Tx for itching?

I wouldn’t over think those concepts, as we all know wind is a nebulous concept at best within Chinese Medicine. But I do agree in general with what you are hinting at by seeking a discussion about wind - and that is that there needs to be more of a release initially. It’s always hard to say what construction workers get into and/or react with as they are in contact with so many undesirable substances and in weather extremes along with depleting physical work - it’s a tough mix for the body to content with. But wind can arise from heat, damp-heat, and from depletion. If you think of the natural course of life for a construction worker - many start young and strong, work a lot, eat debatable diets, get older and more tired - so they start with excess heat and tap out to varying degrees over time. The dryness could be part of it as well, many workers do not hydrate well or have sugary drinks with caffeine to keep working. One of the more recent cases like this that I had it turned out after talking more he was drinking 10-12 sodas a day. We stopped that and all of his symptoms were improved almost immediately, then we fine tuned some things after that to avoid future trouble. He’d been to 5 or 6 doctors before that including a trip to Vanderbilt and nobody looked at the simple things.

Since the antihistamine worked he could just stay on that for a few months (can’t imagine no one had him try that before) - work out his other symptoms/issues and then walk him off the antihistamine and he might stay well.

If it were me, I would probably start by doing some extensive cupping, more blood heat clearing points (SP 10, UB 40, huatuo at T7, etc.), use a formula possibly like xiao feng wan (similar to what you tried, but give it a little longer), or maybe even xiao chai hu tang - to have a more clearing and outward movement the first treatment or two. Then see how the itching is and possibly then work on strengthening the system from there to avoid future problems.

Chad, Stephen thanks very much for the responses.

-I definitely intend to do cupping. I just haven’t had time for it in these first two visits.

Chad: Being a student it’s difficult to not over think everything! I don’t have enough clinical experience/results to fall back on, so it’s easy to lack confidence if I feel I don’t understand etiology. Your point is well taken though.

Re; antihistamine. I too was surprised that he said he’s never taken an antihistamine. Doctors have given him various “pills,” so maybe it was just a language/communication barrier or misunderstanding.

After this last treatment, I had him stop taking the antihistamine, just to see what results the tx would have. Perhaps next visit I’ll advise him to start taking it again and continue a course of acupuncture treatments. Xioa feng wan sounds like a good idea too.

Stephen:
That physiological explanation is illuminating. Thank you. And I had only been thinking of ST yin; I will take into account the Lung yin (which, in retrospect seems obvious considering the Lung/skin relationship).

There aren’t many heat signs except: He reported that after 1st tx and the herbs that he was less hungry (ST heat?) and would feel sated with less food and less discomfort. Also, upon 2nd visit the edges (in front of tongue and about halfway back) of the tongue did appear a bit red in the scalloped areas.

Can you clarify why you advise to refrain from SP-6 b/c of dampness? I was thinking of it more as a moving point in this context-and I wanted to address the LR pulse tightness without using LR/GB channels in order to keep the treatment focused. Just curious about your rationale-there are definitely more appropriate points for him.

Hi all, thanks for a very interesting case study and discussion. Chad and Stephen, your characterisations of the lifestyle and environment of construction workers is indeed illuminating and much appreciated! I, too am a student and I am following along with what you are all saying for the most part however I’m unclear on the cupping aspect of the suggested treatments. I’d like to understand why cupping would be beneficial to this client. We have touched on it in my course although some time back and I am due to revise. From memory cupping is good for excess conditions and opens the channels (so good for expelling wind cond’s) and is it right that it is then good for stagnation and heat symptoms? Stephen, you comment about not necessarily seeing heat symptoms and nor to focus on expelling wind, so I am unclear on the recommendation for cupping. Finally, we were also taught to take care with cupping where deficient conditions are present.
Many thanks in advance for any explanations! Jen