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Message |
    
Anonymous
Username: Lthomas
Registered: N/A
| | Posted on Thursday, December 07, 2017 - 17:19: | |
Hello,
I've been working on cases (not for patients) and I have been stuck for the past couple of weeks (despite working on it for hours each day). I think it's been taking so long, because I feel like the case(s) could be argued a number of ways, which confuses me. I've exhausted all possible options for help, this is my last hope; I am hoping that someone can help guide me in the right direction toward a single or multiple-organ diagnosis for each case.
Case #1
21 year old female enters your office with chief concern of acne.
- It presents as red, pustular eruptions on her forehead + cheeks.
- Comedones present
- Experiences irritability, breast tenderness, mild cramping + loose stools before her periods.
- She is currently in a highly demanding university program and finds it very challenging & busy.
- Her sleep is poor & she has difficulty falling asleep, when she does fall asleep, she stays asleep the entire night.
Pulses:
Superficial / middle / deep
HT: 1 / 1 (frail) / 0
LV: 2 / 1 (wiry) / 1
KD YIN: 1 / 2 / 1
LU: 1 / 1 / 1
SP: 0.5 / 0.5 (slippery) / 0
KD Yang 1 / 2 / 1
0 = absent, 1 = weak, 2=moderate, 3 =excess
Tongue: pale body w/ a light purple hue w/ teeth marks and a thin white coat + small pale tip.
Case #2
29 year-old male enters your office concerned about his shortness of breath. That started 3 months ago while in Vancouver.
- Non-productive cough & slight wheezing
- He gets a “head cold” 5-6 times per year
- He sweats easily
- has constant nasal discharge w/ clear fluid
- gets chills very easily
- He tells you that his father died 4 months ago and he does not want to talk about it.
- No chest pain or palpitations.
Pulses: Weak and slightly floating in Right cun
Tongue: Pale w/ thin white coating, & a wider tongue body at the front
Case #3
39 year-old male with a chief concern of sciatica of the right leg that had been diagnosed by his MD 3 years ago.
- The pain is sharp & stabbing at times but the constant pain is heavy
- Pain radiates down the lateral aspect of the thigh & recently noticed up near the sacral area on the right
- Heat helps when it is sharp & also when it is heavy, stretching helps as well
- Cold makes it worse
- He also tells you that he has loose stools with a foul odor and a poor appetite
- He feels cold all of the time & feels stressed since he can’t provide more money for his family because he is on disability.
- He has not been able to produce an erection during intercourse with his wife for the past year.
- He tells you that he has been a bus driver for 12 years and his shifts are 10 hours long with 3 small breaks.
Pulse: Wiry (L)
Slippery, slow, and weak (R)
Tongue: Light purple w/ teeth marks, swollen in the centre, & marked distension of sublingual veins.
Case #4
64-year-old male crossing guard enters your office with a chief concern of knee stiffness (bilateral)
- Sxs are worse in the fall and winter
- Knees feel heavy &
- Pain is severe just behind the patella.
- He usually wears more clothes than his friends during the winter and has loose stools
- Sx’s are worse before or during a low-pressure weather system when there is rain (damp)
Pulses: Slow, tight & slippery
Tongue: Thick white coating w/ a pale, swollen body and teeth marks} |
Anonymous
Username: Jennifer
Registered: N/A
| | Posted on Friday, December 08, 2017 - 08:03: | |
in my opinion...
case 1: liver is the main culprit. in treatment, I would calm the liver fire and nurture the spleen and heart
case 2: treat the lung and wei qi, warm the interior, expel cold, fortify the exterior
case 3: he's likely got a herniated disc and needs and MRI. the same impingement causing the sciatic pain is probably also the cause of his digestive and fertility problems
I would treat the blood and qi stagnation in the low back, and give traction at the lumbo-sacral area
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Anonymous
Username: Jennifer
Registered: N/A
| | Posted on Friday, December 08, 2017 - 08:10: | |
case 4: look for herb formulas that remove damp and wind for "bi" pain relief, focus treatment on expelling damp and wind... points like GB 20, sp 9, LI 11, sj5, k6, k3, Du4 with moxa, and lots of moxa around the knees, the kidney and spleen channel, and the belly button, moxa around the lower abdomen to help bind stool |
Anonymous
Username: Jennifer
Registered: N/A
| | Posted on Friday, December 08, 2017 - 08:14: | |
I hope that helps! |
Anonymous
Username: Lthomas
Registered: N/A
| | Posted on Monday, December 11, 2017 - 22:43: | |
Thank you SO MUCH for your response! It REALLY does help me to gain an idea if I am on the right track or not. I can't express how grateful I am that you reached out to me, as I've been wracking my brain for the past couple weeks! I'm hoping that you will have free-time to respond again, to a couple of questions *fingers crossed*
Case #1
Assuming my hypothesis of how the patterned developed is correct (I welcome input), I am having trouble connecting LV Qi stagnation + SP Qi deficiency + HT blood deficiency to the chief concern of acne (red pustular eruptions on forehead and cheeks + comedones). I am quite perplexed as the overall case looks like one of cold/deficiency (weak pulses, pale tongue) however, the acne suggests heat/damp. One hypothesis is that maybe dampness could be obstructing the skin causing acne? I have no idea how to connect the acne to the pathologies (i.e. I can't explain how the organs are causing acne). Any suggestions?
My hypothesis is: LV Qi stagnation + SP Qi deficiency + HT blood deficiency:
LV Qi stagnation (wiry pulse, irritability, breast tenderness, cramping before periods, loose stools) was likely the first pattern that developed; facilitated by emotional stress (frustration, repressed anger and/or resentment) from her university program and caused LV Qi not to flow smoothly and become stagnant.
SP Qi deficiency (teeth marks, pale body, slippery pulse, loose stools) likely developed as a consequence of LV Qi stagnation or concurrently with LV Qi stagnation, due to emotional stress of her university program (overwork, irregular diet, worrying, studying, etc.) causing SP Qi to become deficient.
- When LV Qi stagnates, it distributes the SPs function of transformation and transportation. This can lead to the formation of phlegm/dampness due to the weakened ability to transform fluids (teeth marks on the tongue, slippery pulse, pustular eruptions) leading to SP Qi deficiency
- SP-dampness can interfere with LVs circulating function to facilitate LV QI stagnation (positive feedback loop).
HT blood deficiency likely developed from one or both of:
1) Not enough blood production by SP (due to SP Qi deficiency) leading to HT blood deficiency
- Food-Qi produced by the SP is precursor of Blood
2) Blood stagnation due to LV Qi stagnation -- when Qi stagnates, blood also stagnates (purple hue to tongue) leading to HT blood deficiency (also SP)
- Blood deficiency can also lead to blood stasis as deficiency of blood leads to deficiency Qi which fails to move blood. |
Anonymous
Username: Jennifer
Registered: N/A
| | Posted on Monday, December 11, 2017 - 23:53: | |
I think you're looking at it on the micro-level too much. The acne can be the liver heat rising. When you start to harmonize the organs, the symptoms will change. Acne may be from deficiency, when the spleen is not in control of managing the dampness in the body and the liver damp-heat is out of control. Somebody else may be able to explain it better using the 5 element and organ theory.
In treatment, I would stay the course of calming liver heat and stagnation, while nurturing the heart and spleen. It sounds related to sleep and heart also.
You may have to address skin care. Make sure she's using a clean pillow case, and clean wash cloth for face cleaning, no wash cloth at all. Find out what products she uses on her skin. Just suing water would be better than any chemicals that would make the problem worse. |
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Assistance would be VERY appreciated