Case Study: Fibrocystic Breast Disease; mid-cycle acne; possible duodenal ulcer

Case Study: Fibrocystic Breast Disease; mid-cycle acne; possible duodenal ulcer

This case was presented at the October 1998 Clinical Case Conference in Boulder, Colorado, co-sponsored by Medical Herbalism and the Rocky Mountain Center for Botanical Studies.

Learning issues

- Herbal treatment strategies for fibrocystic breast disease

- Herbal treatments for acne

- Safe use of Phytolacca decandra (poke)

- Herbal treatments for ulcers

- Dietary treatment for hyperestrogenism

- Treatment or prevention of traveler's diarrhea

- Herbal insect repellant

- Internal use of essential oils

Client Overview: Female, 32 yo only surviving child, married 2 years to M.D. doing surgical residency, occupation: clinical psychologist, last physical exam 3 years ago

Lifestyle Details: works 9-10 hours per day, reads 1 hour per day, sleeps 7-8 hours per night, exercises regularly with tai chi and working out, is indoors most of the time, vacations 3 weeks per year, feels she has abundant energy for her busy life, occassional marijuana use

Medical history: appendectomy at age 22

Gyn history: regular menses with nothing unusual to note except fibrocystic breasts and acne premenstrually, using diaphragm after IUD removal 6 months ago

Signs and Symptoms: fibrocystic breasts with menses, acne flares mid-cycle (has used ultra-violet light and antibiotics to clear up skin), always cold, allergies to a variety of animals and hay

Diet: diet diary of 4 days shows a varied diet leaning toward lacto-vegetarian, medium fat intake, moderate desserts, eats on a regular schedule, minimal water as a beverage listed

My summary: Healthy appearing young woman enjoying her life for the most part. Fairly high strung. Dry skin, lips. Nails strong, smooth and clear. Tongue with a minimum of impressions and cracks. Concerned about her lumpy breasts and skin which has troubled her since a teen. Seemingly quite open and candid. I want to start with hydration. Has used a homeopathic for the FBD. After 3-4 doses breasts were clear for 8-9 months. Now it is back and does not recede after menses as it, has in the past. Is not responding to homeopathics.

11/26/85

Treatment plan:

- Drink more water daily. Get several water bottles and keep them with you. Drink a minimum of a quart a day.

- Eat more fruits, vegetables, grains, nuts, and seeds daily. Substitute them for baked goods regularily. Find bitter foods you can enjoy like watercress, parsley, horseradish, dandelion greens, etc. Eat something bitter each day.

- Get loofa or other rough wash cloth and a good quality natural soap. Wash face each evening using the rough cloth generously lathered up. Gently scrub entire face but focus on the areas that break out regularily. Use warm water for washing but finish with 10-20 cold rinses. Use cold rinses daily.

- Use only the purest natural products on skin as moisturizer. Calendula-based products are good. Use calendula vinegar 1/3 diluted with water 2/3 as an astringent-wipe 1 x daily.

- Get 15-20 minutes sunshine a day whenever possible without a hat or sunblock. Do not wash after sunning for 30 minutes.

- Vit E d-alpha and mixed tocopherols rotate 200 mg with 400 mg every other day.

Herbs:

Topical/Oral applications:

Phytolacca fresh root extract

4 drams

lymphogogue

Symphytum fresh root extract

2 drams

emollient to give body

to extract

Capsicum dried fruit extract

2 drams warming

adjuvant/counter-irritant

Shake well. Apply to breasts daily preferable after a warm shower or bath. Rub in gently, especially focusing on lumpy areas. Never vigorously massage the breasts. Also use just 3 drops orally in a little water 3 days per week.

Topical application:

Symphytum fresh root extract

4 drams vulnerary/tonic

Apply straight or diluted to face as needed

11/27/85

Phone visit: Alarmed at the stinging of her breasts which lasted for 10 minutes after applying the phytolacca product. Wants to know if it is dangerous. I assure her that as the inflammation recedes the stinging will diminish. Carry on. Call if any questions, recurring headaches, low-grade or high-grade nausea.

5/26/86

Visit: Breast lumps disappeared. Stinging diminished in a week or so. Used most of her rub up and discontinued oral use months ago. Saved a dram or so "just in case." Now is revealing another health problem not mentioned on previous history form. Went to visit her parents and got a bad backache which worsened until she went to see a doctor. Doctor suspected a duodenol ulcer and prescribed Zantac 150 mg bid and Mylanta want to use the Zantac though ad lib. Doesn't it did get her pain free and back home so she suspects it is an ulcer. Has had a history of "upset stomachs" since childhood with stress. Knows that her body responds well to natural remedies and wants to do some sort of ulcer remedy.

My summary: Disappointed that she mentioned nothing of her digestive problems on last visit. More questioning revealed on-going upset digestion which she always attributes to her nervousness. Seems sheepish about not discussing this and further discussion yields that she would rather not discuss uncomfortable situations and symptoms. Is working with some meta-physical/magical connections and knows that herbs would be a good ally.

Herbs:

Oral:

Glycyrrhiza dried cut/sifted

3 oz antiinflammatory, demulcent

Althea dried cut/sifted

3 oz antiinflammatory, demulcent

Blend dried herbs in a tightly sealable jar. Store in a dark place. Measure 3 tablespoons into 4 cups water and simmer covered for 10 minutes. Steep until cool. Take 1/2 cup bid x 1 week, then 1/2 cup tid x 1 week, then 1/2 cup qid x 1 week.

Scutellaria

"00" capsule bid or rid nervine support
21/86
Husband's first visit: He brings a message that she is doing very well. No lumps, no digestive upset. Feels good and still taking the Scutellaria to "take the edge off."

12/11/86

Phone visit: Had a bad cold premenstrually which she feels led to a heavier flow and the first lumps in "many months" (almost a year.) Wants a refill of her Phytolacca which I do with same instructions. Discussion about lifestyle reveals much more eating out and late nights as husband feels better. We laugh.

1/30/87

Visit: Lumps have diminished, but is stressed over big family vacation coming up and wants to take more formula with her. She has been taking the herbs regularily and has some left. I want to change the formula as a respite. She is concerned but concurs. Wants to know if she can get an "anti-tourista" formula to use prophylactically as she always gets diarrhea when they go there. Also wants a natural insect repellant.

Herbs:

Topical/Oral: extract for FBD

Echinaceaangustifolia dried

2 drams immune support

Taraxacum fresh tops/roots

2 drams alterative/tonic

Phytolacca fresh root extract

1.5 drams lymphogogue

Calendula fresh flora

1 dram

immune support

Larrea fresh fall twigs

1 dram

immune support/alterative

Capsicum freshly dried fruit

5 dram

warming adjuvant,

counter-irritant

Signature: Shake well. Take and apply as with previous topical/oral application.

Oral: Digestive tonic extract

Echinacea angustifolia dried

2 drams immune support/anti-septic

Juglans nigra fresh rinds

2 drams anti-parasitic

Gentiana sceptrum fresh root

1 dram

bitter tonic

Juniperis occidentale fresh berries

1 dram

tonic, anti-septic, adjuvant

Mahonia nervosa fresh bark

1 dram

tonic, anti-septic

sweet orange, anise essential oils

10 drops anti-parasitic, flavor

cinnamon, thyme essential oil

5 drops "

Signature: Shake very well. Take 60 drops bid in warm water 3 days before departure and for 4 days on arrival. Then reduce dosage to 1/2 and continue ad lib.

Insect repellant:

Mentha, piperita

1 tsp

Eucalyptus

40 drops

Cymbopogon citratus

20 drops

Mentha spicata

15 drops

Cymbopogon nardus

10 drops

Mentha pulegium

10 drops

Citrus aurantifolia

10 drops

In a 1/2 oz bottle QSAD with almond oil. Apply liberally for insects. Reapply as needed. Try on a sensitive area of skin before departure. Dilute more with almond oil if too strong.

Additional conversations and other assorted formulas for this and that over the next couple of years showed the FBD to be in remission. She felt she had to stay "on the wagon" with stress, attitude, rest, especially dietary issues and water or her menses would get heavier and she would feel a soreness in her breasts which she felt would probably lead to more cysts. She had no more bouts of severe ulcerative pain, but continued to use the anti-inflammatory formula and scullcap to help with mild digestive upsets.

Medical Herbalism.

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By Cascade A. Geller

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