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Difficult Case – Neuropathy

This topic contains 0 replies, has 1 voice, and was last updated by  drhenry 4 years, 1 month ago.

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    drhenry
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    A 59 year old male presented to my office about 1 month ago with a main complaint of neuropathy in the legs (primarily), and also complaining of bouts of depression. He has a sensation of throbbing in the head with also a burning/electric sensation on the legs from the feet up to the knees. He is very tight with limited flexibility in the legs and visible hammertoes. He also occasionally feels mild whole body tremors. The current episode started with his wife’s illness and death in June 2012, although he has a history of depressive episodes going back to childhood. He has significant insomnia and fatigue, and all his symptoms are worse with stress. Currently he takes several vitamins and prescription Lamictal (lamotrigine).

    He dislikes hot/humid weather, although his legs and hands (especially the legs) are moist and very cold to the touch. His appetite is good and he denies any taste in the mouth. He is sometimes slightly thirsty (although he didn’t sound very convincing when he said that to me). He has shortness of breath with a slight linger cough. Bowel movements are frequent (5x/day) and loose/sandy in consistency. He also has frequent urination and nocturia. The tongue is pale, swollen and slightly toothmarked, and the pulse is deep and slippery.

    He has yet to take any herbal medicines. He responds well to acupuncture, feeling better after treatment, but the effect does not last. At this point he is willing to take an herbal formula and I’d like to bounce around some ideas before proceeding.

    I am thinking he has both a Shaoyin and Taiyin concurrent pattern. He certainly has internal vacuity cold as far as I can see. I know that Huang Qi Gui Zhi Wu Wu Tang has as part of the formula pattern treating various types of numbness, but I also know Dr. Feng places this formula in Taiyang. So, I’m open to ideas as to the six channels diagnosis and major formula patterns.

    Henry

    Reply from Dr. Ma Jia Ju translated by Greta Young Jie De

    Huang Qi Gui Zhi Wu Wu Tang is Gui Zhi Tang omit Gan Cao and increase the dosage of Sheng Jiang and add Huang Qi. Therefore this formula is a Tai Yang pattern. The above patient presented with numbness in the lower limbs, occasional generalized tremor, all of which can be ascribed to the death of his wife but he has history of depression. His sleep is poor and felt fatigued but took Lamictal. He disliked humid weather and his four limbs were damp and cool. His appetite was good, no bitter taste in the mouth but occasional thirst, shortness of breath and cough. Bowel movement five times with sloppy stool, nocturia, pale tongue with teeth marks and a submerged and slippery pulse.

    Diagnosis:

    Tai Yin interior deficient cold with  phlegm damp. Therefore the diagnosis should be Tai Yin with interior deficient water rheum upsurge. Ling Gui Zhi Gan Tang + Dang Gui Shao Yao San to warm the yang, tonify the spleen and disinhibit water with simultaneous augmenting qi and nourish blood.

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