June 29, 2011

Two Cases of Wind Rash (Urticaria)

The following are two translated cases by Matt Branham of Eugene, Oregon.

Wind hidden rash (urticaria) Case #1

Dr. Liu Jun Shi case: patient Wu, male 57 yrs old, outpatient service #43115, came for a visit on 6/27/1983.  The whole body was covered with rash which periodically got better and then returned over the past ten years, the whole body itched making life hard to bear.  The rash was worse on the upper body, there was fear of cold, ordinarily when he encountered cold the whole body would break out.   He had tried many treatments, which gave temporary relief, but the effectiveness of the treatments were lacking. Whenever he encountered cold the rash would flare up again.  The tongue body had teeth-marks, and both pulses were slippery and moderate.  This pattern belongs to constitutional yang deficiency.  In addition there is wind evil, so one must warm yang and disperse cold, Wu Tou Chi Shi Zhi Wan with modifications is the treatment.
 Zhi chuan wu, cao wu 3g each, gui zhi 3g, bai shao9g, xi xin 3g, gan jiang 9g, bai zhi 4g, chuan jiao 9g, gan cao 9g, chi shi zhi 30g, decoct and take 3 packets.

Second visit was on 6/30/86.  The urticaria had greatly decreased, the itching and pain were also alleviated.  He was asked to continue taking the original 3 packets.    
Third visit on 7/5/86.  Urticaria had completely receded, and on follow up with the patient regularly after two years there was no recurrence.

Beijing Journal of Traditional Chinese Medicine

Editors comments: When yin cold flourishes internally, yang qi becomes weak, thus the exterior cannot defend against wind evil, leading to wind rash.  Other treatments failed to dispel cold, therefore yang qi had difficulty in recovering; they did not warm yang, and wind did not go, therefore, over a long period of time he wasn’t healing.   Wu Tou Chi Shi Zhi Wan was used to warm yang and dispel cold, only then can one get to the root of the problem, therefore remedying chronic illness in a relatively short amount of time.

Addendum: This formula by Zhang Zhong Jing is an example of his use of wu tou and fu zi at the same time.   Wu tou and fu zi belong to the same category, but their functions are slightly different: Wu tou is good at lifting out sunken and chronic cold.  It also can scatter and disperse wind and cold from the channels.   Fu zi is good at treating organ level cold damp, and is able to warm and transform cold damp.  Due to the fact that this pattern was a yin cold evil, as well as affecting the interior and exterior, zang fu, channels and collaterals as well as the core and surface, Zhang Zhong Jing used both wu tou and fu zi to rouse yang and disperse cold evil.
Chen Ming, Zhang Ji Sheng, Wang, Jin Gui Ming Yi, Beijing University Press 2003

Wind hidden rash (Urticaria) Case #2

Dr. Li Mao Xing's case: patient Zhang, male, age 34. Two years ago the patient caught a wind cold and his whole body broke out in rash with severe itching.  When he scratches, the rash gets worse.  He has tried cyproheptadine hydrochloride and vitamin c treatments which brought about some relief, but still he had frequent recurrence and a cure had not been served.  A week ago, after eating seafood there was a recurrence of the rash, and on 11/15/91 he came in to my office for an interview. 
Examination: his whole body was covered with rash of unequal size, the form of the rash was not uniform, bright red in color and bumpy, the rash color faded with pressure, and itched intensely.  It was also accompanied by low grade fever, headache, thirst, constipation, turbid urine, red tongue, yellow coat, and wiry rapid pulse.  The pattern belongs to excess heat held internally, externally contracted evil, and the issuing of heat toxin to the exterior.  Treatment used Fang Feng Tong Sheng Tang modified.
  Herbs used: fang feng, jing jie, chuan xiong, shan zhi zi, huang qin, da huang(cooked later) all 10g, ma huang, bo he 6g, gan cao 8g, shi gao, ku shen, 15g, mang xiao 12g (decoct separatly) bai xian pi 30g. Take one packet per day water decocted.  After taking 8 packets, the rash, for the most part disappeared, the itching was controlled, but his bowel movements increased in number.  The next step in the prescription removes mang xiao, and decreases da huang, with the addition of jin yin hua 20g, in order to increase the heat clearing, toxicity resolving functions.  After 6 packets the skin rash had disappeared, and the itching was completely resolved.   The illness had been completely resolved and after one year follow up there was no recurrence. 

Zhejiang Journal of Traditional Chinese Medicine

Editors comments: Urticaria is commonly called wind rash; Chinese doctors call it hidden rash.  There are several treatment methods, with the principle methods being; coursing wind, clearing heat, resolving toxicity and alleviating itching.  This case belongs to excess heat in the interior, affected by externally contracted evil, causing both interior and exterior excess syndrome.  Therefore, Fang Feng Tong Sheng Tang was used as it, resolves the exterior and unblocks the interior, courses wind, clears heat and resolves toxicity.  The formula with the addition of ku shen and bai xian pi to clear heat, disinhibit dampness and stop itching, and jin yin hua to resolve toxicity and eliminate fire was used.  The whole formula clears and penetrates both the interior and exterior, thereby disinhibiting dampness and eliminating heat and dispelling toxins.
Chen Ming, Zhang Ji Sheng, Wang, Wen Bing Ming Fang, Beijing University Press 2003

A quote from the Wen Re Lun that Chip Chace had mentioned in our class on warm disease got me thinking about the effectiveness of Jing Fang formulas for the treatment of rashes.  The quote goes something like this, “You can ride your horse and enjoy the landscape when treating shang han (cold damage), but things can change when you look over your shoulder in treating rashes.”  Both of these cases treated urticaria, or skin rashes, from a different perspective.   The first case involved a formula from the Jin Gui Yao Lue while the second used a formula from the Wen Bing tradition.  As rashes of this nature can occur through many etiologies using appropriate pattern identification will lead to the desired outcome.  In case 1, exposure to cold caused the rash to flare.  This patient had weak wei qi due to a constitutional yang deficiency, the appropriate treatment was thus to warm yang to secure the exterior.  Chi Shi Zhi is sweet and warm thus augmenting the qi, its astringent nature was also well suited to aid in securing the exterior.  In case 2, initially the patient developed rash from exposure to wind cold, later after eating seafood the rash recurred this time with marked heat signs.   The wind cold evil was never released from the exterior.  After eating bad seafood the patient experienced a toxic reaction to the food that brought a recurrence of the skin rash.  The skin is ruled by the lungs, the lungs are interiorly related to the large intestine, when the patient presented with heat signs and constipation a purging method was appropriate.  Here the Dr. was consistent with Wen Bing thinking to add exterior resolving herbs so as to vent some of the pathogen up and out to the wei level while also purging the interior heat through the bowels.   While both of these traditions use their formulas in a particular way, they both employ basic pattern identification to reach their conclusions.  To me the unification of these systems comes in the effective use of the Eight Parameters.  These archetypal structures are the hallmark of a phenomenological world view espoused by the ancients and of great value to modern day people.

June 20, 2011

Rib-side pain (Hepatitis)

Liu Du-Zhou, New Chinese Medicine, 1979; 2: 36

Mr. Liu, a 54 year old male presented at the clinic with hepatitis manifesting with abdominal distension and diarrhea. He had very little desire to eat, and experienced rib-side pain that extended to his back. He had taken several formulas which offered very little benefit. It was at this point that I was asked to treat this gentleman. His pulse was wiry and moderate, and his tongue was pale with a white coat.

This was a case of liver disease affecting the spleen manifesting with a decline in spleen yang.

I decided to course (the liver) using Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction).

Chai Hu 12g
Huang Qin 4.5g
Zhi Gan Cao 9g
Gan Jiang 9g
Gui Zhi 9g
Tian Hua Fen 12g
Mu Li 12g

Altogether 4 packages were taken which resulted in the complete resolution of the abdominal distension and diarrhea. His appetite also improved indicating that the liver and spleen were harmonized and his GOT (Glutamyl oxaloacetic transaminase) and GPT (Glutamyl pyruvic transaminase) levels were basically back to normal and thus he recovered.

June 13, 2011

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning

Here is a guest post from the great Sharon Weizenbaum

By Dr. Shi Jin-Mo  今墨 (1881-1969)
Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning.
Translated with Commentary by Sharon Weizenbaum

 In an age in which there is a strong impulse to “detoxify” through various kinds of purges and cleanses, I feel this case offers a breath of fresh insight.  So many times our patients ask us how they can get some bad stuff out of their bodies – whether this bad stuff is heavy metals, candida, lyme or other chemicals.  What I feel Dr. Shi is reminding us to do is to look not at what the toxin is or how to get rid of it.  Rather we should look at the actual signs and symptoms to determine how the toxin damages.  We should ask what the response of the body is and not focus on the toxin itself.

In addition, this case inspires me to consider brain damage in a less fixed and fatalistic way. 

Dr. Shi’s case:

Ms Zhang was 60 when she came in for her first visit.  A couple of months previously she had received carbon monoxide poisoning.  After receiving emergency care she unexpected lived.   However, she suffered from abnormal spirit essence, inability to eat or dress without help from her family, inability to speak or sleep or control her bowels properly.  In general, she seemed to be like a retarded person, frequently covering her head with her arms.  At the hospital in Beijing, she was given the diagnosis of post carbon monoxide poisoning neurosis. 

Her check-up revealed that her pulses were wiry, deep and rough. 

Diagnosis:  Post carbon monoxide poisoning central brain damage with loss of control of body functions and Qi and Blood obstruction. 

Treatment method:  Open through the Luo vessels and regulate the Qi mechanism.

Jiu Chang Pu                           10 gm
Jiu Chao Chong Wei Zi            10 gm
Bai Ji Li     Fructus Tribuli        12 gm
Sang Zhi                                  18 gm
Chao Yuan Zhi                        10 gm
Su Di Long                              10 gm
Sang Ji Sheng                          18 gm
Huai Niu Xi                             10 gm
Xia Ku Cao                             10 gm
Chen Bai Wei                           6 gm
Chang Gou Teng                     12 gm
Shou Wu Teng                        15 gm
Jiu Chuang Xiong                      5 gm

Discussion:  This patient’s appearance was very much like a retarded person.  She was unable to speak or sleep and her movement was slow.  Her pulse was wiry, rough and irregular.  These symptoms all belong to the category of Liver vacuity and Heart Qi insufficiency.  In addition her meridian and luo vessels pathways were not open through.  It was important to principally treat the Heart and Liver channels as well as the three aspects Qi, Blood and Phlegm.  Every time she came there was gradual improvement.  The fourth visit was after half a month of taking the herbs.  Follow up showed that her eating, sleeping, urination, bowels and spirit essence were all normal.  Her movement was still sluggish.  These kinds of clinical illnesses do not appear very often.  I carried out treatment according to my rich experience.  Using differential diagnosis I determined the formula.  With the group of herbs that open through and quicken blood, I had to find just the right balance of drastic and fierce measures.  Altogether she took about 50 packages of herbs and gradually improved. 

Pu Huang treats Blood stoppage pain.  Prepared it can stop bleeding.  Fresh it vitalizes Blood.  It can be used at the base of the tongue to treat inability to speak.  If it is used repeatedly, it will be effective.  This is also a formula from my experience. 

June 10, 2011

Translators Unite!!!

Are you an aspiring Chinese medicine translator?

Have you translated some interesting cases in the past and never shared it with the world?

If so, then our profession needs to read them.  I would like to extend an invitation to anyone out in the cyber-world to post one or two of their translated cases here as a guest writer/translator.  There is so much out there to translate and quite honestly 'the more, the merrier'.  With my current schedule it is hard for me to get too many cases done a month and I would love to see even more posted. 
Chinese medical cases are an incredible medium and learning tool to delve into the mind of the experienced practitioner, and offer us a wealth of useful clinical information.  To date very few case studies have been translated into English, and so for the non-Chinese readers out there, it is critical we get more done.

So if this is of interest to you, please send me an e-mail with a case study to info[at]eraneven.com


June 8, 2011

A Case of Infertility

In keeping with the theme of using classical formulas to treat conditions they are not typically indicated for, I offer a translation of an interesting case of infertility treated with Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). The importance of treating the presentation and not getting too attached to the disease at hand rings true once again.

Liu Du-Zhou’s Clinical Experience in the use of Classical formulas
Journal of the Beijing University of Chinese Medicine, (Volume 17-5: 1994)
Written by Liu Bao-Hua

On December 20, 1989, a 30 year old female presented at the clinic complaining of an inability to conceive for over four years. She was diagnosed in the gynecology department with primary infertility, and has taken numerous formulas to date without any positive outcomes. Her cycle arrived every forty days or so, and would be complicated by lower abdominal and lumbar pain, scanty flow mixed with clots, and she was easily constipated. Her pulse was slippery-rapid and strong, tongue coat was thin-yellow, and the tongue body was bluish-purple. The diagnosis was binding of heat and blood, with obstruction of the chong and ren vessels, causing difficulty in conceiving.

Treatment principle: Discharge heat, and move static (blood), in order to eliminate the old to make room for the new. A powerful formula needs to be used in order to positively treat this obstinate condition.

The formula used was Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi):

Tao Ren 15g
Da Huang 4g
Mang Xiao 4g (added to strained decoction)
Gui Zhi 10g
Zhi Gan Cao 6g

After taking five packages of the formula she reported that her bowels were looser, and she had also discharged relatively copious amounts of black menstrual blood. Her lower abdominal and lumbar pain had settled, and her cycle arrived on schedule. On follow up six months later, she reported that she was indeed pregnant and went on to have a healthy baby girl.

Commentary: Tao He Cheng Qi Tang is basically Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the qi decoction) with the addition of Tao Ren, and Gui Zhi. Tiao Wei Cheng Qi Tang is used to discharge heat, and break binds. Tao Ren is moistening and disinhibiting, and is very good at expelling and eliminating static blood. Combined with Mang Xiao, and Da Huang the action of eliminating static blood and stagnation is strengthened. Gui zhi is used to free and move the defensive qi, following the adage of ‘when the qi moves, the blood will follow’, which will invariably strengthen the overall blood moving effect of the formula. In addition the warm nature of Gui Zhi moderates the cooling nature of both the Mang Xiao and Da Huang. 

June 5, 2011

Case study of Zhang Xiang-Fu (张祥福)

One of the great things about reading and studying case study literature is that we are able to learn from experienced practitioners, new and unique ways of using classical formulas we may never had thought of. When first seeing this case written up under the Wu Ling San heading, I was surprised, as treating uterine bleeding with this formula would never have existed within my thought process. Initially I thought I stumbled upon a true goldmine, but after reading the case it was clear that the practitioner was merely putting more stock into the presentation, rather than the actual disease. This is essentially the bread and butter of Chinese medicine, yet so easily disregarded these days. So nothing too dramatic nor enlightening here but still an interesting case.

***A 35 year old female presented at the clinic on May 12, 1978. The patient has always been overweight and suffered with excessive menstrual bleeding. The timing of her period has always been indeterminate, with flows usually lasting longer than seven days. This afternoon she suddenly experienced acute lower abdominal pain, and violent, heavy menstrual flooding. A local hospital treated her in the emergency department and administered medicinals to stop bleeding, along with intravenous fluid injections, all to no avail. At this point she was referred to me for treatment.  

Current signs and symptoms: Sallow white facial complexion, icy cold extremities, beads of sweat emanating from the head, spitting up of turbid frothy phlegm, acute lower abdominal pain, which favours palpation, a pale, tender, enlarged tongue body, with stasis macules on the edges, a white slightly greasy tongue coat, and a choppy pulse. Laboratory results were as follows: Hemoglobin 6.5g, white blood cells 5200 m3, neutrophils 65%, lymphocytes 30%, monocytes 2%. 

Diagnosis: Fulminant flooding (functional uterine bleeding)

Pattern:  Damp-phlegm obstructing the uterus

Treatment Principle:  Boost qi, stop bleeding, free the yang, and disinhibit dampness.

Formula:  The formula used was Wu Ling San (Five ingredient powder with poria), with the addition of Shai Shen 10g (Sun-dried ginseng), E Jiao 10g (melted and added to decoction), San Qi 10g (powdered and infused). 2 packages were administered.

Follow up consultation on May 14:  She reported that her spirit felt awakened, her limbs now felt warm, and the bleeding had ceased. The original formula was continued for another five packages which were enough to completely resolve the bleeding and bring about a resolution to her condition.

Commentary:  Along with her main symptoms, this patient was also presenting with spitting up of turbid, frothy phlegm, an enlarged tongue body, with a greasy coat, and had always been overweight, which signify the presence of damp-phlegm retention. This damp-phlegm was obstructing the uterus, and causing insecurity of the ren and chong channels, causing menstrual flooding. Wu Ling San was chosen to free the yang, and disinhibit dampness. Shai Shen, E Jiao, and San Qi were added to boost qi, nourish the blood, and stop bleeding. Therefore by simultaneously treating the root and branch of the syndrome, we are able to achieve excellent results.

(This case was translated from 'Selected Cold Damage cases from the Clinical Experience of Famous Physicians'. Originally found in the ‘Chao Nan Journal of Traditional Chinese Medicine, 1989; (6): 19)’

June 3, 2011

It's been a while......

It’s been a while since I’ve posted a case study, so I apologize to anyone who checks out the site regularly. I have been incredibly wrapped up with home life, clinic, and a relatively large translation job that has left little time nor desire to translate anything else. Now that the job is done, I can refocus on translating pieces I actually want to and enjoy.

Last month in Portland at the Zeng Rong-Xiu conference I was chatting with a couple colleagues who write blogs as well about how lonely the blogging world is. It’s hard to know if anyone ever reads these blogs (as comments are few and far between) let alone what they actually think. So if folks don’t mind, I’d love it if you would leave a comment just to say hi, let me know I’m not alone within this blog, and leave any constructive criticism you may have no matter how ego shattering it may be. Don’t worry, I can take it.

Thanks for reading.