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Looking for advice on Tx of chronic eczema

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  • Melanie Miller
    Hi Everyone, I have a tricky dermatological case that I d like to run by the group... Heads up- it s a bit of a long read, but any thoughts or advice you might
    Message 1 of 5 , Oct 2, 2010
      Hi Everyone,
       
      I have a tricky dermatological case that I'd like to run by the group... Heads up- it's a bit of a long read, but any thoughts or advice you might have would be VERY much appreciated! 
       
      I have been working with a patient for one month with a very chronic, very stubborn, head-scratcher of a case of what her Naturopath and Dermatologists are calling Atopic/Contact Dermatitis, AKA: Chronic Eczema
       
      Patient: C.L., 49yo, female, Professional athlete, fitness instructor, nutritional counselor, exercises 3+ times/wk, very thin/lean body type (5'6, 115lbs), good diet with some non-gluten grains, lean proteins, veggies/greens. Non-smoker, no caffeine, little alcohol, hx of minimal cocaine use 20+ years ago
       
      First visit date: 8-31-10
       
      Pt complaints:
      History of eczema since childhood. As a child, mild-moderate in severity, covering small areas such as elbows and popliteal creases, outbreaks came and went, each lasting for relatively brief periods of time.
      Current outbreak, however, began over a year ago shortly after moving from California (cool, temperate climate) to Phoenix, AZ (friggin' HOT). Eczema lesions appear over her whole body- most severely at fingertips, hands, feet. The current outbreak is severe to debilitating at times. The lesions begin with swelling of tissues and fluid-filled vesicles underneath the skin which eventually rupture and ooze. After breaking open, the skin become very dry, cracked, red, burning, inflamed, painful and extremely itchy.
       
      Outbreaks seem to be worsened/induced by heat and stressful situations.
       
      Emotions: Frustration, irritability due to pain and lack of resolution with skin condition...Pt is otherwise happy in her life, meditates regularly, has a good family life/relationship, enjoys her career, etc.
       
      Other clinical findings:
      Hot hands/feet but otherwise tends to be cold; extremely easy to bruise, very slow wound healing in the last 3-4mo (pt suspects d/t prednisone); high BP, avg. 140-90; poor concentration lately; stiffness of joints (esp fingers, toes and esp in am); Menses: Pt has not menstruated last 2 months, menses previously regular, light, avg. 5days, mild cramps before period; Hx of reconstructive surgery left ACL in '04 (still has sharp pain when squatting--> standing); Right lateral epicondylitis (dull-sharp
      Energy level good (7-8/10); Stress level 5/10 (related to frustration from skin condition); Digestion normal; sleep normal, unless awakened by skin itching/pain
       
      Non-TCM therapies utilized by pt:
       
      Naturopath started her on a Silicae, Zinc & GLA daily doses, and started her on a Chorella treatment on 8-20-10 (internal, 4500mg tabs daily with dosages increasing incrementally over time)- slight positive effects initially (less burning, pain) but no noticeable effects on eczema at this point.
       
      MD/ Dermatologist administers Fexofenadine (180mg), Kenalog injections and 15 day courses of Prednisone as needed to quell extreme/intense symptoms that render pt unable to sleep or work. Pt is very aware of the negative effects of steroid therapy and only relies on them as a last resort. Pt has had 5 courses of Prednisone in the last 5 months, the last course 9-10-10 through 9-23-10
       
      Pt has been gluten/dairy free for 6 months- no noticeable positive effects on eczema
       
      Other supplements include a "Wellness Pack" consisting of micronutrient complex, cellular Vitality Complex, Omega Oils, Borage Oil 300mg, Vit C 1000mg, Vit A 10,000iu, Zinc complex 30mg, Vit D emulsified 2,000iu
       
      According to the patient, she has "done every detox and cleanse known to mankind."
       
      Treatments:
       
      1st visit 8-31-10
      (7 treatments to date, twice per week for first 2 weeks, once per week after that)
      Pulse: sl. slippery, thin 1st pos. both wrists
      Tongue: pale, swollen, thin sl. yellow coat, distended sub-lingual veins
      TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
      TX: Sp 9, SJ 5, LI 11, Sp 10, 4 Horses (88.17-.19)
      Herbs: none- pt resistant to taking any more meds/supplements
       
      2nd Visit 9-3-10
      No change in presentation
      TX/herbs/pulse/tongue: Same as above
       
      3rd Visit 9-7-10
      Pt reports experimentally adding wheat back into her diet 3 days ago, which intensified itching within a matter of hours; slight fatigue
      TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation, Spleen Qi Xu
      Herbs/pulse/tongue: Same as above
      TX: BL 13, 17, 20, St 36, Sp6, Sp9, Sp 10, LI 11, Lu 5, LI 4
       
      4th Visit 9-10-10
      Severe flare-up of symptoms! Pt has started another round of Prednisone (15 days). Interestingly, pt reports that although the severity of itching, pain and burning has increased, there are no new vesicles forming under the skin, which is unusual...
      TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
      Pulse: slippery, full
      Tongue: swollen, pale, t/w coat
      TX: Sp9, Sp 10, LI 11, SJ 5, Wood Anger, 4 Horses
      Herbs: KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
       
      6th Visit 9-23-10
      Last day of Prednisone treatment...Less redness, inflammation, still very itchy in some places but less overall. No more burning sensation. Pt notices she is bruising VERY easily. Pt began spotting this week (previously, no menses for 2 months). High stress. Naturopath gave her Oregano oil to support Adrenals and gut function.
      TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
      Pulse: slippery, thin 1st & 3rds
      Tongue: swollen, pale, t/w coat, distended sub-lingual veins
      TX: Sp9, Sp 10, Sp 6, Sp 3, St 36, Wood Anger, Bl 13, 17, 20, 23
      Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
       
      7th visit 9-30-10 (Today)
      Ended Prednisone on the 24th- itching had subsided, but she's now starting to itch again. Some vesicles beginning to form at fingertips, heels of hands, thenar eminences. No burning or pain at this time. Still bruising VERY easily with slow wound healing. Poor concentration lately, joint stiffness. Menstrual cramping last night and this morning with onset of menses today (light flow, bright red blood)
      Pulse: Slippery/wiry
      Tongue: pale, swollen, t/w coat (brushed tongue this am), distended sub-lingual veins
      TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
      TX: Sp9, Sp 10, Sp 6, St 36, SJ 5, 4 Horses
      Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
       
      Siiiiigh, that's a lot of details! It's difficult for me to perceived exactly what's going on with her body since she's been on the Prednisone at the same time as the herbs/acu txs.

      A note on herbs- I've found it rather tricky to get my Scottsdale pts to take anything other than patent herbs (its a "go go go" town and they love their convenience!)  I typically stick to patents, but this particular patient may be willing to try a custom powder formula...
       
      ***I found the following formula in Will Morris' TCM Dermatology notes:
       
      Chronic Eczema (nourish blood, dispel wind, clear heat, transform damp)
      Dang Gui 9
      Bai Shao 9
      Sheng di 12
      Hu Ma 12
      Ku Shen 12
      Bie Xie 12
      Fu Ling 12
      Di Fu Zi 18
      Bai Xian Pi 9
       
      Will, would you recommend this formula in this case? grams per day? How quickly have you your patients seen results on this formula and approx how long would you expect a pt to be on it?
       
      This patient is a very wonderful lady and I wish to give her the best possible treatment but alas, I'm not sure if I'm on the right track or not. Any assistance would be greatly appreciated! 
       
      Best wishes and enormous gratitude,
       
      Melanie Miller, L.Ac. and AOMA Alumn 2009
      Turning Point Wellness
      www.turningpointacupuncture.net
      Scottsdale, AZ.


    • William Morris
      Hi Melanie - So, the pulse became full after the steroids. This suggests that medication is masking the blood deficiency. I usually say tret what you see, but
      Message 2 of 5 , Oct 3, 2010
        Hi Melanie -

        So, the pulse became full after the steroids. This suggests that medication is masking the blood deficiency. I usually say tret what you see, but what you see must also take a longitudinal view.

        She also had an aggravation with adding wheat. Bummer. She must now be very diligent and you might go further with elimination-provocation to be certain whether the allergen is gluten as opposed to wheat.

        The biggest issue I see is one of dosage. Consider 4 tabs every 2 hours during an acute stage. Also, there are companies that will encapsulate for you. Qualiherb does it with 3 bottle minimums.

        Read The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials
        N. C. Armstrong & E. Ernst Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT

        Also, Atopic Eczema “Wind of the four crooks” By Mazin Al-Khafaji JOURNAL OF CHINESE MEDICINE • NUMBER 77 • FEBRUARY 2005. Here is one of the formulas from the article:

        Sheng di huang 24
        Mu dan pi 24
        Chi shao 9
        Long dan cao 9
        Huang qin 9
        Zhi zi 9
        Ma chi xian 15
        Zi hua di ding 15
        Bai xian pi 12
        Xi xian cao 15
        Hai tong pi 12
        Fu ling 12
        Ze xie 12
        Gan cao 6

        I like this formula because it addresses heat in the blood, which I suspect. Confirm that by looking for redder capillaries extending form the distended and reddish-purplish hue sublingual vein. As for pulse, push to the organ depth and left through the blood depth. If it gets wider, more forceful, urgent and or slippery - this suggests heat in the blood.

        BTW - Mazin will be at the Southwest Symposium March 4-6, 2011. https://aoma.edu/southwest-symposium/schedule/
        If you are serious about derm, Mazin will do 2 full days. That will be hot. Arnaud Versluys will also be doing pulses at the symposium.

        Warmly,

        Will




        On Sat, Oct 2, 2010 at 6:01 PM, Melanie Miller <missmelaniemiller@...> wrote:
         

        Hi Everyone,
         
        I have a tricky dermatological case that I'd like to run by the group... Heads up- it's a bit of a long read, but any thoughts or advice you might have would be VERY much appreciated! 
         
        I have been working with a patient for one month with a very chronic, very stubborn, head-scratcher of a case of what her Naturopath and Dermatologists are calling Atopic/Contact Dermatitis, AKA: Chronic Eczema
         
        Patient: C.L., 49yo, female, Professional athlete, fitness instructor, nutritional counselor, exercises 3+ times/wk, very thin/lean body type (5'6, 115lbs), good diet with some non-gluten grains, lean proteins, veggies/greens. Non-smoker, no caffeine, little alcohol, hx of minimal cocaine use 20+ years ago
         
        First visit date: 8-31-10
         
        Pt complaints:
        History of eczema since childhood. As a child, mild-moderate in severity, covering small areas such as elbows and popliteal creases, outbreaks came and went, each lasting for relatively brief periods of time.
        Current outbreak, however, began over a year ago shortly after moving from California (cool, temperate climate) to Phoenix, AZ (friggin' HOT). Eczema lesions appear over her whole body- most severely at fingertips, hands, feet. The current outbreak is severe to debilitating at times. The lesions begin with swelling of tissues and fluid-filled vesicles underneath the skin which eventually rupture and ooze. After breaking open, the skin become very dry, cracked, red, burning, inflamed, painful and extremely itchy.
         
        Outbreaks seem to be worsened/induced by heat and stressful situations.
         
        Emotions: Frustration, irritability due to pain and lack of resolution with skin condition...Pt is otherwise happy in her life, meditates regularly, has a good family life/relationship, enjoys her career, etc.
         
        Other clinical findings:
        Hot hands/feet but otherwise tends to be cold; extremely easy to bruise, very slow wound healing in the last 3-4mo (pt suspects d/t prednisone); high BP, avg. 140-90; poor concentration lately; stiffness of joints (esp fingers, toes and esp in am); Menses: Pt has not menstruated last 2 months, menses previously regular, light, avg. 5days, mild cramps before period; Hx of reconstructive surgery left ACL in '04 (still has sharp pain when squatting--> standing); Right lateral epicondylitis (dull-sharp
        Energy level good (7-8/10); Stress level 5/10 (related to frustration from skin condition); Digestion normal; sleep normal, unless awakened by skin itching/pain
         
        Non-TCM therapies utilized by pt:
         
        Naturopath started her on a Silicae, Zinc & GLA daily doses, and started her on a Chorella treatment on 8-20-10 (internal, 4500mg tabs daily with dosages increasing incrementally over time)- slight positive effects initially (less burning, pain) but no noticeable effects on eczema at this point.
         
        MD/ Dermatologist administers Fexofenadine (180mg), Kenalog injections and 15 day courses of Prednisone as needed to quell extreme/intense symptoms that render pt unable to sleep or work. Pt is very aware of the negative effects of steroid therapy and only relies on them as a last resort. Pt has had 5 courses of Prednisone in the last 5 months, the last course 9-10-10 through 9-23-10
         
        Pt has been gluten/dairy free for 6 months- no noticeable positive effects on eczema
         
        Other supplements include a "Wellness Pack" consisting of micronutrient complex, cellular Vitality Complex, Omega Oils, Borage Oil 300mg, Vit C 1000mg, Vit A 10,000iu, Zinc complex 30mg, Vit D emulsified 2,000iu
         
        According to the patient, she has "done every detox and cleanse known to mankind."
         
        Treatments:
         
        1st visit 8-31-10
        (7 treatments to date, twice per week for first 2 weeks, once per week after that)
        Pulse: sl. slippery, thin 1st pos. both wrists
        Tongue: pale, swollen, thin sl. yellow coat, distended sub-lingual veins
        TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
        TX: Sp 9, SJ 5, LI 11, Sp 10, 4 Horses (88.17-.19)
        Herbs: none- pt resistant to taking any more meds/supplements
         
        2nd Visit 9-3-10
        No change in presentation
        TX/herbs/pulse/tongue: Same as above
         
        3rd Visit 9-7-10
        Pt reports experimentally adding wheat back into her diet 3 days ago, which intensified itching within a matter of hours; slight fatigue
        TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation, Spleen Qi Xu
        Herbs/pulse/tongue: Same as above
        TX: BL 13, 17, 20, St 36, Sp6, Sp9, Sp 10, LI 11, Lu 5, LI 4
         
        4th Visit 9-10-10
        Severe flare-up of symptoms! Pt has started another round of Prednisone (15 days). Interestingly, pt reports that although the severity of itching, pain and burning has increased, there are no new vesicles forming under the skin, which is unusual...
        TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
        Pulse: slippery, full
        Tongue: swollen, pale, t/w coat
        TX: Sp9, Sp 10, LI 11, SJ 5, Wood Anger, 4 Horses
        Herbs: KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
         
        6th Visit 9-23-10
        Last day of Prednisone treatment...Less redness, inflammation, still very itchy in some places but less overall. No more burning sensation. Pt notices she is bruising VERY easily. Pt began spotting this week (previously, no menses for 2 months). High stress. Naturopath gave her Oregano oil to support Adrenals and gut function.
        TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
        Pulse: slippery, thin 1st & 3rds
        Tongue: swollen, pale, t/w coat, distended sub-lingual veins
        TX: Sp9, Sp 10, Sp 6, Sp 3, St 36, Wood Anger, Bl 13, 17, 20, 23
        Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
         
        7th visit 9-30-10 (Today)
        Ended Prednisone on the 24th- itching had subsided, but she's now starting to itch again. Some vesicles beginning to form at fingertips, heels of hands, thenar eminences. No burning or pain at this time. Still bruising VERY easily with slow wound healing. Poor concentration lately, joint stiffness. Menstrual cramping last night and this morning with onset of menses today (light flow, bright red blood)
        Pulse: Slippery/wiry
        Tongue: pale, swollen, t/w coat (brushed tongue this am), distended sub-lingual veins
        TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
        TX: Sp9, Sp 10, Sp 6, St 36, SJ 5, 4 Horses
        Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
         
        Siiiiigh, that's a lot of details! It's difficult for me to perceived exactly what's going on with her body since she's been on the Prednisone at the same time as the herbs/acu txs.

        A note on herbs- I've found it rather tricky to get my Scottsdale pts to take anything other than patent herbs (its a "go go go" town and they love their convenience!)  I typically stick to patents, but this particular patient may be willing to try a custom powder formula...
         
        ***I found the following formula in Will Morris' TCM Dermatology notes:
         
        Chronic Eczema (nourish blood, dispel wind, clear heat, transform damp)
        Dang Gui 9
        Bai Shao 9
        Sheng di 12
        Hu Ma 12
        Ku Shen 12
        Bie Xie 12
        Fu Ling 12
        Di Fu Zi 18
        Bai Xian Pi 9
         
        Will, would you recommend this formula in this case? grams per day? How quickly have you your patients seen results on this formula and approx how long would you expect a pt to be on it?
         
        This patient is a very wonderful lady and I wish to give her the best possible treatment but alas, I'm not sure if I'm on the right track or not. Any assistance would be greatly appreciated! 
         
        Best wishes and enormous gratitude,
         
        Melanie Miller, L.Ac. and AOMA Alumn 2009
        Turning Point Wellness
        www.turningpointacupuncture.net
        Scottsdale, AZ.





        --
        William R. Morris, PhD, DAOM, LAc
        http://pulsediagnosis.com/
        http://www.aoma.edu/
        http://taaom.org/

        This message, including attachments, contains confidential information and is intended only for the individual(s) named. Any use by others is strictly prohibited. Do not disseminate, distribute or copy this email. Please notify the sender immediately by email if you have received this email by mistake, and delete this email from your system.
      • pemachophel2001
        Melanie, Will said pulse is often full. I am assuming he means shi (实) or replete. I d recommend being careful with this response. The hong (洪)
        Message 3 of 5 , Oct 4, 2010
          Melanie,

          Will said pulse is often "full." I am assuming he means shi (实) or replete. I'd recommend being careful with this response. The hong (洪) or surging pulse is easily mistaken for a replete pulse but is actually an image of vacuity (xu 虚) possibly mixed with repletion. The standard definition of a surging pulse is that it is floating (fu 浮), large (sa 大), and forceful (you li 有力). Hence its size and strength may often be mistaken for a replete pulse if one is not absolutely clear about what floating means in this context.

          I'm off to Nepal to practice medicine in a free clinic there for the next month. So I won't be able to follow up on this thread.

          Good luck and best wishes.

          Bob
        • William Morris
          This is a good point, Bob. Yes, I do mean full-excess-replete shi. That is present an forceful at all depths and positions. Agreed 100% on your admonitions re
          Message 4 of 5 , Oct 4, 2010
            This is a good point, Bob. Yes, I do mean full-excess-replete shi. That is present an forceful at all depths and positions. Agreed 100% on your admonitions re flooding pulse.

            Have a great trip. That sounds rewarding.

            Warmly,

            Will



            On Mon, Oct 4, 2010 at 9:51 AM, pemachophel2001 <bob@...> wrote:
             

            Melanie,

            Will said pulse is often "full." I am assuming he means shi (&#23454;) or replete. I'd recommend being careful with this response. The hong (&#27946;) or surging pulse is easily mistaken for a replete pulse but is actually an image of vacuity (xu &#34394;) possibly mixed with repletion. The standard definition of a surging pulse is that it is floating (fu &#28014;&#65289;, large (sa &#22823;), and forceful (you li &#26377;&#21147;). Hence its size and strength may often be mistaken for a replete pulse if one is not absolutely clear about what floating means in this context.

            I'm off to Nepal to practice medicine in a free clinic there for the next month. So I won't be able to follow up on this thread.

            Good luck and best wishes.

            Bob




            --
            William R. Morris, PhD, DAOM, LAc
            http://pulsediagnosis.com/
            http://www.aoma.edu/
            http://taaom.org/

            This message, including attachments, contains confidential information and is intended only for the individual(s) named. Any use by others is strictly prohibited. Do not disseminate, distribute or copy this email. Please notify the sender immediately by email if you have received this email by mistake, and delete this email from your system.
          • Melanie
            Will, thank you so much- this was very helpful. I read the articles you recommended. Wind of the four crooks By Mazin Al-Khafaji was especially helpful in
            Message 5 of 5 , Oct 5, 2010
              Will, thank you so much- this was very helpful. I read the articles you recommended. "Wind of the four crooks" By Mazin Al-Khafaji was especially helpful in explaining the theoretical use of each of the formulas and was also very motivational for me whereas I was becoming rather frustrated with this case. I feel rejuvenated and reinspired, thank you!

              A question regarding the first formula:

              Sheng di huang 24
              > Mu dan pi 24
              > Chi shao 9
              > Long dan cao 9
              > Huang qin 9
              > Zhi zi 9
              > Ma chi xian 15
              > Zi hua di ding 15
              > Bai xian pi 12
              > Xi xian cao 15
              > Hai tong pi 12
              > Fu ling 12
              > Ze xie 12
              > Gan cao 6
              >

              As I've been working soley with patents so far, I'm having to dig way back into the archives of my brain to retrieve daily dosage info for custom formuals! As powders, what would you recommend as the daily dose? 9g daily- 3g TID? Keeping in mind that she's a veeeeeery tiny lady (115lbs)...

              Thank you!
              Melanie Miller

              --- In PulseDiagnosis@yahoogroups.com, William Morris <wmorris33@...> wrote:
              >
              > Hi Melanie -
              >
              > So, the pulse became full after the steroids. This suggests that medication
              > is masking the blood deficiency. I usually say tret what you see, but what
              > you see must also take a longitudinal view.
              >
              > She also had an aggravation with adding wheat. Bummer. She must now be very
              > diligent and you might go further with elimination-provocation to be certain
              > whether the allergen is gluten as opposed to wheat.
              >
              > The biggest issue I see is one of dosage. Consider 4 tabs every 2 hours
              > during an acute stage. Also, there are companies that will encapsulate for
              > you. Qualiherb does it with 3 bottle minimums.
              >
              > Read *The treatment of eczema with Chinese herbs: a systematic review of
              > randomized clinical trials*
              > N. C. Armstrong & E. Ernst Department of Complementary Medicine, School of
              > Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria
              > Park Road, Exeter EX2 4NT
              >
              > Also, Atopic Eczema "Wind of the four crooks" By Mazin Al-Khafaji JOURNAL OF
              > CHINESE MEDICINE • NUMBER 77 • FEBRUARY 2005. Here is one of the formulas
              > from the article:
              >
              > Sheng di huang 24
              > Mu dan pi 24
              > Chi shao 9
              > Long dan cao 9
              > Huang qin 9
              > Zhi zi 9
              > Ma chi xian 15
              > Zi hua di ding 15
              > Bai xian pi 12
              > Xi xian cao 15
              > Hai tong pi 12
              > Fu ling 12
              > Ze xie 12
              > Gan cao 6
              >
              > I like this formula because it addresses heat in the blood, which I suspect.
              > Confirm that by looking for redder capillaries extending form the distended
              > and reddish-purplish hue sublingual vein. As for pulse, push to the organ
              > depth and left through the blood depth. If it gets wider, more forceful,
              > urgent and or slippery - this suggests heat in the blood.
              >
              > BTW - Mazin will be at the Southwest Symposium March 4-6, 2011.
              > https://aoma.edu/southwest-symposium/schedule/
              > If you are serious about derm, Mazin will do 2 full days. That will be hot.
              > Arnaud Versluys will also be doing pulses at the symposium.
              >
              > Warmly,
              >
              > Will
              >
              >
              >
              >
              > On Sat, Oct 2, 2010 at 6:01 PM, Melanie Miller
              > <missmelaniemiller@...>wrote:
              >
              > >
              > >
              > > Hi Everyone,
              > >
              > > I have a tricky dermatological case that I'd like to run by the group...
              > > Heads up- it's a bit of a long read, but any thoughts or advice you might
              > > have would be VERY much appreciated!
              > >
              > > I have been working with a patient for one month with a very chronic, very
              > > stubborn, head-scratcher of a case of what her Naturopath and Dermatologists
              > > are calling Atopic/Contact Dermatitis, AKA: Chronic Eczema
              > >
              > > Patient: C.L., 49yo, female, Professional athlete, fitness instructor,
              > > nutritional counselor, exercises 3+ times/wk, very thin/lean body type (5'6,
              > > 115lbs), good diet with some non-gluten grains, lean proteins,
              > > veggies/greens. Non-smoker, no caffeine, little alcohol, hx of minimal
              > > cocaine use 20+ years ago
              > >
              > > First visit date: 8-31-10
              > >
              > > Pt complaints:
              > > History of eczema since childhood. As a child, mild-moderate in severity,
              > > covering small areas such as elbows and popliteal creases, outbreaks came
              > > and went, each lasting for relatively brief periods of time.
              > > Current outbreak, however, began over a year ago shortly after moving from
              > > California (cool, temperate climate) to Phoenix, AZ (friggin' HOT). Eczema
              > > lesions appear over her whole body- most severely at fingertips, hands,
              > > feet. The current outbreak is severe to debilitating at times. The lesions
              > > begin with swelling of tissues and fluid-filled vesicles underneath the skin
              > > which eventually rupture and ooze. After breaking open, the skin become very
              > > dry, cracked, red, burning, inflamed, painful and extremely itchy.
              > >
              > > Outbreaks seem to be worsened/induced by heat and stressful situations.
              > >
              > > Emotions: Frustration, irritability due to pain and lack of resolution with
              > > skin condition...Pt is otherwise happy in her life, meditates regularly, has
              > > a good family life/relationship, enjoys her career, etc.
              > >
              > > Other clinical findings:
              > > Hot hands/feet but otherwise tends to be cold; extremely easy to bruise,
              > > very slow wound healing in the last 3-4mo (pt suspects d/t prednisone); high
              > > BP, avg. 140-90; poor concentration lately; stiffness of joints (esp
              > > fingers, toes and esp in am); Menses: Pt has not menstruated last 2 months,
              > > menses previously regular, light, avg. 5days, mild cramps before period; Hx
              > > of reconstructive surgery left ACL in '04 (still has sharp pain when
              > > squatting--> standing); Right lateral epicondylitis (dull-sharp
              > > Energy level good (7-8/10); Stress level 5/10 (related to frustration from
              > > skin condition); Digestion normal; sleep normal, unless awakened by skin
              > > itching/pain
              > >
              > > Non-TCM therapies utilized by pt:
              > >
              > > Naturopath started her on a Silicae, Zinc & GLA daily doses, and started
              > > her on a Chorella treatment on 8-20-10 (internal, 4500mg tabs daily with
              > > dosages increasing incrementally over time)- slight positive effects
              > > initially (less burning, pain) but no noticeable effects on eczema at this
              > > point.
              > >
              > > MD/ Dermatologist administers Fexofenadine (180mg), Kenalog injections and
              > > 15 day courses of Prednisone as needed to quell extreme/intense symptoms
              > > that render pt unable to sleep or work. Pt is very aware of the negative
              > > effects of steroid therapy and only relies on them as a last resort. Pt has
              > > had 5 courses of Prednisone in the last 5 months, the last course 9-10-10
              > > through 9-23-10
              > >
              > > Pt has been gluten/dairy free for 6 months- no noticeable positive effects
              > > on eczema
              > >
              > > Other supplements include a "Wellness Pack" consisting of micronutrient
              > > complex, cellular Vitality Complex, Omega Oils, Borage Oil 300mg, Vit C
              > > 1000mg, Vit A 10,000iu, Zinc complex 30mg, Vit D emulsified 2,000iu
              > >
              > > According to the patient, she has "done every detox and cleanse known to
              > > mankind."
              > >
              > > Treatments:
              > >
              > > 1st visit 8-31-10
              > > (7 treatments to date, twice per week for first 2 weeks, once per week
              > > after that)
              > > Pulse: sl. slippery, thin 1st pos. both wrists
              > > Tongue: pale, swollen, thin sl. yellow coat, distended sub-lingual veins
              > > TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
              > > TX: Sp 9, SJ 5, LI 11, Sp 10, 4 Horses (88.17-.19)
              > > Herbs: none- pt resistant to taking any more meds/supplements
              > >
              > > 2nd Visit 9-3-10
              > > No change in presentation
              > > TX/herbs/pulse/tongue: Same as above
              > >
              > > 3rd Visit 9-7-10
              > > Pt reports experimentally adding wheat back into her diet 3 days ago, which
              > > intensified itching within a matter of hours; slight fatigue
              > > TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation,
              > > Spleen Qi Xu
              > > Herbs/pulse/tongue: Same as above
              > > TX: BL 13, 17, 20, St 36, Sp6, Sp9, Sp 10, LI 11, Lu 5, LI 4
              > >
              > > 4th Visit 9-10-10
              > > Severe flare-up of symptoms! Pt has started another round of Prednisone (15
              > > days). Interestingly, pt reports that although the severity of itching, pain
              > > and burning has increased, there are no new vesicles forming under the skin,
              > > which is unusual...
              > > TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
              > > Pulse: slippery, full
              > > Tongue: swollen, pale, t/w coat
              > > TX: Sp9, Sp 10, LI 11, SJ 5, Wood Anger, 4 Horses
              > > Herbs: KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
              > >
              > > 6th Visit 9-23-10
              > > Last day of Prednisone treatment...Less redness, inflammation, still very
              > > itchy in some places but less overall. No more burning sensation. Pt notices
              > > she is bruising VERY easily. Pt began spotting this week (previously, no
              > > menses for 2 months). High stress. Naturopath gave her Oregano oil to
              > > support Adrenals and gut function.
              > > TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
              > > Pulse: slippery, thin 1st & 3rds
              > > Tongue: swollen, pale, t/w coat, distended sub-lingual veins
              > > TX: Sp9, Sp 10, Sp 6, Sp 3, St 36, Wood Anger, Bl 13, 17, 20, 23
              > > Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
              > >
              > > 7th visit 9-30-10 (Today)
              > > Ended Prednisone on the 24th- itching had subsided, but she's now starting
              > > to itch again. Some vesicles beginning to form at fingertips, heels of
              > > hands, thenar eminences. No burning or pain at this time. Still bruising
              > > VERY easily with slow wound healing. Poor concentration lately, joint
              > > stiffness. Menstrual cramping last night and this morning with onset of
              > > menses today (light flow, bright red blood)
              > > Pulse: Slippery/wiry
              > > Tongue: pale, swollen, t/w coat (brushed tongue this am), distended
              > > sub-lingual veins
              > > TCM Differentiation: Retention of Damp-Heat, Blood Deficiency/stagnation
              > > TX: Sp9, Sp 10, Sp 6, St 36, SJ 5, 4 Horses
              > > Herbs: Continue KAN "Derma Wind Release" (Xiao Feng San) 2 tabs TID
              > >
              > > Siiiiigh, that's a lot of details! It's difficult for me to perceived
              > > exactly what's going on with her body since she's been on the Prednisone at
              > > the same time as the herbs/acu txs.
              > >
              > > A note on herbs- I've found it rather tricky to get my Scottsdale pts to
              > > take anything other than patent herbs (its a "go go go" town and they love
              > > their convenience!) I typically stick to patents, but this particular
              > > patient may be willing to try a custom powder formula...
              > >
              > > ***I found the following formula in Will Morris' TCM Dermatology notes:
              > >
              > > Chronic Eczema (nourish blood, dispel wind, clear heat, transform damp)
              > > Dang Gui 9
              > > Bai Shao 9
              > > Sheng di 12
              > > Hu Ma 12
              > > Ku Shen 12
              > > Bie Xie 12
              > > Fu Ling 12
              > > Di Fu Zi 18
              > > Bai Xian Pi 9
              > >
              > > Will, would you recommend this formula in this case? grams per day? How
              > > quickly have you your patients seen results on this formula and approx how
              > > long would you expect a pt to be on it?
              > >
              > > This patient is a very wonderful lady and I wish to give her the best
              > > possible treatment but alas, I'm not sure if I'm on the right track or not.
              > > Any assistance would be greatly appreciated!
              > >
              > > Best wishes and enormous gratitude,
              > >
              > > Melanie Miller, L.Ac. and AOMA Alumn 2009
              > > Turning Point Wellness
              > > <http://www.turningpointacupuncture.net/>www.turningpointacupuncture.net
              > > Scottsdale, AZ.
              > >
              > >
              > >
              > >
              >
              >
              >
              > --
              > William R. Morris, PhD, DAOM, LAc
              > http://pulsediagnosis.com/
              > http://www.aoma.edu/
              > http://taaom.org/
              >
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