1. PAIN AND DIGESTIVE UPSET SHARON CASE May 2012

2. INTAKE Female age 29 First visit: May 16, 2012 Occupation: Farmer Main Complaints: Joint pain and popping Head, neck, shoulder pain Migraines Daily digestive upset – cramping, bloating, irregular bowels

3. INTAKE This patient has a very physically demanding life. She has suffered from body pain for about 15 years. She is constantly in pain in various ways and places. She was living on Advil until her stomach couldn’t take it any more. All of her joints hurt though her left hip is really bad. She cannot sit on a horse properly due to pain and stiffness in that hip. She has constant tightness and pain in her knees and up the sides of her legs into her hips. Her head, neck and shoulders are always stiff. Sometimes this gets so bad it turns into a severe headache that seems to originate in the occipital region. Her headaches can be induced by stress or premenstrually. In general her pain is worse with cold and dampness.

4. INTAKE In addition to pain, this patient suffers from digestive issues. She feels hungry a lot but when she eats a small amount she immediately feels bloated and uncomfortable. She feels nausea in the mornings and tends to have lots of gas pains that are somewhat relieved with her diarrhea. Her digestion has been like this since she can remember. “Always, always” This woman’s menstruation is painful though the dysmenorrhea is not worse with cold or better with heat. She takes between 2-6 Advil/ cycle. She bleeds every 23- 25 days for 4-5 days. The amount is normal with some clots. Premenstrually she will tend to get a bad headache and feel tense and irritable.

5. INTAKE This patient’s sleep is disturbed by both pain and dreaming. She tosses and turns a lot. She feels exhausted most of the time. Sweating, urination are normal. She is robust and rosy cheeked with good skin and bright eyes. Tongue: normal redness with purple. Sticky white moss Pulse: strong, wiry, slightly floating Healthy abdomen with pain in the lower pelvic area. She also had a very full feeling when I pressed into her epigastric area.

6. Pain in the joints and flesh = Stagnation in the channels Worse with cold = cold in the channels Worse with damp = Damp in the channels Especially in the shoulders/neck and occiput = Stagnation in the Tai Yang channels Along the GB channel into the hips = Stagnation in the Shao Yang GB channels Headaches = Qi stagnating in the head Occipital root = Tai Yang Channels Worse with stress = Liver related Worse with cycle = Liver related Digestive issues = issues with T&T Bloating in epigastric area = Qi stagnation in epigastric area Worse with eating = excess Nausea = Stomach involvement Loose stool = stool not formed Gas pains = stagnation in the Large Intestine Better with diarrhea = excess in the Large Intestine Menstrual Issues: Strong menstrual pain = blood stasis in the womb Clots = blood stasis Early menstruation = blood coming out when it shouldn’t PMS = liver involvement Tense and Irritable = liver Qi stagnation Other: Poor sleep = Heart involvement Exhausted = Qi not available Pain with palpation in the lower abdomen = stagnation in the lower abdomen Fullness with palpation in the epigastric area = fullness in the epigastric area Tongue:Purple = blood stagnation Sticky white moss = cold damp

7. DIAGNOSIS Cold damp in the channels, especially Tai Yang and Shao Yang Excess stagnation in the epigastric area Liver Qi and Blood stasis in the channels and womb This effects the heart. Pain in the joints and flesh = Stagnation in the channels Worse with cold = cold in the channels Worse with damp = Damp in the channels Especially in the shoulders/neck and occiput = Stagnation in the Tai Yang channels Along the GB channel into the hips = Stagnation in the Shao Yang GB channels Headaches = Qi stagnating in the head Occipital root = Tai Yang Channels Worse with stress = Liver related Worse with cycle = Liver related Digestive issues = issues with T&T Bloating in epigastric area = Qi stagnation in epigastric area Worse with eating = excess Nausea = Stomach involvement Loose stool = stool not formed Gas pains = stagnation in the Large Intestine Better with diarrhea = excess in the Large Intestine Menstrual Issues: Strong menstrual pain = blood stasis in the womb Clots = blood stasis Early menstruation = blood coming out when it shouldn’t PMS = liver involvement Tense and Irritable = liver Qi stagnation Other: Poor sleep = Heart involvement Exhausted = Qi not available Pain with palpation in the lower abdomen = stagnation in the lower abdomen Fullness with palpation in the epigastric area = fullness in the epigastric area Tongue:Purple = blood stagnation Sticky white moss = cold damp

8. SEEING THE EXTERNAL: COLD DAMP AND POOR BLOOD CIRCULATION

9. SEEING THE INTERNAL Epigastric blockage causing disruption in the up and down in the digestive system. Stomach is not going down, LI is going down too much. Blood stasis in the womb and in general causing poor circulation and an inability to resolve pain

10. TREATMENT PRINCIPLE Resolve cold and damp in the channels Open the epigastric block Vitalize blood in the channels and womb Stop Pain and improve digestion!

11. Pain in the joints and flesh = Stagnation in the channels Worse with cold = cold in the channels Worse with damp = Damp in the channels Headaches = Qi stagnating in the head Occipital root = Tai Yang Channels Worse with stress = Liver related Worse with cycle = Liver related Digestive issues = issues with T&T Bloating in epigastric area = Qi stagnation in epigastric area Worse with eating = excess Nausea = Stomach involvement Loose stool = stool not formed Gas pains = stagnation in the Large Intestine Better with diarrhea = excess in the Large Intestine Menstrual Issues: Strong menstrual pain = blood stasis in the womb Clots = blood stasis Early menstruation = blood coming out when it shouldn’t PMS = liver involvement Tense and Irritable = liver Qi stagnation Other: Poor sleep = Heart involvement Exhausted = Qi not available Pain with palpation in the lower abdomen = stagnation in the lower abdomen Fullness with palpation in the epigastric area = fullness in the epigastric area Tongue:Purple = blood stagnation Sticky white moss = cold damp

12. Wu Zhu Yu6 Du Huo12 Qiang Huo12 Gui Zhi24 Fu Zi12 Ma Huang6 Zhi Mu12 Bai Shao12 Cang Zhu15 Fang Feng15 Sheng Jiang (golf ball size balls) 6 Gan Cao6 Fu Ling12 Ge Gen24 FORMULA GUI ZHI SHAO YAO ZHI MU TANG MODIFIED (DOSAGES ARE IN QIAN/WEEK OF BULK RAW HERBS) PLUS I GAVE HER BAN XIA XIE XIN TANG IN POWDER EXTRACT FORM- 3 GM – 3X/DAY Resolve cold and damp in the channels Open the epigastric block Vitalize blood in the channels and womb Stop Pain and improve digestion!

13. Wu Zhu Yu6 Du Huo12 Qiang Huo12 Gui Zhi24 Fu Zi12 Ma Huang6 Zhi Mu12 Bai Shao12 Cang Zhu15 Fang Feng15 Sheng Jiang (golf ball size balls) 6 Gan Cao6 Fu Ling12 Ge Gen24 FORMULA GUI ZHI SHAO YAO ZHI MU TANG MODIFIED (DOSAGES ARE IN QIAN/WEEK OF BULK RAW HERBS) PLUS I GAVE HER BAN XIA XIE XIN TANG IN POWDER EXTRACT FORM- 3 GM – 3X/DAY Resolve cold and damp in the channels Open the epigastric block Vitalize blood in the channels and womb Stop Pain and improve digestion!

14. RESULT The patient also had acupuncture and was pain free after her first treatment that included LOTS of moxa. This lasted for 3 days at which time her pain returned but to only about 1/3 of the previous level. After a week on the decoction it had gone down to about ¼ of the previous level. She had just gotten her menstruation the day before the first treatment and did not need more advil after that. As soon as she took the Ban Xia Xie Xin Tang she felt tremendous relief in her digestion. This has continued to the present with her now taking 3 gm/day.

15. RESULT After 2 weeks on the decoction and another acupuncture/moxa treatment the patient was completely pain free. She sat on a horse in a balanced way. Her sleep was deep and refreshing After 4 weeks the patient told me that she was only able to drink the decoction at a half dose because it was haying season but that she was still pain free. Her next menstruation arrived on time with no headache but was still somewhat painful. She took 2 advil through out which was an improvement. She had stopped taking the Ban Xia Xie Xin Tang because she ran out but her digestion was still fine.

16. RESULT The patient is taking the decoction at half dose for the next two weeks at which point I plan to change the formula for her menstruation to move blood and stop pain.

17. POTENTIAL WRONG ASSUMPTIONS Diarrhea = Spleen Qi deficiency Exhaustion = Qi deficiency It would be easy to have the idea that the dampness was caused by Spleen Qi deficiency. Headaches = Liver Yang rising (especially with sleep issues) It would be easy to focus on Qi and blood stasis and give a formula like Xue Fu Zhu Yu Tang. This would be the wrong location and symptom and not working with the entire disease factor.

18. DISCUSSION Importance of seeing the individual signs and symptoms for what they are before trying to put them in context Basing the diagnosis on what we know for sure Pulse Disease Factor, Symptom, Location A Qin Bowei concept from a book of essays: A Qin Bo Wei Anthology by Charles Chace and Zhang Ting Liang.