Case

Fertility

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.

• 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.

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 stressedby 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 – anxietyand 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.

• 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 stressedby 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 – anxietyand 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.

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.

• 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.

Symptom Analysisdifficulty getting pregnant difficulty getting pregnantsevere menstrual cramps blood stasis in the uterusbetter with heat cold in the uterusWorse with pressure excess in uteruspms bloating LV involv. qi stag in the LIpms gas LV involv. qi stag. in the LIsometimes pms diarrhea LV involv. too much water

in the LIchronic vaginal discharge too much fluid coming out

of uterussometimes yellowish damp-heat in the uterussometimes brownish either blood or heat in the

uterussometimes clear either normal or damp-

cold in the uterus

body temp too warm heatprefers cold drinks heat in the STstrong thirst a wanting for fluids in the

mouthnot always satiated by drinking drinking not always able

to quench thirstsometimes wakes with swollen eyes too much fluids at

the surface of eyes

difficulty getting pregnant difficulty getting pregnantsevere menstrual cramps blood stasis in the uterusbetter with heat cold in the uterusWorse with pressure excess in uteruspms bloating LV involv. qi stag in the LIpms gas LV involv. qi stag. in the LIsometimes pms diarrhea LV involv. too much water

in the LIchronic vaginal discharge too much fluid coming out

of uterussometimes yellowish damp-heat in the uterussometimes brownish either blood or heat in the

uterussometimes clear either normal or damp-

cold in the uterus

body temp too warm heatprefers cold drinks heat in the STstrong thirst a wanting for fluids in the

mouthnot always satiated by drinking drinking not always able

to quench thirstsometimes wakes with swollen eyes too much fluids at

the surface of eyes

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Symptom Analysisbig meals/unusual food stims peristalsis maybe normal

or yang ming excess

lightheaded yang out of RR in headwith low energy qi not available to body

when yang out of RR in head

from not enough food in ST deficiency in ST involvedfrom eating sugar first thing excess in ST/SP also involvefrom caffeine caffeine/stimulant involved

floaters LV blood deficiencydry eyes with contacts not enough moisture in eyes swellings on inner cheeks swellings on inner cheekswhitish 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 stressanger LV disruptionanxiety HT disruptionsleep disturbance shen can’t anchor chest tension qi stag. in chestAll above from stress LV involved

big meals/unusual food stims peristalsis maybe normal or yang ming excess

lightheaded yang out of RR in headwith low energy qi not available to body

when yang out of RR in head

from not enough food in ST deficiency in ST involvedfrom eating sugar first thing excess in ST/SP also involvefrom caffeine caffeine/stimulant involved

floaters LV blood deficiencydry eyes with contacts not enough moisture in eyes swellings on inner cheeks swellings on inner cheekswhitish 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 stressanger LV disruptionanxiety HT disruptionsleep disturbance shen can’t anchor chest tension qi stag. in chestAll above from stress LV involved

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Symptom Analysisharawhole upper hara can be very tight hara musles tight

(gui zhi/bai shao hara)

TongueDry in middle not enough MW fluidspale 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

harawhole upper hara can be very tight hara musles tight

(gui zhi/bai shao hara)

TongueDry in middle not enough MW fluidspale 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

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All Signs and Symptoms

Student Diagnosis

•cold and blood stasis in the uterus with damp accumulating.•LV blood deficiency•LV yang rising•heat in the ST•ST deficiency?

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Sharon Diagnosis

Student SEEINGThere 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

Use shapes

here

Explaining Symptomsdifficulty 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.

TongueDry in middle: ST heat evaporating fluidsPale sides: LV blood deficiencyThicker 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.

Treatment Principle• 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.

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Student Formula and Explanation