Headaches, Loose Bowels, Stress… Case

[Clint Cain]

What do you think of these pulses? On 10/4/17 a 31 year-old female came into my clinic with a main complaint of stress that manifests as headaches and upper body tension. She is a very busy PhD student right now. Her headaches are in her eyes and at her anterior hairline. She has them on a daily basis, and they are a low level ache. She also has some difficulty concentrating, and some difficulty falling asleep. She was diagnosed with low grade Spondyloslisthesis at L5-S1. With this, she has some lower back pain, very tight hamstrings, and some tingling, numbness, and pain down her left Gb channel. She also feels some of these sensations on the very bottom of her foot. This has been going on for at least eight years. She also tends to get some seasonal allergies, mostly manifesting with dryness of the nose, eyes, and mouth. When she does come down with an acute illness, it manifests as nasal congestion and sinus pain. Her stress also causes some abdominal tension, not really pain, and she can have 2-3 BM/day that are loose when her stress is high enough. This occurs about three times per week. She is constipated before her menses. She has a lot of pain before her menses, and some very small clots with dark xue. She was sweating easily during the acupuncture treatment, and even felt a bit dizzy and nauseous at times, but nothing that was so severe that we had to stop. I practice Japanese acupuncture, and am always very aware of the amount of stimulus I am providing, so this says to me that she is quite sensitive. Pulses: L: 1 and 2 slightly deep thin wiry, 3 deep thin, dong 1-2, faint and slightly expiring overall; R: 1 slightly wiry tight, 2 thin slightly big expiring, 3 deep thin faint, slight rolling up. Herbs: I started her on CHGZGJT + ZSXBGZT. With the faint and slightly expiring pulses, I see the need to treat shaoyin and jueyin, but I am not sure how to approach it. Help please.

[Coleman McMurphy]

My first thought was something based around DGSYS perhaps?

[Clint Cain]

I should also have mentioned that her hands and feet were pretty cold to the touch. More jueyin information.

[Clint Cain]

That was a thought I had, too, but I am not sure. I don’t have much experience with treating jueyin.

[Clint Cain]

I was also thinking that I need elements of sweet earth nourishing in my formula with the slightly big R2, dong 1-2, and tendency to loose BM, rather than ZSXBGZT. And, I also see the need for treating the peripheral xue and yang since her hands and feet are cold, and she has tingling and numbness in her L leg, as well as overall muscle tightness. Basically, I can’t decide between DGSYS, DGSNJWZYSJY, etc.

[Coleman McMurphy]

Urgency, tightness in the abdomen and menstrual issues + other blood xu signs…pulse seems to be close to a match, as well.

[hamishbrown]

DGSYS plus LZW. Hopefully you can head to DGSNT afterwards. I’d be tempted to add XX to the first choice due to the sinus issues, headaches, and nerve-like jueyin based symptoms.

[Clint Cain]

What do you think of these pulses? On 10/4/17 a 31 year-old female came into my clinic with a main complaint of stress that manifests as headaches and upper body tension. She is a very busy PhD student right now. Her headaches are in her eyes and at her anterior hairline. She has them on a daily basis, and they are a low level ache. She also has some difficulty concentrating, and some difficulty falling asleep. She was diagnosed with low grade Spondyloslisthesis at L5-S1. With this, she has some lower back pain, very tight hamstrings, and some tingling, numbness, and pain down her left Gb channel. She also feels some of these sensations on the very bottom of her foot. This has been going on for at least eight years. She also tends to get some seasonal allergies, mostly manifesting with dryness of the nose, eyes, and mouth. When she does come down with an acute illness, it manifests as nasal congestion and sinus pain. Her stress also causes some abdominal tension, not really pain, and she can have 2-3 BM/day that are loose when her stress is high enough. This occurs about three times per week. She is constipated before her menses. She has a lot of pain before her menses, and some very small clots with dark xue. She was sweating easily during the acupuncture treatment, and even felt a bit dizzy and nauseous at times, but nothing that was so severe that we had to stop. I practice Japanese acupuncture, and am always very aware of the amount of stimulus I am providing, so this says to me that she is quite sensitive. Pulses: L: 1 and 2 slightly deep thin wiry, 3 deep thin, dong 1-2, faint and slightly expiring overall; R: 1 slightly wiry tight, 2 thin slightly big expiring, 3 deep thin faint, slight rolling up. Herbs: I started her on CHGZGJT + ZSXBGZT. With the faint and slightly expiring pulses, I see the need to treat shaoyin and jueyin, but I am not sure how to approach it. Help please.

[Arnaud Versluys]

CS? Must say it’s a bit of a strange combo.

[hamishbrown]

Sorry having a blank with the reference to CS? And it’s not a combo (DGSYS plus LZW) that I think I’ve done, so even though it’s strange do you think it’s ok to try and pivot solely off BZ? The combo I have tried, which I’m also wondering if there is a problem with is DGSNT plus LZW. Can chat next week about it at clinic if that’s better?

[hamishbrown]

I guess from that you are referring to the high BS and combining it with GJ in LZW perhaps? And yes, SJ is often used with BS, but not GJ as much, unless it’s with cough mods. GJ warms and dries the centre, and BS does the opposite. Have I got it?

[laurieayres]

Yeah basically, it’s the Li Zhong/Jian Zhong comparison. It’s not that you’d never use the two together, but you’d often want to make the choice whether, for example, loose stools are due to cold damp earth with wood not controlling (GJ), or excessive wood on earth creating too much movement (BS). Combining one formula based around the former and one with its highest dose of the latter would need careful consideration, but is not absolutely impossible.

[hamishbrown]

Thanks for elaborating!

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