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Diagnosis II
Diagnosis Reveals Itself
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Diagnosis II
Diagnosis Reveals Itself
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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
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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
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June, 2012
Menopausal Syndrome Case
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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.
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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.
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History
Hysterectomy 96 for heavy bleeding from fibroids
History of dysmenorrhea since 77 until hysterectomy
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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
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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
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Kidney Yang/Qi
Stomach Epigastric
Heart
SEEING
Kidney Qi deficiency with Empty heat and blood stasis Mixed excess/deficiency, hot/cold in the epigastric area with Yang not descending
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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
Kidney Qi deficiency with Empty heat and blood stasis Mixed excess/deficiency, hot/cold in the epigastric area with Yang not descending
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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
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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
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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
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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
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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.
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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
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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.
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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.
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Case 3: Complicated
Pregnancy
Low Platelet Count
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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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CEU/PDA/CPD approved courses on ProDSeminars.com:
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Clarifying Diagnosis
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Sharon Weizenbaums Complete Pregnancy Course Using Chinese Herbs
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Implantation to Birth: Acupuncture and Herbs
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with Debra Betts, Claudia Citkovitz and Sarah Budd
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