Rectifying Devastated Yang 'Shock' From an Erroneous Diagnosis
By Isali Ben-Jacob
The patient is a 30-year old male of slender, tall build, who presented with a chief complaint of palpitations. On reviewing the intake, his pulse rate was approximated to be 190-200 BPM, with a blood pressure of 90/70, general signs and symptoms of cold perspiration, fatigue and dizziness, and a cold body temperature.
The diagnosis of record was noted as deficient heart yang, and the treatment given was acupuncture and an herbal formula. The apparent plan of treatmet was to lift the yang and provide some warming.
Acupuncture points selected were Du 20 (regulating yang), Du 26 (regulates yin/yang), P 6 (interior gate), and S 36 (command point, middle jiao). The initial herbal formula consisted of huang chi, dang shen, gan jiang, wu wei zi, bai shao yao, and gui zhi, with the apparent intention to lift the chi and warm.
On entering the case at this point and noting from the record that the intake appeared to be incomplete and inconsistent with the additional signs and symptoms noted, as the patient suffered from extremely cold limbs with muscle stiffness of the hands; a pallor, lusterless complexion; shivering from the cold sensation; profuse cold perspiration (leaving the clothing wet); and a collapsed, pale purple tongue, I concluded the diagnosis to be that of devastated yang -- a collapse.
Deficiency of yang refers to a worsened state of chi deficiency and is a consumption of essential chi. It presents itself as with a "relative" excess of yin. It is, in conventional medical terms, an immunologically degraded organic circumstance that describes an inability of the body to react with sufficiency to rectify an assault.1
Deficiency conditions of yin/yang are a reflection of the principle of the interconsuming supportive relationship. A deficiency of yang requires acquisition of the yang within the yin.2
The general clinical presentation of a deficiency of yang is in part of body chills, cold limbs, perspiration of a spontaneous nature, fatigue, a pale tongue, and a weak pulse.3
Collapse of yang, on the other hand, refers to the exhaustion of the yang chi from the body, its active component. The clinical presentation is that of "profuse" cold sweat, a cold body, "frigid" extremities, empty breathing, a "pallor, lusterless" complexion, an absence of thirst, a pale, moist tongue, and a "fading" pulse, which is the clinical picture of the patient.4
Shock is "a state in which blood flow to and perfusion of peripheral tissues are inadequate to sustain life ... usually associated with hypotension." The general signs and symptoms include cold hands and feet, moist, pale/bluish skin, and a weak, rapid pulse. The systolic blood pressure is <90 or is not obtainable.5
The patient's condition developed over several hours and was more consistent with an assessment of hypovolemia, a form of shock that is an immunological breakdown reflecting a condition of regulatory rigidity associated with rising hemoglobin and/or hematocrit levels. This could reflect a thermal injury, and is frequently associated with a concurrent condition of vasodilation.
Hypovolemia is a condition of reduced cardiac output; vasodilation is a regulatory failure of the vessels and dehydration. The plan of treatment requires elevating the blood pressure in order acquire systemic stability, and warming the patient is a preferred primary intention.
The patient's arms felt like ice cubes. His laconic speech, lusterless complexion, and remarkable profusion of body fluids evidenced on his skin strongly suggested that this was a collapsing condition of yang requiring an immediate interior warming of the patient. His pulse rate suggested the integrity of the thalamus-adrenal connection, and his otherwise clinical picture inferred a regulatory disruption along the hypothalamus/pituitary/adrenal path.
The initial herbal formula used dang shen, where the condition called for ren shen. Though they each provide a tonifying action of the chi, the ren shen strongly supports the basal chi and is more appropriate for collapsing conditions. In large dosages, it has demonstrated efficacy on the cardiac system by raising the blood pressure, which was "the" pre-eminent issue in this case.6,7
In addition, within the original formula, warming was intended with gui zhi (cinnamon twig)8 where the condition called for rou gui (cinnamon bark).9Gui zhi, though with similar characteristics to the bark, according to all literature is intended to address dispersal actions as in diaphoresis, which was contraindicated in this case, as the patient manifested not only spontaneous perspiration, but profuse perspiration. Rou gui is intended to warm the interior of the body and expel cold with an action that returns heat to the basal chi.
Devastated yang is seen as an "exhaustion and collapse of the yang ... which is accompanied by severe deficiency of the source chi, the sudden collapse of the yang chi, and an increase of cold in the interior ... characterized by cold extremities, an aversion to cold, an a submerged, faint ... pulse."10
The herbal formula called for was si ni tang, containing fu zi, gan jiang, and zhi kan tsao, as it treats the picture of "extremely cold extremities, acersion to cold ... lethargic state, pale tongue with a white coat ... a thin or submerged faint pulse."
The significance of this formula is that it "strengthens" the yang of both the spleen and kidney systems without injurious consequences upon the yin. The pathogenic factor of cold invades the interior and finds its deposit in the "lesser yin" stage as a shaoyin syndrome, and may thereafter reflect a condition of shock. A cold shaoyin condition was the clinical presentation of this patient, and the plan of treatment was with acupuncture with points along the Ren, Spleen and Kidney pathways, with an emphasis on the use of moxibustion, a protocol that delivers warmth.11
Homeopathically, the remedies that fit this picture are veratrum album and carbo vegetabilis, with the potency delivered (in this case) of 10m in the amount of four drops. Carbo vegetabilis is a vegetable charcoal, and presents itself for conditions of "degeneration" that reflect poor oxygenation of the blood system, making it quite appropriate for an atonic condition. Veratrum album is a flower that addresses conditions of collapse with extreme coldness, prostration, cold sweat, spasm of limbs, fainting, lusterless complexion, and chills with extreme coldness.
The clinical picture for this remedy is an icy-cold body, loss of fluids, a lifeless lassitude, a collapsing state with its attendant feeble pulse, tremors, profuse cold sweat, cold limbs, cardiac pulsation throughout the body, stiffness of the limbs, and dizziness.
Additional information was evidenced from the patient, who indicated a history of several such incidences over the past two years, without any appreciated diagnosis or sustained plan of treatment.
As there appeared to be reactive capacity, it was inferred that intracellular structures and enzymatic actions remained with integrity, and that the filtering actions of the "matrix"13 remained visible. This patient's condition appeared to be rooted within the deposition phase at an immunological stage of disharmony, and with an assault within the impregnation phase, wherein the organism's reaction appeared with some aspects of regulatory rigidity. This was evidenced by impaired blood circulation with its attendant deficiency of nutrient transport and condensation of homotoxins, resulting with an apperance of collapse.
The plan of treatment with homotoxicological remedies was with a composition and an injeel, which was applied SC at G 25. The remedies selected were Cor Compositum and Circuloheel, both remedies by Heel.14
The composition constructs from Heel offer low-potency constituents that cover a broad range of therapeutic action, offering remedies with "similar or complementary tropism action ... are particularly suitable in serious pathologies for their quickness ... connected just to the histopathological problem ... and deeper than medical herbs."15
Cor Compositum offers low-potency components that are directed to degenerated regulatory organ function, tonics (which clear circulatory stasis), and supportive remedies for the cellular protagonists.16
Circuloheel is a combination of a polycord of single remedies in which "... the administration of a potency chord the organism is addressed on several hierarchical levels ..." In this instance, the remedy attends to peripheral circulatory impediments with cold-type manifestations and offers an immanency of reaction.17,18
Testis compositum by Heel is being offered as a long-term protocol, as it is supportive of various metabolic disturbances. It accomplishes this by addressing specific organ tissue, tonification properties, and rectification of the mitochondria by regressive vicariative action due to cortisol flooding. It is of particular value when there is suspicion of an impediment along the hypothalamus-pituitary-adrenal pathway. It is suggested that this is administered Monday and Thursday, between the hours of 5 p.m. and 6 p.m.19
Ren shen yang ying tang is being offered as an herbal long-term protocol for consumptive disorders that require support of the ying chi of the body. It is suggested that 3 grams be taken three times per day (a.m. - midday - 5-6 p.m.).20
In sum, the original diagnosis was of a deficiency of heart yang, and the apparent plan was to lift the yang, whereas the condition was more likely a devastated yang, requiring a plan of treatment that warmed the yang and expelled the cold from the interior. In conventional medicine, it appeared as a condition of shock, requiring the immediate elevation of blood pressure to prevent organ failure and death. The original plan of treatment failed due to an erroneous diagnosis, and emphasizes the adage that it is easy to prescribe, but difficult to diagnose.
The distinctive benefit of the protocol herin applied both for the acute presentation and the long-term treatment is the value of integrative medicine by offering complementary mechanisms to attend to a totality of signs and symptoms, with the intention of generating regressive vicariation with the least adverse consequences.
CAM. Chapter 13: Differentiation of symptoms, 1990, pp. 278-279.
Tonify chi. In: Chinese Herbal Medicine, Formulas & Strategies, 1990, pp. 235-241.
CAM. Chapter 13, 1990, p. 279.
Ibid, pp. 281-282.
The Merck Manual, 17th edition. 1999, pp. 1704-10.
PDR for Herbal Medicine, 1st edition. 1998, pp. 1009-10.
Bensky and Gamble. Materia Medica, 1993, pp. 314-18.
Ibid, pp. 29-30.
Ibid, pp. 300-03.
Bensky & Barolet. Formulas & Strategies, 1990, pp. 215-31.
CAM. Chapter 13: Shaoyin syndrome, 1990, pp. 316-317.
Murphy R. Lotus Materia Medica, 1995, pp. 363-69, 1770-76.
Biotherapeutic Index. Ordinatio Antihomotoxica et Materia Medica, 2000, pp. 18-19.
Ibid, pp. 22-24.
Bianchi I. Homeopathic Homotoxicological Repertory, 1995, p. 331.