🌿 Fengyang Daoist TCM Teaching Case: Polymyalgia

A middle-aged woman haunted by pain and fatigue

I. Basic Information

• Name: Confidential

• Gender: Female

• Year of Birth: 1967

• Occupation: Pet Groomer

• Referred by: Foula Kikis Mastromanolis

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Manifestations of polymyalgia

II. Initial Consultation

• Date: May 25, 2024

1. Chief Complaint

Polymyalgia with generalized muscle and joint pain, accompanied by chronic fatigue for several years.

2. Associated Symptoms

• Obesity

• Acid reflux

• Varicose veins

• Hearing decline

• Dry skin

• Fatigue

• Abdominal bloating and belching

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Tongue manifestation of yang deficiency with cold and dampness

III. Western Medical History

• Diagnosis: Polymyalgia

• Medications:

• Prednisone (tapering, 1 mg)

• Kevzara (Sarilumab)

👉 Patient’s Goal: To gradually discontinue corticosteroids and immunosuppressive therapy

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IV. Etiology & Pathogenesis (TCM Analysis)

1. Etiology

• Long-term overexertion (over 20 years)

• Heavy family responsibilities (caring for parents)

• Running a pet grooming and boarding business

👉 Classified as internal injury due to overstrain (劳倦内伤)

2. Four Examinations

• Pulse: Deep and weak

• Tongue: Pale with white coating

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V. TCM Pattern Differentiation

Syndrome Patterns

• Spleen and Kidney Yang Deficiency

• Cold-Damp Obstruction of the Channels

Pathomechanism Summary

Yang deficiency → internal generation of cold-damp → obstruction of meridians → “no free flow, no pain relief”

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VI. Treatment Principles

• Warm Yang and support vital Qi

• Strengthen the Spleen and tonify Qi

• Warm the Kidney and dispel cold

• Unblock channels and relieve pain

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VII. Treatment Plan

(1) Herbal Formula (Granules)

• Bu Zhong Yi Qi Tang (Evergreen) – 100 g

• Huo Xiang Zheng Qi San (Evergreen) – 100 g

• Zhen Wu Tang (Nong Ben Fang) – 200 g

Dosage:

3 g + 3 g + 6 g per dose, twice daily, dissolved in warm water

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(2) External Therapy

Fengyang TCM Tuina (Nine Meridian Lines), 1 hour per week

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(3) Therapeutic Exercises

• Jiaji Feijing Meridian Exercise (targeting Gaohuang area)

• Baduanjin – 30 minutes daily

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(4) Lifestyle Recommendations

Avoid:

• Flour-based foods

• Dairy

• Sugary foods

Encouraged:

• Meditation and sitting practice

• Balance between movement and rest

• Prioritizing personal health

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VIII. Clinical Outcomes & Follow-up

📅 June 24, 2024 (1 Month)

• Significant reduction in systemic pain

• Mild residual discomfort near LU1 region

👉 Assessment: Marked improvement

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📅 Key Steroid Withdrawal Process

After initial consultation (May 25, 2024):

• Gradual tapering of Prednisone

• Fully discontinued after ~3 months (August 2024)

Follow-up (as of March 26, 2026):

👉 Off corticosteroids for 1 year and 10 months

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📅 October 3, 2024

Hospitalization due to Diverticulitis

Post-discharge adjustment (Oct 28):

• Huo Xiang Zheng Qi San – 3 g

• Bu Zhong Yi Qi Tang – 2 g

Twice daily

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📅 March 26, 2026 (2-Year Follow-up)

Patient Feedback:

• Polymyalgia: significantly improved ✅

New concerns:

• Weight gain

• Difficulty losing weight

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IX. Stage Transformation of Pathogenesis

From:

👉 Yang deficiency with cold-damp obstruction (pain stage)

To:

👉 Spleen Qi deficiency with damp accumulation (metabolic slowdown, obesity)

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X. Ongoing Treatment Strategy

Shift in Focus

👉 From “pain relief” → “metabolic restoration”

Treatment Principles

• Strengthen Spleen and raise clear Yang

• Warm Yang and transform dampness

• Regulate Qi and enhance transport function

Herbal Direction

• Bu Zhong Yi Qi Tang (primary)

• Combined with Shen Ling Bai Zhu San

• Add Qi-regulating herbs

👉 Avoid overly cloying tonics

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Core Strategy (Fengyang Philosophy)

👉 Activate the restored Yang Qi

• Dynamic exercises (Baduanjin, walking)

• Morning sun exposure

• Regular daily routine

• Emotional stress reduction

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XI. Teaching Commentary (Key Value)

1️⃣ Successful Steroid Withdrawal

• Discontinued within 3 months

• Stable for 1 year and 10 months without relapse

2️⃣ Advantage of TCM (Root Treatment)

• Western medicine: controls inflammation (branch treatment)

• TCM: restores systemic balance (root treatment)

3️⃣ Key to Safe Medication Reduction

• Gradual tapering

• Simultaneous support of vital Qi

• Integration of internal and external therapies

4️⃣ Strength of Fengyang Daoist TCM System

• Herbal medicine + Tuina + exercises + mind regulation

👉 A holistic medical model

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XII. Appointment Information

👉 March 30, 2026 (Monday), after 12:30 PM

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🌿 Summary

This case demonstrates that through a comprehensive TCM approach, patients with polymyalgia may safely discontinue corticosteroids within approximately three months, maintain long-term stability (1 year and 10 months follow-up), and achieve significant constitutional improvement.

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