1. June, 2012

2. This patient is 56 years old and her symptoms began around age 50. She suffers from frequent hot flashes that are worse with stress. These wake her up at night 2-3X/night. She will sweat at night slightly with the hot flash. This disturbs her sleep but she also has poor sleep in addition to this. She has been diagnosed with Lichen Sclerosis which she experiences as vaginal dryness and cracking. She was recommended to take prednisone for this but she did not want to. Her digestion if poor as she easily and almost always feels bloated and her bowels are irregular from constipation to diarrhea. Bloating is in the epigastric area and is worse after eating.

3. This patient feels very tired much of the time though she feels this is due to sleep loss. Sweating, thirst, general temperature regulation, respiration all feel normal Signs: Tongue: pale and slightly dusky with a thin yellow moss Pulses: middle and upper jiao pulses full. Lower jiao pulses fall off into deep and thin. Abdomen: Firm and resilient with fullness in the epigastric area and emptiness in the lower belly with a tension above the pubic bone.

4. Hysterectomy ‘96 for fibroids leading to heavy bleeding. History of dysmenorrhea since ‘77 until hysterectomy

5. Hot flashes = Yang out of right relationship Night sweat = fluid coming out of pores at night Vaginal dryness = dry vaginal area Poor sleep = heart involvement Easy bloating after eating = fullness in the epigastric area Diarrhea = stool coming out loose Constipation = stool not coming out Fatigue = qi not available Tongue: Pale= deficiency Dusky = Blood stasis Thin yellow moss = heat in the fu Abdomen: Full epigastric area = full epigastrium Empty below = Kidney deficiency Tight above pubis = Kidney deficiency

6. Hot flashes = Yang out of right relationship Night sweat = fluid coming out of pores at night Vaginal dryness = dry vaginal area Poor sleep = heart involvement Easy bloating after eating = fullness in the epigastric area Diarrhea = stool coming out loose Constipation = stool not coming out Fatigue = qi not available Tongue: Pale= deficiency Dusky = Blood stasis Thin yellow moss = heat in the fu Abdomen: Full epigastric area = full epigastrium Empty below = Kidney deficiency Tight above pubis = Kidney deficiency Hot flashes = Yang out of right relationship Night sweat = fluid coming out of pores at night Vaginal dryness = dry vaginal area Poor sleep = heart involvement Easy bloating after eating = fullness in the epigastric area Diarrhea = stool coming out loose Constipation = stool not coming out Fatigue = qi not available Tongue: Pale= deficiency Dusky = Blood stasis Thin yellow moss = heat in the fu Abdomen: Full epigastric area = full epigastrium Empty below = Kidney deficiency Tight above pubis = Kidney deficiency Kidney Qi deficiency with Empty heat and blood stasis Excess in the epigastric area with Yang not descending

7. Kidney Yang/Qi Stomach Epigastric Heart Kidney Qi deficiency with Empty heat and blood stasis Excess in the epigastric area with Yang not descending

8. Supplement the Kidneys in a warm way to root the rising Yang and vitalize blood Open the epigastric block Kidney Yang/Qi Stomach Epigastric Heart Kidney Qi deficiency with Empty heat and blood stasis Excess in the epigastric area.

9. Gui Zhi Jia Fu Zi Tang Plus Ban Xia Xie Xin Tang Supplement the Kidneys in a warm way to root the rising Yang and vitalize blood Open the epigastric block

10. At the second visit the patient reported that as soon as she began the herbs, she had no more hot flashes or night sweats. She slept soundly through the night all week. Her digestion also felt comfortable with normal bowel movements. In addition her vaginal tissue was moist and the fissures seemed to be healing.

11. I recommended that she take one more week of this formula and then plan to cut back to every other day and see….

12. Conclusions we might have jumped to: 1.Hot flashes, vaginal dryness and insomnia = Kidney Yin deficiency 2.Alternating diarrhea and constipation with abdominal fullness = Liver invading the Spleen