Parkinson's Patient--Metal or Wood?

Parkinson’s Patient

Relevant History
Male, Caucasian, 57 yrs old.

Main Complaint: Parkinson’s Disease, ‘09
Secondary Complaint: Sinus issues.

Signs & Symptoms

Shen: glassy pale, red blotches, very slight eye shadows, occasionally green when he’s been drinking.

Pulse:
Fire, SI excess, Ht ok, PC & TW ok,
Earth; thin, wiry,
Metal--deep (LI deficient, LU better),
Water: OK.
Wood: deep, slightly wiry,

Tongue: swollen, moderately purple, dry with moderate yellow coat heavier in rear, veins sl. swollen
Abdomen: overall cool, tense below CV8, subcostals very tight, pain at LV14, CV17, tense at right ST25 & 26.

Interview (underlining note s/s that I am now benchmarking)

Fire: history of Shen issues, difficulty falling asleep, dreams most night for most of his life, fewer Shen issues w/treatment.
Earth; damp skin, tongue, large decades old black head at BL25 (drained of putrid damp), another smaller at BL21, sinus issues, occasional halitosis, better w/o dairy, dandruff. Hx of obsessional thinking (mostly about his condition, better now.) Eats too much sugar.
Metal: dx’d at time of pet dog’s death, sinus issues, history of bronchitis, born with underdeveloped lungs (Hylane Disease) rashes. Seasonal allergies. Small chest. Sensitive LU5.
Water: born prematurely, both knees operated on, history of nocturia and low back pain, fearful, tinnitus 1xmth. Gait.
Wood: history of consistent almost problematic drinking (red wine) less so since in treatment; lots of coffee; hx of disturbed sleep, clicking occiput & constipation; left arm trembles with painful clenching 1x/2wks, occipital headaches, 1x/mth. Spells of slight dizziness, 2x week, eye fatigue, energy worst 1-4 pm. Does not eat red meat. Tends towards constipation. Hx of depression. Maybe a green tinge to extremities, but I more grey-yellow. Occasional itching.

Bowels: tends towards constipation, better w/treatment.
Sleep; difficulty falling asleep, dreams most nights (hx of difficulty staying asleep.)
H/C; three years ago he had bouts of night sweats/chills; occasional halitosis, now tends to warm.
Medications: Celexa, 40 units/day.
Other; the trembling in his left arm and gait is worse with increased movement and not worse with fatigue. Stiff gait typical of Parkinson’s. Energy good most of the day. Left hand occasionally feels stiff and tight. Hands and feet have puffy, grey “HT” appearance. Patient is functional (nice, sensitive, artist) neither the emotional issues or drinking interfer w/him holding job and being (seemingly) a good father and husband.
Hospitalizations: traumatic birth, knee surgury.

Note: The most significant aspect of this case is that the pulse, tongue, abdomen or Shen rarely reflect a strong Liver or KD pattern. The patient was born with a serious Metal deficiency that has contributed to a weakness in the Fire phase.

Overall Diagnosis

Deficient Metal not Controlling Wood, Wood Deficient, Liver Yang Rising Wind, Deficient Metal leading to Phlegm.

Treatment

I’m going to omit most of this section since the duration of treatment has been almost a year and I’ve tried just about everything with moderate success. That includes cupping, most forms of moxa, and blood letting (but not electro since I find it aggravates wind.) I usually include some Tuina on the affected arm.

I have not yet tried the Tong Ren/Tiandong/Window of the Sky treatment suggested here.

Writing this has lead me to believe that I should strongly tonify Metal and focus less on dampness & Wood.

Duration and Outcomes

Treatment began 2//11 and continues today.

Some symptoms--most significantly depression--have disappeared (low back pain, disturbed sleep, obsessional thinking, occipital clicking, rashes.) Others have improved significantly; drinking, headaches, nocturia, constipation, Shen. Slight improvement in painful clenching, sinuses, gait.

Occasionally complains of being “wiped out” by treatments.

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