A Case of DIZZINESS

Patient: Emily, a 36-year old female.

Chief complaint: Dizziness for one week.

Medical History: The patient has had edema which is more severe in the lower legs for one year. Three months ago, the patient visited her regular doctor and did a few refined diagnostic checks. She has glomerulonephritis and urinary protein is +++ and urinary red blood cells are 150. She has taken wilfordine for more than one month and gotten much better. Urinary protein: +, urinary red blood cell account: 50.

Presenting Symptoms:

Inquiring: Recently she has had blurred vision and dizziness, nausea which is worse when standing up. She has dry mouth with bitter, sticky taste, quick temper, a feeling of oppression of the epigastric hypochondraic region, poor appetite, yellowish and scanty urination with no sensation of heat, normal bowel movement with slightly dry stools, dream-disturbed sleep, weakness and soreness of the lower back and knee joints. Regular menstruation with less menses.

Pulse and Palpation:  BP: 18.67/11.33kPa. Soft abdomen when palpated, the liver cannot be palpated. Uncomfortable in renal area when being knocked. Pitting depression in the lower legs. Thready and string-taut pulse.

Tongue and Observation: Red and purple tongue body with yellow, greasy tongue coating and thick in the middle. Reddish complexion, overweight.

TCM Diagnosis: Dizziness (liver-wind and turbid phlegm rising, with liver and kidney Yin deficiency)

Treatment Principle: Subdue liver Yang, remove wind phlegm, restore the spleen and stomach, nourish liver and kidney Yin.

Herbal Prescription:

Explanation:

 Tian Ma, Gou Teng, and Shi Jue Ming ---- extinguish liver-Yang and liver-wind.

Shen Long Gu and Shen Mu Li ---- subdue and soothe the liver-wind.

Chen Pi, Bian Xia and Fu Ling ---- restore the functions of spleen and stomach, combined with Tian Ma and Gou Teng to remove the wind phlegm.

Fu Ling and Ze Xia (Ze Xia Decoction) ---- are good at strain the phlegm from the urination and make the lucid yang of middle turner and stop dizziness.

Du Zhong, Tuo Si Zi and Sang Ji Sheng ---- tonify kidney and liver, harmonize and pacify the liver ying and yang.

Gan Cao ----has two functions: harmonize all of the herbs, used together with Chen Pi, Bian Xia, Shen Bai Zhu and Fu Ling reinforce the transportation and transformation of spleen and stomach.

Acupuncture Prescription: LR3(Tai Chong), GB20 (Feng Chi), TB5 (Wai Guan), DU16 (Feng Fu), LR2 (Xing Jian), LI4 (He Gu), KI3(Tai Xi), LR8 (Qu Quan), SP6 (San Yin Jia), PC6 (Nei Guan), ST40 (Feng Long), ST36 (Zu San Li), RN9 (Shui Fen)

Reducing, even or reinforcing method.

Explanation:

LR3, GB20 and TB5 ---- subdue liver-yang, liver-wind and specific for dizziness

DU16, LR2 and LI4 ---- help subdue liver-wind

KI3, LR8, SP6 and PC6 ---- tonify kidney and liver, harmonize liver Yin and Yang

ST40, ST36 and RN9 ---- restore the functions of spleen and stomach, remove the wind phlegm from the body

Lifestyle Changes

Maintain balanced emotions.

Reduce overworking and/or excessive sexual activity.

Reduce greasy, sweet, sour foods.

Keep regular eating habits with  more vegetables, no excessive consumption of greasy foods or dairy products.

Mild exercise regularly.

John, 28-year old, male.

Chief complaint

Epigastric pain for a few months.

Medical History

The patient has had for more than one year. Two months ago, the patient had severe epiagstric pain and visited his regular doctor and had his liver checked. The result showed that the functions of the liver were normal, but HBsAg was ++. He has had eaten some Chinese herbs for regulation of the spleen and stomach functions and got better, but he still has epigastric pain when ever he stops taking the herbs. Without any

Presenting Symptoms

* Inquiring

Recently he has severe epigastric pain which is more serious from 1 a.m. to 3 a. m. every day. He also has distending pain in the epigastric and hypochondraic regions, acid reflux, sometimes feel nausea and wants to vomit. He has poor appetite, normal urination and bowel movement, general lassitude, and spontaneous sweating.

* Pulse and Palpation

Soft but with slight pain of upper abdomen when being palpated, with a desire to warm liquids and an aversion to cold.

Slippery and string-taut pulse.

* Tongue and Observation

Red tongue body with thin white greasy tongue coating.

TCM Diagnosis

Epigastric pain("wood over-acting on earth", stagnant liver-qi invades the stomach horizontally and impairs the descending of stomach-qi)

Treatment Principle

Soothe the liver and regulate qi, restore the functions of stomach.

Herbal Prescription

* Chai Fu Shu Gan San

Chai Fu (Radix Bupleuri) 9g

Ci Ji Li (Fructus Tribuli Terrestris) 12g

Xiang Fu (Rhizoma Cyperi rotundi) 10g

Cao Bai Shao (Radix Paeoniae albae) 10g

Su Zi (Fructus Perillae Frutescentis) 6g

Chen Pi (Pericarpium Citri reticulatae) 9g

Fu Shou (Frectus citri Sarcdactylis) 6g

Sha Ren (Fructus Amomi) 4g (cooked later)

Cao Dou Kou (Semen Alpiniae Katsumadai) 5g (cooked later)

Zi Gan Cai (Radix Glycyrrhizae) 6g

Wu Zei Gu (Os Sepia seu Sepiellae) 12g (cooked first)

Duan Wa Leng Zi (Concha Arcae) 24g (cooked first)

Explanation

* Chai Fu, Ci Ji Li, Xiang Fu and Cao Bai Shao ---- soothe the liver and regulate qi.

* Su Zi, Chen Pi and Fu Shou ---- restore the function of stomach and harmonize the liver and stomach.

* Sha Ren, Cao Dou Kou, Wu Zai Gu and Duan Wa Leng ---- reduce acid

* Zi Gan Cao ---- harmonize the herbs

Acupuncture Prescription

LR14(qimen), PC6(neiguan), ST21(liangmen), RN12(zhongwan), ST36(zusanli), BL21(weishu), GB34(yanglingquan), LR3(taichong)

Reducing or even method

Explanation

* LR14 ---- is specific to harmonize liver and stomach.

* GB34, LR3 ----soothe the liver and eliminate stagnation

* PC6, ST21 ---- subdues rebellious stomach-qi

* RN12, ST36 and BL21 ---- tonify stomach, restore stomach function and prevent the stomach from being invaded by the liver.

Lifestyle Changes

* Maintain balanced emotions.

* Reduce overworking and/or excessive sexual activity.

* Avoid greasy, sweet, sour foods.