Dear Arnaud,

 I brought my mother to see you on July 14th and her pulse was the following: Left superficial first, deep weak second (wiry), dong between first and second; right wiry, second big.  You prescribed: Gui Zhi 9, Bai Shao 18, Sheng Jiang 9, Mai Ya 15, Da Zao 6, Zhi Gan Cao 6, Zhi Shi 3, Hou Po 12, Gua Lou 15, and Xie Bai 24.  She took the formula for a few weeks.  However, a couple of weeks ago I told her to stop taking the formula because her tongue coat was becoming increasingly greasy and gray, and a "stuck" feeling in her stomach more pronounced...Would you suggest that I continue giving her the same formula anyway or do you have a new one to suggest? 

Currently her pulse is: Dong between first and second on both sides, but more prominent on the right, rolling up on both sides, left cun floating and soft (as well as right cun), left guan thin wiry, right guan rolling sl. hollow, both chi deep and faint.  She still feels quite a bit of "stuckness" in the epigastrium sometimes after eating - seems like the Zhi Shi Xie Bai Gui Zhi Tang in the formula you prescribed would have addressed this?  Thanks so much for your help!

(List of current symptoms: right lower back/hip extremely stiff/painful in morning, localized itching with a slightly darker pigmented area on mid-back, stuck feeling in epigastrium esp. after eating greasy food, sometimes uncomfortable feeling in throat - hard to describe this.)

Thanks again!

Lisa Sloane

MG (female, Los Altos 12/17 #5) took the newly prescribed formula (Shen Qi Wan + GLXBBXT) for a week and complained with low back soreness got worse then stopped taking it.  She suspects some of the ingredients may be toxic to her kidneys and asked me to send the list of ingredients in English names.  No change in her muscle pain, her blood sugar is still as high as 200.  How do you usually deal with those kind of patients?  I would appreciate your guidance.

Patient: M.C.

Female, 66 y.o.

Patient # 6 on 7/12/10 and patient #1 on 5/24/10, both in Oakland clinic.

Patient has been taking Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang + Long Gu Mu LI + Tian Hua Fen

After two weeks, all symptoms are improving: less back and knee pain, more energy, sleep good.

Bowels are a bit slower, but still every day and her blood pressure is the highest is has been and has been high since starting the above formula.Blood pressure had gone down with the Wen Jing Tang to an average of 119/80. Blood pressure is now 160/89 when it is high, 139/86 when it is low.

It seems weird to me that her blood pressure would go up. I thought Long Gu Mu LI were helpful for this. Her pulse seems a little bit different on the Left Guan it is less deep, thin wiry, sl tight, more mid depth and tight. Other pulse positions seem the same. Her abdomen seems to have more rikyu than when she was on the Wen Jing Tang.

Greetings shang han lunatics! I'm looking for some feedback on this patient follow-up. Thanks!

- Bill Schoenbart

July 9:
Patient saw Arnaud in Los Altos. Observers: Ben, Betty, and Stephen. Major complaints were bloating, abdominal pain, fatigue, and extreme food sensitivities for many years. Has responded favorably to herbs in the past, but always has relapses, sometimes severe and long-lasting. Prescription is a mixture of si ni san, gua lou xie bai ban xia tang, and zhi shi xie bai gui zhi tang. Patient feedback follows. Please note that she is a TCM student, so there is a bit of self-diagnosis in her comments.

July 17:
"I wanted to check in with you about my herbs. I can definitely feel that they are moving things- the first few days I had some mild-medium stomach cramps and I've been pretty bloated this whole time but I'm guessing that's part of the moving quality of the formula. Except for those first few days of a bit of cramping I haven't had any discomfort on them.

But, the last few days, I've really noticed my energy is less and less and I've been having to urinate a lot, and get up once or twice in the middle of the night to go. My teeth have been a bit sensitive when I eat, too. So I'm thinking my Kidney qi is being affected by the herbs? I wonder what you think and if there is any way to stay with the formula and make it a bit less draining for me, or add something to help me keep my strength."

July 21:
"I am actually leaving town on friday morning until tuesday night and will not be able to boil herbs while I am gone, so I won't even be on them for a few days. For the last week or so I have just been doing 2 days on, 1 day off, and that has leveled out my qi xu- I am still feeling deficient but its not getting worse, and it is not severe."

RJ (male, 48 yo, 5/21/10 Los Altos #13, 3/19/10 Los Altos #14, 1/25/10 Oakland #18), CC: Diabetes, high blood pressure, sweating a lot.  He started blurry vision after taking Wu Mei Wan about a month ago.  His blood sugar is under control with the formula without any Western medicine.  When he stopped taking the formula, the blurry vision stopped. He does not have palpitation, light headedness, nor dizziness, but has sharp headache comes and goes.  He does not know his current blood pressure.  His appetite is usual, but his stool is softer than before and it is 4-5 times /day, not formed, without undigested food, brown to dark brown, occasionally but not always with strong smell.  I adviced him to stop taking the formula and see if the blurry vision and headache go away, and take Western med to control his blood sugar.  Please let me know how to manage this case.  Thank you.

JJ (Female, 76 yo, 5/21/10 Los Altos #14 as new Pt) CC: abdominal pain & bloating better with burping, tumor on upper back btw spine and Lu, abcominal hernia.  She has been on GuiZhiJiaFuZiT + SiNiT + ZSXBGZT granule for 2 weeks.  Arnaud's pulse reading is: L: 1 slippery/rolling/wiry/rolling upward, R: 1 wiry/tight.  She feels much better overall.  Less gas, less abdominal pain. 

She now would like additional treatment for her arthritis pain on lower back (for several months, getting worse everyday, better with warmth), medial knee(R) pain where she feels something is moving in her knee upon movement, hand(L) pain with puffiness.  She is on constipation side with the herbal prescription but managing with fruit intake. 

Do you suggest modifying the current formula or staying the current one for a while?  Her current formula is GuiZhi 9, BaiShao 9, FuZi 30, GanJiang 3, DaZao 6, ZGC 6, ZhiShi 3, HouPo 12, XieBai 24, GuaLou 15.

Thank you.

Hiromi

ES Female, 77 yo, 4/16 #10

She took Da Cheng Qi Tang for the first three days and then keep taking Hou Po San Wu Tang + Ban Xia Hou Po Tang + Gua Lou Xie Bai Ban Xia Tang until now for her constipation, abdomenal distension, plum pit Qi, feeling warm, thirst, acid regurgetation, unsmooth urgent urination in daytime, 2 or more times urination at night, and night sweating.  She is feeling very good now -- bowel movement everyday, throat feels better, acid regurgetation is better, no night sweating, urination is smooth and once at night, still feels warm, sometimes bouts of dry cough feeling her throat is closing up.  My question is if she can keep taking the Da Huang formula more than two months until she is going to see you in July.  Her pulse is not hasty anymore, the speed is normal, beat is regular, deep, left cun is sippery. 

Hiromi

WW Male Los Altos 4/16 pt#8

Patient's pulse is now irregularly irregular. 80-100 BPM throughout the day. Both hands rolling up.

Left cun and guan weak. The only change in his syptoms that he reports are some whole body itching on and off and some constipation.

His formula is ling gui gan zao tang plus fuxiao mai.

Should we change the formula now that we have confirmed the jie mai?

Thanks, Betty

RJ (Male) #14 3/19

He realized that his blood pressure is high today (156/103) and wondering if we can do something about it.  It was normal in the last two times when he saw his PCP.  His blood suger is good(fasting 104) by taking the formula without western medications.  He is still experiencing the hair loss, but does not complain about it anymore thinking that it is a trade off.  His current formula is running out.  So please let me know if you would like to modify it to deal with his high blood pressure or not.  His pulse today is, left: deep cun & guan, very deep chi, Dong btw 1&2, right: cun guan slightly deep, guan slippery, chi felt only at middle depth, Dong btw 1&2.  Thank you.

Hiromi

RJ (male, 48, Oakland 1/25 Pt#18, CC: diabetes, high blood pressure, depression, acid regurgetation) liked your formula very much and plans to come back to see you in March with his brother and his girl friend.  His blood sugar level went down to 119 (fasting) without metformin (used to be 300), no thirst anymore, sweating is significantly decreased, bowel movement is formed 2/day (used to be unformed 3-4/day).  However, he is experiencing significant hair loss for the last 2 weeks.  He has never experienced that before and wondering if that is due to the formula (GanCaoXieXinT + GuaLou, GeGen).  He finished 18 bags of the decoction during the period between 1/27 and 3/4.  He still has acid regurgetation (he is still taking omeprazol for GERD, zoloft & wellbutrin for depression).  His pulse (to me) is Dong both 1&2, slippery right cun, wiryslippery left cun, deep overall with very deep on both chi.  He wants to stop the hair loss as soon as possible.  Could you please let me know how to manage this case?  Thank you.

Hiromi