Welcome

Traditional Chinese medicine (TCM) has thousands years history. It has unique basic theories and diagnostic methods. It is a very effective therapy in treating many chronic diseases and some acute diseases. If you are interested in TCM, welcome to pop in to this TCM forum, let's discuss on any topic about Chinese herbal medicine and acupuncture. If you have any health problem, you are welcome to visit my clinic Knowhow Acupuncture at No.1 Harley street, London. If you are far away from London, you can pop in my online clinic to get some help. If you like this blog please share it to your friends.

Monday, 16 July 2018

Kikuchi disease and its TCM treatment

Tiejun Tang
Kikuchi disease is a very rare disease, also known as histiocytic necrotizing lymphadenitis. It was discovered in Japan by M. Kikuchi and Fujimoto in 1972. It is relatively common in Japan, occasionally reported in other parts of Asia, very few reports in Europe and North America. The reason of this disease is unclear, and there are two hypotheses of infection and autoimmune. The main symptoms of this disease are fever, swollen lymph nodes, Skin rash and headache. It is easy to be misdiagnosed as lymph node tuberculosis [1], lymphoma, systemic lupus erythematosus (SLE), etc. Only pathological biopsy can confirm the diagnosis. Western medicine currently does not have specific treatments for this disease, and non-steroidal anti-inflammatory drugs (NSAIDs) can be used to relieve lymph node tenderness and fever. In severe cases, corticosteroids can be applied [2]. 

I have treated one case Kikuchi disease with Chinese herbal medicine and acupuncture few months ago. The case report as follows:

 Mr. L,  Male, 43 years old, married, Asian, Engineer .
Initial consultation: 7th November 2017. Chief Complaint: Right neck lymph node swollen and pain, accompanied night sweats for 3 weeks. The patient found the right submandibular lymph node pain 3 weeks ago; it enlarged gradually, accompanied by headache and fever. His temperature used rise up to 38-39 . He sweating a lot at day and night time. His appetite was reduced, feels slightly nausea. His bowel movement is basically normal and the urine is yellowish. Poor sleep due to night sweat.
Physical examination: an enlarged submandibular lymph node can be reached, the size was about 2.5cm; felt hard and fixed.  His tongue was greasy and the pulse was slightly slippery and rapid.

Diagnosis of traditional Chinese medicine:  LuoLi (瘰疬). Syndrome differentiation: Hyperactivity of fire due to yin deficiencyheat & phlegm accumulating.
Treatment principle: nourishing yin and clearing heat, dissipating phlegm and resolve mass.

Prescription: Modified Qinghao Biejia Tang
Qinghao 10g, Digupi 10g, Zhimu 10g. Shudihuang 10g, Mudanpi 10g, Qinjiao 10g, Huangqin 10g, Huangbai10g, Xuanshen 10g, Huzhang 10g, Gancao 6g. 7 bags; boiled one bag per day, oral taken twice a day.

Acupuncture points: Reduce manipulation on Hegu(LI4), Quchi(LI11), Dazhui (DU14), Fuliu (KI7), Fenglong (ST40); Tonified manipulation on Zhaohai (KI6), Sanyinjiao (SP6), Taixi (KI3).
 
 Second visit: 1st December, 2017
His heat was reduced; the body temperature dropped below 37 °C. Patient still have over sweating, accompanied by hot flashes in the afternoon, dry mouth. His appetite was better than before. He lost 3 kg body weight.  His neck lymph node was as swollen as before. His tongue was red with less coating. Pulse was wiry and rapid. Repeat prescription was given of 7 bags. Acupuncture points were the same as before.

Third visit: 13th January 2018
Sweating and hot flashes significantly improvedtemperature back to normal. On 18th December, he underwent lymph node surgery in the hospital. Pathological biopsy didn’t find cancer cells. The pathological diagnosis was: Kikuchi disease. After the operation, the patient felt weakness and exhausted. His tongue was pale and pulse was thready. Modified Danggui Buxue Tang was given to supplement Qi and blood, and to clear the remaining evil. Prescription: Danggui 10g, Huangqi 10g, Baizhu10g, Xuanshen10g, Zhimu 10g, Huangbai 10g, Banzhilian 10g, Fuling 10g, Gouqizi 10g, Gancao 6g. Boiled 1 bag, drink the decoction twice a day for 7 days.  Acupuncture points are changed to: Zusanli (ST36), Qihai (RN6), Xuehai (SP10), Zhongwan (RN12), Pishu (BL20), and Shenshu (BL23). Follow-up three months through telephone, the patient didn’t have any symptoms.      

Discussing
Because the reason of Kikuchi disease is unclear, there isn’t any specific treatment in western medicine. A report from Taiwan showed the author use Gegen Tang, Chaihu Guizhi Tang and Shengyu Tang to treat early, middle and later stages of Kikuchi disease [4]. The other report from mainland China showed classic herb formula Yinqiao San also achieved a good effect on Kikuchi disease [5].

In my case the hot flashes and night sweats indicated yin deficiency and internal heat. The enlarged submandibular lymph node belongs to the "Phlegm core" or "Luoli". According to the diagnosis principle of combine syndrome differentiation and disease, we selected nourishing yin and clearing heat; dissipating phlegm and mass in the early stage of this disease. Modified Qinhao Biejia Tang was applied. In this formula, Qinghao, Digupi,, Qinjiao, Zhimu for clean asthenia heat; Shudihuang, Xuanshen for nourishing kidney yin; Huangqin, Huangbai, Huzhang for clean heat and detoxification; Mudanpi for cooling blood and detoxification.

His fever and night sweats were significantly relieved after treatment. In order to clarify the western medicine diagnosis and exclude the possibility of malignant tumor, the patient underwent lymph node surgery. Pathological biopsy proved the diagnosis. The patient showed the manifestation of qi and blood deficiency after the operation. A modified Danggui Buxue Tang was prescript to benefit Qi and blood, combined with Huangbai, Banzhilian to clean the remained heat.  Add Gouqizi for raises the liver and kidney yin; Add Xuanshen for clean heat and dispel mass. After several months of follow-up, the feedback showed a positive result.

Although this disease is a rare disease in western medicine, but its clinical manifestations are very common in Chinese medicine’s opinion. It may shows different syndromes at different stages. If the TCM diagnosis and treatment principle is correct, herb selection acupuncture point selection is accurate, it will achieve very satisfactory treatment results. Discussing Chinese herb treatment on Kikuchi disease, it might widen the clinical vision of both Chinese and western medicine practitioner and explore a new idea for the treatment of this rare disease.

Reference:

  1. C McKenna. TB or not to be? Kikuchi-Fujimoto disease: a rare but important differential for TB. BMJ Case Reports 2017; doi:10.1136/bcr-2016-217500.
  2.  Mahmood A. Kikuchi's disease: an unusual presentation and a therapeutic challenge. Yale J Biol Med. 2006; 79(1):27-33.
  3. Hyun M. Recurrent Kikuchi’s disease treatment by hydroxychlorquine. Infect Chemother. 2016; 48(2): 127-31.
  4.  陈俐蓉 . 菊池病中医治疗思辨. 中西结合神经医学杂志 2017; 10(1): 94-101.
  5.   管炜.银翘散治疗菊池病报告1例.中国中西医结合杂志 2014; 34 (5): 631-632.


6 comments:

  1. https://oxcattlegallstones.com/

    ReplyDelete
  2. God bless Dr AIKHOMU for his marvelous work in my life, I was diagnosed of HERPES SIMPLEX VIRUS since 2017 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr AIKHOMU, how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine within 3days. I took the medicine as prescribed by him and 2weeks later i was cured from HERPES contact him via email once again thanks to you Dr AIKHOMU. cure the flowing virus, contact his email draikhomuherbalhome@gmail.com or add him on whatsapp +2348100962873

    cancer cure
    diabetes cure
    ringing ear
    herpes cure
    warts cure
    HPV cure
    HIV cure
    get your ex back
    pregnancy herbal medicine
    Hepatitis .////////////

    ReplyDelete
  3. herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with herpes is by taking natural herbs medicine for it and is only few American doctors that know about this herbal medicine from Dr obudu .. I have read about Dr obudu the great herbalist doctor from African who can cure disease with his powerful herbal medicine. for the people suffering from the following diseases, Herpes, Cancer, Also,Herpatitis, Diabetes, Hpv,Infections ETC should contact him for his herbal medicine because i am a living testimony and i was cured of herpes. Although, i sent him what he requested and he sent me his medicine which i took for 1 weeks and today when i went for test i was tested herpes negative. you can reach him through his email drobuduherbalhome@gmail.com or whatsapp number:+2349023428871 he will help you out.............

    ReplyDelete
  4. My names is Sandra I was diagnosed of Herpes disease 2017, I was told by my doctor that there’s no cure. I was so worried anytime i think about it,i was spending alot on medication,and i was sacked from work,because i was always sick,infact my life was a mess..i was just researching online I saw a lot of testimonials about Dr Odila on how he uses herbal medicine to cure so many deadly disease …. I contacted him via email: drodilaherbalhome@gmail.com and told him my problems, then he said i will be totally cured within 14days,my heart was full on joy when he said that i will be totally cured within 14days ,i just had faith and believe,then i purchased the herbal medicine and sent him my details such as NAME,HOME ADDRESS,PHONE NUMBER ,Then Dr Odila sent me the herbal medicine to me through courier service and I used the herbal medicine for good 14days, then I went for check-up and my doctor confirmed thats am totally free from Herpes it work like a miracle to me ,please viewers out there this is real am so happy to share this testimony .thanks to perfect health GOD WILL BLESS U . contact him through drodilaherbalhome@gmail.com or whatsapp +2348159047935. view his website https://drodilaherbalhome.weebly.com here is my private email sandraprecious100@gmail.com

    ReplyDelete
  5. 5 years ago I had warts, I was treated with some liquid applied to the warts they continued to grow and spread... The next 2 doctors did laser surgery to remove them. 1 year after the surgery, they grew back close to where the 1st ones were' so I was finally told it was hpv. I have had it for very long time, I contract it from my cheated boyfriend and I found out he was also infected and I end up the relationship between us. the warts was so embarrasses because it started spreading all over I have be dealing with this things for very long time the last treatment I take was About 2 years ago I applied natural treatment from Dr onokun herbal cure, a week after applying the treatment all the warts was gone. it's now 2 years and some months I don't have single wart or any symptoms of hpv. wow"" it's great, Dr onokun has finally cured me. Anyone living with hpv contact Dr onokun for natural treatment.
    His email address: dronokunherbalcure@gm‎ail.com

    ReplyDelete
  6. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT     

    ReplyDelete