How many pills do you take a day?
As we age and health issues increase, the number of medications we take naturally grows.
It's common for elderly patients to take over 10 pills a day, ranging from blood pressure and diabetes meds to painkillers and digestive aids.
The real problem arises when 'medication causes a new disease.'
Misinterpreting a drug's side effect as a new medical condition and prescribing yet another drug is a vicious cycle known as a 'Prescribing Cascade (PC)'.
At BM Korean Internal Medicine Clinic, we remain vigilant against the risks of polypharmacy and seek the root cause to restore the body’s innate healing power.
The Crisis of a Prescribing Cascade (An 81-year-old Clinical Case)
Our clinical report, recently published in the Journal of Internal Korean Medicine, details a life-threatening crisis faced by an 81-year-old female patient.
The patient initially visited multiple clinics for back pain, receiving 14 different medications including painkillers and steroids, which led to severe dyspepsia.
While her gastrointestinal function was initially restored through our treatment , a new issue emerged after she was prescribed 'levosulpiride' at another clinic for gastroprotection during ingrown toenail treatment.
In her vulnerable state due to extreme polypharmacy, this drug unexpectedly induced 'Parkinsonism,' characterized by masked facies and gait disturbances.
Furthermore, cumulative exposure to steroids and diuretics from various clinics caused her serum potassium to drop to a life-threatening level (2.5 mEq/L), resulting in profound generalized weakness.
The BM Solution: 'Deprescribing' Rather Than Adding
In this critical situation, adding more medication to suppress symptoms would have been like adding fuel to a fire.
We looked into the 'inner side' of the disease.
- Deprescribing: We immediately identified and discontinued the offending drugs that were draining the patient's vitality.
- Healthy Freedom (HF) Diet: We modified her diet to include high-quality animal proteins and natural sea salt to restore metabolic function.
- Modified Cheonmagudeung-eum (Tianma Gouteng Yin): A customized herbal decoction helped safely restore electrolyte balance without burdening the body.
The results were remarkable. Within just two weeks, her serum potassium normalized (3.5 mEq/L), and the functional deficits—including Parkinsonian symptoms and muscle weakness—completely resolved.
Official Abstract
Title: Deprescribing and Multimodal Korean Medicine for Sequential Prescribing Cascades (Dyspepsia, Drug-Induced Parkinsonism, and Hypokalemia) in an Elderly Patient with Polypharmacy: A Case Report
Objectives: Prescribing cascades (PCs) pose severe risks to elderly patients, particularly those receiving fragmented medical care. This report presents a life-threatening case of sequential PCs that was managed using a comprehensive multimodal Korean Medicine (KM) approach.
Methods & Results: An 81-year-old female experienced recurrent PCs: polypharmacy-induced dyspepsia, levosulpiride-induced parkinsonism (Hoehn and Yahr stage 3), and steroid/diuretic-induced critical hypokalemia (K+ 2.5 mEq/L) presenting with generalized weakness (ECOG grade 2, MRC grade 4). Improvement was observed following a comprehensive, multimodal KM intervention—which prioritized the targeted deprescribing of offending drugs, alongside dietary correction and a modified Cheonmagudeung-eum (Tianma Gouteng Yin; 天麻鉤藤飲) decoction. Within two weeks, serum potassium normalized (3.5 mEq/L), and functional deficits resolved.
Conclusions: The resolution of these life-threatening PCs was associated with clinical recovery after targeted deprescribing and multimodal supportive care. This strategy may help to mitigate the harms caused by fragmented geriatric care.
👉 [Read Full Paper]
Toward Healthy Freedom
Korean Medicine physicians do not simply perform procedures or prescribe drugs for symptomatic relief.
Based on the philosophy that "A physician is a scientist who researches clinical practice," we integrate modern scientific diagnosis with the wisdom of Korean Medicine.
Are you worried about a mountain of pill bottles?
If you seek the power to heal yourself without drug dependence, join us at BM Korean Internal Medicine Clinic.
We will be your reliable pacemaker on the journey to healthy freedom.
