april 24 - medigogy - sharon weizenbaum - clear diagnosis ii

Diagnosis II

Diagnosis Reveals Itself

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Diagnosis II

Diagnosis Reveals Itself

Review

We did not really learn to diagnose

Ways we compensate for not knowing how to diagnose

Why this does not work well

Seeing Symptoms for what they ARE

The diagnosis reveals itself

This Webinar we will

See how the diagnosis reveals itself

The importance of SEEING the patho-physiology in the 3 warmers.

SEEING leads to formula selection

Conformation, Disease Factor, Symptom, Location

Learning through Case Studies

June, 2012

Menopausal Syndrome Case

Intake

This patient is 56 years old and her symptoms began around age 50. She suffers from frequent hot flashes that are worse with stress. These wake her up at night 2-3X/night. She will sweat at night slightly with the hot flash. This disturbs her sleep but she also has poor sleep in addition to this. She has been diagnosed with Lichen Sclerosis which she experiences as vaginal dryness and cracking. She was recommended to take prednisone for this but she did not want to.

Her digestion if poor as she easily and almost always feels bloated and her bowels are irregular from constipation to diarrhea. Bloating is in the epigastric area and is worse after eating.

Intake

This patient feels very tired much of the time though she feels this is due to sleep loss.

Sweating, thirst, general temperature regulation, respiration all feel normal

Signs: Tongue: pale and slightly dusky with a thin yellow moss

Pulses: middle and upper jiao pulses full. Lower jiao pulses fall off into deep and thin.

Abdomen: Firm and resilient with fullness in the epigastric area and emptiness in the lower belly with a tension above the pubic bone.

History

Hysterectomy 96 for heavy bleeding from fibroids

History of dysmenorrhea since 77 until hysterectomy

Symptom Analysis

Hot flashes = Yang out of right relationship Night sweat = fluid coming out of pores at night Vaginal dryness = dry vaginal area Poor sleep = heart involvement Easy bloating after eating = fullness in the epigastric area Diarrhea = stool coming out loose Constipation = stool not coming out Fatigue = qi not available Tongue:

Pale= deficiency Dusky = Blood stasis Thin yellow moss = heat in the fu

Abdomen: Full epigastric area = full epigastrium Empty below = Kidney deficiency Tight above pubis = Kidney deficiency

Diagnosis

Hot flashes = Yang out of right relationship Night sweat = fluid coming out of pores at

night Vaginal dryness = dry vaginal area Poor sleep = heart involvement Easy bloating after eating = fullness in the

epigastric area Diarrhea = stool coming out loose Constipation = stool not coming out Fatigue = qi not available Tongue:

Pale= deficiency Dusky = Blood stasis Thin yellow moss = heat in the fu

Abdomen: Full epigastric area = full epigastrium Empty below = Kidney deficiency Tight above pubis = Kidney deficiency

Kidney Qi deficiency with Empty heat and blood stasis Mixed excess/deficiency, hot/cold in the epigastric area with Yang not descending

Kidney Yang/Qi

Stomach Epigastric

Heart

SEEING


Treatment Principle

Supplement the Kidneys in a warm way to root the rising Yang and vitalize blood Open the mixed epigastric block

Kidney Yang/Qi

Stomach Epigastric

Heart


Treatment

Gui Zhi Jia Fu Zi Tang Plus Ban Xia Xie Xin Tang

Supplement the Kidneys in a warm way to root the rising Yang and vitalize blood Open the epigastric block

Gui Zhi 9

Rou Gui 9

Bai Shao 12

Sheng Jiang 4

Da Zao 6

Zhi Gan Cao 5

Fu Zi 3

Xian Mao 6

Huang Lian 3

Huang Bai 3

Dang Gui 5

Chuan Xiong 3

Gan Jiang 2

Ban Xia 4

Results

At the second visit the patient reported that as soon as she began the herbs, she had no more hot flashes or night sweats. She slept soundly through the night all week. Her digestion also felt comfortable with normal bowel movements. In addition her vaginal tissue was moist and the fissures seemed to be healing.

Gui Zhi 9

Rou Gui 9

Bai Shao 12

Sheng Jiang 4

Da Zao 6

Zhi Gan Cao 5

Fu Zi 3

Xian Mao 6

Huang Lian 3

Huang Bai 3

Dang Gui 5

Chuan Xiong 3

Gan Jiang 2

Ban Xia 4

Results

I recommended that she take one more week of this formula and then plan to cut back to every other day and see.

Gui Zhi 9

Rou Gui 9

Bai Shao 12

Sheng Jiang 4

Da Zao 6

Zhi Gan Cao 5

Fu Zi 3

Xian Mao 6

Huang Lian 3

Huang Bai 3

Dang Gui 5

Chuan Xiong 3

Gan Jiang 2

Ban Xia 4

Concluding remarks

Conclusions we might have jumped to: 1. Hot flashes, vaginal dryness and insomnia =

Kidney Yin deficiency 2. Alternating diarrhea and constipation with

abdominal fullness = Liver invading the Spleen

Case 2: Famous Doctor Case Constipation

By Dr. Zhou Feng-Wu

Ms. Chen was 52 years old and suffered from constipation. She moved her bowels only once every 5-6 days. They were hard like goat stool. This was accompanied by dry mouth but she was not able to drink. She felt epigastric fullness and her qi surging upward and also had dizziness, palpitations and chest fullness. When night came, the upward surging and anxiety became worse. The head and eye dizziness also worsened. Her whole body had slight swelling. Her urination was short and scanty and inhibited. Her face had superficial swelling. Below her eyes she had qing colored fat bags. Her tongue was fat and pale and the moss was watery and slippery.

Symptoms Constipation = Stool not moving through Dry stool = Lack of moisture in Large Intestine Dry Mouth = Lack of moisture in the mouth With Inability to drink = Water in the stomach Epigastric Fullness = Fullness in the epigastric area Surging Qi = Surging Upward Dizziness = Unrooted Qi movement in the head Palpitations = Heart involvement Chest Fullness = Fullness in the Chest Worse at night = ? Excess? Anxiety = Heart involvement Body Swelling = Dampness in the flesh Facial Swelling = Damp in face Inhibited Urination = Water not passing through bladder Darkness under eyes = Poor circulation under eyes Tongue Pale = Deficiency Fat = Damp accumulation Watery moss = Water accumulation

Case 3: Famous Doctor Case This was heart and spleen deficiency with water presiding above and jin ye fluids not moving presentation. Treatment needed to warm and open the Yang Qi, attack the bunching and down-bear the surging.

Ling Gui Zhu Gan Tang

Fu Ling 30

Gui Zhi 9

Bai Zhu 30

Zhi Gan Cao 6

I gave her two packages and the dizziness, heart palpitations and surging qi all decreased. This indicated that the water had warmly transformed. I gave her the same formula but added Rou Gui, 3 grams, Ze Xie 12 grams to assist the Yang in transforming Yin, disinhibit water and transform fluids. I gave her two more packages. The dry mouth was gone and the bowels moved. Her spirit and the surging also improved. I changed the formula to Wu Ling San and Zhen Wu Tang combined. This was to assist the Yang in transforming Yin, to lightly seep and disinhibit water and move the fluids.

Case 3: Famous Doctor Case Discussion: This is a case of constipation combined with epigastric fullness and qi up-

surging into the chest. This gave rise to dizziness, inhibited urination, a fat tongue with

slippery moss. This was Heart and Spleen Yang deficiency causing the water qi to stop in

the interior. When the water qi does not transform, the fluids do not spread and so there

is thirst. Below there is constipation. One should treat the root by warming the Yang and

transforming fluids, Then the Yang itself will return the fluid transformation and the fluids

will spread out. The constipation will spontaneously move (meaning without any laxative

herbs) and the thirst will be dispelled. This is the method that causes transformed Yin to

fall like sweet dew. If you mistakenly use downward attacking methods, the valley will

certainly be filled with snow and the rivers will be frozen. The valley pathway (rectum) will

not move.

Case 3: Complicated

Pregnancy

Low Platelet Count

Intake: Patient is 42 year-old, normal build woman who is 28 weeks pregnant with her second child.

CC: fatigue; palpitations I can feel my heart beat through my whole body all the time. This is most strongly felt in abdomen and chest and is worse when lying down; poor appetitehas to force self to eat, feels generally queasy all the time; easy bruising (platelets are dropping as weeks progress); thirst, but doesnt like to drinksips on hot water with lemon and honey; difficult urination feels like the baby is in the way; Feet are beginning to swell (this didnt happen until 34 weeks with first preg)

Pregnancy HX: During the birth of her first child in 2012, protein was discovered in her urine and she was induced. Delivery went well, but she was diagnosed with HELLP syndrome and pre-eclampsia: her Liv enzymes were elevated and her platelets were low, and her BP was somewhat high. She had been feeling bad during the entire pregnancy, but just assumed that was normal. This time, she came to me early in the pregnancy hoping to prevent those complications. The herbs Ive given her have given her a general and vague sense of feeling stronger, and have helped the appetite a little. But the palpitations and fatigue remain and the platelets keep dropping. Also, her glucose tolerance test just came back abnormal. She has a strong family history of diabetes. Finally, she reports, I lost a ton of water after first birth She was catheterized and remembers having to call the nurse often to change the bag.

Other history: Sexual abuse by family member from approx age 5-10.

Endometriosis/ Hx painful menses

Lifelong depression / anxiety however, patient is funny, friendly, self-aware, insightful and engaged in her family and community. She managed her emotions with medications until her first pregnancy and has been off since.

Intake: Temp: tends to hot especially on face and ears, no abnormal sweating

Complexion: somewhat pale and slightly yellowish, bruises easily

Bowels: goes daily but sometimes doesnt feel complete

Urination: recently has become difficult, doesnt seem to empty fully

Energy: fatigue (more than I think is normal, even with a 2 year-old at home)

Appetite: Poor, has to force herself to eat.

Thirsty, but doesnt really want to drink. Sips on warm water with lemon and honey.

Sleep: not great due to two year-olds poor sleep, but also tends to wake 4-5 am with anxiety

Pain: Occasional stabbing pain lower right quadrant (common also before pregnancy). Had some headaches with cold recently (sinus pressure and cough)

Palpitations with discomfort in chest and epigastrium. Can feel pulse in whole body Worse with lying down

Swelling: in feet and ankles after being on feet

HEENT: floaters always; metallic taste in mouth, off and on

Emotions: strong anxiety with chest tightness. Anxiety initially was much better with pregnancy, but since worried about medical conditions, it has returned.

Body feels heavy

Pulse: surging, large and slippery in general, this past week began to feel slightly choppy and weaker in left chi

Tongue: pale red with puffy edges and tip, thin white coat but thicker in rear

Abdomen: strong abdominal pulsation felt in epigastrium o/w hard to palpate due to pregnancy

Symptom Analysis Feels hot - heat

especially in head--heat in head

Pale yellowish complexionblood deficiency

Bowel movements feel incompletebowels not moving fully

Difficult urination urine not coming out fully

Fatigue qi not available

Poor appetite disturbance of t&t

Feels slightly queasy most of the time dist of t&t

Bruises easily blood coming out of vessels

Preference for warm drink cold in middle

Thirst, but doesnt want to drink dampness in the middle

Wakes in early morning with anxiety HT yang not rooting

Occasional lower right quadrant stabbing pain stagnation in right lower jiao

Painful Menses blood stasis in lower Jiao

Frontal headaches with sinus pressure qi stagnation in yangming channel of the head

Swelling in feet and ankles, dampness

better with rest-- dampness

Body feels heavy-- dampness

Floaters Liver blood deficiency

Periodic metallic taste in mouth-- ?

Anxiety HT sign

Palpitations HT sign Especially in Chest and Epigastric Area

Effecting Chest and Epigastric area

Full feeling in chest and epigastrium Excess in the Chest and Epigastrium

Worse with lying down Excess in the Chest

Feels strongly in whole body ?

Strong abdominal pulsation yang not rooting or excess

Tongue pale red normal

puffy edges and tip -- dampness

Thick white coat in rear - damp in lower jiao

Student Diagnosis

Cold-Damp Stagnation in Middle Jiao and Lower Jiao with HT and Liv blood deficiency and Spleen Qi xu

Cold damp in Middle Jiao with water accumulation

Liver blood deficiency and stasis

Both of these effecting the heart

Sharon Diagnosis

Symptom Analysis Feels hot - heat

especially in head--heat in head

Pale yellowish complexionblood deficiency

Bowel movements feel incompletebowels not moving fully

Difficult urination urine not coming out fully

Fatigue qi not available

Poor appetite disturbance of t&t

Feels slightly queasy most of the time dist of t&t

Bruises easily blood coming out of vessels

Preference for warm drink cold in middle

Thirst, but doesnt want to drink dampness in the middle

Wakes in early morning with anxiety HT yang not rooting

Occasional lower right quadrant stabbing pain stagnation in right lower jiao

Frontal headaches with sinus pressure qi stagnation in yangming channel of the head

Swelling in feet and ankles, dampness

better with rest-- dampness

Body feels heavy-- dampness

Floaters Liver blood deficiency

Periodic metallic taste in mouth-- ?

Anxiety HT sign

Palpitations HT sign Especially in Chest and Epigastric Area

Effecting Chest and Epigastric area

Full feeling in chest and epigastrium Excess in the Chest and Epigastrium

Worse with lying down Excess in the Chest

Feels strongly in whole body ?

Strong abdominal pulsation yang not rooting or excess

Tongue pale red normal

puffy edges and tip -- dampness

Thick white coat in rear - damp in lower jiao

Student SEEING

A weak Spleen as allowed water damp to accumulate in the middle and mingmen fire cannot transform yin fluids into blood, leading to qi, blood and damp stagnation along with blood deficiency. physiological yang cannot penetrate through damp to root in mingmen, and flares up to create heat in upper jiao

Student SEEING

There is cold water damp to accumulated in the middle with a deficiency and stasis of blood. Poor blood quality is one cause of the water accumulation as well. Water accumulation and poor blood quality both contribute to the pulsations

Student Treatment Principle

Drain damp through urination, warm middle,

fortify spleen and nourish

blood

Harmonize the relationship between fluid and blood

Warm the middle to dispel cold damp

Sharon Treatment Principle

Student Formula and Explanation On 1/30, I gave her ling gui zhu gan tang

plus ze xie and zhu ling (granules) to drain damp through the urination

Fu ling 6 Gui zhi 4.5 Bai zhu 3 Zhi gan cao 3 Zhu ling 3 Ze xie 3

This helped her urinate freely, but I was

worried that I was not addressing the Sp qi and blood, so on 2/1 I gave her ling gui zhu gan plus dang gui shao yao

Fu ling 12 Gui zhi 9 Bai zhu 6 Zhi gan cao 6 Ze xie 6 Dang gui 9 Bai shao 12 Chuan xiong 4 E jiao 6 Dang shen 9

Student Formula and Explanation

With this second formula, she reports that her urination is not as good as it was with the first one, and it was not until this formula that her ankles began to swell.

I think it was a mistake not to keep in the zhu ling, and Im wondering if the bai shao may be too astringent.

Now, I propose the following to warm and drain the water while supporting the Spleen

Wu ling San

Ze xie 12

Fu ling 6

Gui zhi 4.5

Bai zhu 6

Zhu ling 6

Student Formula and Explanation

Once urination is normal, I expect the palpitations to reduce as well.

At this time, it would be appropriate to nourish blood, support Spleen qi and continue to gently drain damp.

This would be a time for dang gui shao yao tang

Dang gui 3

Chuan xiong 1.5

Bai Shao 12

Bai zhu 4

Fu ling 4

Ze xie 4

Zhu ling 4

Gui zhi 3

With this case, I am noticing that I dont really know how to think about modifying the doses of individual herbs and would love some insight on that.

Sharons Formula Suggestion This is a Ling Gui Zhu Gan Tang pattern plus a Dang Gui

Shao Yao San pattern

Here is the student formulas

On 1/30, I gave her ling gui zhu gan tang plus

ze xie and zhu ling (granules) to drain damp through the urination

Fu ling 12 Gui zhi 9 Bai zhu 6 Zhi gan cao 6 Zhu ling 6 Ze xie 6

This helped her urinate freely, but I was worried that I was not addressing the Sp qi and blood, so on 2/1 I gave her ling gui zhu gan plus dang gui shao yao

Fu ling 12 Gui zhi 9 Bai zhu 6 Zhi gan cao 6 Ze xie 6 Dang gui 9 Bai shao 12 Chuan xiong 4 E jiao 6 Dang shen 9

Ling Gui Zhu Gan Tang plus Dang Gui Shao Yao San

Dang Gui 12

Chuan Xiong 4.5

Bai Shao 12

Fu Ling 20

Gui Zhi 15

Bai Zhu 12

Zhi Gan Cao 3

Gan Jiang 3

Ze Xie 4.5

Outcome so far Just received an email

that this patient feels much better and that her platelets are increasing!

Yay!

Ling Gui Zhu Gan Tang plus Dang Gui Shao Yao San

Dang Gui 12

Chuan Xiong 4.5

Bai Shao 12

Fu Ling 20

Gui Zhi 15

Bai Zhu 12

Zhi Gan Cao 3

Gan Jiang 3

Ze Xie 4.5

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More Free Webinar Recordings on Medigogy.Com

The Importance of a Clear Diagnosis Part I

The Treatment of Knotty Diseases: How Effective Use of

Classic Formulas can Transform your Clinic and Practice

Blood Stasis and Type 2 Diabetes

Key Points for Treating Bleeding in Gynecology

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