Could use some input on a patient.
Male age 37. CC: Itching.
Started 2.5 years ago. Started in inguinal region. Now, can be anywhere and moves around: forearms, legs, anus, penis, scalp are most common areas. There is no rash associated with the itching, but sometimes scratching will produce discrete red dots on the skin. Sometimes itching will be in just one area, sometimes multiple areas. It is somewhat worse after showering. Otherwise, no obvious climactic factor influences it and it does not change with the seasons.
Patients states that he was fairly stressed when the itching began and that stress can be a problem for him. Has been to various doctors and has seen no relief. Dermatologist referred him for acupuncture.
-Tends to run cold.
-No abnormal sweating.
-Bowel movement-3x days, sometimes loose. Experiences gas and bloating and fullness after eating.
-Urination: Wakes 3x/night to urinate
-Diet: English is patient’s second language and I was pressed for time so didn’t get much detail-I think it’s a typical Mexican diet, though he states he doesn’t eat a lot of cheese.
-Lifestyle: Construction worker. In the past worked exclusively outdoors, but in last few years has more indoor work.
-Experiences pollen/seasonal allergies. At first visit was quite congested with phlegm and watery/itchy eyes. Moved to area in 1992 but allergies didn’t start until 2007
Lung: all positions slippery
SP: Tight (slightly slippery, but moreso tight or just present-which I found curious)
KD yin and yang: nothing remarkable, maybe a little weak
Pale, quivering, swollen, scalloped, thick white coat
On the first treatment I was honestly completely mystified as to why the itching was happening. Clearly, there is a wind component, but as to WHY the wind exists-I have no idea. I chose to needle with the principle of regulating LU/SP and to treat the existing phlegm/allergy symptoms. Clearly, there is damp accumulation and SP qi xu-but I don’t know how or even if that connects to the itching.
Points: LU-5, SP-9. LI-4, LU-7. SP-6. Baichongwo
Principles: Drain damp, support spleen, relieve itching/expel wind,
Cang zhu 9
Ku shen 9
fu ling 12
zhi mu 9
dang gui 9
chuan xiong 6
fang feng 9
jing jie 9
cang er zi 9
On next visit: Patient took herbs for 4 days (though I gave him a weeks worth.) He reported no change in the itching in that time, so decided upon recommendation of a friend to take an antihistamine. The antihistamine stopped the itching! (he said he’s never taken one before).
However, patient reports that his digestion symptoms are all noticably better, with less gas and bloating and nightime urination is reduced to 1x/night. His tongue has a less thick coat and is a bit less swollen. The less thick coat reveals stomach cracks that were not previously visible (or I just missed the first time) Pulse is fairly similar to first visit. I did the following points:
LI-11, St-40, baichongwo
LU-5, SP-9, Ren-12
ST-42 & SP-3 w/ moxa
And gave him a liu jun zi wan patent. (at least I know I can help the digestion!!)
I know this is really long and I appreciate anyone taking the time to read. My questions are as follows:
-Where is this wind coming from??? Patient’s most obvious disharmonies lie in taiyin-qi regulation and the excess damp. I do not know if/how that can create wind. I don’t believe he is blood deficient-so that is not creating the wind.
-A possibility that was suggested to me was that the wind is due to fluid deficiency. This seems an interesting idea. His skin is somewhat dry and there are stomach cracks on the tongue. Could this dryness (which coexists with pathological fluids-dampness) give rise to wind? If so, would simply nourising ST yin be able to anchor the wind? What are strategies to treat coexisting dryness and dampness?
Any thoughts are greatly appreciated.