an observation concerning phlegm vs. pathogenic fluids

August 24, 2008

Thank you for sharing this very interesting case. In the interest of learning,

and hopefully contributing, I would like to share my thoughts. While I use TCM

as the basis for my herbal formulas, I practice a Japanese style of acupuncture,

from which I learned one very important and practical rule: always look for and

treat the deficiency first. In TCM, phlegm is usually considered excess, and the

strategy is to immediately try to resolve or dry, which is a good idea, to a

degree. At the same time, it is probably more important to figure what

deficiency is causing the excess. You mentioned a Lung Qi deficiency which makes

sense, and in Japanese style, the Liver can also be deficient, and I immediately

saw a large Liver component as well. The TCM approach would normally be to throw

every phlegm herb/formula to try to resolve the phlegm. It sounds to me like by

tonifying and nourishing, your currrent formula is actually resolving it better.

The only

suggestion I might offer, would be to use th epulse to determine which Yin

organ is the most deficient, and needle the Yuan Source point on one side, as

well as the mother point on the mother meridien on the same side, normally right

on a woman.

Please keep us informed as to how this goes. I'm interested to hear.

Henry

TCM <Chinese Traditional Medicine >;

Traditional Chinese Herbal Medicine

Sunday, August 24, 2008 5:07:32 PM

an observation concerning phlegm vs. pathogenic fluids

Dear Colleagues,

I want to revisit a discussion that we had about a year ago. We have discussed

many aspects of phlegm before, and over the years I have presented to you

observations concerning the progress of my wife, who has suffered from an

ideopathic seizure and movement disorder for many years. What is particularly

interesting is that the seizures were originally accompanied by a clear, viscous

fluid in her throat, and now this fluid is there a good part of the time. This

is particularly interesting as we are taught that the classics teach that

seizures result from phlegm misting the heart channel.

As would be expected, therefore, the treatment formula my wife would always

receive from the time that I began as a student in 2000 would include herbs

such as Ban Xia, and Dan Nan Xing, and Shi Chang Pu. Yet, the " phlegm " would

never seem to be completely resolved, and the seizures would continue to occur

(almost like a menstrual cycle) every 28 or so days. As I observed the pattern

each month, it started to dawn on me that my " supervisors " just didn't get it,

she would seem to not do better with those herbs, maybe even worse, and whereas

previously her tongue would have a dry " baked " black coating, with a red tip and

cracks, recently, it has had a pale coatless body, sometimes dry and sometimes

moist, with a appearance of piece of raw meat, but pale, not red. Meanwhile the

" phlegm " is nearly constant, at times drooling from her mouth and interfering

with her ability to talk clearly as if she is waterlogged and is constantly in

her

throat, and her thinking has become increasingly muddled recent past. About a

year ago, I purchased an aspirator, which would at least allow her to be

understood, but she hates it and it makes her feel very uncomfortable.

A couple of months ago, when she had a dental appointment, the dentist gave

her aloe vera juice to rince out her mouth with. Interestingly, it seemed to

temporarily resolve the phlegm, and so I purchased a gallon of aloe vera juice,

and have been using it instead of the aspirator. What is interesting, is that

even though energetically, we know that Aloe is cold, she remarks that it feels

like it burns her throat! I should mention at this point, four important other

observations: 1. She has always considered it unlady-like to spit out phlegm

and saliva, and so since childhood, she has swallowed it. 2. Since her first

acupuncture treatment in 2000, when the supervisor needled Du 26, her jaw has

been shaking, at times violently, most of the time. 3. Her pharynx is extremely

sensitive to the touch. 4. The constant shaking of the jaw has clearly depleted

her Lung Qi, and her voice is very soft.

Some months ago, we met with our esteemed colleague , who

suggested that her case seemed to reflect internal wind from pathogenic heat

scorching and injuring Kidney Yin and liver blood. Essentially, he contended,

the Liver is doing the work of the Kidneys, with water unable to restrain wood.

He suggested considering formulas such as E Jiao Ji Zi huang Tang or Di Huang

Yin Zi.

I think that he is right, but that there is another major element which has

profoundly been misdiagnosed and as a result mistreated: Her " phlegm. " It is

my firm conviction that it is not phlegm at all, but as we spoke of a year or so

ago, rather pathogenic, inflammatory fluid which the body has created in

response to extreme dryness and inflammation. Consider why is the throat so

sore and tender to the touch? Because it is inflamed. What are the four

cardinal signs of inflammation: Redness, heat, pain and swelling. Could not

swelling actually be pathogenic fluid? And if it is not phlegm at all, but

rather Extreme dryness, than it would make perfect sence that needling Du 26,

waking her up so to speak, would be the worst possible place to needle!

Furthermore, to treat this pathogenic fluid with herbs that transform phlegm and

dry dampness would, of course, exascerbate her already pathogenic dryness. And

why would aloe

vera feel like it was burning her: because the throat passage is raw and

inflamed, I would suspect. So recently I began treated her with a formula

which is a modification of Bai He Gu Jin Tang, Bei Mu Gua Lou San, Shao Yao Gan

Cao Tang and Sheng Mai San: Dang Shen 30, Mai Men Dong 15, Wu Wei Zi 9,

Bai He 24, Shu Di Huang 21, Chuan Bei Mu 9, Dang Gui 12, Bai Shao Yao 15,

Zhi Gan Cao 9, Gua Lou 9, Tian Hua Fen 15, Chen Pi 6, Tian Ma 9, Bai Zhu 9,

Gou Teng 15, Bai Zi Ren 12, Suan Zao Ren 12, and Ye Jiao Teng 15.

Furthermore, for the last two days I have needled her differently than usual:

Just SI 3,4,5, and 6 on the right hand, and UB 62, 63, 64 and 65 on the left

foot.

Oh, and BTW, she has been drinking 2 oz. of Gou Chi juice twice daily.

I am very encouraged with results thus far and will keep you informed. We are

entering the week when a seizure would be expected. Your comments and feedback

are appreciated.

Sincerely,

www.traditionaljewi shmedicine. net

August 24, 2008

Dear Henry,

Thank you for your wise comments. This was originally a very complex case with

both vacuitous and replete heat. The case has evolved now, and though there

still is some vacuitous kidney heat, it is more of an emptiness now,

of liver blood, Kidney and heart Yin, and Lung Qi, The repletion that remains

is the pathogenic fluid that I describe and the liver wind. So as you can see,

we are primarily dealing with deficiency. And even the two manifestations of

repletion both result from the Yin vacuity, and so indeed the approach is to

supplement and nourish.

Again, as you mention that the TCM approach would be to throw every herb in the

arsenal to resolve the phlegm, I can assure you that that approach was tried and

was completely unsuccessful. That is why I now think differently, that this

really is not phlegm but rather pathogenic inflammatory dampness (as in

swelling).

I will give it a try, adding K3 (Kid Yuan) on the left and Lu9 (Mother point of

mother channel) on the right.

I'll let you know, IY " H how it goes.

--- On Sun, 8/24/08, Henry Ahlefelder <hahlefelder wrote:

Henry Ahlefelder <hahlefelder

Re: an observation concerning phlegm vs. pathogenic fluids

Sunday, August 24, 2008, 7:10 PM