Chronic Constipation and Insomnia Case

[Lettie de Wit]

Good afternoon, I saw a new patient today (58 y.o.) with vitiligo, chronic severe constipation (1x per week; dry hard), hot flushes, severe insomnia (sleeps max 2 hours per night) and neck hernia C2-C3. All her life her menstrual cycle has been every 17 days, whereby every menses was 7 days of very heavy blood loss. Her pulse: very deep weak expiring left guan. Both chi’s hidden, cannot feel them. Deep weak tight R cun. I was thinking of DGSNJWZYSJT, but….she has had never cold hand and feet in her life. Must this symptom always be there?

[collincampbell]

Constipation + ginger is something to watch out for.

[Lettie de Wit]

As she did well on GGHQHLT, maybe something to transition out of that? Maybe something like Shen Zhou Tang + Huang Lian and Huang Qin?

[collincampbell]

What’s going on with that right guan? Could do CH first, and then go into DG. Regulate the period and the blood will get better. Maybe DGSNT w/ double BS. First thing should be simple and SHL. DGSNT plus ZS maybe? This could go to WJT also.

[Lettie de Wit]

Also, her periods have stopped now for 7 years. R guan was bigger weaker, I guess.

[collincampbell]

Okay. That’s the thing that really isn’t DGSNJWZYSJT. Maybe JZT/ZWT combo. Can do ZS at 18.

[Lettie de Wit]

Kevin

[laurieayres]

DGSNT can be useful for constipation when the interior is so cold and contracted that nothing can move. Remember, the liver channel runs across the perineum close to the rectum; DG can reduce urgency; XX decontracts the transverse colon; BS relaxes and moistens the stomach and descends, etc, but as Collin Campbell says, you do need to be careful and sure that it’s the right formula in constipation, as it also has the potential to heat “stuck things” up a lot. Here the pulse fits, but DGSNT shouldn’t have hot flushes, so another possibility is that she may need harmonising first before treating the yin conformations

[collincampbell]

I think it’s the XX, like in DHXXFZT.

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