Bowel ressection and Headaches... advice???

[Guest guest]

Hello Everyone, I'm hoping for some opinions or advice.

 

I have a patient who's a 63yr old male and gets daily temporal

headaches. The headaches usually come on with bowel movements.

 

He's an insulin dependent diabetic, had all of his LI and part of his

SI ressected due to ulcerative colitis. He has had chronic diarrhea

since his bowel ressection. His tongue is dry, purple, and the coat

is peeled in the rear yet it is thick, white, and greasy on the

anterior 2/3rds. He is quite thin and looks " dried out. " His pulse

is usually quite forceful and wiry.

 

I would like to give him yin nourishing herbs, but he has chronic

diarrhea and I wonder about absorbtion. I feel like I should support

the spleen too, however most spleen herbs tend to be drying and I am

concerned about drying him out too much.

 

Any ideas would be much appreciated.

 

Zach

[Guest guest]

I don't know that someone with this resection is ever going to have normal

bowel movements again.

 

This cause of diarrhea isn't really on the zang-fu map. There simply isn't

enough bowel left to reabsorb his excess fecal fluids. With that in mind, I

think that addressing the pattern as it presents otherwise is the right

choice. I'm not sure what that pattern is, really, but the diarrhea isn't

caused by a pattern as much as a western surgery which isn't described in

any classic text.

 

-al.

 

On Sun, Sep 28, 2008 at 2:53 PM, znelms <znelms wrote:

 

>

> Hello Everyone, I'm hoping for some opinions or advice.

>

> I have a patient who's a 63yr old male and gets daily temporal

> headaches. The headaches usually come on with bowel movements.

>

> He's an insulin dependent diabetic, had all of his LI and part of his SI

> ressected due to ulcerative colitis. He has had chronic diarrhea since

> his bowel ressection. His tongue is dry, purple, and the coat is peeled

> in the rear yet it is thick, white, and greasy on the anterior 2/3rds.

> He is quite thin and looks " dried out. " His pulse is usually quite

> forceful and wiry.

>

> I would like to give him yin nourishing herbs, but he has chronic

> diarrhea and I wonder about absorbtion. I feel like I should support

> the spleen, however most spleen herbs tend to be drying and I am

> concerned about drying him out too much.

>

> Any ideas would be much appreciated.

>

> Zach

>

 

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

Zach,

 

I have worked with a few people who have had bowel resections and it

is true that without much large bowel left, their stools will

generally be loose/ watery. What can happen though, is that sometimes

there is still active flare ups of the colitis which will make the

bowel even looser than normal. This is where Chinese herbal medicine

can really make a difference.

 

I tend to focus between the poles of damp heat/ fire toxin in the

yangming and Spleen Qi/ yang vacuity.

 

If very active then a modified Bai Tou Weng Tang works well. During

other times a modified Li Zhong Tang works. The important part to

remember is that with this type of bowel problem I have found it

important to always keep a small amount of a draining herb like Huang

Lian within the mix, as there seems to allows be fire toxins lurking,

waiting to flare.

 

Based on the symptoms you provided I would think that if there is yin

xu it is stemming from a mix of fire toxin/ damp heat that has damaged

fluids. Clearing out the excess and supplementing the spleen will

ultimately help with proper fluid absorption again. I don't think

starting off with a formula to nourish yin may be the best approach.

 

My 2 cents

Trevor

 

, " znelms " <znelms wrote:

>

>

> Hello Everyone, I'm hoping for some opinions or advice.

>

> I have a patient who's a 63yr old male and gets daily temporal

> headaches. The headaches usually come on with bowel movements.

>

> He's an insulin dependent diabetic, had all of his LI and part of his SI

> ressected due to ulcerative colitis. He has had chronic diarrhea since

> his bowel ressection. His tongue is dry, purple, and the coat is peeled

> in the rear yet it is thick, white, and greasy on the anterior 2/3rds.

> He is quite thin and looks " dried out. " His pulse is usually quite

> forceful and wiry.

>

> I would like to give him yin nourishing herbs, but he has chronic

> diarrhea and I wonder about absorbtion. I feel like I should support

> the spleen, however most spleen herbs tend to be drying and I am

> concerned about drying him out too much.

>

> Any ideas would be much appreciated.

>

> Zach

>

[Guest guest]

Zach and all,

 

A brief analysis of your case:

 

Chief complaints: chronic diarrhea, temporal headache followed by

bowel movement; thick coating, wiry and forceful pulse condition.

 

Discussion:

SI governs separation of the clear and the turbid, LI governs governs

transformation and conveyance of waste; resection of LI and SL

damages to these functions, water gets into the intestines leading to

chronic diarrhea. Chronic diarrhea will damage to the right

qi,eventually causes spleen qi deficiency.

 

Spleen qi deficiency will cause center qi fall; clear yang failing to

rise leads to temporal headache or dizziness. Spleen governs movement

and transformation, spleen deficiency failing to convey fluids causes

dampness obstruction in the intestines, exacerating diarrhea;

resection of SI and LI causes local qi stagnation and stasis,

manifested a forceful and wiry pulse; a purple tongue indicates

stasis; therefore, this is a case of root deficiency tip excess case,

dual deficiency and excess.

 

I understand it is important to include all medical history details

of your patients. Seems to me he has oncology issue.

 

Pathomechanism: Spleen deficiency dampness obstruction; qi stagnation

with blood stasis

 

Diagnosis: Spleen qi deficiency

 

Principle of treatment: fortifying the spleen and dispelling

dampness; upbearing the clear and resolving toxic; harmonizing qi and

blood

 

Formula: shen ling bai zhu san (Ginseng, Poria, and Ovate Atractlodes

Powder) with modifications

 

Medicinals:

dang shen (codonopsis)10g

bai zhu (ovate atractylodes)10g stir-fried,

bian dou (lablab)10g

ju hong (red tangerine peel)15g

fu ling (poria)30g

shan yao (dioscorea)10g

lian zi (lotus seed)10g

yi yi ren (coix)30g

sha ren (amomum)10g

wu gong (centipede) one piece

ban zhi lian (bearded scutellaria)10g

sheng ma (cimicifuga)10g

 

<<I feel like I should support

> the spleen, however most spleen herbs tend to be drying and I am

> concerned about drying him out too much.<<<

 

As far as your worries is concerned, it is a matter of choices of

spleen-fortifying medicinals; the recommended medicinals are moderate

and should not cause such side effects.

 

My 2 cents

 

SUNG, Yuk-ming, Phd (Chengdu), PCed(HKU), L AC.(Hong Kong)

[Guest guest]

Zach and all,

 

Here is a brief discussion of your case.

 

SI governs separation of the clear and the turbid; LI governs

conveyance of waste; after resection of LI and SI, the functions of

conveyance and separation of the clear and the turbid are obstructed,

leading to fluid entering into the intestines. It results in

diarrhea. Chronic diarrhea will lead to spleen qi deficiency.

 

Spleen governs movement and transformation of fluids; spleen qi

deficiency failing to move and transform fluids will lead to

retention of fluid in intestines, exacerbating diarrhea. Extended

diarrhea will damage to the right qi; qi descending with the bowel

movement causes center qi fall, causing clear yang failing to arise.

It will result in temporal headache or dizziness.

 

Resection of LI and SL leads to local qi stagnation and stasis. A

purple tongue signifies blood stasis; a wiry and forceful pulse

signifies pain or qi stagnation. A forceful pulse signifies excess;

therefore, this is a case of dual deficiency and excess case.

 

 

Main signs: chronic diarrhea, temporal headache following bowel

movement, purple tongue with thick and greasy coating, a wiry and

forceless pulse

 

Diagnosis: chronic diarrhea

 

Pathomechanism: spleen deficiency with dampness obstruction; dampness

toxin obstructing intestines; qi stagnation with stasis

 

Principle of treatment: fortifying the spleen and dispelling

dampness; rising yang and resolving toxin; and harmonizing qi and

blood

 

Formula: shen ling bai zhu san (Ginseng, Poria, and Ovate

Atractylodges Powder) with modifications

 

Medicinals:

ju hong (red tangerine peel) 10g

dang shen (codonopsis)10g

bai zhu (ovate atractylodges) 15g

bian dou (lablab) 10g

shan yao (dioscorea) 15g

yi yi ren (coix) 30g

sha ren (amomum) 10g

wu gong (centipede) 1 piece

sheng ma (cimicifuga) 5g

ban zhi lian (bearded scutellaria) 10g

fu ling (poria) 10g

lian zi (lotus seed) 10g

 

Seems to me that the resection of intestines may be an oncology issue.

 

<<<I would like to give him yin nourishing herbs, but he has chronic

diarrhea and I wonder about absorbtion. I feel like I should support

the spleen too, however most spleen herbs tend to be drying and I am

concerned about drying him out too much>>>>

 

No need for using yin-nourishing medicinals; once the spleen is

fortified and its function is restored, diarrhea will cease and yin

will be preserved.

 

My 2 cents,

 

SUNG, Yuk-ming PhD(Chengdu), PCed (HKU) (Hong Kong)

[Guest guest]

Is it just that he's straining?

 

Geoff

 

, " znelms " <znelms wrote:

>

>

> Hello Everyone, I'm hoping for some opinions or advice.

>

> I have a patient who's a 63yr old male and gets daily temporal

> headaches. The headaches usually come on with bowel movements.

[Guest guest]

Yes I believe that he is straining, but the headache can last all day.

I'm not sure if the straining is actually causing the headaches or not?

>

> Is it just that he's straining?

>

> Geoff

[Guest guest]

In your initial post, you mentioned that 'The headaches usually come on

with bowel movements'. Your next post said 'but the headache can last

all day'. It seems inconsistent and very often patients themselves are

confused and giving contradictory data to us.

 

Would you care to share with us how your patient is doing now. I am

sure our listed members would like to learn something from your case or

any cases discussed here. It is one of those cases tcm can be more

effectual than western medicine. Thank you for taking your time to

share your case with us.

 

Warmly,

 

SUNG, Yuk-ming, L Ac.(Hong Kong)

[Guest guest]

I'm sorry if I wasn't clear. Perhaps I should have said that the

headaches are initiated by bowel movements and they often last for the

rest of the day. Not every bowel movement leads to a headache (he has

several BM's per day), but most of his headaches are initiated by one.

 

He was getting some relief with acupuncture but the relief was

temporary and inconsistant. Unfortunately he decided that the

treatments were too expensive so he stopped coming and I didn't get the

chance to dig too deeply.

 

Thank you to everyone who responded, it gave me a lot to think about.

If he decides to come back I will let you all know how it goes.

 

Zach

 

> In your initial post, you mentioned that 'The headaches usually come

on

> with bowel movements'. Your next post said 'but the headache can last

> all day'. It seems inconsistent and very often patients themselves

are

> confused and giving contradictory data to us.

[Guest guest]

It is too common that patients with chronic diseases cannot concisely

state their problems because they are so used to them. Doctors are

held responsible to analyze every details before a decent diagnosis

is made. Unfortunately, we are unable to be superdoc as depicted in

the TV series of House. With all sophisicated instruments, advanced

knowhow, and lab test, he can always make correct diagnosis

(eventually) as though peeling the skin of onion. Of course, our

patients won't stay in bed pending for our analysis. What really

ironic to me is the superdoc cannot treat his own chronic pain.

 

My point is TCM practitioners should treat patients according to

pattern identification, pathomechanism, treatment principles,and

medications. Diagnosis of western medicine is for our reference, not

any kind of indicator, or we will lose our direction.

 

Thank you for sharing your case with us.

 

Regards,

 

SUNG, Yuk-ming, L Ac (HK)

[Guest guest]

On Mon, Oct 13, 2008 at 7:50 PM, sxm2649 <sxm2649 wrote:

 

> What really

> ironic to me is the superdoc (House) cannot treat his own chronic pain.

>

 

 

 

 

 

That's a common theme that hearkens back to the story of the mythological

teacher - centaur " Chiron " (immortalized as the centaur depicted as

Sagittarius)

 

He is said to have brought medicine (and math and science and...) to Greece.

But a poison arrow had pierced his leg at one point in his life. because he

was immortal, he couldn't die, and he couldn't heal it. So he ended up

giving away his immortality to free Prometheus. Some believe that the

underlying moral is that only through our own pain can we understand the

suffering of our patients.

 

House may have a leg wound that he can't heal, but it doesn't seem to affect

his ability to be compassionate with his patients. He's kind of pathological

in that regard. He does however, have some really good writers, so while

he's a something of a grouch, he's a really funny grouch.

 

--

, DAOM

Pain is inevitable, suffering is optional.