Patient Last Name: Dv00 Patient First Name: A
Treatment Date and Time: 5/13/00
Sex and Age: Male, 29
1. Chief Complaint: impotence
2. Medical History:
Present Illness: the onset of patient’s illness was approximately one year ago. He was in the Peace Corps, and would spend his summers in West Africa. While there, he was dating a West African woman whom he would see each summer. In his last summer, he told the woman that they shouldn’t continue their relationship and she became very upset. That night at dinner, the patient thought his food tasted funny. After completion of the meal, he felt a cold, numbing sensation from his lower abdomen to the tip of his penis. He described the sensation as if Ben Gay had been rubbed there and the heat wore off leaving it cold and numb. He has had this ever since, and has been unable to achieve an erection or any sensation. He later learned that his ex-girlfriend had gone to see a West African witch doctor who had cast a spell on him and had treated his food with some herbs. After seeing western doctors to no avail, patient went to see an herbalist who misdiagnosed the impotence as a kidney yang deficiency. Patient was prescribed herbal formulas to tonify his yang, and as a result, has experienced such great heat signs that his hair began to fall out and his upper body is laden with heat and dryness.
b. Current Health Status:
Temp: hot
Sweat: none (unable to sweat)
Thirst: for cold liquids
Urine/Urogenital: 2 x/day, moderate amount, clear to yellow in color. Testosterone and prostate normal
Energy: low
Sleep: difficulty falling asleep; gets too hot to sleep; restlessness; vivid strange dreams
Emotions: worry, anxiety, frustration regarding impotence; has lost passion for life; difficulty experiencing joy; difficulty socializing
Head: dry heat sensations; headache 3-4 x/week behind eyes
Ears: ringing; bright red color
Eyes: dry, scratchy, burning
Skin: face and hands very hot and dry
Digestion: gas and bloating
Stool: diarrhea 3-4 x/week; loose with undigested food
c. Past Medical History: none noted
3. Family Health History:
None noted
4. Medications: n/a
5. Allergic History: n/a
6. Physical Exam:
a. Tongue: body: red, scallops, center cracks, red tip
coat: dry, thin white, scanty
veins: dark and distended
b. Facial complexion: slightly red, with bluish hue around eyes and mouth
c. Body shape and posture: tall thin
d. Shen: diminished, lacking vitality
e. Listening and Smelling: groaning voice
f. Palpation:
i. Pulse: 88 bpm
Right – wiry
Left – wiry
ii. Abdomen/Channels: none done; feet very cold
9. Diagnosis: yin vacuity
10. Correspondence of Signs & Symptoms: heat sensations; inability to sweat; thirst for cold; scanty urine; restlessness; inability to sleep; anxiety; tinnitus; dry, scratchy, burning eyes; red tongue, especially tip; scanty tongue coat; rapid pulse
11. Treatment:
a. Points: SP 4
KI 3, 6
LV 8
REN 4
LV 5
b. Herbs: Tian Wang Bu Xin Dan
6/1/00
Changes: dry heat around chest and nose (worse at night and late afternoon). Temperature still hot; hair still falling out, but not as much, oil returning. Emotions affected by hair; feels tired and old, but a little happier this week about hair. Slight sweat this week – needed deodorant for first time. Headache frontal dry heat
Points: Ki 1, 7, 10
LV 8
UB 23, 43
Du 14
Herbs: alternate Tian Wang Bu Xin Dan and Zhi Bai Di Huang Wan
6/8/00
Changes: difficulty sleeping; missing spark – no more desire or zest for life; head really hot and dry
Points: KI 7, 24
HT 3
PC 8
Du 20
Herbs: Gui Zhi Jia Long Gu Mu Li Tang
6/15/00
Changes: after formula noticed warmth and slight sensation in genitals; more oil in hair; energy better. Boiled last two bags together and drank entirety in one hour.
Points: UB 18, 23, 44
KI 2, 7
LV 8
PC 7
Herbs: Gui Zhi Jia Long Gu Mu Li Tang + Sheng Di, Shi Gao and Zhi Mu (with large doses: 90g of Long Gu and Mu Li; 30g of Shi Gao and Zhi Mu; and 24g of rest)
6/22/00
Changes: felt great; majority of heat symptoms gone. Prior to treatment he rated his heat on a scale of 1-10, at 12/10; at this treatment he rated it a 5/10. Also, more warmth in genitals and progressively more sensation.
Points: HT 3, 8
LV 2, 8
SP 2, 9
KI 2, 10
Herbs: same (using Long Chi instead of Long Gu)
Pathology: Patient’s pathology appears to be a combination of spiritual and iatrogenic causes. The onset of patient’s inability to achieve sensation in his genitals directly followed a meal in which his food was tainted with herbs (and possibly witch craft). The focus of these herbs (and witch craft) was to specifically affect patient’s genitalia, making him unable to be intimate with another woman, the result of a vengeful action perpetrated by an ex-girlfriend. While it is not clear what herbs (or spells) were used, it is clear that the result was to leave the patient impotent with a numbing cold sensation. This cold sensation, however, should not be confused with a Kidney yang vacuity – the cold is limited to this area, had an immediate onset, and there is an absence of any other yang vacuity signs. Unfortunately, the first herbalist that patient visited made this mistake and prescribed yang tonics. These yang tonics caused immense heat signs in the patient, resulting in the symptoms listed above. Thus, patient’s presentation is a mixture of demonic possession, herbal toxicity, and iatrogenic causes. His pattern currently presents as a yin vacuity with a separation of yin and yang. Patient’s signs and symptoms reflect floating yang; all of his heat signs are on the upper half of his body. His lower body is cold, with lack of sensation. The herbal and demonic causes of his condition caused an imbalance of yin and yang; a separation at his root or dan tian. The Kidney yang formulas that he was prescribed furthered this imbalance by warming his unanchored yang and scorching his yin. Physically, this imbalance is manifested by the extreme heat signs in the upper half of his body and the coolness in the lower half. Psychospiritually, the herbal toxicity, witch craft, and betrayal from an intimate relation has resulted in patient’s difficulty experiencing joy and loss of passion in life. Patient’s Heart and Kidneys, the central axis of spiritual stability, have lost communication. This has caused the patient to become separated from his destiny. With this loss of communication between fire and water, other elements become affected. For instance, along the sheng cycle from water to fire exists wood. The wood element is responsible for mediating the flow of qi between the water/jing and fire/shen. When the jing and shen are not in contact, the flow of qi becomes disordered. Here, patient has some qi stagnation which has resulted from this disharmony. It is reflected in his frustration, wiry pulse, and dark and distended sublingual veins. On the other side of the sheng cycle between fire and water exists earth and metal. These elements, too, have been affected. The fire in the upper jiao has affected the yin of the metal element reflected in patient’s low energy, hot skin, inability to sweat, heat around chest and nose, etc. The disharmony has also affected the earth and yang of the metal elements resulting in thirst for cold liquids, frontal headaches, gas and bloating, loose stools with undigested food, and scalloped tongue with center cracks.
12. TCM Patterns of Impotence (Therapeutics of Chinese Medicine, by Yan Wu)
PATTENS
DEBILITATION OF LIFE GATE FIRE
KI yang defic
80% Complete or partial impotence, frequent spontaneous seminal discharge, dizziness and vertigo, tinnitus, pale complexion, cold limbs, listlessness, weak aching lower back and legs, frequent urination
T: pale w/ white coat
P: deep thready Ren 4, 2, KI 11
Du 4
UB 23
KI 3
Du 20
UB 31-34 [Ba Liao]
For vacuity of HT/SP add UB 15, HT 7, SP 6 Wu Zi Yan Zong Wan
Zan Yu Dan Also for female infertility
DOWNPOUR OF DAMP HEAT INTO L.J. Flaccidity of penis w/ inability to achieve or sustain erection, accom by premature ejac in most cases; also, sweatiness in scrotum, heavy aching lower limbs, thirst or bitter taste, dark burning urine
T: yellow slimy coat
P: slippery rapid Ren 3
Du 4
SP 6, 9
ST 36
LV 5
If KI yin also, add KI 3 Long Dan Xie Gan Tang
If KI yin also, Zhi Bai Di Huang Wan