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Question and Answers



•    Trigeminal Neuralgia
•    Headaches from Raeder's Syndrome
•    Differentiation of Backache
•    Post-viral Fatigue Syndrome
   
•    Loss of Sense of Taste and Smell
•    Multiple Sclerosis
•    Calf Muscle Ache


Trigeminal Neuralgia

Q:  I have been unable to find any information about trigeminal neuralgia, i.e. how to differentiate and treat it. Do you have any information on it?
   
A:  From the TCM point of view, trigeminal neuralgia (TN) is an affliction of the channels of the face and is generally due to invasion of these channels by Wind-Cold. This "Wind-Cold" is different than the one which causes a cold or flu: it invades the channels of the face directly. This usually happens because there is an underlying Blood or Yin deficiency. In the elderly, or people weakened by various causes, the Wind-Cold stays in the channels of the face to cause the intense pain. In the elderly, this may be complicated by other factors such as local Blood stasis which makes the pain more intense. So, to summarize, there is invasion of Wind-Cold in the channels of the face, perhaps complicated by Blood stasis and against a background of either Blood or Yin deficiency.

The treatment should be to expel Wind from the face and nourish either Blood or Yin and invigorate Blood if necessary.

The distal points to use are: L.I.-4 (which I find works better if used on the healthy side, reducing method) with LIV-3 (on the affected side, reducing method).

T.B.-5 on the affected side (reducing method).

The local points to use are: choose according to affected branch from among Taiyang, ST-7, SI-18, ST-6, ST-5, even method. Gentle moxa stick can be used unless there is Yin deficiency with pronounced Empty Heat (it can be used if there is only Yin deficiency without Empty-Heat, i.e. if the tongue is not too Red).

TN is a difficult disease which requires many treatments.
   
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Headaches from Raeder's syndrome

Q:  I have been asked to treat a girl who suffers from severe headaches and has been diagnosed with Raeder's syndrome. Do you have any knowledge on this?
   
A:  Generally speaking, you have to approach the treatment of this girl as for any other headache, i.e. analyse the symptoms and signs, decide on a diagnosis and treat it accordingly. The very first chapter of my book "The Practice of Chinese Medicine" deals with headaches. Based on the symptoms connected with Raeder's syndrome, the most likely cause of this girl's headache is Liver-Yang rising with local Blood stasis. You need to use both distal and local points.

Distal points: LIV-2, G.B.-43, T.B-5 all on the side of the pain plus L.I.-4 on the opposite side.

Local points depend on the location of the headache: usually G.B.-1, Taiyang, G.B.-9, G.B.-20 all on the side of the pain.

It might also be necessary to nourish Liver-Blood with ST-36, LIV-8 and SP-6.
I have read about Raeder's Syndrome (which you can find on <www.medscape.com>) and, although this would not change the treatment, it might change the prognosis, i.e. it might be more difficult. However, given her age, I don't think it will be impossible.
   
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Differentiation of Backache

Q:  Could you tell me what the TCM diagnosis would be if (a) someone had back pain and it gets worse when they are sitting but better when moving, (b) better with sitting worse with moving and (c) O.K. when sitting but sore and stiff when they get up then it starts to get better?
   
A:  (a) Qi stagnation or Blood stasis
(b) Kidney deficiency
(c) Cold in the back channels
   
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Post-viral Fatigue Syndrome

Q:  I have a patient who is 48 year old and suffered from breast cancer 3 years ago. The specialist told her that she has probably got M.E. as, for the last six months, she has been suffering from the following symptoms: very tired, severe muscle fatigue and ache (especially on her back), difficulty sitting, heavy limbs, poor concentration, a constant feeling of fullness in the epigastric area and on the right side of the abdomen, bitter taste, sore throat, insomnia, scanty dark urine and shivers. Her pulse was Full, tense and the Kidney position was Weak. Her tongue has teeth marks on the sides, is a little bit swollen and the coating is thin-white. Could you advise me about the treatment, including which points and herbs I should use?
   
A:  Judging from the symptoms, it sounds very much like your patient suffers from Damp-Heat in the Middle Burner and muscles against a background of Spleen and Kidney deficiency.

I would concentrate on resolving Damp-Heat first with something like Lian Po Yin and only after some months tonify Spleen and Kidneys with the herbs.

With acupuncture, it is different as you can do both by using Ren-12, Ren-9, ST-36, SP-6, SP-9, BL-22, BL-20 and Du-20.
   
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Loss of Sense of Taste and Smell

Q:  I am treating a woman suffering from asthma with signs of Phlegm and Heat in the Lungs. She has another problem which is loss of her sense of smell and taste, which are reversed with cortisone treatment. As soon as she stops the cortisone, the problem reoccurs. How do you interpret the action of cortisone in this respect from the point of view of Chinese medicine. As cortisone is anti-inflammatory, it should have a cooling action but why does it lead to symptoms of Empty Heat? What pathological process do you think is going on in my patient?
   
A:  The loss of sense of smell and taste of your patient is due to Phlegm-Heat obstructing both the Lungs and the Spleen, the former leading to loss of sense of smell and the latter to loss of sense of taste. You cannot draw direct parallels between the action of Western drugs and their effect from a Chinese point of view. Probably, cortisone resolves Phlegm temporarily. Long-term cortisone use does induce Empty Heat because it weakens Kidney-Yin.
   
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Multiple Sclerosis

Q:  I have been treating a patient who was diagnosed with Multiple Sclerosis . The following is her history and I was wondering if you might give me some advice on how to treat her. I have been mainly trying to build up her Spleen and Kidneys. I have diagnosed the condition as Phlegm-Damp accumulation in the leg channels due to a deficient Spleen; however, there is no numbness of the limbs which is generally a sign of Phlegm accumulation so would it just be Damp blocking the leg channels?

The patient is a 29-year-old woman. She has had progressive weakness of both legs with an inability to balance at times. At present, she does not experience any weakness of her arms. Her appetite, sleep and bowel movements are normal. Her legs and feet are cold and she bruises very easily. Her lower body feels very heavy and 'off balance'. Her condition is aggravated by any extreme temperatures and certain positions of the feet bring on rapid tremors in the legs.
   
A:  Generally speaking, one can identify 4 stages in MS:

1) Very early stage: Dampness in the channels causing heaviness and tingling.
2) Early/Middle stage: Stomach and Spleen deficiency causing weakness of legs, beginning of atrophy.
3) Middle/late stage: Liver and Kidney deficiency causing weakness of legs, dizziness, vertigo, atrophy.
4) Late stage: Liver and Kidney deficiency, Liver-Wind with or without Blood stasis.

All the above symptoms plus tremor and spasms of limbs. If Blood stasis: pain in the limbs.

I think your patient is mostly at the second stage but with elements of the 3rd/4th stage as, of course, the staging is not rigid. I think the main problem in your patient is Stomach and Spleen deficiency, plus some Dampness (feeling of heaviness) plus a hint of Liver-Wind (tremor of legs).

I would therefore say the treatment principles are to (in order of importance):

1) Tonify Stomach and Spleen
2) Resolve Dampness
3) Tonify Liver and Kidneys, subdue Wind

Points:

1)ST-36, SP-6, BL-20, BL-21, ST-31, ST-34, Ren-12
2) Ren-12, SP-6
3) LIV-8, KI-3, LIV-3.

Use also the Dai Mai occasionally (GB-41 on the right, TB-5 on the left) as this drains Dampness form the Lower Burner and is indicated for Atrophy Syndrome in the Su Wen (Ch.44).

Herbs that tonify the Stomach and Spleen, resolve Dampness and eliminate Wind-Dampness from the channels would also be indicated.
   
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Calf Muscle Ache

Q:  I would like your opinion concerning the treatment of a calf muscle problem. The patient is 44-years-old and appears to be in good health. He runs for general conditioning 4-5 miles per day and 3-5 times per week without incident for several years. About 2 months ago, he changed jobs and began working nights. The job requires considerable walking and standing. Soon after starting this job, he began to experience tightness and cramping in the upper calf area when running. I have tried needling local points in the area of greatest pain with electrical stimulation and have used BL-60 as a distal point. Cupping and bleeding of the local area has also been tried with similar results. Do you have any observations or suggestions?
   
A:  I would try using distal points that are above the area of the pain (which you don't specify exactly) such as BL-40. I would also use BL-57 as a local point and maybe Bl-58. Other choices depend on whether the area is hot or not. If it is hot, I would use SP-10. Another approach you can try is to use the Small Intestine channel (related to the Bladder within the Tai Yang) on the opposite, corresponding side, e.g. S.I.-7. I would not use electricity nor moxa.

From a Western point of view, you should look into the possibility of varicose veins (is it hot?): if this is the case, results would be less good than if it is just a muscular problem. In such a case, you should definitely use SP-10 and maybe SP-4.

Finally, I think that running 4-5 miles per day is over-exercise from the Chinese point of view and it does not do any good: as my Tai Ji teacher always stressed "fitness is not the same as health".
   
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