Difficult case of cold body temperature | ChineseMedicineTools.com: Chinese Medicine & Acupuncture Social Community ~ Video ~ Podcasts

Lisa, Since when is she

Lisa,

Since when is she taking herbs and can you list all the herbs she is taking with dosage.

Claudine Paillé

cold

Hi Lisa.

How interesting. I suggest adding herbs to move Qi in the Liver channel, to prevent congestion and heat from the tonic medicines. She must have concurrent Liver qi stagnation for this to be happening. Herbs such as xiang fu, chuan lian zi, wu yao. Chuan lian zi is also cooling, of course, and might be a nice counterpoint.

The fact that side effects were least on the formula which also addresses qi stagnation might be a confirmation of this.

Adina.

stasis

I would think it is blood stasis blocking the yang meridians. it is important to activate the yang yi rather than tonify yang.

After you give her tonfiy herbs, she has more fire symptoms, then it can indicate she is not really yang deficiency or yang deficiency is not bad. it is more like her yang meridicans are blocked then yang qi can't go to surface.

Dampness a factor

Dear Lisa

Have you considered using more damp draining herbs? That tongue shape suggests dampness in the tissues blocking the weak yang from nourishing the surface and keeping it warm. When you use warming herbs, the same obstruction occurs, the dampness now holding in the heat and generating internal heat that is unable to vent.

Michael Ellis

further

Lisa, further to my above comment, there have been several suggestions now about tonifying yin as well as yang, but I suggest great caution doing so using herbs. Any herbal yin tonic will tend to add to the dampness and your client will feel worse -- more tired, more everything. If you go down that track you'll end up with a constant juggle between yin and yang tonics that is ultimately unsatisfactory and anyway misses the mark. There is a confounding factor here that needs to be addressed and it is not cold, but damp. If you want a formula suggestion, Wu Ling San would seem a perfect starting point.

Warm wishes

Michael

damp signs

Lisa, if her tongue is swollen with toothmarks, that is just about enough damp signs on its own (and indication for fu ling, chen pi etc.). And it's certainly not a yin xu tongue. Also, I'm thinking about the cold feeling that is not relieved even in the shower -- it's cold damp in the tissues, not just cold which is much more easily driven out or relieved. The dampness retains or holds in the pathogenic temperature. I suggest you see the red on the sides of the tongue not so much as evidence of Liver fire (in the absence of any other Liver system symptoms) as simply heat bound up in the exterior. I'm in Melbourne, Australia, a relatively damp place especially when there's a southerly weather system producing cold, damp air, and see this sort of thing a fair bit. I still reckon you can make it complicated with yin-yang tonics, qi movers, ying-wei regulators and the rest, or look for a Shang Han Lun style solution such as Wu Ling San.

Michael Ellis

other considerations

It seems many TCM views have been addressed already, so I thought I might comment on a slightly different angle.

Have you measured her body temp? I am curious to see if it is actually low, or this is an overall sensation she has.

One possibility to consider is mercury toxicity. It has the ability to affect the nervous system and blood circulation and has been known to lower the body temperature which of course has a huge impact on the function of all the organs and entire body.

If you know a practitioner who can do some diagnostic testing via something like Biomeridian MSAS then you may find some helpful info. This may involve going outside the TCM field a bit, like homeopathic or naturopathic direction.

There are homeopathic remedies to detox the system of specific toxins, and certainly as for one of the above comments (on molds) there may in fact be some toxins in the system that are holding her body in a continual out of balance state. Commonly, until those are cleared results will be very difficult. I might also suggest a lymphatic drainage homeopathic remedy like Lyphosot from Heel. Seems like she is clogged up a bit and in order for the body to detox naturally the lymph system must be working well

Kevin Preston

Knowing when to change or stop treatment

Hi Lisa,

You ask a tricky question that is truly open to lots of debate.

The pulse is one of the most subjective diagnostic tools us CM Doc's utilize. What is "forceful and wiry" to you, may just be a healthy pulse "full of spirit" to another. This is why it is so important to look at the big picture and focus your attention on it, rather than on just an isolated subjective sign like the pulse or tongue.

Yes I have seen many cases whereby the tongue and pulse contradicted the other signs and symptoms present. This is not uncommon.

Have you taken her blood pressure? If you are worried about stroke then this would be a good thing to monitor.

As I mentioned, the bottom line is whether or not the patient is getting better. If they have come to you because of feeling cold, stiff, and in pain then are those symptoms improving? If she is improving on the treatment you provide then keep going. If the condition is one of Vacuity cold, then she may need to be kept on herbs for a year or more.

I remember a case of Atopy that presented with firey red hot eczema, covering the whole body, with a tongue that was pale and the pulse was just moderate- nothing special. Her treatment was to strongly cool blood heat with herbs, which lasted for about 6 months or so- until all the eczema was gone.

This same woman had asthma and so when the skin was better, the focus was changed to clearing out insidious phlegm cold from the lungs. Basically get her fired up! I remember her look, which was like a fierce teenage stare. Her pulse was strong and forceful. About 6 more months on this pathway and her asthma went away, as well as her allergic rhinnitis. Now many years later, she is still clear of all the above symptoms.

The two treatments offered to this same woman were contradictory and yet they still cleared up the conditions she was faced with. Listening to her symptoms change were far more important than tongue and pulse, at least in that case.

Anyways, we really have to be brave and confident in our path. The above threads listed every possible angle you could ever take. Which one do you choose? We choose the one that gives the best clinical result and adjust as our patient adjusts. If the women responds well to Fu Zi then keep using it. Then over time, start lowering the dose and see if she stabilizes. As Andrea pointed out above, this is where custom formulas give you so much more freedom to work and observe what is doing what.

The reality is that patients are not text books and their symptoms tend to be sloppy and messy, contradicting each other all the time. Sometimes certain theories work and other times they are a waste of time. Below is a quote that my mentor Mazin shared with me on the idea of living too rigidly by theory,

"All poets and philosophers who find
Some favourite system to their mind
In every way to make it fit
Will force all Nature to submit."

Jonathan Swift

Hope this helps,

Trevor

Underlying Problems

Hi Lisa,

When I read all the info you've got there, the first thing I think of is that the Yang is being blocked. (which seems to be the general consensus)

More than likely it is a Qi blockage, probably of the Liver - the sides of the tongue get red when taking hot herbs too long. You treat the liver qi anyhow to assist other organ qi stagnations.

The fact that once she stops taking the herbs everything goes back to how it was - sore back, coldness - indicates that the Yang energy is not flowing freely.

Your treatment focus should be promoting qi circulation (and blood to some extent), unblock the channels (to let the Yang flow freely) as well as tonifying yang, but you don't want to use too many hot herbs.

Things like Bai Shao Yao, Ji Xue Teng, and Gui Zhi are good for unblocking the channels. Try a Gui Zhi Tang formula and see how that helps - my teacher used to swear by it ;) You can use Gan Jiang instead of Sheng Jiang since you're treating internal, not external.

Take it step by step - don't try to treat too many things at once. When you get the qi flowing freely to some extent, you can then change your treatment protocol to suit as symptoms change.

Find out from her about her eating habits and living/working environment - make sure there is nothing that would contribute to it and advise her accordingly with appropriate foods and lifestyle habits to avoid getting yang deficiency cold or qi blockage.

It seems unlikely that it is a cold invasion or cold blockage.

Let us know how it goes.

Cold case

I am just a student and don't know that much about Tx, however I wanted to know has you patient been checked out by a western doctor? I am asking because even though chinese medicine is great there are still a few areas where western medicine is better,maybe she has come kind of disease or infection or something that you are unable to see.

Cold Case

Alex Berks http://www.naturalhealingacupuncture.com

Whomever said get her thyroid checked I think is on the right track. Can you please report back to us what the results of her thyroid tests are.

more thoughts

In your case above, you never stated your diagnosis and treatment principle. We are taught in school that is necessary before initiating treatment. You have fallen into a familiar trap here. I think we all have been there at some point. Grasping rather than thinking carefully about the Qi mechanism to see how it's impairment could explain the presenting pattern.

Please also consider what are the signs she has that are DEFINITIVE. Many of the signs you have shared could indicate a couple of different things. This is why you are confused. For instance, the swollen tongue could indicate a couple of things, the pulse a couple of others, even the cold sensations are not indicative of any one single diagnostic factor. The only thing you reported that is definitive is the low back and knees, which indicate Kidney involvement. But not Kidney Yang, Yin, or Qi unless we have more information.

I agree with the ideas that Michael Ellis has shared. I think we must be careful to stick to TCM at present. Sometimes jumping to a western diagnosis takes us off track.

This pattern has the feel of 'trapped heat'. You should go back and look at the material on Si Ni San. Here, the heat is trapped in the Liver, and warmth cannot get to the outside. The Qi mechanism is not working well.

Warming formulas exacerbate because they actually increase the trapped heat. Therefore, the Si Ni San works to improve the Qi mechanism and circulate the Yang.

Be careful not to confuse Si Ni Tang, where there is true cold. This formula would be too hot for her.

I agree that the pulse is a difficult indicator in and of itself. I think the tongue is necessary for TCM herb prescription. Abdominal evaluation is also very helpful.

Laura C

My opinion is

To think it all over again. Mainly she is showing cold symptoms but yet to much heat easily overexerts and causes damage instead of curing, as if the heat could not be hosted properly or the host cannot manage the heat.

First of all I share the same opionion as some wrote before that A: it at this rate maybe would be better to stop herbal as well as acupunctural medication for a while and B: strongly consider other facts and research those thoroughly while not medication as well as researching not only her western state of body health but also to go back at looking at her body health in the TCM again.

Currently it's like fighting a disease which you dont know of what it is, does or where it comes from exactly. It's obvious that your chances of treatment succes are low at the current rate. Treating further now would bear a risk of maybe strengthening and not treating the disease, and when it grows stronger treating after that will only become more complex and difficult, making it even harder to treat.

Second there really are some infos missing, which is why I would give it another, good analysis and overthinking before taking any to radical action. Because some things arent clear yet, we defenitely need to know more and have a thoroughly analysis of this case. But first up all we should also integrate what we already know about her, and use this to start new questions and ideas giving insight of where this comes from and what causes it.

First of all in one point everyone seems to agree in is that theres at least the Kidneys involved somehow.

Next is we know of defenitive cold in her body, but where it sits and comes from seems to be a mysterium untill now.

And that to much yang quickly damages her.

So first of all we would need: knowledge of thyroid, heavy metalls, maybe other poisons as well as medications which she may have taken or is still taking. Her living environment, temperature, factors(windy? Damp? dry?), dark or bright? and if there may be fungus, yeast, maybe even mites or stuff like that much in her living environment, as well she should be checked for parasites, as if something like that resides in her body, it would be no wonder that treatment failed so far. As well her intestines maybe should be checked for yeast fungus also, not only the house or place where she lives, since I had to fight with Yeast fungus on my skin, I know that they also love to reside in your intestines, as this gives them the perfect growing environment. And last but maybe not least, we should maybe even consider radiation or electrosmog, I know enough of it and that this is actually a really small thing which actually never is strong enough to cause any harm and if it very often only apears in persons wo are, through work or life style, often in contact with radiation and for long time. However I also know that not only is every body different also every body reacts to things differently. So we should consider it, even if its a small possibility, that she may be very sensitive to radiation, so much that it maybe could really affect her health, even if the possibility is small we must consider it and clear it if its damaging her or not. Also since the fact that she gets yang symptoms so easily may be that somehing like radiation which is aggrevating these yang symptoms despite the fact her body constitution is cold, as if when you look at the typicall symptoms of long term or strong radiation they defenitely mach yang types( skin burns, inflammation, hair loss and stuff like that). Oh yes and not to forget maybe it would also be interesting to know if theres any strong vitamin or mineralic deficiency(like strong zinc or iron deficiency) as a strong deficiency(im talking about a real strong deficiency) may really affect her health and actually needs a western based treatment to, I've learned enough so far to know there are not many and only rare cases where a real deficiency is there, but when there is and its a strong deficiency it definetily needs to be looked at, and that when having a strong deficiency in something TCM treatment alone often isnt enough unfortunately.

First of all these things should be cleared, if everything is okay so far and shes clean from all, then we should take the knowledge from knowing her environment temperature and factor of where she lives and calculate that to in her TCM treatment, in this case we can only go back to the TCM treatment then anyway.

Now we must start to question what we have to get deeper into this.

First of all like also said above it would be interesing to have her physical actuall body temperature. Considering that especially: Kidney, Middle san jiao/middle burner, stomach which still is "the sea fire"(actually its in the middle san jiao to but still its not the whole middle burner), to some grade liver as well as from the 4 stadiums, especially Qi-level(inner defend stadium) and the Blood level(xue-level) very strongly affect how much or less heat a person feels. For example there could be cold on several organs, but the patient still feels warm and there are several cold signs to because the patient has strong blood heat and yet feels warm, as this strongly affects the heat feeling of a person. So having her body temperature is a good start.

Now we should, since its a complicated case, go back to the roots what Yin and Yang actually are, how they work, what the stand for and why there is alyway a opposite colored spot in each side of Yin and Yang and why not all Yang is reall Yang and not all Yin is really Yin, why when its dark light shines brighter and is more noticed and when theres light shadows appear. As said to above when the patient suffered a long time coldness or yang deficiency, yin couldnt be produced properly and is actually dying to. Yet I dont believe that this scenario is the case, since her tongue was yet wet and the toothmarks definetily show a deficient spleen and with the wetness maybe also that theres at least moderate or much damp in her body. Here we should also know her body shape and size, big? small? middle,over,underweight? Thats why I said we still need thoroughly analysis on this matter.

But I think its more a scenario like this, similiar to my case, where there is Yin and Yang quite good actually, maybe more or less yin or yang, but its very bad balanced on the seperate organs as well as the substances(blood, qi, body fluids etc.) could be messed up to. I fear this is case since it is till now the most realistic case which matches the most things we know so far, if thats the case it will be hard to cure, since u must constantly be carefull to put yin and yang in the right places only its no use to have a weak or strong based yin or yang diet here you can only go for foods which place yin and yang in the right amounts in the right places. Its hard because it leaves not much room for a diet plan and it will be more strict and leaves not much variety and is hard since you may must get to eat things you normally smaller or stronger dislike. In this case we must know EXACTLY which organs are okay and which ones have yin/fluid or yang/qi deficiency and how her substances are to. Also we should consider that if theres dampness, especially since she is a women, there may be a blood deficiency to.

I too think that theres a high possiblity of a stagnation somewhere in this patient, since dampness often loves to cause stagnations. Theres also definitely a spleen qi or yang deficiency, maybe the dampness also is caused by that but then what is when theres dampness sitting in certain spots? then only strengthening the spleen most likely isnt enough. Theres only one thing which is funny and bothers me, when theres a stagnation it often shows signs of blueisch or purplisch tongue or skin, this appears to be not so in her case. Either there is no stagnation OR there is either a good blood transport but a lacking qi transportation and/or this maybe could be caused through a liver stagnation as the liver controls flowement and movement of qi or the stagnation was only in the liver to begin with. And when it's the liver it could be a possible, although this is the first time I ever hear of something like this, moderate or strong dampness in the liver. In this case dampness draining herbs which act on the liver should be used.

Since her pulse if aggrevated by yang herbs gets forcefull and wiry, there maybe something also or maybe to the liver, and the kidneys and heart. Maybe her Kidneys despite her cold actually always had good yang to begin with and that her kidney yin is actually weak and when aggrevated through more kidney yang herbs it starts to seriously effect the heart maybe the liver to and therefore the pulse.

No matter how you look at it this, this is leading nowhere. So my tip: Stop any medication for the moment, look at her physis and health also through western medicine and in the time your not medicating get a full and detailed analysis of her problems(which is best here anyway when shes not medicated you can see her TRUE unbalances). Use everything you already know to 100% about her and combine it whith the full, detailed analysis when its ready. And also: Keep at it and never give up!

Good Luck