I have seen a difficult case. 43 y/o obese lady with a psychiatric history. Complaint: PMS complaints, from ovulation until menstruation: fatigue, panic attacks, insomnia, back ache and cramps (only 1-2 hours preceding mensruation+ some nausea). The period of complaints is increasing because she is heading towards menopause. She has been having this for 2 years now. She got addicted to zolpidem. She took around 6 tablets a day. Now she is decreasing this with the help of cognitive based therapist. Other aspects of the history: MH/ psoriasis (dry scaly skin), 2 myomas in the uterus, a cyste in the ovarium, had an accident with a bus in 2003 and the small muscles close to the spine are sensitive, subcostal tenderness, painful SI joint, migraine around menses. Other S/S: feels warm, flushes easily in the face, can’t handle spicy food, gets some burning behind sternum. Pulse: overall deep and soggy. Left :1e roll thin wiry; 2e deep faint. Right; 1e roll tight; 2e thin wiry deep (a little higher than the left side). Abdomen: big belly, not lax, some costal tenderness on the side of the spleen, rikyu, oketsu and tender spots in lower abdomen. Before I felt the pulse I was thinking harmonizing +LGZCT, but I don’t recognize this on the pulse. Perhaps DGSNT or DGSYS +LGZCT. What would be a good start with this lady?
