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Case Study - Stopping Long-Term Strenuous Exercise Suddenly: An Epidemic Treated with Chinese Herbal Medicine

by Leon Hammer

Introduction

I am presenting a patient who exemplifies a clinical example of a problem of epidemic proportions. In the United States, this problem affects thousands of young adults who present themselves to college health clinics and other medical care facilities with unexplainable severe overwhelming anxiety and frightening seemingly bizarre mental and physical experiences.

Unfortunately this condition, with much less severe symptoms, is found in older people of especially the `baby-boomer’ generation, who were raised on the false premise that extreme exercise, especially running, is necessary for good heart function, and who frequently stop abruptly when they develop arthritic problems, especially of the knees, as they age. The pulse diagnostic picture is similar.

While the issue falls within the diagnostic purview of Chronic Fatigue, the clinical ramifications are tragically much greater for the younger segment of the population. This is a `qi wild’ condition with serious, extensive and ever expanding symptoms and signs that has not been previously described in the literature. They were first described to me by Dr. John Shen when we encountered a patient with this condition in his clinic.

This paper presents the aetiology, pathogenesis, diagnostic process and the possible solutions for, the management of a young woman ten years after having suddenly and precipitously stopped exercising in college at the age of nineteen after more than eleven years of constant strenuous training as a long distance marathon runner.

Note

The patient was in the USA for a short period, several months. We worked together for about two months during which time I treated her with herbs while another practitioner treated her with acupuncture. Her situation was acute and precluded the complete methodology usually included as part of the acquisition and assessment including an exhaustive review of systems.

This patient lived in a foreign country on a brief visit home in the USA for a few months. Her symptoms made her seriously dysfunctional requiring us to intervene quickly. This urgency precluded some of the recorded information that we would ordinarily include, such as a complete registry of her complaints and history and exhaustive `review of systems’ that are instead summarized below in `presenting problems’ and in the following Symptom-Condition chart.

Presenting Problems

This thirty year old woman’s initial concerns were a feeling of not being connected to her body, that "my heart and mind are not connected”, depression, of not being alive that is very frightening, increasing sensitivity to harshness, loss of boundaries requiring a perfectly calm environment, constantly frantic with the slightest stress [cooking dinner]. Recently there is the sudden onset of increasing frightening thoughts associated with the sense of disconnection from her body and her identity.

"In addition there is postural hypotension, hair falling out and becoming coarse, extreme sensitivity to light difficulty in moving eyes, chest tightness experienced as "caving in”, a very weak voice [increased with exposure to people], unstable heat-cold sensations "giving off heat while cold”, leaking breasts, itchy legs, dry puckered skin, heavy period with clots, constipation with constipation and diarrhoea in the same unfinished movement and greatly diminished energy, especially after her usual sleepless nights with eyes open and teeth biting. Of great distress is her increasing distension of her veins of her arms, legs feet, face, abdomen that is worse with physical exertion, stress, standing, alcohol, spices, fried foods and non-organic produce. Her knuckles were stiff and red in the morning until a "liver cleanse released hundreds of gallstones”.

Recently she has sudden onset of thoughts such as sitting back in the passenger seat of her car and being impaled on knives or jumping from the car. She is scared of these thoughts and ones in which she is present in her body and elsewhere in her mind through which she has to work to get to her being.

History

The patient was four weeks premature and was kept in the hospital for an unknown time for treatment of jaundice. Mother had Braxton-Hicks contractions several times for which she was advised to drink alcohol to ameliorate them, and drank to some extent otherwise.

When asked if she experienced any trauma, physical, emotional or sexual during childhood she did not answer the question saying only that her father was an alcoholic until she was six years old and "so there may have been some emotional turmoil in the family”.

The patient has been a competitive long distance marathon runner since childhood and participated heavily in other sports. She entered college at the age of eighteen with a full athletic scholarship at a well-known university where she joined the track team and competed for a year. At the end of that year there was an episode with the track coach that led to her immediate withdrawal from the team after which she ceased running and all other athletic activity.

Symptoms began with tension, hyperactivity, could not rest in bed; eyes fluttered and open; something wrong w/ arms and legs; personality change gregarious to feeling vulnerable & reclusive. Recently she had a sudden onset of frightening thoughts and depersonalization about which she was afraid to talk.

Pulse Summary [See separate page for Pulse Chart]

Introduction

Typically, when I encounter a patient I take their pulse before inquiring about the nature of their reason for coming and their complaints and history. I find that depending as much as I do diagnostically on the pulse I prefer to not be distracted from as pure a reading as possible and influenced by other information.

Below is a record and summary of my first pulse examination. Almost immediately I was informed by one sign that alerted me to what I was to expect when I heard her reason for coming.

Pulse Analysis

#51 is a 30 year-old woman who has a severe Qi Wild condition [Yielding Hollow Full-Overflowing Wave] and whose Middle Burner is collapsing [Separation of Yin Yang].

The Upper Burner is severely Qi deficient with severe stagnation and some Damp Heat in the Lungs. In the Heart there is Phlegm Misting the Orifices ,Yin deficiency and severe Blood deficiency

There is moderate Qi stagnation and a severe Damp Heat condition in the GI system and GB with some question of Excess Heat [infection-inflammation] in the Intestines [or Bladder, perineum] (Flooding Excess in Proximal Positions and PLB).

There are signs of possible depression [lack of joy], feeling stuck [with her condition] (Cotton 3+), a propensity to panic or phobia [Mitral Valve Prolapse] and Phlegm Misting the Orifices [and possible problems with memory and attention].

In the Lower Burner there are strong signs of infection and Blood stagnation.

Symptom-Condition Chart

The purpose of this chart is to translate symptoms into Chinese medical conditions so that the focus is on the condition and not on the symptom. This is the first step in a methodology developed to teach people how to `think’ in Chinese medicine to reach a diagnosis of an individual beyond a `pattern’

SYMPTOM

CONDITION

Veins distended

Arms, legs, feet, face, abdomen.

Varicose V., petechiae on feet

Worse: Hot, physical exertion

stress, standing, alcohol,

spices, fried & de-natured fds.

Better: Meditate pulling blood

back to Heart; legs over head

spread arms® Joint popping

Separation of Yin and Yang [See below]

Stop prolonged excessive exercise suddenly 11 yrs ago:

ago:

Lost weight; tense; hyperactive; could not rest in

bed

Eyes Fluttered, twitched, and open; something

wrong w/ arms

Personality change gregarious to feeling

vulnerable & reclusive

Tired, hard to rest, loud noise shock, pain rt. pelvis.

and hip

Later: red and stiff knuckles in AM helped w/ Liver

cleanse® hundreds of gall stones; legs itchy, skin

dry, thin, puckered; periods heavy w/ clots

Recently Sudden onset of frightening thoughts & depersonalization

Tension®even cook dinner-frantic

Blood moving up w/ tension

Bite sides of mouth & teeth

grinding and loud biting in

sleep

Separation of Yin and Yang [See below]

Not connected in my body

Heart and mind not connected

Dream that friend `possessed’

could not relate to her for days

Easily startled

Separation of Yin and Yang [See below]

GB-Heart Disharmony

Depression: visions of not being

Alive-very frightening

Separation of Yin and Yang

Run down- Age 22 after college

Greatly ­Sensitive to harshness

Avoid people-lost boundaries

Need perfect environment, calm

Sense that cannot protect self

Sensitive as child-nature-awe

Separation of Yin and Yang [See below]

Energy diminished-

­Moving to England last summer

Separation of Yin and Yang [See below]

SYMPTOM

CONDITION

Postural Hypotension

Moving from family home

Separation of Yin and Yang

not true deficiency- circulation of Blood, not amount of blood

Hair

Falling out-thick, coarse

Separation of Yin and Yang

Liver Blood deficiency: probably not true deficiency-

circulation of Blood, not amount of blood

Eyes-

hard to move

light sensitivity-esp night

Spots- round, black

Separation of Yin and Yang

Liver Blood deficiency: probably not true deficiency-

circulation of Blood, not amount of blood

Kidney Blood deficiency

Chest Tightness, caving in

Relieved by `popping’ w/ meditat

Separation of Yin and Yang

[began after stopping running]

Throat

Yellow mucous in AM

Less with diet change recently

GB Damp Heat

Respiration:

Bronchitis past summer-1 month

moved to England

Voice very weak, frail related to

Degree of discomfort w/ people

Lung Qi deficiency [severe] and Damp Heat

[see pulse & tongue]

Breasts leaked fluid 1 yr ago

Stopped spontaneously


Heat: gives off heat

Prefers heat but heat causes

veins to expand

Qi-yang deficiency

GI

Since college

Constipation w/ travel in

emotion comfortable environ.

Water sound, mucous 25-27yr

BM:unfinshed; constip-diarrhoea

in same movement

Pain: recently had to push-

persisted

 

Separation of Yin and Yang + Liver®Stomach-Int.

[began after stopping running]

Spleen Damp

Spleen Qi-Yang deficiency

Sighing- ages 25-27

Liver Qi Stagnation

Sleep

Tense; eyes open; teeth biting

Tired in AM-improves w/ move

Separation of Yin and Yang affecting

Heart-Circulation®Heart Qi deficiency

Fibroid: large confirmed by exam

Blood stagnation probably related to circulation problems from Separation of Yin and Yang


Diagnostic Catalogue

This catalogue attempts to organize the conditions according to solid-hollow organs, pernicious influences, qi, blood and body fluids, areas of the body, trauma, toxicity and neo-plastic activity.

CONDITION

SYMPTOMS

HISTORY

SIGNS

QI WILD

Circulation impaired

by stopping exercise

suddenly, accounts

for most Sx

See Symptom-Condition chart

Chart above

#1-6, 9, 10

See Symptom-Condition

Chart above

P: Yielding Hollow F/O Wave

Separation of Y/Y

In four principal positions

Changing qualities

HEART

Separation Y/Y

Qi-Yang defic.

 

Shock

Qi Stag. [Closed]

Blood deficiency

 

Qi Agitation

Phlegm Misting Orifices

 

Yin deficiency

Mitral Valve Prolapse

 

Tired in AM

Bizarre emotional –

physical symptoms

"

Chest tight-cave in

Memory-concentrate

Postural Hypotension

Anxiety; sleep-eyes open

Bizarre emotional –

physical symptoms

Panic attacks

Ongoing anxiety

Traumatic interaction w/

coach & w/alcohol father

Premature 4 weeks

Jaundiced at birth

P: LDP ⇋ F/A

 

"

Muffled [3+]

Thin; ratew/exert⇡37b/m

 

Smth Vib: NP,MV,LDP

Slippery

Tight

MVP: ~Slippery; Smth Vib

Muffled [3]

SPLEEN-Stomach-Intest

Qi-Yang deficiency

Stomach-Int Excess Heat

Qi Stagnation

? Colitis; excess damp

heat

BM: Constip-Diarrhoea

Same movement

Unfinished; strain

Constip. w/stress

Pain; mucous, water

sounds

Since college

P: RMP- ⇋ Empty; ⇣Sub[4]

Rob Pnd:RMP3; SPEP3+; LI[3]

SPEP: Muffled [4]

LI: Inflated

PP & PLB Flooding Excess

SPEP; LI, SI : Choppy

LI, SI: Slippery

LIVER-GB

Qi-Yang deficiency

 

Blood deficiency

 

Qi Stagnation

GB Damp Heat

Fatigue

Light sensitive;

Eyes hard to move

Hair falling out

Sighing

No drug history, hepatitis

or parasite

P:

LMP: Yielding Hollow F/O

Empty

GB: Tight; Slippery; Choppy

Robust Pnd [2+]

Lower Burner

Excess Heat

 

Blood Stagnation

Fibroids


P:

PLB-Fld. Excess; Slippery; Tight

PP: Fld Excess; Rob Pnd[3]

PP & PLB- Choppy

LUNGS

Separation of Y/Y

Qi deficiency

Qi Stagnation

Damp Heat

Voice very weak, frail [related to degree of discomfort w/ people]

Bronchitis last summer

P: RDP. SLP - ⇋ Absent

 

SLP: Muffled [5,2]; Narrow

Tense; Slippery

Chest

Separation of Y/Y

Chest Tightness, caving in

Relieved by `popping’

w/ meditation



Kidney

Qi –Yang Deficiency

Blood, Yin Deficiency

Vulnerability

Prefers heat "though

Gives off heat”

Premature 1 month

Sensitive as child

Jaundiced at birth

P: RPP- Reduced Substance

 

PP- Thin [3,4]; Tight


CONDITION

SYMPTOM

HISTORY

SIGNS

Blood

Deficiency

 

Stagnation

Excess Heat

Hair falling our

Postural hypotension

Fibroid-large

Distended Veins

Moving from family home

[See Lower Burner above]

P: Thin [FI-3 Princ. Pos]

Choppy [LPP-PLB]

Ropy [1/4]

Bld. Depth: Thick-Slippery

Emotional

[Other than Qi Wild above]

Nervous System Tense

Feeling stuck

Interpersonal conflict

Extreme constant tension


P: Qi Depth- Thin; Tight

Cotton [3+]

Amplitude Changing side to

side


Summary

The primary issue for this 29 year old Nervous System Tense woman is the extreme Qi Wild condition associated with the sudden stopping of both very extreme and long term physical activity from early childhood until the age nineteen.

The consequences described above in her history and the Symptom-Condition Chart are of almost total and progressive physical, mental and emotional deterioration beginning from the cessation of this activity to the present ten years later. At this time she is borderline psychotic.

The patient’s Nervous System Tense condition and signs of upper burner [Heart and Lungs] qi stagnation may have their roots in early childhood and her father’s alcoholism about which she was reluctant to discuss except to say that he had recovered by the time she was six years old.

Her deterioration is associated with a profound impairment of circulation including a `separation of yin and yang’ of the Heart, severe Heart qi stagnation, agitation, blood and yin deficiency, `phlegm misting the orifices’ and `mitral valve prolapse’. Her slow rate and some of her other Heart conditions may have been due to the extreme marathon running as a child for at least ten years.

The upper burner is further complicated by `separation of yin and yang’ of the Lung, extreme qi stagnation with damp heat and a possible neoplastic process.

The middle burner is very deficient with severe disruption of her digestive function involving Spleen qi-yang deficiency and `separation of yin and yang’, and excess damp heat in the stomach and intestines with signs of an inflammatory process [possible colitis] in these organs. The Liver is yang and blood deficient with some blood engorgement and the Gallbladder has damp heat.

There is considerable blood stagnation and a damp heat inflammatory process in the lower burner.

On the positive side the rhythm is normal, the rate on exertion does not stay the same or go down and the qualities in each burner resemble each other that is sign of a relatively functioning Triple Burner.

Management-Formulation

A. Immediate Interventions

1. Qi Wild Condition

2. Heart

Shock

Separation of Heart Yin and Yang

Qi Stag. [Closed]

Blood deficiency

Qi Agitation

Phlegm Misting Orifices

Yin deficiency

Mitral Valve Prolapse

3. Middle Burner

Separation of Yin and Yang of Spleen and Liver

Liver and Spleen qi deficiency

Stomach-Intestine-Gallbladder Damp Heat and Qi Stagnation

Neo-plastic Process

B. Root Issues

Determined after Qi Wild Condition is resolved

C. Secondary Issues

Determined after Qi Wild Condition is resolved

D. Derivative Issues

Blood

Circulation

Damp Heat

Tissue

Stagnation in Lower Burner

Management-Implementation Plan

A. Life-style strategies

1. Food Diary

2. Underarm Temperature

B. Referrals

1. Gynaecological follow-up

2. Qi Gong

C. Herbs

1. Immediate Interventions

a. Shock and Blood Stagnation in Lower Burner [Large Fibroid]

a. Yunnan Bai Yo

b. Separation of Yin and Yang affecting Circulation and Heart

a. Day I Stop Exercise Suddenly [1-3gm 3x/day and bedtime]

Huang Qi 15 gm

Dang Qui 6 gm

Chuanxiong 4.5 gm

Shan Yao 9 gm

Suan Zao Ren 12 gm

Long Gu 15 gm

Mu Li 15 gm

San Ji Sheng 12 gm

Bai He 9 gm

[Yi Tang 12 gm]

Gan Cao 6gm

Sang Zhi 12 gm

Dang Shen 15 gm

Si Gua Luo 6 gm

Yuan Zhi 6 gm

b. Day II

Sheng Mai San [1-3gm 3x/day and bedtime]

American Ginseng 3gm

Mai Men Dong 9gm

Wu Wei Zi 6gm

+

Korean Ginseng 4.5gm

Chang Pu 6gm

Ye Jiao Teng 6gm

Zi He Che 2gm

He Huan Pi 8gm

Long Chi 9gm

Yu Jin 5gm

Shao Yao Ren 10gm

Rou Gui 1gm

Gan Jiang 3gm

Gan Zao 3gm

Wheat 20gm

Da Zao 10gm

Hu Po 1gm

Ho Shou Wu 9gm

c. Spleen Qi deficiency , ST-GB-Int. Damp Heat and Qi Stagnation

1-3 gm with meals

Ren Shen 6gm

Bai Zhu 6gm

Fu Shen 9gm

Gan Cao 2gm

Shan Yao 9gm

Yi Yi Ren 9gm

Bai Bian Dou 6gm

Jie Geng 3gm

Mu Xiang 3gm

Chen Pi 3gm

+

Huang Lian 2gm

Xiang Fu 6gm

Yin Chen Hao 9gm

Hou Po 3gm

Mai Ya 6 gm

Huang Qi 15gm

Dan Shen

Ongoing

During the approximately two months of intensive treatment the patient was prescribed herbs that she continued to take for one year with minor changes by a colleague, Scott Tower, who treated her in England. She was treated simultaneously, during the two months in the United States, with acupuncture.

On one occasion when she developed menorrhagia she was prescribed the following formula:

DQ & Gelatin w/ G.L. & Aconite + Gionseng & Astragalus

Dang Gui 9.0

Shao Yao 4.0

Chuan Xiong 3.0

Shu Di Huang 5.0

A Jiao 3.0

Ai Ye 3.0

Gan Zao 3.0

Fu Zhui 0.5 gm

Zhi Gan Cao 6 gm

Sheng Jiang 9 gms

Sheng Ma 6 gm

Huang Qi 9 gm

Chai Hu 3 gm

Sha Shen 10mg

Mai Men Dong 9gm

Yan Huo Suo 9gm

Take daily- up to 3gm TID

We saw her eleven months later at which time she was extraordinarily better as indicated by the chart below, except for one episode of severe abdominal pain while visiting her family in the U.S. to which she attributed it. She moved to Sweden where she was referred to another acupuncturist.

The record ends here except for one letter that said she was much better than what I recorded in the following chart below.

The following is a chart that I developed in order to follow the patient’s symptoms:

SYMPTOM

2’25’05

12’16’05

Veins distended

10

5

Tension®even cook dinner-frantic

Blood moving up w/ tension

Bite sides of mouth & teeth

grinding and loud biting in

sleep

7

2

 

Not connected in my body

Heart and mind not connected

Dream that friend `possessed’

could not relate to her for days

Easily startled

7

0

Depression: visions of not being

alive-very frightening

0

0

Run down- Age 22 after college

Greatly ­Sensitive to harshness

Avoid people-lost boundaries

Need perfect environment, calm

Sense that cannot protect self

Sensitive as child-nature-awe

6

3

Energy diminished-

­Moving to England last summer

7

3

Postural Hypotension

moving from family home

0

0

Hair

Falling out-thick, coarse

0

0

Eyes-

hard to move

light sensitivity-esp night

Spots- round, black

 

6

6

10

 

1

1

10

Chest Tightness, caving in

Relieved by `popping’ w/ meditat

7

0

Throat

Yellow mucous in AM

Less with diet change recently

 

0

 

0

Respiration:

Bronchitis past summer-1 month

moved to England

Voice very weak, frail related to

Degree of discomfort w/ people

 

 

 

6

 

 

 

1

Breasts leaked fluid 1 yr ago

Stopped spontaneously

 

0

Heat: gives off heat

Prefers heat but heat causes

veins to expand

8

1

GI

Since college

Constipation w/ travel and

emotionally comfortable environ.

Water sound, mucous 25-27yr

BM: unfinished; constipation-diarrhoea

in same movement

Pain: recently had to push-

persisted

 

 

0

 

 

0

 

 

0

 

Sighing- ages 25-27

0

 

Sleep

Tense; eyes open; teeth biting

Tired in AM-improves w/ move

 

2

Constant Thinking

10

2

Fibroid: large confirmed by exam

10

?


Pathogenesis

The pathogenesis of this massive separation of yin and yang that we call `qi wild’ is briefly as follows: exercise requires increase in blood volume causing the vessels to expand to accommodate the increased blood volume. Stopping suddenly causes precipitous drop in blood volume but the vessels continue to be expanded and contract only relatively slowly. The vessel walls are Yang and the blood is Yin and the vessel walls are not nourished sufficiently by the blood Yin and lose their flexibility causing circulatory problems .The Yin and Yang are separated leading to a Qi Wild Condition in which the tissues of the body, including the brain, are no longer functionally nourished by the Heart, circulation and blood in a stable sufficient fashion. The result is mental, emotional and physical chaos.

Conclusion

Colleges are eager to give athletic scholarships for large numbers of entering students in the hope that some few of them will qualify for varsity teams. In fact only a tiny percentage of these athletic scholarship students succeed and the rest are discarded from the athletic programs.

These are students who have spent their entire childhoods preparing for this moment in their life when they would enter the limelight and go on even with professional athletic careers. The unending physical work they have performed during their formative years is phenomenal.

When they are rebuffed, most of the rigorous training ends abruptly, partially because there is no program to follow, trainers to assist and even more often because the rejection and sense of failure is accompanied by severe depression. For all these reasons they stop exercising abruptly.

Having been a psychiatrist in a college clinic for seven years, I saw forty years ago what has now become a flood of calls for help at college health clinics with the presenting symptoms of depression and especially, severe anxiety and bizarre emotional and physical experiences. I have found this syndrome in adults as well who cease long term exercise suddenly.

I recognized the negative effects of jogging to the heart previous to my Chinese medical training. However, prior to my work with Dr. Shen and Chinese medicine I had no way to recognize the `qi wild’ syndrome that ensues from the circulatory shock associated with abruptly stopping long years of strenuous exercise. He recognized the Yielding Hollow-Full Overflowing pulse wave pathognomonic of this condition and developed a formula, presented above to resolve it. For the patient presented it was a life-altering diagnostic and management-treatment success.

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