The Three Treasures Newsletters
SPRING 2005
QUESTIONS AND ANSWERS
The following are questions regarding the clinical use of the Three
Treasures from practitioners. They are reported below to help other
practitioners in the choice of remedies and treatment principle.
Topics:
1. Topic: TREATING ACCORDING
TO THE FOUR PHASES OF THE MENSTRUAL CYCLE
a. Menstrual Migraines
Q: I have a 45-year-old
patient who has migraine headaches which only occur during menses
and begin on day 2 or 3. She has heavy bleeding on the first two
days of her period which temporarily stops when her headache begins
and then resumes, although not as intense. The headache can last
for up to three days and is located on the left, front aspect of
her head. She also experiences extreme heat in her head and upper
body along with the headache and her abdomen also becomes very distended,
which she says feels as though she is 4-6 months pregnant. Her tongue
is not red, nor does it have red spots or a yellow coating. She
is being treated with acupuncture and a patent remedy for women's
cycle. Please could you suggest another herbal formula that she
could take for this condition?
A: It sounds as though her headaches could
be due either to Liver-Yang rising or Liver-Fire. Since the tongue
is not red and the pulse is choppy, indicating Liver-Blood Xu, Liver-Yang
rising is the more likely pattern. The extreme distension is probably
due to Liver-Qi stagnation. Therefore, she seems to have a common
cluster of Liver patterns: Liver-Blood Xu, Liver-Qi stagnation and
Liver-Yang rising. Since the headaches occur exclusively at the
time of her period, you must regulate the menses by treating according
to the four phases of the menstrual cycle:
Phase 1 - the period itself
Phase 2 - 1 week after the period
Phase 3 - Ovulation time (about 1 week beginning from the end of
Phase 2)
Phase 4 - pre-menstrual phase (about 1 week)
I would suggest the following:
Phase 1 - Bend Bamboo (3
x 2 tablets daily)
Phase 2 - Precious Sea (2
x 2 tablets daily)
Phase 3 - Growing Jade (2
x 2 tablets daily)
Phase 4 - Freeing the Moon
(3 tablets in the morning) plus Bend
Bamboo (3 tablets in the evening)
She should stop taking any other patent remedy while she is following
this treatment protocol.
Note: this practitioner wrote back three
months later to report a dramatic improvement in this patient's
condition.
b. Vaginal itching, depression and malar flush
Q: I am seeing a 38-year
old female who is suffering from vaginal itching and a yellowish
vaginal discharge, which occurs a few days before her period. She
was diagnosed with a bacterial vaginal infection a month ago and
was put on antibiotics. Since then the itching occurs only before
her period.
Her periods are regular, although she does have some menstrual cramps,
which go away with rest, and headaches which occur if she does too
much during her period. She is also irritable, angry and depressed
before and during her period and she took Welbutrin (an anti-depressant)
for her depression for 7-8 months, up until 4 months ago. Her depression
was associated with a complete lack of energy and she slept for
up to 12 hours a day, had tiredness before her period and a mild,
transient pain in her lower abdomen (an ultrasound ruled out polycystic
ovaries).
Her skin is oily and peels if she does not use moisturiser. She
has tinea on her chest and upper back. She also has whiteheads on
her face before and during her period. She had very bad acne from
the age of 22 and has been taking a herbal formula which cleared
her skin and made her periods regular. She begins taking the herbs
3 days before her period and continues for 3 days after her period.
The formula clears Heat in the Lung and Liver and moves Qi.
She also has a malar flush and butterfly redness and a feeling of
heat in the face, even though she feels cold most of the time. She
has a bowel movement everyday, but has difficulty passing stools.
She urinates frequently, especially if she has cold drinks and food.
Her feet tend to be numb and cold before her period.
She has a son, but a history of infertility and took Clomid to get
help her get pregnant. She also has a history of fibrocystic breast
disease.
Her tongue is swollen with some toothmarks and has a pale body,
but is red on the sides and tip, with a sticky yellowish coating
at the root. The tongue can be purplish just before her period.
The pulse is deficient and slightly wiry/slippery.
My diagnosis is Liver-Qi stagnation and Kidney-Qi deficiency leading
to Damp-Heat in the Lower Jiao. However, she has so many combinations
of Cold and Heat symptoms which make me cautious. Can you please
recommend formulae for different phases of her cycle?
A: This patient has many signs of Dampness
e.g. vaginal itching, acne, tinea, fibrocystic disease of the breasts
and a sticky-yellow tongue coating.
Judging from the tongue and pulse it sounds as though she also has
Liver-Qi stagnation. I would not worry too much about the contradictory
hot-cold signs, as these are very common in women and could simply
be due to Kidney-Yang Xu (pale tongue) and Heat deriving from Liver-Qi
stagnation (red sides of the tongue).
I would give her the following:
Phase 1 - Stir Field of Elixir
Phase 2 - Unicorn Pearl
Phase 3 - Clear the Palace
Phase 4 - Freeing the Moon
or Freeing Constraint (perhaps
the latter).
Acupuncture can be used to tonify the Spleen.
c. Menstrual irregularities
Q: I
would like your suggestions on the appropriate Women's Treasure
formulae for one of my patients.
She is 32 years old and has a history of irregular menses. Two years
ago she had a miscarriage at 10 weeks and required a D&C. She
has never had a normal menstrual cycle and her menses have always
been irregular. Her symptoms include: cold hands and feet; a tendency
to feel cold; low back pain with the onset of the menses, PMS symptoms,
such as breast and abdominal distension, irritability and outbursts
of anger. She also has a small uterine fibroid which her physician
has determined does not affect implantation. She is currently on
Follitism (follicle stimulating hormone) and she has a history of
occasional ovarian cysts. Her menstrual bleeding is normal on day
1, but scanty by day 2 and the bleeding only lasts 3 days. Her face
is pale and she is slightly underweight. She exercises 4-5 times
a week. Her tongue is pale and slightly swollen with a wet, thin
white coating. Her pulses are thready and weak.
My diagnosis is Kidney-Yang deficiency, Liver-Qi stagnation and
Blood stasis in the Uterus (possibly also cold in the Uterus due
to the D&C and Kidney-Yang deficiency). I also assume there
is Spleen-Qi deficiency due to the Liver-Qi stagnation. I am not
sure that I see enough evidence on the pulse and tongue to support
a diagnosis of Phlegm.
I believe I need to tonify Kidney-Yang and stimulate the free flow
of Liver-Qi and invigorate and Move the Blood. The formulas I am
considering are:
Phase 1 - Stir Field of Elixir
Phase 2 - possibly Unicorn Pearl, but I am unsure for how long
Phase 3 - possibly Freeing the Moon
A: I agree with your diagnosis. I would
only add that the Blood Stasis in the Uterus probably derives from
Cold. Does she feel noticeably colder during the period? This is
important. Also, there is some Dampness, probably just Dampness
rather than Damp-Phlegm. You also say that the periods are irregular,
but do not say how.
I would do the following:
Phase 1 - Stir Field of Elixir
Phase 2 - Unicorn Pearl
Phase 3 - Unicorn Pearl
Phase 4 - Warm the Menses
I would not do anything for the Liver-Qi stagnation, as you can
attend to that with acupuncture. Otherwise, if you want to treat
it, change as follows:
Phase 3: Warm the Menses
Phase 4: Freeing the Moon.
However, there is no point in using the above while she is on hormonal
treatment.
With acupuncture use: LU-7 on the right and KI-6 on the left to
open the Ren Mai, Ren-4, ST-28, KI-3, BL-23, BL-20 and Ren-12. Tonify
the Spleen with acupuncture.
d. Treatment of Uterine Fibroids
Q: My
patient is 51 years old and has uterine fibroids which have grown
from 69 mm to 200 mm in 2 years. There is retro-pressure of the
uterus on the bladder and ureter which causes leakage of urine,
frequent urination and discomfort during sexual intercourse. She
constantly feels distended, as though she is pregnant.
She normally has a 26-day menstrual cycle, with an occasional 35-day
cycle. Her period is heavy and flooding on the first day with clots
and low back pain. After a week there is staining for a further
week, after which her vagina feels sore.
She rigorously avoids dairy and usually voids her bowels 2 or 3
times a day. Her stools have a soft consistency and she is occasionally
constipated.
She sweats during the daytime and gets up at night to urinate, but
resumes sleep easily. Her libido is low and she is generally exhausted.
She has a prolapse of the third lumbar disc, which causes intermittent
sciatica down both legs and she describes her joints as creaky.
Her pulses are generally slippery, and slightly superficial and
very deficient in the third position. Her tongue has a thick yellow
coating with raised red dots in the front third. Sub-lingually there
is slight purple distension.
I diagnosed Kidney-Yin and Yang deficiency, Damp-Heat in the Liver
and Gall-Bladder, Blood stasis in the Lower Jiao and Liver-Blood
deficiency.
The first herb prescription was: Huang Bea 9 , San Leng 9, E Zhu
9, Hai Zao 9, Du Zhong 9, Xiang Fu 9, Mu Dan Pi 9, Shan Yao 9, Qian
Cao Gen 9, Chi Shao Yao 9, Sheng Di Huang 9, Fu Ling 9 (given in
concentrated powder form).
The tongue is now much clearer and less red and she feels less engorged,
less pressure on her bladder and the clots have almost disappeared
from her period, which is itself shorter and lighter. She is less
exhausted and less sweaty.
I have substituted Huang Bai with Lu Lu Tong and Shi Chang Pu as
there was less Heat, but slipperiness on the pulse. I have added
Tu Si Zi for the Kidneys. I will tonify and invigorate the Blood
as soon as a more balanced picture emerges.
Would you change or add anything to the herbs and how long do you
think that the process will take? Her doctor wanted to give her
an injection to bring on the menopause and shrink the fibroids,
but she wants to avoid this.
A: (after meeting the patient): The patient's
tongue is slightly reddish-purple on the sides (which reflect either
the Liver or the Uterus) with slightly dark sub-lingual veins. Her
pulse was slippery and weak on both Chi positions and the Heart
pulse was relatively Overflowing compared to the other positions.
This is a very reliable indicator of emotional problems and should
be addressed. It may be related to relationships and I wonder whether
her lack of libido relates to problems in her relationship with
her husband, rather than a Kidney-Qi deficiency. Also the failure
of Heart-Qi to descend (due to emotional problems) could play a
role in the lack of libido, i.e. Heart-Qi and Heart-Blood not going
down to the Kidneys, Uterus and genitals.
With a myoma there must be Blood stasis, which is supported by her
tongue and large menstrual clots. However, in her case I think there
is also Damp-Phlegm in the Uterus, which contributes to the pathology
of the myoma. The signs are slippery pulse, ovarian cysts in the
past, lipomas on the legs and abdominal pain mid-cycle. The prolonged
menstrual bleeding is due to Spleen and Kidney-Qi Xu.
In her case I think it would be advisable to treat according to
the phases of the menstrual cycle and I would recommend:
| Phase 2 - |
tonify the Kidneys (7-8 days) |
| Phase 3 - |
resolve Damp-Phlegm from the Uterus
and invigorate Blood (something similar to your formula, but
with resolving-Phlegm herbs, look at the ingredients of Clear
the Palace). |
| Phase 4 - |
move Qi and invigorate Blood (a
variation of Freeing Constraint
modified to invigorate Blood). |
I do not see Damp-Heat in the Liver and Gall-Bladder or Liver-Blood
Xu.
Prognosis: the tennis-ball sized myoma cannot be dissolved and can
only be reduced at the very best. If the other two are small they
could be dissolved, but it will take a long time, at least a year
or more. However, irrespective of whether the myomas disappear,
I think that the combination of acupuncture and herbs can make her
feel much more comfortable, or at worst stop the myomas growing
and stop the excessively long menstrual bleeding. The sub-serous
myomas are the most difficult to treat.
Acupuncture: I would concentrate on lifting Qi in the Ren Mai, which
should help to straighten the uterus and relieve the pressure on
the bladder. I would use LU-7 on the right and KI-6 on the left,
Du-20 and Ren-6.
e. Timing of treatment according to the 4 phases
when the periods are irregular
Q: I
have a 25 year old patient with polycystic ovary syndrome (PCOS)
and infertility. She has highly irregular periods (anywhere from
2 to 8 weeks) ever since menarche and she was diagnosed with PCOS
5 years ago. She suffers from intense fatigue, hirsuitism, low iron
and she had a ovarian cyst removed as a teenager. She has a very
pale and pasty complexion and protruding eyeballs. She is not overweight
and her pulse is slippery.
I want to use Clear the Palace, but your guidelines suggest only
using it in the third phase of the menstrual cycle. The challenge
is that with such irregular menstruation, how do you decide when
each phase should start and stop? Can you advise me on how to decide
when to give Clear the Palace and how long you would recommend using
it? Are there any other Women's Treasure remedies you suggest for
other phases of the cycle? She responded very well to her first
acupuncture treatment; having been bleeding for a month, she stopped
bleeding the day after treatment and felt more energised all week.
A: There are many obvious signs of Damp-Phlegm
in the Uterus. I generally find that the Ben in PCOS is Kidney-Yang
Xu and the Biao Damp-Phlegm in the Uterus. As the periods are so
irregular, I would wait until her period comes and give her Unicorn
Pearl as soon as the period ends, for about 10 days. Then
give her Clear the Palace
for about 2 weeks and see what happens. If the period comes, then
it is very good. If it does not come, I would simply continue giving
her Clear the Palace until
it comes.
There are four rules of advice I would give if the periods are irregular
and the four phases are difficult to identify:
| • |
Check for cervical secretion =
When that appears, the woman is in phase 2 and then 3 |
| • |
Wait for period = that is phase
1 and after the bleeding, phase 2 |
| • |
Check BBT = when it rises, the
woman is at the beginning of phase 3 and, after that, phase
4 |
| • |
Check for pre-menstrual symptoms
= phase 4 |
2. Topic: Proctitis
complicated by salmonella
Q: I
have a patient who has been suffering from proctitis for the past
5 years. He takes Mesalazine 400mg 4 per day (sometimes 6) and Colifoam.
He only loses blood occasionally, but sometimes there is mucus in
his stools. His stools are urgent, thin, ribbon-like and soft, but
not too loose. There is very little odour. He has to urinate frequently,
as much as eight times per day.
He has just been in hospital with salmonella and he was on intravenous
cortisone for one week. When he came out of hospital his knees and
ankles were very swollen and painful and he also had rashes on his
legs which have now gone. He is urinating more frequently and the
urine is often yellow-brown.
He also has long-term severe acne on his face (around the Large
Intestine channel), lips and back. The spots are red, with yellow
pustules. His skin does not feel hot or itch, but after eating his
face often goes red.
His pulses are generally empty, although a bit slippery and rapid.
His tongue is swollen, short, pale and wet with a thin yellow coating,
teethmarks and quivering. He is also thin, as he lost a lot of weight
recently. Please could you advise on a suitable remedy?
A: Your patient shows very clear signs
of Damp-Heat. I would use either Clear
the Root or Drain the Jade
Valley, maybe the former. You could also tonify the Spleen
using acupuncture and I would use the Du Mai channel with S.I.-3
on the left and BL-62 on the right, Du-20 and Ren-3. Retain the
needles for 20 minutes and then needle Du-1.
3. Topic: Kidney-Yin
and Spleen-Qi Deficiency with Phlegm
Q: I
am seeing a number of patients in their mid-50s with a common pattern
of long standing Spleen-Qi deficiency, Phlegm obstructing the ears,
nose and Lungs and Kidney-/Liver-Yin deficiency, in proportions
that vary according to the individual case.
Could you suggest a patent remedy (or a combination of remedies)
that nourish the Yin without overburdening the Spleen and tonify
the Spleen and transform Phlegm without drying and further depleting
the Yin?
A: There is not a single remedy that would do that. The three remedies
that come to mind are:
| • |
Nourish
the Root - to nourish Liver- and Kidney-Yin |
| • |
Clear
Yang - to resolve Phlegm if there is also Liver-Yang
rising, otherwise Limpid
Sea |
| • |
Prosperous
Earth - to tonify Spleen-Qi |
In such a scenario, I would give Prosperous
Earth in the morning, Limpid
Sea (or Clear Yang)
in the afternoon and Nourish the
Root in the evening (3-4 tablets of each).
4. Topic: Spasm
and tightness of the upper back
Q: My
53-year old female patient suffers from constant spasm and tightness
of the muscles in her upper back. She describes the pain as moving
around and it feels like tight cords, particularly around the scapula
and trapezius region. She also describes the pain as sizzling, particularly
when she leans against anything. She has a history of vertigo that
lasted 4 months after going on a cruise. She also experiences occasional
hot flushes and night sweats. She also has a history of TMJ which
was corrected with surgery. Her blood pressure is sometimes high
e.g. 140/90.
The tongue has no coating, except for the right side which has an
unrooted yellow coating, which is not thick. The tongue is red,
cracked and swollen and slightly small and the sublingual veins
are distended. The pulses are wiry overall, slippery and slightly
fast. The right side guan pulse is floating.
Diagnosis: Liver-Yin Xu with Liver-Yang rising, Liver-Qi stagnation
and Blood stasis. There is also an element of Wind trapped in the
channels, given how the pain moves around and "sizzles".
As for the yellow coat on the right side of the tongue, I am not
certain. Is it showing Damp-Heat affecting the Gall-Bladder or that
the illness is at the Shao Yang level? Would you recommend any of
your formulae for this case?
A: I agree with your diagnosis entirely.
I think that the spasm and tension in the back is due to a combination
of Liver-Yang rising and Liver-Qi stagnation. I also agree that
there is some Wind. It is not unusual for the Liver to have 3-4
different patterns simultaneously. The tongue as you describe it
is very bad and it indicates a potentially serious situation. There
are two crucial things that you need to find out. How long has she
had this upper back tension and spasm? Secondly, how long has she
had the yellow coating on the right?
The most benign interpretation of it is that it indicates Damp-Heat
in the Gall-Bladder. If the coating has been there a short time
and appeared very suddenly, it may indicate a serious problem in
the Liver, such as Liver cancer. If the spasm and tension has only
been there a short time, it may confirm this possibility. Obviously,
if the spasm and tension have been there a long time, that is better.
The most important thing to do is to nourish Liver-Yin, subdue Liver-Yang
and extinguish Liver-Wind. I do not have a remedy that would do
all those things and treat the spasm and tension. However, given
her age the menopausal remedy Female
Treasure has those actions and could be used and you could
use acupuncture to treat the muscular problems.
(It was later confirmed that the coating had appeared within the
last 2-3 weeks, but the shoulder pain had been present for 4 years).
The fact that her pain has been there for 4 years means that the
coating and the pain are not related. However, the sudden appearance
of the coating confirms my fears of a serious pathology. The only
other explanation is an invasion of external Damp-Heat in the Gall-Bladder,
which is unlikely.
5. Topic: Weak
urination
Q: My
patient lacks force for urination for a couple of days, beginning
on the fifth day of her period. Her symptoms are: pasty stools once
every 2 days, a swollen tongue with a thick white coating and red
macules, a deep thready pulse, menstrual clotting and cramps.
I have given her Bu Zhong Yi Qi Tang immediately at the end of the
bleeding (day 5) for 2 weeks and Xiao Yao San a few days prior to,
and during, her period in conjunction with acupuncture. Points used
are: BL-20, BL-18, BL-28, L.I.-4, LIV-3, BL-10, Ren-4, ST-36, ST-37,
Ren-3.
A: It sounds as though the weak urination
at the end of the period is due to deficiency of Qi and Blood, which
manifests at that particular time because Blood is naturally relatively
more deficient after the period. There is insufficient information
at the moment, but I would say that the weak urination must be related
to Kidney deficiency, probably Kidney-Yang deficiency. I know that
this is the opposite of what Kidney-Yang Xu normally does (as it
would cause profuse urination), but it can work the other way too.
Bu Zhong Yi Qi Tang makes Qi rise, and so may not help the urine
to descend. Also why Xiao Yan San before the periods? Does she have
manifestations of Liver-Qi stagnation? The periods indicate slight
Blood stasis.
I would suggest Stir Field of Elixir
(only 3 a day) during the period and Unicorn
Pearl for 2 weeks from the fourth day of the period.
6. Topic: Female
infertility
Q: I
am seeing a 35-year-old woman for infertility. Her menses waiver
at the start date of the cycle, but always last for 4 days. She
gets cramps, but no clotting. She also has breast tenderness at
some point in her menses, sometimes before the flow and sometimes
after. Her flow starts off bright red and turns darker red. She
has 2 days of heavier flow and then a slight taper. She gets acne
after her menses and suffers from severe night sweats, which prevent
her from sleeping. As a result, she is constantly tired. She is
unsure if she ovulates, and has no vaginal discharge to detect.
Digestion is normal, and her bowels are sluggish. She gets ringing
in her ears periodically, and sees 'floaters' a couple
of times each week. She is a social worker who works with dying
children and, needless to say, her job is very stressful. Her tongue
is red with a very heavy, greasy yellow coating. Her pulse is soggy
on the right, and very thin and weak on the left.
A: The first thing you have to establish
in infertility is whether it is due primarily to a deficiency or
fullness. In her case, I do not detect many signs of deficiency
and the tongue is quite significant, i.e. it indicates Dampness
and maybe Phlegm. The night sweating could be from Damp-Heat rather
than Yin Xu. Secondly, you say 'infertility' but how long has she
been trying to get pregnant? Thirdly, in infertility it is essential
to have a Western diagnosis primarily to exclude blockage of the
Fallopian tubes, endometriosis or polycystic ovary. Has she had
any diagnosis? Fourthly, in infertility, it is important to take
the Basal Body Temperature (BBT) and also check carefully for a
stringy, clear, egg-white-like cervical secretion, which should
be present for at least 3 days immediately before ovulation. If
it is not there, it indicates Kidney deficiency. To sum up, I would
be inclined to say that her main problem is Damp-Phlegm in the Uterus
(confirmed also by the acne) and would try using Clear
the Palace. If this diagnosis is right, I would use the Ren
Mai (LU-7 on the right and KI-6 on the left) plus ST-28 (important),
Ren-5, KI-14 and ST-40.
7. Topic: Mouth
ulcers from Yin Fire
Q: I
am seeing a 46-year-old female patient who has had recurrent and
sometimes severe mouth ulcers for the past 9 years. They started
after her first husband's death. She is now remarried and has a
supportive husband, although she is still grieving for her first
husband and worries about her children. She has regular menses and
the flow is heavy for the first 3 days and then lighter for a further
4 days. The ulcers usually emerge before her period and are concentrated
on the lips and gums (not the tongue) and she gets swelling of the
area around the mouth as well. The ulcers last from a few days to
weeks at a time. She is generally cold and suffers from fatigue
and poor sleep, especially when her mouth is sore. Her pulses are
thin deep and deficient, especially the Spleen. Her tongue is pale
with a thin white coating. Even when she has a few ulcers I do not
see a yellow coating or rapid pulse. I have been treating her for
8 months mostly the 5-Element way by supporting the Earth element
after clearing blocks. I dispersed ST-44 when she had an acute flare-up
and I also treated the Chong Mai and Ren Mai during acute episodes.
She responded for a while but I am not seeing a sustained benefit.
What herbs could she take? Do you have any suggestions about how
to plan acupuncture treatments to get sustained results?
A: Mouth ulcers are always due to some
form of Heat which may be: 1) Full Heat 2) Empty Heat from Yin Xu
3) Yin Fire. The organs involved are usually, Stomach, Heart and
Liver. Judging from your patient's tongue (pale), I would say that
it is very likely that her ulcers are due to Yin Fire flaring upwards
(which usually happens from a combination of overwork and emotional
problems). You can read about Yin Fire in my books "The Practice
of Chinese Medicine" and "Diagnosis in Chinese Medicine".
Very briefly, when Yuan Qi is weak from overwork, the Minister Fire
in the Lower Dan Tian becomes pathological and flares upwards causing
some Heat above. However, the deficiency of Yuan Qi means that there
is often a deficiency of Qi, Blood and Yang of the Spleen and Kidneys.
This Yin Fire is neither Full nor Empty Heat, it is just different.
It is treated by tonifying the Yuan Qi and very lightly clearing
Heat upwards. I would be tempted to try the formula Bu Zhong Yi
Qi Tang. I have two variations of it: one is called "Tonify
Qi and Ease the Muscles", the other "Breaking
Clouds". I would suggest trying Breaking
Clouds first. With acupuncture, you are right to treat the
Ren Mai, firstly because the ulcers are more before the periods
and secondly because the Ren Mai goes through the mouth. Use LU-7
on the right, KI-6 on the left, Ren-4, KI-13, L.I.-4 on the left,
ST-44 on the right. Treat more frequently in the pre-menstrual phase.
You must also attend to the emotional aspect of the condition by
treating the Heart and Lungs.
8. Topic: Longitudinal
tongue cracks
Q: I
see a lot of patients with longitudinal tongue cracks that do not
reach the tip, often combined with lateral cracks emanating from
the main longitudinal one. Although these patients all have different
conditions and different signs and symptoms, I should be grateful
if you would provide some general guidance on using your product
line when Stomach-Yin deficiency is a significant presenting pattern.
Are there any general formulae that are particularly useful, or
any that demand particular caution? Is it possible to see the tongue
signs reverse with ongoing treatment or does that depend more on
a significant reversal of lifestyle factors? I apologise for the
general nature of the question but it is a dominant theme in my
tongue observations these days.
A: With longitudinal cracks you must first
establish whether it is a Heart or Stomach crack. Judging by what
you say, you are talking about Stomach cracks. The crack you describe
(longitudinal with deep transversal cracks emanating from it) actually
indicates not only severe Stomach-Yin Xu but also Kidney-Yin Xu.
The main remedies for Stomach-Yin Xu are: 1) Central
Mansion 2) Harmonize the
Centre 3) Jade Spring.
With the cracks you describe, I would say they need Jade
Spring. However, if Kidney-Yin Xu is pronounced, then Nourish
the Root would be better as Jade
Spring does not nourish Kidney-Yin. Of course the remedies
may also be combined taking 3 tablets of Jade
Spring in the afternoon and 3 of Nourish
the Root in the evening.
9. Topic: Treatment
of male infertility
Q: I
attended a recent seminar you gave, where you talked about sperm
and menstrual fluid being related. I have subsequently been wondering
whether the treatment of four phases for female infertility would
also apply to the treatment of male infertility due to low sperm
count? Would you use herbal formulae in phases as well and would
you use the same acupuncture points as for females? I have been
treating a husband (age 39) and wife (age 37) for infertility, the
wife for seven months and the husband regularly for three months.
Both present primarily with Kidney-Yang and Spleen-Qi Xu symptoms,
along with tongue and pulse indications.
A: Sperm is indeed equivalent to menstrual
blood and eggs in women (both Tian Gui deriving from Kidney-Jing).
However, one does not treat according to phases in men. In a case
of male infertility from Kidney-Yang and Spleen-Qi Xu, the treatment
should naturally concentrate on tonifying Kidney-Yang and Kidney-Jing
with points such as Ren-4 (probably most important point) and BL-23
(as well as ST-36, KI-3, etc.). Also use the Du Mai every now and
then, i.e. S.I.-3 on the left and BL-62 on the right. In terms of
herbal remedies, if there is a deficiency of Kidney-Yang you can
select Strengthen the Root
or perhaps, even better, Unicorn
Pearl (even though that is in the Women's Treasure). I hope
this helps.
Finally, I would like to remind you to check the clinical manifestations
carefully to exclude the presence of Dampness in the Lower Burner
as that can impair fertility in men. In addition, the role of the
Heart is very important. Just as Heart-Qi descends to the uterus
in women to regulate the menstrual function, in men, it descends
to the prostate and genital system so it has an influence on fertility
as well.
10. Topic:
Signs but no symptoms
Q: I
am treating a 35-year-old woman with 4 young children. She is coming
for acupuncture treatment for the sequelae of a car accident that
took place a year ago (neck pain, mid-back pain, low back pain,
foot pain, numbness in hands and dizziness). She has strong signs
of Heat, for example, a very full pulse (which is also rapid and
irregular), a bright red tongue body with a red tip. She has a very
loud voice and a very extrovert personality and she dislikes heat
a lot. However, she has no symptoms of Heat, i.e. there are no bleeding
irregularities or menstrual problems at all, no headaches, no ear
or eye symptoms, no burning urination, no phlegm and no cough. Her
parents both smoked very heavily and she smoked a pack a day for
10 years and now smokes 6 a day. She does drink a lot of water but
I find that so many people these days drink a lot of water because
they believe it is healthy and it is not a reliable indication of
Heat. I asked her specifically if she is very thirsty. She has a
very physical job (building maintenance) so she said that when she
works hard she gets thirsty. She says she likes to eat, but she
does not get really ravenous. She does have a lot of bad facial
acne. Her signs of Heat are so strong I thought a herbal formula
might be advisable. Which of your formulae would you recommend for
this scenario?
A: First of all, the fact that she has
signs but no symptoms does not surprise me. I have seen that many
times, that is why Chinese medicine is so great as it can be used
for prevention! Because it takes all signs and symptoms into account
to form a 'pattern'. Therefore her tongue and pulse are part of
a 'pattern'. One possible reason for the absence of symptoms is
simply her young age. The absence of thirst I think is simply due
to the fact that she drinks so much that her body has not time to
develop any thirst. Secondly, to choose a remedy, you must really
try and identify (in spite of the lack of symptoms), the location
of the Heat: Liver, Stomach, Heart, Lungs? These are the most likely.
In order to do this, you must analyze the pulse more carefully.
The red tip would indicate a location in the Heart, but there may
be another location too. You do not say whether the tongue has a
coating or not: this is very important to establish as a coating
would indicate Full Heat, and an absence of coating would indicate
Empty Heat. I suspect it must be Full Heat. Possible remedies are:
| • |
Ease
the Muscles (Stomach Heat) |
| • |
Drain
Fire (Liver Heat) |
| • |
Settling
the Soul (Liver and Heart Heat). |
11. Topic:
Contradictory signs and symptoms
Q: I
would like your advice on the following case. I have been treating
a 36-year-old woman with chronic low back pain for the past six
years. The pain radiates down the Gall-Bladder and Bladder channels.
Pressure and warmth relieve the pain, but activity makes it worse.
She feels cold all the time and is very exhausted, although she
sleeps well She has no digestive problems, but has had mouth and
tongue ulcers (Yin Xu type as they have a white rim) for as long
as she can remember. At times they are so bad that she can hardly
speak. Her tongue is very swollen and red with a thick white slippery
coating. Her pulse is slippery, weak and only palpable on a superficial
level. Some of the signs and symptoms seem to contradict each other
and I am having difficulty seeing how it all fits together. Any
help with this case would be greatly appreciated.
A: The general rule is that when the signs
and symptoms are confusing, pay attention to the tongue. As you
describe it, the tongue shows Damp-Heat and generally a Full condition.
I think the mouth ulcers could be due to Damp-Heat and not necessarily
Yin Xu. The slipperiness of the pulse confirms the Dampness. If
it really is absent at the deep level, then it indicates the beginning
of Yin Xu of which she has no symptoms yet. This is not surprising
as often the pulse indicates a condition before symptoms appear.
With regard to the pain down the Gall-Bladder and Bladder channels,
the alleviation with warmth and pressure and the generally cold
feeling would suggest either external Cold invasion in the muscles
(and therefore purely a channel problem) or an Empty-Cold condition
from Kidney-Yang Xu. The emptiness of the pulse at the deep level,
besides indicating potential Yin Xu, also reflects the Kidney in
general and it is therefore related to a Kidney deficiency which
may be Yin or Yang. Moreover, in women more often than not both
Kidney-Yin and Kidney-Yang are deficient and this could explain
some of the contradictions. In these cases, acupuncture is often
better than herbal medicine because you can tonify the Kidney in
general irrespective of whether it is Yin or Yang Xu. I would be
temped to use acupuncture to tonify the Kidney and treat the channel
problem and a herbal remedy to resolve Damp-Heat, such as Ease
the Muscles.
12. Topic:
Chronic vaginitis and fatigue
Q: My
patient has been suffering from vaginitis for the past 22 years
on a monthly basis. Her symptoms began 22 years ago with a feeling
like she was immersed in water. Hot damp weather aggravates her
symptoms. However, she always feels cold, especially her hands and
feet, but gets overheated easily and feels that moisture consumes
her, especially in the vaginal area. Her vaginal discharge is clear
to slightly yellowish, watery (except at ovulation) and has occasional
odour. She has PMS and her periods contain clots. She never feels
rested in the morning, even though she has slept soundly through
the night. Her digestion is poor with a lot of bloating and gas
after eating. Her bowels are now mostly formed but used to be loose.
She drinks over a 100 oz. of water a day, bruises easily, has rosacea,
occasional tinnitus and dizziness when she gets up, or moves, too
quickly. She has low blood pressure and suffers from oedema of her
hands and feet especially in hot humid weather. She also experiences
low back pain.
Her pulses are slightly wiry on the left and slippery and Kidney-Yang
is very deficient. Her tongue is very pale, swollen with a moderately
thick white coat.
I have diagnosed her with Spleen-Qi deficiency, Kidney-Yang deficiency,
Damp-Heat and Liver-Qi stagnation. I would greatly appreciate your
help on selecting the proper patent herbs. I was thinking of Tonify
Qi and Ease the Muscles with Strengthen the Root and Drain the Jade
Valley. How many of each should I give her or could you suggest
something more appropriate?
A: I totally agree. Besides Qi Xu, there
is Qi sinking in these cases. The remedies you have selected are
right but perhaps you can tonify the Kidneys with acupuncture.
Tonify Qi and Ease the Muscles
in the morning (3 tablets)
Drain the Jade Valley in
the afternoon (3 tablets)
Acupuncture: LU-7 on the right, KI-6 on the left, Du-20, Ren-3,
KI-11, LIV-5, BL-20-23.
13. Topic:
Migraine
Q: My
patient is a 49-year-old woman who presents with migraines which
are always one-sided temporal headaches. The migraine can be on
either side, although it is more often the right side than the left.
She averages one headache per month, but can get as many as 3 migraines
in a month.
Her migraines began in her 30's when she became peri-menopausal.
She was completely through menopause at age 40. She was also diagnosed
with osteoporosis of the hip and osteopenia of the spine. She has
no other complaints and feels she is in good health. When she did
have her periods they were uneventful with no clotting or PMS. Her
pulses are deep and weak and her tongue looks slightly pale and
slightly purplish. Her headaches also seem to appear most often
in early morning, pre-dawn. Without having many symptoms to go on
other than the temporal headaches which indicates some Liver-Qi
stagnation, and Kidney-Qi deficiency evidenced by the early menopause
and bone loss, I am not quite sure which patent herbs to prescribe.
A: Judging from what you say, I think
the headaches are caused by Liver-Yang rising which, itself, occurs
against a background of Kidney-Yang deficiency (no, it is not strange
to have Liver-Yang rising from Kidney-Yang Xu). You need to tonify
Kidney-Yang and subdue Liver-Yang. I would suggest Unicorn Pearl
in the morning (3 tablets) plus Bend Bamboo (4 tablets in the afternoon).
If you think that there is a confusing situation of both Kidney-Yin
and Kidney-Yang Xu, use Ease the
Journey-Yang instead of Unicorn
Pearl.
14. Topic:
Urinary difficulty
Q: What
is the difference between Separate Clear and Turbid and Water Passages
in the treatment of urinary difficulty?
A: The main difference between Separate
Clear and Turbid and Water
Passages in the treatment of urinary difficulty, is that
Separate Clear and Turbid
(a variation of Bi Xie Fen Qing Yin) treats primarily the Biao of
the condition, i.e. it resolves Dampness from the urinary passages
to treat the symptoms of urinary difficulty, frequent urination,
slight burning on urination, turbid urine. By contrast, Water
Passages (a variation of Zhi Bo Di Huang Wan) treats both
the Biao, i.e. Dampness in the Bladder and the Ben, i.e. Kidney
deficiency for urinary problems. As it treats the Ben, it is designed
to treat chronic urinary problems from Dampness in the Bladder occurring
against a background of Kidney deficiency. The tonification of the
Kidneys achieved by this remedy is balanced in terms of Yin and
Yang, i.e. it is suitable both for Kidney-Yang and Kidney-Yin deficiency.
It is suitable to treat chronic interstitial cystitis.
15. Topic:
Impotence
Q: I
am treating a 34-year-old man for impotence. His problem started
5 years ago. He does not show many symptoms of Kidney deficiency
except for frequent urination. He also suffers from insomnia and
palpitations and frequently complains of a feeling of tightness
in the chest. All the Chinese remedies for impotence seem to have
strong and hot Kidney-Yang tonics which do not seem suitable to
his case. Can you recommend anything?
A: I think this is a typical example when
impotence derives not from a Kidney deficiency but from a disharmony
between Heart and Kidneys. Just as in women Heart-Qi and Heart-Blood
descend to the Uterus to promote the period and ovulation, in men,
Heart-Qi and Heart-Blood descend to the penis to promote a healthy
sexual function and erection. Interestingly, erection is due to
the filling of the corpus cavernosum with blood and the Heart governs
Blood. Just as menstruation in women depends on the communication
between Heart and Kidneys, in men, the sexual function also depends
on the communication between these two organs.
I find that, more often than not, impotence in young men is caused
not by a Kidney deficiency but by Heart-Qi and Heart-Blood not descending,
a situation caused by emotional stress. The insomnia, palpitations
and tightness of the chest in this patient would seem to confirm
this.
I have formulated the remedy Arouse
Power specifically for this situation, i.e. Heart and Kidneys
not communicating and affecting the sexual function. I would recommend
4 tablets a day.
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