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sideeffects on treatment. - wrong herbal prescription??
hello all.
I need a 2nd opinon on this one. i am wondering why my patient have sideeffects from prescription. i am pretty sure about my diagnose on him: tongue is without coating. deep cracks from root (Kidney) + cracks in lung area.also it indicates heart qi defiency. tooth marks and Liver swollen sides. + it seems swollen and a bit wet. and towards violet veins underneeth.
so it seems here is a lot of problems. he complains from; a bit of atopic ecsema. astma + hayfever. back problems. at winter time he gets a bit depressive.
i have chosen zuo gui wan and added a lot different herbs. I have chosen this, because i think that the kidneys are the worst case here. then i have added herbs for; Liver QI/Xue-stasis + to cool xue. + added for Lung yin-xu. + to tonify Qi. + to harmonise prescription. also i have added for ecsema.
he can not be treatet with acupuncture, as he do not want to.
the problems i am having in this case is; he startet out with having 3gram twice a day. Now he complains that ecsema is worse. his faeses is slimy and he goes to toilet 3-4 times a day. also his back pains got worse. do any of you have an idea why?? sometimes i experience that symptoms get worse, but then dissapears. could that be the matter here?? or what do you think??
sorry for my english - hope you understand :-)
regards Michael
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treat the branches first
Hello Michael.
The side effects show that you need to first clear the excess factors. Using rich yin and qi tonics has likely aggravated a pre-existing dampness or damp heat, which is the most common pathogenic factor with eczema.
You have to carefully re-assess the presence of damp-heat, and maybe Blood Heat, Qi stasis etc, and treat those exclusively before you attempt any tonification, otherwise this is exactly what happens.
Eczema that appears dry can still harbor considerable dampness. The side effects are clearly showing you that tonification is very premature.
But it should all quickly turn around on a modified prescription.
Regards,
Adina.
should focus on the main complain
From above the informations, I think you should focus on the main complain. Sometimes one formula has too many herbs together, it could not target the problem. Maybe you should reduce some herbs, and just focus on KD and LU (Qi and Yin deficiency), then add 2-3 herbs for moving Qi and Blood.
Just my thinking, hope it gives you a little help.
Malou Wang
First digest the herbs
Hi Michael
These are difficult patients because their conditions are so chronic they need lots of patience and faith in treatment, and your patient is starting out with a compromised digestion that needs addressing before he will tolerate the sort of herbs you are using.
A swollen, scalloped, wet tongue indicates dampness (swollen sides probably Spleen or maybe Gallbladder dampness). Any yin tonics or blood cooling herbs will add to this.
My suggestion would be to start with the damp digestion, keep your fornula small and simple, and be very careful about adding any tonics or heat clearing herbs, if those still seem necessary as you progress.
Michael
Agree with Adina.... don't forget about Diet
Instead of repeating everything Adina said, I agree with her.
It is easy to focus and try to treat every sign/symptom, but you must focus on the underlying condition. I am not sure if acupuncture would help nearly as much as herbal medicine, however it would be nice to add as well.
Don't forget to discuss Diet and Stress, both can and will make the condition worse. Incorporate a diet plan based on his symptoms as well.
Good luck!
simplicity
Of course patients would like their symptoms cleared up immediately and without any consequences, but the other respondents are likely correct in recommending treating one condition at a time. Understanding that the skin is probably reacting to letting go of something, it's not really surprising to see an increase in some symptoms while releasing other issues.
A stubborn patient can also resist treatments and have unreasonable expectations precisely due to the things you want to treat them for. It can be hard to explain this circle or get around it.
I never start a patient with more than 2 herbs because we don't know how they will react to complex formulas. And I'm cautious with chronic symptoms to start very slowly so I don't see a backlash reaction, especially if they're not accustomed to taking herbs regularly. Remember, you can permanently injure or kill patients with the wrong herbal formula, but the wrong acupuncture treatment at worst will just make them feel bad for a couple days.
And if the patients don't like needles, use your fingers to stimulate the points. That's why shiatsu exists. Or do some Tong Ren and treat the patient via a proxy doll or drawing.
side effects from herbs
Again, you have not given a very exact diagnosis. You don't give us enough information to evaluate the diagnosis, and you have not listed the exact herbs you gave, so we cannot make a very good evaluation or response for you.
I don't consider these side effects, but effects of wrong treatment because of unclear and imprecise diagnosis.
Unfocused
I agree with all the comments above about your approach not being focused enough. IMHO it is better and much simpler to focus on one or two main complaints at once. Then you can evaluate change. As it stands right now, what are you hoping to achieve? What are you goals?
As for the cracks in the tongue, please remember that people who suffer with asthma and have used inhalers for an extended period of time, can show damage to their tongue.
Trevor
Side effects...
Hi Michael
Seems to me that the underlying problem lies with Pi Qi Xu, ( deficient spleen qi) or possibly spleen yang deficiency, ( I don't know whether he has symptoms of cold or not). This is based on the fact that the tongue is swollen, wet, tooth marked, (and, I would guess, pale), the diarrhoea / loose frequent and slimy stools. Clearly as a result, the stomach function is also impaired, thus you will have a peeled tongue. spleen qi deficiency would lead to an accumulation of damp and because it belongs to the centre, and thus the root of our postnatal constitution, the patient becomes generally qi deficient. this leads to deficiency of the lung with concomitant dispnoeia ( the lungs control the qi) as well as blood deficiency. ( transformation and transportation of the spleen being impaired. the deficient blood affects the liver and the heart. the accumulation of damp affects the circulation and causes stagnation, in addition to the fact that general qi deficiency means that the heart's ability to govern the blood is impaired. of course, the accumulation of damp will over a period transform into damp heat, which will manifest with the eczema and slimy fouls smelling stools. The backache could likely also be as a result of the inflammation in the gut, although, more classically, due to cold or damp in the kidneys and in the lower jiao.
The patient's ability to absorb and digest is impaired, so complex formulae are not going to be of benefit. I would suggest that if the patient is averse to acupuncture, that you use moxibustion, especially "shenque" with salt, Qihai, zu sanli, yinlinquan. and taibai.
The therapeutic principle is clearly to clear damp / heat, tonify the spleen /stomach first, then the other syndromes thereafter.
In that respect Michael Ellis is correct. Treat the digestion first.
Trevor