I have a client with severe abdominal swelling that is sometimes less and sometimes more and can swell up right in front of your eyes. She also has superficial heat rising with emotion and exertion or in a hot room but deep, cold sensations arising from time to time; sometimes during treatment but also at other times. They are felt to be very intense and, if they were hot, you’d call, “hot flushes”. There are liver Qi stagnation/Spleen Qi deficiency signs (distension of the hypochondrium, some pain lower right abdomen, hot flushes,facial flushing, emotional volatility, depression, sighing and cramps) all of which are abating with the use of Jia Wei Xiao San. There are also Kidney and Spleen Yang Deficiency s/s such as cold legs, feet and knees, oedema (mostly in the middle and lower), palpitations, urinary difficulties such as, “false alarms”,or mid-flow restrictions and long term, “swill”, diarrhoea. Those symptoms (with the notable exception of the diarrhoea are abating with the use of Zhen Wu Tang and we also use Tian Wang Bu Zin Wan for the palpitations and insomnia, usually with good effect… We’ve tried a few other formulae too for the fluid retention and digestive problems with moderate and varying effect abut nothing makes the least difference to the abdominal swelling (which is really dramatic). I once tried treating the inner cold with Li Zhong Wan but that made things worse and I am thinking of alternating Zhen Wu Tang with Fu Gui Ba Wei Wan to warm the Kidney Yang. However,while there are improvements I don’t think this program is really working and I’m coming to the conclusion that I should be treating for disharmony or maybe rebellious Qi in the Chong Mai (or one of the other extraordinary channels?). The psychological history does suggest that that might be appropriate and all the s/s fit. Anyway, long story short, does anyone know of a formula specific to toning the Chong Mai Channel and does anyone agree or disagree with my conclusion that that might be the pattern to treat? Thanks for reading this far.
I haven’t used this formula but I know [of] the man who developed the formulas and took a few classes from him. He emphasizes the use of the extra ordinary channels in his clinical practice and I would trust his herbal formula reflects his many years of clinical experience in that regard.
As to whether or not the Chong Mai would be the appropriate channel in the first place I would leave that to someone with more experience using the extra ordinary channels. I have absolutely zero clinical experience using herbs to address the extra ordinary channels nor do I use them much in my own acupuncture practice so I don’t have much to contribute.
Before I delve in further when you say “all of which are abating” and “those symptoms are abating” - what does this mean exactly? I know what the word means, but over what period are we talking about, with what dosages, and how much better are they - 50%, 90%? And are they currently only showing limited signs if they are on herbs - i.e. the symptoms are not resolved completely? Or are they better after a course of herbal treatment and only the abdominal distention is left.
Also are you only treated herbally? Have you done any acupuncture or moxabustion for the patient?
Thanks for your response. Here is further information. I hope it is
helpful but am I’m afraid it is rather long. As some sage once said, “the
words of a confused man (or woman) are many”. I admit the confusion and
hope I haven’t confused you also…
Treatment Period. We have been treating with variable success for a period
of 4 years. All tho symptoms listed are now generally less frequent and
less severe but they become stronger again if treatment is discontinued.
General Condition. Patient is obese but eats little and adheres strictly to
what she consider a very healthy diet (mostly fruits and vegetables and
definitely no, “junk food”. There is a reported history of alcohol abuse
and sexual over-indulgence (about 25 years ago) .
Fluid retention There is now no visible sign of fluid retention (which was
principally showing in the legs and ankles) but some swelling in the legs
returns after a month or so without Zhen Wu Tang.
Inhibition of urine. Urine is sometimes inhibited as in there is an urge to
urinate but no response. Sometimes urgent and copious .
The hot flushes are considerably less frequent and less severe than they
were a year ago but still occur with any level of mental agitation /
excitement and, again, are worse after a month or two without Jia Wei Xiao
Sweating can be profuse but only on exertion.
Palpitations which were very strong and also occurring with relatively mild
excitement are now less intense and frequent and mostly on lying down to
sleep. They were completely in abeyance for a few months last year and
early this year. Then the patient experienced a long period of intense
work/stress at which time the palpitations returned. We have resumed Tian
Wang Bu Xin Wan and they became immediately less intense and less frequent
but still present. Patient also takes Hawthorn 500mg to calm and strengthen
Insomnia likewise comes and goes and is worse with increased stress (of
course). It responds to Tian Wang Bu Xin Wan giving some nights of sound
sleep but not all.
Diarrhoea likewise varies it is usually sloppy stools that the patient
describes as, “porridge”, and sometimes, less frequently now, completely
liquid. We used Shen Ling Zi San for about three weeks initially with no
result. Also tried Fu Zi Li Zhong Wan for a few days but that seemed to
make the condition worse and we discontinued. At one time (and now
occasionally now() there was heat on defecation and we tried Xiang Lian Wan
for damp heat in the bowel but again no result. Also tried a standardised
formula (can’t remember name off-hand) for irritable bowel syndrome again
with no result. Her anxiety and depression also vary in intensity but are
always present (she says she feels, “joyless”).
The muscular cramping which was severe and frequent (daily) and a past focus
of treatment has not been present now for 2/3 months.
Fatigue is sometimes less and sometimes more (never sufficient to prevent
activities) but always present.
Abdominal swelling. Present for about 6 years. Distension under the
hypochondrium is generally present with some discomfort under the right
ribcage. It varies but never goes away completely. Distension of the lower
and middle abdomen comes and goes quite suddenly and it is not clear what
triggers it (except, probably, mental agitation). During some balancing
sessions it has cleared away completely but, it returns. For some time I
was not sure whether it was fluid retention or Qi stagnation (or both) but,
after various tests and trials including recent medical advice, I now feel
sure that it is Qi stagnation. My question now is what is the cause? In
view of the, “cold flushes”, that also occur (usually during treatment) I’m
thinking it might be cold retention (in the Liver/GB or Chong Mai).
Initially client presented with heat above / cold below pattern (with no
awareness at all of the middle Jiao which. That cleared up completely with
perhaps a month of Bu Zhong Yi Qi Wan and she still responds well to that
formula, which we use from time to time, with increased energy. It seems
that after the initial course of treatment and favourable response these
other symptoms became more obvious and it also seems that a pattern of cold
within and hot without is now becoming prominant.
Initially client also experienced constant thirst with constant sipping of
water but no relief of mouth dryness and fairly frequent flaring up of mouth
ulcers. That condition cleared completely and quickly with one course (10
days) of Mai Men Dong Tang.
Also, initially and for some time, patient had a strong odour on the breath
suggesting food stagnation but that has not been present for about a year
My practice. I am not trained to give acupuncture and only trained to use
patent Chinese medicines which I use as an adjunct to my practice which is
remedial therapy (Qi / muscle balancing). In a balance there is generally
widespread, “weakness”, but, principally, instability of the heart /
subscapularis and related imbalance of the shoulder girdle. Liver, Kidney
and Large intestine muscles also usually test weak but are much stronger
overall than they were at the commencement of treatment. There is usually
if not always, an imbalance between GB / anterior deltoid and Stomach /
Pectoralis Major and Minor and sometimes, not always in teres minor / triple
warmer. We sometimes use Wen Dan Tang to harmonize GB/Stomach when it is
showing up strongly. (strangely enough when that was re-introduced recently
it had the effect of disinhibiting urine!).
Medical advice is, “irritable bowel”, and patient has been taking medical
drug for irritable bowel syndrome for the last two weeks also, so far, with
Doses and program. We are using standard doses of 24 pills daily usually 12
x twice daily (for convenience) with increase of dose if symptoms, “flare
up”. If I’m trying a new formula we give it three weeks and assume, if
there is no change at all in relevant symptoms that it is not indicated.
With many thanks for considering this problem for me,
Thank you for your very helpful response. I will look into the formula you
suggest. Thank you also for the caution but I assure you I do not intend to
rush into anything. I will look for further advice before suggesting this
approach to my client. So far however the diagnosis is looking promising .
Although there are others the Chong Mai pattern is manifest and the
client’s body responds with a very positive muscle test to the suggestion.