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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

FEBRUARY, 2000

Clinical Story of the Month 

(Copyright Stemmler 2000)

Oh, my Head! ? Oh, my Foot!??

Nadine Prince and her husband Jim had worked hard all their lives and were finally ready to enjoy their retirement. At 69, Nadine belonged to a group now known as "Young Seniors", a fast-growing sector of the population who may be looking forward to another 20-30 years of quality life. She had reached this age without any major illnesses, which was a strong factor in predicting her longevity. Her brief medical history was reflective of the surgical-interventional trends of the era: tonsillectomy as a child, back surgery in her mid-thirties, a D&C during middle age and, 4 years earlier, right foot surgery for "a foot problem" which had caused her chronic pain. As a result she had a painful scar along the outer side of her ankle, which bothered her off and on since surgery.

Nadine came to see me with a history of 4 months of severe right-sided headache. Her pain would originate from the bony prominence on the back of the skull (what we call the occipital area in Medicine), then radiate up along the back and side of here head (called the occipito-temporal area) and slightly towards the midline (a small part of the parietal area). She had developed this symptom suddenly, overnight and had never before experienced such a debilitating pain. She described it as "excruciating, a raw, burning feeling, like something pushing out from inside the skull". The area involved was so sensitive that "it made it even intolerable to touch her hair". She was unable to sleep on that side, comb her hair, or touch that part of her head in any way. The pain was constant and would not give her a break.

Her family physician first diagnosed her as having a "migraine" and prescribed a series of medications for that purpose. It is rather unlikely for a migraine to present in this constant and ferocious manner and, indeed, Nadine did not respond to any of the medications prescribed; instead, she just tolerated their various side effects without any benefit. She then consulted a neurologist. After two MRI’s and multiple medication trials (again with side effects, yet without benefits), including anti-depressants (which has become sort of a last resort drug when all else fails), the neurologist was "puzzled" with her case.

It was then that a friend suggested she try Chinese medicine and encouraged her to seek us out. By the time I saw Nadine she was a nervous wreck: fearful, dizzy, unable to sleep or eat, practically housebound. She had stopped answering the phone and did not want to talk to or see her friends. Normally a joyous, animated, active person, her natural constitution had reverted to its opposite. Only four months earlier, she and her husband had an enjoyable trip to Europe. Now, such an adventure seemed far from reality; the future looked gloomy and dreary.

As I examined Nadine I formulated a Western diagnosis of "occipital neuralgia", but I knew I needed to evaluate her in her totality in order to have a working Chinese medical diagnosis and the appropriate treatment for her. I noticed throughout my exam that even though her voice was broken by fear and anguish, every so often I could detect a remnant of a very special and contagious giggle, which probably dated back to her childhood years. I was careful not to touch the right side of her skull, since I would have easily provoked a pain crisis. While I was examining her, I continued to obtain an even more detailed story from her and her husband, a most devoted Southern gentleman who had been her loving and caring companion for almost half a century. As I observed and palpated her literally "from head to toe", I noticed that her right headache and her right ankle pain were intimately connected from top to bottom, along the gall bladder meridian. The puzzle was solved! If I wanted to cure Nadine’s headache, I had to work simultaneously with her headache and her post-surgical ankle pain. Most likely, an unresolved past surgical energetic blockage had, over the years, altered the function of that meridian, now culminating with a blockage higher up, close to the origin and along the 3 divisions of this meridian, which covered the zone of her pain.

I decided to use Chinese acupuncture, Korean hand acupuncture and a Chinese herbal formula, and proposed a series of about 10 treatments (plus or minus 2), to resolve her problem. I saw her twice a week, a journey that was difficult for them to make, living one-hour’s drive from the office. But they had a firm commitment to get well, and they never missed an appointment. A maintenance treatment was also designed for the time her headache would have resolved, since I expected that her postoperative blockage would take longer to disperse, given that it was an older problem with anatomical changes (external and internal scar formation).

Two days after her initial treatment she reported that the day after the first treatment she felt better than she had in 4 months. Now her headache was returning, but with less intensity. Three visits and 2 weeks later she was doing a lot better, being able to sleep on her right side and having had one completely headache-free day. Five visits later she was much improved and noticed pain in her low back and right lateral foot. I explained that her pain was "moving down and out of the involved meridian". Two visits and 6 weeks later she reported being free of pain for 5 days. This was her 11th visit, one more than I had predicted. Two days later she counted 7 days without pain. One week later, 13 days without pain, although, still manifesting some right foot pain, which I expected and was prepared to treat. The next week she reported a single episode of pain lasting only one hour but "frightening her to death", at the possibility of recurrence. I explained that one or two of such short flashbacks were common but did not signal a recurrence. Thereafter the pain never returned.

Today, two and one-half months later, the patient is back to her usual self, pain-free, ready to go on her next trip with her husband, giggling with that cute, innocent sound that probably brought about her husband’s first kiss and an uncountable number of friends during a well-lived life. She has now recovered in full and a really fun trip has been planned for the near future.

Christina Stemmler, M.D.

 


AS THE EMPEROR SAID…

(COPYRIGHT STEMMLER, M.D., MAY, 2000)

FEBRUARY, 2000

 

ON THE IMPOSSIBILITY OF CURING DEEP-SEATED ILLNESSES WITH SUPERFICIAL DRUGS

"It happens that a pattern (selected for a) treatment is correct but shows no positive effect whatsoever. In such cases the influences of the illness have entered (a patient) deeply and (have become an) obstinate problem that can not be cured with just ordinary prescriptions and drugs."

"(Obstinate illnesses),…as fatigue, anxiety, blockages, and stoppages, as well as wind, or obturation,)…where the affection has already lasted for more than one (or two) days…and where (the evil influences) have become tied to the proper influences just like oil entering flour, (in such cases) the patients do not know what to do, and they frequently change physicians."

"When the physicians see (that their treatments remain) without effect, they randomly toss a number of different drugs (into the patient, with the result) that the illness only penetrates deeper, day after day, while the damage to the original influences increases, until finally a point is reached where no rescue is possible at all. (Physicians) do not know that such illnesses cannot be cured with one or two ordinary prescriptions…How could anyone expect to cure (a serious illness) with such treatment patterns?"

"What is necessary is that one examines all the different variations of the illness at hand, as well as the origin of the illness, and the circumstances of any change it may have undergone. Also, one must investigate whether there have been any mistakes in the (patient’s) previous treatment with drugs…One must periodically check whether (the treatment) shows an effect, and skillfully adapt (it to any new developments). Then there may be a rationale for a cure of even obstinate ailments."

"If, though, one clings to but a few cure-all prescriptions, whose repeated applications show no effect, one’s strategies will soon be exhausted, and one is bound to have committed mistakes. For the treatment of severe pathoconditions one must, therefore, possess a profound and extensive knowledge, as well as a sophisticated and intelligent mind. Also, one must treat them with full concentration and over long periods of time, and only then will one be able to achieve results."

(Excerpt from The I-hsueh Yuan Liu Lun of 1757 by Hsu Ta-Ch’un, translated and annotated by Paul U. Unschuld and published under the title of Forgotten Traditions of Ancient Chinese Medicine by Paradigm Publications, Brookline, Massachusetts, U.S.A., 1990.)

COMMENTS

Although Dr. Hsu Ta-Ch’un practiced, taught and wrote about Medicine during the 18th century, his wisdom is current and applicable to our times, especially as it concerns the patient in our February Clinical Story.

To one doctor the patient’s headache reminded him of "migraines", so he chose "ordinary prescriptions" for such ailments, providing the patient with no relief, and allowing the condition to penetrate deeper and clinically worsen. The other doctor, a specialist, investigated further, yet still confined himself to only one area of the body (head and neck), never arriving at a conclusion of what really caused the patient’s illness in the first place.

Unfortunately, in our modern Western medicine-only-world such attempts of "curing deep-seated illnesses with superficial drugs" are often the norm. And they inevitably lead to chronic untreated illnesses and unnecessary suffering. Western medicine first dissects the person into mind and body and, further divides the mind as well as the body into multiple parts. From there it tries to diagnose ailing parts as geographically originating from the area where symptoms manifest, without paying much attention to the interaction of the parts it so skillfully dissected. That kind of linear thinking draws conclusions from very limited data, and therefore is subject to a wide margin of error. In the end it provides patients with a simplistic approach to problems which really deserve a complex and sophisticated analysis.

It is only with the addition of Chinese medicine that Western medicine will accomplish that level of sophistication in the diagnostic and therapeutic appraisal of patients. And it is only through this merging of both medical systems that patients’ conditions will be properly understood and effectively treated in a timely manner.

Christina Stemmler, M.D.


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