January 17, 2012

A case of Shào Yīn headache- Wú Pèi-Héng (吴佩衡)

A male (no age or date given) was seen at the clinic complaining of a headache that began to manifest after contracting cold. He was erroneously given an acrid-cool formula, which offered him no relief.

The headache has lasted for over ten days now, and felt as if his head was being split open by a hatchet, which was described as “unbearable”. In the afternoon he would feel an aversion to cold, and generalized body pain. His pulse was deep and weak with no strength. His tongue coating was slippery-white, and he had no desire to drink.

The head is the gathering point for all the yáng, and currently we have a case of yīn pathogens rising and attacking the head. Yáng is insufficient and unable to transform and move these pathogens. The pathogenic factor and right qì are fighting one another, thereby causing this condition. The method of treatment should involve assisting the right qì and expelling pathogens. A modified version of má huáng fù zǐ xì xīn tāng (Ephedra, Aconite Accessory Root Tuber and Asarum Decoction) is able to address this.

fù zǐ (Aconiti Radix lateralis preparata) 100g 
gān jiāng (Zingiberis Rhizoma) 36g 
gān cǎo (Glycyrrhizae Radix) 6g 
má huáng (Ephedrae Herba) 10g 
xì xǐn (Asari Herba) 5g 
qiāng huó (Notopterygii Rhizoma seu Radix) 10g

After taking one package of the formula, the headache pain was cut in half, and after taking another package, his condition quickly resolved.

Commentary: This is a Shào Yīn headache, and because it was treated accordingly, the effect was excellent. Within the formula we see sì nì tāng (Frigid Extremities Decoction), which is able to warm and assist yáng qì to reach the head. má huáng (Ephedrae Herba), qiāng huó (Notopterygii Rhizoma seu Radix), and xì xǐn (Asari Herba), can dispel the cold which has settled in the Tài Yáng, transforming in the bladder (channel). Therefore, the formula is able to warm the channels, scatter cold, assist the right qì, and expel pathogens, to offer an effective treatment.

Headaches can occur in diseases of all six channels, but when we adhere to the methods of six-channel pattern identification given to us by Zhòng-Jǐng, we are able to treat and achieve positive results.

January 4, 2012

A Menopausal case

When I think back of my undergraduate studies in Traditional Chinese medicine just under ten years ago, I remember a time where the possibilities of treatments were endless. I felt that when thrown into the real world of practice I would be invincible. We were taught hundreds of formulas for hundreds of conditions, and were led to believe that we would achieve excellent outcomes if we were only to memorize these specific formulas and apply them to these conditions. Once in practice we quickly learn that this is in fact not reality! One that specifically comes to mind is the treatment of menopausal conditions (更年期综合症).

In many English language textbooks (and even standard mainland texts), menopause is most commonly associated with a yīn deficiency pattern, and is treated with formulas such as Liù Wèi Dì Huáng Wán, Dāng Guī Liù Huáng Wán, etc.  However, once in clinical practice when encountering these kinds of patients, these formulas tend to exert only minimal effects. Now I’m not saying that these kinds of yīn deficiency patients do not exist, they do, albeit in much smaller numbers than we may have been taught.

In my experience practicing in the cold and wet pacific north west, the majority of menopausal woman I treat rarely suffer from a yīn deficiency pattern, but in fact manifest with various patterns, with a strong majority showing signs of yáng deficiency. Yáng deficiency? When I discuss cases with colleagues and talk about treating hot flashes, night sweats, and other menopausal complaints with high doses of herbs like Fù Zǐ or Ròu Guì, they think I’m nuts. However, the proof is in the pudding. The way I see it is that as a culture we are eating poorly, are under an enormous amount of stress, take far too many pharmaceutical drugs, get inadequate amounts of sleep, lack exercise, are far too over stimulated, and consume various vitamins, supplements, and undertake random fasts and cleanses. These are all practices that inevitably deplete our yáng reserves. The essential mechanism that I recognize in many of the woman I see, is a deficiency of yáng that is unrooted in the lower body and floats upwards causing symptoms such as insomnia, hot flashes, night sweats, etc. I feel that it is these ‘heat like’ symptoms that confuse many practitioners, who prescribe various heat clearing, yīn nourishing medicinals all to no avail.

When a patient presents with these seemingly signs of heat, how are we to distinguish between a yīn or yáng deficiency? In his well-written article in the Lantern entitled ‘Playing with Fire’, Gunter Neeb quotes Xú Dà-Chūn from his ‘On the Origins and Development of Medicine’, outlining a very basic diagnostic approach to patients with excessive sweating which can be applied to the excess sweating seen in menopausal conditions:

“Sweating due to loss of yin manifests with aversion to heat, warm hands and feet and skin that is warm to the touch and with warm sweat. The patient is thirsty for cool drinks. His breath is agitated, his pulse overflowing (hong). Sweating due to loss of yang is exactly the opposite: the patient fears cold, the extremities and skin are cool with a cold sweat. He favours bland or slightly sweet foods and is not very thirsty, but has desire for warm drinks. His breath is feeble and the pulse is rapid, superficial and empty”.

This diagnostic guideline above is essentially the same that I have been using when faced with cases of night sweating and have found the results to be extremely gratifying both for me, and my clients. When dealing with hot flashes, I simply inquire how the patient feels following the flush. If they feel very cold afterwards, and also have a lack of thirst, no major dry symptoms, and possible lumbar pain, I will diagnose the pattern as a yáng deficiency.

I would like to illustrate this further with a case from my own practice.

On June 22, 2011 a 48-year-old female presented at the clinic complaining of general menopausal symptoms. These included; irritability, low libido, night sweats, weight gain, occasional hot flashes, poor sleep, light-headedness, a history of low back pain, slight thirst, a strong aversion to cold, and some pretty intense stress recently. Her tongue was essentially unremarkable, and her pulse was deep, and slightly weak. Her bowel movements and urination were normal, and she experienced no digestive issues. Her last menstrual period was in November 2010.

When asked how she felt after either the sweating or hot flashes, she mentioned that she felt very cold, and needed to really bundle up to stay warm. In addition, she had given birth to two boys three and a half years prior, after several rounds of intensive in vitro fertilization treatments.

I saw her pattern as a yáng deficiency, with the yáng being un-rooted in the lower burner, and floating upwards. She was also manifesting very mild yīn deficiency symptoms.

She was administered a formula in granule form, at two teaspoon (6g), twice daily.

Fù Zǐ 20g
Ròu Guī 10g
Bái Sháo 10g
Hé Huān Pí 10g
Fú Xiǎo Mài 12g
Nǔ Zhēn Zǐ 12g
Hàn Lián Cǎo 12g
Mǔ Lì 12g
Lóng Gǔ 12g
Zhì Gān Cǎo 10g
Fú Shén 10g

Results: On follow up one week later, she reported that all her symptoms had improved, and she was feeling “wonderful”. She was given another two weeks of the same formula. On follow up five months later, she informed me that since taking the formula, all her symptoms disappeared, and have yet to return.