Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Hi All, I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis? Thanks, Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later. He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs. He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake. Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep. He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles. Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Hi Emily, It does sound like an emotionally based problem but , has he been tested for delayed gastric emptying or gastroparesis?? If that is the cause, a medication like Propulcid or Reglan may be helpful.If not, you might suggest he consult a Qigong Master and learn exercises to descend the Qi. I did know of one case where a patient with episodes of atrial fibrillation, vomited terribly when going into a fib.Hope you can help the poor man. God Bless you both.............Betty --- On Tue, 9/2/08, emilykonstan <emilylists wrote: emilykonstan <emilylists Severe Vomiting Chinese Medicine Tuesday, September 2, 2008, 10:57 AM Hi All, I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis? Thanks, Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later. He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs. He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake. Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep. He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles. Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Hi Betty, Thanks for your thoughts. Reglan is one of the medications he tried. From what I understand, he has been through the whole gamut of testing, but still doesn't have a diagnosis. He feels like the MDs have given up on him. I like the qigong idea and he actually had done some research on it before he came to see me. I will try to convince him to keep that option open. Emily : medicwoman: Tue, 2 Sep 2008 08:20:28 -0700Re: Severe Vomiting Hi Emily, It does sound like an emotionally based problem but , has he been tested for delayed gastric emptying or gastroparesis?? If that is the cause, a medication like Propulcid or Reglan may be helpful.If not, you might suggest he consult a Qigong Master and learn exercises to descend the Qi. I did know of one case where a patient with episodes of atrial fibrillation, vomited terribly when going into a fib.Hope you can help the poor man. God Bless you both.............Betty--- On Tue, 9/2/08, emilykonstan <emilylists wrote:emilykonstan <emilylistsSevere Vomiting: Tuesday, September 2, 2008, 10:57 AMHi All,I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis?Thanks,Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later.He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs.He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake.Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep.He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles.Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Hi Betty, Just to let you know - Propulsid has been off the market for over 8 years - it caused heart valve damage - but it did help a lot of people. - Mary MedicWoman <medicwoman Chinese Medicine Tue, 2 Sep 2008 11:20 am Re: Severe Vomiting Hi Emily, ??? It does sound like an emotionally based problem but , has he been tested for delayed gastric emptying or gastroparesis?? If that is the cause, a medication like Propulcid or Reglan may be helpful.If not, you might suggest he consult a Qigong Master and learn exercises to descend the Qi. ??? I did know of one case where a patient with episodes of atrial fibrillation, vomited terribly when going into a fib.Hope you can help the poor man. God Bless you both.............Betty --- On Tue, 9/2/08, emilykonstan <emilylists wrote: emilykonstan <emilylists Severe Vomiting Chinese Medicine Tuesday, September 2, 2008, 10:57 AM Hi All, I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis? Thanks, Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later. He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs. He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake. Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep. He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles. Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Hi Emily - this sounds like a Luo channel issue to me, in that it involves the Emotions (and therefore the Blood) and serious Rebellious Qi. Jeffrey Yuen has a very interesting lecture on this, transcription available from the New England School of Acupuncture. I can give you a synopsis off list, if you like, but highly recommend you get the whole lecture. Best of luck. Karen Emily Konstan wrote: > Hi Betty, > > Thanks for your thoughts. Reglan is one of the medications he tried. > From what I understand, he has been through the whole gamut of > testing, but still doesn't have a diagnosis. He feels like the MDs > have given up on him. > > I like the qigong idea and he actually had done some research on it > before he came to see me. I will try to convince him to keep that > option open. > > Emily > > > <Chinese Medicine%40From>: > medicwoman <medicwoman%40gmail.comDate>: Tue, 2 > Sep 2008 08:20:28 -0700Re: Severe Vomiting > > Hi Emily, It does sound like an emotionally based problem but , has he > been tested for delayed gastric emptying or gastroparesis?? If that is > the cause, a medication like Propulcid or Reglan may be helpful.If > not, you might suggest he consult a Qigong Master and learn exercises > to descend the Qi. I did know of one case where a patient with > episodes of atrial fibrillation, vomited terribly when going into a > fib.Hope you can help the poor man. God Bless you > both.............Betty--- On Tue, 9/2/08, emilykonstan > <emilylists <emilylists%40hotmail.com>> wrote: > emilykonstan <emilylists > <emilylists%40hotmail.com>>Severe VomitingTo: > Chinese Medicine > <Chinese Medicine%40Date>: Tuesday, > September 2, 2008, 10:57 AMHi All,I have a patient who can't keep any > food down and gets his nutrients through a feeding tube (more details > below). I have told him that acupuncture could help with his back pain > and sleep issues, but I am doubtful that it can help with a digestion > problem this severe. Has anyone experienced a similar situation? Any > thoughts about prognosis?Thanks,Emily 49 year-old male with main > complaint of severe vomiting for 3 years. The condition started after > an incredibly stressful period where he was scammed out of a lot of > money (the stress continues now as he has to testify in court, etc.). > It gradually got worse over the years; now, he can't eat or drink > anything (even water) without it coming back up 3-5 minutes later.He > has tried numerous medications, botox in his sphincter muscle, gall > bladder surgery, and biofeedback. He now has two implanted tubes-- one > to drain the stomach and one to feed. He has lost 70 lbs.He describes > himself as depressed, short-tempered, spacey, and anxious. He has > panic attacks a few times per week. At intake, he was notably > withdrawn and taciturn-- his wife answered most of the questions for > the first half of the intake.Secondary complaints include back pain > from bulging discs at L5-S1, from a fall down the stairs in December, > and insomnia. He needs tylenol PM to sleep and he wakes several times > during the night with his mind racing. On nights when he takes the > tylenol PM he is able to get back to sleep within 5-10 minutes; if he > didn't take it, he couldn't go back to sleep.He has a history of high > BP and high cholesterol, which have resolved with the digestion > problems since he is not eating much. He also has low energy, runs > warm, and has tight and sore calf muscles.Tongue is swollen with a > thick yellow coat. Pulse is extremely weak and deep, slightly > slippery, third position weakest on both sides. Right pulse is overall > slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 2, 2008 Report Share Posted September 2, 2008 Dear Emily, IMVHO we, as acupuncturists need to consider this case from a very different perspective: Physiologically, vomiting originates from the vomiting center, related to the IX and X Cranial Nerve, located in the lateral medulla and situated just above C1, and from the hypothalamus, housed under the sphenoid. ( We craniosacral therapists are taught this connection). Knowing this, it would behoove you, in addition to P6 which, of course treats nausea and vomiting, it would behoove you to carefully needle Du16, GB20, GB21 and Tai Yang. Anecdotally, as we were flying from Rome to NY recently, a woman started to vomit violently on the flight, and none of the phyicians on board were able to do anything to stop it. Her pulses were very wiry and slippery, and her tongue had a greasy yellow coat. I first needled the above points, and worked distally on her feet and ankles, and soon she was sound asleep, the vomiting resolved. Later, I released the occiputal and sphenoid bones using CranioSacral techniques. Her husband mentioned that this always happens, but this was the worst it had ever been. I heard from him recently, as they were getting ready to return home to Italy, and I mentioned that she should bring some ginger root along and make some ginger tea before and during the flight. The flight went MUCH better! respectfully, --- On Tue, 9/2/08, emilykonstan <emilylists wrote: emilykonstan <emilylists Severe Vomiting Chinese Medicine Tuesday, September 2, 2008, 7:57 AM Hi All, I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis? Thanks, Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later. He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs. He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake. Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep. He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles. Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2008 Report Share Posted September 3, 2008 Hi Emily: You may wish to try Mu Xiang, such as Mu Xiang Shun Qi Wan, to help re-direct the adverse flow of Qi, especially with relation to emotions. Regards, Jack --- On Tue, 9/2/08, emilykonstan <emilylists wrote: emilykonstan <emilylists Severe Vomiting Chinese Medicine Tuesday, September 2, 2008, 7:57 AM Hi All, I have a patient who can't keep any food down and gets his nutrients through a feeding tube (more details below). I have told him that acupuncture could help with his back pain and sleep issues, but I am doubtful that it can help with a digestion problem this severe. Has anyone experienced a similar situation? Any thoughts about prognosis? Thanks, Emily 49 year-old male with main complaint of severe vomiting for 3 years. The condition started after an incredibly stressful period where he was scammed out of a lot of money (the stress continues now as he has to testify in court, etc.). It gradually got worse over the years; now, he can't eat or drink anything (even water) without it coming back up 3-5 minutes later. He has tried numerous medications, botox in his sphincter muscle, gall bladder surgery, and biofeedback. He now has two implanted tubes-- one to drain the stomach and one to feed. He has lost 70 lbs. He describes himself as depressed, short-tempered, spacey, and anxious. He has panic attacks a few times per week. At intake, he was notably withdrawn and taciturn-- his wife answered most of the questions for the first half of the intake. Secondary complaints include back pain from bulging discs at L5-S1, from a fall down the stairs in December, and insomnia. He needs tylenol PM to sleep and he wakes several times during the night with his mind racing. On nights when he takes the tylenol PM he is able to get back to sleep within 5-10 minutes; if he didn't take it, he couldn't go back to sleep. He has a history of high BP and high cholesterol, which have resolved with the digestion problems since he is not eating much. He also has low energy, runs warm, and has tight and sore calf muscles. Tongue is swollen with a thick yellow coat. Pulse is extremely weak and deep, slightly slippery, third position weakest on both sides. Right pulse is overall slightly stronger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2008 Report Share Posted September 5, 2008 Hi Emily and All, I guess this is one of those hardcore cases that can demonstrate the problem-solving nature of CM. In Jin Gui Yao Lue by ZHANG, Zhong-jing, the whole chapter 17 is devoted to discussing vomiting, hiccup, and diarrhea; there are 23 statements and 13 formulas covering pathomechanism, treatment principle, and formulas solely for the discussion of vomiting and I am sure they basically cover all scenarios about vomiting and we can find lots of insights there to deal with your severe case of vomiting. The most severe signs include 'vomiting immediately after ingestion of food' or 'vomiting foods in the evenings that ingested in the morning and verse visa are not found in your case. Therefore, your case is somewhere in between and it is not the worst scenario. I strongly believe it is treatable with positive results. I am not saying it is easy and I cannot come up with prescription for your reference unless I have the following data. 1) more details about gall bladder surgery; that may affect the reflective nerve that exacerbates the vomiting (western medicine stuff) 2) any retching, 3) any stomach pain, 4) any signs of withdrawl from people or suicidal signs. The protocol here is also the basic treatment principle, to harmonize the stomach and descend the rebellious qi. Once the signs of vomiting/retching/hiccup ceases, he should be able to sleep better, able to eat, and feeding tube-free. My 2 cents, Dr sung, yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2008 Report Share Posted September 5, 2008 Thanks everyone, for your input. He had his second acupuncture treatment yesterday. Some minor improvement in back pain and his mood seemed a little better. it was nice to be able to give him some hope, based on the feedback I've gotten from this group and other acupuncturists. I will keep you posted! Emily : sxm2649: Fri, 5 Sep 2008 15:08:00 +0000Re: Severe Vomiting Hi Emily and All,I guess this is one of those hardcore cases that can demonstrate the problem-solving nature of CM.In Jin Gui Yao Lue by ZHANG, Zhong-jing, the whole chapter 17 is devoted to discussing vomiting, hiccup, and diarrhea; there are 23 statements and 13 formulas covering pathomechanism, treatment principle, and formulas solely for the discussion of vomiting and I am sure they basically cover all scenarios about vomiting and we can find lots of insights there to deal with your severe case of vomiting. The most severe signs include 'vomiting immediately after ingestion of food' or 'vomiting foods in the evenings that ingested in the morning and verse visa are not found in your case. Therefore, your case is somewhere in between and it is not the worst scenario. I strongly believe it is treatable with positive results. I am not saying it is easy and I cannot come up with prescription for your reference unless I have the following data.1) more details about gall bladder surgery; that may affect the reflective nerve that exacerbates the vomiting (western medicine stuff) 2) any retching,3) any stomach pain,4) any signs of withdrawl from people or suicidal signs.The protocol here is also the basic treatment principle, to harmonize the stomach and descend the rebellious qi. Once the signs of vomiting/retching/hiccup ceases, he should be able to sleep better, able to eat, and feeding tube-free.My 2 cents,Dr sung, yuk-ming _______________ Stay up to date on your PC, the Web, and your mobile phone with Windows Live. http://clk.atdmt.com/MRT/go/msnnkwxp1020093185mrt/direct/01/ Quote Link to comment Share on other sites More sharing options...
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