Case

1. Case Fertility

2. Intake: • 31 year old female coming for fertility.  She is bright, friendly with a sturdy frame and a healthy glow to her complexion. • MC: fertility:  she has been trying to get pregnant for 7 months. • periods:  regular, every 28 days with normal flow, on the heavy side for 2 days, and healthy blood color. • “really awful” cramps – worse with pressure better with heat. will take alleve if she has to go to work.  no clots. • pms: bloating, gas, diarrhea (although there has been no diarrhea for the past 2 cycles) • vaginal discharge daily - sometimes yellowish, sometimes brownish, sometimes clear -unsure of when each color comes out. • Libido healthy • Other: • body temp:   runs a little too warm - can go without a jacket in winter for a little while. no cold hands/feet. prefers cold beverages but can drink warm no problem. • thirst:  strong and not always satiated by drinking • swelling:  sometimes wakes with swollen eyes. • urination normal. no nocturia. • bowel movements are normal except sometimes a bigger meal or unusual food will make her immediately have to move her bowels but the stools are normal.  She only eats small meals at work because of this.

3. Intake: • healthy skin, nails and hair. • dizziness:   lightheaded and low energy.   triggers- not eating for too long, coffee or eating sugar 1st thing in the morning. • eyes: floaters, dry eyes with contacts • mouth: occasional whitish swellings on inner cheeks. • LU, HT, chest, appetite, digestion, sleep, energy all symptom-free. • neck and shoulder tension from body positioning at her job as an esthetician. • Her back, hips and butt are usually warm, not cold. • emotions:  diagnosed bi-polar but has been medication free for 2 years without any symptoms. tendency to stress - had to quit her job as a teacher but she was too anxious and stressed by it and feels she still would be if she went back to it. she feels a little overly sensitive emotionally about how people treat each other – anxiety and anger but also feels that she can go with the flow and is pretty laid back in daily life. she gets tight chested with stress and it can affect her sleep.   No other physical symptoms with it. when she had anxiety with bi-polar she would get palpitations with it. • hara:  alternates between warm, springy and healthy and being very tight in whole upper belly. No emptiness in the lower belly.

4. Intake: • tongue:  healthy pale red with redder tip and pale sides. Sl. thicker, yellowish tc in the back.  indented. sl. fluted edge on left. Dry middle and back. no dips, cracks, absolutely no distended veins underneath. no purple tinge.

5. Leave this blank for Sharon Symptom Analysis difficulty getting pregnant difficulty getting pregnant severe menstrual cramps blood stasis in the uterus better with heat cold in the uterus Worse with pressure excess in uterus pms bloating LV involv. qi stag in the LI pms gas LV involv. qi stag. in the LI sometimes pms diarrhea LV involv. too much water in the LI chronic vaginal discharge too much fluid coming out of uterus sometimes yellowish damp-heat in the uterus sometimes brownish either blood or heat in the uterus sometimes clear either normal or damp- cold in the uterus body temp too warm heat prefers cold drinks heat in the STstrong thirst a wanting for fluids in the mouth not always satiated by drinking drinking not always able to quench thirst sometimes wakes with swollen eyes too much fluids at the surface of eyes

6. Leave this blank for Sharon Symptom Analysis big meals/unusual food stims peristalsis maybe normal or yang ming excess lightheaded yang out of RR in head with low energy qi not available to body when yang out of RR in head from not enough food in ST deficiency in ST involved from eating sugar first thing excess in ST/SP also involve from caffeine caffeine/stimulant involved floaters LV blood deficiency dry eyes with contacts not enough moisture in eyes swellings on inner cheeks swellings on inner cheeks whitish cold/yin swellings on inner cheeks neck and shoulder tension qi stag in neck & shoulder (TY/SY) from work from work tendency to stress tendency to stress anger LV disruption anxiety HT disruption sleep disturbance shen can’t anchor chest tension qi stag. in chest All above from stress LV involved

7. Leave this blank for Sharon Symptom Analysis hara whole upper hara can be very tight hara musles tight (gui zhi/bai shao hara) Tongue Dry in middle not enough MW fluids pale sides deficiency (I didn’t say LV blood def. here because they are not “very” pale. Is this correct? yellowish tongue coat in back heat in L.W. indented LV qi stag. sl. fluted on left fluted tongue edges

8. All Signs and Symptoms difficulty getting pregnant difficulty getting pregnant severe menstrual cramps blood stasis in the uterus better with heat cold in the uterus Worse with pressure excess in uterus pms bloating LV involv. qi stag in the LI pms gas LV involv. qi stag. in the LI sometimes pms diarrhea LV involv. too much water in the LI chronic vaginal discharge too much fluid coming out of uterus sometimes yellowish damp-heat in the uterus sometimes brownish either blood or heat in the uterus sometimes clear either normal or damp- cold in the uterus body temp too warm heat prefers cold drinks heat in the STstrong thirst a wanting for fluids in the mouth not always satiated by drinking drinking not always able to quench thirst sometimes wakes with swollen eyes too much fluids at the surface of eyes big meals/unusual food stims peristalsis maybe normal or yang ming excess lightheaded yang out of RR in head with low energy qi not available to body when yang out of RR in head from not enough food in ST deficiency in ST involved from eating sugar first thing excess in ST/SP also involve from caffeine caffeine/stimulant involved floaters LV blood deficiency dry eyes with contacts not enough moisture in eyes swellings on inner cheeks phlegm swellings on inner cheeks whitish phlegm cold swellings on inner cheeks neck and shoulder tension qi stag in neck & shoulder (TY/SY) From body positioning from work anger LV disruption anxiety HT disruption sleep disturbance shen can’t anchor chest tension qi stag. in chest All above from stress LV disruption hara whole upper hara can be very tight hara muscles tight (guizhi/baishaohara) Tongue pale sides deficiency Thicker yellowish tongue coat in back damp-heat in L.W. indented LV qi stag. sl. fluted on left fluted tongue edges

9. Sharon Diagnosis Student Diagnosis • Leave this blank for Sharon • cold and blood stasis in the uterus with damp accumulating. • LV blood deficiency • LV yang rising • heat in the ST • ST deficiency?

10. Student SEEING There is cold in the uterus (blue star), the blood is unable to flow smoothly there( black x).Dampness is accumulating in the uterus that is sometimes cold and sometimes hot. (blue and red drips) There is heat in the ST and not enough fluids in the mouth. (red oval in MW). A deficiency in the ST is involved with yang going out of RR in the head. The Liver blood is deficient (pink wavy line), the qi of the chest and hara stagnates (black Xs in the MW) and the LV yang surges upwards (red arrow). Use shapes here

11. Explaining Symptoms difficulty getting pregnant: Cold and blood stasis in the uterus as well as damp accumulation could obstruct impregnation. Pms bloating and gas : Cold and blood stagnation as well as dampness in the uterus could disrupt the smooth flow of qi in the abdomen. Also, water separating from the blood as can happen with blood deficiency could cause bloating pre-menstrually. Pms diarrhea: Heat from qi and damp stagnation in the lower warmer could cause a hyper motility in the LI. Chronic vaginal discharge, sometimes cold, sometimes heat: Blood stasis in the uterus can cause dampness to accumulate. Her blood deficiency with water coming out of the blood and accumulating in the lower warmer could also explain the dampness . As the dampness stagnates in the uterus it can block the yang and pathological heat can form. Body temp too warm with thirst that is sometimes insatiable and pref. for cold drinks: ST heat evaporating fluids. Swollen eyes upon waking, Dry eyes with contacts: water separating from the LV blood could explain why there are not enough fluids in the eyes but too much fluids in the eyelids. Big meals/unusual foods quickly stimulate peristalsis: excess heat in the ST could explain hyperactivity in the yang ming ST/LI. Light-headed with low energy from hunger: unsure because I don’t see any ST/SP deficiency symptoms and wonder if LV blood deficiency could be involved. From sugar on empty stomach: ? From caffeine: The LV yang is unstable and a stimulant such as caffeine could make this worse. Whitish swellings on inner cheeks: I’ve thought and thought about this but cannot explain why there would be yin cold excess in the mouth. Tis plus the swollen eyelids makes me suspect that something is not properly transforming fluids in the head but I can’t see what. I wonder if these are actually off-white and may be phlegm-heat swellings which could be explained the ST heat congealing fluids in the mouth. Neck and shoulder tension from work: This could be a normal reaction to repetitive stress. LV blood deficiency not nourishing the muscles could make one prone to muscle tension. Stress related anger, anxiety, sleep disturbance and chest tension: With stress the LV qi stagnates in the chest, the shen is unable to decend and the LV yang rises. LV blood deficiency could explain the tendency for the qi to stagnate with stress. Hara muscles sometimes tense: LV blood deficiency not nourishing the muscles. Tongue Dry in middle: ST heat evaporating fluids Pale sides: LV blood deficiency Thicker yellow tongue coat in back: damp heat in the uterus. Indented: the tendency for the LV qi to stagnate due to blood deficiency. Fluted on left side: LV yang rising.

12. Treatment Principle • Leave this blank for Sharon • Warm the uterus to invigorate blood and thereby dispel damp. • Nourish the LV blood to emolliate the liver. • Clear St heat See if nourishing the blood to emolliate the LV alone is enough to keep the LV yang anchored as it only rises with stress which does not happen frequently.

13. Student Formula and Explanation Guizhifu ling wan modified Guizhi 1.5 Fu ling 1.5 Baishao 1.5 Chi shao 1.5 Mu dan pi 1.5 Tao ren 1.5 Dang gui 1.5 Xuduan 1.5 Tusizi 1.5 Shi gao 1.5 Would Wu mei with volkerscheid’s idea that jue yin cold stasis leads to damp-heat accumulation be appropriate?