A six-year or old girl came in with chronic eczema located symmetrically around the elbows, back of the knees, on the legs, and on the upper back. The areas were dry, itchy, had mild erosion and lichenification, only mild erythema in areas, and had scabs and scratch marks. She had a history of persistent runny nose, felt hot, restless sleep, talking in her sleep, allergies (e.g. cats, pollen, possible food intolerances), and would easily get sinus and ear infections since the age of four. Her pulse was fast and slippery and her tongue body was red with red prickles and a slightly thicker coat.

Diagnosis: This was wind predominate chronic childhood atopic eczema due to damp collecting, transforming to heat, with an  underlying Spleen qi deficiency.

Prescription:

fú líng pí (Poriae Cutis) 6
bái xiān pí (Dictamni Cortex) 9
bái zhú (Atractylodis macrocephalae Rhizoma) 9
yì yǐ rén (Coicis Semen) 12
gǔ yá (Setariae (Oryzae) Fructus germinatus) 6
mài yá (Hordei Fructus germinatus) 6
fáng fēng (Saposhnikoviae Radix) 9
chán tuì (Cicadae Periostracum) 6
cì jí lí (Tribuli Fructus) 9
gān cǎo (Glycyrrhizae Radix)  6

1 bag over 7 days.

Visit #2 – Eczema looked slightly better and there was less itching. Her sinus problems had been eliminated. Although she still felt hot her sleep was better, meaning it was less restless and not waking up as much. The tongue coat was also slightly less thick.

The previous formula was given plus sāng yè (Mori Folium) 9 and xī xiān cǎo (Siegesbeckia) 6.

Visit #3 – Itching was reduced. She also caught a very mild cold which left very quickly (much quicker than in the past and did not go into the usual sinus infection). The overall body temperature was less hot, and sleep was good. The previous formula was given again.

Visit #4 – There was less itching, no new breakouts for weeks, upper back was completely clear, sinuses were clear, no problem with cats, temperature had normalized, sleep was good. The tongue body was less red with a thin slightly thicker white coat.

Working towards a more maintenance formula, the previous prescription was given minus fáng fēng (Saposhnikoviae Radix) and xī xiān cǎo (Siegesbeckia) with the addition of bái biǎn dòu (Lablab Semen album) 9 and chì xiǎo dòu (Phaseoli Semen) 9, with the reduction of bái xiān pí (Dictamni Cortex) 6.

Visit #5 – Symptoms remain improved; however the tongue coat was still thick. I added zhì bàn xià (Pinelliae Rhizoma preparatum) and chén pí (Citri reticulatae Pericarpium), used châo bái zhú (dry-fried Atractylodis macrocephalae Rhizoma) and châo yì yî rén (dry-fried Coicis Semen) and removed sāng yè (Mori Folium) and gǔ yá (Setariae (Oryzae) Fructus germinatus).

Commentary: I do not find anything overly strange or exciting about my approach for this case. It is a straightforward approach I often take for skin conditions especially when itching is a predominant sign. That is, at the beginning I focus on reducing the symptoms and fundamental pathodynamic, then as the symptoms reduce, I slowly modify the formula to address more of the root problem. As long as the symptoms stay at bay, I will, for example, remove all stop itching type herbs such as chán tuì (Cicadae Periostracum), fáng fēng (Saposhnikoviae Radix), cì jí lí (Tribuli Fructus), bái xiān pí (Dictamni Cortex) etc. and focus more on the internal cause, e.g. strengthening the Spleen and eliminating dampness and any heat that remains.

However, the one thing interesting about this case is that the skin presentation (dry, itchy, no vesicles, pustules, or oozing) which might suggest a blood deficiency type, was treated through a damp and heat pattern. This choice was made due to a proper differentiation of pattern identification, and not fixating on one single element. This formula is based on one of Zhao Bing-Nan’s core eczema formulas; fú líng pí (Poriae Cutis), bái xiān pí (Dictamni Cortex), bái zhú (Atractylodis macrocephalae Rhizoma), and yì yǐ rén (Coicis Semen).

Location: Boulder, Colorado: Case of childhood eczema treated with Chinese medicine

The patient presented with a chief complaint of chronic migraines, which were preceded by a sensation of heat rising to the head. She also felt warm overall, had red eyes that could easily become swollen with yellow discharge, painful and bleeding gums, difficulty falling asleep and would wake up with her mind racing, a long history of menstrual cramps and pain with clots, alternating bowels (constipation and loose) that had a tendency towards a strong smell that were occasionally sticky. Her abdomen was sore to the touch, her pulse was deep, wiry, and jumpy, and her tongue had a yellow coat.

She had tried many formulas in the past including tian ma gou teng yin as well as bitter, cold, descending and purging methods with no success. This is a pattern of fire due to Liver constraint. The treatment method was to follow the Inner Classic’s “when there is fire from constraint discharge it (火郁发之)”

mǔ dān pí (Moutan Cortex)        9
gōu téng (Uncariae Ramulus cum Uncis)               12
sāng yè (Mori Folium)                    6
lu dòu yī (Glycinis Testa)                               6
bò hé (Menthae haplocalycis Herba)       6
màn jīng zǐ (Viticis Fructus)          12
jú huā (Chrysanthemi Flos)         9
zhī zǐ (Gardeniae Fructus)             9
gǎo běn (Ligustici Rhizoma)         6
cì jí lí (Tribuli Fructus)     9

1 bag=2days.

Location: Boulder, Colorado

Commentary: This formula eliminated all migraines, which was the first time this had occurred. Also her sleep and many other heat related symptoms improved. After stopping the herbs a sense of a migraine would occasionally arise that could be headed off quickly after taking the herbs.

Although I like this formula for the headaches and addressing the basic pathodynamic, I do think there is a deeper level to treat to attempt to “cure” the problem. The patient has expressed interest in pursuing a deeper treatment, and if anything interesting arises I will post the progress.

A 35 year-old female on Wednesday, March 31, 2010 presented with a chief complaint of cough and a hot tongue.

The previous day she had a runny nose and felt like she was getting a cold. She also reported that both of her kids had strep throat, which in the past she would get a couple times a year.

Currently she had a dull and achy sore throat. Her cough was mildly productive with congealed thick discolored phlegm. She felt like she was breathing fire, felt hot, irritable, had a dry mouth, no sweat, no chills, and had some eyelid twitching. Her bowels were not moving and when they did they were black and hard. She had a sensation of abdominal bloating and had no appetite.

Upon further inquiry she reported having some dental work on 3/24/10 where she was given a course of Clindamycin 300mg TID, Flagyl 500mg q 6 hours taken with Phenergan, and Diflucan due to some infectious complications. She noticed a red dry rash appear on the dorsal part of her hands after taking these meds.

Tongue: very red body with no coat

Pulse: Slippery and rapid

Diagnosis: Heat in the qi and nutritive level, clumping of the stools.

Treatment principles: Open the bowels, facilitate resolution of heat via the urine, vent the pathogen from the nutritive aspect, and enrich the fluids.

Prescription:

dà huáng (Rhei Radix et Rhizoma) (add) 9g  
máng xiäo (Natrii Sulfas) (add)  6g    
chì sháo (Paeoniae Radix rubra) 6g                             
mǔ dān pí (Moutan Cortex) 6g    
shuǐ niú jiǎo (water buffalo horn) 15g                          
shēng dì huáng (Rehmannia root, Chinese foxglove root) 15g    
dàn zhú yè (Lophateri Herba) 6g   
lián qiào (Forsythiae Fructus) 15g    
dēng xīn cǎo (Junci Medulla) 1g    
huáng lián (Coptidis Rhizoma) 2g

Cooking Instructions: 1 bag=2 days. Cook time =45 minutes. Taken between  meals 2-3 times a day.

Outcome: After taking two bags of herbs all of her symptoms were resolved except for a slightly warm feeling on the tongue and slight thirst. We then switched to a constitutional formula. Note: she stopped all pharmaceuticals after initial consultation.

Commentary: Although many consider antibiotics and other similar pharmaceuticals as cold one must always observe what is happening in the body and treat what they see. In this situation the multiple pharmaceuticals seemed to have pushed the heat pathogen deep into the qi and nutritive level. One clue was the rash on the hands, even though this was “caused by the pharmaceuticals.” An aggressive approach was needed to evict the pathogen and prevent damage to the yin and possibly entering the pericardium. Of note, there were no herbs in the formula to directly treat the chief complaint of the cough. Although this seemed to be the most pressing sign to the patient, there was clearly a bigger fish to fry.

Questions or comments?

Location: Boulder, Colorado

Intro: This is a somewhat informal presentation of a recent case that I found quite educational for myself. It is definitely not the cleanest case (easy success) but that is why I like it. I am still working out the best way to present these cases and if anyone has any suggestions please let me know. I also welcome others to submit their cases for us to learn from. I hope you enjoy it and welcome any feedback or criticisms.

Case: 55 year old male presented with testicular and perineal pain, sensation of “peeing glass”, strong sensation heat in the lower burner, unable to sit due to the pain, and frequent urination in both night and day. This had persisted for many months and had been labeled “chronic prostatitis.” He also presented with a painful left big toe, dry mouth, and very strong emotions (anger, anxiety, fear etc.). The pulse was cloudy (模糊,mó hú mài) and wiry, and his tongue was dark red/purple with a thick coat. The diagnosis was damp-heat stasis in the lower with the treatment principle of transform damp, clear heat, promote urination, and promote the movement of blood.

Long dan cao     6
Che qian zi           9
Huang qin            9        
Zhi zi                      9
Sheng di                9         
Ze xie                     9
Dang gui               6        
Mu tong                6
Chai hu                 6         
Gan cao                6
Huang bai            6
Ku ding cha         2

Instructions: 1 bag=2 days. Cook time =45 minutes. Take 2-3 times a day.

Visit #2: Heat was 40-50% better. Pain had improved. Started a course of Cipro for 1 month. Tongue was red.

Visit #3: In the previous three days the pain was severe. Dx: damp heat + toxin pouring into the lower burner.

Visit #4: Feels very hot, insomnia, urine is yellow, very angry, dry mouth, thirst, and feels energy shooting up. Uncomfortable sensation over his liver. Red tongue, wiry pulse. Diagnosis: Liver Fire.

Visit 5-6: more of the same.

Commentary: Throughout all of these visits a modified Gentian Decoction to Drain the Liver (lóng dân xiè gän täng) was used with various additions to emphasize more blood invigorating (e.g. Vaccariae Semen (wáng bù liú xíng), Manitis Squama (chuän shän jiâ)), pain relieving (e.g. Corydalis Rhizoma (yán hú suô)), toxin clearing (e.g. Patriniae Herba (bài jiàng câo),Taraxaci Herba (pú göng yïng)) , cooling the blood (e.g. Paeoniae Radix rubra (chì sháo)), protecting the yin (e.g. Dendrobii Herba (shí hú)), and descending the yang and calming the spirit (e.g. Fossilia Ossis Mastodi (lóng gû), Poriae Sclerotium pararadicis (fú shén)). But the overall presentation had hardly budged. Pain and heat was certainly still an issue as well as the severe emotions (anger, fear, sadness etc.). Other modalities were also used at this time by other practitioners.

Visit 7: Due to unclear results, I decided to switch to a more modern prostatitis formula:

Huang qi                     10
Yan hu suo                  6
Di long                        4.5      
Zhi gan cao                 6
Hu zhang                     9         
Bai hua she she cao     9
Huang bai                    9         
Sheng di huang           12
He huan pi                   9         
Wang bu liu xing         9
Nu zhen zi                   12       
Ze xie                          6

Visit 8-9: “prostate” seems better. He has noticed that stress makes it worse. Anxiety is less. Pain is 5/10 (was 8/10). Feels like the muscles are very tight/pulled muscle around the perineum. Added 20 grams of Paeoniae Radix alba (bái sháo).

Visit 10: Urethral pain is still severe, pelvic pain is getting better. Lots of emotion. Pulse is very tight and wiry. Fatigue (mentioned that had been going on for awhile).

Chao Chuan lian zi      6
Mai dong                     9
Bai zi ren                     9         
Tao ren                        9
Dang gui                     6         
Huang bai                    9
Yan hu suo                  9         
He huan pi                   9

Commentary: Over the last 10 visits the pain had gone up and down many times. However even though the pain had decreased it was still significantly present. The heat was also very obvious. Due to the unclear results from the above more straightforward approaches. I decided to consider the underlying mechanism for the fire/heat. Taking inspiration from Ye Tian-Shi, I prescribed the above formula (see his constraint case). Notice the more softening approach.

Visit 11: significant improvement, pain and pelvic floor tension was much less. 3 bags of previous. Of Note: Almost all of the previous formulas contained Corydalis Rhizoma (yán hú suô).

Visit 12: + Paeoniae Radix alba (bái sháo) 25.

Visit 13: It was unclear if Paeoniae Radix alba (bái sháo) made any difference) – feeling much better.

Visit 14: Common cold / flu (gan mao), stopped herbs, pain became worse. Thought there might be a lurking pathogen and switch strategies to a yin deficient venting idea. (I was wrong)

Visit 15: Pain became much worse, went back to previous formula (visit 12-13) and pain continued to decrease once again. This confirmed that addressing the underlying mechanism, causing the fire was actually effective. Over the next few weeks the pain completely resolved.

Visit 16: Although no pain remained, there was anxiety, fear, pressure in the chest, and palpitations. This had been going on for many years since the death of his wife. He (and I) thought that this was the underlying cause of all his problems including the fire/prostatitis. This was qi and blood stagnation in the collaterals. The treatment principle was to dredge the liver and open the collaterals. I decided to use a modified Inula Decoction (xuán fù huä tang) from the Essentials from the Golden Cabinet.

Xuan fu hua                9
Hong hua                    6
Tao ren                        9         
Dang gui wei               6
Ze lan                          3         
Lu lu tong                   3
Wang bu liu xing         6         
Mei gui hua                 3

Note: Carthami Flos (hóng huä) sub for New crimson (xïn jiàng).

Emotional symptoms, energy, sensation in the chest all dramatically improved over the next couple weeks.

Location: Boulder, Colorado