Home Forums Diplomate Discussion Thrombocytopenia Case

  • This topic has 7 replies, 1 voice, and was last updated 4 years ago by Lutz Gädke.
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    • #7172
      Lutz Gädke
      Participant

      I need some help with a case. Male, 58 yrs., with essential thrombozythaemia (the body produces too many thrombocytes and erythrocytes due to a genetic defect). Sympthoms: dizziness, sometime tingling of the hands and feet, fatigue. He gets bloodletting + iron infusions as well as aspirin 100 from the doctor. Now he has a tendency for obstipation and thirst from bloodletting. Until now, no other symptoms. Pulses are fast and slightly slippery. The L cun + chi are slightly deep. The cun is slippery, and the chi is slightly tight. The guan is thin wiry and when pressed more deeply it is more slippery. The R cun is deep, and the guan is big and slippery. I think of course of an abscess pattern. Because he had a bone-marrow puncture, from the pulses and from the thinking, it is a scenario in marrow. I gave WBLXS + ML. Other thoughts?

    • #7763
      laurieayres
      Participant

      On the L, the guan is the first you meet and then cun and chi are deeper? With the cun also slippery (yang rushing out) and chi tight (no yang in lower), then this sounds like a Ht/Kid. Think tingling of hands and feet as yang leaving the extremities, and dizziness as rushing up. With a bigger R guan, this sounds like a GZJNT, or as a back up if this isn’t strong enough to treat the tingling, a WTGZT+LG&ML–a Wu Tou Jiu Ni Tang. But first there is other business that must be taken care of with that wiry L guan. He needs to be harmonised. I suspect this is where the tendency to constipation is coming from, and with the bigger slippery R guan and thirst CHGZGJT+LG would fit the bill. Now in terms of the bowels, it really depends what you mean by constipation. If it’s just mild, then a CHT alone should take care of this. If more severe then maybe +GL, or even consider adding a ZSSYS, especially if there is more lower abdominal bloating, skipping a day, and/or incomplete or dropping-like stools. Though with the Ht/Kid, I tend to stay away from BS and use CS, but I don’t find this as effective for moving the bowels in a ZS/SY combo. If it is more severe with dry stool, skipping more days and/or pronounced abdominal fullness, you could start with a DCHT and with the thirst –BX +THF. Furthermore, if you suspect you may be on this for a while, even add GZGCLGMLT, or if the stools start moving pretty soon, then you may not need to add this. In summary: harmonize with CHT, with THF, and LG/ML, or whatever assistance is needed for the bowels. Then move onto a GZ/FZ/mineral combo. If that doesn’t work, try GZ/WT/minerals (or even a WT&FZ combo if you really need the rooting of FZ in addition to the WT).

    • #7765
      Lutz Gädke
      Participant

      Thank you, Laurie, for your detailed answer. Yesterday evening the patient was back with me. Here is a pulse update: slightly fast overall, L guan big, thin, wiry w/ the chi tight. R chi slightly tight. I could hardly feel the slipperyness. Regular bowel movements (but tend to be somewhat dry). His general condition was better. However, the last bleed is now 4 weeks back. On the previous day, blood was taken only shortly before.He received a bloodletting of 500 ml of blood every 2 weeks. Now the rhythm is 4 weekly. Laurie, I see the speedbump in the pulse (ht/kid) or the need to first harmonize. What worries me is that this is a cancer-like event in the bone marrow. We treat cancer as an abscess. What’s going on here? The yang of the kidneys and thus the function of consolidation is weak? Yang rises and heats up the blood (in the bone marrow), which makes it dry? This manifests itself in the excessive formation of thrombocytes, which makes the blood thicker/drier. Is that correct?

    • #7764
      laurieayres
      Participant

      Yes exactly. I see a lot of FZ + mineral anchoring in many of these blood and bone cancers, as you say yang floats hitting metal (upper source of fluids and where the 100 vessels converge) and the pericardium (all adverse upward rushing belongs to fire – possibly this is what’s causing the excessive proliferation of cells?), and then dries out the blood (also floats to the head – brain is filled with marrow). In the earlier stages, I often see things like GZJNT or TXS, and as the blood dries out more SQW+TXS, and at later stages when the blood is really dry and the pulses have become more drumskin DHZCW. Here definitely harmonise first. Then once the thin wiry L has reduced, start rooting the yang. As the R chi is now showing findings, then SQW+TXS may be more appropriate. I was also thinking on top of the GZJTN I mentioned before, you could also think about adding YZ&SM if you wanted a little more cooling on top, or if he is really showing a little more heat at first a EJLGMLT could also be an option. But while that R chi is there SQW+TXS is where I’d go (with TXW+GLQMW as a possible backup).

    • #7766
      Lutz Gädke
      Participant

      Thank you Laurie!!

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