Home Forums Diplomate Discussion Weak Lungs Case

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    • #7133
      Dominik Daling
      Guest

      Male age 62. Ex aikido fighter and researcher in Panama, with a hx of aortic rupture after a car accident; left bundle branch block & a swolen septum, but not coronary heart disease; and psychological hardship due to troubles with his bipolar son. Last fall he got a cold strike onto the lungs due to sleeping with a strong air conditioning in a tropical environment. He developed a severe obstructive bronchitis he had to deal with until 8 weeks ago. Symptoms: tightness and oppression in the chest w/ a burning sensation in heart region, aversion to cold and cold feet, and slightly inhibited urination. His eyes do look a bit crummy, but I don’t really know the look of that, and his voice sounds like there is abundant salivation. It’s husky w/ a panting sound. He has difficulty falling asleep. I put him on CHJLGMLT, which worked on stagnation in the upper. He then developed a cold with swollen lymph nodes close the trachea and stabbing ear pain w/ a sub-febrile temperature. Treated this with CHGZGJT – THF + GL,HL,BX,WWZ, XR and HP (not very elegant, I know). Then A LOT of green sputum came from the bottom of the lungs, and he developed a cough to get rid of it. Followed up with a CHJLGMLT + XR, HP because the chest tightness was still there. Now, he reports a burning sensation in the chest, but less of the left branch block. The formula produced a sweat and heat waves which are gradually subsiding. BMs are three times per day and currently soft stools due to a gastrointestinal infection this week. He has no thirst, no nausea and a minimal appetite. Feels obstructed at Ren 14. His sleep is fine now. Pulse: L: roll up, cun wiry mid, guan and chi superficial wiry level and long. R: cun slightly slip, dong I/II, guan and chi wiry level and long (thinner and deeper than left). To me this looks like a GCXXT – GJ + PJ, but I dunno if the R slippery cun is lung wasting with floating yang. I get the sensation that I want to infuse more fluids to hold the heart yang, but the pulse is quite wiry and superficial. R side hollowness disappeared on CHJLGMLT. His breathing sounds like a heavy smoker, but he does not smoke…

    • #7656
      Aaron
      Participant

      Sounds like BXXXT +GL, XB. You can take the RS/DZ out if there’s any phlegm. I typically take out at least DZ when adding GL.

    • #7650
      Dominik Daling
      Guest

      With his aversion to cold, blue lips and cold damage from the air conditioning, wouldn’t this be too cold for him? Isn’t this yang deficiency of the heart with yang floating out to the lungs and consuming lung nutritive? Heck, I will try this for a week and see how it goes…

    • #7655
      laurieayres
      Participant

      Sounds like BXXXT +GL, XB. You can take the RS/DZ out if there’s any phlegm. I typically take out at least DZ when adding GL.

    • #7651
      Dominik Daling
      Guest

      I did BXXT +GL in the end, so fairly close to you guys. No phlegm in the throat, so left in the DZ/RS.

    • #7652
      Dominik Daling
      Guest

      Laurie Ayres: this patient is much better, but what is most noticeable is his wheezing breathing sound and the heart clenching feeling when walking up a hill quickly. The epigastric block and chest tightness are gone, though. He easily sweats at the back, and has been under a lot of stress due to problems at work. He cannot fall asleep and wakes early. The last prescription, BXXXT + FL12/GZ9 + GL18 wasn’t able to moderate the sleeping issues. Feels very cold and has cold feet. Emotionally angry and depressed, but controlled. His legs show significant varicose veins, and this makes me think of the wiry chis as blood stagnation. Pulses: superficial, wiry and a bit hollow. L: rolls up, cun almost superficial, guan superficial, chi in between cun and guan. R: rolls up, cun floating tight, guan and chi superficial level thin and wiry. He has been on CHjLGMLT/CHGZGJT/BXXXT for quite a while now, and the question is when to move towards the yin realm (maybe his pulses are more hollow than I thought; though they do feel clearly wiry. However, they haven’t dropped in the least on all these herbs). Can I incorporate HQi into a CHT to start material tonification at the same time? Are there other options with the floating wiry quality of basically all pulses?

    • #7653
      Dominik Daling
      Guest

      Aaron Alan Chesterton, Hamish Brown, Peter Slipper, or anyone with an idea that helps me move on with this patient: do you have an idea regarding this case? What is most pronounced: falling asleep takes hours, wheezing of the lungs (dry sound of a heavy smoker), and a clenching feeling in the heart when exercising. What formula comes to mind with such superficial wiry pulses (see above post) which don’t drop on harmonising formulas? Harmonize even longer? Treat it as deficiency taxation, regarding the slight hollow quality? Or even go DHZCW? He is making really good progress, but I feel it could be better and other layers should be addressed, too, before he decides to quit his treatment. Thanks so much, collective brain!

    • #7654
      Christoph Ludwig Beer
      Guest

      Talking about XXTs, here’s my humble opinion: so far, I had literally 100s of patients that manifested with some sort of XXT. Now, interestingly, in some of them the wiry long quality with deep cun just never seems to fade. Still, taking the XXT they feel better overall, but some other layer problems are not adressed. True enough, I sometimes tried to disregard the XXT and view it as something else like water under the heart, but in only very few cases that worked. I have a patient where right now the pulse screams at me “GANCAO XIE XIN TANG ME, YA MOTHERSMURFER!”, and the patient is a bit restless since not so much is changing at the moment, but I WILL NOT change the formula. It’ll only make matters worse, create more confusion, etc. So Dominik Daling, if you are sure from the pulse that this still is a XXT, and since there have been good results, just tell him to be patient and wait until that part of his pathology is settled. Be firm and confident with what you have diagnosed. Now there may be little modifications possible, but the heart of the pathology and the core of the formula will be a dry stomach, so adding HQ or whatever won’t be that decisive either. But I am happy to stand corrected should someone have a good idea here.

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