Q:  A 17 years old female patient (wheelchair-bound; brought in by her mother and care taker) arrived at our clinic yesterday.  The girl has cerebral palsy (severe; able to barely move upper limbs but with a long lag time; not able to talk but "understands" what's going on; face/head is elongated with slight distortion without expression; atrophy and underdevelopment of all four limbs, severe scliosis) and massive amount of phlegm accumulation in her lungs (lots of phlegm and mucous causing her breathing difficulty).  She needs suction of the mucous every 5-10 minutes to keep her airway open.

we used ear seeds: Spleen, Heart, Lung, Kidney, Shen Guan
body magnets: UB13

What are some suggested Ax and Rx for patients with severe form of Cerebral Palsy (just thought that this is an interesting and unique topic)?


A:  Thank you for the interesting case, however it is hard to say the prognosis of cerebral palsy.  So, let me summarize the general TCM pattern for Cerebral Palsy first.

TCM PATTERNS for Cerebral Palsy

1. Yin deficiency with Yang rising
Tian Ma  9g
Gou Teng  12g
Shi Jue Ming  18g
Zhi Zi  9g
Huang Qin  9g
Chuan Niu Xi  12g
Du Zhong  9g
Yi Mu Cao  9g
Sang Ji Sheng  9g
Ye Jio Teng  9g
Fu Shen  9g 
Gui Ban  9g
Mu Gua  9g

2. Qi and Blood deficiency
Huang Qi  120g
Dang Gui Wei  6g
Chi Shao  4.5g
Di Long  3g
Chuan Xiong  3g
Tao Ren  3g
Hong Hua  3g

3. SP/ST deficiency
Shan Yao  15g
Ren Shen  7.5g
Fu Ling  7.5g
Fu Shen  7.5g
Bai Zhu  7.5g
Bai Shao  7.5g
Shu Di  7.5g
Dang Gui  7.5g
Huang Qi  7.5g
Chuan Xiong  7.5g
Zhi Gan Cao  7.5g
Shi Chang Pu  7.5g

4. Empirical Formula
Shi Chang Pu  6g
Chan Tui  6g
Shi Jue Ming  12g
Zhen Zhu Mu  10g
Gui Ban  10g
Jiang Chan  10g
Tian Zhu Huang  10g
Tao Ren  3g
Hong Hua  5g
Quan Xie  3g
Lian Xin  5g

Above are the general TCM patterns, however if you see the phlegm signs in the LU from the patient, I'd like to recommend Dao Tan Tang = Di Tan Tang (Er Chen Tang + Zhi Shi, Tian Nan Xing) + Ren Shen, Shi Chang Pu for your patient.

For acupuncture I often use Element treatment (tonify LV1, sedate SP3) for brain disorders or improving motor dysfunction.  You can also combine Extra Vessel treatment (SI3+UB62 or LU7+KD6) the other side of element treatment.  I use those combinations because DU, Yangqiao, and Yinqiao enters the brain.

Q:  I have a friend who has recently had a D & C to remove multiple uterine polyps. She has a history abnormal (excess) uterine bleeding and two years ago had a polyp removed as well, with more returning. She has a history of very severe PMS (mood swings and anger) - liver Qi stagnation, and has taken Chai Hu Shu Gan San with positive results in the past. She was trying to get pregnant when her polyps returned, with xs bleeding (due to polyps), and now with the recent discovery of unicornuate uterus (she goes for testing to see if she has one kidney this week), she is putting that on hold.
I would love any insight, anyone treated this before?
(I feel that there needs to be a delicate balance between tonifying Qi and building blood but also moving  Qi and blood and not growing more polyps).


A:  I'd like to recommend a formula based on your treatment principle as described above.

Treatment principle: delicately  tonify Qi & build Blood, also move  Qi & Blood, without encouraging the growth of polyps

Xiang Fu  12g
Dang Gui  12g
Bai Shao  12g
Bai Zhu  6g
Bai He Shou Wu  6g
Chuan Xiong  6g
Chen Pi  6g
Zhi Gan Cao  6g

The name of this formula is Xiang Fu Ba Wu Tang (Eight Substance Decoction with Cyperi).

Q: I have heard and read about varying times that needles should stay in a patient.  Is there a standard time that needles should remain in the patient?  Does the standard time vary according to the treatment strategy?


A:  According to Huang Di Nei Jing (Yellow Emperor Inner Classic), Qi circulates throughout the body 50 times a day.  One day is 1440 minutes, and if you divide 1440 by 50, the result is 28.8, which is 28 minutes and 48 seconds.  So 30 minutes is the standard amount of time to retain the needles according to classical theory.

However, the treatment time may be modified depending on many different factors such as: the acupuncture theory used, body constitution, excess or deficiency condition, hot or cold environment. 

Q:  I have a male patient who began to develop psoriasis at age 4 after a bad sunburn.  Since then, it has progressively gotten worse with age.  He was also diagnosed with rheumatoid arthritis and has a full diagnosis of psoriatic arthritis.  At age 50, he has the skin rashes all over his body (patches and spots) and both hands and feet are now deformed-they all have moved out laterally and are of almost no use.

As a new practitioner, I was wondering what the best approach to treatment would be...both acupuncture and herbs, as well as what results would be reasonable to expect.

It is my thought that there is the possibility of latent heat, damp-heat, boney bi and heat in the blood.


A:  Although the current diagnosis is psoriasis, in this case I think the best approach is to follow a theory which always treats the original etiology first; for this patient the precipitating sunburn must be addressed despite the fact that it happened more than four decades ago.

This formula primarily addresses the original etiology, the sunburn:
Jin Yin Hua  12g
Lian Qiao  12g
Che Qian Zi  12g
Zi Hua Di Ding  12g
Pu Gong Ying  12g
Qing Hao  30g
Hua Shi  30g
He Ye  10g
Chi Shao  10g
Ze Xie  10g
Dan Zhu Ye  10g
Gan Cao  10g

After this formula is taken, we can make another formula focusing on the Blood-level and Bone-level.  Changes in the patient's symptoms resulting from taking this formula must be noted before the next formula is prescribed.

For acupuncture, first try using the Four-Needle Technique to tonify the SI: +GB41, +SI3, -UB66, -SI2.  Tonification (+) for this technique means needle following the channel 30-45 at degrees, sedation (-) is against the channel.  This acupuncture treatment will clear the Heat from the Blood level.

This is a long-standing and advanced case.  We have to see the patient's response to the first set of treatments before an acurate prognosis can be determined.  Please let me know what happens.

Q:  I have a 13 year old patient who has severe growing pains.  She went from 5'5" to 5'10 in about 6 months.  The pain is mostly in her knees, and was so severe that she missed 2 months of school because she could hardly walk. 
Does anyone have any thoughts on diagnosis, and how to treat this?  I am also wondering what, if any, affects this may have on her immune system, as the primary reason she came to me was for yin deficient cough.


A:  From the information you've provided, I think Mai Wei Di Huang Wan would be a good formula.

Liu Wei Di Huang Wan is a very popular formula for growing pains, and it seems especially appropriate since you have identified a yin deficiency pattern and knee pain.  Also growing pains occur in the evening, which corresponds to to the pattern of yin deficiency.  For the condition of yin deficiency cough you can add Mai Men Dong + Wu Wei Zi.  Shu Di Huang, the king herb of this formula, nourishes Kidney essence and bone marrow.   In the condition of fast growth rate, the bones are expanding so quickly that they're not well nourished, so Shu Di Huang is good for this condition.

The following herbs strengthen bones and sinews and also stop pain: Wu Jia Pi, Du Zhong, Xu Duan, and Sang Ji Sheng.  So if it is appropriate for your case, you could modify Mai Wei Di Huang Wan with some of these herbs.  Personally, I would try Mai Wei Di Huang Wan first and only modify later if it is not effective enough on its own.

According to Four-Needle Technique, you could strengthen the Kidneys by tonifying LU8 + KD7, and sedating SP3 + KD3.

School absence for two months sounds very severe.  Some experts say that growing pains doesn't occur in the day time, but usually in the evening after physical exertion.  Also, for growing pains that persist more that a week or so, the patient should visit the physician to make sure there is no underlying problem.  Juvenile Rheumatoid Arthritis and neoplastic bone diseases must be ruled out. 

CASE REPORT: Menopause after chemotherapy by BY Choi, L.Ac.

I had a patient who was a 63 year old female with insomnia since her 20s after abruptly cancelling her wedding and breaking off the engagement.  She had difficulty falling asleep, it took her 60-90 minutes to fall asleep, and she woke up at least every two hours.  Her big dream was to sleep six hours straight.  She had tried every solution she could think of over the last 20 years, including western drugs, yoga, meditation, and various other therapies.  Acupuncture was her last resort since she was afraid of needles.  She had hyperthyroidism and she was very thin.  Her tongue was just slightly red-purple. 

I knew that Spleen tonification was the most appropriate acupuncture treatment, but I wasn't quite sure was herbal formula to provide for her.  I was torn between Gui Pi Tang which could address her qi and blood deficiencies and weakness associated with age, or Wen Dang Tang because she was exhibiting some phlegm signs and also had some emotional symptoms.  I couldn't decide, since I felt that the qi and blood deficiency should be treated with Gui Pi Tang, but at the same time Gui Pi Tang could not address her emotional symptoms.

So I called HB for advice, and his solution was simple: use Gui Pi Wen Dang Tang, which is a combination of Gui Pi Tang plus Wen Dang Tang. 

After taking Gui Pi Wen Dang Tang for 20 days, the patient reported that she could fall asleep with 30 minutes every night.  She had also reached her big dream of sleeping 6 hours straight!

Then I changed the formula to Gui Pi Tang since all of the phlegm symptoms had dissipated.  After 20 days of Gui Pi Tang, she could fall asleep with no difficulty and sleep for 7 hours straight.

She wanted to be totally cured of her insomnia, so she requested more herbal treatment.  Since she was tonified and very energetic, I gave her a modified Gui Pi Tang with Dang Shen replacing Ren Shen.  After 20 days of that, her condition improved so that she could sleep for 8 hours straight with no problems.

Three months later, her symptoms have not regressed at all.

CASE REPORT: Menopause after chemotherapy by BY Choi, L.Ac.

A 46 year old lawyer, female, was diagnosed with breast cancer in January of 2007.  Chemotherapy was started right away, as well as other prescription medications.  After these treatments she started to hot flashes and night sweats as if menopause was setting in, even though she still had regular menstruation.  That August, she tried a course of acupuncture treatments which helped her symptoms to be 70% better.  Wanting to get back to work, she abandoned the treatments and went back to a full work schedule.  Her condition regressed completely.  Her MD then referred her to an acupuncturist since acupuncture had helped her previously.  When she came to me in January of 2008, she was severely fatigued with night sweats and hot flashes 20 times per day.  In addition, another small tumor had been discovered and she had a surgery scheduled for mid February.  She requested herbal treatments in conjunction with the acupuncture since her symptoms had regressed after her previous acupuncture treatments.

I had no confidence in treating menopause cases, but this patient really needed me.  I had only treated about 20 menopause cases.  I usually used Chai Hu Long Gu Mu Li Tang, as one of my university professors had recommended, but had never been satisfied with the results.  None of my patients ever experienced dramatic improvement, and one of them even returned the formula because the minerals were causing digestive problems.   
I knew I had to re-evaluate my approach to menopause cases and come up with a new strategy.

So I called HB to discuss the case.  He pointed out to me that her symptoms were a perfect match to Heart-Kidney miscommunication: palpitations, night sweats, insomnia, restless sleep, low grade fever, knee pain, constipation, tongue and pulse showing yin deficiency.  Clearly the best formula choice was Tian Wang Bu Xin Dan.

It was then I realized: my mind had somehow fallen into the pattern of equivocating one formula with one disease.  How had this happened?  I had been practicing successfully for more than eight years, and in every other situation I identified the pattern and treated the pattern accordingly.  There is no one formula for menopause, or any other disease.  HB's advice reminded me of this core concept, and made me realized that even the best of us can fall into that trap if we don't guard against it.

So, I gave my menopause patient Tian Wan Bu Xin Dan + Zhi Mu + Huang Bai.  After just three days of the formula, she reported a dramatic improvement overall, especially her hot flashes and energy level.  I instructed the patient to stop taking the formula by February 10th since her surgery was the 15th and I didn't want to risk any drug interaction.  When she visited my clinic on the 13th, she told me she hadn't stopped taking the formula because it was helping her so much.  Luckily her surgery on the 15th was very successful.  All of the tumor tissue was able to be removed, and there was no drug interaction.  She came back to the clinic for more formula on the 20th and on the 27th.  By that time, her hot flashes had reduced to only twice per day, with almost no more night sweats, and no more fatigue.  After one more batch of formula, her symptoms were gone.

WESTERN SUMMARY

DEFINITION
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS) resulting in loss of muscle control, vision, balance, and sensation.  The immune system destroys myelin, the protective and insulating covering of the nerves.  This demyelination disrupts or stops the nerve signal transmissions in the CNS.  Nerves can regenerate myelin, but not as fast as it is deteriorates in MS. The progression of MS, as well as the types and severity of symptoms, vary widely based on the location and the extent of demyelination.

MS is estimated to affect about 400,000 Americans. With the exception of trauma, it is the most frequent cause of neurological disability beginning in early to middle adulthood.  MS is two to three times more common in females than in males, and generally occurs between the ages of 20 and 40.  The onset of MS may be dramatic or so mild that a person doesn't even notice any symptoms until far later in the course of the disease.

SYMPTOMS
Common early symptoms of MS include tingling, numbness, loss of balance, weakness in one or more limbs, blurred or double vision.  Other symptoms may include slurred speech, sudden onset of paralysis, lack of coordination, or cognitive difficulties. As the disease progresses, there may be muscle spasms, sensitivity to heat, fatigue, dizziness, changes in thinking or  physical perception, pain, dysphasia, dysphagia, tremors, gait disturbances, or sexual disturbances.
Secondary symptoms are caused by primary symptoms. For example, paralysis can lead to bedsores; bladder incontinence problems can cause recurrent urinary tract infections.
Tertiary symptoms are the social, psychological, and vocational complications resulting from the primary and secondary symptoms.

FOUR COURSES MS is unpredictable.  There are four courses that MS takes:
Relapsing-remitting MS: unpredictable exacerbations followed by full, partial or no recovery of some function
Primary-progressive MS: steady gradual progression without any obvious relapses and remissions
Secondary-progressive MS: initially begins with a relapsing-remitting course, but later evolves into progressive disease
Progressive-relapsing MS: steady progression with acute attacks that may or may not be followed by some recovery

A few MS patients have only mild disease and do well without treatment, but most get worse over time. Some pharmaceutical drugs can reduce the frequency and severity of attacks, and may reduce or delay disability. It is not predictable which medications will work each patient, and medications for MS may have significant side effects.  Some may cause flu-like symptoms such as fever, chills, fatigue, and muscle aches. Others may cause allergic reactions, infections, headaches, fatigue, joint pain, or even heart damage.


EASTERN PATTERNS & HERBAL FORMULAS

1. Internal Wind due to deficiency: blurred vision, dizziness, headache, spasm, tremor, unstable gait, irritability, propensity to anger, red tongue, no tongue coating, wiry-thready-rapid pulse
Bai Shao  12g
E Jiao  6g
Gui Ban  8g
Sheng Di Huang 12g
Huo Ma Ren  4g
Wu Wei Zi  4g
Mu Li  8g
Mai Men Dong  12g
Zhi Gan Cao  8g
Zi Ji Huang  2pieces
Bie Jia  8g
Gou Teng  8g
*Quan Xie 3g (pill/powder use only)

*This formula can be decocted if Quan Xie is not used.  If Quan Xie is used it must be in pill or powder form only.

2. Internal Wind due to Blood deficiency: spasm, tremor, unstable gait, weakness of the limbs, dizziness, vertigo, palpitation, thin tongue coating, thready-weak pulse
Tian Ma  6g
Qin Jiao  6g
Xi Xin  6g
Shu Di Huang  12g
Sheng Di Huang  12g
Dang Gui  12g
Chuan Xiong  12g
Bai Shao  12g
Fang Feng  4.2g
Jing Jie  4.2g
Bai Zhu  9g
Huang Qi  9g
Wei Ling Xian  3g
Mu Gua  6g
Gou Teng  6g
*Quan Xie 3g (pill/powder use only)

3. Yang deficiency + Blood deficiency: weakness of the limbs, unstable gait, paralysis of the limbs, cold limbs, unclear speech, clear urination, swollen tongue, white tongue coating, deep-thready pulse
Xian Mao  9g
Yin Yang Huo  9g
Dang Gui  9g
Ba Ji Tian  9g
Huang Qi  120g
Chi Shao  4.5g
Di Long  3g
Chuan Xiong  3g
Tao Ren  3g
Hong Hua  3g

4. Empirical Formula (A): Yin deficiency with Yang rising + Wind-Phlegm in the channels
Huang Qi  15g
Sheng Di Huang  15g
Dan Shen  15g
Bai Jiang Chan  4.5g
Quan Xie  3g
Gou Teng  30g
Xuan Shen  12g
Chi Shao  12g
Bai Shao  12g
Dang Gui  12g
Zhi Mu  10g
Huang Bai  10g
Ju Hua  10g
Bai Ji Li  10g
Jie Geng  8g
Wu Gong  4pieces
Chuan Xiong  5g

5. Empirical Formula (B): LV and KD Yin deficiency
Shu Di Huang  10g
Sheng Di Huang  10g
Gou Qi Zi  10g
Shan Zhu Yu  10g
Lu Jiao Jiao  10g
Gui Ban Jiao  10g
Niu Xi  10g
Nu Zhen Zi  10g
Ba Ji Tian  9g
Wu Wei Zi  9g
He Shou Wu  12g
Gan Cao  5g
Gou Teng  10g
Sang Zhi  10g
Di Long  10g
Mu Gua  10g
Lian Qiao  10g
Xiang Fu  10g
Fo Shou  10g
Zhi Ke  10g
Mu Gua  10g

WESTERN DEFINITION
Kidney stones are one of the most common and painful disorders of the urinary tract.  A kidney stone is a hard crystalline mass that builds up on the inner surface of the kidney.  Kidney stones may contain various combinations of chemicals.  The most common types of kidney stones are a combination of calcium plus oxalate or phosphate; other types of stones may be attributed to high levels of uric acid or urinary tract infections.

Insufficient fluid intake over a period of time is the most common cause of kidney stones, especially in those with a genetic predisposition for developing kidney stones.  Other conditions that may lead to kidney stones include gout, inflammatory bowel disease, excessive intake of Vitamin D, hyperparathyroidism or use of calcium-based antacids.

Kidney stones usually are asymptomatic unless the crystal has become large enough to block the flow of urine when it moves down the urinary tract.  When that happens, a person typically feels a sudden sharp cramping pain in the back, side, or lower abdomen.  Nausea and vomiting may occur.  Pain continues as the sharp crystal is squeezed through the tiny ureter, and blood may be visible with urination.  Fever and chills in conjunction with kidney stones may indicate an infection which calls for immediate medical care. 


EASTERN PATTERNS:
Stone Lin is the closest disease to Kidney stones in Oriental Medicine,  but Kidney stones may also fall under Lumbago, Bloody Urine or Taxation.  Kidney stones may be diagnosed according to the following Eastern patterns:   

1. Damp-Heat:  urinary stones, urinary difficulty, urine stopping midstream, sharp pain in the urethra, frequent urination, urgent urination, lower abdominal pain, turbid urination of possibly yellow or red color, red tongue with yellow coating, wiry and rapid pulse
6.0g  Che Qian Zi
6.0g  Qu Mai
6.0g  Bian Xu
6.0g  Hua Shi
6.0g  Zhi Zi
6.0g  Gan Cao
6.0g  Mu Tong
6.0g  Da Huang
6.0g  Jin Qian Cao
6.0g  Hai Jin Sha
6.0g  Ji Nei Jin
6.0g  Hu Po (amber)

2. Qi and Blood stagnation:  abdominal distension, sharp pain, severe hypochondriac pain radiating to the abdomen, hematuria, pale red tongue with thin white or yellow coating, wiry or wiry-thready pulse
6.0g  Mu Tong
6.0g  Hua Shi
6.0g  Zhi Gan Cao
14g   Zhi Zi (fried)
8.0g  Chi Shao
8.0g  Fu Ling
4.0g  Dan Zhu Ye
2.0g  Yin Chen
4.0g  San Qi
4.0g  Da Huang
4.0g  Xiao Ji
4.0g  Pu Huang

3. Yang deficiency:  low back pain, cold feeling in the low back, pale face, cold limbs, dislike of coldness, lack of thirst, scanty pale urination, swollen tongue with slippery white coating, deep and weak pulse 
9.0g  Fu Zi
6.0g  Fu Ling
6.0g  Ze Xie
6.0g  Shan Zhu Yu
6.0g  Shan Yao (fried)
6.0g  Che Qian Zi
6.0g  Mu Dan Pi
6.0g  Rou Gui
3.0g  Chuan Niu Xi
3.0g  Shu Di Huang
6.0g  Huang Qi
6.0g  Ji Nei Jin
6.0g  Hai Jin Sha

4. SP and KD deficiency:  low back pain, weakness in the lower legs, fatigue, indigestion, abdominal distension even with eating only small amounts of food, incomplete urination, heat sensation in the palms and soles, dizziness, tinnitus, thirst, red tongue without a coat, deep and thready pulse
8.0g  Ren Shen
8.0g  Bai Zhu
8.0g  Fu Ling
8.0g  Huang Qi (honey-fried)
8.0g  Ting Li Zi
8.0g  Shan Yao
4.0g  Mu Xiang
4.0g  Fu Zi
6.0g  Che Qian Zi
6.0g  Ji Nei Jin
6.0g  Hai Jin Sha

Empirical Formulas:  Promote urination and expel stones
12g  Hai Jin Sha
12g  Jin Qian Cao
12g  Ji Nei Jin
12g  Shi Wei
  9g  Dong Kui Zi
15g  Hua Shi
12g  Che Qian Zi

Q:   I diagnosed a patient with Yin deficiency and administered a Yin tonic formula.  The patient feels heavy and tired and wants to sleep a lot since she started taking this formula a few days ago.  As I understand it, tonics should give more energy, so it seems contradictory that the patient feels more fatigued.  Can you explain this?  Could this be a healing crisis phenomenon?  Or does this mean that my diagnosis was wrong?

A:   If using Yin or Blood tonics possibly causes slight heavy feeling in the body and maybe even slight tiredness, this could mean that body is "working overtime" metabolizing the herbs and creating the Yin and body fluids.  Patients may experience more sleepiness and calmness while taking the herbs.  On the other hand, using Yang or Qi tonics will cause the patient to feel more energetic, wake earlier in the morning and be more active, while decreasing fatigue.

Overuse of Yin/Blood tonics will create an overly heavy feeling and somnolence.  This is considered a side effect.  Overuse of Yang/Qi tonics will result in headache, dry mouth and red eyes.  In addition they may have problems falling asleep or waking too early in the morning.

Yang tonics supplement Yang and create a physiological, metabolic, and emotional Yang state in the body.  Vice versa, Yin tonics supplement Yin and create a physiological, metabolic, and emotional Yin condition in the body.

If a child is hyperactive or irritable, using an appropriately modified Liu Wei Di Huang Wan can help to balance the Yin-Yang state of the body.  If an elderly person feels heavy and fatigued, using an appropriately modified Bu Zhong Yi Qi Tang + Lu Rong can help to balance the Yin-Yang state of the body.

Of course, the diagnosis is very important.  If, for example, the patient had a Damp condition, using Yin tonics could exaggerate those Damp symptoms.  In general, Yin tonics are contraindicated for Yang deficiency or Damp/Phlegm conditions; Yang tonics are generally contraindicated for Yin deficiency with heat signs or Heat.  The most effective formulas are delicate combinations of both, administered in the context of the correct diagnosis.