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Cold damp painful obstruction mistakenly diagnosed as damp-heat painful obstruction.

Shi a 28 year old male motor vehicle driver was hospitalised on Sept 13. Two days previous, the patient did some heavy moving from one house to the next in the rain. That night he had very painful sciatica along his right leg. It gradually became worse and he went to the local hospital where he received an injection of a heavy painkiller and diazepam, which took about two hours.(1)

Presentation upon examination: cramping in the right lower leg, that was painful and difficult to bear. There was numbness and tingling on the posterior lateral thigh that occasionally felt like a fire burn, there was vexation and agitation, bitter taste in mouth, constipation, red urination, difficultly sleeping, with tossing and turning in bed that lasted the whole night. The tip of the tongue was red and the coating was thin yellow and slightly slimy. The pulse was slippery, rapid, and had strength. There was a positive sign for the straight leg raise, and huántiào (GB 30) and popliteal fossa were tender with palpation.

An x-ray of the lumbar vertebrae revealed no unusual findings. Therefore, treatment was given for sciatic damp-heat painful obstruction blocking the channels and network vessels. After the patient took 2 bags of herbs, the pain was unchanged. Therefore rǔ xiāng (Olibani, Resina) and mò yào (Myrrha, Resina) were added and again two bags were given, but the pain still did not decrease.

After meticulously sorting out the etiology and pathomechanism, it was realised that the lower limb hypertonicity and pain were actually the disease’s root. This was related to the fact that after the move there was fatigue, he sweated, became wet whilst working in the rain, and then caught a cold. This caused cold-damp obstruction in the vessels and networks. His bitter taste and dryness in the mouth, constipation, red urine, red tip of the tongue with a yellow coat, slippery and fast pulse was because of the severe pain and vexation. Because of the vexation there was insomnia and stirring heart fire, and furthermore this led to a lack of food intake. All of this belonged to the branch, which was pain.

The first diagnosis did not grasp the disease root’s essence and therefore gave a treatment that was ineffective. On the surface it looked like it was correct but it was really a mistake. The correct treatment principle was to scatter the cold and free the network vessels, which assists in order to clear heat. The patient took this type of [medicine] and immediately his pain was greatly reduced. As the pain diminished, his bitter taste, vexation, insomnia, constipation, reddish urine, was also gradually eliminated. With some slight modifications, three more bags of herbs were given and the pain was essentially eliminated. Afterwards a formula that boosts the kidney and opens the network vessels was given to continue the healing.(2)

Commentary:

Various kinds of clinical manifestations of disease have differentiations of root and tip. The root is the essence of the disease; the branch is dependent on the root. If the root is not understood and one mistakes the incidental for the fundamental this will certainly bring about misdiagnosis and mistreatment.

In this case the doctor grasped the patients main pathological condition of cold-damp painful obstruction blocking the channels and network vessels leading to lower limb hypertonicity pain, which was due to the patient catching a cold after being fatigued, sweating, and being out in the rain. At the same time there were the secondary symptoms of, bitter taste, vexation, constipation, reddish urine, red tip of tongue and yellow coating, slippery and rapid pulse that were all caused from the severe pain and vexation. The vexation caused insomnia and stirring of heart fire which further led to low food intake. Scattering cold and open the network vessels was the first priority in order to secondarily clear the heat. This is all that was needed to avoid clinical error. On the contrary, merely basing treatment on clinical manifestations and not meticulously inquiring into the pathomechanisms and cause of disease, and by treating the damp-heat painful obstruction, there was of course, no resolution.

(1) This most likely is interpreted to mean that the whole hospital stay lasted about two hours.

(2) [[侯恒太•临证求真琐谈•江西中医药1988,(2):54]

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  • Leeanna Roswell
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