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Difficult Case (....for me )


#1

Hello

Would nee some help for this :-)

Patient: 49 Old Female

Complaint: Hypertension and psoriasis

Pulse: Deep and slow on the right, deep and full on the left

Tongue: Pale, dry, 2 transversal "cracks" on the lung area, traces of teeths around tongue.

Symptoms: Sensations of alternate heat and cold during the night ( 49 y )
Dry sking with itching on psoriasis areas ( legs, nothing in the upper part )
Psoriasis worse in winter. Anxiety, "burning eyes". Sometimes pain in the chest,
pain in the 4 members worse at night

The patient has had much sadness since a difficult relationship about 5 years ago.
She tends to have hypertension and fell 2 times unconscious this year.

The overall exam makes me think of a blood deficiency ( dry and pale tongue, itching psoriasis ( liver ), dry skin ) but except from that there arn't many symptoms of Blood deficiency. Te pulse reflects an internal cold so how to understand the hypertension ? My treating would be axed on the liver blood ( itching psoriasis, pain in the 4 members worse at night, burning eyes ) and spleen qi ( teeth traces around tongue ). With a stronger spleen, there will be production of Blood and liquids which would nourrish the lungs ( cracks on the tongue ) and the liver blood ( itching caused by liver wind due to blood vacuity ? )

Anyway I'm just a beginner in Acupuncture, let's hope I got at least something right :-)
Thanks for your help with this


#2

Hi,
I'm currently treating a client with psoriasis and the main presentation is an absence of yin. Psoriasis is commonly caused by heat in the blood, so the approach I'm taking is to clear heat from the blood with sp10 & gb31 as well as tonify yin from all sources kidney and liv especially.
It is important to find out where the heat is coming from, does you client have repressed anger about the failed relationship. This may cause the liver qi to stagnate, yin to errode and yang to rise.
In relation to the sadness and the lung presenting on the tongue, I suggest Lung 7 to release grief and lung 9 to tonify lung yin.
I hope this is of some help:-)


#3

Hello Dei

Thanks for that reply, here's some more detailed information.

The patient doesn't show any signs of yin depletion ( no red tongue, no totally empty puls etc..), no signs of liver yang rising. Talking about kindey she does have a "blackish" coulouring under the eyes which makes me think of a Kindey depletion ( works 16 hours a day ). As for blood heat, there are no symptoms of it at all and at feeling body parts' temperature or on the psoriasis zone it isn't especially "warm". She doesn't have repressed anger about the relationship but for sure like all of us, she must have many frustrations with work, so acting on liver qi stagnation like you said would be a good idea also. Ok for lung 9, then I thought of the following points: Sp 10 , Sp 6, UB 17 ( Blood reunion point ), K 7, K 3 --> all these points to act on blood deficiency, I then would add a St 36 ( spleen qi deficiency and for general energy : slow deep puls, tiredness, stimulates blood production : Yang ( Stomach ) stimulates Yin ( Spleen ). Now liver, 2 points: Neiguan ( because it controls and nourrishes the Yin Wei Mo ( Sp, Liv, Kd ) and Liv 3 fo liver qi stagnation.

Could you tell me why using Lu 7, what exact action does it have on an emotionnal basis ? As for your patient, try a UB 40, Blood Xi point, works very well for all Dermatological Disorders. I had some good results with it in the past. Could you also tell me more about your patient, I would be interested ( Pulse, tongue, general symptoms )

Thanks


#4

Your analysis is largely correct except for the lack of yin deficiency signs - which I see as well in the anxiety, obvious restlessness, gender/age, lifestyle, etc. Adding LU 7 perhaps with KD 6 should be very helpful.

As psoriasis is an immune mediated condition it very often reacts to stress. Resolving the LV Qi Stagnation and the Yin Deficiency Restlessness should go a long way towards helping with the condition overall.

To target the condition directly we usually add the following points from the Tam Healing System that I utilize heavily. We use the huatuo points of T1, T2, and T3 to regulate the immune system (bone marrow, thymus gland, and lung/lymph systems respectively). Then we use T4 for the breast, sweat glands, hair follicles (basically any skin condition), T7 on the right side for regulation of the abdominal blood vessel, GV 22 to regulate the hypothalamus and the unconscious mind, and TH 16 as part of the window of the sky points which we use to facilitate the circulation to the brain and the messaging through the spine.

We may also add supporting points such as GV 20, LI 11, SP 10, TH 17, and KD 3 (most of which you have already).


#5

for cold and heat alternate, try "Xiao Chai Hu Tang" soup


for sadness, try "Gan Mai Da Zao Tang"soup


for acupunture: clear Liver and sooth Qi, add 4 gates, ren17, pc6, ren4,6, Du20(lower blood presser), ying tang, ht7 (calm emotion), etc.


Thank you


Regards


Feng Mei



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