Difficult case of cold body temperature

 The first thing that comes to my mind (I'm not an acupuncturist, just studying) is her environment. My family went through toxic mold exposure so our symptoms always came back no matter what while we were living in the contaminated house. ...Not sure if that helps...just a comment I have.

Lisa,

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

Claudine Paillé

Have you looked for a blockage between the three jiaos (upper, middle, lower)? Yes, supporting her kidney fire may keep her warm, but the question I'd ask is to what is she losing the heat?

Consider looking for boundary issues. One of the other responses spoke about her home environment. Does she react negatively to being touched? Does she eat any warming foods or all cold foods?

For chronic support, she might use a TDP lamp at home over the kidney area, such as in treating Reynaud's.  She may be so depleted though that she should start with some congee's to ease her system back into accepting warmth from food if she's unable to consume/retain from regular foods.

Sorry if that's jumping around a bit. Suspect this would be an easier one in person.

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.

Hi Lisa.

If I may, i would sugest a new aproach.

Take out all the herbal remedy until you have total understand the problem.

and make a new acupuncture protocole.

Imagine that you do have the herbs to help you.

If you use only acupuncture what do you need to do?

Tonify kidney yin, Tonify Spleen, Tonify Wei, Cleard the heat from Liver, Move the Qi, Move the Blood, for started.

If you need help in the protocol send me a email.

Regards, Yun Long

P.S.- Sorry my english

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.

Hi Lisa,

You've done a good job documenting and reporting what worked and didn't work.  I would concur with the stagnation ideas in other comments.  It seems like there is deep cold invasion with concurrent yang deficiency, but not enough movement to break into the cold. Sometimes, good old Gui zhi tang is a good place to start for cases of cold invasion. Does she warm up with lots of sweaters and blankets? Or does no amount of clothing change her cold? You mentioned that she is cold, even in the shower, this could indicate a cold invasion vs. a yang deficiency.   I've had good luck with Gui zhi tang modifications for various kinds of cold/pain,  perhaps with more moving herbs. Also, at home, she could do moxa on spleen -6, ren-6, stomach-36 or elswhere. If knee pain is preventing her from excercising or walking, give her some liniment like 7 photos or zheng gu shui to apply and then moxa directly on her knees. Then prescribe a brisk walk daily to get qi moving.

It also seems like there is a concurrent yin deficiency and that tonifying yang too strongly without strong and sufficient yin tonics might be too strong too fast.

Finally, has she checked her thyroid? Is she overweight? Does she have the classic hump at the back of the neck? If she has not checked her thryoid, it may be worth investigating.

I wish you luck!

Cedar

~ The glory is not in never falling, but in rising every time you fall ~

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

Lisa, i agree with the yin deficient comment above. If your yang is depleted for long enough you will have your yin become deficient too. Then if you start tonifying yang reasonably quickly, the yin is not strong enough to anchor the yang and you end with signs of apparent yang (heat) excess. From my point of view that seems to be what is happening here. Alternate her formula with a yin tonic once she gets to the "hot" stage and see how you go. Yin tonics should help her hayfever subside - particularly if her hayfever and wiry pulse are a liver yin xu rather than liver qi stagnation heat.

As suggested above, if she isn't already, I would get her moxing at home. Kid1 is a good point - brings down excess yang if there is yin xu, is also the source point for Kid so can get yang into the channel. Make sure she isnt walking around at home in bare feet as a possible source of yang draining. Ren8 moxa with ginger and rocksalt is also a nice one that I get clients to do. If she has a partner they could also moxa her lower back/sacral area.

Another way of dredging out any cold that is there already is to cup Ren8 then follow with moxa.

Best of luck.

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

Hello Everyone,

 thank you for taking the time to give me your suggestions.

Firstly to answer Claudine, excepting Xi Yang Shen all of the herbs have been in formula:

Jin gui shen qi, shi chuan da bu, du huo ji sheng, kidney mansion, china med menpause 1. Each of these formula have been tried for about two months at a standard dose, always begining with good results but eventually causing too much heat.

the current formula China Med Monopause 1 contains;

Du Zhong, Xu Duan, Sang ji seng, Tu Si Zi, Dang gui, Bai Shao, Dang Shen, Bai Zhu, Fu ling, Ze XieSnag bai pi, Yu jin, chai hu, chuan xiong.

its functions are to tonify kidney and spleen yang, drain damp, smooth liver qi and clear blood stasis. Going by the improvement in her tongue it is addressing these issues but she is still cold and her pulse is weak.

The Acupuncture was given for approx two months before I suggested herbs, and the change in symptoms was dramatic, Du huo ji sheng literally sucked her prolapsed disc back in, and her body temperature became normal, her skin even changed colour, I thought she had caught the sun.

Her diet and lifestyle are good, she exercises regularly including yoga, her work is sedentary and she feels colder when sitting.

Just to answer the comment about yin tonics, I did try this but she very quickly became cold. I agree with the comments of liver qi stagnation and the formula she is on at present ( one month) does address this, but her pulse is weak and she is still cold?  

 Can any one confirm (or disagree) that if her tongue is pink it means the interior is warm but the  slow weak, deep pulse, being a contradiction,  indicates exterior cold, (which would fit with the comment of blockage of yang yi) in which case the reccomended Gui Zhi tang, alongside the current formula should help, or can anyone suggest any others, si ni tang possibly?

Also what is the likelyhood of deficiency of wei qi causing the persistent  cold pathogen,  would this be the cause of the yang yi blockage? should i tonify this at the same time as clearing cold ? possibly with yu ping feng or Reishi?

The suggestion about damp retaining cold or trapping heat is also interesting, but she doesn't have so many damp issues as she does cold and liver qi stagnation, I am tempted to try this but wary of upsetting her system by too much experimenting. The one thing I can confirm is that she is deficient and so would too much draining cause more problems?

the thyroid issue is one I have considered but she does not have any strong symptoms of this, no thinning hair, and not overweight.

I Would appreciate more comments

Regards, Lisa.

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

Hello Lisa

I haven't had a chance to read all of the comments to your post yet, but my first instinct to your question is to stop patent rememdies and find a dispensary that can dispense a custom formula.  This way you can remove herbs that are not totally suitable for her and strengthen the effect through dosage and correct combination.  I think often when combining   patent remedies the end result is way to many ingredients with ineffective dosages of the important medicines.  Good luck

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 

 Hi Lisa,

How long has she been on herbs?

Personally I would listen to her subjective feelings of cold and pain more than I would the tongue and pulse. If she was feeling better on the herbal route you gave her then keep going. If she "overheats" from your treatment then she will tell you so, meaning she will have other symptoms to share like- flushing, sweating, increased thirst, red face, burning urine, etc. As long as she is free of the these other complaints I would keep her on the formula that was working. 

The tongue and pulse can be interpreted in so many ways and often times we have to learn when to NOT listen to them, and trust the patients experience more than anything else. Perhaps she needs to have a stronger pulse and a redder tongue for a while to get things fired up! You may find that these external signs, that you are interpreting, will stabilize over time.

On the flip side sometimes we need to induce what seem like cold signs to patients with lots of excessive heat , as in psoriasis cases. Using large doses of Sheng DI Huang or Shi Gao to actually loosen the bowels does not neccessarily create Spleen Qi Xu, as it is a needed method to purge out the excess. 

We have to be careful how we read our patients and how we theorize their healing. The bottom line is whether or not they are improving, if so then I say keep going!

Dr Trevor Erikson, Dr TCM, FABORM

www.skin.health-info.org

www.acubalance.ca

Hello again,

After summarising the huge amount of information provided, (thank you all), the channel warming method seems to be the most appropriate, according  to her symptoms.                                                                            Cold is the predominating factor, so I will give this a go and keep you posted on the results. 

If this method does't work then you have all given me a host of other methods to try.

Thanks again for your help, much appreciated.

Lisa.

Hello Atisha,

I have just read your comment, can you tell me how long it would be acceptible for the tongue and pulse signs to show heat in this way? The tongue is less worrying, (Although at one point red peeled areas began to appear) but the wiry forceful, rapid pulse concerned me, much to the dissapointment of my then smiling and toasty warm patient.

If I am to expect the pulse to noramlise what sort of time scale rhougly shoud this take, how forcefull, rapid and wiry shoud I allow the pulse to become? As potentially this could cause a stroke I have erred on the side of caution.

have you taken a patient through this sort of extreme change in symptoms to see them normalise?

Lisa.

 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

Thank you Atisha,

That takes a lot of my worry away, I will check BP to keep an eye on this, I feel stupid for not thinking of it,  the answer is simple when someone else points it out!

I agree about the prescription formula, but this is difficult to practice as a small business. Powder prescritions tend to be at least one month supply, which leaves little room for adustment to adverse symptoms.

As there has already been good improvment with some of the previously used formula, and you have allayed my worry about the side effects. I am sure my patient will be happy to continue with this method and feel warm again.

Many Thanks, Lisa.

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.

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.

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.

Hello Lisa,

Some remedies for this case I would highly suggest to you is for the patient to take Black Seed (Nigella Sativa) which is grinded in a coffee grinder, on a daily regular basis as this will detoxify and bring warmth to the body and to as well drink Black Seed Oil with a gulp of Honey as they are both cures, but the black seed oil is very strong in taste yet it does the job. It will help her back problems and central nervous problems.  The Black seed grinded could also be sprinkled in her rice and  foods that she eats daily.  This will also help her immune system and many more things as well to digest her food properly.  Its great for her kidneys and many more things if you do a thorough research on it, you will want to recommend this for some of your other cases, as this seed is known to be a cure all seed and beneficial for many ailments. My two cents.

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. 

What, exactly, is your diagnosis? Please  note and I will comment further

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

Hello Everyone,

Saw the lady in question this week and she is not doing too badly. She had a break from the current formula (China Med Menopause 1) for one week, due to a cold, and noticed after 1 day that her back felt weaker, which confirmed for her that this formula is helping at least in this regard.

her main body temperature is good, but hands, feet and nose are cold, her tongue is a good pink colour, still some toothmarks, and her pulse is stronger.

I thought if I add a low dose of Gui zhi tang to this, it may clear the remaining cold from her limbs and the blockage from the channels, I can adjust  the dose more easily this way, according to signs. 

So many of you have suggested Gui Zhi tang alone, but her back pain has responded well to formula wtih du zhong, xu duan and sang ji sheng, if I take this away I am not sure gui zhi tang alone will be enough. Retained cold pathogen will eventually weaken the healthy Qi, this lady has been cold for decades!

I havent suggested a thyroid test, I will mention it to her.

Normion - Don't worry,  the lady in question was a nurse for many years so I think she is more aware than I am of  any possible medical issues.

Eesa - Will let her know this tip about the black seeds, thanks.

Nattydred - thanks for a clear simple explanation, I will let you know how it goes.

Laura C. - Sorry  for not stating my diagnosis, I was hoping to get suggestions from practitioners more experienced than myself, so I presumed they would recognise the pattern from the signs and symptoms provided, an occupational assumption!  

Thank you all again for you help, it is very much appreciated.

Regards, Lisa.

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

Hello  Everyone,

Sorry it has taken so long to get back with the results, but it takes time to make changes in the body.

I took the reccomendation of gui zhi tang which I prescribed in combination with China Med MPS 110 to strenghthen the internal deficiencies and smooth liver qi.

This combination worked well, the ladies body temp is good and little to no redness or peeling on her tongue. her pulse varies  with the onset of common cold and now the hayfever season has begun the pulse is weaker and sides of her legs cold.

As I think this is due to a failure of the wei qi to warm the superfices, I had her try Ban Lan Gen but this she cold not stomach, so now she is taking Echinacea which seems to be working, her pulse is stronger and legs are warmer.

So this seems to be a problem of all three levels, my next task is to judge correctly when the wei qi is strong enough to reduce the dosage of GZT, my thinking being that the cold will no longer be able to enter the meridians once the wei qi is strong.

I appreciate all of your suggestions, and the lady in question is greatful also, to have benefitted from your knowledge, warm = happy.

Many Thanks

Lisa.