Case Study - Lupus (05/21/12)

Main Complaint: 
Lupus
Relevant History: 

Female, caucasian
38 yrs old.

Main Complaint: infertility
Secondary Complaint: Lupus Erythemotosus
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001471/

Signs and Symptoms:

Shen: dull pale but lively
Pulse: Earth excess, Fire Deficient, Wood Excess and Deficient, Metal slippery, Water Deficient.
Tongue: very thin, patchy moderate white coat, red tip, severely scalloped/ratty

Fire: tongue, occasional palpitations, pulse, midnight insomnia, one recent nightmare, fatigue
Earth: loose stools with dairy, poor energy, intermittent swollen glands, pulse, bi syndrome, fatigue
Metal: history of upper respiratory tract infections, occasional slippery Metal pulse
Water: miscarriages, infertility, hair falls out, history nephritis, ear blocks
Wood: rash with gluten, wakeful: 1-4 am, 12-3 am., occasional stiff neck, pulse.

Bowels; small hard dry “goat stools” except with dairy.
Sleep: Wakeful 12-3/1-4.
h/c: extremities sl. cold
Other; left sided/vertex headaches, GB channel, switches sides; occ. vertigo, mild menstrual symptoms, swollen joints usually on the yangming, also hangnails/on Metal.  Patient is very short, barely 5 feet tall. Average weight.
Ear: marked discoloration at the cardiac orfice.
Abdomen: pain at left GB24, LU1-2, CV17, rt ST 27, 28. Pressing CV2 induces acid reflux. CV8 is damp, lower abd. is tense.
Medications/food; lupus meds, lactaid, betatine hydrochloride, limits gluten,dairy, sugars. Apple cider vinegar bath for rashes.

Headaches, fatigue and insomnia (as opposed to bi syndrome) are the most significant symptoms. The patient has had three miscarriages and one abortion.  The abortion and one of the miscarriages occurred before treatment began. She tends to exhibit a rash after conception.

Overall Diagnosis: 

Female, caucasian
38 yrs old.

Main Complaint: infertility
Secondary Complaint: Lupus Erythemotosus
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001471/

Signs and Symptoms:

Shen: dull pale but lively
Pulse: Earth excess, Fire Deficient, Wood Excess and Deficient, Metal slippery, Water Deficient.
Tongue: very thin, patchy moderate white coat, red tip, severely scalloped/ratty

Fire: tongue, occasional palpitations, pulse, midnight insomnia, one recent nightmare, fatigue
Earth: loose stools with dairy, poor energy, intermittent swollen glands, pulse, bi syndrome, fatigue
Metal: history of upper respiratory tract infections, occasional slippery Metal pulse
Water: miscarriages, infertility, hair falls out, history nephritis, ear blocks
Wood: rash with gluten, wakeful: 1-4 am, 12-3 am., occasional stiff neck, pulse.

Bowels; small hard dry “goat stools” except with dairy.
Sleep: Wakeful 12-3/1-4.
h/c: extremities sl. cold
Other; left sided/vertex headaches, GB channel, switches sides; occ. vertigo, mild menstrual symptoms, swollen joints usually on the yangming, also hangnails/on Metal.  Patient is very short, barely 5 feet tall. Average weight.
Ear: marked discoloration at the cardiac orfice.
Abdomen: pain at left GB24, LU1-2, CV17, rt ST 27, 28. Pressing CV2 induces acid reflux. CV8 is damp, lower abd. is tense.
Medications/food; lupus meds, lactaid, betatine hydrochloride, limits gluten,dairy, sugars. Apple cider vinegar bath for rashes.

Headaches, fatigue and insomnia (as opposed to bi syndrome) are the most significant symptoms. The patient has had three miscarriages and one abortion.  The abortion and one of the miscarriages occurred before treatment began. She tends to exhibit a rash after conception.

Treatments Offered: 

Treatment began on 9/2/11 and continues to present. Most of the treatments focused on the Chong (PC6, SP4) with additional points or moxa for LV stagnation, Earth deficiency/excess, and KD deficiency as needed. Treating the HT directly often results in severe insomnia so I avoid it, opting for PC7 instead. When she conceives I discontinue the Chong which I feel is too moving and focus on tonification via the shu points and treating the rashes. As treatments progressed I started using the tongue more as a benchmark and observed a definite overall improvement (less thin and ragged, less damp) as I used more moxa, especially rice grain moxa on ST36, SP9, SP4. I chose this course in spite of the excess ST pulse. Recently I’ve begun bloodletting the jingwells, usually just one side, ST45, and occasionally the third toe which both of which exhibit flat moles and a hot looking area around the nail bed. This seems to improve her sleep. I also do rice grain moxa on her fingernail beds when she has a hangnail, most recently on rt SI, nail bed and mid-finger.

Duration and Outcome: 

Treatment began on 9/2/11 and continues to present.  As treatment progressed her bowels improved so though small and hard were less difficult to pass. Her digestion is also became more resilient to damp foods (which usually cause loose stools, severe malaise and headaches) Her energy has improved and her joints are better. Her headaches improve with pregnancy.

She conceived after tx 3, miscarried--the fetus’s development was delayed by one week--at week 6. Conceived again at treatment 21; miscarried a Down’s Syndrome fetus at approximately week six. The first miscarriage (during treatment) resulted in prolonged bleeding, ending in a d/c. When she conceives I discontinue the Chong which I feel is too moving and focus on tonification via the shu points and treating the rashes. She recovered much more quickly after the second (third) miscarriage, with the exception of her bowels which took longer to go from extreme blood deficiency constipation to small but not difficult to pass. 

After her most recent treatment we had a conversation about treatments during early pregnancy. She’s having a type of IUI this week (no hormones) and although acupuncture makes her feel good, she’s worried about introducing a new factor early in the pregnancy. I told her to listen to her gut and take it one step at a time.


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