I'm a TCM practitoner and I have a quite complicated case here.
I have a 40 year old woman who is overweight, depressed, and in constant pain. Her most notable symptoms are facial acne, SEVERE moaning/stomach QI rebellion, phlegm/nodules in channels(SP, LV). Her gait is damp-like, sluggish, and encumbered looking. She is an emotional rollercoaster- somedays high as a mountaintop other days low as the gutter.
She is really textbook dampness, IMO, however I've diagnosed her with SP/KD yang def and maybe ST qi rebellion b/c of the constant belching.
I've made some progress and have gotten her to lose about 12 pounds, but this MOANING/belching is unreal. I've never seen somebody so severe as this.
Does anybody have any experience with a patient like this?
Ive had her on Jin gui shen qi wan, ping wei san, gui pi tang etc, but nothing has really quelled the "moaning/st QI rebellion".
Any help or reassesment of diagnosis would be appreciated.
comment by "ChadD" (acupuncturist)
on Jun 2012
You would have to give more diagnostic signs along with tongue and pulse indications for me to comment on a clear diagnosis, but my initial read tells me that Jin Gui Shen Qi Wan and Gui Pi Wan in particular are entirely wrong to treat this range of symptoms and, in general, I question the diagnosis. Emotional ups and downs and acne in particular indicate some aspect of heat, damp-heat possibly, but heat nonetheless. Kidney yang formulas in particular would make this aspect worse even though the general concept of strenghtening the kidneys and spleen to transform dampness is technically correct. There are orders to resolving complicated cases, however.
Again, without knowing more, my initial read would lead me to consider Jia Wei Xiao Yao Wan, or just Xiao Yao Wan, mixed with Shu Gan Wan - so perhaps 5 pills of each 3/x day before meals. If that gets the stomach and emotions a little better under control you could stay with that or perhaps move to something like Wen Den Wan which may deal with the emotional aspects of phlegm better than many other formulas. Jin Gui Shen Qi Wan is far too likely to add more heat/activity into the equation which could really backfire and Gui Pi Wan can be rough on digestion initially, particularly when that system is weak already.top Login/Comment
comment by "brendan"
on Jun 2012
Thanks for the input.
Pulses are deep and weak in rear position. Tongue is swollen/ Scalloped. Patient has a weak bladder as well and wets the bed, which was one of the reasons I assumed it was more kidney related. Also insomnia for about 8 years... my initial approach was to build the spleen and kidney up, and that the stomach qi rebellion was from the dampness causing heat. Again my main concern is dealing with the underlying dampness / phlegm.
Also the periods are every 40 days or so. I'm thinking the xiao Yao San would help with the emotions/ stagnation present as well.
Thanks for the insight.