The practice of a TCM practitioner can often bring unusual cases through your door & the case that is being presented now certainly stands out in my career.

A female aged 38 originally sought Chinese massage to help with her fatigue and muscle aches and was then referred to me.

Ten months ago she and about 20 others who had been working in a government department moved offices. She started to feel not right after 1 week at the new office but continued on at work until the second week when everyone who worked there got sick. It was a kind of a gastric thing with diarrhea. My patient had vagueness, difficult concentration, aching in the whole body, fatigue, low grade fever; confusion, and the aching was worst in the neck & back.

In particular the mental symptoms were quite severe. She had the sensation that the head felt that is was down & the mouth was hanging open, she would get lost in well known and familiar streets, she forgot how to indicate in her car & when she put her foot down to walk she didn't know where the ground was. There was a constant spacey feeling as if drunk. There was also a dry garlic/or metallic taste in her mouth which was more pronounced before a diarrhea attack. The concentration had become so effected that when she would read, she could read the individual words but not make sense of the sentence. There are phases when she feels well but then suddenly gets stomach cramps and loose bowels.

Prior to this she was extremely healthy & active in sports. There was no history of any symptoms or problems and she was happy in her marriage, loved her kids, and went biking and walking regularly. There was only one chronic pre-existing symptom. Period pain on the second day with clotting.

The history of the building was that it had been vacant for a long time before the new government workers moved in. Prior to this there was a factory next door where a canister burst and the fumes surrounded the building. No one knows what was in the canister. It was suggested that the smoke of the burst canister clogged up the buildings air conditioning .

The whole department was then moved to another building but everyone remained sick. I asked my patient to give a questionnaire to the other workers.

The predominant re-occuring symptoms of the others were:

got sick 2-3 weeks after moving office
stomach cramps,
nausea
diarrhea
loose stools
vagueness
foggy unclear thinking
drunken feeling
metallic taste in mouth
tired/fatigue
insomnia-hard to fall asleep
wakes up during night (2-3am)
mild fever
night sweats
distorted body perceptions
dizziness

Medical tests and examinations were exhaustive and it was undecided if it was a form of Legionnaires disease, Pontiac fever, ME, or Aspergillus fumigatus contamination.

The Pulse was tight on the surface and the Tongue had a grey coat, swollen, teethmarks and a swelling either side of the centre which is heart dilation due to shock.(Macioca,1987,63)

She was quite desperate for help but still very skeptical about herbal treatment and explaining to her that an external evil had penetrated and it needed to be expelled didn't really satisfy her.

I regarded her illness as a form of ME. (Maciocia, ,632) Maciocia has summarized ME as being due to 3 main factors that is :
1.residual pathogenic factor
2.latent heat
3. lesser yang syndrome
I feel that when the air conditioning was switched on the people experienced an attack of wind bringing the pathogen with it. The pathogen was more of a damp nature.
My first formula was as follows:

Ge Geng 12g Radix Puerariae
Pei Lan 9g Herba Eupatorii Fortunei
Huo Xiang 9g Herba Agastaches seu Pogostemi
Fu Ping 9g Herba Lemnae seu Spirodelae
Chan Tuei 3g Periostracum Cicadae
Huang Bai 6g Cortex Phellodendri
Ze Xie 6g Rhizoma Alismatis Plantago-aquaticae
Fu Ling 9g Sclerotium Poriae Cocos
Shi Chuan Pu 4g Rhizoma Acorni Graminei
Tai Zi Shen 9g Radix Pseudostellariae Heterophyllae
Hong Hua 6g Flos Carthami Tinctorii

4 packets

The prescription is not based on any particular formula so an explanation for choosing the herbs is as follows.

Two symptoms stood out to me.

drunken feeling
metallic taste

Clinically I have used ge geng to treat the symptom of drunken feeling as it possibly influences the yin qiao mai (Lade,1998,17) .In fact Ge Geng does treat hangover (Bensky and Gamble, 1986 ,66) In addition, Ge Geng would symptomatically address the neck tension and loose stools.

As it was suspected that some kind of toxin got into the air conditioning system because the people got sick after the air conditioning was switched on. I related to this toxin as pathogenic damp. Clavey has given us a special use for Pei Lan where it is used for the sweet metallic taste in the mouth (Clavey,1995,p261).

Huo Xiang is commonly used in concert with Pei Lan to transform dampness and turbidity, harmonize the middle burner and to stop diarrhea and nausea. (Sionneuu, 1997,101)

Chan Tuei is used traditionally to disperse wind and heat but I used it to address her symptoms of delirium, as sometimes seen in childhood febrile diseases (Bensky,1986,55). I see no reason why it can ít be used on adults.

Fu Ping releases the exterior to help the body aches. It is cooling and balances the warmth of Huo Xiang.

Huang Bai and Ze Xie though diuresis clear damp and heat. It can be seen then that part of the herbal prescription is expelling pathogens through diaphoresis and part expelling with diuretic herbs.

Fu Ling is having a multiple role of draining damp with Ze Xie, harmonizing the middle burner with Shi Chuan Pu and tonifing the Spleen with Tai Zi Shen.

Hong Hua was added to address her underlying mild blood stasis that was causing clothing on the second day of menses.

She had 4 packets and I saw her again 6 weeks later with the following to report. There was much improvement and could do things faster at work and generally could work harder. Aching in the neck and arms was till present but much reduced. She notices that the ache gets worse when she sits or lies in bed ie the lack of movement allows damp to settle]. Now only sometimes there is a problem with individual words. Some spacey feelings still exist but not as severe as if she was drunk. Now it feels like she has had a glass of wine in the day time.

The garlic/metallic taste had also lessened.

Moods are better and there is no more fatigue. Cycling for half an hour is now a regular event.

And importantly the bowels are now normal. Concentration is still difficult, especially if learning or doing new tasks.

The tongue no longer has teethmarks and the gray coating has gone. Palpation of the pulse still revealed an external tightness so therefore I concluded the pathogen was still present. It is interesting to note the rapid change in the Tongue. Once the damp evil was expelled, the spleen Qi rapidly regenerated removing the teethmarks.

The next prescription was slightly modified.

Ge Geng 12g Radix Puerariae
Pei Lan 6g Herba Eupatorii Fortunei
Huo Xiang 6g Herba Agastaches seu Pogostemi
Chan Tuei 3g Periostracum Cicadae
Fu Ping 9g Herba Lemnae seu Spirodelae
Shi Chuan Pu 6g Rhizoma Acorni Graminei
Lu Lu tong 3g Fructus Liquidambaris Taiwanianae
Tai Zi She 9g Radix Pseudostellariae Heterophyllae
(Bei) Sha Shen 9g Radix Glehniae Littoralix
Hu Huang Lian 6g Rhizoma Picrorrhizae
Mu Gua 6g Fructus Chaenomelis Lagenariae
Dang Gui 9g Radix Angelicae Sinensis
Hong Hua 6g Flos Carthami Tinctorii

The Pulse still revealed a pathogen so I still needed to use herbs to expel damp but I could now add some tonic herbs like Bei Sha Shen and Dang Gui . Lu Lu tong and Mu Gua harmonize the middle burner as the clear Yang was still not ascending properly effecting the concentration.

Hu Huang Lian drains damp and heat. I have used it however as it treats chronic childhood nutritional impairment. & in her case help her recover from nearly 1 year of weakness.

An e-mail from her about 4 weeks later asked if it was alright to start training again in the gym and cycling like she used for about 1-1 ‡ hours at a time. She was off for an overseas trip and emailed me again about 3 weeks later to report that she was now fine.

Meanwhile at her work a toxicologist had been called in to do an examination and analysis on all the workers. Some of them still regularly have counseling and take medication prescribed by their psychiatrist and others are only able to do light work duties.

This case demonstrates the need to carefully examine symptoms and not be mislead to prescribe on other symptoms. For example ,seeing the teethmarks and having tiredness ,one could of easily gone for tonics such as Si Jun Zi Tang which I feel would of only fed the pathogen and made her more damp. Otherwise one may have chosen to address the shen in the hope to settle the spirit and bring the mental signs and symptoms under control. This may have brought relief whilst taking the herbs but I would expect only to relapse into a diseased state in between visits.


References:

Bensky,Dan &Gamble,Dan (1986 ) Chinese Herbal Medicine Materia Medica Seattle, Eastland Press Inc :p66,55

Clavey,Steven (1995)Fluid Physiology and Pathology in Traditional Chinese Medicine Singapore, Churchill Livingston :p 261

Lade,Heiko (1998) Qi Gong Newsletter of the Australian Chinese Medicine Education and Research Council, Ltd Vol 3:5 :p17

Maciocia,Giovanni ( ) The Practice of Chinese Medicine
:p 632

Maciocia,Giovanni (1987) Tongue Diagnosis in Chinese Medicine Seattle, Eastland Press :p63

Sionneau,Philippe [trans. Bernard Cote] (1997) Dui Yao The Art of Combining Chinese Medicinals Boulder ,Colorado Blue Poppy Press :p101
Heiko Lade
Email: heiko@lade.com