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Fang CaiArticle on why herbs are not dangerous for liver or kidneysOct 27 | EditedReactSurely I'm not the only person who has patients tell me they're scared to take herbs because they've heard herbs can causeelevated liver enzymes, or induce renal failure. I've always given nuanced answers to each patient, but today realized I'm tired ofanswering this question.Does anyone know of a good article on the topic of Chinese herbs and liver-kidney health safety record? one backed by somestudies and safety data? hopefully one that clearly explains the history of the fen-phen/diet clinic/aristolochic acid debaucle andhow that's NOT what we're giving in clinic?I'd love to just send that to patients and say READ THIS! if the question comes up again. thank you in advance! ReplyMaryanne Travaglione Nov 2ReactThere is not an easy answer to this question as it depends often on the quality of the distributorI will suggest taking a look at Spring Wind who addresses some of these questions on their websitehttps://springwind.com/YanaOsteoporosis + muscular painOct 26ReactI have a patient who came to treat old pain all over his spine. He’s not a big talker, works in construction, lifts a lot of heavy stuff atwork, has a history of alcohol abuse for 20 years, but last 8 years has been clean. He’s 50 now. Pain is so severe that he’s taking anopioid. It was difficult to get exact information from him about causes of pain. He said he had had many traumas, many fractures,didn’t know which level. With each appointment I learn something new about him.Today he’s telling me he has osteoporosis and osteoarthritis, and that “everything hurts”. Apparently, the spine fractures werecompression fractures. He was diagnosed 8 years ago (maybe he also stopped drinking at that time).He denies having any digestive problems, though he smells like his spleen is suffering.I gave him You Gui Wan granules 6g 2x/day (probably will raise the dosage if it goes well). I’m not sure that it will address the pain.Thinking about Shen tong zhu yu tang.We only have granules here. It’s possible to make a custom formula.How long do you think he would have to take these? I’m only starting herbal practice, never treated a chronic condition like this.Maryanne Travaglione Nov 2ReactHi Yana
Replygood question with not an easy answer. You Gui Wan may be a good start to support his Kidney, you haven’t included a tongue orpulse for support so not certain but it may be a good start. You describe a long time problem and while other formulas might bemore appropriate to address the specifics of his pain we would need more information to what may worsen the pain, for instance;is it worse in damp weather or cold or hot weather, etc… however you are able to be of help. I would suggest starting with whatyou already prescribed and look to evaluate a decrease in pain rather than thinking to eliminate it completely. Look to see if yourtreatment can produce some time pain free, this would be a good start. As an example I might use a standard pain scale and askthe patient to evaluate current pain daily, might ask them to chart how pain is currently, how pain is upon waking, again evaluatehow pain is after work, and againas night falls and finally at bedtime. I will usually suggest about 3 cycles taking herbs for 10 dayson and 2 days off and reevaluate at that timeto see if there is some improvement, if so… repeat.this is one suggestion, I am certain other practitioners here will offer other approaches but patience is needed in these long termissuesEmily RieffelWhen a longtime patient passes awayOct 5ReactThis past week, I learned that a long-time patient of mine had passed away. I want to take the chance to reflect publicly, because Iknow we all work through grief for our patients, at times, and maybe my acknowledgement will be helpful to someone else.My patient was young, but had been very ill the entire duration of our relationship, and I often wondered if I would see her againafter a visit. She was a cancer survivor for whom chemotherapy had been nephrotoxic. She had kidney and heart failure, and wason dialysis. She also had survived an unusual pneumonia that left her lungs scarred and needing continuous oxygensupplementation. She had many types of pain and neuropathy, and lots of anxiety. There were times, especially early on, when Ifelt very inadequate to the complexity of her presentation, and the severity of her conditions. It was frustrating to feel like Icouldn't "fix" her symptoms. I had to learn how to redefine success in a palliative and hospice context, and to constantly re-focuson presence and peace in the moment.There were logistical challenges to helping her in an outpatient solo-practice setting. Her body was large and weak. Her balancewas off, and she could not get up on her own if she were to fall down. Oxygen is flammable -- NB for lighting moxa! I wasconstantly concerned about risk of infection during Covid, and for the poor circulation in her extremities. When it was hard for herto get on the treatment table, I got a different type of step-stool. When even that was no longer possible, I treated her in a recliner.When that was no longer feasible, we used a sturdy chair. When she couldn't drive herself to appointments, her wife and hermother would bring her. The past two years, she missed many appointments due to infections and hospitalizations. For years, Iput her socks and shoes on her swollen, purple feet at the end of the visit.Despite and because of these many challenges, this patient was the essence of persistence, resilience, bravery, creativity, andadaptation. She was a tremendous teacher to me, because her needs demanded all of these qualities in her caretakers, myselfincluded. She was a reserved, shy person who loved animals, and she rescued so many of them. She also loved watching whales,and that is where I place her in my mind, now -- on the shores, wondering at those great and gracious beings. I am so sad at herpassing, and so grateful I had the chance to know her and travel with her for a ways. ReplyJoy BlaisOct 10ReactThank you for sharing this Emily. The power of compassion and caring can never be underestimated. The willingness to beavailable to her, even as you felt discomfort and frustration that you were unable to do more, was a gift that I'm sure sheappreciated. My condolences.Emily RieffelNewOct 21React@Joy BlaisJoy Blais
3 more commentsReplyThanks, Joy.Sharon Yeung Seeking practitioner in Stockholm, SwedenSep 22ReactCan anyone recommend a practitioner in Stockholm? I checked our global map but didn't see anyone in that area.Many thanks,SharonSharon Yeung Looking for Japanese Acupuncturist with a specialty in magnet or ion pumping cord therapySep 8ReactI have a new patient who presents with a very unusual set of symptoms that is very sensitive to magnetic fields. The issue startedafter an extreme suctioning to her ear and then greatly worsened after an MRI. While she has benefited under my care, I thoughtsomeone who works specifically with magnet or ion pumping cords might be a good fit. She is located in NYC but has sufferedfrom this issue for more than a decade and is willing to travel for the right fit. Thank you for any leads.ReplyCaroline Radice Sep 11ReactHi Sharon: Maybe consult Nigel Dawes on this as he specializes in Japanese styles. If he is not the guy, I'll bet he knows someonewho is.Sage Staggs (she/her)Ma Huang and BreastfeedingSep 6 | EditedReactIs this an automatic no-no?I have a breastfeeding parent coming in today for her first visit and her CC is asthma, on her intake she marked that she does notsweat. So I am already wondering will this be a case for XQLT or another MH based fx???Not sure until I see her of course but what are your thoughts? Her child is 19 months old so my guess is not exclusively breast fedat this point. How do you decide on things like this?Sharon WeizenbaumReplyCaroline Radice Sep 11ReactAutomatic it is not. In an older child, there is less concern as you note as well. My general guidance is have her dose right after afeeding and see how it goes.
ReplySage Staggs (she/her)Sep 11ReactGreat, this is a helpful approach, thanks Caroline!2 earlier commentsSage Staggs (she/her)Why would cupping cause hives?Sep 5 | EditedReactOkay this isn't an herbs question at all but hopefully folks will weigh in anyway.New patient last week, female in her 50s, robust body but weak/soft pulses, pale flabby tongue with toothmarks. Chief complaintwas "frozen left shoulder"- pain and restricted ROM for several years.I started with stationary plastic pump cups on her left shoulder/deltoid area, about 8 cups total, left them on for 10 minutes. Shegot pretty dark purple marks. Then I gave her an acupuncture treatment similar to ML10. She got off the table saying her shoulderwas healed, the best she'd felt in years- awesome!The next week she came back and reported that after the treatment she felt deeply exhausted and went home and went to bedearly (unusual for her) then woke up the next day with the left side of her face swollen and hives down the left side of her body.She has gotten hives in the past from grass and pets, but they were always itchy- these hives didn't itch at all, just big red blotchesand a puffy half-face. This all resolved after 3 days and she was back to normal. Slight return of shoulder pain by the end of theweek but still better than before treatment.Can someone explain how I "pulled out damp" or wind or what happened with the cupping and how it could be related to herswelling? Are there any warning signs I should watch out for? This patient is very happy with her treatment, but I'm sure somepeople would freak out if this happened.(She did share that she had had 4x covid vax, in alternating arms, the last one was along with the flu shot, but she couldn'tremember which arm it had been in. She didn't react at all to any of the shots at the time. She did not have a suspicion about alink here but it crossed my mind as potentially related, since the cups were over the area where vaccinations are given.)Thoughts?Sharon Weizenbaum ReplySage Staggs (she/her)Sep 11 | EditedReactThis is new information about the nature of hives, thank you. I’ll research further.She definitely had local blood stasis and I think also systemic (notes aren’t accessible right now). So that might explain in or as yousaid it could have been vaccine related. I guess no real way to anticipate such a reaction happening?I saw her a second time and repeated the treatment and all went well rather time- and her shoulder continues to improve
ReplyCandace Jania Sep 25ReactHi Sage- Sometimes weird things happen, especially after a first treatment of acu or cupping or anything. Sometimes we don’tknow why - it may be totally unrelated or maybe it is. The important thing is the improvement of the chief complaint and the factthat it hasn’t happened again with subsequent cupping!1 earlier commentSeth ShamonTwo Difficult BLOATING CasesSep 2 | EditedReactQuestion for teacherTwo 30 year old women each with a chief complaint of severe unremitting abdominal bloating. In both cases it is generalizeddistension below the belly button, worse after eating, no borborygmus.Patient 1: Distension is worse with eating and worse with heavy exercise. No other notable symptoms. Sweating is normal,appetite is normal, body temperature is normal (slightly cold feet), menses a little on the lighter side. Pulse feels unremarkable tome, slightly wiry overall. Tongue is slightly pale, slightly scalloped. Abdomen and epigastrum is on the softer side, a bit squishy.Not particularly sensitive to pressure. I don't feel like I have much to go off of. She was on Xiao Yao San + Mu Xiang for a week,then Ling Gui Zhu Gan Tang (this was prescribed after she updated that she had an episode of epigastric fullness with watersounds and palpitations) for a week with no result, except that while on the latter formula she had three days of dry black stoolwhich then resolved.I don't feel like I have a clear diagnosis other than that the qi dynamic in the lower warmer is off and there is some deficiency ofthe spleen.Patient 2: Distension is worse with eating and worse pre menstrually. Abdomen is a bit soft but there are always areas aroundST27, ST30 that are very painful with pressure. Tendency toward loose and frequent stools. Appetite is a bit reduced. Sweating andbody temperature are normal. Menses slightly irregular in length (can be short or long), and in quantity (can be heavy or normal),occasional clots. I've been working with her for longer and she has reported she is better with acupuncture and herbs, but thebloating is still constant (slightly better with herbs). Tongue was historically more pale and thin, now not as pale - recent tonguepicture which is attached shows a peeled red front 1/3 which is new and accompanied by recent dry mouth and thirst and heatsensation. I added tian hua fen to her formula which is Dang Gui Shao Yao San + Huang Qi.For the chief complaint of abdominal bloating - how do I successfully treat this? DGSYS is indicated for abdominal pain with LR-SPdisharmony but what about abdominal distension/bloating?JPEG | 2.4 MPatient 1JPEG | 99.3 KPatient 2Sharon Yeung Sep 8React
1 replyReplySome follow up questions I might ask to get a clearer picture of what is going are the following: Any particular foods make hermore bloated? Dairy, gluten, raw foods etc?is it worse after certain meals?What about heavy exercise makes it worse? She get's depleted? It is a belly intensive workout? she sweats more or getsoverheated etc...Does she feel filled with air or more water retention?What relieves is? A bowel movement? rest?Any ebb and flow with her menstrual cycle?Does she wake with it?When did it begin? Any life changes, dietary changes? food poisoning/stomach bug?Did you put her on XYS because she presented with Lv qi stagnation or lv blood def?Any other associated digestive symptomsAnswers to these questions can lead you to whether there is a hot/cold element to it, food sensitivities, if it's more qi/air stasis orwater stasis. this can then help you narrow down the diagnosis and formula options.ReplyCandace Jania Sep 25React@Seth ShamonOne comment is that DGSYS for patient 2 may be ok but you need to modify it because the bloating does not seem to be waterretention (i.e.) water out of right relationship with blood. I use that for my patients that have more of water retention bloating andare more puffy. These patients both seem to have stagnation in the LI (distention) Where is the wheel not turning correctly andwhy? Once you find that out, then you can focus on relieving that. On a very simple level, it seems to be excess (w/w eating). Ingeneral, herbs that help with excess bloating correct the qi mechanism in the lower burner. Then herbs like Zhi ke/Zhi shi, muxiang, hou po, sha ren will help but those are not going to necessarily create a physiological functioning that will fix their issues.As Sharon said above, I think there needs to be more fleshing out of the symptoms. It could be a wu mei wan pattern, is it a pivotproblem, xie xin tang pattern, it could be many different things. You can add the above herbs to any of these formulas as or ifnecessary. The second tongue looks very clearly to be heat above cold below but do her other signs and symptoms reflect this?More info is needed. Hope this helps.Seth ShamonannaPost chemotherapy caseSep 2ReactQuestion for teacherThe patient is a 58 year old man who began getting right-sided headaches "unlike any headaches he had ever had" in April of '21with pain in the temple, cheek and jaw. His PCP diagnosed him with TMJ and he was taking Advil, seeing a dentist and craniosacraltherapist with no relief for several months. In November he began coughing up blood and phlegm and his doctors finally sent himfor imaging. He was diagnosed with Oropharynx / Laryngeal Squamish Cell Carcinoma and was treated with Cisplatin andradiation. The tumor was attached to the base of his tongue and his tonsils. Full body imaging revealed no metastases but lymphnodes from his neck down to his groin were involved.He has been told that the tumor no longer shows up in imaging, but he is still having severe headaches. He is taking morphinewhich diminishes the pain but does not eliminate it.
He can only open his mouth about 15mm and eating is very difficult for him, he is down to 101 lbs. At the beginning of treatmenthe was able to eat ice cream but he can no longer tolerate sweets, his sense of taste has been affected by the radiationtreatments. His mouth feels very dry to him so he cannot tolerate starchy foods. He is able to eat eggs, salmon, butter and halfand half. He does get hungry but chewing is difficult for him and his tongue does not move well so it is difficult to swallow. Hedoes have nausea for which he is taking Zofran. He is extremely constipated, likely because of the morphine, and he does enemasa few times a week. Stools are small and "like clay"Last week he sat down to eat dinner and woke up 17 hour later still sitting at his dinner table but with diminished use of his leftarm. He has difficulty pronating/ supinating his left arm but has use of his fingers. I also noticed that the left side of his face hasdiminished movement. His smile is uneven and his speech is a bit slurred. He had a radiation treatment already scheduled for thatday and the doctors thought he just pinched a nerve on the left side and did not send him for any additional imaging.He is very cold all the time. He can bundle up enough to be comfortable but his hands and feet always feel cold to him.When he started chemotherapy he would not go to sleep until dawn because he "did not feel safe in the darkness". He is now backto a somewhat more normal sleep schedule, and he can sleep unless he is woken by pain.His pulse is tight and about 82 bpm. It was hard to see his tongue because he cannot open his mouth wide, but it is small, wet,pale and slightly dusky with a pinker tip and deviated to the left.Abdominal diagnosis is not my strength, but there is what feels like a chopstick along the ren channel above the umbilicus, and Ican feel intestinal contents on his lower abdomen.I would like help with an herbal formula for him. The chief complaint is still the constant right sided head pain but my impulse is tostart him on ba zhen tang to begin to rebuild qi and blood. It would need to be a granule formula at this stage.PNG | 1.1 MScreen Shot 2022-09-02 at 11.40… ReplyCaroline Radice Sep 11ReactHi Anna: Radiation and Chemo are so damaging to the system, there may be serious limits to how much you can do, however,definitely worth trying to make him more comfortable.Can to describe the headaches in a little more detail? Severity? What makes them better and worse? Any other systemic cooccurring symptoms? A Basic tonic might be ok but might not match the pattern so could actually make him worse, so better to beclear on what is actually going on in his pattern (though it is obviously involving deficiency).I am surprised he wasn't sent for more imaging after waking with the one sided issues, but hopefully a stroke was ruled out.
ReplyannaSep 12ReactThank you, Caroline.The headaches he is having now are on the right side of his head along GB channel. GB 20 and GB 8 and 9 are exquisitely tender,and he has some tenderness at tai yang. The pain radiates into the right ear and along the right jaw, though jaw points were notparticularly tender upon palpation, that pain is more inside. Swallowing brings on the pain. It hurts to drink water. As mentionedabove, his sense of taste is completely altered since radiation and there are very few foods he can tolerate. I asked him about theseverity of the pain and he said he could not get through the day without morphine, and he still has breakthrough pain while onmorphine.It did sound to me like he had a stroke. He had a radiation appointment scheduled the day he woke up 17 hours later in the sameposition and the doctor who oversaw the radiation appointment said it was "brachial plexus/cranial neuropathy caused by theradiation treatment", but I'm not sure how clearly the patient conveyed to him what happened. No imaging was done. The loss offunction on the left arm is troubling to him but the throat and head pain is the chief complaint.When he came in last week I did right GB 20 with gentle spreading technique, ear Shen men, left P 6 with gentle gatheringtechnique, gentle pulling out technique on right LI 4, gentle gathering on Ren 6 and Stomach 36. He reported better energy andmood, less pain after the session but no change in mobility for the left arm. He is coming in again tomorrow.1 earlier commentBrian LangstonNew client who is on many medications, with many unwanted symptoms, where symptoms may be caused by medications.Aug 23ReactQuestion for teacherHi, I have run across this situation before and wanted to see how other deal with clients who are on many medications and alsohave many unwanted symptoms and some of the side effects of the medications are their unwanted symptoms.I just looked up all of the medications and their side effects and interactions with other drugs. And not only are the side effects forthe medications some of the symptoms my client is wanting help with, some of the drugs can interact with other drugs they areon.Also this is a 52 YO female who is on HRT medications. I say this because it is my understanding these hormone replacementmedications are not necessary and can cause unwanted health issues. This is not my area of expertise and I struggle with talkingwith women about HRT as I have been told by more than one woman that getting off HRT is not pleasant.These are not the only medications this client is on, there is a total of 8 plus 13 supplements, 1 another HRT and others for thesame reasons as the medications.Sharon's voice is in my head, do a complete diagnosis and see where the wheel needs help. I will do this, and I would appreciatereading how others address this issue with their patients.Lisa PateCandace Jania Aug 24React@Brian LangstonYes, I agree with your last sentiment. Where does the wheel need help?In general, if you are tentative, go slow with small doses. Have the patient take the herbs apart from their medication to lesseninteractions. You can even start with food based herbs and/or herbal soups to test the waters so you feel more comfortable.Brian Langston
ReplyI had my father on iterations of ding chuan tang and he was on a ton of meds, including for hypertension but it only ever helpedhim. But be aware of your typical contra-indications and have them monitor BP, glucose etc. because these things can change forbetter or worse depending on the correctness of the formula.If you are a bit concerned about getting it write, perhaps you can do a mentoring session with someone. Good luck! ReplyBrian Langston NewSep 14ReactThank you Maryanne and Candace for your responses. It turned out the client that had me so worried canceled at the last minuteand has not rescheduled.I realize herbal medicine is not for everyone. I have a client who is very happy with our approach with his health issues, which aremany, and his life partner is not interested at all in what I do relying on Western medicine only. And I find that too bad becauseshe is so overheated which I am sure complicates her health issues.Seth ShamonWu Ling San WORSENED Inhibited Urination!!Aug 18ReactQuestion for teacherWu Ling San has worked so well for me for inhibited urination cases that I think I got a bit careless in my diagnosis. But this one isbaffling me. Wu Ling San made a patient's inhibited urination SIGNIFICANTLY WORSE.70 year old woman with CC of neuropathyWM dx: type II diabetes (25 yrs), scleroderma, hypothyroid, fatty liver, history of ovarian cancer (treated 3 yrs ago w/ 6 rounds ofchemo and 25 radiation treatments)She's on lots of meds and supplements as you might expectS&sx: weak and deep pulse, patient feels cold with cold hands and feet, loose stools with occasional constipation, reflux, ankleswelling with spider veins on legs, knee pain, dry mouth, dry itchy skin, low energyurine is frequent, urgent, clear, and incomplete feelingI assessed it as a shao yin + tai yin pattern with damp obstruction in the lower jiao and systemic blood stasis. SP not T&T andKidney yang not steaming fluids in the bladder upward (dry symptoms at surface and upper body). I started w/ one week of ZhenWu Tang, patient reported no change and hated the taste, then I switched to Wu Ling San.3 days on Wu Ling San and the inhibited urination got progressively worse and worse. More urgent, more inhibited, darker urineat times, with ankle swelling getting worse. What gives.[Side note: Is there any guidance on the use of this forum -- I have several more cases that I'd love to share and get input on and I thinkothers can learn from them too but I don't want to overuse and overshare and burden the teachers with posts! Anyway I'm excited to be apart of this community :) ]
3 earlier comments 3 teacher remarksJPEG | 39.7 Kimagejpeg-0JPEG | 817.9 K68244804761--F9FBCB1A-4B7C-4… ReplySeth ShamonAug 20 | EditedReactIt's almost as if with blood stasis, the blood and body fluids separate. Both accumulate and stagnate concurrently but are sort ofseparated. And draining damp further drains fluid from the blood, exacerbating that separation.This case will have me think twice about using a strictly drain/steam damp strategy when there is concurrent blood stasis. Also Ithought the Gui Zhi in the formula might help be enough to move the blood but I can imagine it could even potentially further dryout the blood with its acrid nature, especially if not paired with a sour nourishing medicinal like Bai Shao.Also very interesting to think about DGSYS as helping to absorb fluid into the blood - that makes sense. ReplySharon Weizenbaum Aug 201ReactYes, exactly.I remember seeing a case of advanced cirrhosis of the liver with ascites in a class with Nigel Dawes. He had been giving waterdraining herbs which made him worse. Nigel then gave him Xue Fu Zhu Yu Tang and the ascites got much better. This patient wasstriking in that there were distinct purple veins all over his swollen belly. It made a great impression on me.Seth, your questions are very clear and direct, which makes them easy to address. Thanks for that.Alison Unterreiner, DACM, L.Ac.Ann Arbor, MI practitioners?Aug 18ReactHi all -Looking for any recommendations in Ann Arbor, MI.
Thanks in advance!Alison
2 earlier comments 2 teacher remarksSeth ShamonSkin Tingling at Night (Gui Zhi Zheng but px cannot sweat!?)Aug 16 | EditedReactQuestion for teacherInteresting case here, would love some input.27 year old woman with a chief complaint of severe tingling at night, worse on L+ wrist SJ channel but really all over her body.Supremely uncomfortable tingling that interferes with sleep.Secondarily, severe TMJ, headaches, neck and shoulder tension. These are mostly resolved after two acupuncture sessions but nochange in CC.The patient presents with a floating weak pulse, floating umbilical pulse, tight abdominal muscles, nervous and tense disposition,insomnia, and dream disturbed sleep.When I inquired into her sweating, she reports she never sweats and it's been like that as long as she can remember. 30 minutesin a sauna to break the lightest of sweats.Digestion, energy level, urination, bowel movements, body temperature - unremarkable. No history of skin issues.I was thinking a cinnamon twig formula, possibly Gui Zhi appears the patient has a cinnamon twig presentation, until I realize thesurface is totally blocked.It basically seems to me like yang is out of right relationship & floating to the surface and upper portions of the body, but that thesurface is blocked. I don't know why the surface is blocked! Or how to best treat it! It seems treatment should involve harmonizingying & wei and releasing the exterior. Do you agree and if so how would I go about it? Would gui zhi tang (jia gui?) do it? Do I needma huang? Am I missing something?JPEG | 275.1 KPXL_20220815_165213614
ReplyMaryanne Travaglione Aug 17ReactSharon is such a good source of guidance and I agree with following her advice. Tingling sensations I have found canfrequentlyaccompany a diagnosis of Blood Vacuity and is a especially reported by young women post menses.ReplySeth ShamonAug 17ReactThank you Sharon for the input! I think Dang Gui Huang Qi Jian Zhong Tang makes sense for her, will verify next time she comes inand will update with results!2 teacher remarks1 reply 11 reply 1Ann ClearyReferral in BarcelonaNewAug 9ReactHi, who is there and good with uterine bleeding? I didn’t see anyone on the global map. ReplySharon Weizenbaum NewAug 9ReactHi Ann,Did you meet Quim (joaquim) at the pulse retreat? He's awesome. I am pretty sure he lives in or near Barcelona but at least hewould know who to refer you to.quimilin@gmail.com ReplySharon Weizenbaum NewAug 9 1Reactjoaquim planasNancy LegatoAnyone near Bradenton, FL?NewAug 8ReactHi there,Does anyone know of any White Pine folks or other trusted Chinese Medicine practitioners in the area around Bradenton, FL?Thanks in advance!Nancy
Margaret Sikowitz Ogden/Salt Lake referralNewAug 4ReactHello Friends,Anyone have a recommendation for someone in the Ogden/Salt Lake area who has experience working with patients undergoingcancer treatment? Thank you.MargaretBrian LangstonAha momentsAug 4 1ReactNot sure where to share this but wanted to get feedback.I was listening to Kumiko in the Fukushin course and she was mentioning a formula for addressing numbness and tingling in theextremities. Huang Qi Gui Zhi Wu Wu Tang. As she was describing this a client pooped into my mind who has complained ofnumbness in his face every other day. He is in the moving business and work hard in the AZ heat, and loves the heat. Gui Zhiformulas work well for him. I had put this symptom on the back burner as we were working on more pressing symptoms. But inthis moment I had an Aha moment. This formula fits his constitution and as he sweats so much and has a excess damp cold body.Anyway, I can't wait to try this formula. He has been a client that I have been able to help so much and he is very grateful. And hasmentioned this issue a couple of times.Thanks for reading! I love what i/we do!ReplyMaryanne Travaglione Aug 10ReactHuang Qi Gui Zhi Wu Wu Tang.…excellent, I hope youpost your resultsAdam BroderBusiness help/coachingNewJul 30 1ReactI’m seeking some guidance around practice building and the business end of our work. I may be interested in working with a coach, preferably one who hasexperience in our field, so please feel free to share any recommendations for that. Broadly speaking I’m wanting to understand what reasonable expectationsI should have. I’ve been licensed for four years and have been working for other people in that time, and for the last year and a half I’ve been trying to build aprivate practice. I’m in a town (Santa Fe) with a lot of acupuncturists for not a large population, so the fact that things are progressing quite slowly doesn’tsurprise me. What I’m trying to figure out is just how patient I need to be. I know it takes time but I feel like I should at least be busier than I am. One of theplaces I work is a chiropractor’s office where I see about 3 patients per week, and in my private practice I see about that many per month. If it weren’t foranother business where I work one day each week, where I’m more of a needle technician than a Doctor of Oriental Medicine but in a business model thatpays well, I wouldn’t be able to support myself. My girlfriend and I like New Mexico (we’re originally from Chicago) and I’ve considered moving to another partof the state with fewer or no acupuncturists, but there are risks inherent in that. I want and need to make this career work for me. The GMP has renewed mycommitment and excitement for this work. I’ve been putting myself out there in terms of marketing (website, social media, newsletter, blog, postcards aroundtown) and I’m coming up with new ways of doing that through community talks and partnering with local businesses. It's starting to feel like I’m at acrossroads of choosing to stay here and stick it out or consider moving somewhere else that may be more supportive for reaching my goals. Consulting theYijing, I threw hexagram 39, Obstruction. For more context, I’m 42 and would like to own a home and have a child. This was a career change for me. If I werein my 20s this might not be weighing on me as it is. Thank you for reading and for any feedback you may have.Maryanne Travaglione NewAug 3React
1 reply 11 reply 112 more comments12ReplyHi AdamI respect the struggle you are facing and can say that you are pushing all the right buttons contributing socially in the largercommunity. I cannot offer additional advice but only can share that I am hearing the pandemic has affected many practices,established practices as well as startups. My best advice would be to keep up your involvement in the community, keep up yourgood work and stay put, theses times may require a bit more time than expected. Lastly, I want to share that Summer is almostalways a slow time in the best of practices so may no be the best time to assess practice growth, maybe see what developsthrough the fall, winter and spring wishing you slow and steady growthReplyMargaret Sikowitz NewAug 41ReactHi Adam - Totally agree w/Maryanne. And might suggest that word of mouth might be your best resource. Wherever you land,perhaps you could introduce yourself to the local yoga studio, and/or the people who you engage w/ at your existing business.When I first hung my shingle I reached out to the people I worked with in my other, prior fields and offered deeply discountedtreatments, those people helped to spread the word. I've also found that cross pollination in other networks (political/communityorganizing, hobby-type settings) are great resources where naturally occurring networks develop. Often local organizations(public/private schools, teams, etc.) will solicit services for their own fundraising efforts; if that's a place where you can offer a giftcertificates it brings more people who live and work within your community that will learn of your existence. And hey, if you endup in NM, it's an election year (!) so there might be places to plug into there. Definitely don't assess in August!Good luck.Alison Unterreiner, DACM, L.Ac.Cleveland and Canton, OH recs, plsNewJul 27ReactHi all -Boy, everyone is asking me for recommendations these days...Anyone know someone near Cleveland or Canton, OH?Thanks in advance!AlisonAlison Unterreiner, DACM, L.Ac.North Carolina recs, plsNewJul 26ReactHi all -Looking for recommendations in Wilmington, NC and Boone, NC or somewhere near there if anyone has any.Thanks so much!Alison
1 reply 1ReplyMaryanne Travaglione NewJul 27 | EditedReacthttps://jungtao.edu/clinic/this school in Boone can be a very good resource as it has a thriving clinic, or can be a source for localreferralsRenée KlormanAny Manchester, New Hampshire practitioners, or nearby?NewJul 18ReactThe referral is for a male patient with CC erectile dysfunction. He traveled two hours to come to see me, and I said I would try tofind someone closer.He prefers a female practitioner. Please post your contact information, and I will pass that on to him.Thanks! Renee ReplyMaryanne Travaglione NewJul 20 | EditedReacthttps://www.manchesteracupuncturestudio.org/it’s a community acupuncture practice but has very good reviews so might be worth considering a contact with them to see if it’s agood match for your patientOr… they might be able to supply a local recommendation ReplyRenée KlormanNewJul 21ReactThanks, Maryanne! I forgot that Andy is there. That's a great idea.1 reply 1Molly ShapiroAny extra granulated Ma Huang to sell?NewJul 13ReactI am down to the last of my Ma Huang supply. Until Jade Mountain resurfaces again, I am wondering if anybody has an extra bottleof Ma Huang (granules) to sell? I'll pay for all shipping fees of course. Thank you for any leads! ReplyAndie XuNewAug 9ReactHi Molly, I have the same question! Would love to hear if anyone has a source for Ma huang :)
1 earlier comment 1 teacher remarkYanaPCOS - general linesJul 10ReactQuestion for teacherWhere can I read/watch about treating PCOS?I had 2 young girls with PCOS this year. Each took herbs and regularly came for acu for 3 months, then both dropped, becausethey were not seeing the expected results. I pretty much copied Jane Lyttleton’s formulas from her Treatment of Infertility course(on Healthy Seminars). One of them, for less dampness, and one for more dampness (I’m a beginner in herbs, but for me theformulas made sense, from TCM approach). One girl with less dampness only saw her anxiety reduce and lost 5lbs in the firstweek, and no other results (weight and cycle stayed the same). The other girl, with more dampness, didn’t see any results at all.Zero. As if she didn’t take all these formulas and didn’t come for acu 3x/week at all.I’m likely to have another PCOS patient soon who’s trying to get pregnant. I don’t have her intake yet. Discouraged by the first 2fails, I’d like to learn more about more efficient ways of diagnosing patterns of PCOS and treating them with a dynamic, i.e. nottextbook approach “pattern > formula”, but real-life cases of prescriptions for several months. Honestly, I even have no idea forhow much time they should take herbs to see any result at all and for much longer, to get pregnant. All I know is the textbookapproach I learnt at school, which has nothing to do with the real life.ReplyMartine CornelissenJul 103ReactHi Yana,I understand your frustration, PCOS is indeed not as simple as 'Damp'.I completely agree with Sharon about the 'thick blood' as the basic problem. I've had the best results so far with harmonizing theblood and moving the blood. I ususally first choose a formula according to their overall picture, and then add high dosages ofChuan Niu Xi (18 up to 30gr), Yi Mu Cao (9-12gr) , Ze Lan (12gr), Dan Shen (12-15gr). Hope this is helpfull.ReplyCaroline Radice Jul 102ReactHi Yana: PCOS is incredibly frustrating but agreeing with the ladies above comments. The traditional damp type PCOS is only onetype and the variables within that type can have many different presenting patterns, including often the crappy blood. I find the"skinny" PCOS sometimes more challenging but you can help by improving the quality of the blood as well and body fluids andyang to help with ovulation. I do rely on BBT and following through the cycle with acupuncture for these patients to promoteovulation. Once that is successful, often you can get them in a groove.I have also incorporated non-CM add ins like Myoinositol (Theralogix makes one called Ovasitol) this is a powder that can mimic(and sometimes work better than) metformin, which is often the med these patients are given to improve insulin resistance.Sometimes that has been magical (but outside our scope so they need to buy for themselves online).As always, look for the pattern and treat what you see and my exercise of "pretend you don't know they have PCOS (or fill in theblank disease name) , what would you do?"Sarah Rivkin ISO DBC Pipe Ten 18x40 needlesNewJul 7ReactIt seems every supplier is out of my favorite needle, DBC Pipe Ten 18x40s. If you happen to have some gathering dust that youwould be willing to sell me please message me. I have plenty of DBC Spring Tens, but they don't feel the same and I don't like themnearly as much.
Many thanks!Sarah
Maryanne Travaglione San Fu moxaNewJul 6ReactHi JoyI was on the receiving end for 3 years if San Fu moxa. I can share that it was very helpful as it seemed to coincide with healthywinters and less allergic skin in the spring. cold moxa with grated ginger made into quarter size pellets were placed along ub points on my back and left in place from 3 hoursup to overnight. I do not remember the specifics but the first round did use ub 12 13 and I believe 17, subsequent rounds weredifferent. I did have a good response, meaning I developed blisters each round that were then left to heal, reabsorbing fluidnaturally over the course of days.others cam be more specific, but I did want to share I found it beneficial and was advised to do the treatment each year for threeyears. ReplyJoy BlaisNewJul 6ReactThank you for sharing your experience Maryanne!Joy BlaisSan Fu MoxibustionJul 6ReactQuestion for teacherHi, I am curious about the use of san fu moxibustion as this year's san fu days are just around the corner. If you have anyexperiences to share I would love to hear about them! I am particularly interested in:- when this particular style of moxibustion came into use and if it's considered a modern technique- what recipe you use for the paste- how you extract your ginger juice- preferred adhesives- what points you like to use and how you rotate points on each of the 4 days- any success stories re: useThanks very much!Candace Jania Jul 13ReactHi @Joy BlaisJoy Blais
ReplyWe do san Fu tie twice a year in our clinic (winter fu as well). We use a company called Bema botanicals. They give us a bottle ofpowder that we mix with ginger tea to form the paste. I used to use ginger juice (I just blended a piece of ginger in water) butfound that it was too strong on the skin. They also supply these awesome adhesives with a circular barrier to keep the paste onthe point. I generally use the same points: BL12,13,GV14, and then choose BL20 or 23 depending on constitution. I have seenpeople use ST36 and some other body points but I really have not used those. I have had TONS of success with patients who haveused them. I have no idea if this is a modern technique or not to be honest, but I don’t care because it works.JPEG | 2.1 Mimage ReplyJoy BlaisJul 15ReactThanks for your response Candace! I didn't think Bema would ship them to the US since they contained xi xin. Great to know!Candace Jania New York peeps… Practitioner needed in the Rockways.Jun 24ReactHi all.I need a practitioner for my patient’s mother in law that has stage 4 liver and pancreatic cancer. She lives in Queens, theRockaways. They don’t want to travel. Thanks!ReplyMaryanne Travaglione NewJun 291ReactYou might consider Rebecca Parker, she is in Rockaway Beach and lists having studied with Sharon which is a plus!Sarah Rivkin Is anyone in Michigan in/near West Bloomfield, Bloomfield, Rochester, Troy?NewJun 7ReactA patient of mine will be spending the summer in Michigan and was hoping to continue treatment while she is there. She does notwant to take herbs ;( but I've been treating her with acupuncture and moxa to control the symptoms of rheumatoid arthritis,
regulate her periods, and moderate stress.Please let me know if you'd have room to take her own for a couple of months.Thanks!SarahAnn ClearyHow much can we compensate for loss of organs? AND, How much do you take into account imaging resultsto diagnose?Jun 3ReactHi all,I’d love your thoughts on this case, especially the two questions above.A 37 year old male (born female and still cycling) has made his way to my office because his doctors have recently discovered astomach filled with polyps, and are monitoring with eyes towards a possible total gastrectomy. There is not any dysplasia yet, andhe is the only person in his family to have nodules in his stomach. Nodules were also visualized on his rectum but these wereeasily removed surgically. He suffers from familial adenomatous polyposis, which is considered a genetic disease,(https://en.wikipedia.org/wiki/Familial_adenomatous_polyposis), and had a total colectomy at age 18. He feels no sensation ordiscomfort in his stomach, though it is tender with palpation. When I questioned carefully, he said occasionally he is full easily butit does seem that his most usual experience is an easy appetite with easy digestion in the top half of the tract. Secondary to thetotal colectomy are frequent loose bowels. They are not painful, urgent, or watery unless he is having some sort of gastric upset,which is infrequent, less than once a month. (What are the chances of absorbing this extra water if the colon is missing?)Other signs and symptoms:H/o of sweating with anxiety but has not experienced anxiety recently to know if it still occurs.Historically runs cold but has noticed this is better, otherwise no sensations of hot or cold.Blocked ears that muffle his hearing for almost 15 years.Normal thirst with normal medium yellow urination.Red eczema patches elbows, tendency towards flakey scalp.Numb scar along ren mai at site of colectomy, and numb scar across rib cages that healed poorly (webbing) at cv 14 from totalmastectomy.Regular scanty menses, red color, no pain.Phlegm nodules rectum, stomach. Who uses info gained via modern diagnostics as information for our diagnosis and who considersthis a potential red herring?H/o recent depression that has resolved as of about 3 months ago, just discontinued psychotropic meds the week before oursession and is still feeling well, so I am not considering this as part of his current clinical picture. This manifested as lethargyprimarily.Dusky pale tongue with teethmarks and thick yellow coat.left pulses thin wiry with guan fullestright side wiry fullSharon Weizenbaum,Margaret Sikowitz,Suzanne Connole,Caroline Radice,Candace Jania,Sally,Claudia Citkovitz
My current understanding of his clinical picture is that the chronic loss of fluids through loose bowels has weakened the blood,allowing yang to flare. I am not quite getting how this is causing phlegm nodules on the yangming tube in particular. I am also notsure if this is a glomus. Does any epigastrium tenderness constitute a glomus? I am also working to open up his numb scars withacupuncture, as these sit over very important areas related to his symptoms and because they are numb the channels are clearlyimpeded.Zang fu: liver qi constraint, liver blood xu with secondary stasis, sp qi xu with damp heat, phlegm nodules.6 conformation: taiyin, shaoyang, jueyinI am planning on giving him a modified chai ling tang + dgsys + Mazin’s dui Yao for phlegm nodules:chai hu 12ban xia 12huang qin 9dang shen 9gan cao 3cang zhu 12zhu ling 12fu ling 12ze xie 4gui zhi 9gan jiang 9da zao 6wu wei zi 12xia ku cao 24zhe bei mu 9zhu ru 9dang gui 9chuan xiong 5chao bai shao 9Thoughts on prognosis and diagnosis and formula much appreciated.
1 teacher remark2 repliesFamilial adenomatous polyposis - Wikipedia Embedded File.https://en.wikipedia.org/wiki/Familial_adenomatous_polyposisReplyCandace Jania Jun 4ReactHi @Ann Cleary -You should always take everything into consideration. And I mean that you fold this knowledge into your diagnosis. No, we don’tdiagnose via a Western Medicine Dx, but it tells us information that we can think about as we synthesize the s/s of the patient infront of us. I actually think you did a great with the conformations. As for the glomus, do you see signs of heat or rising qi aboveand non-nourishment or cold below due to blockage? A glomus can also appear with inappropriate purging during a Taiyanginvasion. Perhaps his constant diarrhea triggered a glomus if he had a cold, etc. allowing the pathogen to settle into the stomach.Additionally, Liu Du-Zhou mused that there could be pain at the epigastric region with a glomus, although most believe that thereis not.How did he respond to the formula?Also remember that with continuous diarrhea there would also likely be a yin fluid loss that could cause thickening of fluids andcongealing of damp into phlegm which could explain the nodules as well.Ann ClearySharon Weizenbaum Jun 41ReactHi Ann,I agree with Candace. I like to put the western imaging and diagnosis out of my mind completely as I am doing my CM diagnosisand then go back and see if I can make sense of the WM information with my diagnosis. Most often the WM diagnose does makesense with my diagnosis.It is true that chronic diarrhea can damage the fluids but I'd make sure I see signs of this before diagnosing blood deficiency. Iwasn't sure what the blood xu signs were.
1 replyReplyYou wrote that "My current understanding of his clinical picture is that the chronic loss of fluids through loose bowels hasweakened the blood, allowing yang to flare." What are the signs of blood xu or fluid deficiency? How is Yang flaring and why isn'tYang flaring then in your diagnosis? This was confusing to me.I personally would not diagnose "phlegm nodules" based on the imaging. I have been amazed over the years to see many westernpathological changes disappear without going directly for the pathological change as seen only from WM imaging. This includespolyps, tumors, endometriosis, fibroids, inflammation etc. Going in this direction, treating phlegm nodes, makes your formula verylong.One thing I see from the imaging is that the lesions are pale. From his scalloped tongue and tendency to be cold etc., this makessense.I would suggest thinking about warming his middle more. His formula tends to be cool. For me, the epigastric tenderness does notmean glomus. Glomus, for me, is when someone can't eat much without feeling fullness or discomfort. It's subjective to thepatient and not objective to me. If his epigastric area feels tight and muscularly resistant to pressure, this is a Ren Shen type ofindication.You might think of simplifying the formula to Chai Hu Gui Zhi Tang with increased Ren Shen or Dang Shen plus Dang Gui and a bitof Chuan Xiong to harmonize blood. Do you think that fits with the patient? I can't tell from the info given but it's something toexplore.Andie XuCustom Granule PackagingNewJun 3ReactHi All,I hope you are all doing well. I have started an custom granule pharmacy in the clinic and have been experimenting with differentpackagings for customized formulas... I'd love to hear what you use for packaging for powdered/granule herbs!So far, it seems that plastic bottles are the most convenient. Does anyone have recommendations on a good source for plasticbottles?Thank you!AndieSarah Rivkin NewJun 7ReactHi Andie, I don't dispense herbs myself (I use China Herb and Kamwo). But China Herb uses plastic lined brown zipper bags, whichI think work well. Probably a bit better for the planet than more plastic bottles? I will tag @Cara Frank to ask where she buys themfrom, but I'm going to guess Uline or some place like that. They sell a lot of packaging supplies.https://www.uline.com/Hope that helps!Cara Frank
8 more comments8ReplySarahReplySuzanne Connole NewJun 8ReactHi Andie. I think Sally came up with something that was working for her in her clinic. Tagging her.Sally1 replyAnn ClearyHelp with this Common Post-Covid Symptom in PedsJun 2ReactHi, I’d love some advice on this from any of you with ideas!5 year old who is mostly recovered from Covid that began 2 weeks ago except for GI distress. Frequent BMs that alternate between loose and “beady”, as inbeads stuck together. A couple of days before our session, she happened to use my toilet and needed more toilet paper brought to her, so I had the chanceto notice that BMs are also smelly. Her mother brought her in yesterday because she was going to the restroom multiple times a day at school, experiencingthe urge but unable to have a BM. Additionally, she is also going frequently (3x a day). The child very skillfully reported to me painful rectal spasms. She is alsomore fatigued, napping when normally she does not and gettting tired earlier in the evening. Appetite is normal.Her father had brought her to a naturopath the day before, who prescribed Vitamin D and charcoal. Charcoal seemed to add a layer of GI upset (burping,nausea). (I advised to d/c for now.). There was vomiting last week, and some recent nausea though it was hard to tease out what was occurring the past 3days and what had started with using activated charcoal beginning the day before our session. Based on the follow up below I think nausea is a moreimportant part of the picture than I had initially decided.Thirst is normal, no sensations of hot or cold. Pulses are wiry and normal speed. Tongue is normal color with thicker white moss at root. I was expecting togive her li zhong wan, but after doing intake I thought si ni san was more appropriate bc of alternating loose and dry, wiry pulses, and spasms (as it containsshao Yao gan cao tang), though I still see damp and qi xu in her pattern. Not surprisingly, the child could not tolerate the 1g I gave her in the office and so I didnot send them home with herbs. I did generic shonishin pattern on arms and legs, pediatric cupping behind sacrum and at ub 20, and stickers at li4 and st36.This morning mother reports that last night she was still cranky/ tired, BMs are frequent and child complains of urge to vomit. Not the improvements I washoping for. I am thinking for next time abdominal massage, more wood points, and more tuina on the face and head to calm shen. What do you all think? Iam not going to try herbs again (I don’t want to turn her off forever!), so looking for pediatric acupuncture and body work ideas. ReplyRebecca AvernJun 7ReactHi Ann. This is a somewhat complex picture but I would aim for keeping my approach simple, and to address one thing at a time. Iwould most probably begin by focusing on the Liver Qi Stagnation invading the Spleen, by using Liv 13, GB 34 and Liv 3, all witheven technique. If you can't use needles, I'd put pyonex on those points for about 15/20 minutes. From what you say, the Spleen ismore of an issue than the Stomach at the moment, but if the vomiting/urge to vomit/nausea remain problematic, I would add inLiv 14. Once I saw an improvement , I would then most likely go on to tonify the Spleen. I hope that helps.Sharon Yeung Jun 24ReactIf I am understanding the pattern correctly, it sounds like the child has the urge to go frequently but isn't able to pass a stool easilyand it is incomplete, is that correct? And when she does go, it is smelly. Have you tried a simple Bao He Wan? you can get it in apediatric tincture format in the Kan Gentle Warriors brand. I have had hit or miss results with this brand but it's formatted forchildren in a glycerin base and can be mixed in juice pretty easily. I usually advise taking more than the dosage they recommendto get a better result but you could start with a lower dose. I have often seen nausea as a secondary symptom when there is somestuck stool and it resolves after the stool moves. There will often be flatulence as well bc the stool is trying to move. And thepatient should feel better if she is able to have a complete stool.I would advise them to have her take warm, simple cooked foods that are easy to digest. And I love the idea of abdominalmassage, rubbing the belly in a clockwise direction, the same direction as the intestines if she needs to get things moving andcomplete.
1 replyReplyIf you feel that the source of the disharmony comes from deficiency, you could moxa St 36 and the backshu points.3 earlier commentsAdam BroderBusiness questions re: herbal prescribingMay 30ReactI’ve seen one patient so far for herbs and I’m realizing that there are a lot of considerations when planning to integrate thismodality into a practice. The forum discussion from last year regarding management of clinic flow was helpful for me to see thatsome more seasoned practitioners require or prefer to do 3-4 acupuncture sessions on a patient before prescribing a formula. Iintend to follow their lead, at least in the short term while I’m still learning the basics.Do people charge a separate herbal consultation fee at the time they feel ready to write a prescription (whenever that may be)?What happens if the herbs did not work or resulted in adverse reactions (this is the case right now with my patient in fact)? Is thepatient charged for the new formula? If/when the pattern shifts and a new formula is prescribed, does this come with an herbalconsultation fee? What if, after a few acupuncture sessions the patient only wants to continue with the herbs portion oftreatment? How often are they seen/charged? ReplyMolly ShapiroNewJun 7ReactHi Adam!I've been adjusting these aspects of my practice, still a work in progress. I went from seeing 2 acupuncture patients at a time anddispensing pre-made formulas (no extra time to dispense), to mixing custom individual formulas (much more time to dispense)and seeing 1 patient at a time since the start of Covid. I have set prices for "acupuncture + herbs", "acupuncture only," and "herbsonly" appointment types. Currently my rate is the same for both the "acupuncture and herbs" appointment type and"acupuncture only" appointment type. In my mind I've kept the rate the same because I feel I'm still learning, practicing, andgetting my footing. But it's starting to feel too low.The cost of herbs does include a small markup, but this does not seem to satisfy the time (including studying and years ofexperience) it takes to make a custom formula. I'm currently a 1 woman show. I let my office manager go when Covid started, butperhaps down the road I can get to 2 patients at a time again if I have an intern/student/herb helper to fill the formulas that Iwrite. In the meantime, I think I need to raise my rate for "acupuncture + herbs" visit (1 patient at a time) and keep separate ratesfor those that need just 1 modality (acupuncture only or herbs only, which I can schedule more frequently and/or overlap). I thinkI'm hesitant to raise my rates to include the herb consultation and formula preparation aspects because I question my level ofexpertise... I'm actively working on this block.I've been using the last 2 1/2 years to sort of reconfigure and realign the nature of how I diagnose and prescribe herbs based onwhat I've been learning in the GMP. I've definitely made mistakes. When patients can't finish their formula for whatever reason(taste, negative side effect), I do not charge them for the next bag. These costly mistakes, in particular, have taught me a lot!Good luck with writing formulas! I have found it to be so incredibly beneficial to my patients, and their positive feedback keeps mehungry to learn more and refine these skills further.
2 more comments 2ReplySarah Rivkin NewJun 7 | EditedReactI want my patients to feel comfortable taking my herbal recommendations without hesitation. For this reason I remove thefinancial incentive to myself--or the appearance that I might be recommending herbs because it makes me more money. I chargeone rate for my time, whatever modalities I use with a patient (acupuncture, moxa, cupping, herbs, qigong, etc.) and I use anoutside pharmacy to fill and drop ship formulas. This is probably not the way to make the most money, but it feels right to me.For context, I've been in practice for 16 years. I periodically research what the "going rate" is for acupuncture in my area and Ithink my rates are about average, though they may not reflect my years in practice or doctorate.1 earlier commentJan Wilsonlooking for a practitioner in Chicago; Glenview, North Brook, Deerfield areaMay 18ReactI have a long term patient moving who is moving to Chicago in June. She will be a steady client for the right practitioner. ThankYou. ReplyCaroline Radice NewMay 22ReactShe is terrific! Second for Melanie. Her business is called BeBetterAcupuncture ReplyMaryanne Travaglione NewJun 1ReactThird shout out for Melanie, You will be in good hands9 earlier commentsAlison Unterreiner, DACM, L.Ac.How to view post-covid anosmia in the wheel?May 16 | Edited1ReactQuestion for teacherHello -I'm looking for some help with some recent cases I've got. I've started to treat several patients complaining of post-covid anosmia -both patients have been suffering with loss of smell and taste for well over a year and I'm having trouble in how to look at this.I'm not sure if this would be lung affected (lack of smell) or spleen affected (lack of taste) or both. I'm unclear on if this is blockage(blockage causing loss) or deficiency (deficient qi causing loss) with lack of smell and taste. Is yang being blocked? Is it leaking? Is itseparating? The whole thing has me a bit confuzzled! And to make matters worse, both patients had covid so long ago, they don'treally remember things like chills/fever, how it came on, etc.How are you guys looking at this type of thing? Looking for some clues on how to view this so I can more effectively treat.Thank you in advance for any nuggets of wisdom!Alison
1 earlier reply2 more commentsReplyCandace Jania May 202ReactDon’t forget about lu lu tong for nasal congestion as well because it also adds to the blood stasis clearing as well!ReplyPamelaNewMay 241React@Candace Jania I was having a conversation with Dean Mouscher LAc who teaches Master Tung style bloodletting, and he said hebled the tip of the nose (using a McKesson safety lancet) to relieve blood stasis, and bring back the sense of smell *and* taste inhis post-covid patient. He said she noticed an immediate difference, although last time he saw her, she was still recovering, butmuch closer to 100% than before. I'm curious about what about Covid causes blood stasis - having read about 'sticky platelets', theorizing that it is the dampness ofthe pathogen that causes the blood stasis.Candace Jania ReplyCandace Jania NewMay 24React@PamelaI think blood stasis could be caused by a number of things- dampness and phlegm occluding the flow of blood, heat fromYangming which could dry up fluid and blood, qi stagnation from convalescence, , etc. I think it's hard to say one thing becausesymptoms can differ from patient to patient and individual constitutions are also very different.PamelaMolly ShapiroAnyone order from Ali Herbs lately?NewMay 12ReactHi colleagues!I never ordered from Ali Herbs. The website doesn't work and I never got a response from my email. It feels like what happenedwith Jade Mountain. Maybe somebody has an alternate email address or contact info that has worked recently? Hopefully theyresurface soon!! ReplySage Staggs (she/her)NewMay 17ReactI ordered from them in March and they responded to my questions via this email:aliherbs2020@gmail.comSuzanne Connole NewMay 17React
ReplyI tried today with the link in the GMP and was just directed to Shopify in general. Wish I had tried to order sooner as I am runningout of the basic Covid stuff!1 teacher remark1 reply 1Ann ClearyWho is in San Francisco?NewMay 9ReactFor someone who is still recovering from Covid they got a month ago…ReplyWhite Pine Circle NewMay 111React@Ann Cleary check out the global map, there are a few practitioners on there: https://whitepineinstitute.instructure.com/courses/230/pages/global-mapAnn Cleary
Ann ClearyCovid Case Not Responding, I think I missed the Yangming AspectMay 6React38 year old tall, strong, corpulent female, recovering from Covid that began Easter weekend.Currently she feels as though she has cotton balls in her chest from ren 17 to throat, and needs to use her inhaler a couple times aday. She is coughing up neon green sticky sputum, and her nose is stuffy and throat is phlegmy. Her voice does not sound clear.She has night sweats a few times a month since before covid- wakes up hot, sweaty, and drenched. Feet are warm and moist tothe touch. She gets hives with cold for most of her life, a rash after hot showers, and currently throughout the day gets waves ofheat throughout the day.She is extra thirsty for room temp water, and urine is frequent and incomplete. Appetite is good, bowels are about 3x a day sticky,1x a week loose to watery, sometimes with undigested food. Monthly, there is some phlegm in her stool.She has anxiety attacks that manifest as a rumbling up from the intestines (running piglet) w/w work stress.Her cycle is irregular, she passes small clots that range from meaty to squishy. She gets dizzy in the days leading up to her period,and 7 years ago had severe bleeding 2 weeks post partum when she passed bits of placenta.Pulses: dong right side (I think!)Dong left side with left cun superficial. Deep left chiTongue is dusky pale with teethmarks with sl yellow mossTight epigastrium, tender costal marginsI dx: lung phlegm heat, xiong bi, kidney yang xu (?deep left chi with watery stool?), sp qi and kidney yang xu, liver blood xu andblood stasisTaiyin shaoyang shoayin jueyinI prescribed:Chai hu gui zhi gan jiang tang 32Xing ren 4Hou po 4Ban xia 4
1 earlier comment1 reply 1Fu ling 6Zhi shi 4Xie bai 7Gua lou 7Cang zhu 4I checked in with her today, she has had 5-6 doses of 4 grams each over 2 days. Yesterday she had to use her inhaler 3x instead of2 and has not noticed a change in the phlegm. Usually people respond very quickly to their covid herbs so I see I have missedsomething.The rashes at the surface and the sweating show taiyang, the stuck feeling in the chest with heat and sweating yangming. This hasbrought me to yue bi tang and/ or ma xing shi gan tang.I am thinking to add ma xing shi gan tang atMa huang 6Shi gao 22Zhi gan cao 3Adjusted for the amount of herbs she has left.Does this seem right? I am not addressing the weak blood at this point. Should I add the da zao of the yue bi tang?I will not be able to follow up with her after this (she is in town for work and then going back to Austin) so I would like to help herquickly and safely. Your thoughts are appreciated.ReplyCandace Jania NewMay 6ReactHi @Ann ClearyI think you need to focus on the acute situation right now. I am assuming that there are no body aches, chills, fever, feeling likecoming down with something etc. (Taiyang?) because these were not mentioned. Is she getting rash or hives currently or justhistory of?Also I’m guessing with the inhaler usage she is wheezing?So I am thinking that the formula has to be focused on the LUNGS primarilyI would try:She gan ma huang tangI would remove the xi xin and add gua lou, shi gao. Zi su zi.Ann Cleary
1 reply 1ReplyCandace Jania NewMay 6React@Ann Cleary yes that’s exactly what I was thinking- making it more cooling. you could use those herbs certainly. I would see the rash as more blood heat/Jueyin so perhaps at some point mu Dan pi, sheng di etc. but perhaps not right nowAnn ClearyAnn ClearyAustin, Texas?NewMay 5ReactHi, who is doing herbal medicine in Austin?Rebecca ParkerSuperficial Blood Clot and HerbsMay 51ReactQuestion for teacherHello wise ones. I have a longtime patient who developed a superficial venous thrombosis in the cephalic vein of the right arm as acomplication of a fibroid embolization procedure. I want to resume herbs with her post procedure, but I'm unsure of the safety ofdoing so with a clot that might potentially become dislodged if I give blood moving herbs. They have not prescribed bloodthinners, as it's not as serious as a deep clot. How would you proceed in a case like this? Is it too dangerous to give herbs? She isgung ho to start herbs again, but since I have no experience or training on superficial venous thrombosis, I told her to wait until Icould get some guidance. Thank you! ReplySuzanne Connole NewMay 17ReactI'm tagging Caroline here to see what she thinks on this. I don't have any experience with this type of situation but I am tempted tosay that the herbs work differently than blood thinners. They don't just move/push blood through the vessels. They actuallyimprove the quality of the blood. We see this in menstrual blood as we treat it it becomes smooth, red, liquid and free flowing.What is her pattern, what type of blood moving were you thinking of giving her?Caroline Radice ReplyCaroline Radice NewMay 181ReactHi Ladies: I tend to be very conservative in cases like these and would expect such a clot to resolve on its own. Once confirmed, Iwould be more confident that there would be no conflicts. This is a risk that I am not confident to take on myself for (sadly) liabilityreasons.Pamelabrief hand-holding needed in ordering raw herbs from Kamwo for Mazin Al-Khafaji -style dermatology (eczema) treatmentMay 4React
Hi, all, I’m a relatively new herbalist, graduated from the Won in August 2020. My hands-on dispensary education and experience wasinterrupted by our moving to online classes during the pandemic. This year, I signed up to study with Mazin Al-Khafaji, and have aparticular patient I’ve been working with years. She is no longer local to me (because I moved). She drove 3 hours for an in-personconsult, for her eczema. We had been talking about this since December, and scheduled this intentionally just before I wassupposed to take my first class with Mazin. The class was postponed until early July from late April. I’ve taken three classes onlinewith Mazin in the past six months, two of them via White Pine, plus an excellent weekend on dermatology at the Won with MarnaeErgil. My patient had a re-emergence of eczema following her first dose of the vaccine, about a year ago. She contacted me monthslater, in December after no one had been able to help her, even my herbal colleagues in my former town. She and I have madesome headway with a very cautious herbal prescription I put her on just to help her until I felt more confident and the initial classmeeting with Mazin. Now, however, I feel like making her continue to suffer the eczema until July is a bit much.I’m about to order herbs for her from Kamwo, to have them drop shipped to the patient’s home. I could use an assist on the actualordering from someone who has ordered from Kamwo in the past. I’ve been using Kamwo for dispensing in the past, but it’s thehuge quantities of the herbs for the dermatological purposes that has me being extra cautious.I’m using Kamwo in particular because I’m in Baltimore MD and Kamwo is the closest raw herb dispensary that I know of. It wouldbe helpful to have a conversation with a person who has used this pharmacy for this type of raw herb dermatological formulation,to talk about logistics and how to make it all doable for the patient.Thank you, Pamela Howard, L.Ac.Marnae ErgilReplyCaroline Radice May 51ReactHi Pamela: I'm a 25 year patron of Kamwo and graduate of Mazin's program, so happy to help. Please email me atcarolineradice@gmail.com and we can schedule a zoom1 replyKristin WisgirdaGreenville South Carolina?May 4ReactThanks for any referrals near here. ReplyMaryanne Travaglione May 4ReactI have heard a good report about Dragonfly for acupuncture and massage, not certain of herbal practiceAlison Unterreiner, DACM, L.Ac.How long do we want people on herbs generally?May 31React
1 earlier comment2 more commentsHi all -This may be sort of a basic question, but I'm genuinely perplexed about this....since starting the GMP several years ago, I findmyself prescribing more and more custom herbs. I usually explain to patients that the goal of treatment is not to keep them onherbs forever, but rather, we want them on herbs for as long as it takes to heal the root and then we can begin to wean them off.The thing is - and I know every case is different - I never know how long that actually is! Curious to know how others handle this?I would say my general rule of thumb is that if an issue is acute or a formula too moving/drying/cooling/etc, I keep them on veryshort term (1-2 weeks) at which point I will reassess. However, it gets trickier for me in a case where someone is dealing with apersistent long term issue, they get on the herbs, feel better...than what?! Do I start weaning after 1 month? 2 months? 1 week?What do you all do?!? Would love to know!!Thanks in advance,Alison ReplyBethany Richardson, LAc,May 4 4ReactThe goal in my clinic is to get them balanced so they don't have to stay on herbs as well. I think with a chronic condition, we arewatching the signs and symptoms and adjusting the formula as needed. When symptoms resolve I keep them on the herbs foranother week or so just to reinforce the positive directionality ( things going up as they should and things going down as theyshould) then stop and reassess to see if any symptoms return. If so then treat accordingly.In Yu Guo- Jun's Walk along the River, some of the patients are ultimately put on a supplementing formula that may be used forseveral months with positive outcomes. So, I think there is a case to be made for chronic entrenched conditions needing monthsof treatment.ReplySarah Rivkin NewMay 81ReactYes! @Bethany Richardson, LAc, FABORM that's what I do as well. And for that maintenance/transitional formula, once most of thecondition is resolved toward the end of treatment, I will often use a standard formula (in premade pills/powder/liquid), rather thana custom one, if I can. It's usually sufficient, cheaper/easier for the patient, and easier for me.Bethany Richardson, LAc,Jessica Goldthorpe-manningThanks! And Help with a case…..?Apr 27ReactQuestion for teacherI am thrilled to be new to WPC. But, apologize if this is not the right place to post this question. It is, in fact, this particular case thatmade me realize how much I desire to understand herbs better. After taking the recorded GMP class with Sharon on healthyseminars my mind was illuminated and my soul lit. Even so, I still am not grasping how to help this patient (and yes I plan onattending the june 2023 course:) neither her doctor or dermatologist is grasping how to fix their problem either.Her CC: a constantred rash around her eyes and sometimes along her smile lines and cheeks and jaw line. The only thing that “gets rid of the rash”are steroids. They are red, raised, painful, itchy, murky/clear fluid filled blisters arise that sometimes pop and crust her eyes closein the mornings. She says it reminds her of cold sores that she gets on her lips but all around her eyes. It started about 8 monthsor so ago. Along with dramatic hair loss. And shortly after all of this she began menopause. Is this the right forum to be posting allthis detail? If it is please let me know and I will continue…… if its not please let me know where to go to ask such a detailedquestion. Thank you! And I am very excited to have found a community and not be stranded on an island anymore.
JPEG | 3.5 M99CBB39B-FAC4-47F0-BB08-A17…JPEG | 2.4 M793D2CD1-EDA4-42BE-B7DD-47…JPEG | 2.3 M7009517D-7725-4B6F-8F70-E7C5…JPEG | 2.1 M6EBCC555-5B4C-4A7A-9300-870… ReplyMargaret Sikowitz Apr 282ReactHi Jessica - Welcome to WPC - definitely not stranded on an island here...!This looks like a fairly complicated case with a little bit of everything going on. If it's of interest, there are various forms of casesupport...https://whitepineinstitute.instructure.com/courses/230/pages/emergency-case-supportBUT, even if you decide you're not there yet, I always find breaking things WAY down is key. I like the template (found in the abovelink, and included here as a PDF) to help me organize my thoughts.It could be a useful exercise to go through this. SECTION 1 helps me 'zoom out' to see the bigger picture of the patient, SECTION2= specifics for the CC, and SECTION 3, r.o.s/10 questions. I find ESP w/these knotty patients, I get so caught in the CC that I amdisorganized in section 1 and section 3, so being more systematic there really helps me.Hope this helps, let us know...and you're not alone. Esp DERM, we have so little training in that area.PDF | 68.4 KPDFEmergency Case Support DocMolly ShapiroA way to use less plastic!NewApr 26ReactHi colleagues!I have been deeply inspired by Eran's talk and plan to incorporate a raw pharmacy and use the powdered herb method.Realistically, this will not happen overnight, but more in the 2-5 year plan. In the meantime, I continue to use granulated herbs.Eric Brand
6 more comments6But I HATE plastic and all of the consequences of using plastic. I recently learned that one can purchase bulk packs of granulatedherbs from Legendary Herbs. These are 500g bags, not the hard plastic bottles. I have concerns about the recycling of the hardplastic bottles, and feel more confident bringing plastic bags to the stores that recycle plastic bags (like Target) than dumping theempty plastic bottles in the recycling bin. Either way, 500g in bulk pack is a lot less plastic than 500g in bottles.Since I did not know of this option until recently, I thought I'd share it in case others don't know of it. Also, Legendary recentlyexpanded the number of products offered in bulk packs. They can email you the list. Additionally, I reached out directly toTreasure of the East in response to their Earth Day email and asked specifically about best practices for recycling the hard plasticbottles. I will share their response if I get one!ReplySally NewApr 27ReactI've also started using coffee bags to dispense formulas from my granular pharmacy rather than the plastic bottles I used foryears. They are 8 oz bags and I get them from the most local distributor that I could find... ReplyAnn ClearyNewApr 27ReactHi @Molly Shapiro @Sally Rappeport I think about this a lot, too. It will be a while until I can do raw, as only granules fit in myshared space. But after trying many things to reduce plastic in in my dispensing, including glass bottles with a deposit that patientsreturned and I cleaned and sterilized, I have finally figured out a solution. I buy sandwich wax paper, the same you use for rawformulas, and use it for the granules. I add a sticker to keep it extra sealed, but honestly I don’t think it’s necessary. If you didn’tlearn this fold in school I can teach you! The picture is not my prettiest fold, but they generally look something like that (I put sometorn paper over patient’s name). I have also moved to giving dosages in teaspoons instead of those little plastic spoons and I nolonger have them sent to me. 1 tspn = 2 little spoons = 1 g roughly. The dosage isn’t written on this one bc patient has troubletaking herbs due to stomach surgery and has her own system. Anyway, that one piece of wax paper is way better than washingand sterilizing jars (which didn’t always come back anyway) or giving out new jars every time.Sally,Molly ShapiroJPEG | 2.6 MimageMolly ShapiroDifficulty eating/drinking (including herbs); feeding tubeApr 26ReactQuestion for teacherHi colleagues!
I'm working with a 21 year old female student who developed a severe inability to eat during her move back to the US fromEurope. She describes a glomus in which she gets too full too fast and feels increased heart rate, epigastric fullness, pain thatradiates to her ribs, pressure in her throat, nausea, and then feels a lot of anxiety because she does not like to throw up (she doesnot throw up). Anxiety feels like palpitations the crave pressure, tingling fingers, panicked, stuck food in epigastric area. Sheexperiences a lot of nausea, and nausea makes her feel more anxious.Liquids easier than solid food, but very picky about texture and flavor preferring fruit and sweet foods. She can eat about 2crackers or 5 raspberries at a time.She got a feeding tube and now gets most of her calories this route. She still tries to eat and drink, but it is still quite difficult.IUD for history of prolonged heavy menstrual bleeding and accutane for acne that was red, purple, tender.Runs warm. Hard to fall asleep. Daily rhythms are out of whack; wakes 10am, not out of bed until 3pm.She has a very thin emaciated body. T is tight/crimped, white coat, red dots at tip. P is thin/wiry, deep, L Cun floating (sometimes).Abdomen has hard epigastric area with pulsations, tight RA, bowtie, Saibu Atsu (areas of hardness around the umbilicus).She has been trying to drink Xiao Jian Zhong Tang. If it's been helpful, it is hard to tell for sure. She still has an extreme inability toeat. Below are 3 formulas I have tried. Is it not a XJZT pattern? Do I need to modify differently? Getting the herbs in is a bigchallenge; she feels full after drinking them, and sipping on them throughout the day is challenging for her as well.XJZT:Gui Zhi 9Bai Shao 18Sheng Jiang 9 Da Zao 9ZGC 6Mai Ya 30 XJZT:Gui Zhi 12Bai Shao 18 Sheng Jiang 12 Da Zao 9ZGC 6Mai ya 30 XJZT + Dang Gui: Gui Zhi 9 Bai Shao 18 Sheng Jiang 9
3 earlier comments2 replies 2Da Zao 9 ZGC 6 Mai Ya 30 Dang Gui 9 I've wondered about a Gluten allergy; that perhaps she is reacting to US wheat vs European wheat? I can't imagine asking this patient to cut out any foods, though...We also tried Ban Xia Xie Xin Tang in liquid extract, and that was a definite NO (could not take them in).Thank you for any thoughts and considerations that you have!ReplySage Staggs (she/her)NewMay 2React@Margaret Sikowitz @Ann Cleary @Molly ShapiroI'm jumping in here because I have a new patient with a very similar presentation, she can only drink Ensure. She has whatamounts to a panic attack plus nausea if she eats food. Also migraines, and mostly cold symtoms. Pulses are thin, tongue deeplyfissured. I am interested in trying wu mei wan with her and will re-watch Laura McGraw's WMW talk asap.I'm wondering if it's appropriate to give someone who has suffered from long term constipation (like her whole life- she's 46)? Shenow goes daily as long as she takes mag citrate. WMW seems to be mostly indicated when there is diarrhea along with all thesereversal symptoms.Thoughts?Also, Molly, how's it going with your patient?Thank you.Margaret Sikowitz,Molly Shapiro,Ann Cleary ReplyAnn ClearyNewMay 2React@Sage Staggs (she/her) @Molly Shapiro Thanks for asking this question Sage because after seeing Molly’s response I meant to goback to my notes from class to make sure I was remembering the right jueyin formula and then didn’t get to it. I’m glad I did,because indeed Nadine did say that she sees wu Mei wan patients with constipation. From my notes: “Nadine also seesconstipated patients with big balloon-y left pulses bc not enough downward movement.” If you think about it, that very large doseof wu Mei must really relax everything, so if the relaxation of magnesium helps, so may wu Mei wan. She says that the dose of 81gis important. I have not gone over 30 g yet personally but I would if I thought it were the right formula but wasn’t getting the rightresults. Some other notes that may be especially relevant to your patient, Molly: “rock hard belly. Nadine sees it with sleepdisturbance but not the kind of sleep disturbance people would report, also occasional period or h/o migraines”.What’s this Laura McGraw on wmw? Where do I watch that?Sage Staggs (she/her),Molly Shapiro
Alison Unterreiner, DACM, L.Ac.Oakland, CA referralNewApr 22ReactHi all -Looking for a practitioner in Oakland, CA or thereabouts. Pain specialty a plus.Thank you!Alison ReplyMargaret Sikowitz NewApr 28 1ReactHi AlisonThere are two East Bay folks from WPC on the Global Map https://whitepineinstitute.instructure.com/courses/230/pages/global-map. If they're too far afield, maybe they know folks in Oakland ??? Good luck! ReplyAlison Unterreiner, DACM, L.Ac.NewApr 28React@Marintha Tewksburydo you know anyone out in Oakland?? Thank you!Marintha TewksburySage Staggs (she/her)BXXXT causing constipation in a mixed pictureApr 18ReactHello,I am trying for the first time to open yangming as a way to address insomnia... A new concept for me. I had a new patient last weekwith insomnia as his chief complaint, but his digestion was all over the map, and when this is the case with mixed hot and coldsigns and discomfort after eating, I tend to think of BXXXT. He emailed me 3 days after his treatment and the initiation of takingBXXXT and said that while his sleep had improved since the acupuncture, he had become constipated and gassy, not having a BMfor 72 hours, which is longer than he typically ever goes. I advised him to stop the BXXX.I would like some feedback about where I went wrong in choosing that formula and why it might have caused constipation, as wellas any ideas for a more appropriate formula.Thank you!Case M Chamik 4/12/22M 43
InsomniaAnxietyDigestive UpsetWakes in night/early morning, can’t fall backYang out of r/roverthinking Hyperactive qi? Yang out of r/r?Digestive issues w/w rich foods, gluten Could be damp, T/T probDiscomfort if overates Glomus? YM blockage?Tummy ache relieved by massage Local stagnation in MJBleeding hemorrhoids Heat? Dryness? Blood stagnationNo energy/motivation for exercise Qi not availableOccasional night sweats Maybe damp heat?Craves sugar ?Runs cold Yang defCold hands/feet Yang not reachinggas/bloat, food sens T/TSluggish BM LI stasisSoft BM dampL pulse wiry Wood stagR pulse slippery Damp in MJDark slv Blood stasisRed tip Yang out of r/rSl yellow coat Some damp heat in MJDip at root Ki defVery thin and paleBlood deficiency? GZ type?Dx:Treatment principles:First fx: BXXXT tabletsYang out of r/r r/t YM blockageLI StasisDamp and heatOpen up YM to facilitate upward/downward movement of energy- bring yang back to center/sourceMove bloodSage Staggs (she/her)NewApr 20 | EditedReactQuestion for teacherI saw this patient today and got a few updates:Upon taking BXXXT, he had softer stools than usual for 2 days, after which he got "constipated", and his bowels stopped movingfor 3 days and he was very gassy. Once he stopped taking the BXXT, his bowels moved again and they were again softer than usualfor him.He also clarified that when he feels distention and pain in his epigastrium, it is relieved by passing gas.His sleep has much improved since his acupuncture treatment last week (and perhaps was helped by taking the BXXXT, I don'tknow?).Caroline Radice,Sharon Weizenbaum
1 reply 16 more comments6 ReplyToday I also got a clearer read on his pulse:L thin, wiry, cun deep and weak, chi most superficialR deep, cun and guan weak, chi most superficialand his tongue coating was thinner and white, with only a tiny bit of red prickles around the front.Based on these updates I am giving him Si Ni San with added dang shen and bai zhu.I would still love some insights from any teachers in the group. Thanks! ReplyCaroline Radice NewApr 25ReactHi Sage: Did you do any abdominal palpation with him? I'm not so sure there is a lot of damp heat based on the presentation andthat the BXXXT may have been too drying. There is for sure blockage in the middle but not clear it is from excess either.Tolley SinkReferral Athens, GreeceNewApr 12ReactIs there anyone we know practicing in Athens, Greece?TIA
Ann ClearyMucusy BMs with nodules under skin and recurring upper respiratory infections.NewApr 8 | EditedReactHi all,ThIs one is a doozy. I’d appreciate any insight you have. I made a chart of the for sure signs, happy to add that here if it is helpful,but was trying to be concise with a lot of information.Friendly, chatty, 62 year old college professor seeking treatment for small pebble stool alternating with mucus. The mucus comesout separate from the stool; patient reports there are also white blobs smaller than seeds that come out intermingled with stool.In the past month she had a 2 week stretch where she had 20 BMs a day. B/w fodmap diet. The morning of our first (and only)treatment she had a completely normal BM, 1 of 3 normal BMs in 10 years. She speculated that this may be due to lookingforward to getting acupuncture. Appetite is good.Temp and sweat: runs cold, but reactive to heat. Feels dried out and spaced out with heat.Difficult to sweat even when really hot out.Thirst and urination: Drinks a lot of water (I could not determine actual thirst level through questioning) and has frequent urgenturination.Sleep: terrible, difficulty both falling and staying asleep. Lately she has begun to sleep more during the day.Vitality: some days exhausted, some days full of energy, cannot determine a reason for why some days are better than others.Gyn/ ob: 2 live births, last period Fall of 2016, h/o very irregular periods with red - dark red blood and clotsUpper jiao: Frequent upper respiratory infections since adolescence accompanied by fever. Occur every few months. Recent feverand currently a cough with green sputum.Tends towards stuffy noseMouth sores 2 weeks out of every monthStabbing pain left ub 13-15 area.Lower jiao:2 years ago had surgery to correct a pelvic floor prolapse that rigged up her uterus and bladder with her own ligaments.Severe varicose veins along the kidney and liver channels of both legs. Cannot walk to the kitchen without compression socks asstanding up without them causes pain.Hip pain (gb channel), bilateral, w/w walking.
Skin: Soft squishy lumps along pc channel (and elsewhere I believe, will need to ask more). Doctors consider them benign andhave diagnosed her with MAST.Psychoemotional: H/o severe childhood neglect and mother to 2 children, 1 with serious mental illness. Patient wakes some daysfeeling fine (day of treatment), other days with an “urge to die immediately” (the day before the treatment). Has a therapist andreports that she has not actively had a suicide plan in 3 years. Lives with daughter, son-in-law, and 2 grandchildren, and describesit as the coziest, most peaceful domestic situation of her lifetime.PulsesRight side: very deep and weak across all three positions, nearly hiddenLeft: soft, moderate speedAbd palpation: warm, soft (lacking tone), positive oketsu bilateral, otherwise WNLTongue: purple, yellow coat at rootPhlegm heat in the lungs and large intestine, blood dryness with blood stasis, phlegm nodules, kidney qi sinking, woodinvolvement, xiong biTaiyin, shaoyang, shaoyin, jueyin (taiyang?)My current understanding of her pathology is severely compromised fluids, both taiyin fluids and blood. They have becomethickened and stagnant, and so are pooling and sinking. This is compromised by a weak shaoyin pivot that cannot birth the up andout of the jueyin, nor can it sink the yang back into the congealed yin fluids at night. This weak shaoyin pivot is not able to keep thedoors of the yin orifices closed, nor can it hold up the pelvic floor or the blood vessel in the lower limbs. I don’t see a lot of woodsigns but I do think the green sputum, the repeating symptoms that come and go, the diarrhea alternating with dry pellets, andh/o of menstrual irregularities could justify? I would like some help here. Also, this hidden right pulse is shocking to me. I have onlyfelt it on the left and am not sure how to read it here other than deficiency.This is my best stab at a formula (chgjgzt + sns + hpglxb + added flavors)Chai hu 15Huang qin 9Gui zhi 12Gan jiang 6Tian hua fen 15Mu li 20Bai shao 12Zhi shi 12Hou po 12Xie bai 12Gua lou 12Fu zi 20Chuan niu xi 9Ze lan 9Dan shen 9
1 reply 1ReplySally NewApr 10ReactAnn, It’s quite complex. What is her chief complaint?if it’s the mucous in the stool with small pebbles, perhaps address that andthen see what else changes. Is it a red purple tongue or a pale purple tongue? Do you have a photo? Your formula seems verywood focused which makes some sense, but often with very complex cases, it’s best to simplify more, so that you have clearerresults. The peeling back layers method. Do you think this formula will address the mucous in the stool? If it does not, will youhave a clear path for moving forward? Nadine mentioned that she uses Si ni San for goat turd stool. That might be a good baseformula with some modifications; then once she can digest better, and you can see what else changes, you can address otherissues more clearly. I think you should post for sure S &S for this one and it would also help clarify how to modify the formula.Ann ClearyNewApr 27 | EditedReact@Sally RappeportHere's the update I have been intending to give.I asked the patient specifically which was most urgent among her symptoms. She said it was the bowel movements, and then emailed laterbasically naming many of her symptoms too. :). But no matter, as I had decided this yangming axis was key.I gave her this formula initially:chgzgjt 50dan shen 10fu zi 10fu ling 5mu dan pi 5bai shao 10zhi shi 5tao ren 5After this she reported that she no longer had green phlegm, just a dry intermittent cough. The mucus in her bowels was gone, and she hadhad one complete BM but most days was passing just two little pebbles. She had also been exhausted, and was very concerned that thecervical prolapse that had been corrected surgically was now coming back. She reported that it had first returned with the coughing fromthis last chest cold and she had thought it would go away when the coughing subsided but it did not. It felt like a half out tampax. Her urinaryurgency is improving, but frequency is still very very high.I had shared this case on another forum and Genevieve Le Goff had noted that there was a strong yangming jueyin axis in her presentationwhich would fit with ma zi ren wan. Her pulses were sl more present on the right side (where they had been hidden the first two visits) andwere moderate with soft floating cun left side. I saw in this Claus's explanation of chi gui zhi tang and married the two formulas to make this:bai zi ren 5xing ren 5bai shao 5zhi shi 5hou po 5sheng da huang 5gui zhi 5sheng jiang 5da zao 10zhi gan cao 3fu zi 10dang gui 5dan shen 5I just saw her today. She has been pooping daily, more in the past week than in the past 10 years combined. After one BM she weighed a halfpound less! They are primarily formed, with one that was semi loose and one that was loose. I was very pleased to hear that the sinkingcervix is improving, though still sagging. (What an example of how sinking in the west with the BMs can help the rising in the East!) Herurinary urgency backslid slightly but still better than before starting herbs, and no improvement in frequency. She still has the dryintermittent cough (less frequent) and now has a thirst for cool water and mouth and throat dryness. Her right pulse is much stronger: it ispresent but weak, moderate, soggy, with an absent chi. The left side was moderate and wiry. Tender costal margins and positive oketsubilaterally. Her tongue is purple, tiny yin cracks along center, moist yellow coat at back, swollen edges.Sally
1 more comment 1ReplyNo change in lumps in forearm, no change in varicose veins. No improvement in ability to fall asleep. She is still exhausted, and has had anexacerbation of a strange kind of lightheadedness. She describes it as a momentary loss of auditory and visual function. She mentions forthe first time that her left rib cage swells at night and gets very puffy.My current analysis is that there is not enough physiological moisture to give the yang a pathway to the surface/ top of the body, along witha stuck shaoyang pivot and a very weak shaoyin pivot and severe blood stasis.I have kept the chai hu and reduced the mzrw portion of the formula 1g per ingredient and added large doses of mai men dong and wu weizi. I have also added mu li to melt the nodules and bring fluids into right relationship and anchor any yang that may be causing the strangedizziness. I have also added shi Chang pu:Bai zi ren 4gxing ren 4gbai sho 4gzhi shi 4ghou po 4gsheng da huang 4gchai hu 5gfu zi 10gwu wei zi 10 gmai men dong 10 gmu li 1gdan shen 5gshi Chang pu 5gQuestions I have for anyone willing to weigh in: Is huang qi more appropriate than shi Chang pu here? My plan is to continue reducing themzrw 1g per ingredient each week, is that the best way? Should I be adding more ingredients for these phlegm nodules or just work with themu li for now? I have largely disregarded the blood quality this formula. I am thinking incorporating bai zi ren wan based on her insomnia,severe blood stasis and h/o trauma will be appropriate next week. Thoughts?Joy BlaisWhat are These Red Threads on Tongue?NewApr 6 | EditedReactQuestion for teacherHow would you interpret the thin dark red specks & stringy lines on the back of this tongue? Kidney Yin xu? Heat? Blood stasis? It'snot like a black coating that I've seen before. In person it looks like someone put little cut up pieces of red thread on his tongue.The pale swelling on the R side of the tongue seems particularly pronounced as well.This patient is 72 with asthma, swollen prostate, & severe constipation. He can go a week or more without a BM or with only asmall walnut sized chunk coming out once in a while. Herbs are allowing him to eliminate daily or every other day, but as soon ashe stops them he gets blocked up again. I'm worried that he may have an intestinal mass since the back up in his digestion isfollowed by a rather strong purge that keeps him by the toilet all day. The stool is formed (not liquid), dry at first, then normalconsistency. Afterwards, the cycle of constipation repeats itself. He is going for a colonoscopy soon.Thanks for your input!
JPEG | 952.8 KRed lines
2 replies 21 reply 11 more comment1JPEG | 642.1 KRed Lines 2ReplyAnn ClearyNewApr 9 | EditedReactCurious to hear what others have to say about this. To me it looks like it is dark/ deep red at the bottom of the yin cracks, and so Iinterpret as some sort of congealed blood. What is congealing the blood would be teased out from signs and symptoms. Curiousto hear what the colonoscopy reveals. Can you say more about why this pattern of “catch-up poos” where he goes a lot all in oneday makes you consider a mass? This is new to me.ReplySuzanne Connole NewApr 101ReactI know your question is about the tongue specifically but I wonder if this is a Da Chai Hu Tang pattern? Sharon has a couple blogposts I think about Da Chai Hu Tang for lung conditions. It would fit with the excess belly. You maybe could add tao ren and xingren which sort of connect the lung and Large intestine.Those dark red spots make me think both heat and blood stasis in the lower jiao.Sage Staggs (she/her)Need help looking at big picture in case of low appetiteNewApr 4ReactHello, I'd love some insight on how to look at this case:32 FFatigue, low appetiteAbd: bowtie empty Ki defVery thin physique Blood def?R oketsu Blood stasisV dark slv Blood stasisRed tongue, also tip Heat, heat in upperThick yellow tongue coat Damp heatCracks in center of tongue ST yin def?Pulse rate change ?
2 teacher remarks1 reply 1L pulse thin Blood or yin def?R pulse tight Cold? Maybe it’s choppy so blood stasis?Temp dysregulation shaoyangRaynaud’s Yang not reachingfatigue Qi not availableDizzy when stands up Blood not making it to headheat triggers passing out Yang out of r/rNo appetite Poor t/tFood sensitivities Poor t/tIrritable premenstrually Wood stagnationEasily flushed, w/w stress Yang out of r/r, r/t wood stagnationSome sluggish bowels but tends softLI stasisI see blood deficiency and blood stasis, some yang out of r/r, wood stagnation, and poor t/t.This patient is very thin, seems frail, and complains of never feeling like she wants to eat- there is something about eating thatmakes her feel bad, she feels a full meal is too heavy so she just eats snacks. She has an aversion to nausea and says eating duringthe day often makes her feel nauseated, but she's fine to eat a normal meal at dinner time. I'm not sure how to understand herpoor appetite or what the root of it is. She doesn't seem to have a glomus that I can tell. Can someone provide perspective on thisand some herbal suggestions?Thanks! ReplySharon Weizenbaum NewApr 5 1ReactHi Sage,This looks like a Xiao Jian Zhong Tang pattern to me. However, with the thick yellow tongue moss, there is some damp-heat thereas well. How yellow is it? Given the mixed hot and cold pattern, I might start with Ban Xia Xie Xin Tang then then see if the middlestasis clears up with that. Then you could followup with something like XJZT with Mai Ya for the Yi Tang added GZ. I see this as aneutral temperature formula.For me, the temperature dysregulation would not confirm Shaoyang. This can come from so many patterns so I like to see the coldpart of it as cold and the heat part as heat. Which does she tend to more? Is she mostly cold with heat episodes or the opposite?Hope that helps! ReplySharon Weizenbaum NewApr 6ReactHi Sage,Thanks for the additional information. Interesting that having some breakfast that warmed and nourished helped her appetite.I wonder if you've checked her lower belly for pressure pain. There may be some left over blood stasis from the abortion thatcould be cleared with Sheng Hua Tang, perhaps modified. This blood stasis could easily effect the appetite as well.Sage Staggs (she/her)Can herbs cause gas in breastfed babies?NewApr 3React
2 teacher remarks1 reply 1I’m treating a 2 week postpartum mom for milk supply issues (not enough). I gave her a modified MMDT. She said she thinks hersupply may be increasing some but that her baby has been pretty gassy since she started the herbs. She’s not sure if it’s acoincidence or related to the herbs. Does anyone have experience with this? I gave her the following in granules:mmd 18dang shen 11da zao 12zhi gan cao 6ban xia 6tong cao 9dang gui 7chuan xiong 4huang qi 12gan jiang 9tian hua fen 6Thanks for your thoughts. ReplySharon Weizenbaum NewApr 3ReactHi Sage,It is possible for babies to have a response from the herbs but it's also hard to tell as it is so easy for a newborn to get gassyanyway. I would suggest doing some pediatric tuina and/or teaching the mom to do it. This will strengthen the baby and workwhether it's the herbs or not. You and the parents can get Kyle Cline's book on kindle right away and it's very easy to follow.I am looking at your formula and wonder about the high Gan Jiang. From the formula, it seems you are trying to nourish thestomach fluids while supplementing her Qi and blood. Any reason why it's there?I know in some traditions THF is not used with BX because ZZJ doesn't put them together, with the idea that, either the stomach isdry or wet and can't be both. However, I do sometimes use them together as do other practitioners. I see BX with MMD in MMDTas helping to create the environment for the fluids to be absorbed. It's not there to dry or clear phelgm. So otherwise, this looksgood.Also here is a blog post you might enjoy!https://whitepineinstitute.org/insufficient-lactation-case/ ReplySharon Weizenbaum NewApr 3 | Edited 1ReactHere's the link to the kindle book:https://www.amazon.com/gp/product/B007WS8TCY/ref=dbs_a_def_rwt_bibl_vppi_i0Nancy LegatoPractitioner in Halifax?NewMar 29ReactHi, all --Does anyone have a referral in Halifax, Nova Scotia for someone who has well-managed (with medication + acupuncture) bipolardisorder?Thanks and warm regards,
1 reply 1NancyReplyTolley SinkNewMar 30ReactHi Nancy,Ali Jopp is there. She is wonderful. http://alijopp.com/wp/2 earlier commentsJoy BlaisSjogren's CaseMar 25 | EditedReactQuestion for teacherI have a 60 year old female patient with Sjogren’s who has very dry eyes, dry mouth, dry bowels, dry vagina, & dry skin. She has avery dry bowel movement once every 3-4 days and feels sluggish, hot, & a little sweaty until she has the BM. She’s constantlythirsty and drinks small amounts of water many times throughout the day to wet her mouth, so subsequently she urinates a lot ofclear urine. She has difficulty digesting fatty foods & gets stabbing upper R quadrant pain and bad breath. In addition, she hasstiffness in her neck & low back with cold tingly hands. Her tongue looks pale pink & tense to me with a dry white coat, dip in therear (with thicker coat in back) & a bulbous tip. At first I thought this might be a Wu Ling San pattern, but she does not have a tightor floating pulse. Instead her pulse is very deep on the L & soggy on the R guan. I’m not sure how to interpret all the excess signswhen she actually seems pretty deficient. Any insights for me? Thanks so much in advance!Tolley Sink,Suzanne Connole,Caroline Radice,Marnae Ergil,Candace Jania,Sally,Claudia CitkovitzJPEG | 866 KSjogren's 1JPEG | 1 MSjogren's 2
1 reply1 replyReplyCandace Jania Mar 26React@Joy BlaisI think that you could look to help the block in yangming from heat and dryness. The lack of BMs seem to worsen her symptomsand cause more heat to flare upwards. She has intense thirst and constipation.If she is urinating a lot also, is she like a dry sponge and it’s going right through her because she isn’t absorbing it? Some things tothink about.Are her hands cold from the tingling (nerve issues) or are they really cold?Joy Blais ReplyCandace Jania Mar 26 | EditedReact@Joy BlaisSo Yang Ming is blocked meaning it’s not open, which is creating those other symptoms when she is blocked up. The constipationis blocking the normal downward movement of qi in the LI. It does not sound like a cheng qi tang type of pattern- more likelythings aren’t moving from heat and dryness. I guess my point was that you need to address this within the parameters of her presentation. I’m wondering if a modified bai hu jia ren shen tang (I would substitute shi hu for shi gao)would help to clear heat and generatefluids to mitigate all the dry symptoms. Just a thought.Joy BlaisBrian LangstonBHT pattern, 4 bigs w/acute onset of urinary frequency and urgency painNewMar 28ReactI am starting to work with a client long distance and am asking for help and guidance.Female 37, history of hyperthyroid at 20 w/ pulse of 170+, Dr. radiated thyroid then supplemented with synthroid.Always had a fast pulse, 99 at current cunsult. last week, stated it goes as low as high 80's when resting in bed.Always hot, drinks a lot of water to hydrate, prefers cooler or cold water or cold drinks, if she doesn't drink water as much she isless thirsty. Her urine is mostly clear and abundant, to the point of getting up 10 times at night along with daily numerous times.Sometimes her urine is cloudy & if she does not pee for 4 hours urine can get yellow.Her menstruation for most of her life was irregular, 3 days, light first day, moderate 2nd day, light 3rd day. Never any pain. With ahistory of endometriosis and adhesion. She received acupuncture for getting pregnant including hormones and other treatments.During her last pregnancy she carried so low she believes her bladder was damaged and she had to use a walker towards the end.Her menstrual flow became heavy after this birth. And also developed hemorrhoids. She has since had a hysterectomy leaving herovaries.She cannot eat greasy of fried foods due to diarrhea soon after.As noted above she has the 4 bigs, big heat, big sweat, big thirst, big pulse (I had her check her own pulses and she could feel thepulses at the surface without any pressure on L&R chi, slight pressure for L&R guan & a little more pressure for L&R cun). So I willbe starting out with BHT, and I am concerned as to what direction to pay attention to after that, other than possibly WDT for herproblem with greasy or fried foods.According to the info I gathered in my diagnostic survey there is KY def., GB symptoms, LU & HT affected due to rising heat & yang,qi, blood, yang involvement. I have not done a complete diagnosis as I believe the excess need to be resolved first.I am just amazed that someone could have such high pulses for such a long time. She must be miserable. And she is.
Her sleep is not good, hasn't slept more than 6 to 7 hours in years. She has anxiety, depression, OCD, palpitations, irritable, mentalrestlessness.Her tongue looks fluted(yang rising), damp accumulation turning to heat and dry. Under tongue possibly cool in the middle andwarmer to outer edges. I have never really had experience diagnosing under tongue.This is an overwhelming case for me and yet I believe that just resolving the 4 bigs will go a long way towards helping her feelbetter. And I am concerned that once this clears I will not be able to help with the root issues, as it seems like there are so manyand so complicated.And I am grateful for this forum where I can bring this case to and get support. Thank you in advance.JPEG | 201.9 KBree tongueJPEG | 236.6 KBree under tongue ReplyBrian LangstonNewApr 281ReactUpdate from this client. She slept 1x all night. Pain & spasms are less w/urine @night. Decreased thirst. Less fear, stress, anxiety.Less clammy & sweaty. Better digestion w/less diarrhea flare up. Her pulse also has lowered to 72 from high 80's. This was with 2weeks on the BHT formula. Yea!She would still like to get more sleep and lengthen her short fuse.Her tongue looked about the same with maybe less yellow coat.I decided to continue on this formula as she has had this pattern for about 17 years.Adina KletzelAcupuncture treatment for dying patientNewMar 271ReactHI,I am treating a woman with a brain tumor who is in a place where conventional medicine can no longer help her. She is at homeand is very weak and can't get out of bed. I come and do acupuncture for her in order to help her with her anxiety, ability to
1 teacher remark1 reply 1breathe, stomach pains, and constipation. I normally practice Sa'am acupuncture in my clinic but I feel that she needs somethingmilder and softer. This is my first patient that I am treating in this kind of state and I was hoping for some guidance on sometreatments that might be very soothing and supportive of someone who is facing death.Thank-you so much. ReplySharon Weizenbaum NewMar 27ReactHi Adina,It's a blessing to be able to do acupuncture at such a transitional time. She is so lucky to have you. I've attended quite a number ofdeaths as an acupuncturist and have been amazed at how much a simple, even 1 needle, treatment can help. I kept it supersimple. If the person was afraid, I supplemented kidney. Angry with what is happening I used liver 3, 2, etc., I treated lung if therewas a sense they could not let go. I think you can still use the principles of Saam in a simple way. My experience with dying peoplewas pre-saam. With Saam, you could work in a similar way. I can imagine, for example, simply supplementing Ki 7 would help if theperson is having a hard time because they are worried too much about others, Ht 9 if they are fearful, P9 if they are angry….I butKristin or Toby would have some good ideas about how to simplify as well.Good luck.1 reply 1Adina KletzelRecommendations for practitioner in Los Angelos to treat CrohnsNewMar 24ReactHI,I am looking for recommendations for a practitioner in Los Angelos who can treat Crohns Disease.Thanks! ReplyMargaret Sikowitz NewMar 24ReactHi Adina - I have found a few folks in far flung places using this link:https://whitepineinstitute.instructure.com/courses/230/pages/global-mapThere are a few of us WPC folks in LA - hope you can connect with some of them! ReplyCaroline Radice NewMar 27ReactHi Adina: Margaret is in Brooklyn but I can recommend either Ann Cleary or Jennifer Black in LAAdam BroderOffering input to patients outside of our CM interventionsMar 20React
5 earlier commentsI would like some guidance on how to go about offering patients advice on things such as lifestyle, nutrition, supplements, books,podcasts, other modalities to try, referrals to specific therapists offering other modalities, etc. In my four years in this field I'vebeen working at integrative clinics that offer massage, chiropractic, and other therapies, and I often hear advice being given that isat best misguided and at worst an attempt to inflate the therapists ego (it irks me when I hear people say they just started takingturmeric or berberine because their chiro thought it would help). Personally I don't offer much in the way of these things but itseems like patients would appreciate it and at least I can give advice that doesn't come from an ego-centered place. I've also beentrying to build my own private practice for the past year in a fairly saturated market (Santa Fe, New Mexico), and if I want othertherapists to refer patients to me I should probably form a network and make referrals myself. A lot of this doesn't feel authenticbut then again neither did marketing or social media but after hearing some podcasts and audiobooks plus the encouragementand help of my girlfriend who does this stuff for a living I've found a comfort level with that. Coming back to Sharon's teaching thatthe clinical encounter is for us as practitioners, I'm hoping to find a comfort level with offering guidance to patients in a way thatfeels good and right to me. ReplyMaryanne Travaglione Mar 23ReactI agree with all the advice given here. So much can be accomplished with authenticity and the care with which we interact withpatients. ReplyCandace Jania Mar 25React@Adam BroderAs you continue down your path of Chinese medicine, you will figure it out- what works best for you and for your patients. It’sfunny, on many acupuncture chat boards someone will post for advice and 9 times out of ten the responses will be non-CM (takeCOQ10!) etc.. Nothing wrong with that but when you post on a CM board you usually would expect to get CM answers lol.I normally look to my medicine to answer questions, talk to patients, recommend things, however there is also a place where yougather experience and just know what is clinically relevant and effective for the patient. For example, if someone needs Shao yaogan cao tang for tight spastic muscles, I will of course prescribe a formula centered around that but I may also tell them to takemagnesium, which is a natural muscle relaxer and a spirit calming mineral. I have no problem using what works, as long as I ameducated about it and it benefits my patient.Adam Broder2 teacher remarksEmma Mezher constipation in 7-month oldNewMar 14 | EditedReactHello-I just wondered if there were any simple dietary suggestions for constipation in infants? This 7 month-old is still breastfeeding, andthe mom has tried prune juice and apple juice. It seems to coincide with starting to introducing solids in the last few weeks. Thisweek there was some bleeding in the stools likely due to hemorrhoids, and the child is in a lot of pain. This child had a precipitousbirth and has had developmental issues since then including wry neck, feeding issues and has a congenital issue in one ureter forwhich he will likely require surgery. The mom has been advised to see a specialist re the constipation, but in the meantime Ithought there might be some helpful information on this forum.Sharon Weizenbaum,Suzanne Connole,Caroline RadiceMarnae Ergil NewMar 15 1React
1 reply 14 more comments4ReplyProbably the mom is already doing this, but moving the legs (like riding a bicycle) and belly massage can both help. Also,increasing fluids - they may be taking in mostly breastmilk, but some water can help too.Sometimes, infant constipation is just about training the bowels in what they are supposed to do and so it can take some time. Ido not like to give them laxatives at that age because it prevents the body from learning, but I will sometimes give a Bao He Wanwith a little bit of Da Huang in it as the constipation is often due to food stagnation. Warn the mother that the baby might haveloose stools after. She can dissolve a granule formula into water and use an eye dropper to get it to the back of the baby's mouth -they will taste it less that way. Or, they can cook the herbs and again use an eye dropper. If using pills, it is necessary to crushthem and mix them with some food. ReplyMaryanne Travaglione NewMar 16ReactGreat suggestions! Let us know if the problem resolves with this very practical adviceJoy BlaisTongue HelpNewMar 12ReactQuestion for teacherHello!I was wondering if I could get some help differentiating wet vs dry tongue coating. Sometimes I get confused about what is actuallya wet coat & what is just the person’s saliva creating a sheen over a dry coat.The tongue picture attached is from a 42 year old vegan woman with migraines, fibroids, dysmenorrhea, throat constriction, acidregurgitation, anemia, & emotional issues (anxiety & depression).When I look at this tongue I see a long pale body with cracks in the center and a thin dry yellowish coat along both sides that getsthicker towards the back. The front is slightly lavender with a large concave dip in the lung area. There is also a small red spot on Redge.Would you say this is an accurate description? Does the coat look dry or wet to you?Thanks for your help!
1 reply 16 more comments6JPEG | 719.9 KDry or Wet ReplyTolley SinkNewMar 12 1ReactHi JoyIt looks like a pancake tongue to me and it looks wet not dry because of the water bubbles.ReplyTolley SinkNewMar 13ReactHi Joy,For me bubbles on the tongue = wet tongue = dampnessI haven't noticed both wet mouth and dry coat before but I am no tongue guru :)We do know that there can both be pathological fluid accumulation and dryness in a pattern though.In this case I would hold the diagnosis of dampness based on the wet tongue lightly and see what else there is in terms ofabdominal diagnosis, and other signs and symptoms.I do hope someone else weighs in on this though!Guy Sedan
Judith KenenHelp with case, strange fallingFeb 24ReactQuestion for teacherI'm working with a 56 year Her main complaint is that suddenly 2 years ago she began to have trouble walking in very specificsituations: on slippery surfaces and going up hill, and is better if she is barefoot. She doesn't get dizzy nor is there any numbnessor pain, but it's like she has no traction. She has seen a bunch of doctors. Previous to this she was training for a marathon and hadbeen a runner most of her life. Now she can't run or even walk her dogs and has to be very strategic about how she gets around.Since it's such a strange symtpom, I'm trying to focus on just treating the pattern and hope that will help address the symtpom.She is medium build with a great sense of humor and very personable, complexion is sallow. She also has severe hot flashes butnot sweating.She has Lr blood xu, blood stasis (based on tongue but can't tell where it is in the body), she has dry lips (dry earth), but also somewater bubbles on her tongue so some water somewhere, cold feet, chopstick in the belly ( Ki), somemild surface processing issuesSo Shaoyin, Jueyin, Taiyin, Taiyang and wondering about Shaoyang?I'm stuck on a couple of things:1) about how to define her Ki involvemen from the chopstick as qi, yin or yang because her only cold sign is cold feet, I don't see Kiyin unless I'm not understanding the tongue and she doesn't have any leakage.2) And Her symptoms are deficient, but as a person she doesn't strike me as deficient, so I think it's about 50/50. So I'm not sure ifto include shaoyang- the only sign of wood stasis is a pulled in tongue, but that could be from the Lr blood xu.She could be a Gui Zhi Tang because she has upsurging, dry spleen and blood deficiency but no leakage and she isn't a particularlysensitive type.Would love any and all help! Thank you.
1 earlier commentJPEG | 1.1 MMK pic ReplySally Feb 26 | Edited1ReactI agree with Tolley , I would really try to nail down the sensation and what may have happened just before. Also, I agree with youto treat the pattern and see if that helps this resolve. So I am wary of dry spleen thinking when there are poor processing issuesthat could be causing mouth breathing. Your description of this is a little vague. I assume she is menopausal? When did thathappen? Besides the hot flashes, did she have episodes of heavy bleeding or continuous bleeding at that time? Or any emotionalexcesses? I wonder if Wen Jing tang might be really helpful for the Jue Yin, with increased Bai shao to help relax the muscles andperhaps something for the sinuses? The degree of damp is difficult to assess. Sometimes I determine it by seeing how sheresponds to the formula. i.e. does this formula change her tongue coat? then you could modify it accordingly. ReplySharon Yeung Feb 28 1ReactI am in agreement with Tolly and Sarah. I want to know more about her movement restrictions. Is there stiffness and tightness inthe muscles and if so where? systemic? thighs and calves? Or is it more weakness of the legs? You mention she can't walk uphillwhen slippery but then go on to say she can't run or walk her dogs. Is this because she cannot avoid this specific landscape or forsome other reason? What happens when she doesn't have any traction? Does she feel weakness and instability or othersymptoms?Like Tolley, I also wonder what happened 2 years ago. Did this inability to walk in this circumstance align with menopause?The chopstick is enough to diagnose Ki deficiency and it could point more towards yang deficiency with the pale tongue andchilliness below--I would like to know if she has a cold lower abd, or feels chilliness in the thighs, buttocks etc.It's good to follow your instinct of how you feel about a patient. But I wonder what makes you think of the root of her condition asless deficient when you don't see too many excess signs? Remember that a cheery, upbeat person can still have a root pattern ofdeficiency. If you see some clear wood stasis, symptoms worse w stress etc, then you can say there is lv qi stagnation. When yousay pulled in tongue, do you mean a crimped tongue? I don't see it that specifically in the photo, however, but I'm sure you havebetter insight into this.From your description, I think a modified GZT is a good direction given the symptoms thus far. And if you can fill out some of theother questions we asked, it can help you with modifications.Good luck and keep us posted.Margaret Sikowitz A teachable moment...Feb 17 3ReactHello Friends,I just started working a new patient, coming in for menstrual and ovulatory pain. She is new to NYC, had been getting treatment inher old hometown before coming in. She shared w/me all kinds of reports of an adenomyosis that started growing about a yearafter having a baby (who is now 4).
She is slight, pale, her pulse runs on the thinner side, and deeper in the chi mail, she has dry skin, soft voice, thin hair, pale lips,poor sleep, occasional painful intercourse due to vaginal dryness. Her prior practitioner gave her Liu Wei Di Huang Wan (pill form).She checks many of the boxes in the 'yin deficient' type category, at a quick glance (especially ones I often associate with my earlyyears of trying to grasp this 'yin deficient' concept.)First thing we did was stop her herbs. She's already experiencing less painful cycles and sleeping better. Hoorah!She may have less yin than the average 40 year old, BUT, she has many more signs of cold and stuck blood - lots of spider veins,clotty menstrual flow, runs cold and dislikes cold, has cold hands and feet, tight rigid muscles, distended veins under her tongue.Not a case presentation, but a reminder to me of all the folks like her who I missed along the way, esp early on along the road.Thank you all for your great case presentations (of which this is not) and of course to GMP for helping me find a better road map.Here's to continued learning.ReplyMaryanne Travaglione Feb 23ReactThank you for sharing!ReplySharon Yeung Feb 28ReactSo helpful to reflect on how far we've come since our first meeting with the GMP. Thanks for sharing!Judith KenenHigh estrogen levels and herbsFeb 14ReactI've been treating a woman for several months for heavy and painful bleeding, insomnia and PMS. She was improving until abouta month ago when everything got a lot worse. She got a hormonal panel done and her estrogen was over 700 on CD 12. Shedoesn't want to stop taking herbs but her gynecologist wants her to stop because she is concerned that the herbs are causing thehigh estrogen. Client is asking me to do research to try and identify if any of the herbs could be raising her estrogen. As far as I cantell, there is some research that indicates that some herbs could raise estrogen, but from our perspective, the herbs aresynergistic and if they are the right herbs it shouldn't be a concern. I'd love some advise about what to tell her. The high estrogennumbers are concerning.Thanks,
ReplyMaryanne Travaglione Feb 16ReactHi JudithAs you haven’t said what was in your formula I will guess from your notes that it likely contained Dang Gui as it has a bad rap inWestern medical literature while we know in formula its estrogenic affects are mitigated. In this case you haven’t suggested anychanges in diet that might affect this sudden and dramatic change in her estrogen levels so It is possible that a more investigationis needed and in my experience many MDs won’t go to the next possibility until this first option is satisfied. So if she discontinuesthe herbs and her numbers continue to rise further that investigation will follow. For her, this can be really important, I would notshare with her but my concern would be the possibility of an estrogen producing tumor as this is one of many differentials thatmay well need to be explored. I hope she continues to see you for careand the herbs that have already provided a shift in her menstrual cycle can sustain for a month or two while she continues toexplore what is going on.ReplyJudith KenenNewFeb 24 1React@Maryanne TravaglioneThanks for your response. She had her estrogen levels tested again and this time they were normal so I'm not totally sure what'sgoing on, but yes, I was concerned about a tumor. Thank you.Maryanne TravaglioneSuzanne Connole Question on Granules and DiabetesNewFeb 13ReactHello. A question came up in my class today about granules, and I didn't know that answer, so I'm reaching out to the group to seeif any one has any insight. The student was told that granules are dangerous for diabetics due to the starch used in mostformulations that can affect blood sugar. I know that the ingredient is different for each manufacturer, and that it is sometimeslisted as sucrose on the label. Is this actually a concern though for patients? I have used granules in many diabetic patients withoutany issues, so my experience is that this is not a concern but I should probably know that for sure. Thanks!ReplyCaroline Radice NewFeb 132ReactI recently asked Eric Brand about this for an insulin dependent diabetic and the sugars are more like a fiber if I remembercorrectly. He estimated a daily dose of 9-10 g of his brand, Legendary, was a 2 carb exchange for insulin dosing. For type 2, I thinkit’s a non-issue. I also asked Cara Frank about China Herb extracts and they are alcohol & water, but can be reduced by dissolving in warm waterand are taken at much lower doses so I went with that. otherwise have not had issues.Sally Anyone near Boca Raton, FLNewFeb 6React
For one of my patients who is heading to FL for a few months after passing KI stones. Thx, SallyReplyMaryanne Travaglione NewFeb 91ReactI don’t know him personally but have heard good reports from another practice for Matthew Enright in boc1 reply 1Brian LangstonSlowing down Tai YangNewFeb 2ReactWorking with a client with good results. I have warmed her up with gzt and fz, she is sleeping better and having better BM's.One symptom she mentioned is at 5am heat radiates from her chest and wakes her up. My understanding is this may be Tai Yanggoing to fast so I need to slow it down. Looking at herbs that may do this my thinking goes toward bitter or sweet. bitter as shetends toward dry stools, speed up west a bit and sweet as sweet moistens and stays. The herb that came to mind is bai zhu as it isbitter, sweet, warm.This is all in hindsight as she has come and gone, I'm just trying out my new knowledge to see if I am close or way off.She does have scalloped tongue with dampness.Thanks for any feedback.BrianReplySuzanne Connole NewFeb 7 2ReactHi Brian. I think this is a case of "let's explain this weird symptom with everything we know for sure" rather than jumping to aconformation based on one symptom. It's really interesting and yes, yang is rising to fast in the morning. But why is unclear. Yousay that she is damp, so actually sweet is not a good idea usually. So jumping to sweet might take you down a wrong path. For meif I get an idea of a pattern then I want to follow it down a pathway and ask all the questions that go with that pattern. Does shehave other signs and symptoms that point you to Tai yang? Is there something else happening on the surface that also points toTai yang. What are the spleen/damp symptoms. It sounds like warming was a good plan for her, but if it is cold deficiency spleenwith water we might want to look towards Li Zhong Wan type formulas.So basically I think we need a little more information before jumping to Tai yang here. ReplySally NewFeb 26ReactAlso Brian, I think of blood movers, like Chuan xiong, are pungent so they move up and out. You did not mention your full formula,but perhaps the dosage of the pungent herbs are too high for her. Perhaps Rou gui would be more beneficial than Gui zhi. I don'tthink of the pungent nature of Fu zi as especially moving up and out, though it does to some extent. I think of it being penetratingfrom deep towards the surface, as it's often paired with other pungent herbs to bring it all the way to the surface.Sarah Rivkin Referral for Knoxville TN?NewFeb 1ReactAlison Unterreiner, DACM, L.Ac.
1 reply 1Is anyone practicing in Knoxville TN or might you know someone great who is? Ideally someone who is great with musculoskeletalissues and/or likes working with performing artists. (It's for an old friend with a neck injury who's a professional violinist/flutist,and this is impeding her ability to play. Her doctor is recommending a fusion but that won't work for her.)Thanks in advance,Sarah P.S. @Alison Unterreiner I see you're in Tennessee. Happen to know anyone there? ReplyAlison Unterreiner, DACM, L.Ac.NewFeb 1ReactHi Sarah,I know Sarah Prater is located in Knoxville. She does womens health and fertility primarily, but as you know that doesn’t mean youcan only do fertility. She also has an associate who looks to specialize in all types of things. You can find more info here:https://www.tennesseereproductiveacupuncture.com/phone/about-us.htmlI hope this is helpful!alisonTolley SinkWhat pattern is this?NewJan 27ReactQuestion for teacherI can't see the forest for the trees here. What formula pattern is this?25 year old female. Large.Main complaints:1. 15 years chronic constipation. bm every 1-4 days day small and dry. once per week watery diarrhea with lwr ab pain. Gas. Wholeabdomen bloating.2. Acne on chin (small red dots)Very thirsty for iced cold drinks. Constant hunger. Hot, sweats easily and profusely. Asthma and allergies (cough, sneezing, SOBw/w heat).Urination is frequent (10 times per day, 4 times per night), incomplete, inhibited.Painful menstruation 10/10 managed with continuous BCPoor night vision, tight muscles everywhere, ticklish, dislikes touch. Lower back pain.Volatile emotions full feelingTongue: red, peeled, scalloped, tenderAbdomen: full, hard, distended, epigastric hardness, double oketsuPulse: thin, weak, rapidMedications: Lexapro, Linzess, Solodyn, Spironolactone, LoestrinDiagnosis: Spleen Yin xu, ST heat, LI stasis, Blood stasis in womb, Liver blood deficiency, damp accumulation in Bladder, allaffecting surface, heart and lungs.A modified Tao He Cheng Qi Tang made her sick - sore throat, nauseous, dizzy, cough and sneezingSharon Weizenbaum,Caroline Radice,Allyson Nevard,Sally
Would love help with this case. If someone is interested I would be more than willing to pay for some one on one time and helpwith this.Thank you!JPEG | 1.1 MIMG-4103 ReplySally NewJan 28 2ReactTolley, I would be happy to help. You can go to my website and signup for a mentoring session.However, quick answer: It soundsto me like your patient is having overflow diarrhea: It happens when watery stool leaks out around hard stool in the rectum. Oftenthese patients need to be very carefully purged, especially with a yin deficient tongue like this one. I have them schedule it on aweekend when they can be home, and maybe think about where she is at in her menstrual cycle also. I ask them to take time toplan it so they stay hydrated, etc. I think THCQT probably was not strong enough, when there is so much blockage and deficiency,so the heat just went right back up. Diet needs to be looked at carefully also. I usually ask for a 3 day food diary. Set realistic goalsfor them to change diet/lifestyle, etc. But with the urination issues, and blood stasis, it would be good to look at the entire casemore thoroughly to understand how to help her once she is purged. On the other hand, sometimes the picture changes afterpurgation.ReplyTolley SinkNewJan 28ReactThank you Sally!Nicole ManiezConfused - 19 yr old Female CrohnsNewJan 27 | EditedReactQuestion for teacher19 yr old femaleI have been treating this patient for about 2 yrs very regularly with acupuncture. At her mom's encouragement, she is often tryingnew modalities and supplements and pharmaceuticals. She was dx with Crohns in Spring 2021. I am very confused about this casebecause she has tried so many things and nothing seems to give her much relief. Below is my attempt to come up with a cleardiagnosis. I would love some feedback and guidance. I am thinking she is Gui Zhi or maybe DGSYS modification?Naomi Frank,Alison Morgan
She first came to clinic with eczema at scalp - pretty much resolvedand swollen lymph at groin - still there but not bothersomeTall and thin to moderate buildSkin is pale(I have a hard time understanding her skin and I feel like it help with diagnosis if I understood it - has surface red marking, like ifyou touch her skin, it reacts immediately with redness on the pale shell)Slight darkness under eyesDefinition at abs and slightly tense on palpationMain complaint:Bloat discomfort cramps after eating that is debilitating T+T NOT HAPPENING, PIVOT BLOCK?Constipation DRY STOOLDifficulty to go bmPain only after eating - right after or within 30 minutesPain lasts up to a few hours or lessLies down with a heating pad for it feel better - COLD AT CENTERWas getting pain at stomach area most recently after taking a very large regiment of supplements from a functional medicinepractitionerThen took reflux rx from western pharmAnd then felt more mild feeling at lower abCan get mild occasional faint metallic taste in mouthCan get little spots of eczema near mouth and back of r ear - very smallDef improved over last yrScalp can be a little itchy at Du 16 areaSwollen lymph at groin is still around - still hasn’t seen OB gyn - DAMPTemp: tend to be cold - def hands and feet - feeling anxious sweats - isn’t aware of cold butt or ab - can feel like whole body is cold- COLD OR YANG NOT MOVING TO EXTREMITIESThirst: always feels thirsty - mouth feels dry - loves to drink water - WATER NOT MOISTENING MOUTHBM: constipated - stool test showed hard stool - not a lot of moisture in it - dependent on eating - can be fluffy diarrhea and thenconstipation - hard and dry - hard to push out - can go often during day - small poops and bigger ones - DRY STOOLUrination: normal -Sleep: can wake up with pain to go pee really bad - happens almost every morning at 8-9amReally deep sleeper - could always sleep longer - sleeps alteast 8-9 hrs - DAMP?Energy: still fatigued with afternoon burnout around 2:30 - can take a nap 3 x a weekPain at ab: sharp stabbing lower and when higher feels like cramping pain - BLD STAG AT LOWER JIAO,Sweat: normal unless anxious - ”smelly nervous sweats” at palms and armpits - SWEAT NOT BEING HELD - YANG OUT OF RIGHTRELATIONSHIP- OPEN AT SURFACEDiet: very limited - many restrictions - no gluten, dairy, grains, low fob map, no sugar, no fish, no uncooked veg, no yeast
Emotions: from taking stelara - can get more anxious - but has had anxiety over past few yearsFeels unmotivated to do stuff - would rather lay down - HEART INVOLVEMENT, DAMP?Menses: every 28 daysPain at LBHas getting hot flashes in morning during menses - DEF SWEATS?Day 1-2 pretty heavy - red3-4 med to lightClots pretty often - dark red - BLD STAGStools are easier to pass with menses - SP QIH/a at temples during menses - TAI YANGSkin breaks out during to after menses - DEF HEAT AT SKIN?Can be easily annoyed, but not too bad - MILD LIV INVOLVEMENTP: dusky to purple - darker - BLD STAGBody is normalSome mild red dotsT: L- weak at HT, Liv thick and strong - LIV - BLD STAGR- thin and bounding back at me - QI XUEAb palpation: tender at stomach for her- lower oketsu pts - kind of tense in general - BLD STAG, GUI ZHI BELLYRx: Stelara for CrohnsHas tried A LOT of modalities and treatments and supplementsIs seeing western and alternative docs.She seems to keep trying different things, so hard to keep track of what is happening in her body.Her mother is very motivated to get her feeling well and continues to seek out new therapies for her.Dx: Water out of right relationshipColdBlood StagnationYang not reaching extremities showing coldBlood stagnation due to damp, blood deficiency, qi not moving correctlySome damp at middle jiaoSally NewJan 28ReactShe sounds like a GZ type with issues with fluids and blood and cold. Your diagnosis makes sense but has left out a few things thatwill help you reach a formula: What organs do you see being involved here? What conformations? Is her abdominal pain cramping
1 reply 11 more comment1Replytype of pain? Is she eating or drinking cold food or beverages? ReplySally NewFeb 2ReactSounds like she may have a glomus with crappy blood. Also, her stool may be backed up. Maybe the digestive stuff in 5 is Liveroveracting on Spleen with Liver blood deficiency leading to blood stasis. Can you think of formulas that might help with the gasand pain? She may need to be purged if there is excess in her lower abdomen and leaking diarrhea around the blockage. Thismust be done very carefully. See Tolley's case... It seems to me that she is a GZ type but in the way that GZ treats the blood in Jueyin. I see Jue Yin and Yang Ming and likely Tai Yin and Shao Yang also.Emily RieffelOngoing gratitude for 2020 COVID teach-inNewJan 25ReactI wanted to let each of you know that I still regularly refer to my notes from the lectures you so generously gave at the start of thispandemic. You continue to help me to center and ground my thinking, again and again, to help many people with a variety ofpattern presentations. In this most recent wave, so many of my patients have needed help!Even though I haven't met any of you in person (yet!), I wanted to let you know of your positive ripples. Thank you, thank you,thank you!Sharon Weizenbaum,Suzanne Connole,Caroline Radice,George Mandler,Allyson Nevard,Candace Jania,Sarah Rivkin,Sally,Jennifer Tongren DrinkerJPEG | 4.8 Kdownload ReplyCandace Jania NewJan 26ReactThank you so much for your kind post! Much appreciated always. ;’) ReplyCaroline Radice NewJan 26ReactWhat a lovely post! I loved doing these both as teacher and student and they kept me sane and looking forward to somethingregularly during quarantine.
3 more comments31 teacher remarkJudith KenenNausea and vomitting in pregnancy Gui Zhi Tang vs BXXXT?NewJan 16React33 yr old woman who is 7 weeks pregnant and having nausea and vomitting. I've been reading Gui Zhi Tang section in the ebookand I'm trying to discern if this would be GZT or BXXXT, or something else.I've worked with her in the past on and off and diagnosed her with BXXXT with other patterns and when I gave her those herbs,her upper GI symptoms improved significantly. But she was inconsisitent with taking the herbs and i'm not sure if the glomus wastotally resolved before she reached out many months later to tell me she was pregnant.This px overall presentation is more deficient. Pulses are deficient, she has blood deficienty, dry sp qi def and upsurging. Notseeing leakage. She is emotionally senstitive and thin skinned, especially durng her PMS time. She has no interest in food or waterand eating makes the symptoms worse. She vomits up yellowish colored fluid (bile?) that comes out and she is constipated. Hertemperatue fluctuates a lot. No obvious sweating. She prefers ice in her water. Ginger helps with symptoms.A few questions:I read in the ebook that if there is any Stomach heat, that GZT is contraindicated. So in this case, since she is craving cold drinkswhich intakes ST heat, I'm thinking that rules out GZT, correct? I'm inclined to think this is more of a Sheng BXXXT because ofworse with food and fluids, and craving cold drinks, but her pulses are so deficient, so I'm hesitant.I'm also having a hard time discerning whether this is digestive upset from upsurging or if this is a glomus. I know a glomus iswhen symptoms are worse when something is added. But there a lot of pregnant women who can't eat without it making themfeel sick or causing heartburn, and I want to make sure I'm not overdiagnosing glomus in these cases. Appreciate any guidance.IJPEG | 59.5 KMaggieSuzanne Connole NewJan 17 1ReactHi. There does indeed seem to be heat around the edges of the tongue and the desire for cold, so given that I would agree thatGui zhi Tang is probably not right for her at this moment. It is confusing though as there are other signs that say Xiao Jian ZhongTang!
1 reply 12 more comments2ReplyAlthough she is deficient, the fact that it is worse with food shows us an excess sign. Does she also feel better after vomiting?Is there a sour taste to the liquid she is vomiting up? I believe this would indicate liver/stomach disharmony You could use huanglian, zi su geng, sheng jiang, keeping the ideas of BXXXT opening through the middle with some liver smoothing. ReplySharon Weizenbaum NewJan 181ReactHi Judith,A few things. 1. what do you mean by constipation? Everyday but dry? Every day but difficult and stuck feeling? Every 4 days?Constipation is a broad term that doesn't tell me enough to respond. GZT does include BS, which is bitter and cold so it is good formild LI stasis. It also treats flushing up which can effect both the st and li.2. She likes ice in her water but is she pathologically thirsty? Is it occasional? Sipping? Does she also like hot tea sometimes? I think,if she is not noticeably thirsty for ice-cold beverages and instead just likes some ice in water but also likes tea and warm drinks,GZT is fine. It is not a hot formula but rather body temperature. I remember, when I was pregnant, that my mouth felt yukky andice water felt good in my mouth but I didn't guzzle it. For a stomach heat diagnosis, this is not enough. You need thirst for coldbeverages.3. vomiting yellow can be that the GB is effected but it may not be a primary GB sign.4. "sweating" and "leakage" have to do with and are symbolic for the surface being open so you don't have to see actual sweating.For glomus, she would have a full uncomfortable feeling after not eating much.To me, her tongue looks a bit dusky and wet. For the wet, increase the SJ in the GZT. The wetness would make XJZT difficult to takein. I wonder about GZT + Dang Gui San with the wetness, duskiness and red sides but the pulses would tell. I wonder about herpulses?YanaUpper cold lower heatNewJan 13 | EditedReact78 yo female (Indian)CC: severe cold in the head & upper back for 15 years. Always wears a toque and a couple of scarfs. At night sleeps with 3 blanketsover her head. On the touch it's not cold, only the lower part of the face is sl. cooler. When it's very cold, then she has sharpstabbing occipital & temporal pain, better with heat. Left side ribcage also feels cold. Most likely started after a period of stress(family lost their business)Severe burning sensation in the lower legs for 1.5 years. She has to walk barefoot at home even in winter.Also ST ulcer diagnosed for 6 years. Burning, reflux, pain when drinks warm tea. Avoids spicy since the diagnosis.Sjogren syndrome for 6 yearsMild diabetes (on metformin)Mild arthritisLots of spider veins on yang aspect of the legs, esp. right one
5 more comments 5Bad shallow sleep (takes a pill)Always worries and has obsessive thinkingConstipation for 15 years, hard to push & dry (takes senna)Urgent urinationTinnitusTongue pink, some small cracks in the middle, dark spots in LJ, thin white tcPulse strong wiryWhat if I start with a modification of Cheng Qi Tang/Qing Wei San/Sha Shen Mai Men Dong Tang. The patient herself said that if Ican make her ST feel better, then her feet would burn less.But what is it? Some kind of severe qi stagnation in MJ that blocks cold-heat dynamic? Then why doesn't she have symptoms ofmalnourishment of the brain or some severe thyroid problem? In 15 years it seems to have only affected her ST and LU at thelevel of body fluids.ReplyMargaret Sikowitz NewJan 13ReactVery interesting case - and sure seems like you're on to something with the stagnation.Surely she has poor circulation so this will be key in your treatment strategy.You've included a few formulas but I don't think she's a good candidate for a Da Huang based formula(s) w/her poordigestion/fluid metabolism (constipation/urgent urination). Qing Wei San: does she have fire in her middle jiao? Sha Shen Mai MenDong - a very different approach from the others. Seems like honing in on her diagnosis will be very helpful.Maybe try to zoom out, (I make a lot of lists - Symptom X due to cold, Symptom Y due to dryness, etc. and that helps clarify things.Hope this helps, good luckReplyYanaNewJan 13ReactShe has a ST ulcer. For me it looks like fire.I'm a beginner in herbs, so I'm thinking in simple strategies now. Just wanted to make sure that I understood it correctly as a heatstagnation/bind in MJ that cannot unbind and allow heat to go up and return into the normal qi dynamic.
6 more comments6Alison MorganSoftwareNewJan 12ReactHello!This is a very boring question. I am looking for new software, specifically one that offers scheduling (including a widget to put onmy website), inventory, insurance verification and billing. Currently I am looking at AcuVine and AcuSimple, any recommendationsGREATLY appreciated.Alison ReplyMargaret Sikowitz NewJan 13ReactI use Unified Practice - pros and cons.Pro: all things scheduling, INCLUDING the scheduling widget (on my website, easy to include in emails, posts); I do not think thereis an insurance verification but I'm not sure. V easy to generate superbills, invoices, and inventory is as smart as the data youinput.Con - requires two devices, laptop and iPad (laptop=admin/scheduling, invoicing iPad= clinical input). I loved the bells and whistlesthat the iPad offered at the outset, but now feel like the two device thing is a burden and just end up writing notes on computer,so I am definitely not using it to its maximum capacity.Good luck ReplySally NewJan 15ReactUnified Practice does offer insurance verification. I'm not sure if there are other options, but I use Office Ally, which works great. Iagree with Margaret above about pros and cons. If you've been practicing for awhile, you will likely find your own way but I alwaysfeel I don't use it's full potential.Rebecca ParkerAdvice on transitional doctorateNewJan 8ReactWise ones, I need some counsel. Over the summer it seemed like a great idea to go back to school after 12 years and get mydoctorate, so I enrolled in PCOM's transitional doctorate and took a one credit class to get a taste for it. It felt good to push out ofmy comfort zone, and it was interesting and entertaining. So I enrolled in a 3 credit class for the winter. I just had my first classtoday, and I was so very bored, despite the fact that I'm interested in the subject of the class (learning to interpret lab reports) andfeel daunted by all the busy-work assignments and the amount of effort it takes to appear engaged. I'm considering either
1 reply 11 reply 110 more comments10dropping the idea of getting a doctorate altogether, or switching to an asynchronous program like WON or 5Branches. Are thereany of you who have been through a doctoral completion program who can share their experience from the other side (ormiddle)? Many thanks for sharing any and all perspectives.ReplyCaroline Radice NewJan 9ReactHi Rebecca! Happy New Year and hope you are well.As a long time prof at PCHS (formerly known as PCOM) I was in the inaugural cohort for this program 7 (?) years ago with the restof the faculty there who had to both be qualified and beta test the program. I know it has changed a lot since then, so I may not bethe best to speak on its current iteration, but I know the basic requirements haven't changed much, even if the course content andinstructors may have.My question for you is: what was your motivation in seeking out this degree? If you are planning on being an academic, working ina hospital or other integrated setting, or publishing, it will serve you well having a Doctorate. Short of that, I see no purpose in thisdegree, particularly at PCHS. There is NO Chinese Medicine in the tDACM as that is assumed to have been covered in yourMaster's program. It mainly has the requirements that will enable you to work alongside other health care professionals andinterpret labs/studies etc.It is also geared to new practitioners, so if you have been practicing awhile, there is nothing that you will gain from doing this. Itdid not change my practice one iota, but as an academic, it was necessary.I would recommend you contact Suzanne Connole or Marnae Ergil about Won as they both teach there, even if not in the Doctoralprogram. I can't seem to tag them here, but they will be in the WPC email list.Best of luck whatever you do!ReplyCandace Jania NewJan 9 1ReactHi @Rebecca ParkerI had your same doubts about the PCOM program. Last May I completed my doctorate at ACTCM. I chose that one for 2 reasons-one it was asynchronous and 2 it had more TCM than any other program. I would checkout their curriculum. It was heavily basedin research but I ended up getting my case study published in the Journal of Chinese Medicine. I highly recommend the program.Rebecca ParkerYanaFrequent urination and blood pressure medicationsNewJan 7 | EditedReactThat's a personal case for a dear family member.Female patient of 62yo complains of frequent incomplete urination when she goes to bed (before sleeping) and then in the morning upon waking. Not everyday, but often. Nocturia sometimes 1x/night. Lab tests are fine.She also has a blood deficiency & LV qi stagnation constitution and an early menopause about 20 years ago due to hysterectomy and ovariectomy.Runs hot, sweats, both spontaneous & at nightLike warm drinks but has no thirstAlternating constipation & loose stool, the latter recently better with some grapefruit seed based supplements
Sleep shallow, hard to fall asleep, vivid disturbing dreams.Sadness, worryJoints & back aching if not stretching dailyBeginning of a cataractLast week she got a flu, so in addition to it she also has cough with phlegm & low energyShe's been 2 years off HRT (had severe menopause), and is now taking 3 different types of anti-high blood pressure medications at minimal dosages (beta-blocker, Ca channel blocker, angiotensin receptor blocker) and a statin. Her blood pressure is not often stable, can sometimes jump from high to low, andthere are some problems of ht rhythm.In my understanding, the frequent urination is caused by the drugs.A big limitation, this patient lives in a country where only patented pills are available. No granules, no raw herbs (unless ordered from Ali from unidentifiedsources). Here's the list from their local TCM pharmacy that I can choose from:https://docs.google.com/spreadsheets/d/1T3jMxYfuJeXlfftMnE3tqY17jY7ffStytkqysobYVK8/edit?usp=sharing (not all of them are available though)So I have a couple of questions here.1. These 4 drugs are 4 unknown variables for me here. They're doing something useful, but they're causing a problem in an unclear way. I need someguidance of a more experienced practitioner to navigate here. I want to give her a KD / blood tonic & something to move qi & clear heat, but I'm concernedthat will go against what the drugs are doing.2. Should I be concerned with presence of gancao in the pills? If the herbs fix a part of the problem that the drugs are fixing, then some reduction in drugactive ingredient would be appropriate?I'm thinking of these ones:Jin Suo Gu Jing WanQi Ju Di Huang WanJia Wei Xiao Yao SanSharon Yeung NewJan 7ReactHi Yana,Did the frequent urination begin shortly after starting the blood pressure medication? If that is the case then one could potentiallyconclude that it is related to the medication. I would try to get more information about this.From your description, it doesn't sound like the urination is regularly waking her up at night but rather seems more spasmatic innature since it strikes frequently and incompletely just before bed and upon waking up. If she also presents with blood deficiency,a formulation that helps to address muscle spasms is Shao Yao Gan Cao Tang. This mini formula is part of Gui Zhi jia Long Gu MuLi Tang. Given some of her other symptoms, this may be an effective formula as long as you increase the gan cao and used thehoney-fried version.There is also an opportunity to address the symptoms associated with HBP to see if she could reduce some of these meds. What isher experience of it other than the blood pressure readings? When it jumps from high to low, does she present with anysymptoms? Are there any blood stasis signs? Does she feel stuck in any particular areas of her body?It sounds like there may be a few issues with the fact that she is not local to you. There are pharmacies that can send customherbal formulas anywhere in the world--for a cost. If you would like to focus on a custom formula I wouldn't rule this out,especially if you are feeling constrained by what is available by the local pharmacies and also if you are not familiar with the brandof herbs they carry and their GMP compliance (Good Manufacturing Practice). The wait time from prescription to receiving herbscan be an issue, however, especially when you are trying to treat more acute symptoms, like the residual flu symptoms.In general, I find that if you treat what you see, you can safely prescribe herbs alongside blood pressure medication as long asyour dosages are not too unusual. Subhuti Dharmananda writes about this in this article regarding herb safety and hypertension.(link below)In regards to your question about gan cao in patent formulas, there seems to be little evidence to show it adversely increasingblood pressure when used in common dosages. Subhuti writes:"In a review of published reports on licorice (7), it was observed that: "for the most sensitive individuals a regular daily intake of nomore than about 100 mg glycyrrhizic acid seems to be enough to produce adverse effects. Most individuals who consume 400 mgglycyrrhizic acid daily experience adverse effects. Considering that a regular intake of 100 mg glycyrrhizic acid/day is the lowest-observed-adverse-effect level and using a safety factor of 10, a daily intake of 10 mg glycyrrhizic acid would represent a safe dosefor most healthy adults."So, there is a consensus that about 10-12 mg/day of glycyrrhizic acid should be safe for everyone (even those who might besensitive to licorice effects) and that for most others, a safe level would be about 40-50 mg/day to avoid any blood pressureeffects, with 100 mg (75-120 mg/day) having minimal effects that may barely be measurable. Licorice roots can have variable levelsof GA, with typical figures in the range of 4% for Glycyrrhiza glabra (the Western licorice). If one uses a figure of 50 mg GA as amaximum allowable amount based on the above estimates, regular ingestion of licorice would be limited to about 2 grams perday. Higher dose licorice preparations might be used for a maximum period of 10 days."http://www.itmonline.org/arts/hypertension.htm Embedded File.
1 more comment 1Replyhttp://www.itmonline.org/arts/hypertension.htmReplyYanaNewJan 7ReactThanks for your input. That's really reassuring. I've been a little cautious with gancao after my pharmacology course when ourteacher warned us that it reduced the amount of medication in the blood.This patient is all about biomed and agrees to try CM just because it's a family member. She's unlikely to change anything in hercurrent medications, as she believes more her GP than me. So I'm a kind of a supplement, :-)) I need to go around what's there.I thought about ordering loose herbs from Aliexpress for her, but the sources there are unidentified and they usually sell fixedamounts (like 100-200-500 g), and I have some doubts that she will agree to carefully measure all of them to get proper dosagesand decoct as I instruct. There is also a risk of not finding all the herbs. For example, there is no zhi gan cao. And gan cao is soldonly as an extract.If sending overseas, there is an option to prepare a granulated formula by myself, but it would take more than a month to getthere with standard post, or if I need to get it there next week, then it'll be close to 200$ in shipping.I got her tongue pics, but the coating might be influenced by the recent flu, she hasn't yet recovered from it completely.PNG | 59.4 KScreen Shot 2022-01-07 at 1…PNG | 53.2 KScreen Shot 2022-01-07 at 1…Sarah Rivkin NCCAOM safety CEUNewJan 5 | EditedReactAre there any upcoming courses on WP that would fulfill my one outstanding safety CEU I need for NCCAOM recertification? (Lastcycle I took Claudia's excellent safety and ethics course on Pro-D, which I'd highly recommend to others, but I don't think I canrepeat that.)Thanks and Happy New Year,SarahSharon Weizenbaum,Claudia Citkovitz
1 reply 1 ReplyCaroline Radice NewJan 9 1ReactThis is actually a great idea as so many people are always struggling to find a class to fulfill this when recertification time comesaround! You've inspired me to write one, but not likely for a few months (sorry!) so not sure that will fulfill your time sensitiverequest!ReplyMargaret Sikowitz NewJan 13ReactOOOh yes please! (And, some nuggets from Sharon's pre-eclampsia lecture might be quite germane).Tolley SinkFertility CaseNewJan 3ReactQuestion for teacherHi all!I've been working with this patient for 6 months and feel like I am spinning my wheels a bit so I am hoping to get some insight onwhat I am missing either in diagnosis and/ or treatment.Patient is 37 years old trying to conceive for 1 year. She has a sunken, hiding, hunched over, weighed down and scared look abouther wth darkness around her eyes but physically seems robust.Hx: She was quite ill in her teens and 20s with joint pain, weight loss, fatigue, hair loss, abdominal pain, vomiting and constipationlater diagnosed with a parasite infection.Menses: Had one pregnancy terminated 5 years ago. Cycle is 25-28 days with one day of very heavy bleeding, some minor cramps,clots and dark blood. Premenstrual fatigue, emotional sensitivity, irritability and tender swollen breasts. Legs are achy and weakwith menses.Body: Has fingernail ridges, dry skin. Tends to cold. Strong aversion to wind. Face gets red when hot. Has a feeling that the life isvery overstimulating outside of being in the wilderness. Low back, neck, shoulders and jaw are tight. Tight muscles worse withnight shades.Fluids: Thirst and urination are normal.Digestion and appetite are good. Occasional (2 x month) low grade nausea.Sleep/ emotions: Insomnia b/w gabapentin, worse with stress. Has high sensitivity to sound that started after car accident/ headinjury 12 years ago. Depression/ anxiety - feels vulnerable, unprotected, sad, fearful, sensitive and irritable all worse with stress,mid cycle and premenstrually.Tongue: pale, scalloped, red dots front, pancake shape(the tongue picture shows up much darker on my computer than in person)Pulse: Flooding, fast, floating, wiry, fullAbdomen: tight rectusDiagnosis: Crappy liver blood, spleen deficiency, depressive heatTreatment so far (granulars 9 grams per day)1. Gui Zhi Long Mu Li Tang with carbonized Long Gu and Mu Li + Dan Shen for 3 weeks (she started out with emotions as #1complaint and showed some KD def and more blood stasis) - this formula really helped with her spirit and abdominal KD signsand blood stasis signs improved.Sharon Weizenbaum,Suzanne Connole,Caroline Radice,Allyson Nevard,Candace Jania,Sally
2. Gui Zhi Jia Fu Zi Tang + Xu Duan for 3 weeks- felt good but no change in cycle or getting pregnant3. Xue Fu Zhu Tang + Gui Zhi Tang Day 1-14 and Wen Jing Tang day 14-28 for 5 weeks (improvement in mood, less heavy bleeding,improved abdominal signs but no pregnancy)4. Gui Zhi Tang with Dang Gui (12), Mu Dan Pi (3), Ba Ji Tian (9) for 1 week - tongue improved a lot, emotions good but had morecramping and clots with period5. Si Ni San with Sheng Di and Dang Gui for 2 weeks - mood and insomnia worsened (had some stressful life events as well).Appetite increased, ovulated closer to mid cycle.6. Went back to Gui Zhi Tang with DG, MDP and BJT for 2 weeks - mood and sleep improved, cramps and clots with period.Am I changing things too much? Too quickly? I think I have a tendency to do that when I don't see immediate results. Would loveyour help please. Thank you!!!JPEG | 1.2 MIMG-0539Suzanne Connole NewJan 3 1ReactHi. I can see based on your notes that Gui Zhi formulas overall seem to help in a lot of ways, but not the blood stasis. My initialthoughts are go back to the Wen Jing Tang idea. It is a Gui Zhi based formula that treats cold and crappy blood. The pattern for thisformula includes deficiency heat signs in the upper jiao that you see in her cheeks and her tongue. There is not much coat on thistongue and it is rather thin so that supports the deficiency of the yin aspect.Her tightness on her abdomen and back/neck seem to me to be deficiency in nature so you can include the ideas of Shao yao gancao to ease the musculature a bit and the Gui Zhi Tang combo in this formula may help firm up the exterior so that she is notholding so tightly in a protective way.You can add some kidney herbs to this formula easily. I like Tu Si Zi and Du zhong as they are not overly hot and very supportive.Be care ful with the dose of Wu Zhu yu. I usually use not more than 3gLet me know if this makes sense as a next step. You are very close to the right combo, jsut go back and review what got better andwhat got worse and you will see the Wen jing tang idea there I think.Fertility is hard because we have to wait a month to see the true result. If you see other peripheral signs and symptoms gettingbetter and blood quality and quantity improves, anxiety lessoning, stay the course!
1 reply 11 reply 15 more comments5 Reply ReplyAllyson NevardNewJan 3ReactHi Talia. Are those pulse qualities in all the positions? Is it flooding fast and full everywhere?Adina KletzelActive bleeding in Colitis CaseNewDec 30, 2021ReactQuestion for teacherCase25 year old womanMarried with 5 month old babyMain Complaint: ulcerative colitis with active chronic bleedingInflammation from anus up 5 cm into the sigmoid colonHas bleeding with every stool – either before or after stoolBleeding if pass gasBlood can be bright red of mucusy and brownishCan also be thicker and more slimyStool is sometimes diarrhea and sometimes softVery often has stomach pain, both above and below the umbilicusSometime is tight constricting pain and sometimes it is a cramping pain feeling (like labro pains)Sometimes pain comes with nauseaTenesmus – feeling that s/t is still stuck in LI that she wants to get outSymptoms started 2 and a half years ago after she got engagedHad issue with a friend where she thought she was going to take her fiancé awayFelt jealousy, rage, and disappointment
Had active symptoms for 6 months then went on steroids and went into remission for a year (was able to stop steroids) thenduring pregnancy had to run to a shelter because of rocket attack and got very scared and symptoms started again. Have beenactive since May.Was hospitalized while pregnant, got bacteria, went on antibiotics and now feels like she is contaminated from the bacteria and isOCD about washing hands and disinfecting cuz scared will get bacteria again.Had emergency C-section in July and is currently exclusively breast feeding her baby.She is very thin and narrow with stick like arms and legs.Sallow complexion.Has a ravenous appetite but strictly limits diet to try and control symptoms.Hears bubbly sounds in stomachIs thirsty but don’t drink enoughDrinking too much can cause stomach acheDrinking cold causes stomach acheEmotions: Fearful, OCD, anxietyDepressed, does not want to be aloneCan get angry and snappyOn birth-controlBody temp: not too hot or coldPhlegm in throat – she says from change of weatherHair falling outMesturatinRight now on birth controlWhen had period got period painsFeels tight in lower abdomenScar from C section is numbTightness in vaginal areaSexual intercourse is painfulDry in vaginaRestless sleepPulseGuan – wiry both sides, but on weaker sideLeft side cun -thin and floatingAbdBowtie
Pulsations in lower abdomenNot a lot of flesh, on tighter sideTongueMinor teethmarksPuffy in MW and UWPinkish color and a bit purplyRed tipDiagnosisSP qi defKid qi defLiver blood defBlood stasis in uterusLI stasisHeart affectedSome liver qi stgI would first like to stop the bleedingAnd then strengthen the spleen and blood and calm the shenI think the bleeding is coming from Sp qi def. and liver blood def.Shen ling bai zhu san + shao yao gan cao tang + tonify blood + stop bleeding herbsRen shen 10Chao bai zhu 10Fu ling 9Zhi gan cao 6Shan yao 12Bai bian dou 6Lian zi 9Sha ren 6Jie geng 5Chao bai shao 12Dang gui 10Di yu 10Ce bai ye 10Mu xiang 9Zhi ke 9
Yan hu suo 10I have not treated colitis with herbs before and soMy question is – she does not have diarrhea every day. On many days she has softer stool but she always has significant bleedingwhich can drip out even without stool.Is this the best way to start off in terms of stopping bleeding?She has a lot of tightness in the lower warmer with wiry pulses and so I thought maybe to use si ni san but was concerned with toomuch movement to start with.Other thoughts were bu Zhong yi qi tang and maybe even gui pi tang because of all of the fear and anxiety and add more stopbleeding herbs.I would love some input to know if I am on the right track here.Thanks.JPEG | 270.6 Kpenina tng ReplySally NewJan 2 | EditedReactIt sounds like she could have hemorrhoids and/or anal fissures as well as colitis. Has she been examined? I think the SYGCT isgood and I wonder adding some E jiao if possible or Ji xue tang to nourish and move blood or San qi and Pu huang tan to moveblood and stop bleeding as there seems to be alot of stasis as well as deficiency. ReplyMaryanne Travaglione NewJan 2ReactYou are correct in prioritizing to stop bleeding and then to soothe the Liver and calm the Shen. You did not say how many bags ofherbs she has taken and how she has she responded to your formula.
YanaBreast lumps case in Tian Hua Fen ebookNewDec 27, 2021ReactIn Tian Hua Fen ebook there is a case about breast lumps (page 38).The herbs used there are Chai Hu, Gui Zhi, Gan Jiang, Tian Hua Fen, Huang Qin, Mu Li, Zhi Gan Cao.I'm wondering about the role of Gui Zhi, Gan Jiang vs Huang Qin here. The hot and cold, are they here to reestablish the dynamicof qi?I have a patient now with a breast lumps (fibroadenomas + fluid-filled cysts), severe breast distension from ovulation to periodand some heat signs (+ history of breast cancer in her mom and grand-mom). The pulse is deficient, the tongue is reddish withslightly thick yellowish coating. Would the above formula be too hot for her?I'm thinking about modifying Jia Wei Xiao Yao San with Wang Bu Liu Xing, Lu Lu Tong, Xiang Fu, Zhe Bei Mu or Shi Jue Ming. Whatdo you think? ReplySuzanne Connole NewJan 3ReactHi. I am going to go and read that case today and come back here later. But the formula used there is Chai Hu Gui Zhi Gan JiangTang, which does not seem like the right formula for your case based on what you mention. CHGZGJT is a mixed pattern whereyou see Chai hu/Shao yang symptoms with a messy middle jiao situation of stomach dryness/heat and spleen cold deficiency. Themessy fluid situation in the middle jiao warrants the use of the chalky herbs in that formula. Your case seems more like there isfluid accumulation but not dryness or damage to fluids.I have treated a lot of breast lumps with the type of formula you mention adn that approach seems better suited to your patient.Basically a chai hu based formula, either JWXYS or Xiao Chai Hu Tang as a base with breast directing herbs and nodule herbs.Sharon has some really good notes on the idea of Opening through lecture using Ji Mai San as a modular formula. I think there is apost on the White Pine Blog about this formula as well. I can gather a little more for you later as well.Judith KenenLong CovidDec 15, 2021ReactQuestion for teacherI've been working with a 25 yo female for a few months. She got sick with Covid in July and has continued to have symptoms.Matte complexion, warm manner.Primary sympmtoms:HeadachePressure and Burning feeling in sinusesEars clogged and pop like on airplaneFatigue (comes and goes) though though always someFeverish (comes and goes)Body aches (comes and goes)InsomniaNightsweats
Preexisting SX:Loose and frequent stoolLower abdomen bloating, b/w heatThirst and frequent urination (dispersive thirst)AnxietyTight shouldersMild allergies- runny nose and congestionHeadaches w/w dryingessBlood def symptomsTendency towards coldTongue:mild tooth markspeeled patch (es) sometimes there is just 1, sometimes 2DX: Sp qi, Lr Blood xu, p/p wind, cold, dry, troubling absorbing fluids w/the beginnings of fluid damageTaiyang, Taiyin, Jueyin, unsure about Shaoyang. Don't see a lot of excess but because of her age and the way that the symptomsget better and worse, want to keep it in mine.I tried several variations of Gui Zhi jia Ge Gen Tang w/ different combinations of additions such as Fang Feng, Bai Zhi, Shan yao,Dang Shen, Chao Bai Zhu, Mu Li, Long gu, Rou Gui, Sometimes she seems to be better but then will start to feel worse again on thesame formula. Bowels and lower abdominal pain improved when I added Bai zhu.So I changed her to Chai Hu Gui Zhi Gan Jiang TAng, w/ 15 Ge Gen instead of THF, and 24 Chai Hu and 15 Mu Li. First week sheseemed much better, headache signifciantly reduced and energy much better, bowels back to being loose. But this past week,fatigue, body aches, feverishness worse again.Would love any suggestions. Thank you.
JPEG | 73.7 KIMG_0504JPEG | 104.1 KIMG_0505 ReplySuzanne Connole NewJan 3ReactHi Judith. Hoping some other teachers chime in here and sorry for the delay over the holiday weeks! In reading your case it seemsthat CHGZGJ is the perfect formula based on the fever pattern, the ear involvement (Shao yang) thirst and middle jiao damage.Did the loose stool improve with the Ge gen change and then get worse again? Did thirst improve?I would want to add maybe Bai zhu and Shan yao to increase the spleen portion of the formula and also split using both tian huafen and ge gen to address the Taiyang aspect of body aches and the fluids (Yangming/Taiyin) ReplyMaryanne Travaglione NewJan 5ReactHi Judithany update on this patient? You had a sound approach and wonder what you saw as a follow up. Looking at your case I do wonderif when she started to improve did she resume prior activity? I have often seen folks to soon return to activity just when they needa few days to restore Qi that had been compromised.Emma Mezher Neck Pain and MigrainesDec 14, 2021 | EditedReactHello-I would love some help with this case. I've made some progress, but not with her chief complaint of neck pain.CC: neck pain & migraines31 year old with perky 'can-do' attitude and flushed cheeks has had neck pain precisely at GB20 on the right side and migraines'for as long as she can remember'. The neck pain got worse 3 months ago and is now a daily with dull ache, worse when she'stired. Migraines occur every other day and never happen independently of the neck pain. No nausea or aura.Generalized body aches, worse in damp weathermid to low back and hip achy pain since childbirth 8 months agoFrequent hot flashes happen during the day without sweat. Hard for her to work up a sweat.Thirst for cold drinksDry mouth, eyes, lips
Hard to fall asleep and stay asleep (not related to her infant)Stress 7/10 related to her health and pain levelExtreme fatigueHistory of low blood pressure, lightheadedness twice weekly since childbirthMenses: 28 day cycle, 7 days of bleeding with small clots, no PMSNo digestive issues but appetite is low, no issues with bowel movements or urination.Pulse: choppyTongue: swollen, pale dusky, sublingual distention**Abdomen: lax abdomen, midline drop, R side oketsuDiagnosis: crappy blood, kidney deficiency, damp stagnation ( I also think there is liver blood deficiency, but this is only based onthe sides of the tongue)Formulas: I initially gave her Xue Fu Zhu Yu Tang (9g/day granules) and many things improved significantly initially, but are nowback: headaches were significantly reduced for several weeks but are now every other day again. Body aches, sleep and hotflashes are better/reduced. Lightheadedness is gone.Pulse now: deep, soggy, weak on whole left side especially guan positionTongue now: less dusky, pale sides, slippery white coat in back, red tip reduced sublingual distentionmost recent formula: Jin Gui Shen Qi Wan x chuan xiongThis formula seems too general. I also thought of DGSYS, but am not sure how to modify it so it could also help her neck pain. Iruled out a gui zhi formula because she doesn't sweat and her pulse is deep.Below are most recent tongue pictures, which don't capture the dusky colour.
2 teacher remarks1 reply1 reply 1JPEG | 1.1 MAH1JPEG | 1.5 MAH ReplyMaryanne Travaglione Dec 15, 2021ReactAlong with choosing a formula I want to be certain that you checked her neck to rule out a subluxation, not uncommon followingchildbirth or affecting new moms that are breast or bottle feeding while cradling their growing babes. This might be resolved withacupuncture, gua sha or moxa. ReplyCandace Jania NewJan 9React@Emma MezherWithout doing your diagnosis/assuming it is correct, your past prescriptions don’t seem to be addressing the damp stagnation,which could be contributing. Also if the headaches are w/w fatigue, how can you help her fatigue? Is it the damp stagnation that iscausing the fatigue? Why can’t she access her energy? If you can discern that, it would seem that the headaches would improve aswell. Looking at her tongue, there is a lot of heat in the upper jiao. Is there a blockage in a pivot, yangming? Just some thoughts tohelp you think about what is going on.Additionally, adding guiding herbs to whatever formula works will help to hone it to the area of concern, like Qiang huo and chuanxiong.Hope this helps.Emma MezherYanaHow popular are Chinese herbs?Dec 12, 2021ReactI'm a new graduate from a TCM herbs program and haven't yet started actively prescribing. In the 2 weeks since I got my license Ioffered herbs to some of the patients, but they declined. The last 3 years I've been actively reading TCM groups of FB, watchingvideos by TCM people and in generally I'm immersed in the subject and I've been sure that herbs are quite popular.A friend who studies in a TCM school right now is questioning if she should study herbs too. She asked people around her andeverybody told her that herbs are generally quite unpopular and Chinese herbs are even more unpopular because of the stigmaof protected animal substances and unknown exotic names. According to them, people would rather take herbs that they knowthe names of. She's leaning towards an additional diploma in Western herbology for this reason.Now when I'm thinking about all my efforts in popularization of Chinese medicine in my local non-TCM groups in order to getmore clients to our school clinic, I realize that indeed public has no idea about herbs. And for many, even acupuncture is in thesame box with leech medicine in terms of "what doctor will I go to see if I have a medical problem"?
4 earlier comments 11 reply 16 more comments6From your experience, what part do the herbs take in your practice? ReplyJoy BlaisNewDec 16, 2021ReactYou mention that your friend is considering skipping Chinese herbal study for Western herbology. I think it’s worth considering thepros & cons of this choice. While it’s true that many people feel more comfortable taking Western herbs (or nutraceuticals) as theyseem “more familiar”, they function in many regards as single remedies. In a sense, it is like prescribing a drug for a symptom, onlyit is an herb for a symptom instead. This is of course a generalization about Western herbology, but it is essentially how I see mostpeople utilizing the benefits of Western herbs in my opinion. It’s not that there is anything wrong with that approach, it just that ithas its limitations.I really appreciate that Chinese prescriptions (especially classical ones) are quite elegant & nuanced. Their effective use requireslooking deeper into the dysfunction of the body and knowing how the herbs work with each other in the formula. For me, Chineseherbology goes far beyond a simple symptom to herb approach, and gives the opportunity to restore function in a way that is justvery different than the Western approach. You may have to invest a bit more study into Chinese physiology to use themeffectively, but I think it’s worth it.ReplyBrian LangstonNewDec 16, 2021ReactHi Yana. I am an Herbalist and not an Acupuncturist. I studied in a clinical setting with a mentor who had studied Western Herbsfirst, and chose to learn Chinese Herbal medicine because she was not getting a good enough response with clients with WesternHerbs. She also studied Ayurveda in order to help people with better food choices for their constitution.This was 7 years ago andthe main reason I chose her to train with is I was seeking help with Crohn's as well as life long allergy, asthma & eczema issues. Iasked many practitioners at a Western Herbalist conference if they could help me and they all said no. So, when she said yes, sodid I.Now, I am part of a wonderful family at White Pines institute, where I am expanding my knowledge of herbs and Chinese medicinetremendously. I keep saying to myself and online here, that I am amazed that I have been able to help so many people withChinese herbal medicine, because what I am learning has enhanced my knowledge tremendously.Personally, I have reduced my lifelong allergies, asthma and eczema to a minimal degree, and do not take any western medicinefor the Crohn's nor most other health issues. I have helped all ages of people with many health issues from insomnia, nightsweats, anxiety, skin issues, digestive issues, and more. It has been my understanding that acupuncture was to support the herbs (I may be wrong) and that here in America, acupuncture predominates and herbs are considered an option with some. Whichseems like where you are coming from.I have had many experiences with acupuncture for a variety of issues and in my humble opinion, herbs seem to have a fasterlonger lasting effect for many of the issues I have addressed. I also see a massage therapist and chiropractor as needed and theyall have there areas of expertise that help me address any unwanted symptoms.Congratulations and best wishes on your journey.BrianJoy BlaisSt. Louis, MO provider who accepts veterans insurance?NewDec 04, 2021 | EditedReactI have a VA/TriWest patient who is moving to St. Louis, Missouri. Would love a good referral for him for chronic pain issues.Thanks!
1 reply 1ReplyMarnae Ergil NewDec 07, 2021ReactNot sure about VA benefits, but my 2 St. Louis recommendations are Afua Bromley and Michael Max.3 earlier comments 1 teacher remarkAnni EllistonDec Free Lectures Month - yay!Nov 23, 2021I agree 3Just wanted to say I'm so excited about the open access to the lectures of 2021 next month! There were a couple (Chai Hu Gui ZhiGan Jiang Tang and Ling Gui Zhu Gan Tang are two that come to mind!) that I was sad to have missed! Looking forward tobrowsing for more as well. Thank you! ReplyMargaret Sikowitz NewDec 09, 2021ReactAgree! SO many to go through - kid in candy store. ReplyNan BakamjianNewJan 10ReactAgreed! So much great info to take in and absorb (my spleen qi needs to stay in good shape for all of this)!
10 earlier comments 3 2 teacher remarks1 reply 11 reply 1Alan JanssonIs Classical Acupuncture Diagnosis and Treatment relevant for this Forum?Nov 09, 2021ReactAllo from the land down under,As Mick Jagger once famously sang, "Please allow me to introduce myself."My speciality if I have one, is the treatment of patients suffering from Viral and Post - Viral conditions using exclusively ClassicalJapanese Acupuncture and Moxibustion.I have successfully treated many elite sports people suffering from so called Chronic Fatigue Syndrome and patients sufferingfrom various blood born viral conditions including mosquito transmitted, Malaria, Ross River Fever, Dengue Fever and BarmahForest Fever.I have also had experience treating patients suffering from Mononucleosis and Varicella.I have previously worked with a number of Olympians and Elite Sportspersons in a performance enhancing capacity.I have maintained a general practice for 38 years including the treatment of children and patients suffering from Musculoskeletal,Neural pain, Insomnia, Anxiety and Headache.Since I have never prescribed herbs, I am unsure how clinically relevant my posts might be for members?Your thoughts and feedback would be greatly appreciated.Thank you for your commitment to excellence in practice.All the best,Alan J. ReplySuzanne Connole NewDec 06, 2021ReactHi all. Just and FYI the White Pine Circle is in constant evolution so where there is a desire for a different forum or different courseofferings we are open to ideas and discussion. Decisions for the circle are made by a board of practitioners and we meet regularlyto discuss the direction for the Circle. So yes, we will have more acupuncture discussions and course offerings and look forward toit! ReplyEmma Mezher NewDec 14, 2021 | EditedReactI would be very interested in what you have to say, Alan, and really like the idea of an Acupuncture board!
4 earlier commentsAnn ClearyED and Tinnitus from Long CovidNov 08, 2021ReactI have a male patient suffering from ED and tinnitus due to long covid. He had covid in March of 2020, completely recovered, andthen a month later started experiencing long covid.This is his clinical picture from when he started treatment mid October:Cold toes and fingers, can also get numb when cold, can get very hot at night so sleeps naked.Occasional night sweats, normal sweating throughout the day.Drinks a lot of water because it helps with his "acne' (small pimples near mouth under his mask. Seems that thirst is normal though he pushes fluids.Water runs right through him.Appetite normal, h/o constipation since a small child. Usually no urge with stuck feeling in lower abdomen, sometimes difficult to start.Recent insomnia.Negative outlook.Rigorous exercise routine is still inhibited by SOB during anaerobic exercise (i think this means burpees, can still not do as many as before he got sick.)Recently had an intense dizzy spell from pushing too hard during a training session.Tnnitus is worse on the left side: two tones, high pitch and low chirping sound.ED is lack of firmness during sex, also does not last. Better with Viagra. Decrease in libido. Also has a small hydrocele and a varicocele left testicle, left testicaldiscomfort; dull pain that can radiate down into left testicle. During orgasm feels his left testicle retract differently than the right. Wife is currently pregnant sothis seemingly did not affect fertility.Palpation revealed tender epigastrium and costal margins, worse on left, positive oketsu, dry heels, v slightly empty low abdomen, tender sp 9tongue was moist, teethmarks, thin white coat, pink with orangeish hueLeft pulse: wiry, full, moderate speed, cun floating, guan and chi raised Right pulse: wiry, guan empty at root I diagnosed him with liver qi constraint, mild kidney yang xu, blood and fluids not harmonized, blood stasis secondary to liver qi constraint, sp qi xu, liverblood xu, yang not anchored He has been taking chai hu long gu mu li tang with dang gui shao yao san with modifications and additions to guide to testicles and address his picture as itchanges. His tongue is no longer pale, in fact the edges more recently are inflamed and last visit the coat was yellow--I have cautiously introduced long dancao into his formula and it seems to be appropriate. I also recently added ji xue teng thinking not just about the blood but the vessels that hold it.6 sessions later, urnation is normal, bowels are close to normal, no longer gets hot or sweats at night, his left testicle discomfort is greatly improved, recentimaging did not show the hydrocele (or at least the doctor only mentioned the varicocele, he is seeking clarification), he now has morning erections, but hasnot noticed a change during sex and reports no change in tinnitus. Hands and feet still get cold. Mood is greatly enhanced after treatments (though he isdisappointed to not be able to go all the way back to the hours of euphoria that followed his first treatment. Chasing the acupuncture high :) )This was his pulse at last visit:left: floating cun, weak guan, moderate, chi weak at root, overall empty at rootRight: wiry, weak at rootstill tender costal marginsI think we are going in the right direction but I have some questions:If urination is no longer frequent and indeed there is no longer a hydrocele, is it time to phase out the dgsys and work more just on invigorating the blood?I know that tinnitus is notoriously difficult to treat, and have tried to manage his expectations. That said, should I add magnetite to his formulas? Or someother thing specifically for that symptom? Can the long gu and mu li, with their ability to anchor the yang, take care of this or is this not quite their function?Open to any insight or guidance you may have. Thank you!ReplyMaryanne Travaglione Nov 17, 2021ReactGreat work. I agree tinnitus can be a recalcitrant condition, clearing the YM bock is a good approach encourage flow to theextremities as the hand, feet and genitals all seem to be affected your approach seems right on ReplyAnn ClearyNov 17, 2021React@Maryanne Travaglione Oh interesting, I did not know to think that a blocked yangming could also affect flow to the extremities.That’s a useful lens.Maryanne Travaglione
ReplyMarnae Ergil NewDec 07, 2021 | Edited1React@Ann Cleary @Maryanne TravaglioneRemembering that the SP distributes qi to the 4 extremities, and the relationship between the SP/ST, if there is a yangming block,then the SP's ability to bring qi to the 4 Limbs can also be blocked. As usual, @Maryanne is able to see through the forest and getright to the meat of things.Ann Cleary,Maryanne Travaglione9 earlier comments 1 2 teacher remarksAlison Unterreiner, DACM, L.Ac.Dark spots on tongues of dark skinned patientsNov 04, 2021ReactHello all -I have recently had several patients present with dark spots on their tongues which would typically be clinically relevant, howeverthese patients are all dark skinned, making me wonder if other practitioners have noticed this as a trend among patients whohave dark skin.I looked in the Kirschbaum book and don't see many examples of dark skinned folks in there, so I'm not sure if I should read thisas stasis or if this is what these patients tongues naturally look like. When I question them about the spots, they reply they aren'tsure if their tongues always looked like that or not, leaving me to question if stasis is a part of the diagnosis or if this is just theirtongues natural coloring.I will attach a pic that is of particular interest for reference - this patient is a male, 70 years old, with a history of traumatic impactin war and lifelong PTSD leading to alcoholism and inability to keep a job. Could totally be stasis! Could also definitely be what histongue naturally looks like!I'm not sure and curious what other practitioners have seen and if anyone has experience to share.Thank you,AlisonPDF | 20 MIMG_8169Ann ClearyNewNov 17, 2021ReactI remember being told in school that dark tongue spots on a darker skinned person could be physiological or pathological, and sowhen I see this I look for confirmation in other s/s, all points made above. I did want to add that there is a very useful IG accountfor health care providers called @brownskinmatters It won’t answer any questions about dark tongue patches, but it shows actualimages of skin illnesses on dark skin that are usually depicted in textbooks on white skin.
4 more comments4ReplyReplyJa'Nelle Jefferson, LAcNewNov 17, 20211ReactIn school, I was told this was constitutional for patients with darker skin and I disagreed completely! There is a tendency in west tothink just because something is common that it is normal. We know what a normal tongue is supposed to look like "fresh pinkcolor, etc." I also believe it is due to the legacy of oppression and trauma of people of color in addition to probably eatingincorrectly for our constitution.In the student clinic, I ended up treating the patient who was a dancer complaining of tight painful tendons for blood deficiencyand she regained flexibility with reduced pain, but unfortunately did not continue treatment.As a practitioner of color, I'd venture to say I see more African-American patients (maybe 60%) and I have NOT often seen thesespots. When I have seen it, I usually see the smaller macule spots on the sides of the tongue, but only about 4 people total in 4years.The main thing I'd caution against is assuming you need to move or break blood stasis. Because of the rates of blood pressureissues among darker skinned people I'd lean more toward long term blood deficiency aka "crappy blood" (as Sharon W. would say)as the root cause and moving deficient blood damages it further. I always think of Bai Shao for this thick blood.Personally, I have seen stasis spots more frequently in transmuted Shaoyin presentations with no other obvious signs of bloodstasis. One patient with diagnosed fibroids/endometriosis but no palpable masses or other blood stasis signs from a tcmstandpoint - she felt horrible on blood moving formula from another practitioner. I switched her to a Si Ni San modification andshe began to feel better quickly. Another patient, a man with a constitutional liver excess type tall athletic build that drinks alcohola couple times a week and doesn't eat well. Also feels better quickly on simple formulas like Ba Zhen Tang - his spots actually docome and go. One thing I will say is they feel better fast and don't come back, so I have not been able to see if the spots disappearon most.In Huang Huang's Ten Key Formula Families page 99, "dark tongue or a tongue with purple spots" is listed as one of the Si Ni Sanpresentation symptoms. Mitchell/Wiseman SHL page 511, line 318, "When in lesser yin disease [there is] counterflow cold of thelimbs, the person may cough or have palpitations, or inhibited urination, or pain in the abdomen, or diarrhea with rectalheaviness; Si Ni San governs." (I put the quote b/c I often see this misquoted as a shaoyang formula.) I'd almost bet he has some ofthese symptoms. Of course if there were a lot of excess stasis you'd think about Xue Fu Zhu Yu Tang, but I don't think that is agood formula for blood deficiency blood stasis.Aside: I'm currently also experimenting with Yi Guan Jian modifications I found in the Plum pit qi section of Maciocia's ChineseMedical Psychiatry. I'm finding Chuan Lian Zi more useful than Chai Hu for thin pulse, dried out liver blood deficiency patients whoeasily get headaches on Chai Hu and the CLZ also drains damp heat which I would imagine would be useful in recovery afterAlcoholism. That also makes me think of Ze Xie which was mentioned a few months ago in Acupuncture Today article to be liverprotective. Then that makes me think of Dang Gui Shao Yao San but only if there is edema and also Liu Wei Di Huang Wan.The particular spots on his tongue remind me of liver spots which are often on the skin of lighter people. I suspect those spotscould also be caused by crappy/ dried out liver blood.Now, with all my talk about Shaoyin, I also found Sharon's class on Healthy seminars about Jueyin and metabolic disordersessential in treating African-Americans as they often have systemic "crappy" blood signs. Moles, skin tags, darker skin in areas,dark gums, dark streaks on nails, dysmenorrhea, blood sugar and pressure problems, repressed anger/fear, etc. etc. etc. So I'dprobably add jueyin herbs for him!Please let us know what happens!1 teacher remarkCandace Jania Anyone near Sherborn Mass?NewNov 02, 2021ReactI have a Lyme/post-Lyme patient up there that needs herbs and acu. I am unfamiliar with the area so if anyone is near there withexperience let me know!
ReplySharon Weizenbaum NewNov 05, 2021Reacthttps://www.rootandbranchom.com/practitioners/Eileen Power Depaula and Geoff Depaula are not far from there. Wonderful practitionersReplyCandace Jania NewNov 05, 2021ReactAwesome thanks Sharon!Alison Unterreiner, DACM, L.Ac.Cleveland, OH recommendation?Oct 27, 2021ReactHello all -Looking for a practitioner who does fertility near Cleveland, OH.Many thanks in advance for your help!Warmly,Alison ReplySage Staggs (she/her)Nov 02, 2021 2ReactOur own @Susan Carter is practicing in Cleveland! Highly recommended, she has experience with fertility.https://cleacu.com/bioSusan Carter ReplyMargaret Sikowitz NewNov 11, 2021ReactI just learned that we can put ourselves on the GLOBAL MAP - link here, a fabulous tool. @Susan Carter - want to add yourself?Susan Carterhttps://whitepineinstitute.instructure.com/courses/230/pages/global-map Embedded File.https://whitepineinstitute.instructure.com/courses/230/pages/global-map
Brian LangstonInsomnia, tinnitus, dry eyes, chronic constipationNewOct 27, 2021React43 YO female, video consult. Main complaint is chronic insomnia, wakes at 3 am & can't fall back asleep. Wakes with "speedyobsessive compulsive thoughts" about work or home issues. Also states waking related to parasites she believes has are moreactive at night. States history of parasite problems with other family members.Next complaint is tinnitus, random high pitch ringing for a few minutes to throughout day. And upon waking at 3am R sideconstant ringing for hours. Also hearing impaired, voices sound muffled and asking people to speak up or repeat what they say.Headaches, pressure in front of brain w/w working or thinking too hard. History of dull headaches, headache on back of head,forehead & behind eyes. B/W head injury and subsequent treatment.A long history of dry eyes and blurry vision.She is not thirsty for water.Chronic constipation. Occasional pain with hard stools. Has internal hemorrhoids and anal fissuresShe noticed deep crack down middle of tongue plus back of tongue coat orange/brown with bitter taste. I included 2 tongue picswhich looks pale with white coat, thicker white coat to rear plus some peeled edges & possible crimped edges. Plus I notice aviolet/purple hue to her tongue color.Also reports memory loss with difficulty remembering words.Low energy & not motivated with lack of focus.Past issues of sweating at night from head plus hot palms & feet at night. Plus dryness of mouth, lips, tongue, throat, skin, noseand especially eyes as stated above.Past issue with dizziness, depression, irritability, mood swings, mouth and tongue sores, gas, eczema on hands, swelling of ankles.Currently her cycles are irregular, every 2 months, more normal heavier flow rather than scanty, 5-7 days, heavy 2 days thentapers off. Past cycles were irregular, short, light flow, dark color.Plus she also has swelling in the ankles.I have worked with this client (long distance) for many years with a focus on treating blood deficiency and stagnation, according toher acupuncturist these 2 issues are her chief problems. Since my current enlightenment with GMP I am starting to see hersymptoms in a different way and would like some help.I woke this am at 4 am with this client on my mind and decided to write up this info. and ask for help. Reviewing SuzanneConnole's information on DGSYS, I noticed the 2 types of crappy blood she described, dry & deficient and water & blood separate.A formula she mentioned for dry & deficient was wen jing tong, in reading the indications irregular cycle, dry lips & mouth andwarm palms and feet stood out. And I know I am not suppose to go from symptoms to formula, though this direction seems toaddress some symptoms I have struggled with. Which is why I am asking for help. And the swelling of ankles brings my attentionto the second type of crappy blood, water leaking out of vessels, leaving blood thick & creating dryness. Ack.My intention list all the symptoms according to my new learning and SEE what they tell me for sure. I will post here later when Ihave finished. Until then I am hoping to get some input regarding questions I need to ask.JPEG | 1.2 MTongue1JPEG | 1.2 MTongue2
1 teacher remarkBrian LangstonNewNov 01, 2021ReactBeen a busy week, back to this case. Here are a list of symptoms and what they tell me.Chronic insomnia (wake early & cannot get back asleep/ mind busy) Not sleeping wellw/w not getting back asleepw/w mind getting busyTinnitus Ringing in the earsHearing impaired (voices sound muffled) Not hearing wellHeadache (Pressure in front of brain) & behind eyes Stasis in headw/w workingw/w thinking too hardb/w treatment of previous head injuryDry eyes Eyes not nourishedBlurry vision Eyes involvementNot thirsty SP or ST coldChronic constipation LI not movingOcc. pain with BM Stasis in LIInternal hemorrhoids Stagnation in LIAnal fissures ??Her tongue exam.Deep crack down center ??Orange/Brown coat HeatBitter taste Fire not descendingMy tongue exam (2 pictures attached above)Pale DeficientViolet/purple hue Blood stasisCrimped Wood involvementWhite coat thicker to rear Cold/DampMemory loss/difficult remembering memory affectedLow energy Qi not availableLack of motivation and focus shen affectedLate cycles (every 2 months) Womb not bleeding when shouldFlow heavier (use to be scanty) Flow more normalCycle lasts 5 to 7 days Normal?Swelling in ankles & thighs KY Yang def
ReplyDiagnosisDef. cold-damp in LBAccumulation of damp in LBBlood deficiencyCold in SP-STStasis in LIWood involvementKY yang deficiencyFormulas recommended:Tong Qiao Huo Xue Tong to invigorate blood & dispel blood stasisSuan Zao Ren to nourish the heart & calm the shenWu Pi San to resolve dampness & reduce edemaMarnae Ergil NewNov 02, 2021ReactHi Brian - thank you for posting this case. I want to look at your diagnoses for a moment.1. Deficient cold-damp in LB. I am actually not sure that I see cold anywhere in this presentation. The cold signs you mention arelack of thirst and a slightly thicker tongue fur in the back. For me, this is not enough to indicate cold. The lack of thirst may simplyindicate damp or failure of the fluids to move and the tongue fur while slightly thick in back does not indicate cold to me. Is shecold? Does she prefer warm fluids? I know you cannot take her pulse, but perhaps she can at least give you a pulse rate. The latecycles could be indicative of some cold, but there is no pain and no sensation of cold so the evidence is not there.2. Accumulation of damp in LB: Again, I am not prepared to say that the damp is only in the LB. From the tongue which appearsswollen and the slightly thick tongue fur at the rear as well as the lack of thirst I do think that there is an issue with fluids in thispatient, but not necessarily accumulating in the LB. What specific signs make you think this?3. Blood deficiency: Again, what are the signs? Yes, she has irregular menses and she has insomnia. The irregular menses could bedue to many factors so we cannot say that it is blood deficiency and the same with the insomnia - in fact from some of the othersigns that you present I think that the insomnia is more about heat and the heart/liver than it is about blood deficiency. Youmention that the tongue looks pale to you. It is very hard to tell from a picture and you certainly have more experience of thetongue but this does not appear pale to me. I see the light blue-purplish hue but I see the color as fairly appropriate with possiblea slight red color.4. Cold in SP/ST: Again...signs to support this? Other than the lack of thirst which you ascribe to SP/ST I do not see any signs.5. Stasis in LI: Something is causing her bowels to not move well. There is some pain and dryness. When you say stasis, do youmean blood stasis? I agree that there is something blocking free flow/movement and given the hemorrhoids and anal fissures itmay well be blood stasis, but it could also be related to the qi dynamic and damp and to possible heat.6. Wood involvement: Yes, I agree that there is probably some wood involvement although I like to have more specificity. What arethe signs that you attribute to wood involvement? I see the crimping in the tongue and the issues with the eyes (blurry, and dry).
1 reply 16 more comments6Reply7. Kidney yang deficiency: Again, I do not see the signs to support this diagnosis.I would like to make a suggestion - that you make a table with each of your symptoms and next to the symptom write down ALL ofthe possible things that could cause that symptom not just what you currently think that symptom is telling you. Start with yourchief complaint because interestingly, none of your diagnoses are actually addressing that. Once you have completed the table Ithink you will find it easier to break this case down and come to a more nuanced diagnosis than you currently have. This is sort oflike starting from scratch with this case but since you are having difficulties with it I think this is a good idea. Usually when we findthat the work we are doing with a patient is not achieving the results that we want it is because we are not clear enough about ourdiagnosis and need to step back and start from the beginning again.I am sorry that I did not give you an answer, but I hope that we can continue to help you decipher the presentation here whichshould ultimately bring us to the formula.1 earlier comment 1 teacher remarkBrian WahDoes anyone know of classes on Menopause? I see a ton on fertility, depression, pain...Oct 22, 2021ReactLooking to get more insight into this time in a woman's life. TIA ReplyMargaret Sikowitz NewOct 28, 2021ReactSharon you beat me to it - Caroline's is where I would definitely start. Good luck Brian! ReplyMaryanne Travaglione NewNov 03, 2021ReactAgree, you will have a great foundation studying under Caroline Radice1 teacher remarkBrian WahRaw vs Granules? (Just found this area to post questions!)NewOct 21, 2021ReactI'm slowly progressing through the GMP class and wanting to know what are practitioners doing in terms of Raw herbs vsGranules? Right now I have mainly granules...If raw...are people using ziplock bags, vacuum seals, plastic containers?Sharon Weizenbaum NewOct 22, 2021 2ReactHi Brian,I hope others chime in. We use both in our clinic but will be transitioning to mostly raw powders. Eran Even will teach a class onthis in January.
12 replies 12ReplyWe use paper ziplocks that we get from Uline. https://www.uline.com/BL_3125/Kraft-Stand-Up-Barrier-Pouches. This was arecommendation by Eran as well. For bulk we use paper lunch bags.ReplyMargaret Sikowitz NewOct 28, 2021ReactEran's other classes are no longer available (but there is a great piece he wrote on Thirst in the SHL still available here: Thirst in theSHL5 earlier comments 1 1 teacher remark1 reply 1Emily RieffelGuidance for acute allergic swelling from bee stingOct 17, 2021ReactA patient of mine is hospitalized with acute allergic facial swelling after being stung on her upper lip by a bee. So far, she is notresponding well to antihistamines that they have administered. I don't have any further details, but will likely see her tomorrow ifshe is released. I would love some thoughts or experiences from those who have worked with this type of acute allergicpresentation, as it is not something with which I have much.Are there key differentiating questions you would ask? Are there formulae that pop right to mind?Thanks in advance!ReplyMargaret Sikowitz NewOct 28, 2021ReactLove the jing well points, great before/after. Do you know if she'd had prior bee sting reactions like this one? Thanks for sharing. ReplyMargaret Sikowitz NewOct 29, 2021ReactExample number I can't even count that high on how this medicine excels! And bravo to you, too! Imagine how many (western)specialists she would have had to see?Sage Staggs (she/her)Dizziness when takes Wen Jing TangOct 13, 2021ReactQuestion for teacherI'm working with a perimenopausal woman who has headaches, spotting, and vaginal itch as main complaints. My diagnosis isliver blood deficiency with wood stasis, and I'm giving her a modification of Wen Jing Tang. She's reported experiencing dizzinesswhen she takes the herbs- she stopped taking them for a few days then when she restarted, the dizziness returned. Can anyonehelp me understand why she would feel dizzy taking this formula?
5 earlier comments 4 teacher remarks3 replieswu zhu yu 3dang gui 4chuan xiong 4bai shao 4dang shen 12gui zhi 4mu dan pi 4e jiao 4sheng jiang 4zhi gan cao 4ban xia 9mai men dong 8zhi mu 8huang bai 3ReplyAnni EllistonOct 15, 2021ReactI'm curious if the dizziness is more dampness or blood deficiency type. Is it with lying down / turning head too, or just with risingfrom sitting etc? Either way, could this be an indication for being a DGSYS pattern? Or just adding FL, ZX, & CZ to her WJT to bring inthe whole of DGSYS to it?ReplySharon Weizenbaum Oct 19, 2021 1ReactDo let us know how she does when she goes back on herbs!Miriam FreudenbergBreast cancer: Scar needling & Dang Gui QuestionsNewOct 10, 2021ReactHello dear fellow students & TOM-lovers,I'm Miriam from Wiesbaden / Germany, opened my own practice 6 months ago and this is my first post in this forum :)My patient is 52 and has been diagnosed with estrogene receptor-positive breast cancer 7 years ago. She received radiationtherapy and an operation (cancer was located just above the nipple). All cancer growth could be removed and she has since takenTamoxifen (blocking estrogen receptors in the body). She is suffering from the side effects of her medication and has symptomsof heat, phlegm and yin deficiency.I am treating her with acupuncture - which started off well - and would like to add a herbs.I have two questions on this case:1. She has dense, painful scar tissue on her breast, just above the nipple. Pressure hurts (she can't sleep on her belly) and the MRIcan't penetrate the tissue during exams, it's so dense.I have experience needling scar tissue to restore the flow of qi. However, I also learnt in school to not needle breast tissue. What'syour advise here?The patient herself is open to be needled on the breast itself. The scar holds a lot of trauma and I'd love to gently needle it.2. I learnt that Dang Gui can stimulate estrogen production or acts similarly. I'm not sure yet about her initial formula but considerJia Wei Xiao Yao San, which of course contains Dang Gui.. I'd rather err on the side of caution so wonder how I could replaceprecious Dang Gui.
1 teacher remarkWhat are your experiences with prescribing herbs for women who suffere/d from estrogen receptor-positive cancer?Are there any other herbs I should exercise caution with?This is my first post-breast cancer patient (but not my first patient with signs of heat and pfleghm, of course. We treat patterns, notWester diagnoses, yes! ;-)) and I am grateful for any hints and advise.Thanks so much, I love this forum! :)Miriam ReplySharon Weizenbaum NewOct 10, 2021ReactHi Miriam,1. What was the reason given for not needling breast scar tissue? I have done this with no adverse reaction as I had not beentaught not to.2. The question about Dang Gui is one that touches on a broader question of how much we adjust our formulas based on westernresearch into chemical constituents. I am interested to hear what others have to say about how they approach this. For myself, Ibase my formulas only on the presenting pattern and try not to consider the idea that Dang Gui contains estrogenic constituents.The reasons for this choice is are as follows1. I was taught this way by all of my teachers2. The issue is the body's misuse of normal estrogen and not an issue of too much estrogen in the body. In other words, avoidingestrogen does not correct the pattern and a formula with Dang Gui may be the formula that will correct this.3. Treating the pattern accurately is the best way to prevent recurrence and to correct the body's misuse of estrogen. For me, thismeans correcting the pattern.4. There is also research that phytoestrogens as are in Dang Gui are binding with the estrogen receptors in a way that ispreventive and protective of breast cancer.Shu Di Huang, Bai Shao, Nu Zhen Zi all have phytoestrogens and there are more. At some point we are practicing with an arm tiedaround our back.If you or your patient is not comfortable with this then, to me, above all you and your patient should work together in a way thatyou both feel safe. Additionally, a good reason to avoid using Dang Gui is if you feel your patient may be litigious if there is arecurrence. In general with any cancer patient, I want to make sure we have a good rapport. Of course this is important witheveryone but with anyone in a life/death situation it is even more important.If you want to replace the Dang Gui, you might consider Dan Shen, keeping in mind its cool nature. You could also combine bloodnourishing herbs such as Gou Qi Zi (which has been show to inhibit estrogen receptor positive cancer growth in some studies)with Xiang Fu or Wang Bu Liu Xing.I am so interested to hear how others work with this issue.ReplySarah Rivkin NewOct 12, 2021ReactIf you are nervous about needling on the breast, I've also had very good luck treating scars with techniques from Japaneseacupuncture: rice grain moxibusion along the scar, particularly where it feels ropey; and various techniques with the teishin (noninsertive acupuncture needle). For the teishin techniques, I believe Bob Quinn (one of my favorite teachers) has some videos onYouTube about this, I've also used Philip Strong's techniques https://www.youtube.com/watch?v=AMt8xm_Bmvg
6 more comments61 teacher remarkPetra SchirraCase Review due dateOct 04, 2021 | EditedReactQuestion for teacherHi Suzanne, I am in your case review class. I can't find the due date anywhere for the second case. Would you mind telling meagain. Many thanks, PetraSuzanne Connole ReplyYour Friendly Admin NewOct 06, 2021 1ReactHi @Petra Schirra there is a discussion forum in Suzanne's course, I think you'll have better luck asking questions there in thefuture. The due dates are visible both in the syllabus and if you click "Submit Case 1" or "Submit Case 2"Petra Schirra
8 9 10 11 Anni EllistonCalling all Superheroes...Oct 04, 2021 3ReactI saw this picture on the front of a graphic novel today and just laughed out loud. "Now THERE'S a woman with super powers!" I said to my daughter. "Onewho knows to wear a scarf when she's flying around!"So I wanted to share that with you all, for a laugh! But I ALSO want to add that I am just so grateful for the superheroes that Sharon and this team are, forsharing so fully and freely all of your knowledge.And also to say how fantastic it was to get the email about the "acute case support system", where we can access help within 48 hours for our mostchallenging cases. You are doing such an amazing service to our community.Thank you! Fly on! (with your scarves)...Sharon Weizenbaum,Suzanne Connole,Eran Even,Caroline Radice,SallyJPEG | 3.4 MIMG_2939ReplySally Oct 04, 2021 1ReactSo sweet, Anni! Thx! And thank you Sharon!!ReplyEmily RieffelNewOct 17, 2021 1ReactMy daughter and I love Ms. Marvel! :-) Thanks for this fun post, Anni!49 students have completed the assignment. Visit Topic Activity for details.Practice Support
Tolley SinkWashington StateSep 29, 2021ReactWho is practicing near Skagit county, Washington, close to Burlington about 1.5 hours north of Seattle.Sabine, maybe you know someone?Thank you so much!TolleySabine WilmsReplyMaryanne Travaglione NewOct 06, 2021ReactSince there hasn’t been a direct response I would recommend reaching out to SIOM, Seattle Institute of OM. They have wonderfulproviders associated with the school and may be able to offer guidanceAlison Unterreiner, DACM, L.Ac.Seeking help with herbal formulaNewSep 26, 2021ReactQuestion for teacherHello -I have a patient who I have been treating for months now for central retinal vein occlusions, a condition that if left untreated willcause total loss of vision. Taken from the internet: Central retinal vein occlusion (CRVO) is a blockage of this vein that causes thevein to leak blood and excess fluid into the retina. This fluid often collects in the area of the retina responsible for central visioncalled the macula. When the macula is affected, central vision may become blurry.The treatment for this is an injection straight into the eyeball, which reduces the pressure, but it inevitably returns and at this time,my patient is receiving these injections once every 6 weeks (up from once every 4 weeks).I have had good success treating her with acupuncture, but a few months ago in an aim to further support her, decided to addherbs into the mix. While she has not had any negative effects, I'm not certain of the formula and would like more seasoned eyeson this case as it is so serious and I know the right mix of acupuncture and herbs could really transform her life and the outcome.A little about this case:CRVO - started almost 2 years ago in R eye, noticed vision was diminishing - vision was fuzzySaw ophthalmologist and saw immediately it was CRVO and received an injectionWhile healing from cataract surgery, CRVO came back, this time in both eyes - has been receiving injections in both eyes ever sinceCRVO can cause HA, feeling of pressure mostly around R eyeHAs occurs every few days, sometimes even 1x/day - dull ache frontalQOP: pressure bordering on pain, similar to a tension HAWorse with: putting pressure on head, as in leaning forwardBetter with: being busy or when relaxingReview of SystemsHEENT - ringing in L ear about 5 years, high pitchedHigh blood pressure - diagnosed about 2 years ago, found out after being diagnosed with CRVOHair/Skin/Nails - dry legs and anklesDigestion - 1-2 BMs/day, loose and formed, some sloshing sounds heard in abdomenAppetite - emotional eaterUrination - slight incontinence with coughing and sneezing, no history of childbearing and just chalks it up to age, urine is clear to pale yellowThirst - low, craves room temperatureTemp - runs warm, aversion to heat and humiditySweat - sweats on exertion, I notice the patient is frequently sweating in the summer months when she arrivesMenses - in menopause, which came early, periods were regular with no pain notedSleep - some difficulty staying asleep - has been helped a lot with regular acupunctureEmotionally - works as a professor and enjoys what she does but not the people she works with, lives alone with 3 dogs, has a good support system, I cansense her fear about her health - she is very worried since she lives alone and does not have children that she may lose her independence and the life shehas built.
1 teacher remark1 reply 11 more comment1Body type - she is a tall woman who is very large, she carries most of her weight in her abdomen which is big and fleshy. Abdomen is cool to the touch. Shewears a lot of makeup so it's difficult to tell her face color, but she looks pale yellow.Tongue/PulseT: small, pale purple, pointed red tip, dry white coat, cracks at centerP: L: slippery, deeper level, fullest cun, R: slipperyI diagnosed her with Spleen Yang deficiency causing internal damp and gave her Ling Gan Zhu Gan Tang with modifications. In the 6 confirmations I see heras having a problem in with Tai Yin fluid metabolism, as it seems everything goes up with her (high blood pressure, eye pressure) and there is dryness belowin her legs and some urinary incontinence. This is a quick synopsis of my thinking, but these were some of the main ideas.Here is the formula I gave her:Fu Ling 18Gui Zhi 12Bai Zhu 9Gan Cao 6Man Jing Zi 15Ju Hua 15Gou Qi Zi 15Nu Zhen Zi 12Ge Gen 9 (for high blood pressure)I am not convinced this is the right formula as she hasn't seen any major shifts other than no longer hearing sloshing and her legs aren't so dry - so anyinsights are greatly appreciated.Many thanks,AlisonReplySharon Yeung NewSep 27, 20211ReactHi Alison!Thanks for the great write up. I have a few more questions. How old is this patient? Any glomus? Any coughing or lung symptoms?Were the sloshing sounds in the epigastric area or in the low abd? Is the amount of water/liquid she takes in correspond to theamount she urinates? I agree the middle jiao water symptoms are, as Toby Daly would say, "the grossest thing in the room" andneeds to be better absorbed. I wonder if the water accumulation in the middle jiao, however, is more excess in nature thandeficient and could be causing a blockage in the middle given the slippery pulse, the headache worse with pressure. The fullslippery pulse in the cun can indicate water pushing up into the upper jiao. If the sloshing is in the stomach than Sheng Jiang XieXin Tang could help. I also wonder about crappy blood given the purple tongue, dry skin, and sallow complexion. Borrowing ShaoYao, Chuan Xiong and Ze Xie from DGSYS can help to integrate the water with the blood, invigorate blood and give an outlet forthe accumulated fluids.ReplySharon Yeung NewSep 28, 2021ReactGiven the water sounds are in the epigastric area, I would try SJXXT and see if it helps. The Sheng jiang will help to warm anddescend the water and the formula will open up the stagnation in the epi area. In this case, when I think about "damp clearing" I'mreally thinking about resolving the accumulated water/jinye fluid stagnation and getting her wheel to turn by unblocking themiddle jiao. Keep us posted!Sage Staggs (she/her)Question about how to manage patient flowNewSep 22, 2021ReactI have a few questions for folks who have a "full" practice and do lots of custom formulas.
1 teacher remark1 reply 11 reply 114 more comments14How many patients do you see per week?How many rooms do you work out of?Do you have an assistant, receptionist, or associates?I moved to a new town and have been slowly growing my practice at the same time as starting the GMP and WPC, so am spendingway more time making custom formulas than I did in my previous practice, where I worked out of two rooms. Now I am seeing 15-20 patients a week out of one room, and I'm not sure how much more I can handle as a solo practitioner without any assistance. Ilike to send my patients home with herbs the day of their appointment (I make them onsite) but if I were to start working out oftwo rooms, I don't know how I would have time to put together formulas.I'd love to hear from more seasoned herbal practitioners how they have figured this out. Thanks! ReplyCaroline Radice NewSep 26, 2021ReactHi Sage: Congratulations on your growing practice! If you customize and fill herbs for every patient, it can be challenging to expandto more rooms without assistance. I fill many (but not all) formulas on site and about 50% of my patients either don't need a refillor modification every visit, or are not currently taking herbs so that helps some with timing. I see around 12-15 people a day onaverage. I work solo with 2 patients per hour and it seems to work to fill quickly in between for ongoing patients but I work quickly.For new patients, when I'm really deep diving into forming diagnosis and formula, I often won't send them home with the formulabut rather explain it takes a little time to finalize and they either return to pick up later or next appointment. Refills and mods go alittle quicker once established. You might schedule a little writing and filling time after new patients in your schedule and youmight also consider booking 2 per hour every other hour or only a few times per day to start building it up. It is a blessing to besuccessful on whatever terms you decide work for you. ReplySharon Yeung NewSep 28, 2021 1ReactCongrats on the growing practice, Sage. I agree with a lot of the suggestions that Caroline made. I also see 2 patients/hour and seeabout 12-15 day but I don't have the time/bandwidth to write formulas during these clinic days. That said, I also don't fill formulasin the office, I outsource to a pharmacy. If it's a refill or sl modification, I can place the order that day. Otherwise, with new ortough cases, I like to dedicate less rushed time outside of clinic to work on these formulas. I keep some patents in the office forsome acute conditions or if I want a patient to take something right away until their custom formula is ready. Perhaps bringing anassistant in might be a good option to start seeing more patients, write the prescriptions and have someone else fill them. I havean office manager who does part time hours each week and it is so so helpful. I tend to hire from TCM schools so it also is a reallynice, mutually beneficial relationship. Good luck to you and wishing you a continued thriving practice.Molly Shapiro3x gave herbs, 3x gave diarrhea. Still unsure why?NewSep 17, 2021 | EditedReactQuestion for teacherA long-term patient returned after several years for main complaint of low back pain and post-surgical nerve pain on her L knee.She has many standout signs and symptoms, yet all I succeeded in doing was giving her urgent, cramping diarrhea on 3 differentherbal formulas. (Historically she was acupuncture only). I am trying to understand why.72 year old woman, long history of hormone replacement therapy for hot flashes, but is no longer on that regimen.
Low back pain: Worse with standing or walking too long. It is a tight, deep pain that is relieved with rest and support and bendingat the waist. The muscles feel seized and stiff.Standout symptoms:Patient is pale. Very pale, especially around eyes. Many varicose veins are observed, especially in lower legs which also tend toswell, especially in the heat. The skin appears thin, and you can see the purplish-blood underneath.Blurry vision. Gets charley horses in legs.Very hot, never chilled. Very thirsty for room temp to cool. Wakes to pee and drink, sometimes hard to go back so sleep. Urinereported normal. Flushes heat in upper body, sweats from head. Always trying to get cooler.3-4x/week, bowels are incomplete/messy and fluctuate too hard/soft. 60% of the afternoons, reports nausea that is relieved witheating.Takes aspirin for blocked carotid artery that was detected when investigating severe migraine headaches.Carries excess weight in middle, the abdomen feels too big for the patient, and she feels lethargic and heavy.Tongue/pulse/abdomenTongue is Red, tight, peeled center, thin yellow coat, distended purple sublinguals.Pulse: 3 different observations on last 3 visits. I'm surprised to see such variations in my findings as I look at them again now. Thefirst 2 findings were before any herbs1: deep, slippery, L Cun floating, R Guan wiry; 2: L Cun floating, deep, thin, weak, choppy overall R Cun full/slippery; 3 (after the WJTformula): right side deep, weak, thin; L Chi empty, L Guan wiryAbdomen is soft, spongy, hard epigastric area, Rikyu (involuntary spastic jump with touch), bilateral OketsuI know there is for sure crappy blood, dryness in earth, sp qi deficiency, and KD weakness. I thought for sure Bai Shao wasindicated and used it in high proportion to other herbs in all the formulas, but the only constant in each formula is the Bai Shao,so perhaps its bitter/cold is the culprit? What did I miss? I know this patient well, and if I feel strongly that I figured out theproblem, she will let me try again.Initially I thought the heat was from deficiency and used the Wen JIng Tang base. Maybe I made it too hot with the Fu Zi. After thatdidn't go well, I thought maybe the heat was coming form a block in the middle and tried to clear that with Ban Xia Xie Xin Tangand improve blood quality in a cool way with with Suan Zao Ren Tang (and added Bai Shao). Within 24 hours of each formula, thepatient reported urgent diarrhea with cramping that would also wake her up at night. I'm using granules with Dextrin filler, butthis feels more like user error that allergic reaction. I think an herb like Tian Hua Fen might be good for the thirst and stiff muscles,but unsure how to package it into a formula.Where did I go wrong?
1st formula (this was 2018):Dang Gui Shao Yao San (pre-mixed)2nd formula:WJT Mod:Dang Gui 6 Chuan Xiong 2 Chao Bai Shao 18 Gui Zhi 6 Rou Gui 3 Mai Dong 6 Dang Shen 6 ZGC 6 Mu Dan Pi 3 Wu Zhu Yu 1 Sheng Jiang 3 Ban Xia 3 Fu Zi 9 3rd formula: Ban Xia Xie Xin Tang + Suan Zao Ren Tang + Bai ShaoBan Xia 6 Gan Jiang 3 Huang Lian 2 Huang Qin 6 ZGC 9 Dang Shen 9 Da Zao 6 Chao Bai Shao 15 Suan Zao Ren 9 Fu Ling 6 Chuan Xiong 3 Zhi Mu 6 Thank you for reading and any feedback offered!Guy SedanNewSep 19, 2021 | EditedReact
1 reply 12 more comments2ReplyHi Molly, Is the diarrhea smelly or hot? Painful? This information can give us some idea about her reaction to the herbs. I think you should focus an the diagnosis before suggesting any specific herb. This is not a Hot/ Cold glomus as she feels hernausea is better with eating so BXXXT is not appropriate. Also, we don't see any signs of cold so WJT does not seems appropriatetoo. As the Spleen deficiency and the crappy blood do stand out, DGSYS maybe correct . Given that is has Dang Gui and Bai Shaowhich both can cause diarrhea, you may need further modify like replacing Dang Gui with Dan shen, using Chao Bai Shao, orgiving more emphasis on her deficient Spleen. Notice that she also has St Yin Xu, from her peeled tongue coating, It also seems she is suffering from wasting and thirsting as she is thirsty a lot and maybe pees a lot as she wakes up to pee. Iwould try to question more about her peeing . How frequent is it? Is her urination beneficial ? Does she strain? I would like to knowif she feels that the water she drinks just passes right through her. You mentioned that she feels heavy and her legs tend to swell up especially during heat makes me think that dampness in the LJ isalso a factor. Do her symptoms get worse in hot humid weather? I would also question the Rikyu finding . It is my understanding that RiKyu is not determined by involuntary spastic jumps withtouch, but just feeling the tight RA muscles. Maybe what you are feeling is a sign of excess in the abdomen, which reacts with"jumps" when you press deep? We know she suffers from blood stagnation. ReplyMaryanne Travaglione NewSep 22, 20211ReactMy first thoughts when I looked at the case was the bai shao might have been the main culprit as I have had the experience of baishao over stimulating bowels but realized you had thought already to modify and a chao bai shao I would think it a good solutionand better tolerated. Considering this was not the outcome the oder of the diarrhea is important for differentiation of hot/ coldThe formulas as prescribed seem quite warm and may be to activating rather than supportingAnni EllistonEye infection / allergy / eczema combination!NewSep 17, 2021 | EditedReactWould appreciate some new eyes on this eye case!Woman (48) with history of eczema (fingers, eyelids - but wasn't flared up currently) appeared to be having an allergic reaction around R eye (possible dog furexposure, highly allergic). Itchy on & off, worse at night, slightly swollen medial upper lid, very slightly red, raised and flaky patch on medial lower lid, verlyslightly red lower conjunctiva. Itching of eyeball / lids was main complaint. Slightly itchy throat. Better after acupuncture and while camping, then flared upagain. On & off pattern.I had just taken Mazin's intro to dermatology course (wonderful!) so decided to go with his wind-heat herbs idea to attack the branch and gave 4 days of:
5 more comments5SDH 24MDP 9CS 9JJ 9FF 9BJL 12JYH 12LQ 12HQ 9ZGC 6No real change on herbs, still on & off, but no worse when I saw her 3 days after finishing herbs. Also had stiff neck and shoulders, slight headache, and slight"sore" throat (just a bit rough feeling).Then flared up overnight with extreme itching, very red conjunctiva, discharge (clear with a bit of slightly thicker and yellowish), puffiness around eye, pain. Allin R eye.Bled her er jian and gave 2 days of Gao Mao Ling tablets plus Ju Hua tea / compress (had 10 minutes and couldn't make a custom formula and kind ofpanicked and just gave what I had on hand! Feel bad for veering from SHL course!). No change, said possibly slightly worse. Eczema also returned on upper Leyelid (a more common presentation for her) and a dot on one finger.Recommended she see MD due to worsening and discharge and she was diagnosed with probable bacterial infection in addition to allergic reaction and giventopical antibiotics plus optional antihistamine eye drops. Improved today after 1 day of antibiotic ointment. Eczema on fingers and eyelids worsening.Current state:Eye less red and puffy with antibiotic ointment (1 day in) but still itchy and uncomfortable.Eczema patches on eyelids and ring finger more pronounced.Insomnia past few nights, waking at 2 am, last night awake from 2-4 am, early waking at 6 am.Thirst today.Cold body (typical), feet colder.Slight dull headache.BM had been more constipated, herbs helped get moving.Urine slightly yellow, was a bit cloudy last week.I don't feel like I have enough of a depth of understanding with Mazin's approach and I'm not clear on the SHL path on this one either! Aspects of Three YangConformations? Treat from the Shao Yang due to the on & off nature of it? Or is it still needing to just be cleared from the exterior? I feel like I could putsomething together (if Shao Yang XCHT or CXHGZT plus SG, Ju Hua, JJ, FF, BJL, maybe JYH & LQ etc) but would love to hear any more refined thoughts. Maybethere's a perfect SHL formula I don't know about yet! I can provide more general symptoms as well if needed.Much thanks...ReplyAnni EllistonNewSep 17, 2021ReactTo add: there may also be a liver qi / stress component to it. When I focused on that with acupuncture (currently and in the past)the symptoms improved more than when I focused on the eye and inflammation symptoms directly. ReplyAnni EllistonNewSep 17, 2021ReactPhotos she sent to me today. The yellowishness is from a solution the MD used to detect any corneal scratches, it's not thedischarge.PNG | 500.1 KScreen Shot 2021-09-17 at 1…PNG | 167 KScreen Shot 2021-09-17 at 1…
Guy SedanCOVID patient, Male age 52NewSep 11, 2021 | EditedReactHi there, Patient has been feeling sick for 4 days. Diagnosed with COVID. Right now is sufferings from nausea, alternating fever and chillshappening two to three times a day. When he suffers from chills he also is averse to wind. The fever has reached 39.2 (102.5Fahrenheit) but right now only reaches 37.8 (100 Fahrenheit) . No pain . His sleep is not well as the fever rises during the night at around 2:00 and he says he is slightly agitated. Ever since he is sick he also suffers from distention and heaviness in the epigastric area which is worse with food and drinks. Hehas no appetite and no thirst. The distension and heaviness are gradually felt also in the chest area. The distention in the chestfeels like a backup symptom which is due to the block in the epigastric area. Breathing is normal. No cough. He has a little phlegm which now is becoming more difficult to expectorate but is stilltransparent/whitish. His energy levels are ok, but when he has fever he feels exhausted. Slight hesitant urination (A symptom which he suffered from before) Pulse 78 (when healthy it is less than 60). Slightly full in GB position. Tongue: Puffy, with teeth marks, thick, slightly yellow coating. Wet. Diagnosis: Shao Yang involvement with dampness in the MJ and LJ As he is a Chinese Medicine practitioner himself, he has self prescribed himself with a tincture of XCHT, 5 CC three times a day,with no relief. I think given the medium (not using raw herbs) and the small dosage, this was not enough to get a desired effect. Treatment: open the Shao Yang Pivot, dry dampness in the MJ /LJ and treat the glomus XCHT+ XXXT + Hou Po, Fu Ling Chai Hu 18 Huang Qin 9Ban Xia 12 Dang Shen 9 Sheng Jiang 9Da Zao 6 Zhi Gan Cao 6 Huang Lian 3 Gua Lou Shi 6 Hou Po 9 Fu Ling 9 I would happy to get any comments from people who had some experience treating Covid. Thanks GuySharon Weizenbaum,Suzanne Connole,Caroline Radice,Allyson Nevard,George Mandler,Laura Mcgraw
2 replies 213 more comments13JPEG | 69.9 KAReplyAllyson NevardNewSep 11, 2021ReactHi Guy,Does he still have the feeling of coming down with something? Is he having chills or feeling hot? If so, you will need to address theTai yang as well - maybe something like chai hu gui Zhi tang instead of xiao chai hu tang or huo Xiang zheng Qi San. It sounds likethe dampness is the star of the show here. let me know what you think! ReplyCaroline Radice NewSep 12, 2021 1ReactHi Guy: His presentation may have changed since you posted as is typical with Covid pattern progression, but I would have startedwith a Chai Ling Tang as well based on the picture you painted. Likely he is past the CMWS part - I have used San Ren Tangelements for this as well to open the block with all the dampness. Let us know how he is!1 teacher remarkJudith KenenClarifying understanding of OketsuNewSep 10, 2021ReactQuestion for teacherMy understanding is that you diagnose Oketsu by pressing in deeply around ST 27. If someone feels pain immediately, before youcan barely push in (I've had this experience a couple of times) , is that still an Oketsu? And if it isn't an Oketsu, then do we just sayit is a for sure "stasis" and then do the rest of the diagnosis?Thank you.
ReplySharon Weizenbaum NewSep 11, 2021ReactHi Judith, I am not sure. I would suggest checking with Kumiko who is in our GMP and who teaches the Fukushin class in the WPC.For me, if it is generalized discomfort rather than on one spot, it would not be oketsu. I would also look for the knot of oketsu toconfirm. There may be generalized discomfort (yes, some kind of stasis) AND oketsu so finding the knot would confirm the oketsu.The knot is important. You press your hand in rather slowly and find it. There should be a sharp pain as you move laterally overthe knot. I also suggest looking at Nigel Dawes' Fukushin and Kampo. Great book!ReplyYanaNewSep 13, 2021ReactIn Master Nagano (Kiiko Matsumoto) style oketsu is the painful area on the left at KD15, ST26-27. It's based on the anatomicalexplanation: when there is stagnation in the abdomen, the portal vein has trouble pushing blood to the liver, and this creates abackflow of blood just opposite the liver organ, past the umbilicus.It's not one point, it's rather an area. There might be a nodule, but not necessarily.They're looking for a nodule in this area (oketsu kai) to needle to treat right GB20 pain if liver organ is involved. There is animaginary line drawn from right GB20 to liver organ to oketsu, as if it was a channel. So when the oketsu reflex is cleared, it can beneedled directly to treat GB20R reflex related to a liver disbalance.The intensity of pain in oketsu just shows the severity of stagnation. If there is pain all over the abdomen - oketsu, immune reflex,uterus, ovaries, adrenals, dantien etc), it's called busy hara. In this case they start with regulating fire points. Usually that removesthe generalized pain, and the remaining reflexes are the treated appropriately.1 reply 1Alison Unterreiner, DACM, L.Ac.Practitioner recommendation in Houston, TXNewSep 08, 2021ReactHello wonderful WPC folks!Wondering if we know any practitioners in Houston, TX? Looking for general practitioner with strong herbal skills.Thank you,AlisonReplyCandace Jania NewSep 08, 2021ReactJennifer Law Choo is amazing! http://easternharmonyclinic.com/our-approach/meet-the-team/jennifer-law-choo/Judith KenenWorking with heavy, painful periodNewSep 02, 2021ReactQuestion for teacher
3 teacher remarksI have a case of a 39 year old woman with very painful, very heavy menstrual bleeding that I have a few questions about. She has avery petite build. I've been treating her for about 3 cycles. She has a strong desire for heat with menses as well as clots that arebetter after passing. She is blood deficient. She doesn't have any of the Ki involvement signs we learned in the GMP but she hashad 5 kids, 4 within 7 years, so I'm counting that as Ki def. I have a few questions. The skin on her belly moves on top of her flesh. Ibelieve we consider that a Sp deficiency sign, but I wasn't sure if it's normal for a woman with several pregnancies and if so, is thatsign still considered a deficiency?I've given her versions of Wen Jing Tang and Gui Zhi Tang w/Dang gui and Chuan Xiong. She felt better on the Gui Zhi Tang version.Before her period, I added in 9 Ze lan and E Zhu, and 3 Xi Xin and Wu Zhu yu. When she bled I gave her a version of Dang gui Si NiTang,: Rou Gui 9, Dang gui 9, Bai Shao 9, Xi Xin 3, Wu Zhu 6, Sheng Jiang 9, Da Zao 6, ZGC 6 and Wu Ling Zhi 9. I've made slightadjustments to the bleeding formula to try and improve it. Overall, her pain, clotting, heaviness and desire for cold is improved, byabout 30%, but she is still laid up in bed for at least 2 days totally wiped out by it. I've experimented with adding some Ze Lan andE Zhu with the bleed and there was a little improvement but it wasn't significant. Once I added Pu Huang and it slowed thebleeding too much and made her feel stuck.I'm not sure if I just need to give it more time. What is a reasonable amount of improvement to expect and how many cycles wouldyou give it before changing things more? I would love to know any other ideas folks have. I already plan to add Fu Zi since she is socold below and to address the deficiency from the pregnancies. Would you add the Fu Zi during the bleed too?Would love any guidance. Thank you. ReplySharon Weizenbaum NewSep 03, 2021ReactHi Judith,Why the E Zhu and Ze Lan? Why during bleeding? I use E Zhu for membranous dysmenorrhea and usually use it before bleeding tohelp break down the lining before menses. I most often use it with Rou Gui and Xu Duan. Ze Lan I use for blocked menses and seeit as lightly purgative of blood stasis.I agree with the diagnosis of great deficiency. This sounds like a Wen Jing Tang pattern to me. I would modify depending on thedegree of dryness and heat. Do you need the E Jiao, Mai Men Dong? Could you make it more warming of the blood with Rou Gui,Wu Yao, Xiao Hui Xiang and Yes, Fu Zi. I suggest trying this to see how far you get. If you reach a new plateau, add Yan Hu Suo, PuHuang and Wu Ling Zhi to help stop pain more. Dang Gui Si Ni Tang is more for just cold and not very strong for blood deficiencyor deficiency in general.Of course, I'd see what else is going on in the whole pattern.Does this make sense?Judith KenenNewSep 03, 2021ReactThanks Sharon.It's really helpful to discuss the nitty gritty of dosaging and additions to the cases, especially with menstrual issues.I'm sorry, I keep getting Ze lan and San Leng confused in my mind, but I used E Zhu and San Leng, not Ze lan. I used them for themembranous dysmennorhea. To clarify do you use the Rou Gui and Xu Duan with Ze lan or E Zhu?
5 more comments5ReplyI tried hem with the one cycle during the bleed hoping to help break up some of the clots. But I hear that that's not what youusually do and didn't do it this last time.I will look at Wen Jing Tang again. Thank for the suggestions of more warming herbs to add. I'm never sure how much to warm anddon't have much experience with those herbs so good to have them in mind.I understand DGSNT being mostly for cold, but thought it was also for cold from pain which I think is significant during her bleed.But of course Wen Jing Tang is also for cold. So in her case, would you keep her on the Wen Jing Tang the whole cycle, including thebleed?And add E Zhu and San Leng to Wen Jing TAng about 10 days before the bleed, right?And for the skin that moves over the muscles on the abdomen, that's pathology whether its because of lots of pregnancies or not,correct?Thanks again for taking the time again. With every case I learn so much to apply to others.Alison Unterreiner, DACM, L.Ac.Practitioner in Nashville, TN?Sep 01, 2021ReactHi all -Wondering if anyone has recommendations for an acupuncturist in Nashville. Fertility experience a plus.Thank you!Alison ReplyMaryanne Travaglione NewSep 08, 2021 | Edited1ReactI do not know personally but have heard of Judy Gibson as a reliable practitioner and she has a focus on fertility. I looked her upand she is at 7diectionsacupuncture.com. Hope this helps ReplyAlison Unterreiner, DACM, L.Ac.NewSep 08, 2021ReactThank you so much!Elaina GreenbergNeed help: patient with severe water issuesNewAug 28, 2021React
36 yo male. Very talkative and intense man. Very fit but not sinewy, shorter stature, with thick black hair. Has a tendency to talkpast me and hard for me to lead the intake. Provides incredibly detailed information that isn't very helpful for dx. Gets tangentialvery easily. Coming in for "water metabolism issues." Sx started after 2 days working outdoors in 110+ degree heat in 8/2018,hasn't been the same since. (I have done my best to hone in his symptoms and organize them, in nearly 20 years of practice, Ihave never had such a difficult time getting useful information from a patient). He's a nutritionist and very conscious his reactionsto the minutiae of food and water / mineral intake. He has seen many providers of varying modalities to try to help but hasn'tfound the help he is looking for.Symptoms with too much water (too much being 8oz / day)Brain Fog - w/w sweating w/w drinking water prefers cold water but drinks room temperature parched but unable to drink b/c difficult to think no sensation of heavy headed or water in head eyelid spasm, sty in eyes, or mouth sores with too much water describes it as an inability to think, is normally very task oriented and driven, but with too much water (as in 8oz is too much) willget distracted, have poor memory, and lack motivationJoint pain - w/w warming food / spices - cumin, coriander, chili w/w fatty foods and Vit D joints in hands and fingers L shoulder blade R neck and traps R popliteal fossa painWhite Hair - patches of white hair over night if too much water if drinks more than 16oz water will wake with white hair b/w Ca supplement - but Ca causes constipation Muscle twitch eyelid and muscle spasms with too much waterSo very thirsty but unable to drink water because of above symptoms. He will rinse mouth out with water to try to alleviate beingparched yet unable to drink.Urine- urinated way more than drinks hesitancy no cloudinessDigestion- Strong appetite but has to overeat to not feel hungry has to be overfull to prevent blood sugar issue not voracious, but forces self to eat more to prevent waking at nightpoor TT fcn with many foods, especially cheese and dairy pebbly BM little blood little mucus 1x/ day bloated slow digestion burps a lot after lunchRectal Itching - started 1990 w/w seafood feels in middle of the night or can feel all the time b/w Ayruvedic herbs but herbs caused joint pain hx dry rectum b/w Ayruvedic herbs Does not know what Ayruvedic herbs were given or their energeticTemp - vegan for 6 years now eats what can and always cooked loves heat but sensitive to heat Sharon Weizenbaum,Guy Sedan
windy days gives bad gas runs warmThin / brittle nails - fungus yellow nails brittle and cracked ridged nails dry skin bottoms of feet dry red peeling skinMigraines - L temporal HA with wifi w/w Ca and if hypoglycemic has had 10 this year no hx of migraines or HA b/w cheese - will be gone in 15 minutes but causes constipation blurry vision > can't read > aura > fatigue > HA global > DRAINED > unable to fcn after HA no nauseaSleep:not ideal even with 7 hours used to function well with 6 hours now dragging with 7 hours / night doesn't wake restedrestless hot at night easy to fall asleep wakes around 2:24am easily but falls back asleep naps around 15 min at 3pm - deep sleepLibido:patient reports strong libidoif doesn't masterbate daily, will have night time spermatorrhea after 1 month while has strong sex drive, can be depleted after sexTongue:thick yellow coat in back - tacky peeled front 1/2deep small center crackdusky pale bodyred papule on tippurple fissures on sidesscallops +2 out of 3 vessel distentionPulse: Wiry FloodingL guan fullestZang Fu DiagnosisDamp in UB Sp Yin Xu Sp Qi XuKid Qi Xu Stomach Fire Phlegm in MJ and LJ Water glomus6 Confirmation Dx (help please)Yangming ShaoYinFormula (help too)Gan Cao 3.1gGua Lou (Gua Lou Shi)4.6gJu Hong 4.6gRou Cong Rong 6.2gFu Ling 6.2gBai Shao 6.2gBai Zhu 11.6gJi Nei Jin 7.7gZhu Ling 6.2gZe Xie 4.6gTian Hua Fen 9.2gpatient took 1 spoonful 2x/ day with meal and very minimal water for 1 day. After the small dose of herbs he reported"unbalanced hypoglycemic energy" which he described as -electricity in my fingers, not grounded, anxious energy R eye twitching that started after taking morning dose of herbs that lasted all day Was exhausted with brain fog and had to nap that was more described as "forced sleep by necessity" Horrible night sleep - physically restless, nocturia 1xThoughts: In retrospect, I don't think I did anything to address the glomus and YangMing block.
3 teacher remarks1 reply 11 reply 1Feedback and support is very welcome. Thank you in advanceJPEG | 98.3 KIMG_4098 ReplySharon Weizenbaum NewAug 29, 2021ReactHi Elaine,What really stands out to me is the water stagnating in the middle and lower body. With the strong Yin Xu signs, it is clear thatwater is not being absorbed. Water can definitely cause glomus. I'm not seeing phlegm. Where do you see that? I see his digestionin effected but not that Yangming is not functioning. It seems it's being bogged down by pathological water that is not beingabsorbed into physiological Yin.I would suggest Wu Ling San first. I would add Shan Yao, Tian Hua Fen and Tai Zi Shen. Also increase Bai Zhu to bring the waterinto the Large Intestine.Does this seem to fit?ReplySharon Weizenbaum NewAug 29, 2021 1ReactYes, you could also add Bai Shao for the lack of fluids in the muscles = twitching.Higher dose of Bai Zhu is 3X average dose of other herbs.Between meals and he can take it in water but with just enough water to get down. Let us know!
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2 teacher remarks1 reply 13 more comments3Judith KenenResticted breathing and pain-help soon please, px moving to Panama!NewAug 26, 2021ReactQuestion for teacherI'm working with a 30 year old woman who has had tightness in her chest, muscular chest pain and restricted breathing for 10years! She is tall and thin and has ashen coloring. Shiny shen in her eyes and very sweet. She can't ever take a full breath exceptafter exercising really hard. She always has mild pain from cv14-cv10 and on Ki, St and Lu points on chest which are all tender tothe touch. When she eats, the pain and restriction gets worse. She used to have burning in her throat and chest as well which shecontrols with diet. She strikes me as very tight and controlled. We have discussed her relationship with anger and her discomfortwith it because of family hx with very angry parents. I have done some guided imagery with her and when she gets moreemotional, pain gets worse and she gets palpitations, but in her day to day life, her mood is generally good. She is going to look fora therapist who does somatic work. Otherwise she is very healthy, no issues with bowels, thirst, urination, menstruation, etc.Her tongue is pulled in on the sides, color normal. DX: Shao yang and Jueyin with mixed hot and cold glomus. I combined BXXXTand Xiao Chai Hu Tang and added Bai Shao. She reported that the general pain and restriction remained the same but that thepain didn't increase after eating, which is an improvement. So I kep her on BXXXT on pill form, and then gave her a combo of GanMai Da Zao Tang and Si Ni San, w/18 of Bai Shao, 12 Zhi ke instead of Zhi shi, and added Hou Po. She reports after a week thatsymptoms aren't improving, but that she isn't experiencing any exacerbation of symptoms. I'm thinking of upping the Bai Shaoeven more and upping the Chai hu as well, and maybe adding Dang gui and Chuan xiong. I would love any guidance andsuggestions. My heart really goes out to her.ReplySharon Weizenbaum NewAug 26, 20211ReactHi Judith, Thanks for the case.I wonder if there is epigastric hardness. The reason I ask is because she is thin. I am not sure what led you to a mixed hot and coldglomus pattern but I'm wondering if it may be more of a deficiency dryness of the spleen. I am also seeing that the glomus is acausative factor for the breathing difficulty so I may consider this as an upsurge. I am thinking about Gui Zhi Jia Gui Tang withDang Shen. Check the epigastric area for resistance and that would confirm the Dang Shen for me. Also check the pulse. The GuiZhi Jia Gui Tang pulse would most likely have a floating pulse in the Cun, either one but mostly left. If there is wiriness in the Rguan, increase the Bai Shao. I do see the wood involvement but, for me, Gui Zhi Tang treats wood blood deficiency. It would alsomake sense with the palpitations. With her being so thin, the parching of BXXXT might be too much for her.Does that seem to fit?ReplyMargaret Sikowitz NewAug 26, 20211ReactLet us know how it works and I wonder, is she coming in for acupuncture? I'm using lots of LV 14 like a key that allows thediaphragm to move more freely, and/or pairing LV14 + LU 1. I'm sure folks here will also have a very thoughtful SAAM appraoches.
2 teacher remarks2 more comments2Candace Jania Practitioner in Tel Aviv?NewAug 26, 2021React@Keren SelaHi all! I have a patient that is spending a few months in Tel Aviv and she needs an acupuncturist for fertility support. I can't find anyinfo online for Keren, so if anyone can let me know who is practicing (Keren if you see this you too!) there that would be great!Keren SelaReplyCaroline Radice NewAug 26, 2021ReactHi Candace: a long ago classmate of mine is also practicing in Tel Aviv and is friendly with Keren and may be able to help. Pleaseuse my name and email him at nshraibom@gmail.com his name is Nadav.ReplySharon Weizenbaum NewAug 26, 2021ReactHi @Candace Jania, I am tagging some greats in or near Tel Aviv but also don't forget our global map! There are all people I knowpersonally to be wonderful practitioners @Keren Sela @Guy Sedan @Adina Kletzel @Sharon Gamzo.For those who I tagged who are not on the map, make sure to put yourselves there!Keren Sela,Guy Sedan,Candace Jania,Adina Kletzel,Sharon Gamzo4 earlier comments 3 4 teacher remarks2 replies 2Sage Staggs (she/her)Long covid forum?Aug 19, 2021ReactHmm, I seem to remember seeing an announcement for a long covid focused group- was that on here? Apologies if this isn't theright place to ask- I didn't know where else to go! ReplyMargaret Sikowitz NewAug 26, 2021ReactIs it possible @Sage Staggs that you're referring to the excellent presentation that @Candace Jania did a while ago? I tried to find itand perhaps it is archived. Now I'm seeing a combo of Long Covid folks and recovering from breakthrough people and wonder ifanyone here finding correlations or patterns in the folks coming in for Long Covid or breakthrough Covid?The patients run the gamut, I'm finding, but the theme post illness is a raft of 'crappy blood' related symptoms. (Can we say that here? I associate this phrase with my first GMP, also known as 'How I learned I was abusing tonics'.Candace Jania,Sage Staggs (she/her)Margaret Sikowitz NewAug 26, 2021 1ReactLive and learn...oh, the other gem I repeat often: Treat what you see! Good luck and keep us posted.
7 more comments 7Reply1 teacher remark1 reply1 replyMolly ShapiroCEUs for Buddhist Precepts Ethics courseAug 17, 2021ReactQuestion for teacherI took the quiz for Toby's Buddhist Precepts Ethics course, but haven't received notice from NCCAOM to print the CEU certificate. Itook the quiz again a week later, and now it's been several weeks. Have others received their CEU certificate for this class?I'm wondering if there is something else I need to do on my end to get proof of these ethics CEU's? I know the course will only beavailable until the end of this month, so I thought I'd ask now in case I need to take the quiz again.Thank you for any suggestions or feedback, and please let me know if there is a better discussion forum to post these types ofquestions. Thank you!Your Friendly Admin ReplyMaryanne Travaglione Aug 18, 2021ReactI don’t know the answer, but I can recommend checking in the NCCAOM website as the new site offers the possibility of teachersdirectly sending the information to the NCCAOM and the ceu listed right away to the certification site under your # ReplyEmile Sorger Aug 19, 20211Hi @Molly ShapiroThanks for asking about that. Things are a little delayed with these CEUs but there's nothing else you need to do on your end. Wehave your quiz and it's just taking a little extra time. I'd say for future reference a question like this will be answered more quickly in the Technical Support Forum.Molly ShapiroNaomi FrankF - 33, CPTSD: Anxiety; hypervigilance, tics, panic attacksNewAug 09, 2021ReactQuestion for teacherI would be so appreciative of anyone's input on herbs and dx/process.For context: I am a new GMP student and tho did I herb training years ago have mostly had an acupuncture practice, using patentson occasion for cases I considered straighforward and referring out at other times. I'm jumping in the deep end with this one andI'm not sure if herbs are even a good idea given the meds she is currently taking (which she would like to get off of). I will add mysymptom analysis in another post. Sorry it is a long read.... and thank you for your time.Sharon Weizenbaum,Sally
____________________The patient is a 33 year old female with a sturdy build. Her main symptoms are very evident, happening multiple times every hour.They calm down with acupuncture but the results don’t last.Chief complaint: "C-PTSD" which manifests as constant hyper-vigilance, exaggerated startle reflex, motor and vocal tics, panicattacks. She has with nightmares, flashbacks. These symptoms are rated 9/10 and have slightly improved with acupuncture visitsand medications.These difficulties started 18 months ago while getting out of an abusive marriage and have been recently exacerbated byresponding to fatal and near-fatal overdoses at work including finding a body of a friend in a tent. She's recently been put on leavefrom her work in a shelter. She has 2 small children and finds that the symptoms recede when she is taking care of them and ableto feel more anchored in the immediate moment. They are aggravated by stress and also by a lack of routine being off work. Shetakes medication for ADD, and was dependent on amphetamines in for some time during her high school years.Temperature: she tends to heat and is warmer at night. Intermittent sensation of coldness on L dorsal foot (GB, maybe Stchannel) that she needs to warm up with heat pack in colder weather (also see Emotions)Thirst: she drinks frequently as a habit but does not force fluids. Dry mouth as a side effect of Aderall (taken for ADD)Sweat: her skin is moist and it takes vigorous movement for her to break a sweat (then it will mostly affect her face). She is alsonot getting much exercise. Feels she is craving physical activity.Digestion: she has cravings from junk food especially at the end of the day. She has no appetite in the morning but we think thishas to do with being a single mom to 2 young kids. BMcan be sluggish and sticky, recently eliminating more easily but stools are very thin. She has gained quite a bit of weight during thelast 18 months.Urination: normalSleep: hard to fall asleep unless she is physically exhausted. Feels on edge and craves stimulation. Frequent nightmares. Feelsnervous energy in her body when can’t sleep, described as buzzing empty feeling. Compulsive behaviours like skin picking areworse at night. Can experience heaviness in chest, and above eyebrows, and pressure around Lung 1.Pain: has a large abdominal wall hernia since first pregnancy (2016) aggravated after 2nd pregnancy (2018). Causes pain and shecannot lift heavy objects. She describes a chronic stuck/tender area on R side of ribs. Was checked out in ER last year when thiswas bad, it was dx as a shingles flare up.Surgeries: 2 C sections - 2016 and 2018.Menses: regular cycle; spotting (brown) for 2 days before flow starts. Can have spotting mid cycle (related to passing larger BM,she thinks) Chest tenderness pre-menstrually. Dysmenorrhea some months: pain and tingling in tops of thighs, shaky legs, jittery.will feel flushed if this happens. WW pressure.Emotions: fear which can cause teeth to chatter, cold, tingling, lack of ability to speak. Has desire to run away but fear of goingoutside, wants to hide in a corner. Also descries a draining and emptiness and says that “everything feels just out of reach”.Anxiety can feel cold: e.g. a rising sensation of coldness from Heart 8 to armpit and behind her jaw. (also see Sleep) Pulse: thin, tense, sometimes rapid. Feels submerged and indistinct.Tongue: pale, lavender, greasy coating, inflated rim, redder tip (photo attached)Medications:Adderall - ADHD (has taken for a long time)Zoloft - PTSDPrazosin - PTSDAtivan - PTSD
1 teacher remarkJPEG | 152 KACtop5AugNaomi FrankNewAug 09, 2021ReactSymptom Analysis - I attempted ‘for sure’ in italicsI have not yet done abdominal palpation in person (will give this a go in clinic tomorrow - it is a very a new skill for me.) I did haveher check for glomus during the herb intake, which I do online - I don’t think she has one.Anxiety:skin picking / compulsive movements - Qi moving uncontrollably [?]exaggerated startle reflex - Qi moving uncontrollably [?]motor tics - Qi moving uncontrollably [?]vocal tics -Qi is escaping/moving uncontrollably [?]anxiety presents as coldness in Ht channel - Heart involvement - cold damageteeth chatter with fear - Qi moving uncontrollably [?]many upper body symptoms:WW lack of structure/routine: Wood involvementInsomnia:hard to fall asleep - Shen cannot settlewakes frequently and anxiously - Shen cannot settlebuzzing empty feeling -tension in upper body esp thumb & index finger - tension in Lu/LInt channelsnightmares: Heart involvement, Shen unsettled
1 reply 1Reply‘ADD’ aggravation:poor short term memory - Qi not available in headpoor concentration - Qi not available in headshe sighs/deep breathes when stressed - Qi needs to exityawns a lot - Qi needs to enterSweat/fluids:hard to sweat - surface is closedsweat is on face -dry mouth (side effect Aderall) - moisture not reaching mouthDigestion:cravings for junk food in evening (snacking is coping mechanism) - not well nourishedcan tend to sluggish stools - Qi deficiencythin, sticky stools - Qi deficiencyPain:abdominal wall hernia: deficiencytender stuck area below R ribs: Wood involvementMenses:brown spotting pre-menses - blood stasisdysmenorrhea in some cycles: - blood stasispain worse with pressure - excesspain & tingling, shaky legs and jittery (with dysmenorrhea)feels flushed (with dysmenorrhea) - Yang not containedthinks heat would be comforting - coldbreast tenderness premenstrually - Wood involvementTongue:pale - deficiencyredder tip - Heart heatlavender hue - Blood stasisgreasy coating - Dampnessinflated rim - Wood involvementReplyAdam BroderNewAug 10, 2021ReactI am also a first time GMP student but wanted to take a crack at sharing my observations. I also see a lot of Wood involvement,plus cold, blood stasis and Yang not rooting. I don’t know if we consider channel trajectory much here. The tongue looks to havesome slight teeth marks so maybe the Spleen is involved somehow. As for the surface being blocked, you said her skin is moist, somy understanding is that that indicates the surface to be open even though it takes a lot for her to sweat. Along with the flushingand maybe some of the other findings that could indicate the use of Gui Zhi. Definitely a lot of emotions at play here too. Thanksfor sharing, I’ll be interested to hear what more seasoned folks have to say.
12 more comments121 teacher remarkAnn ClearyHigh Fever in 4 Year Old (my daughter)NewAug 05, 2021 | EditedReactQuestion for teacherHi all, I would love some feed back on this case, my daughter. She called me in her room tonight after falling asleep because shehad wet her bed. I thought this was unusual because she had two other accidents today while sleeping and she hadn’t drunk toomuch before bed and hadn’t skipped the potty. She’s been potty trained for a while now, and occasional accidents do happen, butthat was a lot in one day. All were while sleeping. When I touched her I realized she was cooking with a high fever.Tip of tongue is red, pulses rolling, rapid, big, highest in the center (I rolled one finger over the three positions). I asked her if herhead hurt or her body and she said the top of her head hurts and the outside of her body. She told her dad a bit later that herhands around pc 8/ ht 8 also hurt. Her cheeks were flushed. She was in a good mood, interacting normally. Her lips seemedredder and she asked for water several times, of which she just had a sip each time.Other relevant information— she ate normally at dinner and we spent the late afternoon in a park that had a water feature thatturned off at 6pm, still warm out. At dinner (tacos outdoors) she complained of being cold. I was chilly too because it’s the time ofday that the temp drops, but she does not usually notice this.This looks like yang ming heat and bai hu tang to me. I would just like outside verification that the body aches don’t mean it is stillin the exterior. But line 176 seems to allow for bai hu tang for some sort of acute attack, despite confusion over if the lines havebeen transposed. Also line 219 says "if there is sweating, prescribe bht, ", and she has none. If bht is indeed appropriate, whatdosage for a four year old?I did a little gentle guasha on her and shonishin and her fever has come down a bit. Any suggestions for body work alsoappreciated.Thanks so much. This kid has gotten hot before but it was all pre-pandemic, and I was never concerned about her body’s ability tomanage, especially because then as now her mood and energy were not worrisome. Of course now, Delta is in the back of ourminds and I don’t want to wait to intervene.Sharon Weizenbaum,Margaret Sikowitz,Caroline Radice,SallyReplySharon Weizenbaum NewAug 05, 2021ReactHi Anne,For me, the body aches mean that the pattern is still, at least a bit, on the exterior. It sounds like a Bai Hu Tang pattern to me butyou can also give a nod to the exterior by adding some Ma Huang, if you have it. If you don't have Ma Huang, you can add someJing Jie and Fang Feng. If by the time you get this, the aches are gone, I'd leave out the acrid warm herbs.Do let us know.Margaret Sikowitz NewAug 05, 2021ReactHi Anne - Oh a sick kid, always tough. I love that you went w/shoni shin, and how great she could identify those areas near end ofchannels where she felt pain.I (also) always went with those end of channel areas for the little ones, sometimes shoni shi, sometimes massage with with a goodtug/massage on the jing well points often with a quick needling (w/out retention) for whichever channel seems most prudent
1 reply 11 more comment1Reply(teething, oral discomfort - LI 1/urinary issues, SI 1, sleep disruption, HT 9) .It sounds like what you are observing is common, perhaps more alarming given Delta etc, but these little ones heat up fast, andthat usually dissipates fast. Good luck w/all - keep us posted.1 more comment1Amy JennerPractitioner in New London CT?NewAug 04, 2021ReactI have a young patient starting college at U.Conn and am hoping for some support for herThanksReplyMaryanne Travaglione NewAug 04, 2021 | EditedReactYou might want to look up Kathleen Poole, I believe she is in New London and could be a good suppotReplyClaudia Citkovitz NewAug 06, 2021ReactKathleen is great! Mysticriveracupuncture.com1 reply 1Alison Unterreiner, DACM, L.Ac.Referral in New Orleans, LANewJul 19, 2021ReactHi all -Not sure if this is the right place to post, but I'm looking for a recommendation in New Orleans.Please let me know if there's anyone you would recommend.Thank you!Alison ReplyMaryanne Travaglione NewJul 21, 20211ReactI have heard good reports from folks who saw Kate Iberg.
3 more comments3ReplyMargaret Sikowitz NewJul 22, 2021ReactHad hoped to find someone here: https://whitepineinstitute.instructure.com/courses/230/pages/global-map but alas, hopeMaryanne's referal helps.Judith KenenBlocked menstruationNewJul 14, 2021ReactQuestion for teacherHi everyoneJ! I've been treating a 40 yr old woman who is waiting for her period so she can do an egg transfer but her period won'tcome! She has a history of irregular cycles, 22-42 days, but she is on day 56 now and still no period. Hx of fibroids. Her periods arevery painful in her back and she only has a full flow with clots for 1 day and then a day of spotting. She gets migraines before theperiod and also gains a lot of water weight premenstrually. In general her flesh is squishy all over her body and she is overweight.Slight swelling in ankles. Cold in general, especially extremities including nose. Loose stool. Skin is dry and prone to excema. Lipspurple. Tends to be thirsty for room temp, urination normal. Mild Blood xu symptoms.Her abdomen feels very squishy when you feel it at first but as you go in deeper it feels very full and very painful, intense oketsuon both left and right.Tongue;slight purple, pulled in on sides, dry, dark marks on the tip, some distension underneath.I diagnosed her with Sp def, mild blood xu, systemic blood stasis as well as localized blood stasis in the uterus, and damp in theflesh and lower jiao. From her signs and symptoms, I would explain the blood stasis as coming mostly from the damp. I don't seeany Yang Ming or Shao Yang pathology but the stasis in the belly is so strong, and her period seems so blocked that I wanted to doa little purging but wasn't sure if da huang was approporiate since I understand it to be more for a Yang Ming block.I gave her a combination of Gui Zhi Fu Ling Wan and Dang Gui Shao Yao san. She felt less puffy, better in general and began tolose some weight but then it plateaud and she didn't get her period. So I added some herbs with more of the moving throughaspect and gave her Gui zhi 9, Chi Shao 9, Mu Dan Pi 9, Chi Shao 9, Fu Ling 15, Chao Bai Zhu 12, Chuang xiong 6, Ze Xie 9, ChuanNiu xi 12, Ze lan 9, Da Huang 3 and still no period.Really would like to clear some more stagnation before she tried to tranfer the only embryo she is to give her a chance of itworking.Would love any thoughts or suggestions. Thank you.JPEG | 71.5 K
2 teacher remarks2 replies 21 more comment1Nirjary ReplySharon Weizenbaum NewJul 16, 2021 1ReactHi Judith,Your diagnosis seems spot on to me. As for what to do, the focus really depends on whether there is a real block there now. Iwould check to see if she feels a strong sense of fullness that she feels a period would relieve. This shows you whether the dam isblocking and that there is a build-up waiting to discharge. The other aspect that is important is the pulse. You have to see thesesigns of fullness to purge as you are suggesting.She does have a block but there is also the tide of the menses to work with. She may have missed a period and now there hasbeen a retreat of the flowing. I would suggest waiting to purge the blood stasis until that fullness is there again.Also check about whether she strongly craves warmth during her pain time or if there is membranous dysmenorrhea. If she doescrave warmth, you will definitely need a good warming method. You could perhaps use Dang Gui Si Ni Tang Jia Wu Zhu Yu ShengJiang premenstrually and then, when the fullness comes, add Tao Ren, Chuan Niu Xi and maybe Da Huang. Does that make sense? ReplySharon Yeung NewJul 20, 2021ReactI agree with Sharon W. that I would inquire more into cold signs as it does seem to be involved based on your description.Warming can move the blood and transform the stagnant fluids.As far as whether or not she has skipped a period, has she been tracking her cervical fluids? I find that knowing when egg whitecervical mucus arrives helps to determine when to expect the period. Did she take any meds last period in preparation for the eggtransfer or was it a natural cycle?Adina KletzelWeird sensation at nightNewJul 11, 2021ReactQuestion for teacher50 year old womanMC: At night starts to feel a really weird sensation starting from her bladder that shoots down to her toes and up through herarms to her fingers. It is a weird uncomfortable feeling that is like fingernails on a blackboard. It is just strange and terriblyuncomfortable.She wakes up from it and the only thing that helps is getting up and going to the bathroom.When she goes to the bathroom her bladder is really full.She empties it out and then the next time the bladder fills up again it happens again.This happens 3-5 times a night.She thinks it started during radiation from breast cancer.At that time she also started hormone therapy and got her second covid shotDuring the day the bladder can be full and this will not happen.In addition in the past week she has a feeling a warmth running over the surface of her body
Her hands and face feel especially warmSC: feels a lot of stressGets nervous about things and gets all tight insideAppearance and demeanorThin, thin boned, sallow dark complexion, mole on St 1, dry lipsSymmetrical but looks washed out and tiredShe is uptight, anxious, stressed, gets annoyed easilyTalks a lot – tells a lot of details of her issuesAttention to detailA bit strong and forceful in her outlookDoes feel a bit heavy. Not a light energyLikes things to be done a certain wayLifestyleWorks full time for a companyFeels a lot of work stressMarried with 4 childrenAll girlsOldest is 24 and youngest is 18Very involved in her girls emotional lives.Diagnosed with breast cancer last November.Had surgery, radiation and now taking hormone therapyBody morphology and flesh qualitySkinnyThin skin, not a lot of fleshSkin is not dry except for skin on faceEmotionsGets angry but more from a place of being overwhelmed at all that she has to doHas a short fuseCritical of selfFeels a bit heavier and down since finishing radiationNervousLikes to be busyFeels still needs to be supported and coddled since having breast cancer but since treatment is over does not get it and she feelsmore down
MedsTakes meds for high blood pressureMeds for hypothyroidGICan get very gassy if eat heavy foods or too late at night. Will also feel bloated.Has a bowel movement every dayLactose intolerance - gets gasGets nauseous when stressedHigh stress makes her vomitWhen found out had breast cancer could not eat for first 3 weeks. Lost a lot of weight.Body TempUsually feel more coldHates being coldAlways keep a sweatshirt handyLately she is feeling more hotUrinationHave to pee soon after drinking waterAt night sometimes takes a couple of minutes for pee to start flowing outBodySays is sensoryLights from police car botherWears sunglasses in sunHas a kidney stoneGet headaches if don’t drink enough or from stressShe has TMJ and grinds her teeth at nightShoulders and neck are very tight and stiff.She feels them all of the time and are painful.She rates the pain at a 9TongueRed tipSides paleOn the paler sideSmall, short tng
Dip in kidney areaAbdomenLower abdomen is more firmSome rib side tensionHear bubbly sounds in stomachPulseL – very wiry and pulled tightR – weaker than right side but also wiry.Weak in cun positionDiagnosisLiver blood def.Liver qi stgKid qi def.Wood invading earthI thought to strengthen her kidney qi, nourish blood, and nourish and volatize fluids.I thought to give herJin gui shen qi wan +si ni san + Si wu tangRou gui 3Gui zhi 4Sheng di 18Shan zhu yu 12Shan yao 12Ze xie 8Fu ling 9Mu dan pi 12Chai hu 12Bai shao 20Zhi shi 9Gan cao 9Tian hua fen 10Dang gui 9Chuan xiong 4Mu li 12
2 teacher remarks1 reply 19 more comments9I would love to hear some feedback and suggestions.Thanks!ReplyAdina KletzelNewJul 11, 2021ReactJPEG | 57.5 KCaryn tongueReplySharon Weizenbaum NewJul 11, 2021ReactHi Adina,Can you be specific as to what your question is?9 earlier comments 11 reply 1Joy BlaisFireball in the Clinic!Jul 10, 2021 | Edited 1ReactDoes anyone have a TDP lamp recommendation (specifically a brand and supplier to get a good one)? My lamp just exploded intoa blaze of glory. I've heard that the lamps made in Japan are a little safer than the ones made in China, but I honestly don't know.All I know is that I don't ever want to see a fireball in my clinic again. Thanks for your help!P.S. does anyone use a dual head lamp? Would you recommend it? ReplySharon Yeung NewJul 20, 2021ReactI agree that my TDP lamps often get wonky but I have successful been able to fix them or send them out to be fixed. I gotfrustrated with them at some point and bought an infrared lamp and within the year it was broken and I needed to throw it out.So my current TDP lamps of over 10 years may have some mismatching nuts or bolts in the neck, a safety pin instead of a turndial, and have been sent to the TDP hospital at least once, but they're still going strong!
2 more comments2 ReplyAnn ClearyNewAug 05, 20211ReactI was so excited to hear about your fireball of a patient, but this was good, too. I hope the new lamp lasts just as long and thenlonger.Molly ShapiroBowels stop moving without Mang XiaoNewJul 08, 2021ReactQuestion for teacherHello colleagues, I presented this case to Sharon for one of my case reviews. I am copying the original intake below. In a nutshell,this patient has significant swelling and pain in her lower body, hypertension, and a block in the large intestine. Pictures of legsand abdomen are included. The treatment principle was to open the bowel with Tao He Cheng Qi Tang. Once the belly softens,ideas like Gui Zhi Fu Ling wan and Dang Gui Shao Yao San were discussed. Initially everything went great with the THCQT. Whereasshe had been only moving her bowels once every 4 days with a stool softener, we found the right dosage of THCQT and she wasmoving her bowels daily, normally. She reported improvement to energy, but nothing else changed. Abdomen didn't soften,swelling and pain didn't reduce, blood pressure remained about the same. Every time I try to change the formula, the bowels stopmoving. Even with high dose of Tao Ren in GZFLW or using Da Chai Hu Tang. Her abdomen remains very full and tight. SometimesI am able to find a slight Oketsu finding on the R side, but it is hard to find/not strong. It is also really hard to dig down deep to findit. Is it possible that she needs THCQT long-term? Is that safe? I get anxious to get her off of it because it seems like a short-termpart of the overall treatment plan. I would love to hear from others who have more experience than I do using Mang Xiao. Andperhaps there is something else to try that I am not seeing. Thank you for taking a look and for your feedback!70 year old woman who first came for treatment 8 years ago for knee pain and weight loss. During this time, pain has beenmanaged with acupuncture and cortisone shots, but has not resolved or improved.Main complaints:The patient has lower body pain in her back, hips, knees, ankles, and feet. Most bothersome is bilateral knee pain that is deep,dull, achy, and stiff. It is worse in cold or damp weather, the morning, going downstairs, after eating processed foods, and withwalking. After walking her legs become sore with tight and painful muscles. The pain varies from a 1-6 out of 10 and is better withrest, support, ibuprofen, acupuncture, cortisone shots, and pain patches.The patient also presents with swelling in the flesh all over her body with substantial edema of the lower legs, ankles, and feet. Theskin of her lower legs is stretched taught and indents only slightly when pressed. The skin stays indented and does not spring backwhen released. Picture attached. After sitting for long periods, the skin on her lower legs gets warm and red, and the swellingaround her ankles increases. The skin on her lower legs itches at night. The edema is worse after eating salty foods.Appearance:The patient has swollen flesh all over her body. In addition to her large lower legs and feet from the edema, her abdomen appearsparticularly large and distended. Picture attached. Her complexion is pale, sallow, dry, and dull. On most visits, it is noted that theskin on her arms is blotchy red.General:The patient is a Librarian and has a very sedentary lifestyle. She sits most of the day, gets outside rarely, and uses all of her timeoff to nap and rest. These tendencies have increased since Covid. She has very low energy and motivation for things like cooking ameal. She is highly intelligent and very kind and funny, but presents with a constant underlying sadness. When she feels emotionalshe gets a tightening in her abdomen and a flushing up of nervous energy. She cries easily. She is a widow and lives alone with hercat.Thirst/Sweat/Urination:The patient reports a dry mouth but says she hasn’t felt thirsty in years. When she does start to drink water, it is pleasing and shedrinks a whole glass, but she easily forgets to drink while working. After she urinates initially, she has to wait on the toilet for therest of the urine to come out. Urine is pale to light yellow. She reports drinking and urinating more on the weekends when she is
not working, and she drinks mostly hot tea. If she drinks water close to the time she goes to sleep, she will wake up 1 time tourinate; otherwise she does not urinate at night. She reports sweating easily, but not copiously.Appetite and Digestion:The patient is Finnish and craves a lot of salty foods like smoked fish but also eats packaged lunch meats and processed foods.She has allergies to some raw fruit and vegetables with an itchy mouth as the reaction. The patient takes a daily stool softener forhard and dry stool, and moves her bowels 2-3x/week. Without the stool softener, she does not move her bowels and they becomehard and difficult to pass. The bowel is also less dry and hard with increased water intake and eating papaya. When moving herbowels, she reports the passing of a thick plug of stool followed by formed, but soft stool. She notes more swelling in her legswhen she has not moved her bowels. There is lower abdominal fullness associated with not moving her bowels, but no pain ordiscomfort reported.Temperature:Patient has an aversion to cold weather, but likes windy weather.Other:Seasonal allergies to pollen with runny nose and a non-productive cough as the symptoms. She has shortness of breath withexertion. Once every 1-2 months, the patients gets a flare of irritation from “lichen sclerosus” that comes with itching around thevagina and rectum. The skin feels raw, like it’s chafed, and burning, and is worse with sitting. It lasts 2-3 days and is treated withsteroid cream.Medical history:Current Medications:Gabapentin 800 mg /2xdayCyclobenzaprine 5 mgCandesartan 32 mgHydrochlorothiazide 25 mgVerapamil Er 240 mg /2xdayLivalo 2 mgClobetasol cream 0.05%Colace 100 mg /2xdaymultivitaminIbuprofen up to 4x/dayHerbs taken sporadically over years. Past outcomes include:Ob/gyn history: Uterine polyps, 1 healthy pregnancy and delivery2014: Surgery for abdominal hernia.2017: Hysterectomy for thick endometrium with cancer cells + 4 weeks radiation.Western medical diagnoses include high cholesterol, high trigylcerides, elevated A1C, and hypertentionZhen Wu Tang: irritable and like her blood pressure was increasing and an overall “funny” feeling like she was having hallucinations.Wu Ling San reported feeling racy and jittery.Jin Gui Shen Qi Wan associated with itching and palpitations.Xiao Chai Hu Tang gave panic attacks and nightmares.Gui Zhi Tang helps her to resolve a cold.Fang Ji Huang Qi Tang + Ma Huang = more energy, more limber, but dry eyes and waking to urinateFang Ji Huang Qi Tang + Fu Ling = a lot of urination, but an increase in swelling and more constipation (hard, dry, difficult to pass)Current: Gui Zhi 9, Huang Qi 30, Dang Gui 9, Chuan Xiong 3, Fu Ling 9, Ze Xie 9, Bai Zhu 9, Bai Shao 9, Sheng Jiang 6 = possible increase in swelling
1 teacher remark8 more comments8PNG | 413.3 KTongue pic1PNG | 323.9 KTongue pic 2PNG | 450.5 KEdema picPNG | 401.2 KABdomen picReplyCaroline Radice NewJul 11, 2021ReactHi Molly: The Meds and high salt diet I think make this challenging to overcome without continuing treatment as it seems to bequite chronic. I would be more concerned about taking Mang Xiao long term to be honest as it takes out a lot of fluids into thebowel to help move the stool than I would be continuing the THCQT along with mods. Is your concern the blood moving aspect orthe draining aspect? If draining fluids (as in her response to FJHQT + Fu Ling --> more swelling and constipation) what else mightexplain this? What else explains Body Fluids out of right relationship?ReplyMolly ShapiroNewJul 12, 2021ReactHi Caroline, thanks so much for taking a look at this case. During my discussion with Sharon, I was able to see that the edema hereis due to crappy blood, KD Yang Xu, and the block in the LI. Sharon was quite certain that this Yangming block in the LI needs to becleared first before any work can be done on the other side of the circle (as evidenced by negative side effects each time I tried a SiNi method in the past). As for the salty diet, I've come to theorize that she craves these salty foods because of the dry, boundstool. Eventually, the idea was to get to something like Zhen Wu Tang while using Dang Gui Shao Yao San/Gui Zhi Fu Ling Wanalong the way, but not until the excess is cleared first. I'm wondering if I tried to take her off the THCQT too soon, or how I cankeep the bowel open in a less harsh manner. I don't have much experience with Mang Xiao, and my concern is its strong effect onthe fluids in a person with such great fluid imbalance. I do recall a case that Sharon talked about of one of her patients who hadchronic lower body pain and was prescribed THCQT. It didn't sound like a 1-time treatment strategy to open the bowel. Still Ithought I'd check to see if this strategy was safe to use longish-term if the pattern still fits because of the Mang Xiao.
9 more comments 9Judith KenenFacial hair on female client and irregular cycleNewJul 07, 2021ReactQuestion for teacherI'm working with a 33 year old woman who has been trying to get pregnant for a year with no success. She has very few for suresigns and symptoms to diagnose her with:-cold and stasis in the shoulders (car accident)-P/p of cold and wind related to allergies-wood involvement from tongues lightly contracted.She also has some hair growth on face which might indicate an issue with blood not moving through, but I"m not sure that is a forsure sign. She tracks ovulation which happens any time from day 12-19 and her BBT chart shows a dip in her temps about a weekafter ovulation. I don't think either of those are for sure signs either, but please correct me if I'm wrong. I wanted to try and justtreat her on what I saw for sure, hoping that it might help with ovulation, BBT and facial hair. I gave her a combo of Gui Zhi Tangand Gui Zhi Shaoyao Zhimu tang, which helped with the shoulder pain and allergies, but not any of the hormonal/fertility issues..I've thought about adding Tu Si Zi and am open to other suggestions.Thanks.ReplyCaroline Radice NewJul 11, 2021ReactHi Judith: I think a few more details about her cycle might be useful, e.g., timing, quality and color of blood, any PMS or otheraccompanying menstrual symptoms, and anything else on Tongue pulse or abdomen? It is said that women are yin and theirblood goes down in menses and that men are yang and the blood goes up to create facial hair, so does the blood not descendingmake any sense with the rest of your diagnosis? Does the BBT explain what is happening? I would be cautious of trying to use BBTto interpret your diagnosis, but rather use it to explain what you see. Often, from a biomedical hormonal point of view, facial hairin females would indicate an androgen imbalance as is often seen in PCOS like presentations along with other testosterone likesymptoms like excess weight, hair loss, and irregular ovulation, agitation etc. Let me know if this fits your pattern as you say thereis not a lot to go on here.ReplyMarnae Ergil NewJul 12, 2021ReactI second Caroline's comments. What is her cycle like - is it irregular based on when she ovulates and other than the cold shoulderswhat is her body temperature like? As Caroline says, do not base too much on the BBT, but...A BBT that drops about a week afterovulation can indicate that her progesterone is not stable which can make it difficult to hold a pregnancy.
2 teacher remarks1 reply 14 more comments4Nan BakamjianAdvice needed regarding herbs as "anti-inflammatories" for patient doing a round of PRPNewJul 03, 2021ReactHi everyone!I have a patient that is undergoing PRP for a partial tear in her glutes, and has been told not to take any anti-inflammatory medsor supplements for a 3 week period. She also has a very painful knee that the ortho tells her needs to be replaced ASAP. I havegiven her a round of a custom formula based on Du Huo Ji Sheng Tang, and she was also taking some tablets with turmeric, gingerand boswellia (ru xiang) for additional pain relief.I know we are not thinking in the Western term of "anti-inflammatory" when we give herbs, but I am not sure if they count as suchfor the purposes of the PRP treatment. I believe that the restriction is to avoid any prostaglandin inhibition, or platelet aggregationinhibition, because that interferes with the the PRP healing process. I'm not sure where to draw the line for herbal treatment.She has been given a list of foods that support the healing process such as leafy greens, beef liver, oranges, kidney beans, blackeyed peas, and rice (plus other fortified cereals). I hate to see her struggling with so much pain, but also don't want to interferewith the PRP treatments.If anyone has any experience with this, or thoughts about how to approach this restriction with herbs, I would love to hear fromyou.Thank you in advance,Nan ReplySharon Weizenbaum NewJul 03, 2021ReactHi Nan,I don't know much about PRP but it is adding platelets to the area. I think the warning against "anti-inflammatories" is becausethey thin the blood. These would make the PRP less effective. That is my understanding. It is not like taking Coumadin where itwould be dangerous.I suggest doing a diagnosis that completely leaves out the pain she is experiencing, as if you didn't know about that symptom.What do you notice then? Give her a formula for that pattern. I would leave out any herbs that are mimicking pain killers. Ofcourse, if she is very Yang deficient with weak kidneys, consider Fu Zi. In that case warming her up would only help the PRP workbetter. Is she blood or spleen deficient? etc…Supporting her constitution while she is undergoing this would be great.I think it may also be important to be able to evaluate the effect of the PRP, so if she is on pain meds, herbal or otherwise, thatcould interfere with that. How does that sound? ReplySharon Weizenbaum NewJul 04, 2021ReactI think of Du Huo Ji Sheng Tang as a very gentle follow-up formula, meaning that it can support work I've completed to hold. I'venot seen it be effective for pain itself. I wonder what other's experience has been.Do let us know if you need help sorting out the diagnosis!Elaina GreenbergReferral near Bridgton, Maine?NewJun 29, 2021React
1 reply 1Anyone out there?ReplyAmy JennerNewJun 29, 2021ReactI'm in Rockport Maine, on the coast. about 2 hours from Bridgton...Emily RieffelCutaneous lupus caseNewJun 22, 2021ReactQuestion for teacherI am a newbie to working with Classical diagnosis and formulae, and so I would love some support with a challenging case.The patient is a 59 year old woman, ed. software designer, who has been diagnosed with cutaneous lupus. She has a heavy, pear-shaped body, a pale and sallow complexion, patches of darkened skin on her face and whole body, darkness under the eyes, mild-moderate non-pitting edema in her legs, and spider veins on her lower legs and feet. Her voice is deep, low, and restrained, shefrequently sighs, and her qi (to me) feels like it is dragging down. Her belly is cool, watery and sloshy -- I can see ripples just underthe surface, and the lower abdomen is spongy. Her tongue body (see photo) is thin and small, with a crimped look, and a dip in theKD area. The tip is swollen and red, with a midline HT crack. Her lips are thin and purplish. Her pulse is soft, deep, and weak. Guan& Chi positions are very diffuse, as if they fade into nothing.Her main complaint is whole body achey pain and soreness just under the skin. She has episodic burning sensations in her skin,especially at night and especially in the upper body. At those times the butterfly malar rash on her face also becomes redder andpainful. Her clothing constantly feels very uncomfortable -- sometimes it feels better to wear loose things, and sometimes betterto wear tight things. Occasionally she has bouts of itching all over her body. Small cystic lumps form under her skin on her upperback and neck, rise to the surface, and burst painfully. Her limbs feel very heavy and weak, and recently she has noticed weaknessand clumsiness in her hands -- her grasp is not reliable for picking things up and she often drops things.She typically feels very cold in her core and craves heat (three heat lamps! moxa galore!), however plunges in very cold water cansometimes relieve her body pain. Occasionally she has night sweats -- they were more severe a few years ago.Her memory, focus, and concentration are also a significant concern for her, as they impact her professional abilities. She oftenfeels scattered, drowsy, unable to think clearly, and "too exhausted to focus through the fog." Lately it is becoming more difficultto recall simple things, like whether she has taken her medication, and so she has started to write things down more, as a crutch.She has frequent insomnia due to the pain, and to feelings of anxiety about her health. She self-medicates with marijuana andalcohol. Generally she is very frustrated, irritable, and distressed, but "tries to contain it and not lash out."Other details:-Longstanding respiratory seasonal allergies that cause sinus and ear congestion and pressure.-Easily feels full and bloated, "feels fat". Sometimes slight nausea. Stool tends to be slow/sticky, slightly constipated.-Frequent thirst for small cold sips.-Urination 1-2 times per night, otherwise unremarkable.-Long history of ankle, low back, and hip pain -- some veterbrae formed abnormally small due to recessive genetic trait fordwarfism in her family.-OB history of two births, second was a C-section, and one abortion. Uterine ablation for heavy bleeding in 2006.-Trauma history of being thrown from a horse (1980), hit by a car as a pedestrian (1997), and car accident (2006).-Currently taking prescribed hydroxychloroquine and using topical steroid cream for skin eruptions.*************My diagnosis for this patient is systemic Blood Stasis combined with Dampness (in the Flesh, MW, and LW) and Kidney YangVacuity with Heat/ Qi Rising out of right relationship because it is not rooted below and/or stored in the Blood.
My treatment principle is to Vitalize and Harmonize the Blood, Transform pathological Dampness into physiological fluid, and re-direct Yang downward and root it in the Kidney.In creating a formula, I'm not quite sure how to prioritize and stage the treatment goals. Her pain seems so tied to all three factors(Blood stasis, Damp, and Heat), but the root seems to be the KD Yang vacuity. How to balance and integrate it all? Here's what Ihave so far, and I would love feedback! Would you use Fu Zi here? Are there too many ingredients? Do the dosages seemreasonable? This will be an encapsulated extract powder, so I am thinking a daily dose of 12g/day for a body weight of 220 lbs.(Patient is allergic to mushrooms, so I wasn't sure about Fu Ling; also her tongue didn't seem swollen or scalloped).Huang Qi 15Bai Zhu 10Bai Bian Dou 12Shan Yao 12Ze Xie 10Dang Gui 10Chi Shao 10Chuan Xiong 6Mu Dan Pi 6Chuan Niu Xi 6Bai Ji Li 10Mu Li 15Tian Hua Fen 15Shi Chang Pu 3JPEG | 1.8 MIMG_1698
1 reply 11 reply 13 more comments3ReplyCandace Jania NewJun 23, 2021ReactHi @Emily RieffelA few thoughts on your case-I think it is a great start. The one thing I see missing is addressing the LR involvement (frustrated, irritable). For systemic bloodstasis, I think of XFZYT which has both components of moving both the qi and the blood. I would add Zhi shi and hou po toaddress the bloating and constipation with downward qi movement, which will also help the blood to move as well.If your treatment principal is to root the yang into the KD, then there is nothing currently in the formula that would do this and Fuzi would fit the bill. Adding gan cao of course is important to root it down.The best way to see if the formula is correct is to try it! I always explain to the patient the nature of Chinese Medicine and howeasily changeable it is. Often a wrong formula will give us tons of information about the patient and what they truly need will cometo light.Your doses seem good although Shi Chang pu is often used at higher doses and I am not sure it will help at 3 g.Emily Rieffel ReplyMargaret Sikowitz NewJun 24, 2021ReactHi Emily - fabulous case/formula and I like Candace's ideas: try it and you'll know if it works AND adding Zhi shi and hou po; sheneeds help with all that damp, (esp if you can't use fu ling). And good point re: larger patient, larger dosing. Good luck.Elaina Greenberg3 week old baby with jaundice and swollen weepy eyesNewJun 13, 2021 | EditedReactMy long time patient just had a lovely baby boy who is dealing with jaundice and blocked tear ducts that is causing swelling of hiseye lids, and yellow discharge from his eyes, all preventing him from opening them. Their pediatrician feels that they aren'tclearing as fast as they would like.My patient has a traditional Chinese postpartum meal service that is being delivered to her - she is eating plenty of nourishingsoups.Her diagnosis is currently Lu Qi and Yin Xu, Kid Qi Xu, Liver blood Xu - Jueyin confirmationHer formula is Wen Jing Jia Mai Men Dong TangMai Men Dong 24Tai Zhi Shen 15Geng Mi 6Da Zao 8Zhi Ban Xia 3Bai Shao 15Zhi Gan Cao 8
1 teacher remarkHuang Qin 6E Jiao 8Mu Dan Pi 6Sheng Jiang 6Chuan Xiong 4Dang Gui 12Gui Zhi 8Wu Zhu Yu 2Tian Hua Fen 8Tu Si Zi 8My initial thoughts are1. have my patient squirt breast milk in his eyes, that always cleared my kids anything lickety split (we've talked about that and sheis into it).2. Make a jin yin hua with horsetail eye rinse.Here is my big question-1. Can I add something to my patient's formula that is not necessarily constitutional but to help with the baby's jaundice? Do youthink her formula would be helpful as it stands? Or do I go a little on the westernization of Chinese medicine (gasp) and maybereplace Huang Qin for Huang Lian? ReplyMarnae Ergil NewJun 14, 20211ReactHi Elaina -In terms of the eyes, I think that both of your ideas are good ones. As you say, breast milk is pretty great for clearing things up. Iusually use Ju Hua for an eye wash and find that it works wonders!As far as the jaundice goes, honestly, most babies have some jaundice and it clears up as their livers start to function better. Whatthe baby needs more than anything is sunlight and as it is summer (at least in the Western Hemishpere) I would suggest gettingthe baby outside, uncovered, for at least an hour a day. The typical treatment for this is to use the UV lights on the baby. When myfirst daughter was born she aspirated some milk and was in NICU for 18 hours. When she developed jaundice they would not lether go home and kept her under the lights for 9 days. They tried to get me to stop breastfeeding as breast milk can sometimesalso be a cause of jaundice. Mom should keep breastfeeding no matter what and just get baby in the light.Not sure exactly what is going on with the mom but if the formula is right for her, I probably would not make any changes to treatbaby at this point. It will resolve on its own.Sharon Yeung NewJun 15, 2021 1ReactI agree that keeping the formula appropriate for the mother's presentation is the best approach.
8 more comments8ReplyI have used a Ju Hua wash with great effect. Just don't place decocted ju hua directly on the eyelids as a poultice---I made thatmistake once on myself and had an allergic reaction :P. If the parents are open to it, I have also needled newborns shallowlywithout needle retention for blocked tear ducts. They usually don't notice a thing and simply sleep or breastfeed during theprocess.Marintha Tewksburydifficult case of nightsweats and depressionNewJun 12, 2021ReactQuestion for teacherDear ColleaguesI could use some help with this case:Sherry is in her mid-60s; pale and timid with soft, squishy flesh. She has been suffering from incessant night sweats anddepression for over a year. The night sweats are extreme. 2-3 times/night she is hot & drenched in sweat. Each time she sweatsshe must change all her clothes and sometime the sheets on the bed. She is so wet that she slides off of the toilet bowl if she goesto urinate and her hair is drenched. Once the sweating has subsided and she has dried off and changed clothes, she is freezingand unable to get warm no matter how many blankets she puts on the bed. I have observed that the night sweats have increasedif there is extra stress (husband traveling for work, bad news about a relative etc). Needless to say, her sleep is very interrupted,and she feels that she only gets 4 -5 good hours per night.In general, Sherry tends to be cold, lots of blankets and heat lamps help her relax during treatment.Her abdomen is soft and weak in the low abdomen. Pulses are generally tight, deep in the Chi and flooding. Unfortunately, due toCOVID restrictions, I don’t have a picture of her tongue.Sherry has suffered from depression for most of her life. It comes and goes in severity. It is severe at this time. She weepsuncontrollably. When she is speaking, she gets very flustered and tends to shout. She feels that she is unable to leave the house.Coming in for an appointment is a Herculean task. She says she feels too weak to face the world.Sherry has a hard time eating. She feels that there is a constant knot in her lower abdomen which prevents her from swallowing.This knotted feeling increases with stress & is relieved by breathing techniques & conscious focus on positive mantras. 3-4 timesper weak she wakes with nausea and retches clear liquid and is unable to get anything down. Even on good days, she is only ableto eat small amounts of food at one time. She prefers warm food and liquids.Sherry received a diagnosis of Perimylagia Rheumatica last year and has pain that migrates from hips to shoulders to wrists. Herpain is better with warmth. In the past, the pain has been severe and was her chief complaint. Currently, the pain is a 5-6 out of 10is not at the forefront of her concern.For me there is a lot of Yang deficient signs, she is cold, cold, cold. There is some Spleen deficiency in the soft, squishy flesh. Thereis also Kidney Qi deficiency with all of fluid leakage and the weak low abdomen and deep Chi pulses. And there is a good deal ofWood related tension as evident in the tight low abdomen that is worse with stress, and the labile emotions, and the fact that thenight sweats seem to increase when there is extra stress.These are the formulas that I have tried:Shen Qi Wan (4/27/21) Fu Zi Tang (5/14/21) Ze Xie 9 Bai Zhu 12Gui Zhi 3 Fu Ling 9Shan Yao 12 Fu Zi 15Fu Ling 9 Zhi Gan Cao 6Fu Zi 3 Bai Shao 12Sheng Di 24 Ren Shen 6Shan Zhu Yu 12
1 teacher remarkWu Mei Wan (6/2/21) Gui Zhi jia Long Gu Mu Li Tang modified (6/4/21)Wu Mei 14 Gui Zhi 10Xi Xin 1 Rou Gui 5Huang Lian 3 Dang Shen 9Huang Bai 6 Chao Bai Shao 20Gan Jiang 4 Xu Duan 7.5Fu Zi 10 Gan Jiang 9Gui Zhi 3 Da Zao 5Ren Shen 9 Fu Zi 6Dang Gui 9 Long Gu 10Chao Bai Shao 12 Zhi Gan Cao 15Mu Li 10Neither Shen Qi Wan nor Fu Zi Tang had much effect on reducing the night sweats. She was completely unable to drink Wu MeiWan causing an increase in clenching in her abdomen and retching.The night sweats are slightly better with Gui Zhi jia Long Gu Mu Li Tang, resulting in a little less frequency and a little less sweating.She looked a little stronger at her last visit; still very weepy, but not as consumed by the emotions. Looking back over this case, Ithink I need to increase the warming herbs and maybe increase Chao Bai Shao to address all of the Wood related tension in herabdomen. I am not sure of the dosage of Fu Zi and would love to know what others think.Any insight into this recalcitrant pattern would be very much appreciated!Thank you!MarinthaCaroline Radice NewJun 13, 2021ReactHi Marintha: Interesting Case! A few questions on some symptoms that might help clarify:She has a small appetite or gets full fast because of the knotting in the center?How are her BM? frequency and consistency, etc. and Urination?Is she thirsty?Can she send you a screen shot of her tongue if you're not looking in person? Since vaccination rates are so high in my area, I havebegun looking in person regularly again with a brief mask removal, but for telemed and in the past year, I have found that you canget a pretty good idea if they send you a photo of the tongue. I do find it really helpful in clarifying diagnosis too.It looks like a block with heat above if she's both hot and sweaty, but also cold below based on the rest of your presentation, andas everything is worse with stress/depression, clearly there is wood involvement.
1 reply 11 reply 14 more comments4ReplySo do you think this is more of a Shao Yang pivot not getting the Ming Men fire into position or weak Ming Men or both? Lack ofconsolidation at the surface will surely have depleted her as well so that will feature in her diagnosis as well.ReplySally NewJun 13, 2021React@Marintha Tewksbury Good work. It seems that you figured out that Tai yang is involved as it's moving upward and outward tooquickly with the opening of the pores and alot of cold. What other conformations are not functioning well? She's not able to takefood in and experiences so much cold; in addition she has a soft belly. It sounds like you are seeing Tai yin functioning poorly asit's too weak or cold to transform (descending in the East towards Shao yin storage so it can transport and disseminate fluids backup).I'm unclear when you say under the umbilicus, whether you mean below the umbilicus or kind of behind the umbilicus. Oh, thisanatomical language is awkward, and conveying it is so important. Do you think the knotted sensation is due to cold? (Gan jiangcomes to mind) Or more a deficiency spasm (Bai shao, perhaps Xiao Jian Zhong tang). GZjLGMLT was a great place to begin. Youcould consider modifying it or combining it or shifting to another GZT based formula that would address the Tai yin aspect more.I ask my patients to practice taking the tongue photos and do it by the window or outside if possible. I let them know that it is alittle bit tricky.Marintha Tewksbury1 teacher remark2 more comments2Debra ByerNo SubjectJun 10, 2021ReactCan anyone recommend an acupuncturist in or near Nyack NY?ReplyYour Friendly Admin NewJun 10, 2021ReactHi @Debra Byer While I can't recommend anyone personally, there are two practitioners in the Nyack area on the Global Map. https://whitepineinstitute.instructure.com/courses/230/pages/global-mapDebra ByerReplyDebra ByerNewJun 12, 2021ReactThank you!! I guess I didn't see them
4 teacher remarks10 more comments 10Adam BroderHerbal help for my dogNewJun 06, 2021ReactQuestion for teacherI’d been interested in joining the White Pine Circle but when I saw Sharon post that help could be found for my dog here that wasthe push I needed. We love our Regina so much. She’s about 30 lbs, red heeler mix. She was rescued 4.5 years ago at which pointwe thought she may have been 7 or 8 but she seems a lot older than 11 or 12 right now. Over the past year she has slowlydeclined in energy. It was maybe 6 or 8 months ago that she stopped being able to jump up onto the couch. We knew she had aheart murmur and not the healthiest kidneys, and had a hunch that she was in some pain. I’d give her Shen Tong Zhu Yu Tangmost mornings, and an herbal supplement for joints at night. Then over the last few weeks she really started to decline, notwanting to go on walks. Appetite and pooping/peeing were all fine. We took her to the vet last week, and a day or two before theappointment it became very difficult for her to hold herself up. The vet diagnosed advanced kidney disease and a UTI. She stayedovernight to receive fluids and electrolytes but was returned to us in a bad state. Holding herself up is very difficult and when wecarry her she’s really floppy and heavy. She’s been put on gabapentin, an antibiotic and a special diet. We’re supposed to bring herin next week for an ultrasound on her heart and abdomen but if she cannot regain her energy and stability it seems moreappropriate to put her down. I know gabapentin can cause ataxia but this started before we put her on that. She is drinking andpeeing a lot. She peed inside an hour ago but I don’t see that as incontinence as much as she just couldn’t get up to walk to thedoor. From what I’ve learned so far in the GMP, her weakness of limbs seem to be a for-sure SP sign. Her abdomen is lookingmore bloated, so retained water is there but I can’t recall if that’s a for-sure sign of anything. I think her peeing a lot is leakagethough, even though it may not necessarily be incontinence, so I would think to look to the CM Kidney. She has bouts of pantingand bouts of rapid heart rate. Please help with a formula recommendation. Thank you.ReplySharon Weizenbaum NewJun 06, 2021ReactHi Adam, I'm so glad you joined!I am not a veterinary herbalist but I have found that we can have a lot of success just applying out methods for our animals.With you dog, I would suggest Zhen Wu Tang. This is because of her age, the frequent peeing/thirst and water swelling. I might addShan Yao to help strengthen the absorption of the kidneys.The other thing I would strongly suggest is indirect moxa along her spine on the Hua To and bladder line. When my dog Josh wasold and dying, this made him so much more comfortable and I think it also extended his life.My guess is that she is not super hot right? If she is, we may want to re-think. Does she crave soaking in cold streams?ReplyAdam BroderNewJun 06, 2021 | EditedReactQuestion for teacherThank you, I’m glad I joined too. There have been several offerings so far that I’ve been interested in attending. Thank you also foryour recommendations. I just ordered the herbs to be sent overnight from Lhasa. Fu Zi then is safe for dogs? I suppose if it fits thepattern. What dosage would you recommend? As for her body temp, she has been panting but that may be from other problems.Earlier this morning she was shivering which she has been doing from time to time as well. We feed her ice which she likes, andmy girlfriend has a cold pack on her now which she seems to tolerate well. She doesn’t appear to be overly warm to the touch. Imay try some minimal moxa and see how she does. She’s been tolerating needles pretty well.Sage Staggs (she/her)Sweat comes out with needlesNewMay 11, 2021 | EditedReactQuestion for teacher
1 reply 1I'm having difficulty diagnosing a patient. I am posting in the Practice Support forum because I am new at diagnosing andprescribing the way that Sharon teaches, and I would love it if someone could help walk me through it a bit.He is coming in for chronic loose stools (sometimes pencil thin) and diarrhea with an odor, and low energy.He shared that he tends to sweat spontaneously with strong emotions and I have witnessed this at every treatment (4 so far),since he is nervous about the needles- he breaks out in a heavy, wet sweat as soon as I start needling. I have tried to have himbreath with the needles, used a firm guiding hand pressure, etc., but the sweating keeps occurring. I wonder if his pulse is fast dueto heat or due to anxiety about the acupuncture treatment.At first I didn't realize how big an issue the sweating was for him so I gave him BXXXT since I suspected a glomus and he seemed tohave some mixed heat/cold signs. He took it for ~5 days and it didn't have any effect on his digestion so I moved to a Li ZhongTang modification with gui zhi and bai shao- I haven't seen him since giving this formula so not sure of the effects. Do you thinkthat would be strong enough to address the sweating, or does he need GZT, or another formula to restrain the sweat? Looking atmy notes here it seems he may have too much heat and damp for a tonic formula like that anyway.He feels mostly neutral temperature-wise, although his belly is cold right around the umbilicus.He has a robust/round body shape and his belly has a buoyant quality.Sleep is fine.Digestive problems worse with cold or greasy food.Some belching.No pain in belly.Normal urine.No thirst, drinks barely any water some days, has 2 cups coffee/day.His pulse is fast, thin, deep and slippery with weak chi.His tongue is slightly puffy, peeled in the front with a red tip and a thick white coat at the root.I'm really trying to makes sense of how the sweating fits in with his chief complaint of loose stools/diarrhea.Can sweating be due to damp? If so, how would one approach treatment?I appreciate any insight anyone can offer, particularly on the sweating aspect.JPEG | 2.3 MIMG-3521 ReplySarah Rivkin NewMay 16, 2021ReactHi Sage, What struck my initially when reading this is that both the sweat and the stool are instances of something coming out toofast. My first question would be, why do you think this is happening? What effect did you latest formula have? Finally are youwondering about damp because you are seeing evidence of it, or is that a "diagnosis of exclusion"?
2 replies 214 more comments 14ReplyCaroline Radice NewMay 17, 2021ReactHi Sage: Not seeing any heat except the red tongue tip and fast pulse, and damp not really clearly present except a little in thetongue? Not clearly cold symptoms either other than the belly feeling as I would expect more pain for Li Zhong Tang. Seems hisexterior is not regulated and exterior stimuli triggers anxiety in a Gui Zhi Formula kind of way. Any other exterior signs?5 earlier comments 2 4 teacher remarksPetra SchirraNeed help with my dogJun 02, 2021ReactI have a big dog that I adopted 3 years ago (mostly a mutt, but has a little German Shepard in his genes) and he is estimated to beabout 9 years old. He is from Rumania, was on the street and a couple of years on a chain, living outside in extreme cold and heatwith no shelter. He was emaciated when I got him and of course traumatized.These are his problems:- Pain that comes from his spine and sacrum, Vet and Osteopath say he is in a lot of pain. We started Osteopathy and Acupuncturelast week.- Drags his hind paw a bit when walking- Since pain increased he sleeps a lot- Weak digestion, gets diarrhea or soft stool easily (we puree his food, otherwise it comes out undigested)- Has no heat tolerance at all, all symptoms get worse as soon as it gets warm. When warm he walks very slowly. Loves winter thebest.- Has anal gland issues ( I can tell by the smell and he scoots bis butt at least 2 times a weak on floor)- He drips (sometimes a lot) after urinating almost every time (not in the house, just outside when he goes pee)- Gets anxious easily (which makes sense considering his history)- His gums are constantly a little inflamed (gnawing on bones helps, but doesn't get rid of the gum inflammation completely)- He wants to eat all the time- As for character: he is very introverted and very peaceful, but internalizes everything.- His tongue ranges from pale lavender to purplish, with a thin greyish coat in the back.- As far as I can tell his pulse is wiry, full and irregular(previous acupuncturist said his kidney pulses were weak)- I have noticed his irregular heartbeat since I had himI am looking for an herbal formula to heal his spinal and sacral problems, and help with his overall issues because things aregetting worse and I don't want to give him pain killers. An acupuncturist once gave him Shen Tong Zhu Yu Tang, which causeddiarrhea with mucus after 2 doses.Thank you so much in advance for your help!Sharon Weizenbaum NewJun 10, 2021ReactHi Petra,
1 reply 11 more comment1ReplySome breeds are incessant eaters (I have one) so I'm not sure this is pathological. But could you come up with an evaluation basedon what we've done so far with your thoughts? It's more practical for you to be his main doctor and we can review your specificquestions. I don't think I can take on being his ongoing practitioner.ReplyMaryanne Travaglione NewJun 16, 2021ReactThe Ge Gen Tang maybe helpful but not as an ongoing formula. If you find it has been helpful you might think to try it for about 2-3 days a week for about 3 weeks and reevaluate to see if symptoms are improving, and a different formula may than be indicatedto support ongoing care.
5 earlier comments 1 1 teacher remark1 more comment1Elaina GreenbergSpleen Yin XuMay 23, 2021ReactI confess that I'm struggling with seeing this diagnosis. I get Sp Qi Xu is a spectrum of dryness to damp. So is Sp Yin Xu really justSp dryness? Is differentiating that between Stomach dryness (dry lips) and Sp dryness the difference of excess vs deficiency? I havelistened in on so many case studies and have reviewed my notes, but I'm missing a key piece.ReplyCandace Jania NewJun 09, 2021ReactSorry - deleted this post by accident- reposting-I posted a photo of pictures of SP yin xu from Barbara Kirschbaum's book. You may find it helpful within the context of yourdiagnosis- it can serve as a confirmation or a jumping off point to ask more questions.Both Kirschenbaum and Steven Clavey state that ST yin xu is shorter duration, SP yin xu is longer duration. Not sure if absolute butinteresting to contemplate Earth being deficient and eventually becoming dry and cracked and unable to absorb.Almost all SP yin xu formulas contain chalky herbs: Yi pi tang, Pi yin xu tang, shen ling bai zhu san (qi and yin) to help absorb thefluid in a physiological way.JPEG | 148.7 KSP yinReplyElaina GreenbergNewJun 13, 2021ReactIt is all getting clearer, this has all been so helpful. Thank you.Amy JennerTachycardia in Long Covid in 3 parts. Could really use some helpNewMay 11, 2021 | EditedReactHI All,This case is in 3 posts because it wouldn't all fit in one with some kind of character limit per post. The other 2 are labeled part IIand part III.I could really use some help on this one. This poor woman has been suffering since she had covid 14 mos ago. I appreciate yourinput
2 teacher remarks39 year old female, medium build, normal weight. Warm, friendly, bright, interested in the process, wanting to be helpful givingdetailed answers.MC: At present time: tachycardia and arrhythmia since suspected Covid 14 months ago. Ht rate unregulated, when stand up, iechanging position, it goes from 90’s to 110-140. Her ‘normal’ resting rate these days is in the 90’s. Lying down the rate is lower, 75-100 vs standing 100-140. Taking a low dose metoprolol (12.5mg) which she says takes the edge off. Dr wants a higher dose but shecant tolerate it.Suspected Covid: Acute phase = extreme fatigue, extreme H/A, dry sinuses/cough, sl chest tightness, dizziness, loose stool, chills.Then she felt like she was coming out of it and then had an episode of extreme palpitations which led to uncontrollable unstablepulse rate and BP. Peeing and pooping for 24 hours which ended in the ER with dehydration and the palps. Then a month oftingling/numb limbs, dizziness, palps, chest pain upper left, fatigue, H/A, weakness, SOB, brain fog, fever/chills like hot flashes,sweating. Has been very slowly improving since that time. Has had all the tests over the last year with Cardio => POTS = PosturalOrthostatic Tachycardia SyndromeNow: Some days wakes w nausea and or headache. Movement (gentle exercise) helps ie stationary bike, walking, hiking. Positionalchanges trigger tahcycardia ie positional changes in yoga, moving too quickly from one plane to another, standing too long. HTrate higher when standing than sitting/lying down.Dr. advised “toning vagus nerve” by finishing shower with cold water which seems to help. Being outside in winter feels good. Thecold feels good but doesn’t really affect heart rate.Diet consists of whole foods with fish and eggs at the moment. Prefers warm drinks, never iced. Had several episodes of feelingflushing/tingling/malaise after eating red meat which freaked her out, so has avoided recently. Digestion is fine- no issues withupper digestion. Some days she can wake nauseous and headachy and ginger tea helps. Bowels soft and 2-3 times a day. Nostrong odor or food visible.Urination is normalShe tends to be on the chilly sideEnergy: can have whole days of fatigue (better in the last month down to 1x per 2 wks). Hasn’t been able to work since got sick andhas to rest on those days. Her energy can drop after a period of activity to where she cant get off the couchMenstruation: regular 28-32 day cycle. 1st day can be crampy but not terrible. Some months has breast tenderness the weekbefore. Bright and heavy the 1st 2 days then tapers off to day 5. Cramps like heat. No clotsMusculoskeletal: pain and tightness in the upper back and neck/shoulder areaJPEG | 30.6 KIMG_3730 (002)JPEG | 30.6 KIMG_3730 (002) R lCaroline Radice NewMay 17, 2021ReactHi Amy: What patterns seemed to jump out at you for her symptoms? And just curious, has she been vaccinated? I have had somelong haulers (and it has been written about in the media) feel so much better from lingering symptoms after the shot.
1 reply 17 more comments 7 Reply ReplyAmy JennerNewMay 19, 2021 | EditedReactI did this post in 3 parts bec it wouldn't all fit in one. you can find my process in the other 2 posts. But basically shao yang and shaoyin
Molly ShapiroFecal incontinence + Abdominal fullnessNewMay 10, 2021 | EditedReactQuestion for teacher57 year old robust female with fecal incontinence which started after the birth of her 3rd child. She reports passing dark, tarry stool when it feels like sheneeds to pass gas. Sometimes a small amount comes out while she is urinating. Fecal incontinence used to happen before her periods and continues tohappen on a phantom cycle. LMP was about 1 year ago. Last periods were described as extremely heavy and blood was a blue-red with dark clots. Fecalincontinence can also occur quickly after eating "sensitive foods" like gluten and eggs and is preceded by mild cramping and rumbling as well as with exercise.She has gained 20+ pounds in the last 1-2 years and feels very uncomfortable around the middle of her body.Appetite/Digestion:Bowel quality ranges and is either difficult to pass, incomplete, messy, sometimes orange/sometimes normal color, sometimes mucous, loose, diarrhea, ornormal. It's always changing. She reports a lot of burping and gas, pain in the epigastric area and burning, sharp pain under the ribs that craves heat. Shefeels very full in her abdomen. She feels bloated with air and maybe water. Strong craving for sweets. Lower abdomen craves warmth and pressure. She usedto get tired after passing bowels, but no longer.Urine/Thirst/Sweating/Temp:Aversion to cold. 3-4x/week wakes at 3am with heat and sweating, this is worse with alcohol. Thirsty. Prefers cool water. For whole life, she describes urinaryleakage that happens if she has a full bladder and waits too long to urinate. This happens with sneezing, laughing, and need to urinate. Urination irritates theskin on her vagina; it is itchy and sensitive. (Diagnosis of lichen sclerosis). Urine tends dark. She likes to cover neck and shoulders while working.Other:Sighs frequently. Sallow complexion. Tired and heavy head with weather changes; gets a crushing fatigue. Gets headaches with incoming storms. Energy dipsin the afternoon. Low back is tight and weak, b/w stretching. Bilateral hip tightness. Gall Bladder was removed 4 years ago. History of breast fibroids. Sweat isyellow. Seasonal allergies: sneezing, itchy nose, dry and irritated eyes, clear runny mucous. ADHD diagnosis, she describes this as a 'hyperactive brain' andbrain fog (it is unclear if this has a wet quality). Wakes with a headache if dehydrated. Swelling in hands with hot weather.Pulse:Deep, slippery, full, forceful. L Guan is more full. Both Chi positions are weak.Tongue:See also pics. Red sides, dusky, thin yellow coat, purple dots on sides (toward the rear), tight, purple sublinguals, crack in UJ area.Abdomen:Big, full. Slightly tight epigastric area. Tight under ribs, empty lower abdomen.Her bowel quality and consistency is improved with variations of Da Chai Hu Tang and Hou Po Qi Wu Tang, and she has less frequent incontinence and lessconcentrated urine. On these formulas she reports more energy, less gas and bloating, but still feels very full and still has gas and bloating. About a year ago,when I added herbs to harmonize blood, she started to bleed. I think I am missing a Shaoyin aspect here; the KD are deficient and cold, and not able to store,right? I think this is mixed excess/deficiency. Shaoyang/Yangming/Shaoyin. Looking back on my notes, she did respond well to formulas with Fu Zi (less tiredafter moving bowels, less bloating), but I was trying too many ideas to clearly see what was helping. I wanted to run this case by other eyes before I continueon.Many thanks for your considerations! PS. Sorry, when I look at this entry it is spaced out nicely; I don't know why it looks so crunched after I post it?JPEG | 65.3 KIMG_0052JPEG | 66.5 KIMG_0050JPEG | 65.7 KIMG_0053Brigette GouletNewMay 21, 2021ReactHi Molly! I can certainly see the challenges with this case. There are signs of stagnation, leakage and cold. From the symptoms Isee leakage: urine, stool, blood (from past history). It's as if she can't consolidate. She's cold in general: aversion to cold, craves
5 more comments5Replyheat for rib side pain and cold in the lower abdomen. Then we have the tongue which appears quite excess: its fat, dusky, stasisveins and indented. So to me I see SP Qi and Yang deficiency, maybe SP Yin; Wood involved: ribside pain, Indented tongue, bloodstasis (dusky tongue, stasis veins underneath) and deficiency (sallow complexion) and Lung involved, but I would leave that to theside as the Wood/Earth issue seems primary. Now as far as formulas go I am looking at a base formula of Chai hu gui zhi tangsubstitute Ren shen with Dang shen. I also might want to add Bai zhu, rou gui and maybe substitute gan jiang for Sheng jiang. youcould also add some fu zi if you think she needs this.These are just some of my ponderings. Hope some of the ideas might be helpful for you. ReplyMolly ShapiroNewMay 22, 2021 | EditedReactHi Brigette! Thank you so much for your thoughts on this case! I also see the excess and deficiency, but I see more KD deficiency(empty lower abdomen + leakage) than SP. I see wood excess like you. I'm wondering if this is a Fu Zi Xie Xin Tang pattern? MaybeFu Zi Xie Xin Tang + Da Chai Hu Tang? Having another voice chime in is so helpful in the thinking process, thank you!Amy JennerTachycardia and Long Covid part IINewMay 11, 2021 | EditedReactIt wouldn't let me publish the whole thing at once, so here is the 2nd half:I wasn't sure about all the for sure signs here, could use some help... Sorry about the formatting, it gets scrambled in translationand when I tried to add some spaces on this platform, it takes them out when I save it.Tachycardia/arrhythmia --Heart AffectedTachy-- Ht too fastarrhythmia-- HT irregPalps --feels Ht beatDizziness --wind in the headLightheaded-- qi not ascending to headBetter with-Lying down ---defSquatting down ---?Worse withInversion --?Quick movement --?Stress-- liv involvedStanding long period --defChanging position -?Over doing-- defBM 2-3 x/day --stool too quickWarm bev preferred --Cold
1 teacher remarkTemp: tends to chilly --coldNausea --St reversalb/w ginger tea --cold ST reversalEnergy:Fatigue occ. --qi not availableCrash after activity --deficiencyMenstrualmild cramps --mild bld stag wombcramps like heat --cold in wombBreast tender some cycles-- liv qi stag some cyclesTight neck/upper back --muscles not nourished Tai yang area ReplySharon Weizenbaum NewJun 03, 2021ReactHi Amy,w/w stress is just wood, not necessarily liver. Otherwise great job. This strengthens my sense of the cold and Yin conformationwith GZJLGMLT. BTW, I had a post covid case that was very similar to this. I used a modification of this formula and it waswonderful.Amy JennerTachycardia in Long Covid part IIIMay 11, 2021 | EditedReactIts not that long, really. not sure why it is balking...Tongue:Sl puffy Sl -DampnessSl DSLV -Mild sys Bld StagSl scall Sl -SP defThicker yel coat mid -sl Dampness and heat midABD:Hardness around navel -Bld stagSl oketsu -mild bld stagEmpty below navel- kid defTympanic epi - ?Flaccid -def
1 teacher remark1 more comment1Pulse: irregular and rapid, taut, fineRt cun lowRt guan wiryLft chi lowHer abdomen is soft and easy to press into but not spongy, really. I was surprised that there was so little resistance to pressing in.It is like a rubber band that has been over stretched and has lost some of its elasticity. Couldn't really feel the muscle structure orfind the edge of the rectus. So, I wasn't sure what I could say for sure about the flaccidity other than possibly deficiency. She is nota heavy person so it seemed unusualOrgans: HT, Liv, ST, Sp, kid, crappy bldZang fu: sp qi/yang def, kid def, crappy bld, cold in ST, Ht affectedSeeing: shao yin is not coming down on the right, but getting stopped at the chest. Shao yang not pivoting ministerial fire intoposition securely, and tai yang is not fully functional with the tight neck and shouldersshao yin, shao yang, tai yangFormula idea: Chai hu gui zhi tang + fu zi tangThanks for taking the time to go through it all with me ReplyBrigette GouletNewMay 23, 2021ReactHi Amy! What a challenging case. She's not feeling well and yet not a whole bunch jumped out at me. I reread it multiple timestrying to get a feel or flavor of what is going on. I see the Wood involved, SP Qi def, Kid Yang def, dampness and blood stasis. I amstill not so good and identifying the conformations, but that looks good. I also looked up the formulas and they seem to be on theright track. It will be interesting to see how she does. It's so hard to see our patients suffer. Especially one so youn. ReplyMargaret Sikowitz NewMay 27, 2021ReactAh, I am sorry, you did say you listed in 3 parts, I missed that and now see your other info here.1 teacher remark1 reply 1Sarah Rivkin New Orleans referralNewMay 06, 2021ReactIs anyone here practicing in New Orleans and experienced with cancer survivorship/recovery or might you have a practitioner to recommend? A lovely patientof mine will be there for the next few months and would like to continue acupuncture and herbs while he's there.Thanks!SarahReplySharon Weizenbaum NewJun 03, 2021ReactAmy Yeostros is there I am pretty sure. She's wonderful
Joy BlaisChronic Idiopathic UrticariaNewMay 05, 2021 | EditedReactQuestion for teacherThis patient is a healthy looking fit 33 year old woman with a rosy complexion who has had chronic idiopathic urticaria for 6months. The hives come up over her arms and legs (and to a lesser degree her neck). They are pale red, slightly raised, and itchy.There is no exudate. They flare up in one area for a few days & then disappear only to return a few days later in another area.They usually come on later in the day or at night. Before she gets the hives, her skin gets hot and the itching feels like it comesfrom under her skin. It feels good to apply ice or to take a hot shower. She has had continuous hives for the last 2 weeks sincereceiving the covid vaccine.She was born premature & had underdeveloped lungs. She was diagnosed with asthma at age 6, feels constricted breathingduring pollen season for which she uses an inhaler. In 2014 she developed MRSA from an insect bite on her L thigh. The hivesbegan in that exact location 6 years later. She has cold hands & feet, flushes up easily, sweats easily, and has urgent frequentcopious urination (urinates about 5 times a day & gets up 2-3 times a night to urinate light yellow urine). She drinks a lot of waterduring the day though (3 liters), so this may explain the urinary frequency. No digestive issues. She takes Cyclofem bcp thateliminated her previous menstrual symptoms of deep red painful cystic acne, heavy bleeding & cramping for 7 days a month, &nausea. Her menstruation is normal currently.Her tongue is pale pink, scalloped with a twc, redder tip, and a slight dip in the rear. There are also diagonal cracks in the center.Her pulses are floating, slightly rapid, and thin. Her abdomen is extremely ticklish all over preventing proper palpation.Medications given for hives: Xolair 350mg injections (since January 2021), Pepcid 40mg daily & Zyrtec 40mg daily, all with no effect.Symptoms:Hives on arms & legs Rash on the surface of the extremities--pale red --heat on the surface of ext--itchy --wind on the surface of ext--slightly raised --yang on the surface of ext--come and go --cycling rash on surface of ext--b/w ice --heat on the surface of ext--b/w hot shower --rash b/w venting--start at night --rash coming at night--w/ hot skin --heat--w/w covid vaccine --w/w vaccineConstriction in lungsLU affected--w/w pollen --poor processing of pollenCold hands & feet Yang not reaching extremitiesEasily flushes up Yang not rooted belowSweats easily Surface too openUrgent urination Urine coming out urgently--frequent --urine coming out too often--copious --too much urine coming out--light yellow --normal colored urineTongue--Pale pink --deficiency--Scalloped --SP Qi xu--twc --normal coat--red tip --normal--slight dip in rear --slight KD xu--diagonal cracks in center --Yin xu in EarthTCM Dx: SP Qi & Yin Xu, LU involvement, KD Qi Xu, Heat & Wind on the surfaceSharon Weizenbaum,Suzanne Connole,Eran Even,Caroline Radice,Guy Sedan,Allyson Nevard,Thom Heil,Laura Mcgraw ,Cara Frank,Sally
Conformations: Taiyang, Taiyin, (Shaoyin)Rx: Gui Zhi Tang ModifiedGui Zhi 9gBai Shao 9gSheng Jiang 9gGan Cao 6gDa Zao 9gHuang Qi 30gJing Jie 12gAny suggestions? Am I seeing this correctly? Thank you for any input!JPEG | 976.4 K5-4-21 Whitney Tongue (4) ReplySally NewMay 05, 2021 | Edited1ReactI think she needs some Ma Huang. Can you get it? I would probably use Ge gen tang or Gui zhi Ma huang Ge Ban tang to morestrongly move Tai yang up and out. You probably need a high dose of Ge gen, 15-20g at least. I think you could combine this withWu ling san as the Tai yang UB fluids are not functioning well either. This might be achieved by adding Fu ling to the formula. Mahuang may be available from Kamwo if you order it in a custom blend. I would leave out the Huang qi. I think of that as more forskin edema, and I don't see her as having alot of damp on the surface. She seems to have more wind with a weak center. Justmake sure after a therapeutic sweat that she stops the formula. ReplyJoy BlaisNewMay 05, 2021 | EditedReactSally, thank you so much for your input! That makes sense! The Jing Jie was my attempt at a substitute for the Ma Huang. Thispatient has never done any kind of natural medicine before & is a little nervous about it. I hesitated to give Ma Huang to someonewho may get bad feelings about it later. I'm going to wait & see what happens without it for the time being & then cross thatbridge later if I need to.I see what you mean about leaving out the Huang Qi. You're right, she doesn't have damp at the surface. I'm going to check in withher about the urination on the next visit & see if Wu Ling San is appropriate. I might just ask her to reduce her water intake & see ifthat solves the frequent urination issues. She is drinking sooo much water even though she's not really thirsty.I appreciate your help so much, thanks for taking the time to respond!
2 more comments21 teacher remark1 replyShneyderman ShneydermanChai Hu formula for a patient with hypertensionApr 29, 2021ReactQuestion for teacherI have a 40 year old patient that I have been treating with acupuncture for chronic cough with post nasal drip. We have been doinggood progress with Kiiko style acupuncture and cold laser until the spring allergies kicked in. Now we are back to square one andhe is willing to try herbs.Western Dx: allergies, hypertension (HTN), hyperlipidemia, GERDMeds: beta blockers and diuretic for HTN with middling success, anti-histamines, nasal sprays with no effect, proton pumpinhibitors for GERD, statin.Supplements per my advice: magnesium, L'argenine, CoQ10Presentation: 40 year old slightly overweight, high stress job with dry cough and post nasal drip, worse during the day and whentalking from his mid-20s. Body aches, prone to ankle sprain and shoulder pain, had nocturia prior to acupuncture treatments(acupuncture resolved that). Prone to frontal headaches, has sleep apnea. No issues with BMs or sleep. Main complaint: getting ridof dry cough and post nasal dripTongue: wet, wet, wet, Red tip, midline crackPulse: wiry, slippery/soggy. Fast if comes to acupuncture from work, normal when he comes from home.My Dx: I think he has ShaoYang disorder with lots of dampness. All this dampness seems to prevent things from moving and fromthe pivot turning. I also think that his hypertension is part of that problem of heat being stuck up top. So I want to use modifiedXiao Chai Hu Tang w/o Sheng Jiang and Ren Shen, but add to it Wu Wei Zi and Gan Jiang and Mu Dan Pi and combine it with WuLing San.My question: I was taught (in TCM, but still!) that Chai Hu should not be used for patients with hypertension, but I feel that hishypertension is really not 'Liver Yang Rising'. Would love to hear people's opinionson that matter and on my Dx/formula choiceReplySharon Weizenbaum Apr 29, 2021ReactHi Shneyderman,What is your first name?Gosh, what a complex case. He's on so many meds for a 40 year-old!I don't see enough information for helping with the diagnosis. I always like to know about thirst, sweat, appetite, body temp andwould love to see a tongue picture. What about the color of the tongue body?As for your question though, it is a mistake to equate hypertension with Liver Yang Rising. In my practice, the diagnosis ofhypertension is something I like to explain with my diagnosis rather than something the helps me to diagnose, if that makessense. If the diagnosis is correctly a shaoyang issue then it must be treated that way. I've definitely used Chai Hu based formulasfor hypertension as well as Fu Zi based formulas.The wetness of his tongue sounds striking to me and water accumulation could help explain some of the symptoms anddiagnoses. I wonder how he can have no issues with sleep AND sleep apnea? Maybe it is that the sleep apnea does not actuallywake him up. At the same time, depending how bad it is, it can very much effect the quality of sleep.Let us know!Sharon
1 reply 1ReplyTolley SinkNewMay 02, 2021ReactAs an aside here is a helpful blog post on Chai Hu by Sharonhttps://whitepinehealingarts.org/can-chai-hu-excessively-raise-the-qi/1 teacher remarkAmy JennerborborygmusApr 27, 2021ReactI was watching the palpating the abdomen presentation last night and had a question about borborygmus. When we palpate theabdomen and hear sloshing sounds we can know we have water but I hadn't thought about borborygmus as being a water sign. Isit? Or does it depend on how wet it is sounding? ReplySharon Weizenbaum Apr 29, 2021ReactHi Amy,I always ask about the nature of the sound. Is it a watery sound or an air-like sound. Borborygmus is not necessarily water. Only ifit sounds watery.2 earlier comments 1 teacher remark1 reply 1Tolley SinkPractitioner in PhiladelphiaApr 25, 2021ReactHi, Can anyone recommend a practitioner for a fibromyalgia patient in Philadelphia? She lives in Media, PA. I don't see anyone onthe map. Thank you!ReplyCara FrankNewMay 02, 2021ReactHi Tolley!Yes- we're right in Philly. www.sixfishes.com, 215-772-0770. There's a few terrific practitioners right in Media if your patient prefersReplyCara FrankNewMay 02, 2021ReactI guess I better check to see if I am on the map
Tolley Sink5 Years Whole Body Severe ItchinessApr 15, 2021 | EditedReactQuestion for teacherHello lovely colleagues, would love some help please! Thank you!David is retired, age 76, has a small frame, yet round distended belly with skinny legs. He is very friendly, speaking clearly andloudly. He complains of severe skin itching and pain, everywhere except his feet, worst on his back. When it’s not itchy there is anuneasy feeling like his skin is raw and the nerve endings are burned. Itching makes it worse as does any kind of contact: clothing,showers (even cold), lotion, etc. His skin is dry and covered with dark spots everywhere. On his back most of them are also raisedand crusty. His symptoms don’t change relative to temperature, weather, time of year, or food. This started gradually 5 years agoand has been getting progressively worse.He has decreased night vision and ridges in his fingernails.His thirst is somewhat low in that he doesn’t get thirsty even when playing tennis for hours in the summertime but he drinksnevertheless. He is able to sweat but it takes a lot of exercise and heat and even then it’s just a light sweat. He was diagnosed withidiopathic anhidrosis., Urination is normal but he takes flomax. Without this urination is frequent, incomplete, weak and scanty.He says he is hungry all the time except in the morning. All of his life he has a BM every other day with a tendency to hardness anddifficulty passing.He generally feels cold especially in his hands and feet.2 surgeries from a pinched nerve due to scoliosisEnergy and sleep are goodHis tongue is red, purple, small, scalloped, and indented with thick greasy yellow tongue moss (I’ve attached photos but the photosdon’t show just how small the tongue isAbdomen - distention and fullness in the upper, cold, epigastric hardness, tightness under the right rib, tight rectus, hardnessaround the belly buttonPulse is floating in both cun, thin wiry and and tight overall on the left, overall slow and deep on the right (not very confident in mypulse skills so please don’t put any stock in these pulses)My diagnosis was Spleen and Kidney yin deficiency, crappy blood and lower warmer damp heat. (I thought his tongue had lots ofsmall cracks the first time I saw him)The first formula I gave him was a modified Wen Jing Tang (see below) which he took for a week with no effect but I made amistake with the spoon size and he was only taking about 6 grams per day. For the second formula I focused more on the dampheat and regulating the mixed hot and cold in the middle with a modified Ban Xia Xie Xin Tang which made his itching worse! NowI am thinking more along the lines of Xue Fu Zhu Yu Tang with Ci Ji Li, Fang Feng and Jing Jie but I wanted to call in some supportbefore I keep dragging this poor guy through the ringer. Thank you for any input!Formula 1Wu Zhu Yu 2Gui Zhi 6Dang Gui 9Chuan Xiong 6Bai Shao 6Mai Men Dong 9Mu Dan Pi 6Dang Shen 6Zhi Ban Xia 6Sheng JIang 6Zhi Gan Cao 5Sharon Weizenbaum,Guy Sedan,Allyson Nevard
5 earlier comments 4 teacher remarksFu Link 9He Shou Wu 9Formula 2Zhi Ban Xia 9Huang LIan 6Gan Jiang 3Huang Qin 4Dang Shen 6Zhi Gan Cao 3Ku Shen 9Da Zao 4Dang Gui 9Sheng Di 6Chuan Xiong 6JPEG | 732.5 KIMG_E3368JPEG | 51.9 KIMG_3392Tolley SinkMay 04, 2021 | EditedReactQuestion for teacherHe's been on the formula below for 1 week with no change. In going over his case again what's so striking to me is that he doesn'tsweat normally and doesn't get thirsty when exercising in the heat. I'm really questioning some of my diagnostics here too. Forexample maybe the tongue isn't actually short and the blood deficiency and Spleen deficiency aspects are minor. I think the heatthat is there showing on the tongue could explain the blood stasis. I'm not left with much to go on but I feel certain that I'd like todo something cooling and nourishing to the fluids. Mai Men Dong Tang comes to mind. But maybe my dosages on last week'sformula were off? Thoughts so much appreciated!Here is the formula as I wrote it:Bai Zhu 8Gui Zhi 6Ma Huang 2Sheng Di 16Sharon Weizenbaum
1 reply 1ReplyShan Zhu Yu 8Shan Yao 8Fu Zi 2Ze Xie 6Fu Ling 6Mu Dan Pi 6ReplySharon Weizenbaum NewMay 06, 2021ReactHi Tolley,So his tongue is the same too? I do think a week is not quite enough to tell but I would expect something to feel good to him orsome change in tongue or pulse. What do you think is the source of the heat? Could it be Shaoyang/Taiyang? I agree the tongue isso red and indented. If you switch the emphasis to Shaoyang/Taiyang, how does that sit with you in relation to him?I wonder about Xue Fu Zhu Yu Tang with added Ma Huang and Gui Zhi. How does that fit?1 teacher remark1 more comment1AmyBai Zhu for constipationNewApr 14, 2021ReactI remember Sharon teaching that a large dose of BZ can be used to put fluids into the bowels to treat constipation, and Iremember her saying 30g. Does anyone have more information about this? Can it be added to any formula? Is it only if you areusing a formula that already has BZ? Any key signs - I'd assume a fluid metabolism issue, Earth not controlling water, as Bai Zhuhelps percolate water through earth into water for storage... I'd love any nuggets you have on this, such as a case study,experience, etc. Thank you!!!ReplySharon Weizenbaum NewApr 24, 2021ReactHi Amy,I use Bai Zhu like this but only if there is spleen deficiency with fluid going in the wrong place instead of in the intestine. So, no, notfor any formula and not for any fluid metabolism issue. I often use it is there is damp accumulation in the lower body or frequenturination with dry stool. It has to fit the complete diagnosis. Does that help?ReplyAmyNewMay 02, 2021ReactJust seeing this now! Yes, that helps and rings the bell, I remember better now you talking about it. Thank you.Tolley SinkReferral near West Palm Beach, FLNewApr 13, 2021React
1 teacher remarkWho do we know that is practicing near Boynton Beach, FL? This is for a 90 year old friend of my Dad's. Thanks! ReplySharon Weizenbaum NewApr 24, 2021ReactHi Tolley, I don't off hand but did you check the global map? ReplyTolley SinkNewApr 24, 2021ReactHi Sharon, I did check the map but there isn't anyone on there in all of Florida. I found these practitioners whose names I passedalong: Susan Schiff, Jeffrey Zurawin, Leslie McKnight and Jill LougheryJoy BlaisCrohn’s, esophagitis, GERD, ADD, anemia, and neck painNewApr 12, 2021 | EditedReactQuestion for teacherI am seeing woman with Crohn’s, esophagitis, GERD, ADD, anemia, and neck pain but I am not completely confident with mydiagnosis & formula. I would appreciate any feedback!35 year old woman, intelligent with average build, engaging but somewhat scattered in her speech, history of abuse & neglect as achild, seems a little anxious.Medications: Adderall, Bupropion, Protonix, probiotics, iron, Mirena IUDSymptoms:Neck pain on R Stasis in R neckArm numbness on R Qi blockage in in R armCold hand on R Cold in R handAcid taste in mouth GB Heat--w/ burning in throat --GB Heat affecting throat--w/ hoarse voice --GB Heat affecting voiceThirst for cold drinks ST HeatNausea Poor T&T--w/w tomatoes & brussel sprouts --Poor T&T w/w tomatoes & brussel sprouts--w/w empty stomach --Poor T&T w/w empty stomachBloating Poor T&T--w/w food --Poor T&T w/w foodAbdominal Pain Stasis in the abdomen--w/w food --Food Stasis in the abdomen--b/w Apple Cider Vinegar --Stasis in the abdomen b/w ACV--worse before BM, better after BM --Excess stasis in the abdomenDry stool Stool dryLoose stool Stool looseUrgent Stool Stool urgentMucus in stool Damp in the intestinesVaricose Vein in L leg (removed) Blood stasis in L legCold foot in L leg Yang not reaching L footWhite toes in L foot Yang not reaching toes in L foot--w/w cold --Cold in L footRon Hershey,Allyson Nevard,Shannon Larson,Laura Mcgraw ,Sally,Sharon Weizenbaum,Tolley Sink,Suzanne Connole,Eran Even,Guy Sedan,Sharon Yeung,Keren Sela,Thom Heil,Sarah Rivkin,Jennifer Tongren Drinker
1 teacher remarkCold hands & feet Yang not reaching extremitiesShallow breathing Poor LU function--w/w stress --Wood related poor LU functionPostural dizziness Qi & blood not reaching the headOccipital headaches Stasis in occiputSweats easily Sweat coming outFatigued Yang not availableDifficulty falling asleep Yang not settling at nightAbdominal Dx-soft glomus -Qi obstruction in epigastrium-ribside tension -Wood involved-discomfort above umbilicus -Stasis in middle-discomfort below umbilicus -Stasis in lower-mild oketsu (bilateral) -Blood stasisTongue-hammer shaped -Shen affected-extreme trembling (has semi-attachedfrenulum)-LR Wind-dirty coat in center -Damp in center-red -Heat-mild toothmarks -SP Qi xuTCM Dx: GB Heat, ST Heat, SP Qi xu, Poor T&T, food stasis, Qi stasis in the abdomen, Damp in intestines, Blood stasis, Wood rltdLU dysfunction, LR WindConformations: Shaoyang, Taiyin, (Jueyin)Formula: Si Ni San plus Xiao Chai Hu TangChai Hu 24Bai Shao 12Huang Qin 9Dang Shen 12Sheng Jiang 9Zhi Gan Cao 6Ban Xia 24Da Zao 12Zhi Shi 12Thank you for any suggestions!ReplyAllyson NevardNewApr 13, 2021ReactHi Joy! A couple of quick questions. Double checking that her body temp is neutral with cold hands and feet? And her urination istotally healthy and uninhibited? What are her pulses like? And what about her emotions? Looks like you said she has nausea that’sworse with an empty stomach which means ST deficiency. So she has mixed excess and deficiency in the middle. Overall does sheseem more excess or deficient to you? Is her hara more towards lax?Joy BlaisNewApr 13, 2021 | EditedReact
2 more comments 2ReplyHi Allyson,Thank you for your response!Yes, she did say her body temp is comfortable (not too hot or too cold) and that only her hands & feet get cold. As far as herurination goes, it is light yellow in color & she gets up 2 x in the night to pee, flow is uninhibited. Her pulses were wiry & rapid withthe L cun position poking up aggressively. Emotionally she has some anxiety which manifests as chest constriction & shallowbreathing. She seems speedy & a little scattered to me (has an ADD diagnosis). The nausea is actually worse in the morning (whenshe hasn’t eaten yet) which could be from the excess acid in her stomach. Since she also has nausea intermittently throughout theday (and she was not sure if it was before food or after food), I didn’t want to assume it was from deficiency, but maybe I waswrong there. Her abdomen was interesting – it wasn’t overly lax or overly tight, but when I palpated she felt subjective feelings ofdiscomfort. Clearly she has lots of digestive issues, but the only real SP Qi xu sign I saw was the slightly toothmarked tongue. Herfirst appointment ran 30 minutes overtime because the focus of the intake got derailed a few times and there was so much to getthrough. I wasn’t able to go as deep as I needed but I’ll work on fine tuning this diagnosis on the next visit.Thanks,Joy
Amy Jenner38 yr old Man, infertility- formula help pleaseNewApr 11, 2021ReactHe and his wife have been trying for 3 years. At this point, she is undergoing treatment from western docs as well as acupunctureand herbs. He is a warm friendly guy, engaged in the conversation, interested in the process. He is medium built, a little squishyand pudgy in the middle. HIs sperm samples show low to normal number, slow to normal swimmers, morphology normal to high.Here is what I have so far. I'm not feeling super confident that I am thinking about this correctly and could use some help withthat.Digestion is unremarkable except for sticky, sometimes slow BM. better with cooked foods, worse with smoothiesurine normalHe occasionally has heart palpitations that occur when he has been exercising and stops. Diagnosed a premature atrialcontractions.Stress is relatively low, good relationship, work, finances etc. They aren't well off, but comfortable enough.sleeps wellsweat: has to work pretty hard to get a sweat going.varicosities on his legsTemp: cold feet, back, knees, low backTongue: pale, puffy, scallopsAbd: soft spongy flesh, empty low abd, oketsuAnalysis:Sticky BM Stag LIbw cooked SP defww cold/raw SP yang defPalpitations HT affectedww exercise HT qi defvaricosities Bld StagSweat not easy hard to sweatcold feet, back,knees low bk Kid Yang defTongue:Pale defpuffy dampnessscallops Sp defAbd:spongy flesh SP defempty lower Kid Def
1 teacher remarkOketsu Bld stagI can see that there Kid and Sp yang def with cold crappy blood all affecting the heart. I want to warm and tonify the Kid/Sp Yangwith an eye to warming and harmonizing the blood.Jin gui shen qi wan + li zhong wanFu zi 9Rou gui 6sheng di 24shan zhu yu 12shan yao 12ze xie 9fu ling 12mu dan pi 9gan jiang 9ren shen 9bai zhu 12zhi gan cao 9I appreciate your input!JPEG | 31.5 KIMG_3574 (002)Sharon Weizenbaum NewApr 11, 2021ReactHi Amy, How did he do on your formula? Any news? The only thing that catches my eye is the Yin tonic aspect of Jin Gui Shen QiWan. That does not seem necessary and it dilutes the formula. The cold in the lower body is so striking. Yet the proportion of Fu Ziyou are using is very low. I would consider Fu Zi Tang. It seems to touch all bases in a more focused way. The only thing it doesn'taddress is the blood stasis. How bad are the varicosities on his legs? Lots? Big swollen or spider veins? I would still want to see how
2 more comments2Replyfar I got with the warming before going straight to the blood but, if it is extensive, this well could be part of the issue. A secondstep. How does that sound? Does it seem to fit him?ReplyAmy JennerNewApr 11, 2021ReactThank you , I was struggling over the yin tonifying aspect of JGSQW so FZT is very helpful. The varicosity in the legs is an area ofthick ropey vein on 1 leg, he does have distended sublinguals which I missed transferring my notes. I was inclined to see whathappens with the blood if I got everything warmed up and functioning better. I have been putting off giving him anything because Iwas struggling with the yin part, so I hadn't given it to him yet. Will let you know how this goes. ThanksEmma Mezher Looking for help with a caseNewMar 24, 2021 | EditedReactI'm looking for some insights with this case., thankyou!CC: Stiff joints and fatigue60 year old woman with a bright pale face, sparkly eyes, trim body and a quiet demeanor diagnosed with MCTD ( a mixedconnective tissue disorder that has elements of lupus, myositis and systemic scleroderma). Symptoms began a couple of years agoduring a 6-year stint as a nurse working in a cold OR room, resulting in the present diagnosis. She came off steroids in the fall of2020 and stopped Methotrexate 3 weeks before her appointment. Just under 2 years ago she underwent treatment for bladdercancer.Primary symptoms are knee, hip and ankle stiffness, pain and weakness. Knees bother her the most and stiffness is primaryfollowed by achiness and then weakness. The discomfort is fixed in nature and constant. Other symptoms include thigh pain thatfeels heavy, stiff and weak and severe fatigue. also complains that her thighs feels heavy, stiff and weak. She has some swelling inher fingers. Symptoms are better with walking and get worse when she is sitting or still. Moving of any kind takes a long time andshe moves slowly and deliberately.Runs cold, is very sensitive to cold and has Raynauds.Doesn't sweat much, only a little if the weather is warm.Thirsty for room temp water.Dry eyes.Appetite is good and she eats a whole foods diet. No issues with digestion or bowel movements.Urination is normal and closely monitored due her cancer history.She takes 10mg THC in order to sleep otherwise she wakes up a lot.Tongue: pale with a thin yellow coat and some sublingual vein distentionPulse: deep feeble and wiry especially in chi positionAbdomen: rib-side tension, rikkyu, epigastric hardness, weak lower abdomenPalpation: legs are a normal size but appear tight under the skin, maybe like a kind of superficial edema? Fingers are visiblyswollen yet mildly so. Liver and kidney channels feels cold to touch.I decided this was Bi Syndrome with cold primary, damp secondary and wind tertiary.To me this patient is primarily cold and has kidney yang deficiency. Based on the epigastric hardness there is some spleen yindeficiency and inability to process fluids well. I feel like there is some heat, as seen in the thin yellow tongue coat, but I feel like it is
3 teacher remarks1 reply 1secondary to things not moving well. There is a minor blood stasis component. (distended veins, fixed pain)I decided to try a modified Gui Zhi Shao Yao Zhi MuTanggranules, 9 g/daygui zhi 12gshao yao 9gzhi mu 6ggan jiang 6gcang zhu 8gzhi gan cao 6gfu zi 9gdu huo 4gnui xi 4gmu gua 6gReaction to formula: Patient states the thigh symptoms are resolved and she has more energy. However, she developed shoulderjoint pain while taking the formula and states there was no change in her lower extremity joint symptoms.I am concerned about the flare-up in her upper extremities, as this is not something she has had before.Updated pulse and tongue: I only see this patient for herbs, as she sees my colleague for acupuncture. I had the opportunity toretake her pulse and tongue, but is was after an acupuncture treatment.Pulse is deep, wiry and hesitant, tongue looks more pale dusky, yellow coat is gone. ReplySharon Weizenbaum NewApr 11, 2021ReactHi Emma, With her thin body and signs of dryness, I would think more of Dang Gui Si Ni Tang maybe even with more bloodenriching herbs, like adding Chuan Xiong, Bai Shao, Mai Men Dong --moving it toward Wen Jing Tang. Also adding Fu Zi. Perhapsthe GZSYZMT is a bit too pungent warm in balance. So it is in the direction she needs but with more moistening sweet herbs. Also,with the thirst and body pain, consider adding Tian Hua Fen. How does that sound? ReplySharon Weizenbaum NewApr 11, 2021ReactYes and thin body and thirst.
Ann ClearyDifficulty Locating Heat In Order to Determine DiagnosisNewApr 07, 2021ReactHi members and elders, your thoughts are all very much appreciated. :)51 year old femaleBuild: stocky, compact, strong, no clear distinction between ribs and belly.Surgical history: lymph node removal, breast reduction, hysterectomy (due to fibroids and bleeding), gastric sleeve surgery duringwhich they also narrowed her esophagus, left knee surgeryH/o severe anemia, discovered to have hemoglobin at 5.85 in 2017 and was rushed to ER for blood transfusion. Doctor’s wereshocked that she was walking, talking, functioning. When it was at 11, now up to 12.5.CC: fibromyalgia managed with bimonthly acupuncture (she has good, medium, and bad days, evenly distributed between all ofthese).Cold feet, likes to keep neck covered with a scarf (new development).This past week has been extra thirsty, does not crave any particular temperature water. Dry mouthNeeds to wait at the end of nearly every urination for more to come out.Poor appetite. In addtion, can only eat and drink small amounts due to gastric sleeve and esophageal surgery, used to have asensation of food sitting in her esophagus but that has gone away some months ago.BMs every 3-4 days. Very occasionally watery with undigested stool, but otherwise dry, BMs that aren’t painful.Feels pressure at the zyphoid process, slightly improved in the past two weeks.Able to fall asleep with THC/ CBD gummies, but does not wake rested.Getting drowsy about three times a day, sits and waits for about 15-20 minutes for it to pass.Palpitations about 2x a week.Pain:8/10 at worstmedial to scapula bilaterallyburning pain across shoulders
right flank pain, ranges from deep ache to tight spasm (though no spasm in about a month) worse with certain movements,including getting out of the car. Subscapularis when palpated via the underarm is tense, previously was rock hard (as in felt like abone, not a muscle)left knee intermittently painful, continuing to improve as she strengthens her legs, when painful lasts for about half an hour,sometimes longer.Very tense shoulders that in the past were truly rock hard.Pulses:Right: slippery thready rapid, choppy cun Left: wiry thready rapid choppytongue: mauve, white coat, peeled along the center crack (I think this reflects the gastric sleeve) See photo. The swollen lung areais exagerated by the camera. Question: does this tongue count as having the indent that would indicate liver involvement?What I know for sure:cold feet yang warmth not reaching the feetaversion to wind weak exterior (gui zhi)poor appetite poor t&tBMs every 3-4 days poor t&toccasional watery BMs with undigested food too fast t&tthirst with dry mouth poor fluid metabolismincomplete urination poor fluid metabolismepigastric pressure something blocking the yangmingpalpitations something blocking the yangming, causing heart yang to go up instead of downinsomnia yang flaring when it should be descendingdrowsy qi unavailablethready pulses blood or yin xurapid pulses heatchoppy pulses, including at right cun blood stasis, especially in the upper jiao (esphageal surgery and breast reduction?)mauve tongue blood stasis with yang and/ or blood xupeeled center crack stomach yin xu?pain qi stagnationspasming pain blood not nourishing the musclesburning pain at the surface damp heat at the surface? (I have seen this interpreted in other school’s this way and as in indicationfor huang qi)chronic knee troubles kidney involvementrock hard muscles muscles not nourished by bloodQuestion: once again I am getting stuck on where to locate the heat. The pulse does not clearly say yangming or shaoyang. Thereis something blocking the yangming though I am not sure if it is food or damp or stagnant blood. So would this make it yangmingheat? Or does the burning surface mean that it is in the taiyang?
1 teacher remarkExcess or deficiency: mixed, about equal. (This exercise has been very useful for me. This patient is a good example. Until recently,I have seen her as primarily deficient, and while it’s true that she has been getting stronger, I am now able to see that her build,ability to withstand her physical ailments, blocked yangming and blood stasis mean she has always been less deficient than I hadinitially interpreted.)zang fu: sp qi xu with cold damp, blood deficiency with blood stasis, heat somewhere, glomus, kidney yang xuyangming, taiyin, shaoyin, jueyinTreatment principle: unblock the bowels and bladder, strengthen middle jiao to make blood, nourish blood, bring warm healthyblood to the surfaceThis leads me to a combination of da chai hu tang with wu ling san, increased bai shao, and added blood movers such as dang gui,tao ren, yi mu cao (which ends up incorporating the idea of dang gui shao yao san). In the past, bai shao has given her waterydiarrhea, so I am thinking to use chao bai shao despite her constipation troubles. I would love to hear any feedback on thediagnosis or treatment, especially about how to locate the heat or determine what the glomus is made of. For example, with thecold feet, white coat, occasional watery diarrhea and undigested food, could this be bxxxt territory instead of da chai hu tang?There is no full right guan, and the pretty severe blood stasis along with surgical intervention in the shaoyang area (breastreduction) has me leaning towards the da huang in da chai hu tang. But I can see a rationale for both ideas.JPEG | 521.6 K67CA280E-1960-495B-B0F1-AC9…JPEG | 538.6 K6889A2B1-7CBF-4478-BFE9-0D9… ReplyAnn ClearyNewApr 07, 2021ReactCatching up on other cases in this section, and seeing @Sharon Weizenbaum asking for some to be moved over to the SpringForum. I only see this section, so if I have posted in the wrong area please let me know. :)Sharon WeizenbaumSharon Weizenbaum NewApr 11, 2021ReactHi Ann, Great write up and good tongue pic too. What I see is that the heat is due primarily to stasis. Where is the stasis? I thinkShaoyang in a Si Ni San way and blood stasis. The stasis can block the movement of the warm life yang so it builds up. It is notuncommon at all for systemic blood stasis to cause heat on the surface of the body. I think Da Chai Hu Tang is too purging for her.
1 reply 1ReplyWe also know that her blood is somewhat deficient as well as her spleen perhaps. I would use Xue Fu Zhu Yu Tang. That includesSi Ni San and Tao Hong Si Wu Tang and it is on the cooling side. One of the causes of her blood stasis, besides the Shaoyang block,could be that the heat is thickening it. You could use a combo of Chi and Bai Shao. This, along with the Tao Ren should be enoughto help her bowels move more smooth. The Damp is not significant enough (to me) to use Wu Ling San. I would suggest adding FuLing to this formula.Does that feel right to you, since you are the one who knows her?3 more comments 3Joy BlaisQuestion About Transgender Inclusive TerminologyNewMar 30, 2021ReactOn my intake form I have an area titled "for women only" that asks about menstruation, pregnancy, menopause, etc. I had to givea title to this section after more than one cis-man tried to fill it out (often with multiple question marks and confused answersabout their menses). Anyway, I realize that I need to update this title. "People with Uteruses" doesn't really cut it. Do you have anysuggestions that are trans friendly? I was thinking "For Assigned Females", or something similar. Thanks!ReplySuzanne Connole NewApr 04, 2021 1ReactThis is a really good question. I think it was recently discussed in the Venus Rising Facebook group but I am not sure a conclusionwas reached. I'm curious if Gynecology is still inclusive? It refers to the system rather than the gender? So that section would be forany one who has or has had a uterus/tubes/ovaries.ReplyJoy BlaisNewApr 04, 2021ReactThanks Suzanne :)1 teacher remarkTom KennedyZhang Zhongjing bookNewMar 13, 2021ReactHi,A while ago I heard about a book on Zhang Zhongjing (it was on a podcast or in an article, I can't remember). It was about thevarious myths surrounding him and it sounded fascinating. Does this ring a bell with anyone?Also, any thoughts on the case I posted a while ago would be much appreciated.Best wishes,Tom.
ReplySharon Weizenbaum NewMar 21, 2021ReactGosh Tom, I don't know. If you find out, will you let me know? ReplyTom KennedyNewMar 22, 2021ReactSure, of course. It's very frustrating that I can't remember where I heard about it!Molly ShapiroAsymmetrical tonsils and phlegm in 4 yoNewMar 09, 2021 | EditedReactMy son is 4 1/2. A couple of years ago his doctor noted that his left tonsil is bigger than the right. We've been seeing an ENT who iskeeping an eye on it, but no suggestions for treatment have been made at this time. There have been no symptoms of theenlarged tonsil. The doctor seems to think he might just grow into it.Within the last year I've noted an increase in his need to clear his throat from phlegm. Sometimes when he speaks, his throatsounds thick with phlegm, like he’s choking on it. He clears his throat throughout the day, it seems worse during/after eating. Hedoesn't cough, it doesn't come up. He clears his throat then swallows it. Nose is clear.I've been searching for a formula to help with the phlegm while keeping in mind the enlarged tonsil. There's not much else to workwith (thankfully). Appetite and digestion are strong/good, sleep is good. Physically active, good energy. His diet is (mostly)nutritious, has variety, he eats his veggies.About once every 1-2 months he'll get some heartburn in his chest (burning I think) thatresponds well to a couple of swigs of sauerkraut juice. I think his temperament is within "normal," however I'll note that he seemsmuch more quick to anger and irritability than his younger sister (worse if tired or hungry).The tongue seems to reflect heat, I thought from a blocked pivot. I was using that to explain the enlarged tonsil. The phlegm isgetting caught here too, perhaps from the heat acting on the fluids? I’m not sure if I am seeing this right, and the best way to treatit.He'll take any formula in liquid extract form. So far I've tried Xiao Chai Hu Tang, Ban Xia Hou Po Tang, and Chai Hu Jia Long Gu MuLi Tang. I haven't let him take any formula for too long because I wasn't seeing any immediate response and am cautious to pushthe pattern in the wrong direction. I've always used the Kan liquid extracts, but perhaps this is a great reason to try the liquidextracts that @Cara Frank carries?I'm attaching pictures of his enlarged tonsil (not easy to take!) as well as tongue.Thank you so much for any feedback/insight!!Cara Frank
3 teacher remarks2 replies 22 replies 21 more comment1JPEG | 148.6 KCED7324C-F08B-4653-8795-A06…JPEG | 143.9 K30CFE62E-DCF8-4F01-872F-DB5…JPEG | 167.2 KE02DC13F-A354-4AF6-92BC-AC9…ReplySharon Weizenbaum NewMar 10, 2021ReactHi Molly, That is a red tongue with a bit of a pointy tip. I think about Ban Xia Hou Po Tang but modified for the heat. When the tipof the tongue is red like that, I often add Huang Lian but I would just add a little. You can also add Zhi Zi. I know Huang Huang hasa formula that is a modification of BXHPT like this but I can't recall it exactly right now. maybe @Eran Even knows? How does thissound?Eran EvenReplySharon Weizenbaum NewMar 10, 2021ReactI think @Cara Frank might have Ba Wei Chu Fan Tang in a liquid extract at China Herb?Cara FrankAmy JennerHypomania with digestive and menstrual difficultiesNewMar 09, 2021ReactI would appreciate any thoughts you might have on this case.36 yr old femaleCC: menstrual difficulties, spotting mid cycle and sleep cycle offJen is a 36 year old life coach that moved to rural Maine from NYC with her husband last year. She lives with Bipolar II and takeslamictal daily. She is hypomanic and it feels like being in a washing machine to be with her. Rapid speech, very descriptive in apoetic way of very small details of her physical being. Today she described how her toes are generally cold and feel like she isstanding in the mud of a mangrove swamp with the mud squishing between her toes. I find it easy to get lost when listening toher. She is a sober alcoholic, sober 4 years. Does use pot to "give myself some space" several times a week and is not sure she is incontrol of it.Her emotions she describes as a roller coaster, rolling between being irritable and snappy (sometimes yelling at people) to veryexcited about a new idea. Worse with stress.
1 teacher remarkSlp: needs 8 hrs, but struggles to have the discipline to go to bed before midnight and is still up at 5 or 6 am. Feels "on" all the timeand fatigued.Appetite: is poor, the only thing that is appealing is sugar and carbs. Burps a lot. Occasional HT burn. Had been eating vegan diet,but is starting to incorporate more animal productsThirsty for warm/hot beveragesBowels loose with a sharp sour odor, and undigested food. GassyRT sided post nasal drip and tonsil stonesskin is dry with acne on the upper backTends to chillinessMenstrual: sticky brown spotting sometimes up to 10 days before 1-2 days of bright red bleeding and another 7 days of stickybrown spotting. very little cramping, intercourse is painful, and she has premenstrual breast tenderness.Abd: tight rectus and ribsideempty bow tieoketsu on leftT: palesl orangethin coattight bodysl scallopedP: wiry in both guanpear shaped with thin upper body and fleshier through the thighs and buttocks.sallow complexion with some pimples around the mouthI see her as over all deficient with Liver yang rising, kid Qi and yang def, Sp qi and yang def, Crappy bld. Shao yang, Tai yin, shao yinI see it is as the pivot problem affecting the ability for the ministerial fire to get into the correct position to warm the spleen T&T. Iwanted to get that working and see what happened with the menstrual cycle if we get the SP working better. I want to anchor theyang.The formula I gave her today was Si ni san with mu li, long gu and gan jiangcha hu 9zhi shi 9zhi gan cao 9bai shao 9mu li 6long gu 6gan jiang 6Thanks for any help you can offer. I so appreciate having all you guys out thereSharon Weizenbaum NewMar 10, 2021React
ReplyHi Amy, What is her subjective experience of the postnasal drip and tonsil stones? I also wonder about the painful intercourse. Is italways painful? Vaginally, deeper in, severe or mild?One reason I ask about the PND and tonsils is to see if she has a sense of congestion in the throat.To me, the poor appetite and sour smelling stool point to food stasis. this could prevent Yang from descending. I am not sure howmuch of the hyperactivity above needs shells and bones to settle and how much it needs the right side digestion opened up. Ieven wonder about something like BXHPT modified. Dr. Huang uses this for spirit disturbances. It could be integrated with XuanFu Dai Zhe Tang. The burping strikes me too. It would not be a stretch to integrate CHJLGMLT with BXHPT and XFDZT if you use DZin place of Long Gu. I would leave out the Da Huang though.I'd try to open her digestion more before supplementing, which it seems you are doing. Does this make sense? ReplyAmy JennerNewMar 10, 2021ReactIt is making sense. That is what I was trying to do. Taking ideas of CHJLGMLT w/o the yang ming /tai yang. Without the digestionworking, I didn't want to add supplementing herbs, and I was a little worried about the shells and bones for that reason. TheBXHPT makes sense as the Tonsil stones are noticeable when a stone is about to pass. It gets hot, swollen and irritated feeling.The sensation of something being there is not there all the time. The PND is there all the time and feels it in the top of the throatlike she could hawk it up.Intercourse is painful enough that she doesn't want to do it. It is painful because she doesn't lubricate well and very painful whenhe is deep inside her which she tries to control.I couldn't remember what the sour smell was for sure, honestly, so it makes sense that giving the right side of the wheel a pushwould help.How's this?Xuan fu Hua 9Dai zhi shi 9sheng jiang10ban xia 9ren shen 6da zao 12Zhi gan cao 6Hou po 9Fu ling 12zi su ye 6chai hu 15gui zhi 6huang qin 4Thanks so much, I really appreciate the help
Sarah Rivkin Referral in SwedenNewMar 09, 2021ReactIs anyone here in Sweden and particularly adept at treating menopausal symptoms? Or might you have a recommendation? Iagreed to do a video consult with a patient's girlfriend next week, but I'd prefer to hand her off to someone who might be able tosee her in person--or at least not have to figure out the legality and logistics of getting her herbs from another country. Thanks!2 earlier comments 1 teacher remarkMolly ShapiroHow to take a good tongue pic with iphone?Mar 05, 2021ReactDoes anybody have advice for taking a quality tongue picture with an iphone? Mine always seem blurry or lighting is wrong. Whatsetting do you use? Do you stand close up or zoom in? Do you center the yellow box directly around the tongue after patient sticksit out? I look forward to hearing your tricks! ReplySharon Weizenbaum NewMar 21, 2021ReactThank you Joy. I am going to use these instructions for the GMP cases! ReplyMargaret Sikowitz NewJun 24, 2021ReactHi and question here on looking at tongues: are you looking at any in person now? Most (today's schedule: all of them!) patientsare fully vaccinated. Wondering where people are on this point...?Joy BlaisConfused about a Mixed Hot & Cold CaseNewMar 04, 2021ReactQuestion for teacherHi All, I'm looking for suggestions for this mixed hot & cold case.I am seeing a relatively fit, robust, & active 74 year old man for a shoulder strain. While treating him with acupuncture for theshoulder pain, he inquired about treatment for his current urinary issues. He was diagnosed with prostate cancer about 5 yearsago and had his prostate removed which did not change his frequent urination at night. He currently gets up 4 times a night tourinate. The urine is clear to light yellow and not inhibited. He has mild to moderate cold hands & feet and wakes once a night toclear thick phlegm from his throat by gargling with water & swallowing it down. His abdomen has slightly loose skin, hardadhesions under in his lower belly where he had prostate surgery, and some pulsations around the umbilicus. His tongue is longand red with a thick white coat covering the entire surface except for a long peeled red patch over the L side (on the R side whenlooking at the patient), the tip is red and squared, & there are very mild toothmarks towards the front of the tongue. His pulse iswiry in all 3 positions on the L and deep on the R chi. He takes medication for high blood pressure.For Sure Signs:Shoulder pain Stasis in shoulderFrequent urination at night Urine too frequent at nightCold hands & feet Yang not reaching extremitiesPhlegm in the throat Phlegm in throatLoose abdominal skin XuAdhesions in lower abdomen Stasis in lower abdomenPulsations around umbilicus Xu in lower jiao?TongueSharon Weizenbaum,Guy Sedan,Allyson Nevard,George Mandler,Sharon Yeung,Thom Heil,Laura Mcgraw
2 teacher remarks1 reply 1-Long Heat-Red Heat-Thick Coat Dampness-White Coat Cold-Peeled patch on L LR Yin xu--Red --LR Yin xu with Heat-Tip Red Heat in HT-Tip Squared HT Involvement-Mild Toothmarks Mild SP Qi XuTCM Dx: LR Yin xu with Heat, KD Qi Xu, phlegm damp in throat, BL not transforming fluids, Mild SP Qi XuConformations: Jueyin, Shaoyin, ShaoyangI am considering Si Ni San with increased Bai Shao & added Fu Ling, Ban Xia (for the throat phlegm), and maybe Shu di Huang orGui Zhi (for the xu below), but I am really not sure. He clearly needs the heat and LR Yin xu addressed but he also seems to have alot of cold dampness. The very wiry L pulse makes me think of more constraint. He denies any thirst, urinary hesitation, dribbling,or incomplete urination so can I still think about the urinary frequency as dampness in the BL, or is it simply some xu in the lowerjiao causing the urine to leak out (ministerial fire not in position causing pooling of cold fluids)? Even though he is elderly, he is fitand active. I’m sure there is some deficiency from age, but he seems strong.Any advice for me?Thanks! ReplyThom HeilNewMar 06, 2021React@Joy Blais Hi Joy -- Thanks for sharing your case. Before you land on a formula, I think it's important to take a step back and look athow you're processing the information you're getting from your patient. A few observations:-- It would help to see a photo of this patient's tongue. I can't tell if the tip and peeled patch are more red than the rest of thetongue or if it's just easier to see the tip and peeled patch of a red tongue because they have less coating.-- KD qi xu doesn't show up in your symptom analysis, but it's in your diagnosis. How did you come to that conclusion?-- Diagnosing LV yin xu depends on being able to diagnose KD yin xu. Is there evidence of KD yin xu?-- "Cold dampness" and "constraint" aren't necessarily opposing ideas. Remember that dampness can cause a wiry pulse becauseit's constraining the yang.-- "Can I still think about the urinary frequency as dampness in the BL, or is it simply some xu in the lower jiao causing the urine toleak out (ministerial fire not in position causing pooling of cold fluids)?" That's three different explanations, so I would either goback to my intake to find the answer or go back to my patient and collect some more information. Otherwise, it's just a guess atthis point.-- It would probably be worth checking out how much fluid he takes in during the day. Also, what kind of blood pressuremedication is he on? Is it a diuretic?My comments are certainly not a comprehensive review, but I think those are some good places to start clearing up your ideasabout this case. It seems clear that your patient has dampness and heat (and they don't seem to be comingled yet), but thepattern is unclear to me at the moment. Maybe someone else can be more incisive with their comments.I look forward to seeing how this develops!Joy Blais
2 replies 21 more comment1ReplySharon Weizenbaum NewMar 21, 2021ReactHi Joy, How is it going with this case? 80 oz of water a day sounds like a LOT! Why does he drink so much? Is he thirsty for that? Ifhe has the urge to drink that much, I would say he is quite thirsty. If not, then could you have him only drink when thirsty and seehow that helps. Also find out what other liquids he is taking in like tea or coffee.I wonder if he has a lot of muscle tension below the umbilicus that may be hard to feel due to the adhesions. With the tongue, Iagree that it sounds like Kidney Yin and Qi xu.What about his body temperature. I am thinking along the lines of Shen Qi Wan to supplement Kidney Yin and Qi. It could be a bitmodified with increased Shan Yao to benefit water more. I think the water needs to be absorbed more into physiological Yin.Does that make sense with him?1 teacher remarkTom KennedyDifficult neurological caseNewMar 03, 2021ReactHi everyone, I’d be very grateful for any thoughts on the case below:30 y/o male, main presenting symptoms of strange 'nervous system' sensations on top of head/down sides of face/GB channel of lower legs, and SP/KIDchannels of feet. Started 5 years ago after a 'feeling of shock' when smoking marijuana, and began as an aching pain. He says it feels 'like a nervous systemthing', and doctors initially suspected MS (since ruled out).He has a variety of sensations, including a lot of 'popping', as well as cold water trickling sensations and more static heat sensations (the heat sensationsmore prevalent when he’s relaxed). He feels there is somehow a connection with breathing, and he often feels he can't breathe as deeply as he'd like. Stress isa big factor, but when busy he doesn't notice the symptoms as much as when relaxed. He also feels there's a strong connection with his feet - when he uses amassage ball or has reflexology, it seems to connect with the other areas and activate them.He struggles with social anxiety.Some feelings of sinus congestion/pressure/blockage in the head, including eyes and ears.Describes his overall body temp. as normal, but his feet and knees can feel cold on palpation, and he sweats easily/profusely with exercise (and often whilehaving acupuncture).No dizziness, but some 'head rush' getting up quickly.No other pains.Bowels/urine mainly normal, but some flatulence and some history of IBS/loose stools.Dry eyes (long-term issue). No headaches. No real mouth/throat dryness. Not much thirst but drinks water habitually.I've tried a number of approaches with herbs, without any obvious success other than some 'activation' of the sensations at times.For a while I viewed is as dampness lodged on the exterior, and used a combination of FJHQiT and FJFLT, gradually increasing the huang qi. I previously triedshaoyang formulas with no real change either.Tongue pale, swollen, moist, slight toothmarks.Pulse slightly slow, soft.I won't say any more about my diagnostic understanding of the case so as not to muddy the waters, but happy to say more if it's helpful. Thanks in advance!JPEG | 24 KAttachment-1
1 more comment1ReplyTolley SinkNewMar 13, 2021ReactHi Tom, I see a some lavender/ purple color in the middle of the tongue indicating blood stasis. I think the water pathology makessense with the tongue as well which can help explain those unusual/ weird symptoms. Sorry I'm not more help with the wholepicture or formula but that's what I noticed. Interesting case! ReplyTom KennedyNewMar 13, 2021ReactMany thanks for the input Tolley, much appreciated. The tongue picture isn't great, but I know what you mean, there could be anelement of blood stasis.Elaina Greenberg35 year old woman with sun allergy (not good since she lives in LA), eczema, gluten intoleranceNewMar 03, 2021React35 year old female, mildly obese, but with good vitality to her eyes and Shen. She is vegetarian and has the goal to be vegan buthasn't fully gone there. She does not eat raw food. She is consciously working on losing weight and in addition to watching herfood, she is walking 3 miles 2x/ week and does weight training with cardio for 20 minutes 2x/ week. She has been doing thisroutine for about a month now and feels good doing it.Sun Sensitivityunable to be in the sun for more than 20 min in the summerbreaks into hivesred spotstextured small bumpsitchyb/w aloedoesn't blisterwhen goes away will turn silvery and have a sheendry skinif temp more than 87 body over heats and shuts downhand can get super hot and uncomfortablehand don't alternate from hot to coldif room is hot will get hotif room is cold, will get coldeczema onset 3 years agoworse in wintertends to feel static electricity on things and self easilyon arms and shins / back of legs will get eczema in winteritchylittle blotchy
skin little reddernot related to diet because onset during clean eatingb/w lotion and aloeskin - red splotches on cheekscan be raisedcomes and goesnot itchyw/w hot showerb/w coffeeGluten intolerance dx 5 years agohad some gluten that was "the straw that broke the camel's back"was horizontal for 8 hours because of painsince then has been off glutenif has gluten has significant bloating, pain, and migrainesnow if ingests gluten, she will make self vomit to prevent reactionBloatingw/w dairyGas with dairy - smellyBM regular in amrarely in afternoon or evening will have 2nd BMeasy to passcompletecan be stickywould love to lose about 25#Urination:frequent 5-6x/ dayno urgency+hesitancy - has to focus to releaseno nocturiaThirst:used to be really thirstyhas reduced in the past 7-8 months
now consciously drinks waterpref room tempdoesnt like ice water - sensitive teethlikes hot waterBody temptends to run really hotnow has cold hands and feetno sx of Raynaud'sno night sweatsno spontaneous sweatingtypically doesn't sweat with moderate exerciseSinus congestiongluten will also cause white mucus to come out of nosegoopy4-5 years ago had the worst sinus infection everfelt in whole face, jawdoesn't use neti potb/w steamb/w Sudafeddrinks apple cider vinegar in hot water every am and hasn't had a sinus infection since started thatR sinus more blocked than Lcan be bloodysnores - doesn't wake with HAhx of hair losseyebrows and scalp - area growing on scalpon top of head has a line / bandnever seen MD for itreally dry hairbruises easilySleeps at least 6-8 hoursdoesn't wake in middle of the nightno night sweats
easy to fall asleepwakes groggydoesn't wake restedLMP 1/13PMP 12/15worst menstrual cycle in the past 8 yearshx of mood swings with periodno birth controlmenarche at 14/15cycle is 28-29 daysPMS - chocolate cravings+breast tenderness3 days prior starts more mood swingsDay 1 takes 2 Midolsearing pain in uterusb/w heatb/w pressuremedium flowpain starts with bleedingbiggest clot - silver dollar sizednot painful to passdeep dark red bloodDay 2 - painful still, medium flowDay 3 lighter flow, no pain, but tender and bloatedAnxietytense shoulders and chestclinched stomach and tongueclenches toes and fistsb/w meditationb/w cannibas edibleno panic attacksno palpno SOBstress is primarily mental - worryP: rapid, thready, L guan flat T: red tip, thin white coat, scallops, pink body, +3 vein distention
1 teacher remarkDx: Cold crappy blood in uterus, Poor TT Fcn, Spleen Qi Xu, Liver blood Xu, Heat trapped under skin Hot and Cold combo - gave BXXXT with Bai Zhu & Bai ShaoAfter herbs patient reported having more even body temp. Hands and feet were no longer cold. Stools felt even more complete.She wanted to test her sun sensitivity.On an 75 degree day she did a 1 hour hike in mid-day sun. She wore a long sleeve shirt while others around here were in tank tops. She didn't sweat despite the layers and exercise. Her hands got very hot and itchy, they did not turn red Had little swelling in hands but resolved after rest Itching resolved with rest, but hands remained hot Was flushed and red in the face, but no sweating - felt this was her normal, but is is abnormalShe wore sunscreen, but still developed hives on places exposed to sun Lasted 3 days Red skin raised skin spotty blotches Itchy skin - when itched skin, felt like it was on fire b/w aloesince then has had an aversion to warm drinks Hands have been super hot Dry skin Aversion to windSo this is were I'm lost- clearly she has heat on the surface and that the surface is closed. I think if she could sweat she would be alot happier. Thoughts? Advice? Guidance? Tips on how to think of this?I would love to help her deal with the sun especially before summer really comes out here.JPEG | 85.4 Ktongue after BXXXTIMG_3177Elaina GreenbergNewMar 12, 2021ReactGuy Sedan,Sharon Weizenbaum
1 reply 11 more comment1Reply@Sharon Weizenbaum @Guy Sedan I would love to hear your input for her. Thank you.ReplySharon Weizenbaum NewMar 21, 2021 | EditedReactHi Elaina, Sorry for the delay!@Elaina GreenbergI think you are in the realm of the Gui Zhi Ma Huang Ge Ban Tang for her. I think you can go back in our course notes and find thisand also read about it in the Gui Zhi Tang Plus ebook. You are right that her surface needs to be regulated. Not sweating is the keybut she also has aversion to wind so it needs to be a combination formula like this. Make sense?However, I think the glomus and digestive issues are also important to address at the same time. Why does she want to be vegan?I would encourage her not to "try" to lose weight but rather to work with you to improve her metabolism of food, which is clearlynot so great right now. Helping her be comfortable eating and comfortable with a wide range of nourishing foods seems key tome. What is your diagnosis? How do you see her glomus? Is it a glomus? You said bloating but didn't say where. I am assuming it isepigastric.Can you continue this case in the new spring forums? I'd love to hear how it goes?Elaina Greenberg
1 teacher remark1 reply 1Sarah Rivkin Advice on raising ratesNewMar 02, 2021ReactHello, colleagues,I've known for a while that my rates are low for where I practice. In addition I've now absorbed all the costs of COVID safety--including only seeing one patient at a time, rather than two, as I'd historically done. I also will be finishing my doctorateimminently. I think most of my patients can afford to pay a bit more, FYI.So, should I:A. Just say I'm raising my rates as of such-and-such a date.B. Talk about all the additional costs I've absorbed because of COVID safety.C. Mention that my rates are no longer a reflection of my fifteen years of practice with a doctorate.D. Some combination of the above.Would greatly appreciate the thoughts of anyone who would care to weigh in!Thanks,Sarah ReplyAnni EllistonNewMar 02, 2021 1ReactHi Sarah, I hear you!Rather than raise rates at this time I opted to shorten my appointment times, which I don't love but have now adjusted to. I usedto work 2 rooms and see 7-10 clients per day. Now it's 5-7 per day in 1 room, with 50 minute appointments instead of 60, to avoidback-to-back and allow for cleaning time. To be honest, other than the reduction of income I actually am quite appreciating it, onlyseeing one person at a time and having more time to accomplish other tasks during the day instead of being on the run. So (otherthan financially!) I feel I've gained from it too. I totally struggle every time I raise my rates, but think I need to do that as well in thenearer future (hear my discomfort!!).In terms of your multiple choice, I would say A! And then maybe bring up the additional studies you have been doing and benefitsin a separate, very positive way. Such as:"As of x date my updated rates are...""I'm really excited to share with you that I am in the final stages of completing my doctorate. The knowledge that I have gained hasbeen..."Anni =)
4 more comments4ReplyElaina GreenbergNewMar 03, 20212ReactMy vote is A - You don't have to justify or defend your need to raise rates. I just put a sign out 1 month prior to my rate increaseand said as of January 1st I will be charging... No one has been phased by it and the two patients who asked if I would treat at areduced rate I was happy to do so. The reduced rate was still more than I had made the previous year, so everyone felt good. I had a millennial venture capitalist kick my ass about raising rates every year. I was so resistant to do so and his unabashed /unashamed drive to make money was a new idea to my Gen X "you're a sell out if you make money" old punker mentality. He toldme that it had been so long since I had raised my rates that I was making less money than in previous years. It was the right adviceat the right time. You are worth it!Sarah Rivkin Nice article to share with patients on postpartum food and careNewMar 01, 2021ReactHi all,I thought this was a good article to share with patients on how most traditional cultures have special food and care they give tonew moms. Nice how it puts the practices we do/recommend in context. The New York Times is rather conservative when it comesto recommending "alternative" practices, but I still think the article is useful. (I'm also now curious to read the study it references.):Many cultures have special postnatal customs and there are notable similarities across cultures. A 2010 cross-cultural study published inthe journal Archives of Women’s Mental Health found that the period of healing after childbirth is almost universally observed for 40 days,whether that is explicitly written into its name, such as the Latin American cuarentena, or quarantine, or in the Chinese zuo yue zi, orsitting the month. Moreover, traditional postpartum foods, regardless of their specifics, are prized for similar reasons: to “warm” the birthparent, aid in digestion, replenish minerals or increase milk supply.“It doesn’t matter what culture you’re from, a lot of these themes emerge because there are very real and central medical truths to wherethey come from,” said Dr. Jennifer Conti, a Bay Area-based OB-GYN, adjunct clinical assistant professor at Stanford University School ofMedicine and author of “The Vagina Book.”“Women used to die all the time from labor and birth,” Dr. Conti said. “In the absence of modern medicine, if things you can do to keep aperson alive are to keep them warm and out of the cold, keep them well-nourished, keep them rested, then it makes sense that those aretypes of support you provide and the types of foods you prescribe.”Whether or not these foods and practices have proven nutritional or medicinal properties — and the science is not wholly conclusive —there is immeasurable value in nourishing the birth parent. The foods represent rest and assistance, necessary for physical and emotionalhealing.See:https://www.nytimes.com/2021/02/25/parenting/postpartum-food-traditions.html?referringSource=articleShare&fbclid=IwAR0ceu5pf_iCGoGx3X56oRyzNJzFSCUDkWDxHkBzm5FZQkc1giShngWEcJEEnjoy,Sarah
Postnatal care: a cross-cultural and historical perspectiveChildbirth and the immediate postpartum period represent a major transition in a woman’s life. This period is considered a vulnerable time for the mother and child in most societies, and rituals for this transition are common. In this study, we present some examples of postpartum customs in a cross-cultural and historical perspective. Also, we present the current knowledge on the possible impact of postnatal care on mental health. Systematic literature searches were performed in Medline, PsycINFO, and the ScienceCitation Index Expanded (ISI) for the time period 1966 through May 2010. Reference lists in books on pregnancy and childbirth from the University Library in Oslo were used to obtain additional information. We found that the postnatal period seems to be universally defined as 40 days. Most cultures have special postnatal customs, including special diet, isolation, rest, and assistance for the mother. The uniformity of customs across different cultures is striking. However, many postnatal customs that were common before 1950 are no longer existent. The focus on rest and assistance for the mother after delivery has gradually decreased. Studies of associations of postnatal care and mental health in the mother are limited and show inconsistent results. More knowledge is needed on postnatal care and mental health.Source: https://link.springer.com/article/10.1007/s00737-010-0175-1 Embedded File.https://link.springer.com/article/10.1007/s00737-010-0175-1Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review - Cindy-Lee Dennis, Kenneth Fung, Sophie Grigoriadis, Gail ErlickRobinson, Sarah Romans, Lori Ross, 2007Many cultures around the world observe specific postpartum rituals to avoid ill health in later years. This qualitative systematic review examined the literatur...Source: https://journals.sagepub.com/doi/full/10.2217/17455057.3.4.487 Embedded File.https://journals.sagepub.com/doi/full/10.2217/17455057.3.4.487
1 teacher remark Embedded File.https://www.nytimes.com/2021/02/25/parenting/postpartum-food-traditions.html?referringSource=articleShare&fbclid=IwAR0ceu5pf_iCGoGx3X56oRyzNJzFSCUDkWDxHkBzm5FZQkc1giShngWEcJEReplySharon Weizenbaum NewMar 21, 2021React@Sarah Rivkin Thank you for these. I am created a resource page and will add these to it!Sarah RivkinJa'Nelle Jefferson, LAcDifficult Case: Damp, yin deficiency, blood stasis - Dang Gui Si Ni Tang w/o Xi Xin?NewFeb 24, 2021ReactHi. Thank you for reading my case and sharing your ideas! Sorry it's very long, but I feel like there are so many important detailswith internal medicine especially in older patients and complex conditions. When I read case studies in books, I often find myselfwith unanswered questions that would clarify the case for me. Suggestions are appreciated!L. F. Female 62 yoChief complaints: recovery from sequela of long-term mold exposure in home (heaviness, fungal infections, stomach infections),Raynaud's with very cold/white fingers & toes (used to be whole hand/foot, but improved with IV mold treatments), weight loss,pre-diabetic blood sugar levels when weight creeps up.Current Presentation:Stubborn toenail fungus for years,She has a great appetite, loves eating, thirst is normal, but she prefers cold drinks & hates taste of almond extract, bitter & sour,but likes salty, sweet, spicy. She eats gluten free & avoids sugar.Urine input=output, light yellow & needs to lean forward to completely void bladder, Stools are formed brown 1-2 times a day, butoccasional constipation,
Her temperature runs low 96-97, she does not tolerate very hot or very cold weather, hates humidity, doesn't sweat much, not atall before mold treatments.She doesn't get sick often but if she gets sick her throat will be red painful white spots, no abnormal sweating. She has beginningof cataracts on eyes. Her gums are receding & bleed easily, teeth stained from long term antibiotic useShe has neck tension which sometimes causes headaches.Energy 6-8/10 feels heavy especially in afternoon. Not particularly fond of exercise but rides her bike a few times a weekIn menopause since 58 yrs old, only a few hot flashes at the beginning- no symptoms since, has inactive fibroids, all leg hair gonepast 10 yrs.HX: Longterm antibiotic use for strep as child, as adult 10 yrs mold exposure in home, diagnosed & treated beginning 2016, somemold-toxin levels in blood still high, h-pylori & ecoli discovered during mold treatments, more antibiotics, irregular periods most oflife until after birth of 2nd child and OCP, then regular cycle, PCOS diagnosed as causing infertility & given fertility drugs andextended difficulty delivering first child 9 lbs, but no c-section & no problems during pregnancy, no fertility or delivery problemswith 2nd child, 2012 thyroid cancer - removed right thyroid, synthroid & then bioidentical hormone meds right after but nonesince, LASIK in 2000 for nearsightedness,Tongue pictures below - no coat & long vertical crack.Pulse - not available, virtual herbal consultI've made the mistake of trying to treat damp & yin xu/ blood xu & stasis simultaneously using unique modification to formulasfound in Formulas & Strategies or American Dragon Website. Formulas so far are below:#1 was well tolerated & tongue became less red# 3, 4 & 5 In response she has had heart palpitations & felt funny after takingAll herbs were granular form, but she prefers capsules if it will be very bitter.1. XCHT + SWT + GJ, THF, 9/32. Ban Xia Xie Xin T. Mod. 9/223. Xiao Yao San + DanS, DS, XF, FS, HQi - 10/144. Wen Jing Tang + HL, SNT, Sheng Di 12/95. Zi Yin Jiang Huo T + Liu Wei Di Huang W 1/19I'm thinking I shouild always have started with Jueyin so I'd like to prescribe Dang Gui Si Ni Tang and after watching the Andy Ellisvideo about xi xin, I'm thinking about adding Huang Qi, Di long, and possibly Chuan Wu.I'd also like to give Zeng Ye Tang to address the large crack in tongue/ST yin but afraid it will aggrevate the damp sensitivity &possibly cause heart palpitations.I'm concerned about the heart palpitations with some of the formulas and can't figure out why, so I'm a bit nervous it may happenagain and so is she. If it does, this may be the last formula she tries!What would you do? All ideas are welcome!Best,Ja'Nelle
1 teacher remark1 reply 1JPEG | 60.8 KLF 02.17JPEG | 63.5 KLF 02.17 sl ReplySharon Weizenbaum NewMar 21, 2021ReactHi @Ja'Nelle JeffersonThough I think her western diagnoses are important to consider, I'd love this written so that the western isn't all mixed in with thesigns and symptoms. I wonder if you could do this? It would help me so much to see what is happening more clearly. A section forwm dx and tx and a section for her actual presentation to you.Some things I'm unclear on that help me. You said occasional constipation - how often is that and how bad? Doesn't tolerate hotor cold well - what happens? Body temp is so important, what is your sense of how she runs. (not on thermometer) What happensif she eats sugar or gluten? "Doesn't sweat much" Do you think she has a sweating imbalance, meaning does she not sweatenough? What is her constitution, complexion? What is her main complaint if there is one, in terms of symptoms she is sufferingfrom rather than "sequela of mold exposure." I mean, if there was a symptom she could be rid of for good, which would shechose?This would help a lot. Thanks!Ja'Nelle Jefferson, LAcNancy LegatoExtremely difficult stool following BXXXT?NewFeb 23, 2021ReactHi, all --A patient I have been seeing for emotional upset, epigastric blockage, and digestive problems recently had an acute onset ofbloating followed by extreme difficulty with bowel movements. This occurred abruptly following an acupuncture treatment (YinTang + Sp4, PC6 with ion pumping cords) and also about 4-5 days after starting Ban Xia Xie Xin Tang with Tai Zi Shen instead of RenShen and added Chai Hu.I would love your input on how I could have done this better, and also how I can help her now!This is a 45 y.o. woman, normally very active and energetic, who has been struggling with crushing sadness recently whileprocessing a traumatic relationship with an emotionally abusive religious elder over 8 years in her adult life. She has a history ofHashimoto’s disease and has gained quite a bit of weight in the past few years. She was previously slim, now has quite a bit ofweight around her belly. She has been struggling with frequent hunger, decreased energy, increased thirst, and increased physicaltension with a desire to press her tongue to her palate and wind her fingers around one another when laying down.
A couple of weeks ago I had prescribed her some BXXXT with integrated XCHT with Tai Zi Shen instead of Ren Shen, because shehad epigastric discomfort after eating with some heat signs, some cold signs, some excess signs, and some deficiency signs. Lastweek she had some abdominal distension and flatulence, but also felt somehow empty as well as heavy.At that same treatment, I also did acupuncture (Yin Tang with PC6 and Sp4 with ion pumping cords). Later that day she feltabruptly much better emotionally, but simultaneously had such abdominal distension that it actually caused some back pain. Shealso was only able to have very small stools three times, which she did not tell me at the time. I told her by phone the next day tostop the herbs, which she did. She took the formula a total of 5 days, 3 grams 3 x daily. I also suggested she try doing 4 doors onherself, which she did, but it did not help and may have actually increased the bloating. Last Friday after 4-5 days without stool,she went to the doctor and then had a full workup for possible intestinal blockage. They ultimately found only that she has a lot ofstool stuck in her intestines and gave her a laxative, which did work to some degree, but she did not feel completely emptyafterward.I saw her today. She is doing great emotionally and also has more energy than she has had in a while. She has had small amountsof very gluey BM a couple of times over the past 3 days. Sometimes she tries, but only some air comes out. This morning she wasable to press out some very thickly gluey stool after trying a long time. She was tired afterward, and cold. She is sweating quite abit at her chest, upper back, and face, especially after she drinks warm tea or when she goes bike riding. She has a full feelingthroughout her abdomen but also a weak feeling, like she doesn’t have the energy to push out the stool. She is burping some andhas some flatulence. Her body temperature is overall OK, definitely not hotter in the afternoons but rather cooler. She has a lot ofthirst, wants to drink both warm and cool, but feels that only cool helps her thirst. She is peeing soon after drinking. She also hasan abundant, brownish, thin vaginal discharge, which she often has around her period, but may have started earlier this monthwhile she was on the herbs.Here's my rundown of her symptoms and what I think they mean for sure:Constipation BM not coming outWith gluey BM BM not dryEnergy worse after BM DeficiencyFull feeling in upper abdomen Stagnation in upper abdomenBloating in lower abdomen Stagnation in lower abdomenFlatulence Some Qi coming out belowConstant hunger Heat in StomachBut quickly feels full in upperabdomenBlockage in Stomach domainW/w period Wood involvedBurping St Qi rebellingConstant strong thirst Wanting fluidsb/w cool fluids Heat in Stomach domainAlso likes warm Cool in middleFrequent urination Urine coming too quicklyBody temp: cool Yang not warming the bodyCold feet Yang not warming the feetWorse with laxative DeficiencySweating at face, upper back, andchestSweat coming out aboveW/w hot fluids HeatW/w exercise DeficiencyVaginal discharge Fluids coming out from vaginabrown Heat/StagnationThin consistency, Large amount Cold/DeficiencyDifficult to sleep thru night Yang not settling nightsDysmenorrhea before and 1stday of periodLiver Qi StagnationTension in upper palate withdesire to press tongue against itStagnationw/w lying down Excessw/w current symptoms ???Tension in fingers with desire towind them around one anotherStagnationw/w lying down Excessw/w current symptoms ???Abdomen: Full throughout Stagnation in AbdomenEmpty feeling at Ren 15/14 Deficiency above the stagnationDiscomfort with pressure at Ren12,Sp15 esp. L, St 25, Ren 4 thru 6,Stagnation in St, LI, SI
left St28-St29Pulse:Right cun: deep, slightly fullYang is held under by stagnationRight guan: thin above, bowstringin the middle, and full belowRight chi: thin and fast above,bowstring and fast belowLeft cun: a bit short, thinLeft guan: fullLeft chi: fullTongue: see picture“Liver lines” Wood involvementThin, dry, slightly yellowish furDryness, slight heat, slightstagnationPeeled right side DrynessSublingual veins distended, blueinlower ½Blood stagnation in lower JiaoExcess vs: Deficiency: Mostly deficiency at the root, with excess as a branch.Organs involved: Spleen, Stomach, Large Intestine, and Liver, with Urinary Bladder and Kidney affected.Aspects of these Organs: Spleen Qi Xu, Spleen Yin Xu (deficient, dry, cold); Large Intestine shi (excess, dry). Stomach Yin Xu withHeat. Liver Qi and Blood Stagnation. Kidney Qi, Yin, and Yang Deficiency.Cause of Blood Stasis: Liver Qi Stagnation leads to Blood Stagnation in UterusCause of Dampness: I had previously seen some Dampness in her picture, because she had difficult urination along with herthirst, but I no longer see this in her symptoms. In fact I think a large part of the issue is difficulty absorbing fluids in the Spleenand possibly also Kidney.Explanation of Symptoms:Thirst and frequent urination: Spleen and Kidney not absorbing fluidsConstipation: LI stagnation due to Spleen Qi deficiency with difficulty absorbing fluids.Vaginal discharge: Kidney deficiency with difficulty absorbing fluidsTension in upper palate/tongue and fingers: I think this is worse recently because of fluid loss.Diagnosis in “5”: Spleen Qi Deficiency with difficulty absorbing and holding fluids; LI Qi stagnation due to Spleen Qi Deficiency;Kidney Qi/Yin/Yang Deficiency also not absorbing fluids and leading to some fluid accumulation and runoff below.Diagnosis in “6”: TaiYin, YangMing, ShaoYin = JueYin (?)For sure aspects that could be left out: Blood Stasis in Uterus is both less urgent and I think not so involved in her othersymptoms.Treatment Principle: Tonify the Spleen and Kidney Qi, Yin, and Yang, rescue fluids, enhance absorption; move the stool.Formula: I feel torn between the need to tonify the Spleen and help it absorb fluids while also moving the stool down and out,without further damaging either fluids or Qi. Xiao Jian Zhong Tang (but is it too warm?) + Bai Shao, Mu Li, Tian Hua Fen, and a smallamount of Zhi Ke, Hou Po is my thought.I would love some feedback from others more knowledgeable and experienced! Thanks in advance for your support!Warm regards,Nancy
1 teacher remarkJPEG | 84.9 KTongue coating was a little yellower in person.IMG_2619JPEG | 93.1 KIMG_2620JPEG | 105.1 KSome acne on the chin she thinks is mask-related.IMG_2621Ja'Nelle Jefferson, LAcNewMar 01, 2021ReactHi Nancy, Your patient looks somewhat similar to patients I've seen in the past.If you did not see it, the video/discussion on Zeng Ye Tang is relevant here due to the deep vertical tongue crack which is a seriousfluid depletion in the middle. This is what likely started the blockage/constipation. And 2 of the herbs in there are blood herbs
1 reply 1Replybecause. . .I think blood stasis/unhealthy blood is an important cause as well. Besides the stasis in the uterus you mention, her tongue ispurple, I see the weight gain around the middle as possible beginning of metabolic issue, oketsu - tension around ST 27,Sharon W. has talked in the past about the body's inability to absorb fluids properly and using Dang Gui Shao Yao san for that.In my experience, patient's don't respond well until you heal the blood, and the BXXXT would just have dried the blood further.When you add in her deficiency heat flaring signs & symptoms, I start thinking maybe wen jing tang instead since there is a largedose of mai men dong and also mu dan pi for balance, I've seen modifications on AmericanDragon.com with Sheng Di Huang aswell.I'm hoping someone else will chime in too since I've only been practicing for 3 years. Also hoping you'll take a look at my case aswell. Let me know what happens!Best,Ja'Nelle ReplySharon Weizenbaum NewMar 21, 2021ReactHi Nancy, Sorry for the delay responding. I wonder if anything has changed.A couple of things I notice and that stick out for me. First is that, though there is deficiency, you are right that it is in thebackground. It appears to be more excess and more hot to me.I also think that this time in her life, where she is coming off of being abused (damage from cold) could manifest as very layeredtreatment. The fact that she felt so much better emotionally after your initial work with her seems like a really good sign - and thenthe next layer comes up. You can work with each layer as it shows. I wouldn't put too much into the idea that you did somethingwrong but just move on to the next step. At the same time, her tongue is quite dry so it may be that the pungent hot and bitterparching was too drying for her so it's good to keep that in mind as you go.I wonder about starting with Shao Yao Gan Cao Tang with that pulse. You could modify with Dang Gui, and a little chuan Xiong forthe blood stasis. Also Hou Po. This way you are using bitter cold without drying. I also think that tension with the tongue on thepalate and knitting her fingers sounds like SYGCT to me. Keep in mind the "dispersion thirst" as well. Adding Tian Hua Fen may begood.How does this sound?Elaina Greenberg33 wk pregnant woman with pelvic pain -Feb 22, 2021ReactPlease help with a case, I'm a bit of a loss regarding 6 confirmation dx and herbs. Let me know if you need more info. Thank you inadvance35yo woman, 33 weeks pregnant - first pregnancyGot pregnant easily and had a smooth first trimester. We worked together for a year prior to pregnancy to address anxiety.She is a fit woman with bright vitality. In the past year she has gotten married, got pregnant, navigated the stroke and death of hermother-in-law, and became essentially a personal assistant to her father-in-law who is dealing with the death of his wife by nearly
living at her house and drinking too much. She and her husband also purchased a house and are working on the remodel. She hasa full plate and for a person who craves alone time, this has been difficult to not have her space.Anxiety that manifests with a strong need to be alone and rest with her dog. She will often pick at her skin if the anxiety bubblesover.She likes to snack on carbs when the anxiety peaks.B/W exerciseShe has not been very compliant with granule herbs or tincture formulas. She will take Dan Zhi Xiao Yao San in tincturesporadically. She started this formula prior to her wedding and reports that she feels better when she takes it.Diagnosed with SPD - symphysis pubis dysfunction at the beginning of her 2nd trimesterbroad pelvic painreports a down bearing sensation as pregnancy progressesno crampingno spottingradiating to the sacrum and low back now that the baby is getting biggerunstable hipsw/w lifting legs - will use arms to lift legs to avoid muscle engagementw/w walking - 8/10 pain with lifting legsb/w rest - is now doing self-imposed 2 hours of bed rest / daygets relief when in bed, but not lastingas baby grows feels increased pressure in pelvisb/w physical therapy but not lastingcan have sciatic pain that radiates down L side of low back to UB36 areaw/w sittingstarted recently to get leg cramps at night - unable to move because so painfulhip pain makes more tiredEasily agitatedless agitated when takes Dan Zhi Xiao Yao Sanno thirstpref room temp wateraversion to coldfeeling warmer, but comfortablefrequent urination 1x/ hourfeels like she is urinating more than drinking this weekyellow darker urineno burning
no cloudinessnocturne 1x/ nightlittle appetiteno longer losing weight,craves carbs but was diagnosed with gestational diabetes - allowed 30g of carbs / meal but she isn't eating that much. Prior todiagnosis with GD she craved carbs and ate a lotrecently reported refluxevery time she eats she feels like she throws up a bit in her mouthno bad or bitter taste in mouthburping all the timegets full quicklycan feel like something is in her throat when swallowsBM is harder to passb/w Mg supplement nightlyable to go every other daylarger stool can be uncomfortable to passoccasional bright blood on tissue when wipeswas waking at night for 1-2 hours but better nowmind gets active at night if wakeslow energyfeels like baby is riding high and getting kicked in the ribsbaby is head downTongue thin coatyellow coatRedder tipthin bodycenter crack in middlepapules ono sidespinched sides and tip (like a U shape constraint)Pulse rapidthreadyL side tends to be more thin than R
4 earlier comments 2 teacher remarks5 Phase Diagnosis:Liver blood XuLiver Qi constraintHeat irritating the HeartHeat in Urinary BladderDeficient stagnation in hipsSt Qi rebellingDryness and stagnation in LI6 Confirmation Dx: Jue Yin Pattern because deficiency more than excessReplyElaina GreenbergFeb 22, 2021React@Sharon Weizenbaum is this a good time where Ren Shen would be used? Are we in rescue territory?Sharon WeizenbaumReplyElaina GreenbergNewFeb 24, 2021 | EditedReact@Sharon Weizenbaum I was able to listen to the class. Hooray! Question 1. If we are to look at a pregnant woman as not being pregnant first, doing the diagnosis, and then seeing the pregnancy,I'm struggling to see how my case is more an issue of deficiency. I guess with the reflux symptoms I'm thinking Gall bladder heatmore than lack of nourishment bringing the fetus up. I think I would still stick to the formula I posted earlier, but would also add Zhu Ru, reduce the Fu Ling and Bai Zhu since there ismore dryness than a wet soggy Spleen showing up on her tongue.Sharon WeizenbaumYanaVomiting for 2 months in a 12 yo childFeb 15, 20211ReactGirl 12 yo, professional gymnast; projectile vomiting for 2 months, now more than 10x/dayThe condition started after a stressful period of competitions and ingestion of an expired fruit jello (they're not sure what exactly triggered it).S/s at onset: fever 38.5C, severe HA, dysphoria, low energy, vomiting for 4 days; then low grade fever for 4 days; then resolved; a week later vomitingrestarted from 1-2 to 10-20x/day till nowThey got all the possible tests done (except spinal puncture): CT-scan, MRI, ultrasound, blood, gastroscopy, nuclear text, barium study, covid test. All perfect,except H.pilori detected. Discharged from hospital with no treatment provided. Diagnosed with rumination syndrome and recommended only to practisediaphragm breath.Intake after mother's words, as I haven't seen her in person yet:Feels hot since onset; likes hot bath (before that was on a cold side)Says that she sweats (maybe due to feeling hot)Appetite: always good, 4x/day; easy to feel full, sometimes after 2 spoonsNo other digestive discomfortThe girl gained 3lbs of weight since the onset of condition
She has been treated for a month by my herbs teacher and I don't know what he prescribed her. The only thing I know that first hejumped on the cold accumulation pattern, but later changed his mind and prescribed something else. They went for acupuncture2-3 times maybe, and a couple of weeks of herbs, which were vomited out for the most part.They tried blended food in small portions (10x/50ml), and it worked for a day with no vomiting, but the next morning all 500ml gotout as if not moving at all down ST. So now she is on normal food.I'm thinking about LV attacking ST with some phlegm-heat in MJ. I see it like a very strong squeezing action by LV in MJ, when the ST contents cannot or hardlygo down and are propelled back up and out. Qi also cannot flow smoothly and is very much accelerated in the upper part of the body causing symptoms ofLV yang rising.I also see some disbalance between upper an lower created by this squeezing separation: the upper is hot now, and lower has been getting colder (mirkyurine points to lack of fire to transform fluids).With my very limited knowledge of formulas, I found Zuo Jin Wan & Wen Dan Tang to correspond partly to what I think should be done.Better ideas would be welcome.Also any ideas on how to make the herbs get through this bottleneck in her MJ? She's good at vomiting out both liquids and solid food... So just maybeprescribing her more frequent ingestion of bigger quantity hoping that at least 1/4 would stay in?Vomitus now: 3-4x/day full projectile vomiting of ingested food; 5-7x/day - small regurgitation of transparent liquid with some food particles that make alllook like whole wheat flour in salivaFirst there were more vomiting by the evening, now it's any time of the dayWhen in hospital, she had episodes of increased heat in ST (foul vomitus, very irritated throat & ulcerated gums, thirst), but not nowNausea has been intermittent, sometimes accompanying vomiting and other times notLess vomiting if eats lemon, craves sour nowPlumpit qi, intermittent > feels like worms crawling (this appeared several weeks before the onset of vomiting)Unusual loud and strong belching a couple of weeks before the onset of the condition, not nowNo thirst nowUrine quantity is normal, light yellow; since onset of the condition cloudy, possibly cloudy now too (she's not sure)BM: now dry like pebbles, variable consistency due to occasional IV fluids in hospital, from 2x/day to 1x/2 daysHA was intermittent severe since onset, now mild on/off: intraocular, frontal, temporalSighs oftenSome SOB due to general weakness; possibly palpitations; in hospital she had bradycardia at night and tachycardia when flare-ups of vomitingRinging in the ears, constant; doesn’t depend on the HAComplains of low vision in Rt eye, and flying zigzags; when checked, diagnosed with perfect vision; when used diagnostic drops, then the visiontemporarily improved; today had red eyesDenies any trauma before the onset; 2 days after the onset, when still in fever & migraine stage, she had an osteopathic regular adjustment and hechecked her spine and head > okSleep: now somnolence, able to fall asleep anywhere any time; feels rested in the morningWhen in hospital she had dreams that she is about to miss her flight or train; now she has anxious dreams, nightmares of being eaten, and mom issaving her from the mouth of the “monster” (not TCM, but this is my favourite part from my previous experience of dream study)Mild muscular spasms/tics yesterday evening after falling asleep for a couple of hours minSpasmodic intermittent pain in lower right quadrant for a year; when in hospital, the pain was wandering, from under the ribs when sitting to lower rightabdomen when lyingSince onset occasionally red itchy spots, like mosquito bites anywhere on the body, resolve in a couple of hours; when in hospital she had fluid-filledbumps with burning sensation when picked (possibly due to meds); generally poor wound healingEnergy: low, she has not been able to follow her daily exercises for 2 months, only restarted yesterday and was very tiredEmotions: the girl denies stress before the onset except the final competitions in December when she was almost shaking from stress, mom says she didhave stressNo menarche yetVery tight muscles from intense daily exercisesJPEG | 507.3 K150332699_767812337447785_2…
7 earlier comments 3 teacher remarks1 reply 12 replies 21 more comment 1ReplyElaina GreenbergNewFeb 21, 2021ReactMy 8 year old daughter has been diagnosed with rumination syndrome as well. She too was a gymnast but is now a ballerina aftertoo many injuries. Her pattern and presentation is VERY similar. Thank you for posting this case and for the responses.ReplyElaina GreenbergNewFeb 22, 2021React@Yana Dee We haven't yet gotten it under control to be frank. In fact she is having an endoscopy / colonoscopy as I'm typing this. I'm in thewaiting room. What has helped reduce the frequency of her vomiting and spastic episodes has been Gonstead Chiropractic andginger moxa on R8. My office mate is a Gonstead Chiro and has been adjusting her T6 only. That has made a huge difference. Shewas vomiting like a bird 8-11x / evening sometimes with reflux sometimes without. The adjustment brought her down to 4x in anepisode and even stringing together a week without vomiting at all. After we get past this round of tests, I'm looking forward totrying Xiao Jian Zhong tang with her.YanaAdina KletzelChild HeadacheNewFeb 15, 2021ReactHI,I am treating a 9 year old child for headache. I don't usually treat children but her Mom is a friend so I said I would give it a try. Iwould love some guidance from those who treat children on a more regular basis.The challenge I am finding is that there is not a lot of information to work with.Main Complaint: headaches on her forehead and temples mostly but sometimes it moves up to the top of her head as well.Sometimes it moves down under her eyes.It started 10 months ago - a week before Covid broke out.It came once a week at the beginning and now its every day.She wakes up with the headache. Sometimes it lasts all day and sometimes it goes away after a couple of hours and comes back inthe evening.It feels like banging on her forehead and squishing the sides of her head.She rates the pain at a 7.Loud noises make it worse.Sleep: trouble falling asleep. Takes around half an hour to fall asleep.Digestion, thirst, body temp, sweat, urination, bowel all normalAppearance: thick curly red hair, tall and bigger boned for her age but average weight, healthy looking complexiongets occasional leg crampshas to clear some phlegm from the back of her throat 2-3 times a day
1 teacher remarkEmotions: even tempered mostly but gets upset if someone says something not nice to her or accuses her of something she didnot do. Sometimes cries in those situations.Gets anxious in school related situations - worried about completing assignments and scared to be in the same room as a meanteacher.Is very neat and meticulous with her thingsHas friends, is decisive and asserts herself when necessary.Pulse: fast, deep, wiry on the deep levelTng: normal color, red tip,I will get a picture and upload it.Abdomenrikyu in LA, tight in LAsaibo otsusome epigastric hardnessLiver meridian painful when pressedLiv 3 painful when pressedI don't see a whole lot of pathology here except for some kid weakness (LA rikyu) and yang flying up to the head. The epighardness suggests some SP dryness - but I do not see that come up in any symptoms.There is also some emotional tension and tightness.I thought maybe to go in the direction of gan mai da zao tang with some ba ji tian and maybe tian ma.Does anyone have some diagnostic suggestions here or a direction for treatment?I feel like I need some experience treating children in order to see what I may be missing.THank-you. ReplySharon Weizenbaum NewFeb 15, 2021ReactHi Adina, I look forward to the tongue picture.In the absence of cold signs it doesn't sound like Wu Zhu Yu TangYou are right that there is not a lot to go on. Any sense of what occurred at the onset? I would leave out any kidney diagnosis asshe is so young and clearly vital.We can see that her Yang is either flaring upward due to deficiency (in the east) or staying up due to blockage (in the west)It sounds like both to me as she has tight muscles and rykyu (deficiency of blood Bai Shao indication) is a fairly robust build andperhaps a bit of a perfectionist. What about Si Ni San + Shi Jue Ming, Yu Jin and He Huan Hua.Also, does she seem at all about to menstruate - meaning have her breasts grown and has she grown pubic hair? In that case, itmay be blocked menses. The pulses speak to more blockage.
2 more comments 2ReplyAdina KletzelNewFeb 16, 2021ReactJPEG | 55.9 KTalor tongueSage Staggs (she/her)Allergy case- would like insightNewFeb 11, 2021 | EditedReactQuestion for teacherI don't have much experience with allergies and I admit my formula knowledge is weak outside of women's health so I'm lookingfor some help.45FCC: Sneezing fits multiple times a daySome sinus congestion with clear mucus, some PND evidenced by spitting white phlegm in the morning. She also feels "wheezy"and has chest tightness, esp when laying down. This all started when she moved to a new house in a new town 1 year ago and hasbeen intensifying over time.Chronic insomnia, has to read to fall asleep and then wakes multiple times in the night, sometimes is up for a while with anxiety.Low back and hip pain.Digestion good, regular formed BMs, occasional urgency if she eats too much fat. Has had a hemorrhoid for several years thatgets itchy and sometimes bleeds, worse right before her menses.Energy pretty good but sometimes tired if sleep is really poor. Tends to worry and overwork (on the computer).Period is regular, ~25-26 day cycle, irritability and sadness before and cramping before and during.Occasional headaches due to stress, exhaustion, premenstrual.
1 reply 11 reply 12 more comments2Tongue: slightly enlarged (flat, not puffy), slightly dusky, very thin coat with more toward the back, slightly red tip.Pulse: Blocked on the left side (this was confirmed when I took her to a class with Brian LaForgia, Shen/Hammer pulse teacher- hesaid it was strong in her neck but blocked somewhere between there and her radial artery). There is a hint of something in the leftguan but the rest is totally absent. Right side is soft in the cun, thin in the guan and weak/absent in the chi.I've been treating her for 8 years (she's my wife- which makes the diagnosis and treatment a bit trickier of course). She used torespond well to Gui Pi Tang for sleep but no longer does. I've tried Bu Zhong Yi Qi Tang and many other spleen formulas withoutmuch results. Pei Min Kan Wan seems to reduce the sneezing a little bit, but not much. She takes Xiao Yao San as needed for PMS.Currently she is taking Da Bu Pi Tang which is Li Zhong Tang with wu wei zi, xuan fu hua, and mai men dong, but I don't really feelthat it's right for her either. I also have her on Peace Pearls (SZRT+LZW) but they haven't helped much with sleep either.I'd like to understand how to view sneezing diagnostically (in this context and others) and how to treat it. I'm curious how muchprogress one can make with allergies caused by the environment- in this case I am suspecting mold. I've also tried multipleapproaches to treat her hemorrhoid- many topicals and a number of herbal combinations, with little success. And we seem tohave hit a wall with helping her sleep.Thank you for your insights!ReplySheila LiewaldNewFeb 14, 2021ReactNot herb related, but I am very familiar with mold toxicity (could be Marcons in the sinus) but have you tried a really good airpurifier in the bedroom? If you have mold in the house (walls, HVAC etc) it's going to be pretty hard to treat if you remain in theenvironment but at minimum a puridifer can go a long way, and being very anal about cleaning, I'm talking ceiling fans, tops ofdoor jams and kitchen cabinets. I am a huge fan of ERMI tests (they aren't the end-all but do give probably the best snapshot of abuilding for mold). XClear is a decent nasal spray to help open the nose and it has GSE that helps break down biofilms and is anti-all the things in the TCM EPI world. She also might not be detoxing. NAC could be supportive. ReplyCaroline Radice NewFeb 15, 2021ReactTreating one's partner is fraught with complications but that aside, sneezing would be a sign of an exterior problem. What is yourworking diagnosis is my first question and other 10 Qs I'm curious about (unless they are normal): Body temp, sweating, appetite?It's much easier to arrive at a good formula if it comes from a pattern.Sheila LiewaldWould love feedback on complicated rash case.NewFeb 09, 2021 | EditedReactQuestion for teacherHello all, I am new to this so I hope I am doing this right.Male 36 yr old
No medsHx of dengue fever, multiple bouts of salmonella, historically used to frequently get sick to stomach, vomit, diah, but the past fewyears this has not been an issue. Stays active, eats well and all the things, organic, did strongly reduce gluten and that helped hisdigestion go to the next level of feeling better. Has a penchant for beer and alcohol most nights but not more than 1-2 drinks.We live in dry cold climate during the winter.Rash started about 2 years ago.Started in armpit hair in the summerAnti-fungal OTC didn't do much thrush cream helped more.Will fade then flareNo gluten past 6-7 months, still doing dairyONE SIDE only has also come and go around the anus.worse in summer and sweatsometimes itches, itches more at nightno paindry bumpy, not oozy or weepyno derm seenno lymph swellingslowly migratingBM daily, well formed to soft, 1-3 times a day. He lives up in the mountains so I don't get to "see him" outside of tele.I had tried yin care topically to start- it did nothing. He had some bentonite clay in the house so I had him try this too as a daily compress. Didn't seem to domuch. Moved on to Lian Po Yin modified tea. No change.Here's the next formula I have had him on- seemed like it was taking the edge off in that the rash got paler, less itchy, and the rash was calmer. So I did a refilland it seems to be reverting back again. Ban xia 25Huo Po 21Huo Xiang 21Zhi Zi 21Dan dou chi 21Huang Lian 15Huang qin 15Shi gao 15Gan cao 21Da zao 21Ren Shen 21Would love insight. I am not nailing this one.JPEG | 177.6 KIMG_8815JPEG | 135.7 KIMG_8817
1 more comment1ReplyAmy JennerNewMar 08, 2021ReactI wonder about monostat cream and taking a break from the beer...not Chinese medicine per se, but with the history of digestiveillness, the itchy anus and rash w/w warm damp it sounds yeasty... ReplyJoy BlaisNewMar 25, 2021 | EditedReactQuestion for teacherHi Sheila,Thanks for sharing this case. The thing that stands out for me is the tongue which is very cracked indicating significant Yindeficiency. Your patient also has a history of losing fluids through vomiting and diarrhea, as well as fluid damage from the denguefever.Did you ask him about thirst or urination? Does he have a dry mouth? Dry skin in general? Is his body skinny & sinewy, robust &large? Does he have any stuckness in his digestion (bloating after eating, burping, stomachaches, etc.)? Is he generally cold, warm,cold hands & feet? How is his energy?Could you tell me what your Zang Fu diagnosis was for him? How did you come to this formula?His current symptoms seem to be worse with heat (during the summer when he gets hot). My best guess with the info youprovided is that his rash is from deficiency more than excess. I don’t see damp signs although I can see how an itchy red rashcould lead you to think damp heat. The rash itself is very dry though (not oozy or weepy) and dryness alone is enough to causeitchy skin (it doesn’t necessarily mean damp).I see that you are using a lot of herbs that clear heat that can also be parching (drying), some that transform damp, and not manyherbs that enrich fluids. This may be something to consider changing. I would focus on enriching yin to clear heat vs using strongYangming heat clearing type herbs (if that seems like it fits his diagnosis to you).I look forward to hearing Sharon’s thoughts about this case!Sheila Liewald,Sharon WeizenbaumJoy BlaisNeed Help with a Cancer & Covid Case!Jan 28, 2021 | EditedReactQuestion for teacherHi! I’m hoping to get some help with a case. This is a 68 year old emaciated patient who recently had severe blood loss after acolonoscopy & polyp removal (Oct-Nov 2020). A few weeks after the blood loss, he had surgery to remove a foot of intestines dueto colon cancer as a well as remove a bladder tumor. Pre & post surgery he has had episodes of atrial fibrillation and chest pain.While in the hospital he contracted covid-19. His acute covid symptoms have resolved but he is severely fatigued and is havingSharon Weizenbaum,Ron Hershey,Suzanne Connole,Guy Sedan,Allyson Nevard,George Mandler,Laura Mcgraw ,Sally,Claudia Citkovitz,Jennifer Tongren Drinker
trouble recovering from the surgery & infection. He has no appetite and has lost over 50 pounds in a few months. He currently hasepisodes of chest pain, back pain, migraines, & lower abdominal pain. Eating even small amounts causes nausea, stomachdiscomfort, and a feeling of fullness. I have not been able to see this patient in person so I am making my best guess at herbs witha focus on restoring his appetite so that he can rebuild blood, qi, yin & yang. He has hemochromatosis, type 2 diabetes, high bloodpressure, liver cirrhosis, sleep apnea, heart murmur from rheumatic fever as a child, and disputed hyperthyroidism. He was alsodiagnosed with iron deficiency anemia and elevated platelets.Symptoms:Chest Pain Stasis in the chestw/ dizziness Chest stasis w/yang rising to the headRapid Heartbeat Heart beating too fastPoor appetite Poor T&Tw/w eating food Poor T&T w/w foodNausea after eating food Poor T& TLower abdominal pain-----------------------------------------------------Upper abdominal discomfort after eating foodStasis in the lower abdomen-------------------------------------------------------Stasis in the middle after eatingb/w heat Cold stasis in the middleSevere fatigue Qi not availableworse after eating Qi not available w/w food, middle shut downworse after BM Qi not available w/w BMworse after any activity Qi not available w/w activitySallow complexion Blood XuRapid weight loss Loss of Yin??Cold Body------------------------------------------------------Cold feetCold------------------------------------------------------Yang not reaching feetLow back pain Stasis in the backb/w heat Cold stasis in the backDry mouthMouth wants fluidsUrgent stool Stool coming out too fastSoft stool Stool too softHeadaches Stasis in the headw/ flushing up of heat Head stasis w/ yang risingPoor sleep (only 1-2 hours a night since serving inVietnam)Shen not settled at nightTonguePale pink body Blood deficiencyDeviated WindPeeled in back KD Yin xuPeeled tip HT Yin xuPeeled sides LR Yin xuMidline crack Normal or SP Qi XuThin white coat NormalThicker coat in backNormal, and/or some dampness accumulating in thelower jiaoZang/Fu Dx:HT & LR Yin & Xue XuKD Qi Yin & Yang XuSP Qi & Yang xu
1 teacher remark1 reply 1Conformations involved:ShaoyinTaiyinJueyinSince this patient is only able to eat a few tablespoons of food a couple times a day, my main concern is to work on getting hisappetite back so that I can add in herbs to help build blood, qi, yin, & yang. I am thinking about starting just with a formula like LiZhong Wan with little Zhi Shi and then when he is able to digest better, adding more herbs for enriching the blood & fluids (likemodified Zhi Gan Cao Tang plus Dang Gui, Dan Shen, Suan Zao Ren, maybe Jie Geng). Any advice? Thanks so much for your help!! (Newest tongue pic) ReplyEmily RieffelNewFeb 02, 20211ReactJoy, given the many challenges for this patient, it seems wise to begin with helping him to regain his appetite with Li Zhong Wan.When I was learning with a doctor in a clinic that treated many patients with HIV, hepatitis, and cancer, he would often includefood stagnation herbs for this kind of appetite loss, especially Ji Nei Jin. Perhaps cooking the herbs in a chicken bone stock wouldbe a good option/ alternative as well. Another doctor would frequently recommend other food herbs, such as egg and powderedblack sesame seed for gently addressing recent severe blood loss.Joy BlaisNewFeb 05, 2021 | EditedReactQuestion for teacherHere is an update on this case: the patient has not had any racing heartbeat or chest pain this week. He has been taking the belowformula for about 4 days:Li Zhong Wan ModifiedGan Jiang 9gRen Shen 9gBai Zhu 9gZhi Gan Cao 9gZhi Shi 6g
He says that drinking the herbs helps relax his stomach and reduce the queasiness & nausea. He is still not able to eat regularamounts of food due to lack of appetite and also mentions that he cannot taste his food so everything is uninteresting anyway. Healso says that he has slightly more energy & is now able to walk to the mailbox and back without extreme fatigue. The lowerabdominal pain, cold, low back pain, headaches, & general fatigue persist.I am switching the formula to:Fu Zi Li Zhong Wan modified with food stasis herbsGan Jiang 9gRen Shen 9gBai Zhu 9gZhi Gan Cao 9gZhi Shi 6gFu Zi 6gJin Nei Ji 6gShan Zha 3gMai Ya 3gplusZhi Gan Cao Tang ModifiedZhi Gan Cao 4gSheng Jiang 3gRen Shen 2gGui Zhi 3gShu Di Huang 8gSheng Di Huang 2gMai Men Dong 2gE Jiao 2gHuo Ma Ren 5gDa Zao 10gDang Gui 3gI wanted to keep the formulas separate in case he has difficulty digesting the yin & blood nourishing herbs. I will have him slowlyadd in the Zhi Gan Cao Tang to the main formula.The latest tongue pics are attached.I’m noticing a bit more purple in the center that I missed in my earlier symptom diagnosis which I think is blood stasis form cold.There is also a little red circle on the L side on the edge of the peeled area. It may relate to the area of intermittent lowerabdominal pain that the patient feels on the R side below the umbilicus, but I’m not sure (maybe it’s just a peeled spot). He isgetting a CAT scan of his lower abdomen this week. He mentioned that some mesh from a previous hernia operation had to be
2 more comments2 Replyseparated and moved during his colon resection surgery, so perhaps that’s related? The colon resection was on the left side, buthe is not sure which side the bladder tumor or subsequent Kidney stent were on.I’m open to any suggestions or changes you think I should make to the formula. Do you think Zhi Gan Cao Tang is a good choice orshould I be focused more on Kidney Qi, Yin, & Yang (like modified Jin Gui Shen Qi Wan with added blood tonic herbs)? What aboutthe dose of the food stagnation herbs in the Fu Zi Li Zhong Wan, should I increase the amounts of Jin Nei Ji, Mai Ya, & Shan Zhu?Thank you in advance for any feedback and insights!JPEG | 1 M2-4-21 Tongue (1)JPEG | 395.6 K2-4-21 Tongue (3)Anni EllistonStubborn Edema & Distension Case - would love some help!NewFeb 01, 2021 | EditedReactI've been working with this client (mostly at a distance, with phone consults and mailing herbs) for a while and I feel stuck. Yourfresh eyes and expertise are very welcome!Female, 42Main complaints - puffiness of body (nose area, arms, legs, extremities) and a feeling of pressure + visible distension of abdomen,constipation.Here's the details and my categorizations:Exterior:Skin puffiness (nose, ankles, fingers, upper arms, lower legs), pitting edema (sock lines)No sweating, even with exercise (nor with Ma Huang, see below)Aversion to wind ( = earaches, neck aches)Dry skin, oily faceNeck / spine tightness, stiffness (on & off)
Headaches, occiput, mild (on & off)Athletes foot - inflamed, itchy, sore (on & off)Half & Half:I don't see it. Sometimes nausea, chest tightness, frequent sighing.Interior:YangMing - aversion to heat, insomnia (on & off) with waking irritable in night, heartburn (occ), irritability / frustrationTaiYin - distension, whole ab - soft to hard (hard by end of day, sometimes throughout day), feeling of abdominal pressure fromwithin, frequent belching, gas, fatigue, mental fogginess, urine tends to be scanty, BM - tendency to constipation with BM everyfew days and sticky stools - better with herbs but still not 100% consistent (some still sticky, soft, a few skipped days, but overallbetter).Blood Deficiency:Muscle cramps, nominal aphasia, insomnia with early morning waking sometimesBen Tun:Anxiety episodes (slight panic), insomnia on & offMy diagnosis:Taiyang, Taiyin, Yangming with some blood deficiency and Ben TunHere's what I've tried:First:Ma Xing Yi Gan Tang Jia WeiMa Huang 5Xing Ren 10Sheng Yi Ren 30Zhi Gan Cao 5Chen Pi 30Zhi Shi 10Hou Po 10Fu Ling 20Bai Zhu 25 & / or BZ 20 Cang Zhu 20Then doubted my diagnosis and thought maybe I was missing a Half & Half, so tried 6 days of:Chai Hu Gui Zhi Tang Jia Wei(additions were Ge Gen, Fu Ling, Bai Zhu, Cang Zhu, Chen Pi, Zhi Shi)Mistake! Fatigue, fullness, bloating, distension increased, tightness unchanged, and no improvement in puffiness or bowels orurine.
Then:Yue Bi Yi Gui Zhi Er Tang Jia WeiMa Huang 6 - 10Shi Gao 45Zhi Gan Cao 6Da Zao 20Bai Zhu 20Gui Zhi 18Bai Shao 20Fu Ling 30Dang Shen 10Sheng Jiang 20Chen Pi 30Zhi Shi 12Ban Xia 20Ge Gen 15Ze Xie 15 - 18And THEN, tried the above with MH 12 (6 days) and then MH 14 (4 days). I use raw herbs and one bag is decocted twice and thentaken at a rate of 250 ml twice daily (so one bag of herbs lasts 2 days).Sometimes it appears to be clearing dampness via more full and frequent urination, and "almost" a sweat but not (despiteblankets, hot water bottles, hats etc). Bowels have improved but puffiness and abdominal distension and pressure only getmodest changes (up to 30% better) and it doesn't last.My next thought was to pare it back to:Yue Bi Jia Zhu TnagMH ??SG 45SJ 15ZGC 6DZ 20 (or 10?)BZ 20Is her exterior really SO frozen that the original formula of 18 g MH dose would be needed / appropriate?? I don't know if I feelcomfortable going there. (Also, I'm in Canada and while I CAN get it in raw form it's very time consuming and not straight forwardand I want to keep my supply for other potential urgent cases too). Easier in granules, and I could make the whole formula ingranules. OR, is there some deeper imbalance that must be addressed first in order to release her exterior / clear her dampness?Thoughts? Questions? Corrections?Thanks so much...
1 reply 18 more comments 8ReplyAnni EllistonNewFeb 01, 2021React@Sally Rappeport - maybe this is a GZT case?! Or just something you could help with? Thank you!SallyReplyCaroline Radice NewFeb 01, 20211ReactHi Anni: Such an interesting case! I'm reminded of a case that had the similar puffy bloating presentation and lack of sweat and Iused a modified Gui Zhi Ma Huang Ge Ban Tang + a lot of Huang Qi for the exterior dampness + Fu Ling/Bai zhu/Chen Pi. Althoughmy patient also had some skin itching, the pathology sounds similar as a modified GZT + MHT.2 earlier comments 1 teacher remarkRon HersheyLooking for practitioner in Silicon Valley, Santa Cruz or San FranciscoJan 22, 2021ReactI have a young troubled woman in my Breathwork remote class who needs compassionate experienced help with a complex ofemotional instability, hormonal issues and pain. I don't have all the details, as she's not my patient. Anyone out there? Manythanks, Ron ReplyJulia RoseNewFeb 11, 2021Reactmarintha tewksbury is in SF ReplyClaudia Citkovitz NewJun 04, 2021ReactHere is Nikki Fancher, she is one of my favorite practitioners anywhere. She was a nurse before she became an acupuncturist, andis extremely warm hearted and caring, but super smart with great boundaries and huge clinical intelligence. She mainly doeswomen's health. https://www.newmissionacupuncture.com/
Nicole ManiezDifferentiating Cinnamon Twig + Bupleurum?Jan 22, 2021ReactHI All.Sharon's explanation of my last post was super helpful for me to begin to differentiate presentations and constitutions. I havemultiple female patients that seem like they could go either way - I I am trying to better understand the differences betweenCinnamon Twig or Bupleurum. Here is one of the cases. Let me know what you all think. Thanks!44 yr old femaleModerately thin and slightly muscular physiqueTends to be pale if not suntanned.Tongue - Pink, little dusky, slightly red tip, red dots at tip and sides. Teeth marks on sides. Thin white coat.Pulse - R - extends up to thumb - floating, thin, rough (beats are off)L - deeper, thinAb Palpitation: Some tightness at epigastric and below ribs. Overall tight. Lower ab, tight muscles deeper. Heartbeat aboveumbilicus.Enjoys intense physical activity (long road cycling, mountain biking, dirt biking), but also likes to read for hours.One child, 18 yrs oldMC: Mood swings with angry outbursts a few times a year.Recent heart break due old childhood wounds being reopened via issues with one of her parents. She felt a shock at this time andhad an episode where she didn’t want to be alive and was extremely sad, ruminating. She has never been on Rx for mooddisorders, but felt so bad and expected more situational stresses, so tried Celexa at the advice of her PC. After 2.5 weeks, she hadcontinued heaviness on her chest, a feeling of SOB, and palpitations all the time - all issues she was not aware of previous tostarting Rx. She stopped taking Rx under care of PC and continues to have some palpitations and chest discomfort, but overallfeels better off than on Rx. Wants to try CHM instead of pharmaceuticals.(Heart involvement)She has a history of intense feelings before menses, not every cycle - about 4 or 5 cycles a year. Since around 40 yrs old, her cyclesare slightly shorter than usual at about 26 days. She spots dark blood for ½ day, then bleeds dark red for one day, some clots(used to have more), then light bleed for one day and finishes with light spotting for a day or two more.PMS varies, some months very emotionally intense with irritability, short fuse or feeling very dark and depressed. Desire to bealone and escape. PMS starts at least a week before menses. Relief with start of menses. Uncomfortable breast tenderness mostmonths. Can have low back ache with menses. Can have slightly heavy watery leukorrhea before ovulation for a few days(Qi stag,Liver involvement- angerBlood stagnation + cold - clots, dark emotionsLocation: lower burnercyclical pattern)
Temp: cold hands and feet (less since taking Celexa), butt cold. Like to be warm and at night can feel hot while sleeping, but likesthat extra warmth. In last year or so, feels some flushing from time to time, but likes it.(yang not getting to extremities, cold, yang out of right relationship)Thirst with desire to drink. Sometimes mouth feels extra moist, but can have dry, pale lips.(Dry blood with water not in right place?)Pain: Tends towards low back and SI joint pain - uses PT exercises to keep things in place - otherwise a bit hypermobile.Fingers and thumbs get stiff, worse with overuse biking.(Liver involvement?, lower burner)Urination - normBM - tends to loose stool - BM 1-2 x every morningSweat - normApp - good, if doesn’t eat regularly, gets short tempered/stressedDx: Cold, Yang out of right relationshipLiver and blood stagnationWater out of right relationshipWen Jing Tang mod (heartbeat at ab, small joint pain, desire for warmth, thin physique, pale lips, cold hand, feet, & butt, darkdepression but only with PMS?, )Wu zhu yu 3Dang gui 12Chuan xiong 6Bai Shao 12Gui Zhi 9Dang Shen 12Mu Dan Pi 6Gan Jiang 6Gan Cao 3Mai Men Dong 10Add:Da Zao 15Fu Zi 9Fu Ling 9Bai Zhu 6Omit: E Jiao, Zhi Ban XiaOR is this more a Chai Hu presentation?
1 more comment(muscular build, feels cold and hot, pms - mood swings, dark depression but only with PMS, pressure chest and hypochondria,breast tenderness, tendency to qi/blood stag, cyclical pattern of symptoms)ReplySally Feb 01, 2021ReactI would say it may be More of a combo. I don’t see a lot of blood stasis or pain with periods. Did you try this formula yet? Youmight modify further to address LV like a higher dosage of Bai shao and maybe add Fu Ling for the weak spleen.ReplyNicole ManiezNewFeb 02, 2021React@Sally Rappeport Thanks for the time and reply. She just started the formula, so nothing to report back yet. There is Fu Ling in theformula already and the Bai Shao is a bit on the higher end. I think I see this case as predominantly Liver involvement, with somewater out of right relationship - which I guess could be SP, but also think it could be more of the "crappy blood" description - shehas a desire to drink - so less damp and more, let's get the water back into the blood. I saw the blood stag mainly with the clots inmenses, dusky tongue and was thinking the dark emotions. I am seeing the blood stag originating from cold and qi stag. I will postback about how it goes and always to love to hear feedback on others ideas and how I may be misleading myself. Thank You!Sally2 earlier commentsTolley SinkPractitioner in Somerset, NJ?Jan 22, 2021ReactWho is in Somerset for a covid long hauler? Thank you!ReplyTolley SinkJan 22, 2021ReactThank you Candace and Caroline!ReplyClaudia Citkovitz Jun 04, 2021ReactCan't go wrong with either of these phenomenal women!!!Nicole ManiezNewbie trying to understand diagnosis and classical formulasJan 19, 2021 | EditedReactQuestion for teacherHi All. I have mainly using patents from I guess what is a TCM perspective since I started practicing in 2008. I am ready to gainmore confidence and knowledge via classical formulas and this community. I recently completed the distance learning on Knotty
Diseases, along with watching everything free I can find. Here is a case work up that I am attempting to follow Sharon's advice onintakes and diagnosis, and am getting stuck. Any help on understanding the diagnosis and next steps, highly appreciated. I amdefinitely wanting to just choose a formula, and am realizing I don't actually have a clear dx yet and want to stop doing what Ialways do - skip steps! Find my intake below, with attempts at a dx below it. Thanks!18 yr old, female, thin. First year college student, at home, all online due to pandemic.Pale skin. Hx of dark circles under eyes.T - Pale, pink, orangy tongue body. Full body. Small red dots at front and sides of T. Thin white moss. Wet. Slightly dusky.P - L - fine, deep at chiR - wiry, rolling, feels slightly rapidAcne:X 4 years. Better in summertime. Worse in the winter. Had one period of few months without acne.Mainly on checks, at sides of mouth. Little on forehead, which is new. Can have a little on back, but rare. Skin feels rough andbumpy on upper back. No tendency to rashes or red.Purple, cystic with scarring - ½ of acne is deep and doesn’t erupt. Then can have an outbreak with more pus. Shifting from deep tomore superficial and pus. Sometimes the deep ones are painful when pressed. No throbbing pain. Monthly change to acne. Defworse before menses, better after menses. Has a lot of blackheads. Some acne can just be painless bumps that never exude pus.Menses:Lasts 5 days - used to be longer - every 25-31, usually 29 days. Some clots now, but much less than before. Red blood most ofcycle. Starts with spotting, ½ day - red blood.LBP pre and Day 1-3, can have loose stool or less frequently constipation. Can have mild bloating. Now can have mild pain. Takesibuprofen on day 2 most periods. Pain at lower abdomen. Not sharp stabbing, more generalized pain.Hx of lips getting really pale during menses.Hx of nausea, would turn really pale and sweat with severe pain and heavy bleeding on Day 1-3/4 , used to have 7 day menses.Breasts sore. Heavy at inner thighs. These symptoms are gone with Modified Xiao Yao San. Before Xiao Yao San - took Cinnamon +Poria, but didn’t take it as regularly and didn’t notice much benefit. Used to be irregular, skipping months with more clots.Emotions: feels always emotional. Tends towards “really sad”, for 50% of the time. Feels heavy in her chest. Anxiety is always thereunderlying - sweats on hands and maybe armpits and feet. Can get a red face with embarrassment or social anxiety. Moredepressed before menses, and then emotionally well once period starts until around ovulation - then up and down and thendepressed for PMS.Temp: can have hot flashes without sweat, but wants to take off clothes, can last 30 seconds to a few minutes - either due toanxiety or randomly. May go a whole week without any and then will have a bunch. Unaware if related to menses or cycle.Naturally sweaty hands. Extremities tend to be cold. Tends to be cold. Aversion to cold. Can feel cold on upper back betweenscapula. Likes to have pillows behind back.Sleep: gets 8 hours, doesn’t feel well rested. Can wake at 1-3am, pees and goes to sleep within 30 minutes.Energy: usually feels fatigued during the day.
Digestion: worse lately, not specifics, just feels off. Used to always poop in morning and now it is random, 1-2 x a day. Feelscomplete and usually well formed. Bloating rarely. Appetite poor with anxiety. Can feel hungry, but is afraid to feel nauseous whileeating breakfast or dinner - for many years. Never been good at eating. No thirst. Doesn’t like to drink fluids.Musculoskeletal: Upper back aches a little. LBP with menses. Knees can hurt, esp L attributed to back packing. Finger can hurt,worse in cold, in little joints.Hx of seasonal allergies - really bad for 2 weeks in both March and August - itchy, watery eyes and runny, clear nose and sneezingwith fatigue. Can have runny nose on waking each morning - clear, then goes away after starting day.Had mild case of covid at end of December - with stuffy nose, fatigue, mild body aches and loss of taste for a few days. She reportsfull recovery.What do I know for sure?Pale complexion - def or colddark circles under eyes - poor circulationPale T - defRed Dots on T - heatDusky T - blood stagAcne, cystic - blood? stagnation at skinAcne, pus - damp at skinAcne, worse with menses - cyclical changesAcne, better in summer/worse in winter - cold at skinMenses, pain - stagnationMenses, clots - stagnationPale lips during menses - blood not spreading to lipsMore hot flashes at start of menses - yang out of right relationshipDepressed before menses - excessMenses - cyclical mood and physical changesMenses, LBP - ?Hot flushes - yang out of right relationshipSweaty hands - surface open or damp at skinAversion to cold - coldFatigue most of the time - energy out of right relationshipSad - Lung involvement?Anxiety - Heart involvement?Heavy chest feeling - ? pivot? stagnation or damp? fullness at chest
1 teacher remarkUpper back cold - cold at upper backFear of nausea with eating - damp or blockPain at fingers - cold dampFatigue: Qi not availableAttempt at Dx:Yang not reaching extremities showing cold (damp)Blood stagnation due to damp, blood deficiency, qi not moving correctlySome damp at middle jiaoHeat signs from yang not in right relationshipSharon Weizenbaum Jan 20, 2021ReactHi Nicole, Thanks so much for the work you did with this case. I think your diagnosis sounds pretty right on. I would suggest acouple of changes. 1 is that I don't see dampness. There is some local pus with the acne but not overall. I'm not sure what signspointed you to damp in the middle Jiao. I would also emphasize cold.Overall she fits the Gui Zhi Tang formula family so clearly! Did you listen to Sally's lecture on Gui Zhi Tang in this month'sresources? To me, she seems to fit the Wen Jing Tang pattern (see article in permanent resources) as well as the Gui Zhi Jia LongGu Mu Li Tang pattern. All of this is free here and though there is a cost, I highly recommend Sally's full Gui Zhi Tang course formore on these formulas. Both formulas integrate the Gui Zhi Tang principles. I think that, by warming and enriching her blood, theblood stasis will improve as cold deficient blood is a major cause of blood stasis. I also think that the Long Gu and Mu Li will downbear the Yang and stop the sweating. I suggest not working directly with the acne but just seeing how things work out when herblood is nourished and warm and her Yang is settles.I think you don't need all of Wen Jing Tang. Maybe something like this:Wu Zhu Yu 3Rou Gui 9Gui Zhi 9Dang Gui 12Bai Shao 12Chuan Xiong 3Mai Men Dong 6Mu Dan Pi 6Dang Shen 12Zhi Gan Cao 6Fu Zi 9Long Gu 15Mu Li 15
1 replyReplyDoes that resonate with your sense of her?let us know!SharonAdina KletzelDry and hot hands, feet, mouth, and lipsJan 18, 2021 | EditedReactQuestion for teacherHI,I could use some guidance on the following case.41 year old male, married with 4 children.He has a strong build, broad shoulders, strong arms, average weight.MC: Dryness and heat in hands, feet, mouth, and lipsIt is always there, can even prevent him from falling asleep at nightDrinking helps but does not take it away.He has borderline diabetes but is not taking meds.thirst: for room temp water.Feels heat rising up to head when stomach is empty or when he is very tiredStools: loose, usually once a dayurination: normal.sweat: sweats lightly when hot and with exertion but doesnt feel that it cools him off. Feels that he does not sweat enough. Wisheshe would sweat morehot/cold: feels hot in heat but not to the extreme. Feels that sometimes the heat gets stuck in his head and he has to rest andmeditate to get it down.PHlegm: every couple of weeks feels that phlegm gets stuck in his nostrils and sinuses and feels blocked upsleep: light sleeperpoor night visionemotions: tendency to get angry but works on controlling it and breathing it outTngsee attachedred and dry in MWsome cracks in UWsome teethmarksPUlseguan and chi : wiry, strong, and hardcun: weak
Abdomenrikyu - lower and upperRib side tension both sidessaibo otsuepig hardnessI see liver blood def., sp yin def., kid def., and ? surface a bit closedHe is more excess than deficiency and I dont see any block in yang ming and there is wood involvement so that points to shaoyang. My question is concerning Tai yang. He says that he feels like he has heat trapped inside and that he wishes he could sweatmore than he does so the heat can be released. It just doesnt seem that his surface is deficient and so I wonder at including theTai Yang in my diagnosis.My confusion is also that when I nourish fluids strongly he gets more clogged up in his nostrils and sinuses.I tried Chai hu gui zhi gan jiang tang but it was too warming and did not relieve that dryness and heat.If Tai yang should indeed be included I thought that Chai hu gui zhi tang may be good because it turns the shao yang pivot,encourages the surface to complete and to bring the surface all the way up and out, nourishes fluids and I added mu li to volatizethe fluids that seemed to have thickened from the heat, dan shen to nourish the blood, and ba ji tian to str the kid.Chai hu gui zhi tangChai hu 12Huang qin 9Tian hua fen 9Dang shen 6Gan cao 6Sheng jiang 6Da zao 4Bai shao 6Mu li 6Dan shen 6ba ji tian 9I would love to hear others suggestions and if there are other recommendations and specifically whether this formula could helpwith the heat and dryness in the hands, feet, mouth, and lips.Thank-you so muchJPEG | 69.5 K
2 earlier comments 1 3 teacher remarksYG tongue 18:01:2021 ReplySharon Weizenbaum Jan 18, 2021ReactHi Adina,One rule I have is to always look at what IS there and not what is missing. What he does have is a relatively robust constitution, awiry pulse, rib-side tension and enough anger that he has to work with his breath to manage it. Stuckness in the digestion is not aSi Ni San nor Shi Gao sign so the absence of this does not relate to these herbs. For me, the idea of cold hands and feet as a signfor Si Ni San is code for, Yang not circulating well. It does not mean that they have to be cold. I've seen this myself for this formula.The tight rectus is what made me think of Si Ni San as well. XCHT is okay too, maybe better. but with Bai Shao and I like yoursubstitution of Tian Hua Fen for Ban Xia. Maybe that is enough without the Shi Gao. For me, the Shi Gao comes to mind because ofthe heat going up when he is hungry and the thirst. Let us know.ReplyAdina KletzelNewApr 30, 2021ReactQuestion for teacher@Sharon WeizenbaumHi,I wanted to follow up on this case and ask another question. (The full write up is above in the first post of this thread)The si ni san and shi gao did not resolve his issues.It is now much hotter here and he is getting right sided pain on the SI, SJ, and GB meridians that resolves itself after having hotexplosive diarrhea.He feels that heat builds up in his head and has no way out. He is not sweating very much at all. His only relief from this heat buildup is this hot explosive diarrhea. He still suffers from heat and dryness in his hands, feet, and face at night. His sugar is still highand his hands, arms, legs, feet, and lips are still very dry.His nostrils are also constantly stuffed.He also says that every so often when he gets drunk he breaks out in a good sweat and he feels much better for the next couple ofdays afterwards.It seems to me that there is a blockage at the surface and the heat can't get out. The only way for it to leave is through the yangming. There is also heat in the yang ming.After doing a full analysis it seems that the formula Ma xing she gan tang may be able to help open the blocked surface and clearthe heat from the yang ming.Since I do not have much experience with using Ma huang formula I did want to check that I am not completely off track.I also want to know if I should add gui zhi to the formula to make the opening of the surface stronger.Also - if I do use the formula I would stop it as soon as he had a good full sweat. Right?Thanks so muchSharon WeizenbaumSharon Weizenbaum NewApr 30, 2021ReactHi Adina,
ReplyYes, it sounds right that, if this formula made the heat worse, then opening his Qi on the interior without releasing the exterior iswhat is going on.I am not sure MXSGT is right though. I would suggest considering and comparing other Taiyang/Yangming (Shi Gao) formulas.Consider the chronic nature of his condition as well. With an acute MXSGT pattern, you would stop the herbs as soon as there is asweat or even a change for the better. With a chronic condition, it may not be the right formula and simply inducing a sweat mightnot be the only treatment principle. I'd suggest doing the whole diagnosis freshly rather than just giving a formula based on heatand lack of sweat.Guy SedanCovid patient Woman age 48Jan 13, 2021ReactWoman, age 48 (The wife of the previous Covid patient I treated). Normal to heavy body type (as much as I can see through Zoom)Main complaint: tiredness, coughing mild headache and lack of appetite.A week ago she started feeling sick with with nausea, tiredness, headaches , and then felt better ,and only in the last two days feltworse again.She wakes up tired and unrefreshed. Muscles feeling heavy.Does not feel like she is coming down with something but feels that she is almost over with the disease but not totally “out of thewoods”.Head feels heavy , slightly hot , with mild pain in her forehead. The pain improves when she gets up.Her oxygen saturation is good (96%) , but she feels she her breathing is not easy. Her chest does not feel “clean”. Cough whichoriginates from the upper lungs but sometimes when she changes position , she coughs a lot and feel that the entire chest iscoughing. Her cough also worsens when she lays down to sleep but then calms down. The cough is not dry but not watery. Shedoesn't expectorate but the phlegm does not feel very sticky, and she occasionally swallows her phlegm.Throat bothers her . Feels as if obstructed by flakes/crumbs.No thirst. Prefers warm drinks.No appetite. Apart from slight occasional nausea, she has no digestive issues. Stool tends to be soft with occasional bleedingwhich are probably from hemorrhoids. This is a long standing issue. Urine normal. No aversion to wind/cold. Sweating normal. Nobitter taste.Her calf muscles feel restless.Pulse 87 bpm. Her normal pulse is around 75 bpm. Left side, the guan position is more pronounced compared to the Cunposition. , The pulse on the right side is stronger than on the left.Tongue: pale, slight teeth marks, heavy white coating with a slight yellow ting.Given her pulse, the waxing and waning of symptoms , the slight nausea, and the feeling that she is still slightly “sick” without anysigns of Tai Yang and Yang Ming, I diagnosed “Shao Yang pattern” with phlegm cold in the lungs which is starting to heat up.Treatment:chai hu 9huang qin 9dang shen 6bai zhu 9kuan dong hua 9ban xia 9Chen pi 6gua lou shi 6sheng jiang 6Sharon Weizenbaum,Suzanne Connole,Allyson Nevard,George Mandler,Sarah Rivkin,Sally
2 earlier comments 1Bai Shao 6gan cao 3As with the previous patient, I will appreciate any thoughts or suggestions about this case.It will take time to get herbs to her (1-2 days), so in the meantime I am thinking to give one left-over package I ordered for herhusband , reducing Chai Hu and Dang Shen:chai hu 9huang qin 9dang shen 6ban xia 5sheng jiang 6da zao 3gan cao 3JPEG | 136.7 KYael 2021-01-13JPEG | 56.4 KYael 2021-01-13 sub ReplySuzanne Connole Jan 14, 2021ReactThat's great. Sometimes I feel like that formula is a wee bit magic. I was also thinking about bai dou kou for her, the open up thethe middle and improve appetite. ReplyGuy SedanNewJan 15, 2021ReactThanks! Yes, this a good herb to consider. I was not aware that Bai Dou Kou has such an affect on the chest.Guy SedanCovid PatientJan 09, 2021 | Edited1ReactDear colleges,Sharon Weizenbaum,Sarah Rivkin,Suzanne Connole,Sally,Allyson Nevard,George Mandler
6 earlier comments 3 teacher remarksI will appreciate any suggestion/comments as this patient does not have much symptoms to go by.Patient is Male 66 year old. Feeling of coming down with something with extreme fatigue and heaviness especially of theextremities with a constant need to stretch his muscles.No pain. No SOB. No aversion to wind or cold. He did suffer chills in noon but now he is not feeling cold. Does not feel generallyhot but does feel his fever rising especially at around the throat area. His temperature reading is 38.5 Celsius (101.3 Fahrenheit )Coughs slightly. In the morning it was productive with white phlegm but right now it is a dry cough.Since he is sick , he has lost his appetite and suffers from upper abdominal distention. No thirst. No nausea.No abnormal sweating . Normal urination. No lost of taste or bitter taste .Pulse is 60 bpm. He took his own pulse on the left radial pulse, it seems that the guan position is stronger than the Cun on the leftside.Attached is tongue, which looks partially peeled, pale with some purple spots.It is now late in night so I am tired I may missed some important questions to clarify. Will be happy if there are any things thatneed further clarification.Usually suffers from soft BM but ever since he feels sick his BM are better formed.Given that there are no signs pointing to the exterior, or Yang Ming, by elimination I diagnosed a Shao Yang pattern withdampness in digestion and muscles. I am thinking of given him Chai Ping Tang in the following dosage;chai hu 15huang qin 9ban xia 6dang shen 9chen pi 6cang zhu 6hou po 6gan cao 3JPEG | 83.3 KEyal BGuy SedanNewJan 11, 2021React
1 more comment 1 ReplyThank you Sharon and Suzanne for the feedback and pointing out the dryness. I am happy to report that after prescribing amodification of XCHT , he reports feeling much much better, "good as new", and his temperature is normal again. I prescribed thefollowing formula using three packets of raw herbs . These results are after taking two cups of the first package :chai hu 15huang qin 9ban xia 5dang shen 9sang ye 9sheng jiang 5da zao 3gan cao 3mu xiang 4 I will continue monitoring his state as I understand that Covid patients state can be fickle.ReplySharon Weizenbaum NewJan 11, 2021ReactWonderful! Thanks for the feedback.Emily RieffelPost-chemo neuropathy & burning mouth syndromeJan 07, 2021ReactQuestion for teacherThe patient is a 66 year old female retired teacher, with post-chemotherapy/ radiation polyneuropathy. She was treated withlumpectomy, chemotherapy (tamoxifen) and radiation for breast cancer in 2006, and since then has experienced nearly constanttingling and pulsing sensations in her hands, feet, and legs, with occasional electric shock-type sensations. The neuropathy hascaused some difficulty with balance, and a few falls. It has also caused frequent waking from sleep. She sometimes experiences asensation of waves of heat spreading in her upper abdomen, which tends to be worse at night.After being treated with high-dose doxycycline in 2007/8 (a doctor presumed that her ongoing fatigue, in combination with a fewtest markers, indicated chronic Lyme), she developed increased fatigue and burning mouth syndrome, mostly affecting hertongue, and occasionally her lips when severe. Stress, fatigue, and anxiety all cause the burning pain to worsen. There can be ametallic taste in her mouth at times.The patient is extremely fatigued, especially after eating a mid-day meal, after which she often needs to nap. She also experiencesa great deal of uncomfortable bloating and gas immediately after eating. She has hot and cold sweats, day and night. Her handsand feet are always cold. She has frequent palpitations and anxiety, especially at night, and frequent night urination. She is notparticularly thirsty. Other symptoms include: sore low back and knees, low libido, photophobia, poor night vision, visual floaters,slight vertigo, tinnitus, history of ocular migraines, easy irritability, and some recent weight gain. Bowel movements regular/formed/ painless.This patient is soft-spoken, reserved, and very pinched in appearance. Her build is slightly pear shaped and soft/paunchy in thebelly. Her skin is dry, drawn, and pale-sallow, with a red-purple nose and purple thin lips. Her tongue is swollen and deep red-purple, dry and lacking coat, with small transverse cracks in the MW. (See photo) Her pulse is forceless in the KD positions on Land R, but slippery and slightly rapid the first two positions.I have treated her a few times with acupuncture, with points to Nourish and Anchor Yin, Clear Empty Heat, and support Yuan qi,but very inconsistently due to COVID. She is quite sensitive, and using more than a few points in a treatment has causedexacerbated insomnia. So far she has had some relief from the burning abdominal pain, and improved sleep, but no change to the
neuropathy. She was initially reluctant to try herbs, because of traumatizing experiences with other physicians, but she hasbecome open to the possibility, with ongoing conversation.My diagnosis for her is: Blood Stagnation, with Empty Heat parching KD/LR/HT Yin and Blood, and SP failing to transform fluids inthe MW, causing MW Qi stagnation.I am picturing her landscape as arid, cracked clay, where it is easy for food and fluids to stagnate and fail to percolate and nourish.Whatever grows there is poorly rooted and spindly.I am thinking that we will need to help her SP Qi to absorb and distribute fluids before Yin and Blood can be nourished with anyricher medicinals, but I would also like to begin alleviating her pain as soon as possible by invigorating Blood in the channels andcollaterals. Here is what I am thinking, but I would love feedback and suggestions to improve my thinking and approach. Thankyou so much!Ji Xue Teng 15gChi Shao 6Dang Gui 9Huang Qi 15Shan Yao 12Fu Ling 12Zhi Ke 6Tian Hua Fen 12Mai Men Dong 9Dan Shen 6JPEG | 229 Knoname
2 teacher remarks1 more comment 1 ReplySharon Weizenbaum NewJan 10, 20211ReactHi Emily, I think you diagnosis is right on target. Do you have any feedback from this formula yet?A couple of questions, What is her menstrual and childbearing history? And what temp liquid does she like.Her tongue appears to be quite purple and you also mentioned that her lips are purple. It is also dry and fluted. It does not lookvery swollen to me but more fluted. In other words, I don't see dampness.My thought is that the day and night sweats are super important to stop as she is continuing to lose fluids and Yang that way. Iwould suggest Gui Zhi Jia Long Gu Mu Li Tang to control the rising Yang and to stop the sweating. In addition, Gui Zhi Tang doesimprove the quality of the blood with Gui Zhi plus Bai Shao and Da Zao. I've seen Gui Zhi Tang help sleepiness and fullness aftereating as well. Without signs of fluid accumulation, I would not use Fu Ling.In terms of the neuropathy, I would suggest stopping the leaks with the day and night sweats and the Yang rising and being lost upabove first and then seeing how the neuropathy is rather than going for it directly. I would work with it with acupuncture, moxaand external remedies.With all the rising Yang, in the pulse, on the tongue and so many symptoms, I want to, what I would call, slow the Jue Yin. Mu Liand Long Gu will do this. They will help keep the Yang from being discharged upward so easily and with the Ying/Wei harmonizingof Gui Zhi Tang, this will help keep the sweat in as well. I would use both Rou Gui and Gui Zhi.I ask about the menstrual history because I want to know the extent of the stasis of blood. Though we for sure want to slow theJue Yin, we also want to make sure it is moving. As I said, the Gui Zhi plus Bai Shao and Da zao will move blood but that issomething I would keep an eye on. You could add Dang Gui, Xiao Hui Xiang.I think, if you can correct this basic energetic and loss, you would have more to work with in terms of the neuropathy.Does this make sense? ReplyEmily RieffelNewJan 10, 2021ReactThank you so much for your thoughts on this case, Sharon. It is very helpful to be reminded that I should prioritize stopping theleakage of sweat, despite neuropathy being the patient's main complaint. The concept of "slowing down" Jue Yin is new to me, butit makes intuitive sense, as you have explained it.To answer your question regarding GYN history -- the patient had a D & C in 2008 for uterine fibroids and polyps. She had threevaginal births previously, without complications. I will ask further details on her menstrual history, but it does seem likely thatthere may be further history of blood stagnation there. She has no strong preference for either hot or cold drinks.I will incorporate your suggestions and circle back with an update on this case in a few weeks. Thank you once again!Adina KletzelDifficult acne caseJan 05, 2021ReactHI,I have been treating a case of acne for a while with only minimal success and could use some guidance and tips on this case.A 22 year old male university student. Thin, sallow complexion, wears glasses, looks a bit slumped over, more deficient type.Chief complaint: acne since he is 15 years old.
Big red swollen pimples that look more like lesions than pimple.They feel tight and he picks at them to relieve the pressure inside.Yellow puss and blood ooze out when he breaks it open.ON his face, neck, shoulders, and neck.Pimples take at least 3 weeks to heal, some even take months.His face is oily and he also has a lot of black heads.Energy level: 5. He is a student and has a demanding part time job. Stays up late studying. He always feels low energyDigestion: gets very tired after big meals. low appetite. Skips breakfast, eats a small lunch and some dinner.has an anaphylactic nut allergy since age 3. Lactose intolerant.Sweat: hands and feel always sweatyTemp.: not too cold or too hot but likes to be covered - likes to wear long sleeves with hoods. Feet always cold.Thirst: moderately thirsty - rates his thirst as a 5. drinks room temp watermouth is dryUrin.: Pees once every 2 hoursbowel: skips 1-2 days a weekEmotions: tight and tense when stressed (which is most of the time since starting university). feels anxiety by CV 14 area - says its"just there"feels a little down also because of hard work. Pushes himself hard to succeed.respiratory: gets a dry cough at every change of seasonTonguePulsewhole pulse is strong , tight and wiry and floating upexcept for right cun - that is weakerand right chi is a bit weaker on deeper levelAbdomenit is all tighttight lower abdomenrikyu in upper abdomen and epig area as wellRibside tensionepig hardnesssaibo otsuoketsuehard CV lineMy diagnosis isSP qi and yin deficiencyReddish, white coating in MW and LW. thicker in LWlong crack down the middle from LW up to but not including UW. Some horizontal cracks extending out from main crack to LW area.Red dots on liv/gb area and on tipSlightly distended purple sublingual veins
Kid qi and yin deficiencyLiver Blood def.Blood StagLiver qi stagnationDamp heat on the surfaceMy first line of treatment was to strengthen the middle and nourish fluids which I did with a modification of XJZTGui zhi 9Rou gui 9Bai shao 18Mai ya 20Sheng jiang 9Shan yao 12Wu wei zi 5Zhi mu 6Ba ji tian 12Zhi gan cao 9this helped nourish fluids (less thirsty and dry mouth) and also helped a bit with digestion and appetite. He had a bit less breakoutof pimples but the ones he did get were still big and full and are taking at least 2 months to heal.I would love some guidance in how to continue treatment of his overall constitution and specifically how to prevent breakout ofthese lesions and help their healing.If others also have some topical remedies to help drain and heal the lesions that would be great too.THank-you!ReplyCaroline Radice Jan 06, 2021ReactCan you post any photos? Masking identity of course, but even some close ups on the lesions is helpful for your notes to watchimprovement. Because of his weakness in the middle, I would be careful of the typical bitter cold herbs so common in treating thisvia Mazin's techniques, however, there are a few that can be helpful to break up the toxic damp stasis on the surface, particularlyif they're cystic, as long as you're protecting his middle which looks like you are doing a good job with: High doses (like 20-30 g)Dan Shen & Bai Hua She She Cao have been really helpful and since his pulse is more excess, the clearing will likely be welltolerated. Also, Huang Qi for helping the surface heal and Yi Yi Ren for clearing damp and nourishing skin. These I learned fromJing Fang approaches which was a new approach for me (both at around 20-30 g also). There are some topicals via the Derm Mline that I have also found helpful at Kamwo look for Dian Dao Shui Gao at night (used to be very yellow but now clear) and Fe ZiShui during the day. Let me know if this helps!Adina KletzelNewJan 07, 2021React@Caroline RadiceThank-you so much Caroline. That is really helpful. I was not familiar with using those herbs for clearing up the toxic damp on thesurface. I really appreciate the information.Caroline Radice
Reply ReplyClaudia Citkovitz NewJun 04, 2021ReactAny follow up on this patient @Adina Kletzel ?Adina KletzelMaryanne Travaglione Healing using soundNewJan 01, 20211ReactHi allI am struggling with continuing care of long time patients. There is an underlying grief that is clearly coming to the surface andharder to push down. I have found that I have been suggesting Qi Gong five healing sounds with reasonable success and it issomething we can do together on line. The use of sound as a healing tool has led to additional conversation where I’ve been able to explore using singing or chanting as atool to circulate Qi, Clear heat and calm the spirit. An example that pointed this out for me was that yesterday a simple conversation with someone led to a discussion of a favoritesong from childhood which then became the pathway to open Qi. Initially the conversation had started with a complaint of“heartburn” following her overindulged during the holidays. She was now feeling bloated and uncomfortable in her upperabdomen, but after a asking further she reported feeling uncomfortable loneliness After the discussion there came about a good cry followed by laughter. We were able to use some of the healing sounds to calmher spirit and rectify Qi. Finally I was able to suggest a simple clear soup recipe and a good nights sleep to heal the soul. I’ll checkon her again tomorrow. I’m looking to see what others are suggesting for self help during these isolating days.thanksMaryanne ReplySarah Rivkin NewJan 01, 2021ReactGood question and while music and singing are important parts of how I care for my own spirit, it's not something I've reallyexplored clinically. With patients I do the same kinds of things you mention. I'm uploading an essay I wrote on the topic forMedical Acupuncture (it's the second article in the PDF, don't know how to separate out just my piece) on teaching patients self-moxibustion on ST 36 that you and others might find of interest.PDF | 60.1 KPDFResilience essay Medical Ac…
1 more comment1ReplyMaryanne Travaglione NewJan 02, 2021 1ReactThank you for sharing this. Great reminder to include the use of moxa for self care1 reply 18 more comments8Sarah Rivkin assessing air quality in the clinicNewDec 30, 2020ReactI've learned so much more than I ever wanted to know about ventilation and aerosols, practicing this year during COVID. Made alot of changes to my clinic and style of practice (medical-grade HEPA filter, exhaust fan, open doors, one patient at a time, intakesvia video etc.), but as I've watched positivity numbers creep up I was nervous: Am I doing enough? Are the things I'm doingworking? Well, then I learned that the easiest way to see if you're getting enough air exchange (3-6 per hour) is to get a CO2 meter.Guess what? I did, and my levels are great! (Under 600ppm, target should be 600-800ppm.) Yippee! I'm going to share my findingswith my patients, as I think it will give them peace of mind, too. I'm also going to experiment to see if I have to keep the windowduring winter (brrr!) or if I can keep levels good without it.Happy to share more specific resources from my research, if that's of interest to others. ReplyCaroline Radice NewDec 31, 20201ReactI have colleagues who are running UVC lamps in the rooms between patients but not clear on the risk v benefits of theirantimicrobial activity vs. ozone or mercury vapor production. Anyone else using these? An article that summarizes thishttps://www.energyvanguard.com/blog/do-uv-lamps-really-improve-indoor-air-quality ReplySuzanne Connole NewDec 31, 2020ReactYes please! I have cross room windows so I have been doing a lot of windows open, but it's cold now. Also curious what air filtershave folks gotten that don't crack the bank bu are hopefully effective?Adina Kletzelmigraines before period and ovulationNewDec 30, 2020ReactHi,I could use some guidance on a case of a 45 year old woman who gets migraines a couple of days before ovulation and a couple ofdays before and first day of period. MIgraines can also come with stress.She is a skinny but somewhat muscular woman, she is a sports teacher.She is a mother of 3, works 2 jobs and is finished a degree in movement therapy.She is highly stressed, worries and overthinks everything, is tense and seems as if she is carrying a large weight on her shoulders.cries easily when overwhelmed, poor self-confidence.Migraines began in highschool with school stress.
The pain is mainly behind her eyes - often on right side sometimes on both sides, on the temples, forehead, and on the top of herhead.When the migraine gets really bad she vomits continuously and has to go to the emergency room.very nauseous with migraine. can't eatMigraine is w/w noise and light and stressA bit b/w rest.Dry mouth and constipation with migraine.tight neck and shoulders with migraine. GB 20, BL 1, St 1, very painful to touch with migraine.in summer - got very hot with migraines, in winter cold with migrainesBefore ovulation and period: sensitive in breast and bloating.Menstruation: scanty - bleeds on first day and then very light bleeding on second, third day - just some brown stains.minimal cramping. darker blood. cycle - 27 daysDigestion: bloating after food, some gasGI: tendency toward constipation. DOesnt go every daybody temp: very hot in summer, average in wintersweat: normaltongue: peeled in LW and UW with red dots. LW - red dots raised and puffy.MW - puffy, pale - except for small patch of red and dry in MWsome white coating in MWsides pale with teethmarksAbdsink right into Lower abdomena bit of rikyu in LAsoft abdomendistended and firm by CV 14 area - extends to st meridian on rightalso some distension under right rib and onPUlseLeftguan – is full and pushing upwardCun – weakChi – deep and a bit wiryR – guan – a bit full and stagnantCun – thin and a bit floatingChi – weakerWhat I see is Liver blood def. , Kid and Ht yin def., Sp yin def., stg. in the stomach, LIv qi stg.I would like to nourish blood, nourish Sp and kid yin, move liv qi, and relax her tension.
2 teacher remarksIt seems that two separate formulas for after period to ovulation and ovulation to period would be called for but her cycle is quiteshort and her issues begin a couple of days before she ovulates so I am not sure it is appropriate in this case.I thought to use XZJT to nourish the SP yin and add herbs to nourish kid yin and help descend the qi from the heart to the kidneysalong with herbs to open up the stagnation in the middle.I thought of the following formula but would really love feedback and guidance.Gui zhi 5Rou gui 6Bai shao 18Sheng jiang 9Da zao 6Gan cao 6Mai ya 20Bai zi ren 12Nu zhen zi 14Dan shen 9Huang jing 9Hou po 6Sheng di 9Lai fu zi 9Dang gui 9I was also wondering if there was a formula that I could give her when the headache symptoms begin in order to help it passeasier and quicker.Thanks in advanceAdinaSharon Weizenbaum NewDec 30, 2020ReactHi Adina, Thank you for an interesting case and for taking the time to write it up.I am interested in what others say from other perspectives.For me, this sounds like Jueyin going too fast primarily and also a bit slow with Shaoyin weakness as well. Since you are advancedin your GMP studies, you'll know just what i mean I think. I agree with your Zangfu diagnosis. This is primarily deficient so we are inthe Yin conformations and there is Yang flaring, relating strongly to wood so that puts us right into Jueyin. We can see that theministerial fire is flaring strongly and is not controlled by adequate fluids/blood. By enriching Yin blood, you can slow down thatflaring. I would suggest Wu Mei Wan for when she is starting to get the headache. Don't you think it fits the Wu Mei Wan pattern?Can you get Wu Mei Wan? I hope so! I like your formula for the in between times. I've changed it a bit. I add Fu Xiao Mai tointegrate Gan Mai Da Zao Tang. I don't think you need Mai Ya when you have Lai Fu Zi. Mai Ya for the breast is when the breast islumpy and full. If we think of Fu Xiao Mai as the substitute for Yi Tang, we have also integrated your XJZT idea. I added Fu Zi tostrengthen the storage of Yang with increased Zhi Gan Cao and Rou Gui. She is mostly cold with the heat being only Yang comingout of storage and not excess heat. As long as we promote storage, we need to supplement Yang. With the controlling herbs suchas Da Zao, Nu Zhen Zi, Bai Shao, Sheng Di, this should be fine. And I think a bit of Chuan Xiong is important to keep the Jue Yinmoving while we slow it down.Gui zhi 5
1 reply 15 more comments5ReplyRou gui 12 Fu Zi 9Bai shao 18Sheng jiang 12Da zao 6Zhi Gan cao 9Fu Xiao Mai 12Nu zhen zi 12Chuan Xiong 3Sheng di 9Lai fu zi 9Dang gui 9Does that help? ReplySharon Weizenbaum NewDec 31, 2020ReactYes, I think you see it clearly. That's what it sounds like to me. I suggest using the Wu Mei Wan just when she starts to feel badlyand not preemptively. If it helps right away, stop it and start again if symptoms come on again. You are welcome!Claudia Citkovitz OK this is embarrassing...Dec 29, 2020ReactTennis elbow is supposed to be so easy!It's a classic case, pain in the brachioradialis below the elbow, spikes to '9' when turning the hand with weight, LI10-11ish with tighttender points above and slight but pronounced rolling in of the shoulders so the LU1-2 area is sunken and tender. The patient is ahealthy, trim, upright 67 and works too hard as a carpenter, he had hoped to retire by now but needs the work and feels it'sovertaxing his body. The pain is minimal at rest but 3-4 all day and 5-6 after work, spikes to 9 several times a day with work. WhenI started to see him his tongue was pale and slightly scalloped, pulse narrow forceless and superficial, 70ish. I didn't find anythingremarkable at all in his abdomen, except a slight softness below the navel (but I'm not the best abdominal palpator TBH). Hedenies unusual heat/cold sensations or sweating more/less than others, digestion is fine with some dryness, nocturia x 1, not athirsty person but hydrates attentively. He also reports zero erectile function, despite active libido. His face is a little pale, andthough he is trim and well built, there is none of the hard sinewy look career contractors often have, it looks as though the fleshwould be soft if he didn't work so hard.My assessment was that he was indeed overtaxing his body, so I nourished qi/blood/essence and used adjacent and distal pointsfor the elbow. Over about 2 months his pulse/tongue have improved consistently -- color pale red now, scalloping gone but thereis a little of that livery rolled edge. No change at all in the ED, nocturia perhaps slightly less, and he reports only a slightimprovement in the pain though it's my impression he's functionally better off (and still working way too hard without gettingworse, FWIW).
1 teacher remarkI don't like to needle locally into deficient type inflammation, but I would if someone assured me it would help. I was very proud ofmy nourishing/tendon strengthening herb formula (written below in qian) but clearly I could do better. Any suggestions for herbsor acu?Jiang Huang - 2Dang gui - jiu - 4Huang qi - 5Bai shao - 3Zhi gan cao - 2He shou wu - 3Ye jiao teng - 5He huan pi - 5yin yang huo - 1Ba ji tian - 3Gui zhi - 2ReplySharon Weizenbaum NewDec 30, 20201ReactHi Claudia! It's been way too long! Thanks for posting!Yes, you should be proud of that formula! I think the ideas of it, to nourish blood, move Qi within blood, stop pain and supplementkidneys are spot on. My suggestion, given the sinewy build, would be to integrate Si Ni San with a high emphasis on the Shao YaoGan Cao Tang aspect of it and not so many pungent flavors, since he is sinewing and more deficient. So more nourishing andrelaxing and less moving. Maybe just Si Ni San with the Yang tonics and leave it at that.I would also ask him to only drink when thirsty. If he is pushing fluids, it is super hard to tell if he has thirst. I would also questioncarefully if he has any urinary hesitation, stop and go etc. Often people say their urination is fine but if you ask more carefully yourealize there is hesitation. If there is, add Fu Ling to Si Ni San. I am attaching a pdf with 4 cases of using Si Ni San for men. Threehave sexual issues.What side is the pain on? I would consider Sa'am liver supplementation on the opposite side of the pain, especially if the pain is onthe left (liver side) In this order: Lu 8 -, Liv 8+, Ki 10+, Liv 4-. Especially if he is super polite with sparkly eyes.PDF | 64.6 KPDFSi Ni San for MenReplySuzanne Connole NewDec 31, 20201ReactHi Claudia and Sharon! I like the Si Ni San idea systemically for him. I often see that ED and in women vaginal issues can be a Si NiSan patter as the genital region can be viewed as an extremity not receiving the nourishment it needs to function. I'm lookingforward to reading the cases you posted, thank you for that! I would say that overall I think the formula is good. I like to add Sangzhi when the problem is on the lower arm as it guides to the limbs, especially the arms. I wish I had a source for that! With thesame idea, I might swap out ye jiao teng for ji xue teng which is more blood moving. In general though vines spread to the limbs aswell which I am guessing was your idea there already. Good case! The deficient repetitive stress ones are the hardest pain to treat.
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6 earlier comments 1 1 teacher remark1 reply 12 more comments2Sharon Weizenbaum Treating women during pregnancy?Nov 30, 2020ReactI am currently taking two classes. In one, the teacher recommends a very hands off approach with pregnant women. In the other itis very hands on. My teacher, Dr. Qiu Xiaomei was an herbal obstetrician as well as a gynecologist so my background andapproach is hands on when there is an imbalance. Hands off if all is well. Sometimes disharmonies a woman experiences inpregnancy may be considered normal by the allopathic obstetrician and I see it as something that needs care such as poorappetite, glomus, water swelling, fatigue, low back pain etc. I am curious how people in the WPC feel about treating women inpregnancy? What was your training about this? ReplyCandace Jania Jan 01, 2021ReactMy experience is very similar as well. I support the pregnancy with acupuncture first but will use herbs if imbalances arise thatneed internal medicine or if there is a history of recurring miscarriage. ReplyCarrie MurphyJan 02, 20211ReactI work with a lot of fertility cases so happily see them through pregnancy and labor induction. My general approach is once amonth for well mother care, and more often if anything arises, from threatened miscarriage to just the regular stuff of life likeheadaches and heartburn and LBP. The thing I don't treat is fatigue, I think most pregnant and postpartum women need A LOTmore sleep and rest than they get, and I can't correct for that. Herbally, I try to start at the food end of the spectrum in pregnancy,only prescribing full formulas if needed. If a woman is on a formula while trying to get pregnant, I usually have her come off of itduring pregnancy and see how it goes. Conversely, I have had women who had to go off of normal meds like ambient whilepregnant, and use herbs to cover the gap.3 earlier comments 1 teacher remarkSally Success story with blocked tube yesterday!Nov 25, 2020 7ReactInfertility patient got pregnant this month with Clomid. After ultrasound showed that best egg was developing on her blockedFallopian tube side, they decided not to do an IUI. I added Di Long to her formula during ovulation and just past for a few days andtold her to try anyway. Pregnant!!! We don't know if the tube unblocked or one of the smaller eggs on the other side caught up,but she had a positive test before her treatment yesterday!ReplyAllyson NevardJan 3ReactAmazing, Sally!
ReplyMaryanne Travaglione Feb 9ReactThank you for sharing as it is so important to hear success stories. It keeps us trusting that the correct diagnosis and matching it toour incredible pharmacy can provide joyful outcomes