PA I N A N D D I G E S T I V E U P S E T

SHARON CASEMay2012

INTAKE

Female age 29First visit: May 16, 2012Occupation: FarmerMain Complaints: • Joint pain and popping• Head, neck, shoulder pain• Migraines• Daily digestive upset – cramping, bloating,

irregular bowels

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.

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.

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 mossPulse: strong, wiry, slightly floatingHealthy abdomen with pain in the lower pelvic area. She also had a very full feeling when I pressed into her epigastric area.

Pain in the joints and flesh = Stagnation in the channelsWorse with cold = cold in the channelsWorse with damp = Damp in the channelsEspecially in the shoulders/neck and occiput = Stagnation in the Tai Yang channelsAlong the GB channel into the hips = Stagnation in the Shao Yang GB channels

Headaches = Qi stagnating in the headOccipital root = Tai Yang ChannelsWorse with stress = Liver relatedWorse with cycle = Liver related

Digestive issues = issues with T&TBloating in epigastric area = Qi stagnation in epigastric area

Worse with eating = excessNausea = Stomach involvementLoose stool = stool not formedGas pains = stagnation in the Large Intestine

Better with diarrhea = excess in the Large IntestineMenstrual Issues: Strong menstrual pain = blood stasis in the womb

Clots = blood stasisEarly menstruation = blood coming out when it shouldn’tPMS = liver involvementTense and Irritable = liver Qi stagnation 

Other: Poor sleep = Heart involvementExhausted = Qi not availablePain with palpation in the lower abdomen = stagnation in the lower abdomenFullness with palpation in the epigastric area = fullness in the epigastric area

Tongue: Purple = blood stagnationSticky white moss = cold damp

  

 

DIAGNOSISCold damp in the channels, especially Tai Yang and Shao YangExcess stagnation in the epigastric areaLiver Qi and Blood stasis in the channels and wombThis effects the heart.

Pain in the joints and flesh = Stagnation in the channelsWorse with cold = cold in the channelsWorse with damp = Damp in the channelsEspecially in the shoulders/neck and occiput = Stagnation in

the Tai Yang channelsAlong the GB channel into the hips = Stagnation in the

Shao Yang GB channelsHeadaches = Qi stagnating in the head

Occipital root = Tai Yang ChannelsWorse with stress = Liver relatedWorse with cycle = Liver related

Digestive issues = issues with T&TBloating in epigastric area = Qi stagnation in epigastric

areaWorse with eating = excess

Nausea = Stomach involvementLoose stool = stool not formedGas pains = stagnation in the Large Intestine

Better with diarrhea = excess in the Large IntestineMenstrual Issues: Strong menstrual pain = blood stasis in the womb

Clots = blood stasisEarly menstruation = blood coming out when it

shouldn’tPMS = liver involvementTense and Irritable = liver Qi stagnation 

Other: Poor sleep = Heart involvementExhausted = Qi not availablePain with palpation in the lower abdomen = stagnation in

the lower abdomenFullness with palpation in the epigastric area = fullness in

the epigastric areaTongue: Purple = blood stagnation

Sticky white moss = cold damp  

 

SEEING THE EXTERNAL:COLD DAMP AND

POOR BLOOD CIRCULATION

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

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!

Pain in the joints and flesh = Stagnation in the channelsWorse with cold = cold in the channelsWorse with damp = Damp in the channels

Headaches = Qi stagnating in the headOccipital root = Tai Yang ChannelsWorse with stress = Liver relatedWorse with cycle = Liver related

Digestive issues = issues with T&TBloating in epigastric area = Qi stagnation in epigastric area

Worse with eating = excessNausea = Stomach involvementLoose stool = stool not formedGas pains = stagnation in the Large Intestine

Better with diarrhea = excess in the Large IntestineMenstrual Issues: Strong menstrual pain = blood stasis in the womb

Clots = blood stasisEarly menstruation = blood coming out when it shouldn’tPMS = liver involvementTense and Irritable = liver Qi stagnation 

Other: Poor sleep = Heart involvementExhausted = Qi not availablePain with palpation in the lower abdomen = stagnation in the lower abdomenFullness with palpation in the epigastric area = fullness in the epigastric area

Tongue: Purple = blood stagnationSticky white moss = cold damp

  

 

Wu Zhu Yu 6 Du Huo 12Qiang Huo 12Gui Zhi 24Fu Zi 12Ma Huang 6Zhi Mu 12Bai Shao 12Cang Zhu 15Fang Feng 15Sheng Jiang (golf ball size balls)

6

Gan Cao 6Fu Ling 12Ge Gen 24

FORMULAGUI 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 channelsOpen the epigastric blockVitalize blood in the channels and wombStop Pain and improve digestion!

Wu Zhu Yu 6 Du Huo 12Qiang Huo 12Gui Zhi 24Fu Zi 12Ma Huang 6Zhi Mu 12Bai Shao 12Cang Zhu 15Fang Feng 15Sheng Jiang (golf ball size balls)

6

Gan Cao 6Fu Ling 12Ge Gen 24

FORMULAGUI 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 channelsOpen the epigastric blockVitalize blood in the channels and wombStop Pain and improve digestion!

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.

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.

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.

POTENTIAL WRONG ASSUMPTIONS

Diarrhea = Spleen Qi deficiencyExhaustion = Qi deficiencyIt 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.

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.