Post by Master Kim on Dec 19, 2014 17:05:06 GMT -5
An acupuncturist's question in a Facebook group, Acupuncturists on Facebook
I have a complicated case that I would love some help with. 13 year old boy with abdominal pain all across entire abdomen for 5 days. Pain is 7/10 and achy, but he gets waves of intense sharp, stabbing pains that get to 9/10.
Long history here so I will summarize. Over the last year he had strep throat 8 times. Has of course taken tons of antibiotics. His last bout of it was in August. Had strep, double ear infection, sinus infection. Once The infection cleared up, he was left with constant nausea for 2 months, during which time he was still having chronic sinus issues and a cough. 3 weeks ago he finally started feeling better, so his tonsils were removed 11/14 due to all the strep throat infections. Then all of a sudden 5 days ago he woke up, went for a walk, ate one scrambled egg, and then this pain just hit him suddenly and hasn't gone away since. Went to ER and they found nothing except CT showed some inflamed mesenteric lymph nodes and fatty liver. Also showed that sometime in the past he had giardia, but the family has no memory of this. Doctor has diagnosed it as "functional abdominal pain" and referred him to a psychiatrist. They are also doing a stool culture and blood work. Waiting on results.
Bowel movements: has only had 3 in the last week, 2 of which were diarrhea, and with stronger odor than usual. (He normally goes 1-2 times per day) Bowel movements have no effect on the abdominal pain. Appetite is low now bc of pain. He is overweight however. He did recently gain 20 lbs in the 3 weeks after his bout of nausea passed. 194 lbs, 5'2".
Currently he is running a low grade fever of 99.3, but he says his fever never gets above 100, even with strep throat. BBT tends to run about one degree low). However, he always feels hot. Does not ever feel thirsty. Only drinks about 1-2 cups of water a day.
Long history of nasal allergies, constant postnasal drip since he was a young child, asthma sometimes with exertion, lots of phlegm generally. His abdominal temperature was distinctly divided: was VERY cold above the belly button, but quite warm below. All the was across to his sides. The pain is not limited to any particular location. It encompasses the entire abdomen.
Tongue is light red, with slightly narrow tip. Coat is very dry bits of thick white coat. Like little sprinkles of coat, mostly in center and back. Pulse overall deep and xu, but wiry and choppy in SP position. Today I just did acu (Sp 6, St 36, Ren 12). It was his first time so I kept it simple. Also put heat lamp over cold abdomen which warmed up nicely, but no change in his pain during the treatment. I'm thinking about herbal formulas, but he has mixed heat and cold and phlegm, so I'm not really sure which direction to go in. Li zhong wan was my first thought, but I'm afraid that will be to warm for him. Ban Xia Xie Xin Tang comes to mind as well. Any thoughts on herbs? Would Xiao Chai Hu Tang be appropriate here?
I have a complicated case that I would love some help with. 13 year old boy with abdominal pain all across entire abdomen for 5 days. Pain is 7/10 and achy, but he gets waves of intense sharp, stabbing pains that get to 9/10.
Long history here so I will summarize. Over the last year he had strep throat 8 times. Has of course taken tons of antibiotics. His last bout of it was in August. Had strep, double ear infection, sinus infection. Once The infection cleared up, he was left with constant nausea for 2 months, during which time he was still having chronic sinus issues and a cough. 3 weeks ago he finally started feeling better, so his tonsils were removed 11/14 due to all the strep throat infections. Then all of a sudden 5 days ago he woke up, went for a walk, ate one scrambled egg, and then this pain just hit him suddenly and hasn't gone away since. Went to ER and they found nothing except CT showed some inflamed mesenteric lymph nodes and fatty liver. Also showed that sometime in the past he had giardia, but the family has no memory of this. Doctor has diagnosed it as "functional abdominal pain" and referred him to a psychiatrist. They are also doing a stool culture and blood work. Waiting on results.
Bowel movements: has only had 3 in the last week, 2 of which were diarrhea, and with stronger odor than usual. (He normally goes 1-2 times per day) Bowel movements have no effect on the abdominal pain. Appetite is low now bc of pain. He is overweight however. He did recently gain 20 lbs in the 3 weeks after his bout of nausea passed. 194 lbs, 5'2".
Currently he is running a low grade fever of 99.3, but he says his fever never gets above 100, even with strep throat. BBT tends to run about one degree low). However, he always feels hot. Does not ever feel thirsty. Only drinks about 1-2 cups of water a day.
Long history of nasal allergies, constant postnasal drip since he was a young child, asthma sometimes with exertion, lots of phlegm generally. His abdominal temperature was distinctly divided: was VERY cold above the belly button, but quite warm below. All the was across to his sides. The pain is not limited to any particular location. It encompasses the entire abdomen.
Tongue is light red, with slightly narrow tip. Coat is very dry bits of thick white coat. Like little sprinkles of coat, mostly in center and back. Pulse overall deep and xu, but wiry and choppy in SP position. Today I just did acu (Sp 6, St 36, Ren 12). It was his first time so I kept it simple. Also put heat lamp over cold abdomen which warmed up nicely, but no change in his pain during the treatment. I'm thinking about herbal formulas, but he has mixed heat and cold and phlegm, so I'm not really sure which direction to go in. Li zhong wan was my first thought, but I'm afraid that will be to warm for him. Ban Xia Xie Xin Tang comes to mind as well. Any thoughts on herbs? Would Xiao Chai Hu Tang be appropriate here?
Based on Ascetic Saahm's formula #1, fostering lung,
subdue LI5, ST41, SI5, BL60, KI2, GB38 and LR2.