Constipation and Poor Circulation Case

[traceywalker]

I have a client who is really concerning me. He is a 39 year old helicopter pilot presenting with extreme fatigue and poor circulation. Hands and feet really cold, and he says he feels cold and uncomfortable in his lower jiao abdominal area. He does a lot of agricultural spraying, so there’s huge chemical exposure. Used to be really fit, but has had declining health in last 3.5 years after nasty flus in the winters of 2016 and 2015. Since these flus and chest infections, he easily gets sick, and it will usually go to his chest with lots of mucus and a blocked nose. He is a dad of 3 young kids, and has had alot of stress in last few years. Stress makes all his symptoms worse. Appetite is good, and he sleeps well, but is very constipated. He can go 2-3 days w/o a BM, but says this is due to sitting long hours in helicopter. When he does go, it is often dry and passes in pieces. Although with a few days of not working, he passes soft stools. He says that the constipation makes him feel ” sick in the guts”. No sweating, but feels the cold more than rest of his familly. When stressed, he gets a generalized headache–can’t say where it is in the head. He’s thirsty, and drinks a huge amount of water, pees up to 12 times a day and 1-2 times at night. He knows the amount he urinates, as he goes every time he lands to reload. Is this just habitual? But even with all the water his bowels are dry? (BZFZT?). He is dizzy first thing in morning and has a lot of saliva in his mouth, so always needs to swallow. On examination: slight man, hands and feet very cold, red face with dry cracked lips. Pulse : (L) cun deep, guan and chi both superficial, wiry and long with D1/2 and D 2/3. (R) all 3 positions superficial wiry and long. From our first class… long wiry in all positions…wood…poor prognosis. Haven’t done JG, and it seems there is material damage, but left pulses seem YM…dry bowel and lips…However he is so cold inside. I don’t think a XXT is right? Prior to seeing me, he saw another acupuncturist/herbalist last year who gave him a lot of XCHT. Every time she tried to move to” tonics” he became constipated.

[reneeknott]

Andres

[traceywalker]

Have really considered both those formulas. However he doesn’t have any sensation of a glomus, no overt HT-KD disconnect signs, and his hara is really weak and empty below the ziphiod. On palpating, he did not even have oketsu. I agree the pulse looks like XXT on the L, but his sick gut feeling is very low below navel in the bowel area. The wiry could be SNS, but he is so cold and the gut feeling is one of cold, so I’m nervous to give him such a cold formula.

[Aaron]

After XXT, when the pulse changes, he’ll move into a yin confirmation pulse. Then you can heat him up. You don’t have to have a glomus to prescribe a XXT. The bowel issues you described can fit a XXT. It’s not uncommon to see this kind of thing – where you can see the shaoyang pattern on top, as well as the yin confirmations underneath.

[Jay Bartlett]

aarudberg

[reneeknott]

There is a pulse for SNS which is a dong between L 2/3, isn’t there? And SNS is indicated for pain in Lower ab. I wonder if this is a case of cold due to stagnation, which is the type of cold SNS is indicated for. You are the one who has seen the patient, though.

[Jay Bartlett]

Maybe a HPQWT?

[Aaron]

If you went XXT route, then with a dong, you’d add LZW or GZRST to it.

[timothyross]

lesliesilver

[hamishbrown]

If he is thirsty, then you will at least have to minus the BX and add THF if you go the XXT route, and I’d be using extra GJ and SJ to protect his center if you do. But the thirst with the urination you describe could be an indicator for BZ. His blood sounds very cold, so in the end you, may end up in a DGSNT that moves his bowels via warming. With the dryness in the bowels, it is tempting to suggest flushing him out with a MX based formula, and then moving to a GZRST plus SNS maybe. Or HLT (heat above, cold below) minus BX plus THF comes to mind. HLT (no HQin with his cold blood could be good, especially if he has already had heaps of it with the prior XCHT and already tried to be harmonised there), plus SNS is also possible. Also would you say his pulses are hollow? So if that is more confusing than helpful, I would suggest start with HLT(-BX+THF) plus SNS (not a normal mod, I know, and may not be acceptable, but is just what is coming to mind), then when the heat clears above, go SNS plus GZRST. Then hopefully you’ll be able to move from there to a JZT or DGSNT.

[traceywalker]

You know I have been thinking about this. I am quite concerned about him, as he is soooo exhausted and feels so ” crook”. I think I will try to do what I can, but also suggest further investigations. Thanks.

[traceywalker]

Thanks ICEAM familly …lots to ponder. Which XXT formula to start with? Not BX, as thirst, and no mucus, plus lots of dryness… GCXXT? No upper distress, but he does have thirst, a red face and dry lips?

[timothyross]

I might start with something along the lines of SNS plus ZSXBGZT. In the context of my previous post, I want to see if I can get things moving by attacking the Dong pulses. I’m banking on the thirst being more in the domain of dry blood and taxation, which I’d be focusing on after passing into the Yin conformations.

[traceywalker]

Thanks Tim… I don’t make my own formulas, so will look to having this made up. I thought you needed hypochondriac symptoms for SNS? Forgot to mention that his is reddish with a dry slightly yellow coat

[Author]

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