share on other sites More sharing options...
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