Lower limb pain (painful obstruction)

Yīn and blood insufficiency mistakenly diagnosed as cold-damp painful obstruction pattern.

Liao was a 62 year old man who was hospitalized because of left buttock and left lower limb pain that had been going on for 3 months. He presented with left buttock and left posterior thigh muscular pain, fatigued spirit and lack of strength, poor food intake, bland / lack of taste in the mouth that was slightly dry, dry stools, facial color was dark and stagnant.

Tongue: pale purple body and a thin yellow coat
Pulse: wiry

He was given a formula to scatter cold, dry damp, boost qi and quicken the blood. After taking 30 bags of herbs, the pain did not decrease. On the contrary there was an increase in distending pain as well as numbness and tingling in both lower legs, occasional hypertonicity of the foot, dry mouth, yellow urine, dry bowel movements. His tongue became pale purple, and he had a thin yellow coat and wiry pulse.

The formula was changed to enriching yīn, nourishing blood, and quickening the blood. After 15 packets both lower leg muscle symptoms of distending pain, numbness and tingling etc. were gone.

Source: [缪以星•临证随笔2 则•湖南中医学院学报，1986,(1):33]

Translated by: Jason Blalack

Commentary:

Although this case seems a bit obvious in retrospect, it is far from an uncommon occurrence among inexperienced herbalists. This case does not have clear cold signs, yet the doctor stubbornly latched on the words of Elementary Questions (sù wèn, painful obstruction chapter), which says,

when the three qi of wind, cold, and damp combine (attacking at the same time), this becomes painful obstruction disease”

Consequently there was an incorrect diagnosis of cold-damp painful obstruction pattern, and scatter cold and dry damp formula was given . Although the patient was venerable, his was blood deficient and his fluids were depleted, which prevented him from lubricating his intestines below, and enriching his mouth above. Therefore his stools were dry and his mouth was slightly dry. His limb’s sinews (and vessels) lost moisture, resulting in pain, numbness, and tingling. Because of the fluid and blood body depletion and the ongoing use of spicy, warm, fragrant, and dry medicinals, which further damaged the fluid and consumed the blood, the disease was aggravated. It was like adding fuel to the fire.