Case statements

[Guest guest]

This is a rather long post about a simple example of teaching methods.

Last semester I taught a class called Principles of Treatment at

Emperors. It's been kind of a rogue class and when I took it over I

decided to use Bob Flaw's Statement of Fact as one of the required

text. For one assignment I gave them a simple case study they had to

complete with the various approaches and then justify with quotes from

the book. (You can see these later in the analysis.)

 

I was really happy, especially with this one, about what people came

up with. I hope the author forgives me for making it public. And I

believe the case is from Gancao.net (used with permission).

 

I also used the book in my Fundamentals Class. Their assignment came

at the end of the semester and people really seemed to enjoy reading

it after having gotten much of the material earlier.

Doug

 

 

 

 

 

 

Chief complaint: Dark scanty menstruation

 

History:

 

40 year old Yoga instructor, very active lifestyle with a 5 year old

daughter. She eats irregularly and often on the run. She had a

healthy pregnancy and no surgeries or major illnesses.

 

She reports that her menstruation is scant in amount, dark in color

which is described as brownish purple. She admits to noticing some

clots. Abdominal cramping occurs on day one. She is fatigued during

her menstruation period and even worse after the period. Her energy

is very low lately.

 

Objective assessment:

 

Her complexion is pale. Her tongue is pale purple and more pale on

the sides. Her pulse is thin, choppy and wiry.

 

Analysis

 

Yin – Yang High activity lifestyle uses up yang qi. When Yang is

deficient, qi stagnates (Maciocia, 1989).

 

Heat – Cold Dark and purplish menstrual blood, purple pale tongue

imply the presence of cold coagulation. Cold coagulation results in

qi stagnation.

 

Deficiency - Excess Her pale complexion and pale tongue suggests a

blood deficiency. Low energy and a feeling of fatigue support the

presence of qi deficiency. Where blood goes, qi follows. There is

likely Qi and Blood deficiency. Evidence of stagnation, and thus

excess, is due to the impaired qi flow.

 

Five – Elements Her diet pattern fails to nourish the earth. The

earth is barren, water is dry, and wood is withered. The spleen,

kidney and liver all are in peril.

 

Diagnosis: Liver blood and qi deficiency with qi stagnation due to

cold coagulation

 

Treatment Plan: Tonify liver blood, tonify qi and warm the uterus

 

Due to the cyclical nature of the problem, different portions of the

menstrual cycle will require a different treatment regime.

 

Day 4 – day 14

Treatment Principle: Tonify liver blood

 

Herbal prescription: Bai Feng Wan

Wu Ji Tonifies liver, kidneys, and spleen

Ren Shen Tonified yuan qi, benefit the lungs,

supplements the center

Shu Di Huang Tonifies blood, benefits the yin

Dang Gui Tonified blood, regulates the menses, invigorates

the blood

Bai Shao Tonifies blood, regulates the menses

Chuan xiong Activates blood, moves the qi

Xiang Fu Regulates menstruation, alleviates pain,

regulates liver qi

Geng Mi Tonifies the yin

 

Acupuncture: Point Rationale

Sp 6 Tonifies spleen,

Harmonizes the liver, and regulates

Menses

Kid 3 Tonifies kidneys

Liv 8 Tonifies liver blood

UB 18 Tonifies the liver

UB 20 Tonifies Spleen

UB 17 Tonifies blood

ST 36 Tonifies qi and blood

 

According to the Statements of Fact by Flaws (p. 34), the liver

governs the sea of blood (Chong mai), the liver is the sea of blood

and the blood chamber (uterus) is the liver. These statements affirm

the relationship of the liver, blood and menstruation. In treating

menstruation problems, blood has to be addressed. Flaws page 37

statement connects the liver and the kidneys: The liver and kidneys

are of or share a common source. Treatment of blood deficiencies must

include the spleen which engenders blood. The spleen is the viscus of

transformation and engenderment of qi and blood (Flaws page 54).

 

Day 15 – day 21

Treatment principle: Tonify Qi, Blood, and Yang

 

Herbal Prescription: Shi Quan Da Bu Tang

Ren Shen Tonifies yuan qi

Bai Zhu Tonifies the spleen

Fu Ling Toinfies the middle

Shu Di Huang Tonifies blood, benefits the yin

Bai Shao Tonifies blood, regulates the menstruation

Dang Gui Tonifies the blood, regulates the menses

Chuan Xiong Activate blood and moves the qi

Rou Gui Disperse cold, warms the kidneys

Huang Qi Tonifies the middle and supplements the qi

Gan Cao Tonifies the spleen, augments qi and blood

 

Acupuncture: Point Rationale

Ren 4 Tonifies yuan Qi and regulates the uterus and menses

Du 4 Tonifies kidney yang, benefits yuan qi and jing

ST 36 Tonifies qi and blood

Kd 3 Tonifies Kd, benefits the essence

Sp 6 Tonifies spleen, Harmonizes the liver, and regulate menses

ST 36 Tonifies qi and blood

UB 20 Tonify spleen

UB 17 Tonify blood

 

Moxa Ren 8 to warm the uterus, strengthens the spleen.

 

Both qi and blood need to be tonified together. Qi is yang, blood is

yin (Flaws p. 13). Without yang, yin cannot transform; without yin

yang cannot engender (Flaws p. 10). Qi is able to engender blood

(Flaws p. 101). Blood is able to engender the qi (Flaws p. 101). The

spleen is tonified to continue producing blood. Spleen yang is rooted

in kidney yang (Flaws p. 62). In tonifying the qi, tonifiying the

kidneys must be included in the treatment plan. Source qi is effused

from the kidneys (Flaws p. 103).

 

Day 22 – day 28

Treatment Principle: Dispersing cold and move qi the blood

 

Herbal prescription: Wen Jing Tang +

Wu Zhu Yu Dissipates cold, moves qi

Gui Zhi Warms yang in the Chong and Ren channels to restore

normal menstruation

Dang Gui Tonified blood

Bai Shao Tonified blood and regulates the menses

Chuan xiong Activates blood and moves qi

E Jiao Tonified blood

Mai Men Dong Tonifies the yin

Mu Dan Pi Activates the blood and disperses blood stasis

Ban Xia Descends qi

Sheng Jiang Reduces toxicity of Ban Xia, and also warms the middle

Gan Cao Tonifies the spleen harmonizes the formula

Ren Shen Tonifies qi

 

Acupuncture: Point Rationale

Sp 4 + Pc 6 Open the Chong channel

Sp 10 Activate, tonify and move blood

Kd 6 + Lu 7 Open the Ren channel

Ren 4 + 6 Tonify qi, blood and Kd yang

GB 34 (combined with Ren 6) to move qi of lower abdomen

ST 36 Tonifies qi and scatters cold

Liv 3 Moves qi and blood

 

In this phase of the cycle, the intent is to open the channels and

facilitate the arrival of menstrual flow. Warmth will help move the

stagnant qi due to cold. The blood and qi like warmth and are averse

to cold. Cold leads to weeping and inability to flow, while warmth

leads to dispersion and going (Flaws p. 108).

 

Summary

 

In women, it is blood which makes their root and qi which makes for

function (Flaws p. 110). The patient's lifestyle cannot be overlooked

if the treatment plan is to work in the long term. Heaven feeds

humans the five qi; earth feeds humans the five flavors (Flaws p. 2).

Patient should be persuaded to modify her eating habits to include

foods that tonify blood. The root of a quiet body must be supplied by

food (Flaws p. 162). The patient is very busy. Does she need to be

very busy? Physical overtaxation and labor lead to spleen disease

(Flaws p. 164). The spleen is the viscus of transformation and

engenderment of qi and blood (Flaws p. 54). Moreover, the " Internal

damage of the spleen and stomach causes the endangerment of hundreds

of diseases " (Flaws p. 63). It will be important for the practitioner

to find out her exercise routine. If her exercise routine is in

excess, the sinews and bones may be over taxed. Overtaxation of the

sinews and bones lead to damage of the liver and kidneys (Flaws p. 219).

 

The patient is very busy. Time is her enemy. The question is if she

will have time to reflect the importance and investment towards

wellness and balance. Pilates focuses on balancing the physical body.

She will benefit from balancing her life. The blood within a woman's

uterus is exchanged on time each month, eliminating the old and

engendering the new [or fresh blood] (Flaws p. 111). As her cycle

changes towards health, maybe she too will change her perspective of

her health priorities.