Editor’s Note: The following are excerpts from Integrative Chinese Herbal Therapy, a three-volume series that shares the extensive clinical experiences of Dr. Lee Chen-Yu. This series includes over 600 case studies, offering insights, instruction and inspiration for the application of Chinese medicine in the treatment of pathoconditions that range from common maladies to intractable diseases. Dr. Lee’s therapeutic methodology provides a template for bridging the gap between the classics and our modern world. They have been modified only to conform to Acupuncture Today's editorial style guide.
Case #1: It’s An Inflammatory Demyelinating Polyneuropathy (From Volume III)
Q: Today, a 24 y/o male diagnosed with Guillain-Barre syndrome (GBS) came for a clinical visit. The first episode occurred when he contracted a respiratory tract infection at the age of 10 y/o, which unexpectedly progressed into tingling sensations (paresthesia) that affected the distal extremities, prompting a stay in the hospital for treatment and a thorough examination. He was diagnosed with GBS, but the symptoms completely resolved without any problems.
Then, at the age of 15, he suddenly began having a similar type of paresthesia in the limbs, warranting a lengthier three-month hospital stay. This time treatment was not effective in resolving the symptoms, as the patient was discharged from the hospital with weakness (reduced muscle tone) of the arms and legs, bilateral atrophy of the muscles between the fingers (still capable of finger abduction and adduction though inhibited and weak), and bilateral leg weakness (he is able to walk with the assistance of a walker).
Over the years, his condition has seemed to stabilize for the most part, but I did notice bilateral muscle atrophy of the extremities below the wrists and ankles. Do you think Chinese medicine medicinals could effectively treat his condition? Please offer your invaluable insights!
A: GBS and its subtypes and variants are postinfectious pathoconditions, resulting in inflammatory demyelinating polyneuropathy. This patient has apparently incurred a relapse, one of the merely 3% of GBS patients who do.
At the onset (acute stage), it can be identified as exterior pattern. In the post-acute stage (≤ 6 months) without administration of immunosuppressants (i.e., corticosteroids, intravenous immunoglobulins (IVIG)) and the presence of inflammation, it can be identified as yin vacuity fire pattern, requiring administration of yin-enriching fire-downbearing medicinals. In the post-acute stage, following the administration of immunosuppressants and the absence of inflammation. In the chronic stage, it can be identified as dual vacuity of qi and blood with kidney yang vacuity pattern or kidney yang vacuity pattern.
Your patient’s condition can definitely be classified as in the chronic stage, requiring the administration of formula variants such as Shi Quan Da Bu Tang, Ren Shen Yang Rong Tong, You Gui Yin, Shen Qi Wan, Bu Yang Huan Wu Tang, or Gui Qi Jian Zhong Tang. Just make sure to include The Three Great Yang Supplementers,* ma huang, di long, and ren shen / chuan qi powder.
If tetany (periodic painful muscular spasms, tremors and hypertonicity) presents, then add The Three Insects; and if anal sphincter paralysis presents with constipation, consider prescribing either Paralysis Formula #2 (Shi Quan Da Bu Tang variant) or Paralysis Formula #3 (You Gui Yin variant).
Treatment of acute postinfectious demyelinating pathoconditions such as GBS during the “golden period” (acute stage ≤ 2 weeks) will inevitably provide the best outcome. For patients presenting with exterior pattern symptoms of fever, generalized malaise, and heaviness and painful distention of the limbs at the early onset of infection, you should prescribe heat-clearing exterior-effusing formulas such as Yang Dan Tang, Da Qing Long Tang and Ge Gen Tang. Just make sure to include The Three Yellows:** sheng shi gao, ma huang and di long. Chinese medicine can still offer effective treatment during the post-acute stage (≤ 6 months), but the results will take longer, with a less likely chance of complete recovery.
CM offers excellent therapeutic efficacy for the treatment of GBS. However, your patient has already entered the chronic stage. Intervention now will first involve preventing further deterioration and muscular atrophy, and then working toward progress in the future.
Let’s put it this way: If it takes one month to stabilize the condition and two months to start showing signs of progress, then you could consider yourself well on the way to becoming a “master” physician.
Typically, for most patients like this, it will take anywhere from six months to one year to achieve significant improvement in symptoms. That’s why it is important from the outset to clearly explain your therapeutic regimen and the likely time frame for progress – and by all means to have patience!
Remember! GBS may also cause cardiovascular autonomic dysfunction (arrhythmia) and even respiratory failure that leads to death. So stay vigilant and be prepared to respond!
Case #2: Lung, Liver and Lymphatic Metastases (From Volume I)
Q: The patient is a 62 y/o female who was diagnosed with left-sided breast cancer and had a lumpectomy performed three years ago. This year she began having shortness of breath and heaviness in the chest, so she went to have it checked out. Examination confirmed the cancer had spread to the lungs, liver and lymphatics. At this stage, what is the best treatment approach?
A: If the patient has already started chemotherapy, then I would prescribe a heat-clearing, phlegm-damp-transforming and water-disinhibiting formula such as Chai Ling Tang (large doses of fu ling and ze xie), adding ting li zi, fang ji, ma huang, xing ren, da huang, and ren shen / chuan qi powder. And if hematopoietic dysfunction presents, then add The Three Great Yang Supplementers and Xi Lu Rong.***
If the patient has not received chemotherapy, then you can still prescribe the above prescription, subtracting The Three Great Yang Supplementers and adding Tong Jing Fang (breaks blood and frees the channels) instead. If there is metastasis to the lymphatics presenting with swollen lymph nodes and tidal fever, then add qing hao, zhi mu, and di gu pi.
Shortness of breath suggests pleural effusion, for which Chai Ling Tang variant can be prescribed to relieve symptoms and allow the patient to live in harmony with this condition.
Remember! If chemotherapy and/or corticosteroids have not been administered, then this condition can be identified as stasis heat pattern, and thus, you should not add The Three Great Yang Supplementers!
Case #3: Non-Hodgkin’s Lymphoma (From Volume I)
Q: A 70 y/o female patient was diagnosed with non-Hodgkin’s lymphoma (NHL) and she presented with swelling on the left side of her nose. She is currently receiving chemotherapy and her WBC count is slightly low, but she has a good appetite. Is it necessary for NHL patients to receive chemotherapy?
A: If the diagnosis of non-Hodgkin’s lymphoma is indeed accurate, then you can follow the shao yang heat pattern therapeutic approach. You can prescribe shao yang-harmonizing / resolving and blood-nourishing, yin-enriching formulas such as Xiao Chai Hu Tang, Di Gu Pi Yin, or Shui Niu Jiao Di Huang Tang. Just make sure to include qing hao, zhi mu, di gu pi, huang qin (and/or huang lian and huang bo), chuan qi, yu sheng wan, and wan ling dan.
If soft, diffuse swelling of lymph nodes present, then add The Four Lings**** (disinhibit water by bland percolation and fortify the spleen and disinhibit dampness) or change the formula to Wu Ling San, adding huang qin (large doses), qing hao, mu dan pi and di gu pi.
If chemotherapy induces leukopenia, then you should add ren shen / chuan qi powder to promote an increase in the WBC count. If the WBC count does still not increase, then add The Three Great Yang Supplementers.
Remember! Once chemotherapy has been discontinued, you must subtract The Three Great Yang-Supplementers; otherwise, lymph node enlargement may return.
Notes
*Gan jiang, fu zi and rou gui.
**Huang qin, huang lian and huang bo.
***Xi lu rong (fine-haired deer antler) is a premium-quality lu rong that has reached 60% to 70% growth (thus at peak hormone levels), which Dr. Lee identifies as xi lu rong, with the “fine” velvet sheen of the antler describing its texture and appearance.
****Fu ling, zhu ling, ze xie, bai zhu,and cang zhu.
Formulas
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