The patient was a 38 year old female who was referred by her ENT for help treating an 11 year history of
severe dry mouth post acne medication use. The patient stated “My dry mouth symptoms began in 2008 during a 5 month round of accutane. I experienced a lot of tartar build up as a result and had to increase my dental cleaning frequency in an attempt to combat the issue. It became a chronic problem… requiring a daily scraping of tartar build up from my teeth due to low salivary flow.” In addition, the patient reports that at the onset of dry mouth she started to have recurrent throat infections which led to the removal of her tonsils. The patient was pursuing medical treatments to increase the flow of saliva. The ENT referred the patient to my office as he felt that the only medicines available for this had risk of significant side effects and therefore he felt it best to exhaust all other options first.
Overview Of Treatment And Results:
The patient’s treatment consisted mainly of Herbal Medicine and partly with Acupuncture. She was seen every 3 – 4 weeks on average, taking herbs daily in between. The patient reported a “30%” improvement after 4 weeks. This gradually increased every visit. At 15 weeks, the patient reported a 75% improvement.
Major improvements developed after 15 weeks. At the 18 week visit, the patient reported that for 11 years she had to do daily deep cleaning and scraping of her teeth however the plaque build up had reduced enough that she had not had to do that for the past three weeks. At that point, while the symptoms had improved I decided to continue treatment at a reduced dosage for a few weeks to be certain that the progress made would not regress after stopping treatment. In addition, we sought objective measures of improvement from the patient’s Dentist who she had seen regularly over the last ten years.
Final Results
In all, treatment lasted for 8 months total to correct 11 years of Dry Mouth. I followed up with the patient at the 1 year mark and the patient had the following to say about her treatment, “Since treatment, I’ve seen a stark decline in the buildup of tartar, and no longer need to scrape my teeth daily. Additionally, my dentists’ measurement of my teeth “pockets” have improved since treatment. Though my saliva flow is not back to pre-2008 levels, it is significantly more manageable now and my teeth are a lot healthier.”
Further Discussion Of Chinese Medical Concepts:
For the most part the overall goal with the dry mouth is straight forward, increase the flow of saliva in the mouth. However, in order to achieve that goal I used Chinese Medical diagnosis, correlating treatment strategies, and then constructed herbal formulas according to those strategies.
Many readers might not be familiar with some of the terms I use. While I will try to explain them as best as possible what I think is most important is to understand that these terms are not just theoretical but have very practical implications. While their may be terms you might struggle with like Qi, suspend your disbelief for one moment to at least absorb the overall process.
The patient’s main presenting symptom was lack of saliva in her mouth and throat. In addition to symptoms reported above the patient typically presented with a thin and wiry pulse. Her tongue was large, pale purple in color, and typically had no coat or only a thin coat. In addition to questions about the main symptoms upon further inquiry the patient reported mild fatigue and heavy menses. I saw the issue at hand as one of deficient body fluids and deficient Stomach Qi and Yin. There was also an overall deficiency of Qi and Blood. I treated this by selecting sweet and sour herbs together, while also tonifying Stomach Qi, and using a small amount of herbs with an acrid quality to help open orifice of the mouth.
I used sweet herbs as they tonify or build and I wanted to increase bodily fluids. Sour herbs were also used as they help astringe body fluids and yin. Sweet plus sour are flavor combinations that are known to generate Yin and Body Fluids. Herbs like Chinese Ginseng which are known to tonify Stomach Qi were used. I did this because Stomach generates body fluids and I wanted to support that process. I used acrid herbs as they are dispersing and opening, they help free the flow of various bodily components. The use of a small amount of acrid herbs here was to free the flow of saliva. Regarding the basic treatment principles there is more that can be said but that os a general outline.
Herbal Formula Ingredients
The formulas varied but were very loosely based on formulas such as Sheng Mai San, Sha Shen Mai Men Dong Tang, Zheng Ye Tang, and Bai He Di Huang Tang. In addition there were other tonifying herbs, sour herbs, and/or some acrid herbs. I started with a small amount of herbs but I saw more improvement as I added additional herbs with the above qualities. Sometimes less is more and sometimes more is more. The formulas usually ended up having 12 to 15 herbs.
The patient took 12g of granulated herb extracts, twice daily dissolved in hot water. The following is an example of a typical formula the patient took is:
Sheng Mai San
Bei Sha Shen
Tian Hua Fen
Huang Jing
Shi Hu
Wu Mei
Shan Zha
Bai He
Sheng Di Huang
Bai Shao
Dang Gui
Chuan Xiong
Gan Cao
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