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Obstetrics andGynecology ForumArchive
Sarah GamblePreferred Kidney Tonics and What about Rou Gui?NewJan 11, 2021ReactIn our fertility formulas, our diagnosis is essential, and kidney tonics are used alot, but which kidney tonics does everyone like touse to fine tune the outcome and why?I will give it a start with a few…but there are so many good ones to explore, so please add on.Xu DuanBa Ji TianBu Gu ZhiWhat about Rou Gui?Here is a question: if RG can warm the Spleen to disperse cold while it guides fire back to the source, invigorates the yang, then…Do these combined amazing components of Rou Gui make it an honorary kidney tonic?tonify while moving the blood (marvelous to tonify while moving, it’s an all in one)quiets the fetus and prevents miscarriage, stops uterine bleeding (value engineering - it has some Huang Qi like aspects)invigorates yang while courses wind, rids damp/cold with weakness (uterine cold, any bronchial, musculoskeletal/connective tissue issuesthat may be Lu/Lv or Lu/Ki)Control ascending liver yang (nip hypertension/stress, addresses endocrine)secures the essence, invigorates yang, warms (support the yin fluids while toasting the yang)promotes Kidney’s absorption of Qi (this is primary and it doubles as grasping the qi, contain what is gained)Warms Spleen yang and stops diarrheaCalms asthma by aiding the kidneys grasping the Qi(estrogenic support, uterine bleed support, impotence)Warms the kidneys and invigorates yang (sounds like a ki tonic)Guides fire back to its lower source (more attention to the Kidney)Dispels cold and warms the channels, frees the flow of the channels +vessel, alleviates painPromotes the engenderment +transformation of qi + blood, Warms spleen to disperse cold (a must for building a baby, disperse spleen coldbefore it even gets any additional cold to the ki)Keren SelaNewJan 13, 2021ReactGreat post! Lets add 1 more (there are so many!)Tu Si Zi - cant see my clinic without it:
2 replies 21 more comment1Replyneutral in temperature so doesn't invigorate Yang. More of a kidney Qi tonic than a yang tonic or even "benefiting the yin withinthe yang". As one of the seeds in Wu Zi Yan Zong Wan - especially indicated in fertility or "seed" issues. I remember Sharon sayingthis is a parasitic vine that clings - like the baby is a "parasite" in its mother.Strengthens the Kidneys absorptive capacity while also entering the Liver and nourishing Blood. And of course calms the fetusBrightens the eyes - I think of this not just in the narrow sense of visual disturbances of sorts but in the deeper aspect ofimproving the Liver Hun's ability to see the future - envision a future and pan. How do you envision yourself as a mother? as afamily? What is inherent in you that can fill that space if your plans do not go as expected? Seeing into ones deepest aspect of thesoul and asking these very difficult questions is sometimes a huge part of our work with fertility patients. ReplyCara FrankNewJan 14, 20211ReactHi Sarah,This is a topic I discuss with my students: Are warming herbs yang tonics? Yes and no. This is because not all yang tonics are warm.Tu si zi is the most obvious example of this. but all have an inherent dynamism that lifts, wakens, roots, etc. The yang toniccategory is, in general, split between structive tonics- du Zhong, gou ji, etc and then "hormonal" for lack of a better wordmedicinals, such as yin yang Huo, tu si zi, Xian Mao. And I agree, xu dual is the sweet spot in this family.I DO think that rou gui has tremendous value for warming the body I don't quite see it as a tonic. I see it as an agent. Maybe likebetacarotene is a precursor to vitamin A. it's a pro-vitamin. Also, one caution- it really does move the blood. So caution with heavybleeding. And it can be drying if dosed too high. It makes me thirsty. but a little bit- it dials up a formula in a really marvelous way.It makes a yang nourishing formula more vivid. Anyway, just my thoughts1 teacher remarkAdina KletzelBai Zi ren and opening through the ren maiNewJan 03, 2021 | EditedReactHI,I am trying to gain a better understanding of the herb Bai zi ren particularly relating to issues with menstruation.I know that it down bears ht qi to bring it through the ren mai and helps connect the downward movement of the heart to thekidneys.Dr. Xia Gui-Cheng also says that Bai Zi Ren not only opens-through the large intestine, it also opens-through the Ren vessel,promoting menstruation when it is blocked. (taken from Sharon Weizenbaum's blog at whitepinehealingarts.org).Would this mean that bai zi ren should only be used in cases where there is a lack of opening through of the menstruationbecause of liver and kid yin deficiency with a lot of dryness?I would love if others can share in what kind of cases using bai zi ren has been particularly helpful so that I can more fullyunderstand how and when to use it.THank-youSharon Weizenbaum NewJan 03, 20211ReactHi Adina, Thanks for bringing up this wonderful herb! Here is the link to the post: https://whitepinehealingarts.org/bai-zi-ren/
1 reply 13 more comments3ReplyI think it is important to think of Bai Zi Ren as a gentle opening herb, unlike Tao Ren, Chuan Niu Xi, Da Huang etc. If we think of theYangming as a kind of conveyer belt, these stronger bitter herbs push it along, while Bai Zi Ren, as a sweet, oily herb, works morelike oiling the dry, rusted, moving parts.Also, we know that Yangming is the mediator between the heart and the kidneys and they depend on its movement to be incontact from south to north. Bai Zi Ren helps Yangming move in order to connect the heart and kidneys. This means that it treatssymptoms of blocked menses, especially when there is dry stool and spirit symptoms premenstrually. It will help the stool and theblood move out and this will give relief to the spirit. ReplySuzanne ConnoleNewJan 07, 2021ReactHi Adina. I would say yes, you will find it most useful in patients who are dry. I like to think of it as a heart/uterus connecting herb,so yes opening the Ren mai in a gently moistening way. I find it especially helpful with patient who are blood/yin deficient andhave anxiety/palpitations. I find myself using it a lot in my fertility patients.2 teacher remarksRon HersheyLarge, meaty clots in menses with no dysmenorrhea.NewJan 02, 2021ReactQuestion for teacherI have a patient who has a very heavy 7 day period with large, meaty, substantial clots that she really feels passing, almost like astool, and yet she has no cramping or pain with the period. For the first couple days of the period, there is a strong bearing downfeeling in the lower abdomen. There is a very strong emotional, agitation and even mania & paranoia before the period begins &at times, even during it, and it's this emotional distress that is the most disturbing for her. I am not elaborating the full case here,of course, but I'm intrigued by this degree of blood stasis in the womb with no dysmenorrhea. I know that heavy bleeding itselfcan contribute to a degree of blood stasis, but could it result in such meaty, substantial clots that are so noticeable to pass? Iwould expect those to be more the smaller, slippery, less consequential kind.Sharon Weizenbaum,Maria Morris,Suzanne Connole,Caroline Radice,Guy Sedan,Allyson Nevard,George Mandler,Sharon Yeung,Laura Mcgraw ,Sarah Rivkin,Sadie Hays ReplyCaroline RadiceNewJan 02, 2021ReactHi Ron: Do the clots dissipate and fall apart once passed? Other cold/deficient s/sx and other heat above? I had a case similar tothis that I will try to post who was more the Cold Def type (she also had some myomas) that once warmed and strengthened,improved enough to conceive (which was her main goal). Could be a Wen Jing Tang base but there are others. Can guide withmore symptoms!Ron HersheySarah RivkinNewJan 02, 2021 1ReactCould the big, meaty clots be because there is deficiency here? KI qi or spleen is too weak to hold onto the tissue? Things arefalling out? She has that feeling of bearing down. If the clots are big it makes sense that she'd feel them, because of their size.
10 more comments10 ReplySuzanne ConnoleCase Study for discussionNewDec 31, 20201ReactHere is a case that I use in my gynecology class. What do you think about it?34 years old, trying to conceive for 2 years, no pregnancies, no miscarriagesPatient has been trying to conceive for 2 years. She is working with an RE now and doing a cycle with Letrozol. Sperm analysis wasgood. Hormone levels are in range. Ultrasound has been done and ovaries and uterus appear normal. No history of pregnancy.Cycle 31-32 days. Ovulation is at days 16-17. Using OPK to read peak day. Does have fertile mucous 2-3 days.PMS: often gets a headache at ovulation and the day before the period. Has spotting of brown dry blood for 5 days before periodstarts to flow. Emotional sensitivity and breast tenderness. Often has diarrhea with periodPeriod: Pain 1-2 days moderately heavy flow for 2 days then light for two, coin sized clots.Energy: moderate. Feels okSleep: about 7 hours. Crazy weird dreams. Does not feel fully rested.Mood: stressed/anxiety easily. Manifests as anxiety in the chest with racy heart and fluttery feeling, heat rises up through chest toface. Gets red cheeks and warm and sweaty.Digestion: tendency to loose stools, no smellDiet: omnivore, cooks most of own food, little alcohol or caffeineTemperature:Feels warm in face and chest with anxiety but otherwise feels cold often and hands and feet are cold. Tends to feelsweaty which gets worse with anxiety.T: light red (normal) tongue, slightly scalloped, rep tipP: thin, floating on rightAbdomen: tense along the midline and epigastric area. Overall cool and tight feeling.My questions for my students were:Does this patient have infertility?Explain your answer.Why do you think she is not getting pregnant in Chinese Medicine ReplyCaroline RadiceNewJan 02, 2021 1ReactI love this! (Because it is how I teach so of course I think it's brilliant!) I have a short course on "What are you really treating?" thatasks just this! Look for it as a WPC GYN offering soon. Clearly, not enough yang rooted in her uterus.Carrie Murphy NewJan 03, 2021ReactCaroline Radice,Suzanne Connole
2 more comments2ReplyRou gui springs to mind here to anchor yang into the uterus and out of her dreams. 5 days of spotting before flow feels like asputtering engine due to weak floating kidney yang, crazy dreams are that floating fire harassing the heart. I think I would do fairlymoving acupuncture like Ren 17,6 four gates type thing. Then, a yin and essence nourishing formula during the first half of thecycle to stimulate a more timely ovulation, and switch to yang and jing nourishing in the second half. That late ovulation andspotting before cycle both seem to me like her body has trouble revving itself up to switch between yang and yin and back. I likepairing liu wei di huang wan and jin gui shen qi wan or zuo gui wan and you gui wan as bases. I would also recommend goodhydration, lots of dietary fiber, and gentle movement to help her (western) liver manage hormone shifts. I would call this a fertilitycase, not an infertility case. I don't see any big problems with her getting pregnant with some tweaks. I am noticing how much I getfrom meeting with a patient that I dont get from a case study. I do not really have a picture of her in my mind. Tricky! but fun froma thought puzzle perspective. How are you seeing this @Suzanne Connole and @Caroline Radice?1 reply 18 more comments8Candace JaniaPhasing menstrual cycle treatmentNewDec 31, 2020ReactWith treatment for GYN or fertility, often we give formulas reflective of where they are in their menstrual cycle. But sometimes wedon’t. With my patients, I have treated both ways. If the disharmony is clear and simple, I will often use one formula with minormodifications regardless of follicular or luteal phase. If the patient is more complicated or the menstrual cycle is irregular orproblematic, then phasing formulas typically makes more sense.In your own practice, how do you decide to use one formula or a phased approach for women? ReplySuzanne ConnoleNewDec 31, 2020 1ReactI think I follow a similar process. In the past I always did phased treatment, but now more often if there is one main pattern I justtreat the pattern. Sometimes I might add a patent or a pill to the base formula to augment a particular part of the cycle or tosmooth out the phase, but mostly keeping with my main treatment. I choose this especially if the cycle is mostly regular, meaningthe timing is good and ovulation seems to be happening normally so I don't feel I have to "work" on one phase specifically. It has isuppose become a more instinctual treatment choice and I will try to be more mindful of when and why i am choosing onetreatment method over another and report back! ReplyCaroline RadiceNewDec 31, 2020ReactGreat question! I have also done both, but would say most commonly tend to use a formula that fits their pattern, and thenmodify that with herbs to support the phase of the cycle and/or guided toward the patient's particular challenge. For example, afertility patient who has excess or painful menses would focus on preventing that prior to the bleed and treating that during,though the base formula may be similar. Same for adding an herb or two to "open through" (in Sharon-speak) at ovulation time,and support or control Yang in the luteal phase. So a Wen JIng Tang type patient might get a little wang bu liu xing or zao jiao cimidcycle (if the pattern fits). Sounds similar to your practice?SallyDryness and dampness, excess and deficiency combined in a fertility patient with multipleissuesDec 30, 2020React
Cross post from Classical Formulas:I have a 44 yo fertility patient with multiple issues. She is blood deficient and has a history of cysts all over her body ( ovarian butalso splenectomy due to it being covered by 100's of small cysts). She is thin and tall and doesn't appear to be damp at all. She hasfibroids, extremely dark and distended sublingual veins and a pale purplish tongue with reddish thin rough edges and asometimes thick coat, white coat in the rear. She is cold all the time now though when she first started to see me, she hadpersistent heat sensations in the upper body and insomnia. They did not seem to be hot flashes as they would last for a fewhours. ( This stopped after the first few weeks of treatment) She has a history of SIBO with constipation and constant andpersistent bloating for many years. I have been building her blood for several weeks. Her periods became more red with lessbrown spotting. Her formula was based on Dang gui shao yao san to help bring fluids back into the blood with herbs to help movethe stagnation in the intestines. Her bowel movements became more regular, every other day, but she continued to feel bloatedespecially in the luteal phase of her cycle. I decided to use a combination of Tao He Cheng Qi tang and Hou po qi wu tang duringthe week before her period this month; she will be starting to try to get pregnant in the next cycle (previous to this her husbandwas away for work when she was ovulating, so they were unable to try.) She had brown spotting again, but then passed large clotswithout pain and had a huge clearing bowel movement plus the bloating is gone for the first time in several years. I'm hopingthose clots passing will shrink the fibroids and she will have a better chance to conceive. She was so happy about the bloatingbeing gone!! I'll try to keep you posted on this case because it's such an interesting one. In terms of the 6 conformations, Yangming was not opening through so the bowels were sluggish; the qi and fluids were not transforming well which also affected herbowels and her Jue Yin blood. I think her pivot issue lies in Shao yin with yang being unable to be stored and then fluids wereunable to enrich the blood in Jue Yin. I have used Fu zi in her formulas and it seems to be helping her with storage and improvedyang qi transformation of fluids.ReplyCaroline RadiceDec 31, 2020ReactGreat case! An it confirms an observation I have had in my patients that people who are lumpy are lumpy all over! Fibroids, breastand ovarian cysts, intestinal and uterine polyps, lipomas etc seem to present in various forms in these types of people. The thindamp types (like the skinny PCOS patients and what sounds like yours) seem like a lack of fluid and blood absorption causingsome congealing or lack of free flow. Does this ring true with you?ReplyKeren SelaDec 31, 2020 1ReactYes - please keep posting on this case! Caroline - that definitely rings true, the thin, yin xu that don't show any signs of dampness.Shows us once again that not all cysts are dampness and reminds us not to jump to conclusions. Dang Gui Shao Yao San is such agreat basis to start from!1 teacher remarkCaroline RadiceThoughts on Breast StressNewDec 29, 2020ReactI've been thinking about how the stress of the pandemic has effected my patient population and have observed many physicalstresses worsening or recurring this year among them. I often say "stress finds your weak spot" and in addition to the noticeableincrease in TMJ (even my dentist says he has never seen so many cracked teeth as this year!) and other muscle strains & spasmsfrom poorly equipped home offices, I'm seeing many complain of increased peri-menstrual breast pain. Perhaps it reflects mymostly female population and GYN-heavy practice, but I've used more Jie Geng, Lu Lu Tong & Qing Pi than I have in a long time asformula modifications. Even the lucky amongst us who don't worry about income and food have been under this ongoingsuspended stagnation. It does make sense that if you are being treated for PMS or Peri-menopausal issues (another topic fordiscussion!), this would be a weak spot for stress to hang out. Fortunately, acupuncture and herbs work really well for this! Anyoneelse experiencing similar?
3 replies 317 more comments17ReplySharon Weizenbaum NewDec 30, 2020ReactI have been on sabbatical since exactly when the pandemic hit, mid-March so my patient population in minimal and focused oncovid. However, I have been reviewing lots of student cases. What I am also seeing is Shao Yao Gan Cao Tang and the addition of GeGen and Tian Hua Fen (if there is thirst) in formulas for extreme muscles tightness and tension. Do you see that as well? ReplyCaroline RadiceNewDec 30, 2020ReactOh my yes! I was staying GYN focused in my commentary above, but the extension is exactly this! Using a lot of Chai hu gui zhi ganjiang tang (a most marvelous formula!) and Ge Gen add-in to many other formulas for those stricken by the work-from-home neckstrain. In reference to CHGZGJT, a blog post Brandt Stickley made at the height of the pandemic has some commentary:https://www.brandtstickley.com/blog/2020/4/30/an-interpretation-of-chai-hu-gui-zhi-gan-jiang-tang Would love to hear yourthoughts on this also!
Tolley SinkHelp with Postpartum CaseNewMar 09, 2021ReactQuestion for teacherHello all. I think this is such an interesting case. I appreciate any thoughts, thanks!5 days postpartum, first child, age 34. Pregnancy was healthy aside from some minor constipation andhemorrhoids.Labor was long (36 hours), vaginal birth, epidural and pitocin. Breast feeding is going well. She has beendiagnosed with femoral neuropathy causing numbness in her right foot. She still has hemorrhoids butbowels are moving well due to stool softeners. Last night when going to urinate she had a heavy bleed andfelt freezing cold afterwards followed by sweating. She has some pain on the right side of her abdomen ifshe takes a deep breath. Her mood is all over the place - happy, sad, crying and laughing and she is havingdifficulty falling asleep due to a busy mind. She feels chilled since the episode last night. I'm doing a homevisit tomorrow so I don't have pulse but was hoping to bring her formula with me since she lives up themountain and we are supposed to get a big snow storm here in a few days. I've attached tongue photosbelow. She's of medium/ small build with healthy quality of flesh, mild mannered and very kind.I am thinking of giving her Sheng Hua Tang/ Gui Zhi Tang/ Gan Mai Da Zao Tang like this:Dang Gui 12Chuan Xiong 4Pao Jiang 2Zhi Gan Cao 4Gui Zhi 9Sharon Weizenbaum,Claudia Citkovitz
2 teacher remarksBai Shao 9Sheng Jiang 6Da Zao 9Rou Gui 6Fu Xiao Mai 6JPEG | 2.7 MIMG_0523JPEG | 2.3 MIMG_0522Sharon Weizenbaum NewMar 09, 2021ReactHi Tolley, @Tolley SinkThat tongue is really purple! With this and the right side pain I would say that the bleeding is caused fromblood stasis. Though it is significant that she felt so chilled and sweaty after bleeding, the main thing is toclear that stasis. The stasis can obstruct the Bao Tai and cause spirit disorientation. I would explain thespirit issues this way rather than adding the GMDZT. I don't quite understand the GZT but maybe you canexplain? I would go with Sheng Hua Tang with the Tao Ren. It's an important ingredient. You could alsoconsider a small amount of Yi Mu Cao, like 2 gm. And you could add Pu Huang and Wu Ling Zhi. I like theRou Gui.I would also have her make a tea of Xi Yang Shen to drink if she has another bleed. She might have aphysiological bleed as the stasis comes out.Does this all make sense?This type of blood stasis in the Bao Tai is the most common type of postpartum depression or insanity.Please keep us posted!Tolley Sink
2 more comments2 Reply ReplyTolley SinkNewMar 09, 2021ReactHi Sharon,Thank you sooo much for your feedback! I was thinking GZT because I was seeing the insomnia and flutedtender tongue as a kind of upsurge along with the chills and sweating and also as a blood nourishingformula. I see how that is off track now. What you wrote makes perfect sense. I will try that and keep youposted. Thank goodness for herbs, CM and you!Ozben FelekCupping and using e stim during pregnancy for a patient who has hx of miscarriagesNewMar 08, 2021ReactHi Sharon and all other colleagues and teachers,I have a 31 years old patient who came to my clinic in October for neck and shoulder pain, tightness andalso infertility. I am also treating her husband for chronic neck pain.She looks very energetic, and has a healthy appearance (body weight is normal, good muscle tone exceptthat neck and shoulder muscles are tight). She has a 4 years old son, she had 4 miscarriages in the pastwithout known causes.She is a super mom, works, goes to school and loves heavy work out (with mine and her Dr srecommendation she has not been exercising heavily for the last few weeks) , she had been trying to getpregnant for a year.When she first came in, she had seen another acupuncturist for neck and shoulder tension and she told methat only cupping and e stim locally relieves her tension. Mr Tung or Kiiko style acupuncture for her upperSharon Weizenbaum
1 teacher remarkback tension , distal needling did not work at all but every time I used cups and using e stim she feels therelief immediately.The first question is that would it be safe to continue using cupping and e stim on her neck and upper back(avoiding gb21 area)?The second question is that now that she is pregnancy and she does not have any signs and symptomsbeside the upper back tension, would I give her any formula help with her pain and also prevent anothermiscarriage and wait till see how things unfold?Her previous symptoms before she got pregnant :-Low energy, fatigue even though she always looks like she has plenty, she does not have a low voice orbody language or type for a low energy person)-always feeling cold (even though she used to come to the clinic with shorts when the weather was not toohot)-neck, shoulder tightness , pain-short menses, light bleeding-infertility-her pulse was thin , weak and deep-tongue was sl pale and had a few dark spotsI gave her wen jing tang , added herbs from DGSYS , also added fu zi and increased the dosages of fu zievery other week.Her pulse became stronger, the dark spots on her tongue are gone. She is not feeling cold or tiredanymore.
ReplySharon Weizenbaum NewMar 21, 2021ReactHi OzbenI would probably avoid e-stim and cupping on her during pregnancy. I also think they don't go to the rootof the issue and would probably not do it at all.Are you saying she is not pregnant now or she is? Also, it does not sound like infertility but rather, habitualmiscarriage, right?So, I think you are saying that she is pregnant now and still has neck pain. I would want to know more but,given that WJT was such a good formula for her, I would consider GZT jia SY. If she is more thirsty and full Rguan, I would add THF. If loose stool, and tight right Cun, Ge Gen. Of course, I don't know so much butthese are my thoughts. How does this sound?Stacey WhitcombQuestion on treating Bacterial Vaginosis at 36weeksNewFeb 03, 2021ReactNew practitioner here, however I have provided birth Doula services over the years, and have andextensive sports medicine and massage career spanning over 20 years.I have a 29 yr old in her second round of bacterial Vaginosis. First time was treated with antibiotics. Shealso has a mask skin infection on her face.She is a tall pogo stick with a huge belly bump at this time.Tongue: pale, puffy, thin sticky white coat, scallopsPulse: Rapid, slippery, forceful (pretty consistently thru pregnancy)She got P'Oed at her MIL last weekend and is now presenting with DH in LJDigestion is comfortable and no problems. Does have a tendency to seasonal allergies and has had an itchythroat occasionally in the last couple weeks. We live in Bellingham, WA. VERY damp cold here. Suspect moldallergies. Grass allergies are going to start today....BM Daily and completeEnergy is pretty good, however they did put her on iron about 1 month ago due to fatigue. She has atendency to overwork.
1 teacher remarkHX - 2 previous early miscarriages. 2 years ago when I met her she was SP and KD xu with LV qi Stasis.Occasional wood overacting in the form of Bruxism.BABY - now at about 36.5 weeks. Head is 75 percentile, belly is 90 percentile. Guessing weight is over 8lbnow. They are not going to let her go over term.NOTE - they have not started antibiotics yet. still waiting test results. I am treating her today and going tosuggest every other day to see if we can get it under control before they demand she takes antibioticsagain.QUESTION: Can I use vaginal steaming in this situation? How can she do steaming? Do you guys have tips?How does this formula look? Can she do toilet moxa or is that too moving? Any other suggestions?Cang Zhu 10g, Huang Bai 10g, Niu Xi 10g, Ku Shen 9g, Yu Xing Cao 30g, Cook to get liquid for fumigationand washing.I actually have these herbs in my little bulk pharmacy.THANK YOU!!ReplyKeren SelaNewFeb 11, 2021React@Stacey WhitcombHi Stacey. Thanks for posting. Sounds like she is asymptomatic correct? No VD? No discomfort? UrinationOK? Just the positive result? This goes to the diagnosis of course and the choice of herbsI have never done a vaginal steam in a pregnant woman before, seems too strong, and inviting a lot of heatand movement to the LJ. So I am curious, as you are, to see if anyone has done them before.Stacey WhitcombSharon Weizenbaum NewMar 21, 2021ReactHi Stacy @Stacey Whitcombwhat is this: "She got P'Oed at her MIL last weekend and is now presenting with DH in LJ"Stacey Whitcomb
ReplyI am wondering how this went?1 teacher remarkAllyson Nevardconcerning pains in early pregnancyNewFeb 01, 2021 1ReactI have a patient who came to me for fertility. She is heavy with a very cool empty low belly, low self esteem,very cold, thin, deep, weak pulses and a pale, pancake flat tongue with a large dip in the back, moist thin,wtc. She was starting IVF and wanted support. She got pregnant on her 1st try and at 6.5 weeks startedhaving severe cramping twice per day lasting 10 minutes. She described the cramping like intense periodcramps that would make her double over. She had occasional waves of nausea and her tongue had alavender hue. I gave her Dang Gui Shao Yao san with Tu Si Zi and Xu Duan to integrate elements of ShouTai Wan. I just called her (2 days later) and the cramping went away. She's feeling a bit more nauseas so shewill have one dose per day in the mornings for now.ReplySharon Weizenbaum NewFeb 02, 2021ReactHi Allyson, How is she now? I know time is of the essence in these cases so sorry it's take me 22 hours torespond! Your treatment is just along the lines of what I would suggest. I would maybe leave out the FuLing and Ze Xie as she does not seem to have water pathology. I might also increase the Kidney supportwith Du Zhong and Sang Ji Sheng. Be sure to Chao the Bai zhu and Bai Shao if there is any loose stool. Andmake sure the Chuan Xiong is quite low. The nausea is good! Look for her left Cun to start getting stronger.That's what you want. If she starts bleeding with baring down sensations that could be an almost inevitablemiscarriage but then it would be worth it to use Fu Zi to shift that.R lAllyson NevardNewFeb 02, 2021ReactThanks, Sharon. I actually mistyped. I used Dang Gui San not DGSYS. She definitely did not have any fluidimbalance. I am going to see her Thursday and will add the sang ji sheng and du zhong. I told her to call meright away if she gets any other symptoms so I am hoping no news is good news. I’ll keep you posted.
1 more comment 1Reply1 teacher remark1 reply 1Candace JaniaHerbal navel paste for hyperemesisNewDec 31, 2020ReactHave any of you used an herbal navel paste for hyperemesis? I remember Sharon giving us a recipe for itlong ago but I have never used it. Anyone have success with it or something similar so she doesn’t have toactually ingest (and likely vomit) the formula? Most of the time when giving herbs for morning sickness, Ijust have them sip a slightly watered down version of it all day until they can tolerate more. But if someonehas good experience I would love to hear about some success. ReplySharon Weizenbaum NewJan 30, 20212ReactHi Candace, I've not used this but did give the recipe. You can also put Wu Zhu Yu on the bottom of thefoot. Either place, just make sure they remove it if the skin get's irritated. ReplyClaudia CitkovitzNewMar 23, 2021ReactI've used wu zhu yu on the soles of the feet for intractable hiccup, it worked and was not too irritating. I likethe idea of a navel paste as well, would be curious to know the formula!Suzanne ConnoleBreastfeeding and Lyme DiseaseNewDec 31, 2020ReactI know it's not exactly Chinese Medicine but does any one have any experience or knowledge onbreastfeeding and lyme disease transmission? My patient is debating not breastfeeding as her doctor toldher she should not.
2 replies 21 more comment1My inclination is that the benefits of breast milk outweigh any potential transmission, but as far as I can tellthere is very little data.Thanks for any insights! ReplyMargaret SikowitzNewDec 31, 2020ReactReceived question like this from patient, and similarly found no good info. Her midwife advised her tonurse, following your logic. ReplyCandace JaniaNewDec 31, 2020 1ReactBorellia can cross the placental barrier during pregnancy, which can cause stillbirth. So my guess is that herLyme is not necessarily “active” at this time or was she treated during pregnancy? How long ago was sheinfected? I think that these are important questions to ask before talking about breastfeeding. I, also, donot know the answer to this question but I agree with logic that breastfeeding would be superior.For what it’s worth, on the CDC website, it states, “There are no reports of Lyme disease being spread toinfants through breast milk.” (https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/lyme.html)That does not account for any co-infections that may also be there as well.Why not treat the mom for Lyme with our awesome medicine?Suzanne ConnoleQuestion on topical skin treatments in PregnancyNewDec 31, 2020ReactI have a question for those that are more into dermatology than I. I have a newly pregnant patient who haspsoriasis. It has not gotten any worse than it normally does in the winter, but it does interfere with sleepwhich i am concerned about. She is 47, first pregnancy with a frozen egg from age 40, so I am being extra
5 more comments 5cautious with her. How much does using herbal ointments topically affect the pregnancy. Should I just treatthe ingredients as I would internal herbs and avoid blood movers, da huang, etc? I'm looking at Emily's rightnow, as well as a possible homemade soak. The pattern on the skin is more blood deficiency with a littledepressive heat. The main concern is itching, with occasional dry cracking of skin. I do not see signs ofblood stasis any where. I do see signs of both liver qi stagnation in her cycle information and kidneydeficiency on the pulse and abdomen. I do not plan on using internal herbs with this patient. Curious to seehow others think about this.ReplyCaroline RadiceNewDec 31, 20202ReactI have used topicals for psoriasis in pregnant people effectively without issue. However, I would avoidapplying any on or near the belly or low back. The basic patterns with itching, scaling and dryness (less thedamp type) often respond well to Bai Bi Gao (one of Mazin's Dermatology M products available at Kamwo)but it is a bit messy. I had a woman who had a large plaque across her nape and the method is to apply thepaste at bedtime, cover with plastic wrap to occlude for better absorption, and then sleep with it. As youcan imagine, she had a whole head wrap thing and towels on her pillows, but within a month or so she wasclear. Be sure to tell your patient is is dark blue, so staining can be an issue if not well covered.Suzanne ConnoleReplyCandace JaniaNewDec 31, 20201ReactI am so happy you posted this question, Suzanne, as I just made my own zi cao gen but added xue jie(among other things) and was wondering the same thing. Although I think the traditional zi cao gen wouldbe a good place to start (it usually only has zi cao and dang gui) if the skin is simply itchy, dry and cracked.Caroline, I agree with you about careful placement of the topical as well and have also used bai bi gao andit worked well for a mild case.Claudia CitkovitzTerrific case study on treating preeclampsia with acupunctureNewDec 29, 2020ReactHello everybody!
3 more comments3I am very excited about this discussion forum, and I wanted to start it off by sharing a stellar case studythat was published this year by my colleagues Zena Kocher (also a moderator of this group!) andacupuncturist/midwife Valerie Hobbs. https://www.liebertpub.com/doi/full/10.1089/acu.2019.1399 ReplyMargaret SikowitzNewDec 31, 2020ReactSuper helpful case - I am sheepish to admit I have not thought about how useful all of these Stomachchannel 'Sea of Blood points' for treating this. And this also answered a question I've also thought a lotabout "There is no reliable first- or second-trimester test to predict the development of PE". ReplyCarrie MurphyNewJan 03, 2021ReactMargaret, I have never thought about the sea of blood points for this presentation either, but reading theDiscussion section of the case study illuminated the thinking for me. I have a patient who had worryingthird trimester BP spikes but not PE in her first pregnancy before she was my patient. She is now seeingme to prepare for her second pregnancy, and is significantly anxious about going through all of it again.Does anyone have advice for me on doing what I can to prevent this? She is a strong earth type, solidlybuilt and athletic, a propensity toward spleen deficiency, scalloped tongue, low self esteem, worrying,caring. When she gets anxious, her neck gets tight. I have been using a very ordinary sort of SP 3,9 ST 36,40, GB 21, P6, yt, Du 24 and BXBZTMT with her and her BP is now 120s over 70s and her anxiety is wellreduced. Once she is pregnant again, I will likely want to pivot somewhat and would love feedback.
1 teacher remarkAdina KletzelArticle - 'Tidbits From An Experienced Gynecologist' by Sharon WeizenbaumNewMar 13, 2021ReactIn the article, ‘Tidbits from an experienced gynecologist’, by Sharon Weizenbaum some cases from Dr. Qiu Xiao-Mei werepresented and I was particularly intrigued by the discussion of the formula Ji Mai San. Sharon explains that the formula is used incases where there is blockage between the upper, the breasts, and the lower, the womb. The culprit in this blockage is the spleenand stomach which is not assisting in the descending action toward the womb. The formula Ji Mai San serves to open this middlewarmer blockage and allow for the proper interaction between the upper and lower while also relieving liver constraint.In this formula presentation we will see symptoms of breast lumps, painful menstruation, amenorrhea and infertility and blockagein the middle.I see that there are a number of cooling herbs and so I would guess that the blockage in the middle would be causing more heatsymptoms. I assume we would see symptoms such as bloating, belching, nausea, and other forms of digestive upset as signs ofstagnation of the spleen and stomach. It seems from the herbs in the formula that this would be more of an excess blockage aswe would see in a yang ming presentation or even a shao ying pivot block affecting the middle but I was wondering if there aredeficiency presentations that this formula could be used for as well.In addition, could the blockage present as a glomus with the addition of the stagnation above and below symptoms?I would love to hear some more case example of others who have used this formula successfully. ReplyTolley SinkNewMar 14, 2021ReactI've used ideas from this formula when there was spontaneous lactation long after breast feeding had ended. ReplySharon Weizenbaum NewMar 21, 2021ReactHere is a link to the article Tidbits in case anyone is curious. I think the formula is more useful as a formula that expresses ideasthat you can riff on. I never saw Dr. Qiu use this formula alone or exactly as it is written. So, depending on your diagnosis ofexcess/deficiency, hot/cold, as well as other parts of the pattern or symptoms, you can modify.
Adina KletzelMy Reflections on the Earth and Fertility video by Sharon WeizenbaumNewMar 10, 2021ReactI love listening to the explanation of the movements of the conformations as pertaining to the actual movements that take place innature. When Tai yang is explained as the mornings suns up and out movement and yang ming as noon time when the sun has togo down and in and how Shao yang has to turn in order to go up again I can see it so clearly. I can also see how the yinconformations have to store and hold and steam that fire and moisture back up again.This way of seeing makes it seem like diagnosing is so simple - we just need to ask where is that life force? Is it blocked and if yeswhere? Is it being stored properly and if not which of the yin conformations are not doing its job? That is when we look toward thesigns and symptoms and SEE what the body is trying to tell us. THe outer physical realm is the key to unlocking the inner hiddenrealm.Using this model makes approaching fertility less daunting. Fertility is about taking in, storing, and expressing out. We have to askthe same questions - is something blocked that doesn't allow the taking in process? Where is there a problem with storing? Andagain how is the expressing out being restricted?Clinic is not always so simple but when trying to see the movements it certainly feels like diagnosing is getting easier and moreaccurate. I look forward to keep on building the confidence to be able to see fertility patients and apply this same theory.Adina KletzelUTI after intercourseNewMar 10, 2021ReactI have a 58 year old client who gets a UTI every time she has intercourse. She has to take an antibiotic in order to prevent theinfection. She would like to be treated for this problem through Chinese medicine.Her general diagnosis is one ofBlood xuCold in stomachLiver qi stgKid xuShe also used to have terrible pains in her lower abdomen for a couple of days before ovulation.She went into menopause at age 47 and started getting unrelenting hot flashes and so she went on hormone replacementtherapy. She is starting to open up to the idea that her hot flashes can be helped through herbs but first she would like to get offthe antibiotics after intercourse.Would I approach this case just by treating her general pattern or is there a specific approach to the UTI's after intercourse thatothers have found that works?THanks so much.Sharon YeungNewMar 10, 2021ReactI would diagnose according to pattern differentiation. Also find out specifics of the UTI symptoms. Is there burning and pain withurination? Dull ache, no burning? Is there frequent urge or scanty, dark urine? What is the odor of the urine? Cloudiness? Withsome of my post-menopausal women, I have seen that the deficiency of yin and increased overall dryness and vaginal dryness arehelped by ZBDHW in which urinary difficulty is one of the symptoms it treats. But again, determine her specific diagnosis first. In
Replysome cases, I have had patients take a small dosage of herbs prophylactically post-intercourse instead of having them take herbsregularly.Adina KletzelHealthy consistency of Menstrual bloodNewMar 07, 2021ReactIs there any way to measure if the menstrual blood is not too thick or not too watery?I have a patient who is 45 and is always very hot. Her main complaint is migraine headaches so amongst other things the formulashe is on includes cooling herbs such as huang qin, zhi zi, chi shao, and sheng di huang. She recently told me that her menstrualblood is more watery than it used to be.That can either be a good sign that the blood is cooling off and so it is not as thick or it can be a sign that too much water is leavingwith the menstrual blood. Since I don't have a whole lot of experience with this I wanted to make sure that something in theformula wasn't making the blood too watery. How would I know that? And furthermore, what is the consistency of the menstrualblood SUPPOSED to be like?Thank-youReplySharon YeungNewMar 10, 2021ReactI think color is going to be important along with the consistency. Healthy menstrual blood should flow without clots or thickeningand be a vital red color. If it really is mixed with too much water, then it becomes more pinkish in color. Does she have an increasein dryness signs from loss of too much physiological jin ye fluids? Did she use to report more clotting or thickening of the blood? Ifso, then becoming more liquid will be an improvement. What is the state of her vaginal discharge? Is there unending dripping ofwatery discharge? This is more pathological and might accompany 'too watery' menstrual blood. Also take into account what typeof menstrual products she uses. Pads and cups may give a more accurate account of the menstrual blood state than a tampon.And lastly, I would take this sign in conjunction with her other symptoms. Does she feel less hot? Have her other heat signsimproved? This along with less clotted blood may demonstrate overall improvement in her condition.ReplyAdina KletzelNewMar 11, 2021ReactTHank-you your points make a lot of sense. I will look out for the signs and symptoms that go along with more watery menstrualblood and that will help me determine whether this is a pathological development or a welcome sign.Adina KletzelWen JIng Tang according to Huang HuangNewMar 05, 2021ReactI read the article Wen Jing Tang According to Huang Huang by Sharon Weizenbaum in the resources section and have the followingquestions:1. Dr. Huang Hang said that WJT is primarily a moistening formula and not a warming formula. It still does have a few warmingherbs so could it be given to a person who is very hot if some cooling herbs were added - such as shi gao or huang lian? I askbecause my original understanding of the formula was that it is for someone who shows dry and cold signs. Dr. Huang huangseems to be saying that if we see dryness and crappy blood this formula can be used.
2 replies 22. Dr. Huang Huang says that the dose of Whu ZHu yu should be lowered if the person is very dry but the formula is for peoplewho are really dry so what would determine the need to lower Whu zhu yu? Also - if the formula is primarily a moistening formulaand not a warming formula why would WHu zhu yu be included in the first place?3. Huang Huang says:"The wen jing tang patient can present with fever, heat in the hands and feet, dry lips and mouth and these are all signs of a heatpattern.Yet the aversion to wind, spont sweat, dark colored tng body and lower abdominal tightness and pain area all evidence of a coldpattern."From this it seems that WJT is really a mixed hot and cold pattern.The symptoms that HH listed here however are not for sure hot or cold symptoms except for the fever. How should we be seeingthe hot/cold dynamic in the WJT pattern? Is it a mixed hot and cold pattern or it doesn’t have to be?ReplyCaroline RadiceNewMar 05, 2021ReactHi Adina: Such great questions! Wen JIng tang was a mystery to me, started to make some sense as Sharon and Huang Huangdiscuss, but I also consider Feng Shi Lun/Hu Xi Shu perspective as useful clinically. The lineage of the latter two considers WJT a JueYin formula where blockage in the middle impairs nourishment, moisture and cooling in the upper as well as warmth below, soyou have mild heat and dryness like thirst above and cold below often with stasis as seen in many menstrual patients. It really is arich and juicy formula with all the blood herbs (3 of 4 Si Wu + E Jiao) + clear with mu dan pi, moisten with MMD, but the centermoistening herbs really help enrich the dry, weak blocked middle (Ren Shen, Sheng Jiang, ZGC) and the Cold below obviouslytreated by the WZY & GZ.So I mainly think of it as a heat above/cold below with dryness and often stasis. Which is all of what you mention above. WZY is avile tasting hot and spicy herb, so I rarely use above 3-6 grams personally. It is good for bringing the warmth back down to middleand lower (which is why its good for vomiting and headache in some formulas) as these patients often have a lot of cold below.One teacher's commentary I remember also is that if Mai Men Dong is removed because the patient doesn't have dry mouth orthirst, it becomes more of a Tai Yin formula. Interesting, yes?Hope this was helpful!Adina KletzelMiscarriages, amenorrhea, and knee painNewFeb 21, 2021ReactQuestion for teacherHi,I am treating a 50 year old woman for strong left sided knee pain. She has 4 children but has a history of repeated miscarriageswithin the first couple of weeks of pregnancy. She was able to have a successful pregnancy once she was put on blood thinners.She also stopped having a period mostly at the age of 37. She had maybe 2 periods a year since then which included crampingand some dark and mostly brown blood which lasted for a day.The question I have is in doing the diagnosis for her now can I say for sure that she still has blood stasis in her uterus?I would think that if there is blood stagnation in her middle that it can be contributing to the lack of proper blood flow to her lowerbody/knees.
1 teacher remarkIf this is the case then I would need to treat this blood stagnation.I will give some more details about the case in order to offer a broader picture and I would love some feedback on these issuesand suggestions for treatment. THank-you.Main complaint - strong knee pain - some on BL meridian, some on spleen, liver, and stomach. w/w cold air. b/w warmtha bit swollen. b/w massage.She is a big, broad shouldered overweight woman with a puffed out stomach and wide hips.Her stomach is big and goes all the way up to under the ribs. It is a hard stomach but you can push in some - it is not completelytight.She is always hot.gets angry, strong and harsh,but sad and hurt because husband does not respect her and puts her down.trouble focusing, jumps from topic to topic and seems to exaggerate her symptomssweats a lot in heat.dry skinedema by ankles - not pittingfrequent urin.gets constipated if doesnt drink enoughpoor night visionforces self to drink. aversion to cold water.tngpuffy, normal color, red tipyellow coating in LWbig raised red dots in LWthick purple sublingual veinsteethmarksPUlsedeep and weak (surprising! how do we explain this??)Abdomenpuffed out from lower warmer all the way up to under ribsDiagnosis: crappy blood, SP qi def., Liver fire, blood stasis in the uterusgave her Da chai hu tang and gui zhi fu ling wan and added Niu xiHe knee pain went down from an 8 to a 4.Thank-you!
ReplySuzanne ConnoleNewFeb 23, 2021ReactWhen there is a history of blood stagnation in the premenopausal life, I always look for the signs of blood stasis. They are almostalways still there even though the menstrual symptoms are not. So don't make an assumption, but rather look for the signs. I thinkthere's a tendency to use information from the past to diagnose the present. It is better to use that past info as a clue as to whatto look for in the present. Looks like you were able to do just that in this case! Has the formula helped with the constipation andfull belly? Once you see that the Yangming is more functional and open through you might want to switch to Xiao Chai Hu Tang asa base, or Xue Fu zhu yu tang which includes the liver regulating action of Si Ni San. There does seen to be a water componenthere with the puffy tongue and edema. That may clear actually as you open up the bowels and the qi mechanism so watch thatand see if it needs more addressing. If so, you can incorporate Dang Gui Shao Yang san to work on the water/blood relationship. ReplySharon Weizenbaum NewMar 04, 2021ReactHi Adina,from an 8 down to 4 is darn good! Sounds like you are on the right track.Could you send a tongue picture in good light?What is her complexion like?Did you check for oketsu, especially on the left? It can be difficult to check in an inflated belly but super important. Press in quitefar.The pulse may be deep and weak due to deficiency but it could also be that the life force is buried under the stasis. What wouldyour guess be?What happened when she was 37 that made her stop menstruating?You also do have enough to diagnose blood stasis with the sublingual veins, the dark blood with cramping.Suzanne ConnoleExperience with topicals for Cervical dysplasia?NewFeb 11, 2021ReactHello. I have recently had a couple patients come in with abnormal pap results and HPV+ diagnosis. Both of them are in a watchand wait situation with western obgyn care and are making changes in life and diet to prevent any progression. One of them hasclear signs of blood stagnation and cold in the lower jiao so I am confident that treating that will make a difference in the conditionof the cervix itself. If it works I will for sure share the case here. The other I am doing an intake on soon.My question is, I know there has been research on treatments done in China using herbal suppositories to treat the local areadirectly. This, of course, is very modern treatment and I realize would still require pattern diagnosis. I am interested to see if anyone has had experience doing this and maybe has some resources on formulas or how to make the suppositories. Thank you for any suggestions!SuzanneCaroline RadiceNewFeb 11, 2021ReactHi Suzanne: Not super helpful now, but I used to have an amazing company that made herbal suppositories in Oregon but sadlythey went out of business. As you know, Lorraine Wilcox will be presenting at Shen Nong Society Conference on making vaginal
4 more comments4Replysuppositories and she is the master of making medicinals! I will dig up the ingredients list if I can from the belly up company. Itactually really worked well on the 3 month wait to clear the tissues. ReplySuzanne ConnoleNewFeb 23, 2021ReactThank you Caroline! anything you find will be greatly appreciated! and that you found it effective is also promising.Emily RieffelTopical herbs for lichen sclerosis, vulvodynia, pubic folliculitis?NewFeb 08, 2021ReactI have been struggling to help a woman, age 63, who has had lichen sclerosis for at least 20 years, but likely since childhood (sheremembers episodes of intense itching from an early age). Her symptoms:-Intense vulvar and labial pain, primarily at night, sometimes with burning, sometimes with itching. Lichen plaques are white, notred.-Pubic hair itching and scratching.-Both are better with cold compresses -- she lays in front of a fan when symptoms are severe.-Occasional yeast infections, but no ongoing abnormal discharge.-Whole body overheated at night; feels cool during day with cold feet.-Often thirsty for cold drinks.-Malar flush-Extremely labile and intense emotions - easy to cry, often angry, anxious, frustrated, overwhelmed, despairing, joyful. All of theabove within a one hour visit-Long-term IBS, with episodic foul-smelling diarrhea, many food sensitivities and allergies, bloating, heartburn-Long-term cigarette smoker, 3-4 per day-menopause @56, prior 1 live birth via C-section, 1 abortion, regular menses, heavy/clotty/painful-tongue: short, swollen, peeled, shiny, moist with a slightly dusky body color, red tip-pulse: deep, weak, choppy at times, moderate paceI've been working with a diagnosis of HT/ KD Yin Vacuity Empty Heat, combined with LR Depression and Damp Heat, but maybeI'm missing something?She's tried Yin Care for the folliculitis, and topicals from Dermatology M: Huang Lian Gao and Zi Cao Shui Gao, all to no avail.Acupuncture helps sometimes, but not always. She doesn't want to take herbs because of a history of bad reactions to otherherbs years ago, and to many foods.Thanks in advance for your thoughts and ideas!
2 replies 21 reply 13 more comments3ReplyCaroline RadiceNewFeb 08, 2021ReactLichen Sclerosis is an incredibly recalcitrant and notoriously difficult to treat disease, especially if she has had so long. The topicalsyou mentioned would not be strong enough for this and the only one that I have had any success with is one in the Derm M line,but not available through the US distributors so you would need to order directly from the UK Avicenna clinic. I think you canregister as a practitioner through the Derm M site (not Kamwo). Its called Cang Zhu Shui and keeps the LS at bay, but will not cureit. Vulvadynia will be reduced also if this is the main cause. Good luck!ReplyNicole ManiezNewFeb 10, 2021React@Emily Rieffel Interesting case. I don't have any topicals but just wondering what you would do if she was interested in internalherbal formula.Emily RieffelNicole ManiezDoes this presentation need added herbs to raise for prolapse?NewJan 28, 2021 | EditedReactQuestion for teacherHi All.I am new to using Classical Formulas, just finished the Knotty Disease course on Healthy Seminars and am using Ten Key FormulaFamilies, along with a trying to read and watch all I can on White Pine. I have some questions about the following case - and I keeprunning into some confusion around female patients that are slim to moderate build with gyno issues and trying to differentiatebetween Cinnamon Twig + Bupleurum. I appreciate straight forward feedback, so feel free to correct all my misdirections :) Thanksfor your time and thoughts!Here it is:28 yr femaleModerate petite build, cheerful, teaches yoga, complexion goodGave birth to first child in March 2020.T= pink, slightly dusky, slightly small (not flabby), thin white coatP= moderateBirth was good, nothing out of the ordinary or difficult in initial recovery besides main complaint of pain and pressure atperineum, pubic bone and vaginal area. Patient complains of bearing down pressure at perineal area, like before giving birth,worse with menses (too painful to wear a tampon), makes intercourse painful, can feel tight during intercourse. Tissue of vagina ismoist and intact. Sometimes pain can move to pubic bone.Did PT x 3 months in fall and issue started to resolve. Did a lot of exercises to strengthen perineal area.
In December, pain got a lot worse again. Can be a heavy sinking feeling to a sharp stabbing sensation.Menses before birth was every 60 days. Bleeds about 5 days, moderate flow. Some clots. Post birthing, menses now in 40 daycycle, some clots, reports blood to be red. Menses returned 5 months postpartum. Breast feed until 3 months when son startedhaving allergies to her milk, so stopped breastfeeding.Can have a cold butt, can feel heat at night or wake up hot. Enjoys cold beverages and has thirst. Sweat normal.Sleep and energy as expected with new baby.Abdomen is slightly tight at ribs. Feels more empty at lower ab.Pre and during pregnancy the main complaint was low back pain/sciatica that was treated with acupuncture.BM + urination normal.Bearing down pain - lower qiao not holdingSharp stabbing - blood stagnation, coldPain worse with menses - pain worse with down flow?Blood clots - blood stagnationMenses every 40 days - cold in lower jiaoCold butt - cold (reports hands/feet normal temp)Heat at night - yang out of right relationshipAb tight at ribs - Liver involvementLower ab empty - deficiency at lower jiaoDx:Cold in lower warmer creating blood stagnationLiver qi stag and blood xue, Kid Yang xueWen Jing Tang? - i don’t see dryness or damp/water in the wrong places and her emotions/presentation seem pretty even, butseems to fit with cold, deficiency and stag in lower jiao. Her blood stag doesn’t seem severe, so thinking the focus on cold/def ismore important - thus not thinking si ni san.Does this modification need the added additions to raise?Wen Jing Tang modWu Zhu Yu 3Dang Gui 9Chuan Xiong 6Bai Shao 12Dang Shen 12Gui Zhi 9Mu Dan Pi 6Sheng Jiang 6Gan Cao 6Zhi Ban Xia 6Mai Men Dong 10
1 teacher remark1 reply 14 more comments4additions:Deficiency at Lower jiao:Xu Duan 9Warm + bring yang back to gate:Rou Gui 6Raise qi:Huang Qi 9Chai Hu 3 ReplyCaroline RadiceNewJan 31, 2021ReactHi Nicole: I would suggest the blood stasis is a larger component here based on the symptoms listed: dusky tongue, stabbing pain,clotty bleeding, worse with intercourse and tampon, etc. and not too much on the vacuity side for which the upbearing might beindicated. She has mild heat above at night, thirst etc. but don't assume long menses always cold induced (though often is!). Whatare other cold signs aside from cold butt? I would think about warming certainly but maybe more qi and blood movement as welllike Gui Zhi Fu Ling Wan with Dang Gui & Chuan Xiong. Does this fit the pattern you are seeing? ReplyCaroline RadiceNewFeb 04, 2021 | EditedReactHi Nicole: Blood Stasis is always secondary to something (except trauma, which birthing can be) and post partum qi & bloodvacuity would make a lot of sense as the root, but you do need other signs and symptoms to support this (which may be theemptiness you're feeling). Losing some integrity due to undernourishment to the muscles and sinews post birth can cause them tofeel heavy and sinking, so you might consider the Dang Gui/Chuan Xiong mod as an element of Dang Gui Shao Yao Sanmodification to nourish the blood as well as regulate, but adding Huang Qi may help as well on both counts too!Adina KletzelHormonal Treatment for breast cancer and the cycle that emergesNewJan 25, 2021ReactQuestion for teacherWomen who are being treated for breast cancer with hormones to suppress estrogen and progesterone production and therebystop the function of the ovaries can also go through predictable patterns in their ‘cycle’. Some of these women report someirritability, unrest, dryness and insomnia before their monthly shot that suppresses their ovaries and exhaustion, bloating,heaviness, and some depression after the shot. Many also experience weight gain, hot flashes, thirst, dryness, constipation, andmore frequent urination throughout the years of treatment.In attempting to support these women a full diagnosis is always done but I have found that some women respond well to si ni sanbefore the shot as there is a feeling of something being stuck. The ovaries and uterus are trying to perform a certain function butare being blocked and the body has a certain energy that can’t be expressed. After the shot some support of kidneys and settlingthe rising yang has been helpful.
1 reply 11 more comment1Since this is a chronic situation the need for support is ongoing. I would love to hear others experience in treating these womenand if anyone has seen any patterns of successful treatment emerge.I also am looking to understand if there is any predictable effect forced menopause has on the kidneys in particular or any othersystem in the body that would be helpful to look out for.ReplyKeren SelaNewJan 28, 20211ReactHi Adina - it gets really complicated with hormones that suppress the normal cycle - doesn't it? We always worry not to give herbsthat can somehow stimulate the innate production and counter the suppressing drugs. And these are women who will always askto make sure there are no phytoestrogens in the herbs...So here is how I usually go about it. The liver is responsible for detoxifying and metabolizing all the drugs we ingest. In a womanrecovering from cancer and taking suppressants - it is most probably working overtime, congested, hot and deficient in yin andblood. So checking the status of the Liver is key - and in choosing a formula like Si Ni San, if the pattern fits, it is the right direction.From my experience, this "menopausal" syndrome women are thrown into shows up a lot of times as heat above and cold below,dry above and damp below and using Jue yin/ Shao yang formulas are useful. I try to stay clear of known phytoestrogens for thesake of preventing any misunderstandings (even DG has been proven not to be a simulator in breast cancer and yet is stillcautioned in Estrogen receptor positive cases).Dr Yuning Wu recommends staying away from strong Yang stimulating herbs that can "heat up Kidney Yang too quickly" like XianMao, Suo Yang and Lu Rong. I understand this to mean not wanting to stimulate some hormonal function (activating the yin of theovaries with Yang) in a way that can counteract with the drugs.Integrating is tricky, we are liable and these are very delicate patients. ReplyAdina KletzelNewFeb 20, 2021ReactThank-you for your comments and sharing your experience.From my experience, this "menopausal" syndrome women are thrown into shows up a lot of times as heat above and cold below, dryabove and damp below and using Jue yin/ Shao yang formulas are useful.I find this to be very true. I am often challenged finding the right balance between hot and cold - they often feel cold but warmingherbs will cause and increase in hot flashes and dry mouth and thirst but cooling off too much will drain their energy.I find the same challenge with the wet/dry dynamic. Without the right balance they can easily become too dry or too wet.Do you have more specific recommendations for the types of formulas that have worked for these women?Thanks so much!Emily RieffelSpecific herbs for intense premenstrual nipple pain?NewJan 22, 2021ReactI have a patient with intense premenstrual nipple pain, related to LR Qi depression and stagnation in the Chong mai, with lack ofopening through. I'm thinking of using a modified Ji Mai San, as the whole breast is moderately swollen, and she also has intenseabdominal cramping during menstruation...but I wondered if I could more specifically target the focused nipple pain. Thoughts?
1 teacher remark2 replies 26 more comments6(More background: I have been working with this patient for more than a year now -- she had had extremely heavy peri-menopausal menstrual bleeding and clotting. With a lot of invigorating and harmonizing the Blood, and rebuilding Qi, she has afairly normal flow volume, color, and consistency now. Her tongue has changed from purple and peeled to pink and coated. Theedges are still fluted, and the tip a bit red. The cramping and breast/nipple pain are the lingering remnants of what was muchworse).Thank you! ReplyCaroline RadiceNewJan 22, 2021ReactBest guide herbs to breasts for me have been Qing Pi, Lu Lu Tong, Wang Bu Liu Xing and Si Gua Lou. Sounds like you need to loveboth Qi & Blood for her and should cover the whole breast. You may also want to use a Fu Ling or similar if the breast is swollen,and I like Jie Geng to open the flanks with this. Have not thought of one specific to just the nipple, but now will look into it more! ReplySuzanne ConnoleNewJan 22, 2021ReactAgreeing with Caroline above. I would add Bai ji li to that list and maybe Dan shen. Is there cold involved in the pattern?Specifically is there cold extremities? I have had both nipple pain and dysmenorrhea respond to Dang Gui Si Ni Tang. I had apatient who had nipple reynaud's that caused intense pain at PMS time and the pattern fit.Sharon YeungThyroid and FertilityNewJan 14, 2021 1ReactI would love to get other's thoughts on what they do when they encounter the situation where a patient's thyroid levels are withinnormal range, but not within the narrower range recommended for fertility. In most of these cases I have had, the patient is doingwell on an herbal formula but usually opts to take a minimal dosage of synthroid to get within the recommended TSH range. Haveany of you used herbs to accomplish this?I had a case where the patient was feeling 'better than she had ever felt in a long time' while on her herbs and we were seeing verypositive changes in her cycle but when I added herbs (JGSQW jia wei) to theoretically lower her TSH into the recommended range,her balance was completely thrown off and her TSH level surged upwards. I know better than to prescribe based on a W diagnosisbut, alas, I lapsed in judgement. What is your experience? ReplyCaroline RadiceNewJan 15, 2021ReactHi Sharon: Just had a patient yesterday who was put on synthroid because TSH was at 2.5 and IVF clinic wanted her below 2. Shewas an anxious mess as I think it threw her into hyper! Palpitations etc that we had to get under control (we did fortunately atleast for the day...) and requested she consult RE to see if she could be allowed to discontinue. Totally messed her up and she wasjust getting into a great groove. Strict adherence to certain values can be such a negative.
2 more comments2ReplyKeren SelaNewJan 21, 2021React@Sharon Yeung, @Caroline RadiceHi Sharon and Caroline. Here in Israel there is one very famous Dr that gives Utherox to all his IVF patients who have a level over2.5 as well. I have usually watched over closely and taken out the stronger yang stimulating herbs if they were on any.Unfortunately, his recommendations trump mine and the patients comply and take the drug. Just another example of thecomplexity of integrity. I do try to see if there are any yang rising signs that show up and treat those.Caroline Radice,Sharon Yeung
Suzanne ConnoleSubstitutions for E JiaoNewJun 21, 2021ReactHello all. Starting a new thread after Caroline's note about the ethical concerns about E jiao. I know thistopic has come up before in other forums and I want to create a list of substitutions for myself and also tooffer to students as I teach these formulas. These are my ideas so far but I have not tried them all yet.I was told that Xian He cao is a good substitute for the stop bleeding action of ejiao for deficiency patterns.Does any one have any experience with this substitution in Wen Jing Tang or Jiao Ai Tang?I've tried to sub shu di huang for the nourishing action but it doesn't feel quite the same.Has anyone tried using powdered beef gelatin in the formula directly? Would it have the stop bleedingeffect or just the nourishing effect? I have had patient use gelatin and bone broth as a food but have nottried puttingit in the formulas.Sharon YeungEndometritis and FertilityNewJun 15, 2021ReactI have a patient who is currently trying for baby #2. She tried for nearly 3 years for her first and eventuallyhad a child with the assistance of IVF. On her journey towards pregnancy, one of the REs detected she was
positive for endometritis and treated her with a round of AB. This particular RE takes a more investigativeapproach and rarely uses IVF. While she did not become pregnant under his care, on the IVF cycle whereshe eventually became pregnant, she retested for endometritis, tested positive and did a round of AB andeventually became pregnant. The IVF doctor treating her did not this endometritis was of particular clinicalsignificance and did not think she needed treatment for it but was willing to take into account the other REstests results and followed through with a round of AB. I have not come across this diagnosis nor seen itregularly tested for with my other fertility patients and am wondering if any of you have this experience.When I treated her when she was trying for her first, she had a damp-heat presentation that showed upmostly in her sinuses and was difficult to resolve especially because it was very much related to her dietand lifestyle. I don't necessarily think the endometritis is connected to this but wonder if any of you haveseen cases of this related to infertility. ReplySuzanne ConnoleNewJun 21, 2021ReactI've only had one or two patients who have had this testing done, so I can't say that I have much experiencewith it. If the RE thinks that the low grade infection in the endometrium itself is the cause of the fertilityproblem, it is tempting to go looking for damp-heat. That you see damp-heat in another place is interestingas often what is above is also happening below so I would look for it. Also thinking about the tube ingeneral, if the sinuses are blocked it can affect the pelvis/lower jiao movement as well.From a different perspective, the uterine environment is all about the quantity and quality of blood and it'smovement. So I would focus on that aspect. My questions would be: Are blood and waterharmonized/integrated? Does the blood flow smoothly from heart to uterus? Does the period come onsmoothly and discharge well/efficiently?Sarah Rivkin"kitchen medicine" to support uterine liningNewJun 04, 2021ReactI was just making some adjustments to the formula for a fertility patient who was diagnosed as having athin uterine lining, and thinking of including lu jiao shuang. Being a fan of kitchen medicine, this got methinking about recommending she include gelatin (and maybe bone marrow, oxtail, bone broth, etc.) to herdiet.Have others used these (or other) dietary strategies to plump up the lining and do you think it has worked?
3 more comments3I'm hesitating a bit because she doesn't present as yin deficient or dry generally, rather there is clear qistagnation and some blood stasis, and maybe a little cold. ReplySuzanne ConnoleNewJun 07, 2021ReactGood idea Sarah! I would guess that it might work better as food for her. If she tends to stagnation, puttingit in medicinal dose in a formula might make stagnation worse. Bone broth is a good idea, or something asa powder in a smoothie might work as well. As far as why her lining is thin, I have seen blood stagnation bethe culprit for this problem, as stagnant blood cannot generate new blood. ReplySarah RivkinNewJun 08, 2021ReactYes, that's what I was thinking. I suspect the cause in her case is blood stagnation, which is what I'm mostlyaddressing with the formula. Then to have her more gently supplement through her diet will be a nicecompliment. Thanks for weighing in!SallyInfertility Case from the winter with Lots of damp and constipation: Pregnant!!NewApr 22, 20211ReactI just wanted to report that my difficult case with history of cysts plus dampness and constipaiton. Herformula was based on Dang gui Shao Yao San and Hou po qi wu tang. Positive pregnancy with this lastcycle. She only tried one other month as there were complicated logistics involved. I will see if I can get thatcase back up here. ReplyAnn ClearyNewApr 22, 2021ReactI remember this case because because it had a formula that was new to me (and I now forget), and thesmall dose of fu zi to help transform damp stuck with me. I would love to be able to review.
Reply2 more comments 2Joy BlaisChaotic Eastern WInds LectureNewApr 08, 2021ReactThank you Keren for a great lecture & case study! I was wondering about your abdominal diagnosis for thispatient. You mentioned that she had fatty deposits under & around the umbilicus. Does this indicate dampaccumulation in the middle & lower jiao? If not, what did you interpret this sign to mean? Thanks verymuch!!Keren Sela ReplyKeren SelaNewApr 09, 20211ReactHi @Joy Blais! Thank you!Yes, they were indicative of damp accumulation. From my experience, fat is a tissue that resonates with thecentral direction and indicates problems with t&t and damp accumulationJoy BlaisReplyJudith KenenNewApr 10, 2021ReactThank you for the lecture. You mentioned Dr. Yi Tian Ni. Do you know what book it is where there isdiscussion of the geometrical acupuncture?Sage Staggs (she/her)Menstrual migraines, 37FNewApr 05, 2021React
Question for teacherI have a telehealth patient who came to me a couple months ago for chief complaint of menstrual crampsduring the entire luteal phase. After taking modified Jiao Ai Tang (listed below), her cramping reduced anddigestion improved, but now her menstrual migraines have increased in frequency.Here are her current symptoms (no pulse because telehealth, I will update with tongue photo once shesends it):migraines day before period and at end- shaoyang pivot issueoccipital/orbital/whole head- shaoyang, yangming?photophobia- ?nausea- ST going uppain w sex- stagnation in LJcramps- shaoyang pivot, blood stagnationbetter w heat- cold r/t blood stasis-better w mvmt- stagnation-large clots, purple- blood stasis, cold?heavy bleed- shaoyin not containing-hemorrhoids/anal fissure, worse w cycle- blood not held, worse at shaoyang pivot time-dry skin- blood def? fluids not absorbed?thirst at night, not quenched- fluids not absorbed-wakes often- yang not consolidated at night-cold h/f- yang not reaching extremeties-stress/anxiety- heart/shen issue, not enough blood to soothe heartpolyp- blood/phlegm/damp stagnation-palps- yang not secured, risign up and harassing heartlow energy- yang not storedgas/bloat (has been better)- stag in MJloose stools (have been better on herbs)- poor T/Tfood sens- poor T/Turgent BM- yangming too fast/taiyin too slow??clench/grind- shaoyang pivot issuechest tender- shaoyang pivot issuesad- ?irritable- stagnationovulates day 12-14- weak shaoyin?menarche at 15- weak shaoyinlow libido- weak shaoyinhx of long, high fever- fluids scorched, absorbtive capacity of tissues reduced?not much sweat- taiyang is functioning wellloves to exercise, helps w cycle- stagnationloves sauna- cold/yang not consolidatedstiff upper body- stagnation/blood deficiencyHere is the original formula that she took for about a month overall:e jiao 6ai ye tan 6sheng di 12chuan xiong 6zgc 6
dang gui 9bai shao 12fu zi 20bai zhu 9fu ling 9pao jiang 3gan jiang 3chai hu 18tong cao 9My thoughts are that perhaps chai hu isn't right for her (I would think it's appropriate for her but amworried it may be involved with the increase in headaches- because maybe it is too moving/acrid?) Butwhat should I use to treat the headaches then? Perhaps ge gen would be more appropriate- maybe add inGZjGGT?How can I look at treating the stagnation (mood stuff, breast tenderness, issues at pivot times) from anangle that doesn't require chai hu?I would maybe add shan yao for the heavy bleeding.I feel like I'm missing something because I am still coming up with a similar formula looking at hersymptoms now.ReplySage Staggs (she/her)NewApr 06, 2021React@Keren Sela @Sharon Weizenbaum @Caroline Radice Would any of you be able to address my questionabout Chai Hu above? I've given it for headaches in wood excess/ liver stagnation types in the past and acouple times the headaches have gotten worse. I'm not sure if I need to choose another herb, or whetherI'm improperly combining chai hu (ie- give it with more bai shao, etc).Sharon Weizenbaum,Keren Sela,Caroline RadiceKeren SelaNewApr 06, 2021ReactHi Sage - thanks for posting. It would help alot if you you would write out your full diagnosis and then wecan see if the formula matches. Here are a few things that you wrote that I questioncramps- shaoyang pivot - why?ovulates day 12-14- weak shaoyin? Perfectly normal I thinkmenarche at 15- weak shaoyin also could be normallow energy- yang not stored - could be due to stagnation as well...chest tender- shaoyang pivot issue - more ribs or sides - chest c/b due to alot of thingsRegarding Chai Hu - if the migraines are due to a Shao Yang problem - CH is not an issue at all. In fact it isindicated and will not raise the qi but actually help it descend.If I understand your formula correctly it is a mix of Jiao Ai Tang and Dang Gui Shao Yao San? Do thoseformulas fit your diagnosis?
6 more comments 6ReplyJudith KenenAmenorrheaNewMar 30, 2021ReactQuestion for teacherI've just begun treating a 23 yr old woman with amenorrhea. I've only seen her on telehealth so far but willsee her in person this week. I could use some help. She has been diagnosed with Hypothamic amenorrheaand lean PCOS. She has never gotten a period without the help of birth control. She is very underweightand denies any eating disorder but is working w/a therapist and nutritionist. As a teen she was an athlete.Mother had PCOS. She craves cold drinks and urination is normal. She runs hot at night, has infrequentnightsweating and sweats more than others with exercise or stress. She reports that she is sensitive to thetemperature outside, so very cold when it's cold, and overly hot when it's hot. She tends towardconsitpation especially with stress. She has tight shoulders and hips that are w/w stress and better withheat. She has pain with intercourse. Her shins are ashy and scaly, especially in the winter. Her tongue is haspeeled patches in the back, has a red body and distened veins underneath.I expect that her Kidney's are depleted because of being underweight and the degree of exercise.She has Ki yin deficiency because of peeled back of tongue.Her tight muscles indicate undernourished muscles and therefore blood deficiency.She has blood stasis.She has wood involvement.She has heat in her Stomach.There is heat.I have given her Wen Jing Tang w/ Rou Gui, Sheng Di and Tian Hua Fen, and took out Wu Zhu Yu, but I'm notsure it's quite right for her, because she isn't especially cold although quite deficient. She has been on it fora couple of weeks and doesn't report much change.Wondering also, if whatever formula I am giving her, will we be looking for signs of ovulation to know weare on the right track? Anything else?
Thoughts and suggestion appreciated!ReplyKeren SelaNewApr 01, 2021React@Judith KenenHi Judith, great case. Looks like a right direction - heat above and cold below, underlying cold anddeficiency stemming from the Shao yin and Tai Yin. Amenorrhea, especially from menarche will take a longtime to treat. If you are seeing her in person then adding acupuncture to the herbal treatment will help.What is her pulse?Just a note on part of your diagnosis regarding stomach heat - insult of cold, whether external (drink,outside temperature, lifestyle) or internal will create create heat in the body as it is combating the cold.This is the normal/correct response of the body. but by cooling off the heat we see we are actuallyaggravating the problem. From what you described it seems like she is more the deficient, depleted type.Please give more info after you see her in person as to full diagnosis and have patience, it may take a whileJudith Kenen ReplyJudith KenenNewApr 10, 2021ReactThanks Keren. She describes that her thirst is decreasing anyway, so I'll cut back on the Tian Hua Fen.Although I think I understand what you are saying about the heat being created to combat the cold, whatI've understood from the GMP and working with a mentor, is that you would still want to address thirst andthe heat. I've practiced for a while but have never felt confident about my pulse taking and I'm new toabdominal diagnosis, so I do it but not very confident about what I feel. Nothing jumped out about eitherher pulse or her abdomen. Pulse didn't seem deficient to me. Her tongue is a little purple, normal coat, hasa few red dots and is distended underneath. But all of her symptoms seem to be improving.
1 more comment1YanaNo SubjectNewMar 30, 2021ReactI need advice on a case of a 49yo woman with genital pain for over 5 yearsPain is located around clitoris and urethra and starts in the morning after a couple of urinations. Pricking,burning sensation. Not affected by urination itself or moving bowels. No pain during sex or orgasm, butgets worse after orgasm. Better in warm water, with baking soda washing and when she moves; worse withsitting and with stress. Also worse at ovulation & before bleeding.Also in the same area itching of labia major (reduced after eliminating pork from the diet)Also some pain in the entrance of vagina in the very beginning of intercourse (since the beginning of sexuallife).The main symptom (pain in clitoris and urethra and itching of the labia major) started after a severe stress.The patient had all the possible tests done, and no pathology or infection found.- Generally cold, not sweating- Medium appetite. A lot of gas, bloating and gurgling.- Regular bowel movement, though when she reduces the amount of raw veggies in the diet then feelsblocked. Slightly prone to constipation.- Urination normal, but gets foul during period. Occasional nocturia- No discharge- Blurry vision, orthostatic dizziness, low night vision- Sleep relatively normal, sometimes wakes up at night and hard to fall back asleep- Prone to stress, but has a good shen and is super-motivated to resolve her problem- Looks puffy, like SP deficiency type- History of mild endometriosis 16 years ago, treated with D&C and hormonal therapy
- 2 kids (26 & 14), both by c-section (first was an emergency)- On the second c-section her doctor told her that she has a very thin uterine wallTongue red dull, thin yellow dry coatingPulse on the deficient side. LV is the deepest and weakest of allShe's been taking Jia Wei Xiao Yao San in pill for 3 weeks and notices that she's a little calmerShe has also taken a couple of bags of each of the following prescribed by another practitioner.1. Dang Gui 10, Bai Shao 10, Fu Ling 15, Bai Zhu 10, Ze Xie 10, Chuan Xiong 5, Yi Mu Cao 30, Xu Duan 10,Xiang Fu 10, Huang Bai 10, Ru Xiang 5, Mo Yao 52. Dang Gui 9, Bai Shao 9, Fu Ling 6, Bai Zhu 12, Chuan Xiong 6, Yi Mu Cao 15, Xu Duan 9, Xiang Fu 9, HuangBai 9, Ru Xiang 6, Mo Yao 6, Mo Han Lian 12, Nu Zhen Zi 12, Gan Cao 3The only result from these has been that she started to have some breast distension before period. Notsure if it's related.I see that the practitioner mostly had in mid a gynecological condition. I feel like her digestive tract shouldbe addressed more at this stage, as she has some heat down there. However, I'm hesitating prescribingcold herbs as she's generally cold and her low back is cool on touch.She also needs her blood and yin to be nourished, but her spleen might not accept it at this stage.She has definitely received some spleen support in the last month from the above formulas, but it hasn'tchanged much in the overall spleen function, to my opinion. Maybe the dosages should be higher?What are your thoughts?Keren SelaNewApr 01, 2021ReactHi Yana, great case! Vaginal pain is a tough one, since the emotional aspect of it is usually dominant.besides the c sections and the history of mild endo, has there been any abuse history?What is your full diagnosis? It looks like a complex picture of local excess and stagnation with underlyingcold and deficiency .I am attaching an article from the Lantern regarding vaginal pain. It has some great info in the discussionarea that can shed some light. I especially like the fact that the formulas used there incorporated herbs
Replythat "calm the spirit" , nourish and move the blood. You will also notice that the dosages are higher. Hopethis helps and please updatePDF | 101.4 KPDFLantern1-1 vaginal …ReplySuzanne ConnoleNewApr 04, 2021ReactSome thoughts and questions:Agreeing with Keren, vaginal pain is really hard to treat!Have you thought about doing topical herbs, like a sitz bath? I can dig around and find some suggestionsfor you.I have a tendency to always start with the gut. If it is not working well then the formulas cannot beabsorbed properly so starting there may be the best choice. It sounds like the middle jiao is more stagnantthan deficient.I have a couple questions. What do you mean her urination gets foul? What is her period like? Are thereblood stasis signs?You mention nourish blood, is there signs that make you think about that? She seems quite stagnant soyou would want to be careful with sticky herbsThe external genitalia can be seen as an extremity. Sometimes I think about Si Ni San or Dang Gui Si NiTang in these cases. You mention cold, is she cold all over or mostly hands and feet?
Sage Staggs (she/her)Irregular menses, flooding and spottingNewMar 30, 2021ReactI am a new GMP student and so very new to the concepts that Sharon is helping us learn to improve ourdiagnostic skills. I would love some feedback on this case!25FIrregular Menses, flooding and spotting.Some cycles are 28 days but some as long as 42 days. Spotting for several days before period, then 1 dayvery heavy bleeding, 1 day normal flow, then 2-5 days spotting. Sometimes bleeding will stop for a day ortwo and then restart. Sometimes has clots and dark blood. Hx of dermoid cyst removal from R ovary 2018.Often gets menstrual migraines, sometimes severe menstrual cramps day before and day of period. Cysticacne worse, bloating, and breast tenderness in premenstrual time, can be emotionally labile. Non-migraineheadaches have been a chronic problem for her throughout her cycle.History of taking lithium for several years but weaned off it this year and is doing well- there may havebeen a misdiagnosis/overmedication. Has Hashimoto's and takes levothyroxine, energy is low. Has beenundergoing treatment for allergies/mast cell activation syndrome and mold illness with functional medicinedoctor- has been taking a lot of antihistamines this past year which caused her to gain about 20-30 lbs.Switches between sluggish stools and loose, has episodes of acid reflux.Chronic dry eczema on knuckles and elbows- itchy, light patches.Thirsty all the time, water goes right through her, drinks a lot of room temperature water, urine is clear andcopious.Lots of joint pain and low back pain- thinks LBP may be related to menstrual/pelvic pain.Feet are always cold, hard for her to regulate her temperature otherwise. No abnormal sweating althoughshe reports strong smelling body odor- she does manual labor outside for work.Sometimes hard to fall asleep or wakes but other times it's fine, seems related to stress and sleep hygiene.Sign/symptom What I know…Irregular cycles Shaoyin not containing yangSpotting brown blood JY too fast, MF scorches bloodHeavy flow Shaoyin not containing yangInterruption in flow Possible physical blockage or dry bloodClots Blood stasisDark blood Blood stasisMigraines with periodMF flaringPainful cramps Stagnation, jueyin problemCystic acne premenstrually Fire and dampbreast tenderness premenstrually Pivot problem- shaoyangbloating premenstrually Pivot problem- shaoyangemotional lability premenstrually Pivot problem- shaoyangChronic tension headaches throughout themonthYang risinglow energy Yang leakageAllergies Wei qi problemweight gainT/T deficiency?Sharon Weizenbaum,Caroline Radice
sluggish stools/loose stools T/T not strongReflux ST going updry itchy eczema Fluids not nourishing skin, irritationdispersion thirst Fluids not being absorbedclear copious urine Fluids not being absorbedjoint pain, worse before period Stagnation, pivot of yang to yin timeLBP stagnationHands/feet cold Yang not reaching extremitiesbody hot/cold Shaoyang pivot problemstrong body odor Damp and heat?some insomnia related to stress Yang not contained? Heat rising?Enlarged tongue, toothmarks Fluids not being metabolized properlyRed prickles front half of tongue Heat in upperSlight center crack in tongue Weakness in digestionSublinguals dark purple Blood stasisR Pulse rough Blood stasisL pulse slippery thinBlood/fluid deficiencyBoth chi positions weak/deep Kidney deficiencyLooking at the chart, she has the most symptoms in these areas:Blood stagnationHeat risingFluids not absorbed/dampnessShaoyang pivot problemsPoor Yang storageProblems with T/TI assigned herbs to each of these categories and came up with a list, then found that I had Jiao Ai Tang andChai Hu Gui Zhi Tang with some additions.e jiao 6ai ye 9sheng di 12chuan xiong 6gan cao 6
dang gui 9bai shao 12chai hu 12gui zhi 4.5da zao 6sheng jiang 4.5huang qin 4.5dang shen 4.5ban xia 6fu ling 12bai zhu 6ge gen 9What do you think?JPEG | 1.6 Mimage_67216129 ReplyCaroline RadiceNewMar 30, 2021ReactHi Sage! I like how you're thinking about this case and see you're moving a lot of the stagnation in thepivots and addressing the blood and damp elements. Has your patient tried the formula yet?
1 reply 13 more comments3 ReplySage Staggs (she/her)NewMar 30, 2021ReactNo I haven't given her herbs for a while. I wanted to run this idea past folks on the forum and see if I'm onthe right track before prescribing. In the past I tried a few other formulas without any change (BZYQT,JWXYS and a variation of Lifang Liang's Gong Xue Fang).Ann ClearyRetention enemas and other local/ internal herbalapplications for uterine pathologiesMar 26, 2021 | EditedReactHi all,I’d love to hear your thoughts on local/ internal application for, in this case, a subserosal fibroid. I have apatient of child-bearing years who has come in with a fibroid the size of a small watermelon. She looks tobe about 4-5 months pregnant (the the shape is oblong and diagonal) and the fibroid pokes up into herright rib cage. This weekend I will see her for the fifth time, and we are steadily making strides with theneedles and the herbs. However, in 3 months she will begin the first steps in treating it with Westernmedicine. The last time she discussed it with a doctor, the discussion centered around total hysterectomy.It is my first time treating a fibroid this big, so have little to judge how quickly this can shrink, but I can’timagine it will have shrunk enough to be a candidate for laparascopic surgery in just two more bleeds.That has got me thinking about ways to get closer to the fibroid with the herbs. I have been thinking aboutretention enemas and also yoni pearls. I have seen more studies on retention enemas, though currentlycan only find abstracts on pubmed. I wanted to find some studies to see what kinds of formulas were used.My question is this: would I use the same herbs that I would prescribe to be ingested? This of course is avery labor intensive approach and I do not yet know if it is more than my patient is up for, which brings meto yoni pearls. These are new to me, so I will describe them if they are also new to you. They are smallbundles of dry herbs on a string to be worn internally like a tampon for 1-3 days. Like a suppository, butmaybe a little bit tidier.Sharon Weizenbaum,Suzanne Connole,Caroline Radice,Allyson Nevard,Cara Frank,Sally
1 teacher remarkI have been reviewing different compositions from different companies, and many contain externalapplication Chinese medicinals that are anti-itch, anti-bacterial, anti-parasitic (tu fu ling, she chuang zi)along with blood regulators that are loving to the womb (yi mu cao, dang gui, etc.) They are marketed forgeneric use for a wide range of vaginal/ womb issues such as BV, yeast infections, endometriosis, fibroids. Iam thinking about making some of my own so that I can make the bundle more specific to the patients’needs and control the quality of the herbs used, but am again curious if any of you have any experiencewith this type of application and how you would go about selecting a small amount of herbs to usevaginally. My thinking is that if there is no itch or burning, that those herbs would be left out. It also seemsthat the best approach would be to move blood locally, and if I am thinking this way maybe I would leaveout the parts of my formula that have to do with the larger movements of yang throughout the body (thesix conformations). I would love to hear any thoughts or experience you have.And of course, there is the classic castor pack, although this too is messy and not easy for everyone toincorporate into their daily routine.Also, very much looking to forward to Lorraine’s class at the Shennong Conference on vaginalsuppositories, and I know it will have a lot of good information relevant to this. We’ll be throwing mydaughter’s bday party so I won’t be able to see it until later.Sharon Weizenbaum NewMar 28, 2021 | EditedReactHi @Ann Cleary @Caroline Radice , I taught once at the IFS symposium on my experience with Fibroids. Ithink you can watch that still. I am tagging Caroline too as she has a lot of experience here.The main thing about treating Fibroids is to see that the blood stasis they represent is a branch. Bloodstasis is always a branch. If we go ofter the branch only or primarily, the results are poor. If we go for theroot, even ignoring the branch, the results are often good. My advice is to diagnose this patient as if shedidn't have the fibroid. The fibroid is a "red herring" in Caroline Radice's words. It keeps you wanting totreat the fibroid instead of the reason the fibroid is there. How would you treat her if you were blind to thefact that there is this big fibroid there? What are her other signs and symptoms, her history andconstitution? Does she have bleeding issues. If she is bleeding heavily, the main thing is to see why she isbleeding. In my experience, treating the root of the bleeding so it stops, often results in fibroid shrinkage.Without doing anything to shrink the fibroid.Secondly, this is a very big fibroid. It is important to know where it is. If it is on the outside of the uterus orpedunculated, there is no way that a vaginal or rectal insertion, or even internal herbs will help. She willend up being so frustrated. If it is on the outside, the good news is that 1) often the bleeding issues are lessand 2) surgery is likely helpful.Ann Cleary,Caroline Radice
1 reply 18 more comments8ReplyIf you'd like to share more about the case, I am happy to help here but maybe these key points are a start?ReplyCaroline RadiceNewMar 28, 2021ReactHi Ann: Thank you for this great question. I have treated a lot of women with fibroids (notice I did not sayI've treated a lot of fibroids) and to Sharon's point, a lot more info might get to the imbalance that createdthe fibroid and where to start with herbs. I have not used enemas for this, and the ones I have used aretypically rectal as the absorption is better there, and even then, more with endometriosis. Lastly, I wouldagree that this is a huge mass that is unlikely to respond as quickly or easily as surgical removal. Iunderstand balking at the hysterectomy so would be interested in the whole pattern to see if there is a wayto tackle this, but I would have less confidence in one so large as the potential collateral damage, e.g.,bladder or bowel blockage could be quite serious if it isn't already.
SallyPregnancy and COVID Vaccine?NewApr 22, 2021ReactHas anyone had a pregnant patient get vaccinated? Most of my patients were able to get vaccinated beforeconceiving. The one didn't think she would get pregnant so easily. I haven't heard yet what her OBrecommends. She's in her 40's... What are your thoughts about this? She heard there was a Pfizer studythat just started... I lean towards waiting at least til 2nd trimester. That is based on the idea that at least themost basic development in the baby is formed already at that point.ReplySarah TewheyJun 02, 2021ReactHi Sally.I am a new member and just joined and saw your post.I don't know if your question is still relevant as it was posted awhile ago, but the midwife at my hospitalreports that approximately 70% of the pregnant people in my area are opting to receiving vaccine inpregnancy if they did not receive it prior to becoming pregnant. She reports that most individuals areopting to receive it in the second or third trimester. I am fortunate to be in an area with very high rates ofvaccination (between 66% and 89% among the four townships on the island) so the pregnant people in myarea might be skewing more toward receiving vaccine than in areas with lower overall vaccination rates.All the best,Sarah
2 more comments2 ReplySarah RivkinNewJun 08, 2021React@Sally Rappeport most of my pregnant patients have gotten vaccinated as soon as they were eligible. Ifyou look at the article @Claudia Citkovitz posted in another thread or at other research that's evolvingaround COVID it seems the disease itself is far riskier in pregnancy than the vaccine is.I would also consider the emotional toll that fear of contracting the disease seems to take--and how thateffects pregnancy. Not to mention the isolation, lack of exercise and physical contact, etc. continuing to liveas we have been for the past year, while most folks are able to move on because they are vaccinated.Claudia Citkovitz,SallyCarrie MurphyPreventing pre-eclampsia in a second pregnancyNewApr 01, 2021ReactHello! I started a post about this last season, but cant find it now, so starting again. I have a patient whohad to deliver early (week 35) in her first pregnancy due to pre-eclampsia. She is now ten weeks pregnantwith her second pregnancy, and anxious to prevent a repeat. She has an earth constitution, a tendency toworry and stew, low self-esteem, some dampness in the lower body. Her blood pressure and anxiety areboth well-managed now with acupuncture and BXBZTMT. She exercises regularly. She is off herbs now andworking with a nutritionist on getting her diet right. How can I best support her?ReplySharon Yeung NewApr 07, 2021ReactI would continue to treat what you see. I find that patients can present very differently at each stage oftheir pregnancy so as long as you continue to adjust her formula regularly throughout the pregnancy, youhave the best chance of preventing pre-eclampsia. I have started to ask patients very early on in theirpregnancy if they are noticing any swelling or tightness in their hands and feet. I find that most womendon't report water swelling till it's much more apparent. It sounds like your patient already has a tendencytowards 'dampness' (jinye?). If we can target fluid physiology early on, it may help manage blood pressure.You can consider Dang Gui Shao Yao San if it fits her presentation. It both nourishes and moves blood,drains dampness and promotes the absorptive capacity of the spleen. It's often used during pregnancy tomanage fluid physiology issues.
3 more comments3ReplyReplySuzanne ConnoleNewApr 08, 2021ReactAgreeing with Sharon Y. on this. Maybe get more info on what happened in the later part of her pregnancythe first time, did she have swelling then? What other symptoms did she present with the pre-eclampsia? Ihave seen this pattern often of water metabolism imbalance, or the water and blood relationship being outof whack and leading to the increase in pressure. I think of it as the water is coming out of the blood intothe tissues, leaving the blood less fluid/more stagnant. Does that sort of sound like what is happening withyour patient? Dang Gui Shao Yao harmonizes blood and water, bringing them back together. I usuallyreduce or omit the chuan xiong depending on the level of blood stasis present.Candace JaniaTotally devastatedNewMar 28, 2021 | EditedReactInteresting that Claudia posted about COVID and pregnancy...My long time patient was 22 weeks pregnant with twins (IVF). She started bleeding around 16 weeks. OBcould not find any pathology (SCH etc.) and cervix was fine. They surmised a small placental tear but werenot concerned. We started herbs to help with the bleeding, which helped to stop it to almost nothing. Aweek before week 22, she came in with some "allergy" symptoms. I asked if they gave her a COVID test andshe said no and she said she gets these symptoms every year and her allergy meds helped... I told her sheshould get one but moved on. Her symptoms felt much better after acu and guasha and she felt great allweek so I didn't see the need for herbs.6 days later, she had mild cramping, then felt intense pressure and delivered her babies at home, and theydid not survive.I later learned that they did a COVID test in the hospital afterwards and it was positive. She had just had her20 week anatomy scan and all was perfect. I saw no indication in her pulses that something was amiss.A follow-up with a new OB said her cervix was not strong enough to hold the babies and she just deliveredthem early. While I understand that this can happen spontaneously, I don't buy it. The funeral director thatshe had the babies' service at told her that she was the 6th woman that was between 20-22 weeks in her
3 replies 31 more comment1pregnancy that delivered prematurely in the last 2 weeks and they all tested positive for COVID. Pathologyof the placenta showed only the remnants of the small tear but no thrombosis, which they believe was anon-issue. We are waiting for autopsy results.I did more research and have been finding that they are seeing evidence (CDC and March of Dimeswebsites) that COVID can cause premature labor.This post is to both let people know of what this virus is doing and also any thoughts on this. This seems tobe a separate issue from the clotting. Any thoughts on maybe changing the way we manage unvaccinatedpregnant women, especially in this critical time period? Especially perhaps encouraging herbal medicineeven more? ReplyAnn ClearyNewMar 29, 2021ReactHi Candace. I don’t have any answers to questions but am glad to know about this, especially as morefertility and pregnant patients are beginning to wonder when they should get the vaccine. Also to say,really sorry to hear and my heart goes out to you and of course, to your patient and her partner. ReplyClaudia CitkovitzNewApr 03, 2021ReactOh no Candace I'm so sorry to hear that. I am aware that they're saying there are no adverse effects inpregnancy but from a common sense perspective it seems to me that there is an obvious and well knownconnection between inflammation and premature labor, and and at least in some patients C19 causes astrong inflammatory response. Was your patient yin deficient or prone to inflammation in any other way?Claudia CitkovitzCovid and PreeclampsiaNewMar 23, 20211ReactSo the evidence is starting to mount that Long Covid sufferers have what docs call 'micro-embolisms' andwe call Blood Stasis (here's a paper on that https://onlinelibrary.wiley.com/doi/pdf/10.1111/jth.14856)
We know as well as they do that blood stasis is a setup for severe preeclampsia. So I am wanting to looktowards (A) proactively cleaning up blood stasis where it appears in post C19 patients who want to havekids, and (B) supporting post C19 patients through their first and third trimesters when the problems areset up and manifest.Has anyone started on this yet? Any thoughts?
COVID‐19 and acute coagulopathy in pregnancyWe present a putative link between maternal COVID‐19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS‐...
1 teacher remark4 more comments 4Source: https://onlinelibrary.wiley.com/doi/10.1111/jth.14856 Embedded File.https://onlinelibrary.wiley.com/doi/pdf/10.1111/jth.14856ReplySharon Weizenbaum NewMar 28, 2021ReactHi @Claudia CitkovitzHow important for us to have this eye for blood stasis and "crappy blood" in our post-covid patient whowant to have kids! And in general for post-covid patients. Thank you. I bet, over time, we will see theseconnections more and more.Claudia CitkovitzReplyClaudia CitkovitzNewMar 28, 20211ReactSIEAM is doing a study on herbal medicine for C19 now, hoping there will be a follow-up with long covid....https://sieam.edu/news-and-events/2020/4/15/study-on-chinese-herbs-and-the-treatment-of-covid-19-related-symptoms
Sarah GambleGluten Free/ BarleyNewJun 29, 2021ReactWhat about Gluten Free? Barley is gluten full. The patent formula (Xian Gu Fang) was perfect for my patient,but I could not give it to her, because of the YIYI Ren. I do hate to substitute, but I started contemplatingwhat if I make her a raw formula and leave out the Barley, perhaps increase the Zhu Ling. Does anyone elserun into this? If so, any other suggestions?Immortal Valley Formula Ingredients for Xian Gu Fang for damp heat pattern, lower burnerBai Hua She She Cao 12%, Yi Yi Ren 10%, Tu Fu Ling 10%, Jin Yin Hua 10%, Shan Yao 9%Bai Shao 9%, Huang Bai 8%, Zhu Ling 8%, Huai Niu Xi 7%, Chong Lou 7%, E Zhu 5%, Hong Teng 5%ReplyMaryanne TravaglioneJun 30, 2021ReactIncreasing the Zhu Ling a bit might be a good solution. I am just being careful here to state that wheat, ryeand barley all contain gluten protein. I am saying this as a reminder as I had a patient who was also aacupuncture student and had poor digestion and she substituted the yi yi ren with fu xiao mai andtriggered an autoimmune response. It was a good reminder around gluten sensitivityCaroline RadiceNewJul 11, 2021 2React
1 more comment1ReplyHi Sarah: This actually came up in the Winter Herbs forum and I think is stored somewhere in WPC files,but YI YI Ren is not barley, it is millet, which does not have gluten. It just looks like pearl barley. The issue Ihave had is cross contamination, but many of my gluten free folks do fine with Yi Yi Ren for what its worth.Sarah GambleNo SubjectNewJul 06, 2021ReactI welcome all reminders. Thank you Maryanne!Ja'Nelle Jefferson, LAcHas anyone combined Chai Hu Gui Zhi Gan Jiang Tangwith Gui Zhi Fu Ling Wan for herpes + infertility?NewJul 12, 2021ReactHi!I am considering combining CHGZGJT with GZFLW for a patient with herpes & long-term infertility age 44.She has a tendency to develop fibroids & cysts and amenorrhea. I think the GZFLW would be perfect exceptthinking it may cause a herpes outbreak. She has been on LDXGT with little effect although the breakoutsusually don't occur but have been popping up more as we try to build blood & qi. She responds well totonics such as shi quan da bu tang but after awhile fluids start building up causing runny nose & cysts &brown scanty period.She has very few other health complaints, great energy, very active, no urinary issues, stools can go soft butare usually formed and very regular 1-2 daily, no abnormal sweat, feet can be cold but hands usuallyneutral. Periods are regular 28 day cycles and 2 days in length after years of amenorrhea that wasregulated with acupuncture. Some small clots at times, it can be brown & spotty but sometimes turn redwhen we are nourishing blood.Any ideas are appreciated but I really want to know if anyone has used or would use this combination?Thank you!PollHave you combined Chai Hu Gui Zhi Gan Jiang Tang + Gui Zhi Fu Ling Wan for Herpes + Infertility due to lowcirculation?
2 more comments2You may only respond to this poll one time.Skip voting and go to results2 participants responded.The poll is open. Results will be availableto each participant after voting and toothers after the poll is closed.Close Poll Download Poll ResultsNo, I've never tried that!Yes with good results!No, but I suggest something else for this caseReplyMarnae ErgilNewJul 12, 2021React@- Ja'Nelle: I have not tried the combination, but I am not sure that there is really enough to go on here tomake a determination. Why do you think that the GZFLW would cause a herpes breakout? Moreimportantly, what is your goal here - what are you treating? Do you have a diagnosis?ReplyMaryanne TravaglioneNewJul 14, 2021Reactthis approach is far different than the LDXGT that has been clearing liver heat thereby addressing theherpes. So it seems that your concern using these more warming formulas is warranted, however moreinformation needs to be included to guide this transition. You clearly have done some great work as youreport a history of cysts and amenorrhea and now report she has a regular cycle. That is important, but Ifyou are looking to switch to nourishment from heat clearing that is a big move and difficult to supportwithout a fuller understanding of your reasoningSarah RivkinYin Care alternative?NewJul 14, 2021ReactIt seems that Yin Care has been discontinued, none of my normal sources have any more, and I'm reluctantto buy it off of Amazon. Is there another patent/premade alternative with similar applications that you like?And/or a reputable distributor that still has it in stock? Does anyone know what the issue was and why it
1 reply 15 more comments5was discontinued? I prefer to make up my own formulas, but sometimes it's very convenient to have on theshelf.Thanks!SarahReplyTolley SinkNewJul 15, 2021ReactHi Sarah @Sarah Rivkin,You can get it from Yao Company but the fragrance free is sadly out of production.https://www.yaocompany.com/shop/Sarah RivkinReplyMargaret SikowitzNewJul 22, 2021ReactI know of none - what a shame. If you find an alternative, please share!Nancy LegatoModifying Dang Gui Shao Yao San for delayed menstruationNewSep 08, 2021ReactHi,I have a patient with delayed menstruation (going on 43 days) in addition to long-term digestive and skinproblems. (She has kind of a textbook PCOS picture: delayed menses, thick around the middle and hips,weight gain, acne, some hirsutism; plus a mild glomus and sticky stool.) I am thinking of prescribing herSheng Jiang Xie Xin Tang + Dang Gui Shao Yao Tang with some modifications to help harmonize her Blood
1 reply 1and bring on her period. I have some questions around modifying the Dang Gui Shao Yao San; if anyonehas feedback, I'd sure appreciate it!Thanks in advance for your thoughts!NancyDang Gui or Dan Shen? Stick with Dang Gui for the idea of tiao/synchronizing the period, or substituteDan Shen, with the idea of not making sticky stool worse?Add some additional Blood movers for bringing on the period? E.g. can I add Yi Mu Cao 9g (assumingmost herbs are 9g). Or would Ji Xue Teng be better for someone tending to the cold side?How do I know how much to move and how much to tonify when my ultimate goal is really toharmonize the Blood, even though she's quite late for her period? (Bl stag: her cycle is long, somesmall clots, tongue is currently slightly dusky, and I read the additional dampness that comes at thebeginning of her period as a result of Blood stagnation. Bl def: tongue tends pale on the sides after herperiod, the period itself tends scanty, poor night vision) (Maybe though it's enough to know she hasBlood Stagnation and Dampness at the same time. She also has mucus with her menstrual blood.)Bai Shao and Ze Xie dosages? BS and ZX are both dosed quite high in the original formula version.However, my focus for this patient is not so much abdominal pain (she has only a light pullingsensation with her period) as the Blood-water balance. I was thinking 15g for each.ReplyCandace JaniaNewSep 08, 2021ReactSo to answer some of your questions,I think dang gui should be fine in a balanced formula. I think it is necessary for the idea of DGSYS to work.Yes, add additional blood movers as you said her tongue is quite dusky, so there seems to be an elementof blood stasis.If you are unsure about how much to move or tonify, use where she is in her cycle to guide your decisions.For example, moving blood and qi before the period, tonifying more after bleeding, etc. Then based on herresponse to the herbs, you can modify accordingly.Bai shao and ze xie dose of 15 would likely be fine.Hope this helpsCaroline RadiceNewSep 12, 2021React
1 reply 11 more comment1ReplyHi Nancy: My first question, based on your brief presentation, is how deficient is your patient? That mayhelp you decide when and how much to push. How are her objective signs like pulse tongue andabdomen? Do you have indications that she ovulated? (either BBT or cervical mucus). Often PCOS patientsbubble and don't release follicles so might need more to promote ovulation to build a lining to havesomething to push out of uterus. Damp & Blood Movers definitely and possible a little Yang push, butagain depends on the patient. Hopefully that makes sense! Also, 15 g Bai Shao and Ze Xie may be toolaxative. I would start with 10 g and see. Dang Gui is kind of a must for this kind of pattern for me, but ifyou address the digestion then moistening BM may be less of an issue. Let us know how it goes!Ann ClearyCandace’s Metrorhaggia TalkNewSep 22, 2021ReactThis was such a great talk, Candace, thank you so much. Not just for the usual reasons of seeing someoneelse’s thought process, but because you shared such a real life case with all the ups and downs! Soinformative.I also do not do teleconsults outside of cold and flu stuff because I miss too much. It was nice to hear amuch more seasoned practitioner acknowledge the same. Earlier in my short practice, I would get textupdates from friends in lieu of a proper follow up appointment before modifying their formula, with thisidea that it was less cumbersome for them. Quickly I realized that the wrong formula is much morecumbersome for everybody and I wasn’t doing them or my self a favor. I also eventually learned that givingsomeone more formula so that they wouldn’t have to come back as soon is also not a time saver if they arenot at the right stage of disease, all ideas you touched on and are so important to hear.The shan zhu yu for spastic abdominal pain was new to me, and any reminder to reread a chapter in AWalk Along the River is welcome.I have a question. You said that if you had been in contact with the patient in the second case that youcould have averted them taking the blood movers too soon. What kind of questions would you ask to teaseCandace Jania
1 reply 11 reply 1out a period from intracycle bleeding? I have not treated any metrorhaggia, and if my patient came backbleeding on day 28 I would have certainly thought that was their period that then just went on for too long. ReplyCandace JaniaNewSep 23, 2021ReactHi Ann-Thank you for the above.For this patient, her periods were irregular and we had just started to regulate the length of the cycle.Normally I would have women with membranous dysmenorrhea start the formula a few days before. Forher, she can usually tell the difference just by the amount of blood,the amount of cramping and themigraine headaches. I would also have asked her about PMS symptoms. Many times you can see on thetongue a change in the color to more purple before their period in addition to increase in distention of SLveins in the presence of blood stasis. All of this is never assured with this type of condition, but at least itwill be much less likely of an error with more consistent and in person treatment.Hope this helps. ReplyMargaret SikowitzNewSep 23, 2021ReactI look forward to reviewing Candace's lecture, and further to your questioning about blood - (imagine this isredundant) but I ask about color. Often I present a palate 'from rose to merlot, burgundy, rust' etc - and italways delights me when patients actually notice and report back accurately. They're taking note, but noone has asked them this before!
1 teacher remarkAnn ClearyHerbs for Breast Feeding WomenNewJun 22, 2021ReactHi, I would love to hear from more experienced practitioners about herbs affecting babies who are drinkingtheir mother’s milk. I recently prescribed gui zhi jia shao yao tang with zhi shi to incorporate si ni san andadded sheng di and large dose of suan zao ren. The mother reported that with one dose, her daughterdeveloped a rash. She had mentioned a rash to me previously with a previous gui zhi formula, but I did notrealize at the time that this had started after the mother had started herbs. It certainly seems due to takingherbs. My question is, are there herbs that are more likely to affect the babies drinking the milk? As in, isthere a likely culprit here?I suggested that she try 3 spoons 2x a day instead of 5 spoons 2x a day to see how her child responds, andto moderate accordingly. Is this a sound approach?Thanks in advance.Candace JaniaJun 23, 2021ReactHi Ann-I always tell the mom to take her herbs immediately after breast feeding, thereby extending the length oftime between ingestion and feeding, decreasing the likelihood of herbs affecting baby. Yes, decreasing thedose is also a good idea. How is the mom responding to the formula? That is an important consideration aswell. I would also make sure your diagnosis and synthesis are correct.
1 reply 111 more comments11ReplyReplyCandace JaniaNewJun 23, 2021ReactI never say never- if the pattern warrants it’s use than there are times it could be appropriate in raresituations. However you are correct in that you should be VERY hesitant to use it as it would absolutelycause GI distress in a young one. If I used da huang, it would be short term and would have the patientpump and dump until pattern resolved. However in this situation short term is unlikely as the cause is froma medication. - I’m guessing she will be on it for a while? what is the cc that you are treating here?1 teacher remarkTolley Sink31 WeeksNewJun 23, 2021ReactHi all,I'm looking for a formula suggestion for a 31 week pregnant woman. It's her 2nd pregnancy and she is 36years old and generally healthy. Her diagnosis includes Spleen deficiency, crappy blood and upper warmerwood related heat. Her CCs are heartburn and constipation. Her pulse is full in the left guan and otherwisemoderate in general. I've given her a combo of DGSYS with Huang Qin and the heartburn improved but notthe constipation.Thanks for reading!Sharon WeizenbaumSharon Weizenbaum NewJun 23, 20211React
1 more comment1ReplyHi Tolley! @Tolley SinkWhat is your dose of Shao Yao in the DGSYS? You might increase that if there are other signs of blood xutightness. If there is water pathology, you might consider increasing the Bai Zhu. If the blood stasis signsare stronger, Dang Gui could be increased while decreasing the Chuan Xiong.Tolley Sink ReplyMargaret SikowitzNewJun 24, 20211ReactPlease keep us posted! I like the elegance of just tweaking things a little - @Sharon Weizenbaumsuggestions above, for these crappy blood (pregnant) women. I will forever associate this perfectdescription with 'how I learned to move and stop over-tonifying' after my first go-around with Sharon'sGMP - a game changer for my practice.Sharon WeizenbaumAnn ClearyPrescribing DGSY to a 37 yo 7 months pregnant patientNewJun 24, 2021React7 months pregnant 37 yo., slender build.Initial CC: anxiety, intermittent pain left low back that occasionally radiates down left ub channel as far asub 57, feels like a vague numbness.Is no longer anxious or getting palpitations or umbilical pulsations that were associated; the greasy whitecoat and floating cuns associated with this are also gone; also no longer urinating at night.Current symptomology:Intermittent metallic taste in her mouth since beginning of pregnancy; has improved since beginning herthird trimester, it always accompanies her intermittent nausea but will also occur without nausea (she hasnot had nausea since starting treatment, so this is not a current symptom); metallic taste will last an entireday and then will go a couple of days without.regular BMs are stickyPhlegm in her nose. (I forgot to ask which color but prior to treatment it was bloody and now is not.)Melasma on foreheadTender liver 2 right side
tongue: very fluted edges, sl heat spots, dusky, thin, sl yellow coat, front and center of tongue are like asunken bowel although this is progressively less with treatment.pulses: wiry, moderate, full guan left side.dx: sp qi and lung qi xu, liver qi constraint causing gallbladder heat, poor quality blood, blood deficiency inleft ub channel causing qi stagnation.tx strategy: course liver qi, clear shaoyang heat, harmonize blood and fluids, tonify sp and lung qi.Formula: equal parts xcht with dgsys without full dose of bai shao:xiao chai hu tang 35gdang gui 4chuan xiong 4bai shao 5bai zhu 5fu ling 5ze xie 11I see the blood fluid disharmony in the empty ub channel, sp and lung qi xu, melasma, dusky tongue, andpreviously frequent urination (since resolved, so maybe I should no longer consider?). I saw reference insome of Sharon’s Healthy Seminar videos to a labwork chart that can indicate when dgsys is needed. I havenot been able to find those reference charts on line, maybe it could get posted here? :) I would also just likemore eyes on this work up as I am still new to prescribing herbs like dang gui and chuan xiong duringpregnancy so I want to make sure that I am not missing anything in my diagnosis and treatment strategy.ReplyMargaret SikowitzNewJun 24, 2021ReactHi @Ann Cleary , there's a case just before yours on this forum (@Tolley Sink ) where she discusses adifference CC but 'crappy blood' is part of the picture and she also asks about dosages of bai shao. "...Youmight increase that if there are other signs of blood xu tightness. If there is water pathology, you mightconsider increasing the Bai Zhu. If the blood stasis signs are stronger, Dang Gui could be increased whiledecreasing the Chuan Xiong...." I've included here Sharon's input, and advise that though I (still!) feeldaunted using the original formula's bai shao dosage, I think adding to what you've got here seemswarranted. And, further to your point, yes, sure, if the urination issue has resolved, I too would put that onthe back burner. Let us know what you think and how things go with her. Good luck!Tolley Sink,Ann ClearySuzanne ConnoleNewJul 05, 2021ReactHi. By fluted edges do you mean scalloped, like a spleen sign or do you mean turning upwards? justclarifying. I see that there is blood deficiency which definitely puts you into the Dang Gui Formula Family.Where is the water? Is she puffy somewhere? To me Dang Gui Shao Yao San is warranted when you seedryness/blood deficiency accompanied by signs of water accumulating somewhere else. So that the
1 reply 12 more comments2Replydryness is not actually from lack of water but from water being out of place/circulation. You mentionedthat there was a urination problem but now there is not? In these cases it is helpful to include only whatshe is presenting with now so that we can help as much as possible.I see some heat signs on the tongue and the metallic taste may actually be a bitter taste which wouldindicate heat. Huang qin is a great herb for this which you already have in your formula. Is she hot or cold?any feverishness?Danggui is quite safe in pregnancy. I usually lower the percentage of chuan xiong in the whole formula. Ithink what you have here is fine for dosing. I use raw herb dosing so in the original formula there is 12Dang gui and 6 chuan xiong I think. I often lower the chuan xiong to 3 to keep its action there in theformula but moderating it a bit. Remember that the formula is harmonizing and not "bloodCracking" and isdesigned for pregnancy so it is pretty safe. if you see crappy blood treat it as crappy blood is a problem inlate pregnancy and delivery!I am hoping this is helpful Tag me if you have answers/questions so that I can jump back into the forumquickly.Carrie Murphyplacenta previaNewJun 24, 2021ReactI have a first time pregnancy, 30-weeks pregnant new patient coming in next week with placenta previa. Ihave a general sense of it as a Spleen yang problem, a general sense to uplift Spleen and support Kidneyyang, and obviously treat what I see in terms of her pattern. Wondering if there are any other specialconsiderations or tips as I approach this case? ReplyTolley SinkNewJun 25, 2021 | EditedReactA colleague of mine who specializes in treating pregnant women with Japanese acupuncture told me to dodirect 1/2 rice grain moxa on DU 20 for this. I've done that same treatment for hemorrhoids and it hasworked well! You'll need bobby pins to pull the hair away and down but you can do it without burning anyhair.Carrie Murphy
2 more comments2 ReplyCarrie MurphyNewJun 25, 2021ReactThank you!1 reply 1Emily Rieffelgratitude for pre-eclampsia theme!NewSep 21, 2021ReactI want to express my gratitude for the pre-eclampsia learning resources in the circle, last month, thismonth, and in the future! I am learning so much, and am so inspired to bring this learning to my practice. Ican't usually attend live, so I wanted to be sure all the teachers know how much their work is appreciated.Sharon Weizenbaum,Claudia Citkovitz ReplyClaudia CitkovitzNewSep 21, 2021ReactAw thanks Emily that's great to hear! Yes, it's a huge problem that we can be very helpful with, but areoften -- rightly -- reluctant to just jump in without specific guidance. We are very much hoping that thehuge collective wisdom of the practice support forum, as well as the new rapid consult feature, willencourage people to extend their comfort zones in an organic and healthy way.
3 earlier comments1 replyAnn ClearyFu Zi in Breastfeeding WomenOct 24, 2021ReactAre there reasons not to give a breast feeding mother fu zi, assuming the diagnosis is correct? I am not worried about toxicitybecause obviously the herb is prepared properly. I’m thinking more about possible effects on the endocrine system that might notbe beneficial to a wee one. ReplyCaroline RadiceNov 14, 2021ReactHi Ann: Thoughtful discussion, however I think we walk a slippery slope if we worry too much about the herb constituents from abiochem/biomed perspective. Obviously, toxicity and extreme purging aside, I have few qualms about using herbs if they fit thepattern in breastfeeding women. Hijacking a little but...I have often hedged more conservative with my breast cancer patients and possible estrogenic herbs and have reached no realconclusion on this: How do we know if an herb has an estrogenic effect as cooked in a formula vs as an individual herb (which isobviously not how we dispense them) but is how they are often evaluated. So of course I looked it uphttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604035/ and it seems there is no clear link, but this detail is out of my expertise.Great question and I think if you're pattern is sound, worry less.Ann ClearyIs Danggui Safe to be Taken by Breast Cancer Patients?—A Skepticism Finally Answered by Comprehensive Preclinical EvidenceAngelica sinensis (AS, Danggui) has long been regarded to stimulate breast cancer growth; hence, the use of AS in breast cancer patients remains a major concern for both patients and practitioners. Since safety studies of herbs would be unethical to ...Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604035/ Embedded File.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604035/Yaron SeidmanDec 21, 2021ReactI just want to mention here that in the past I used to import and use large quantities of Fu Zi from Jiang You in Sichuan, 1000lb perimport. At one point shipment was blocked by FDA at port, and fought them for about a year to release it. Case was escalated toFDA in D.C. finally I got an official letter from FDA stating the Fu Zi is unlicensed drug and hence can't be used. I had to sendshipment back to China and switched since to other substitutes that I have already developed during the year of struggle.
4 repliesReplyWhen I mentioned it to few noted practitioners who use fu zi, they said that since they didnt get the letter from FDA it does notconcern them. hmmmI think that as long there is no reaction and no lawsuit its a non issue, but if there is a problem, the unlucky practitioner mind findthemselves in a difficult spot.hope this helps.1 earlier comment 1 teacher remark2 more commentsAnn ClearyPre-eclampsia PreventionOct 02, 2021ReactThank you so much for this talk. I have seen Sharon reference these ideas in Healthy Seminar talks and have been very curious tounderstand grateful. So much useful information and I’m grateful more is on it’s way. I’ve ordered the books, and am about towatch Claudia’s trophoblast talk. One question: where is the Zena and Valerie talk that Sharon refer’s to? Maybe it was month’sago and is down now? Or maybe it was a GMP thing. Either way, I’d love to know their last names so that I can look up their work.Thank you!Sharon WeizenbaumReplySuzanne ConnoleOct 04, 2021ReactI was hoping to see that talk as well! It might have passed. I will take a look around for you today.ReplyAnn ClearyOct 04, 2021React@Suzanne Connole Thanks, Suzanne!Suzanne Connole ReplyAnn ClearyNewOct 19, 2021React@Suzanne Connole In case others are still looking for the Trophoblast talk, I can now see it on Healthy Seminars library:https://communitylibrary.healthyseminars.com/course/qi-blood-and-trophoblasts-an-integrative-overview-of-acupuncture-during-pregnancy/#lifter-course-contentSuzanne ConnoleColleen GibsonCEU'sSep 22, 2021React
2 earlier comments 1 teacher remarkJust wondering if there will be any CEU's available in this topic category in the near future? Thanks! ReplyMargaret SikowitzOct 14, 2021 1ReactHi Colleen (et al) -Sharon's ebook is alive and well and amazing!Thank you Sharon - what a treasure!https://whitepineinstitute.instructure.com/courses/230/pages/pre-eclampsia-ebook Embedded File.https://whitepineinstitute.instructure.com/courses/230/pages/pre-eclampsia-ebook ReplyColleen GibsonOct 22, 2021ReactI just finished the e-book and quiz. Wonderful - thank you Sharon! After I completed the quiz and submitted the screen jumped tothe next mini course. How do I know if I passed the quiz or not for my CEU credits?
Ann ClearyGestational Diabetes, tight muscles, uncomfortable BH and suspended fetus.Sep 25 | EditedReact38 year old petite woman, 33 weeks pregnancy with second child, h/o of severe insomnia and tight dry muscles prior to thispregnancy. She has gestational diabetes this pregnancy, same as her first pregnancy. She came in at 31 weeks because she washaving sharp, painful TMJ and tight painful back muscles (top center and bottom). Other symptoms were increased thirst withincreased urination, bowels that occasionally skipped a day and were dry. Dry lips. She felt as though she couldn’t get a goodbreath and had lumbar pain with a dragging discomfort from her belly. She was fatigued and easily irritated. Her sleep was somenights good, some nights bad. Her tongue was swollen with teethmarks, dry white coat. Her pulse was 12 beats per breath, yangfloating both cuns, big hollow right guan, wiry elsewhere. Her sugar was spiking sometimes to 200, w/w work stress, and so shehad started insulin 3 weeks ago. She was already taking Zoloft and Metformin. My understanding was that she had blooddeficiency, so her muscles weren’t nourished and the yang was starting to float. I gave her huang qi dang gui jian zhong tang withfu xiao mai instead of yi tang because of the diabetes, poor sleep, and added mai men dong to help the bowels, sleep, anddryness, along with dang shen and bai zhu to help moisten further and appropriately allocate water.In a week she reported improved bowels but still not every day. Jaw pain had not returned. Sugar was also better, in the 80s in general and postprandial 120s. Pulses were better, 4 bpb, still superficial cuns, and wiry elsewhere, no longer big and hollow. However, now she reported sweatingeasily, and there was no improvement in the dragging belly, urination, sleep, fatigue. Her chronic back pain persisted, even though it improved for a fewdays with acupuncture. She had also been accidentally taking about half the dose of the herbs. I gave her the same formula without the huang qi, sincethe right guan was no longer big and hollow.When I saw her last week, bowels had started to improve, and then became dry and was going every 2 days. Jaw pain had returned, dragging sensationwas the same, thirst was stronger, sleep was worse. Still no decrease in urination. BH were becoming stronger and uncomfortable. She also reportsthat baby was moving a lot and it felt uncomfortable. She now also has nausea. This is all coincided with overwhelming work stress. She denied anysensations of hot or cold and said she was no longer sweating easily, though I observed that she was sweating profusely from her head at the end ofthe treatment. Her pulses were wiry, rIght guan > left guan, and soft left cun. Her tongue was red and puffy with the same thickish dry white coat. Iinterpreted this as a dang gui shao yao san situation with suspended fetus due to qi deficiency and stagnation. I prescribed her a modified dang guishao yao san:Bai shao 48Dang gui 9Chuan xiong 5Ze xie 12Bai zhu 12Fu ling 12Chen pi 6Du zhong 9Xu duan 9Shi hu 9Zi su ye 9She wrote to say that thirst and urination at night were getting worse, and should she increase her herbs. When I inquired further, she said that slowbowels, inability to get a good breath, tight muscles, nausea, which she thinks is a result of her worsening sleep. What am I missing? Also, by myassessment, her pulses are improving, less yin and yang separation, but her symptoms are not improving, so how much weight should I give to this? Isee so much dryness in her muscles, tongue, bowels and this is easily explained by the frequent urination. I think I am missing the qi stagnationcomponent. I am considering going back to the jian zhong tang with added mai men dong, shi hu, du zhong, Chen pi, zhi ke, and fu ling. Should I addsha ren to see if that helps the nausea since the zi su ye did little, or wait to see if zhi ke is enough? I had initially wanted to include long gu mu li in herfirst batch of herbs, but I didn’t only because I’ve only seen shells and minerals in pre-eclamptic pregnancy case studies. Now her pulses don’t seem tosupport that idea, but given her severe insomnia after her first child and her increasing insomnia now, would this make sense here? Your experienceand thoughts much appreciated. She will be week 34 when I see her next.Sharon Weizenbaum,Suzanne Connole,Caroline RadiceAnn ClearyIf a Patient Continues Moxa After Baby has Moved into the Correct Position, Can They Flip Back?NewSep 16ReactCaroline Radice,Candace Jania,Claudia Citkovitz
2 replies 21 reply 1Hi, a 32 week new patient came in because her baby is transverse. We did a treatment and moxa and I sent her home with a moxapole. When I checked in on her today, she said she felt him move but can’t quite tell if he is in the right position. She asked, if shecontinues moxa, could he flip back? And I realized that I don’t actually know the answer! Does anyone here?Also, normally when I do moxa I wait for a cold area to warm or the skin to turn pink, but neither quite apply to ub 67 and thismother felt the singe very quickly, so I pulled back and went to the uncomfortable sensation 3x on each side. Should I be doing itfor longer? I sent her exercises from the spinning babies site and I saw on there that they recommend moxa for 20 minutes eachside.ReplyEmily RieffelNewSep 16ReactI usually follow Debra Betts’ guidelines, which she has developed from extensive clinical experience and also clinical trials. Shesuggests 20 minutes each side for 10 days. If the baby gets into a good position, she advises to finish out the 10 day cours, butreduce the time to 10 minutes. That said, you have to adjust to the particulars of the person before you!ReplyCandace JaniaNewSep 30React@Ann ClearyHow interesting the baby flipped to breach. Is she continuing with the moxa? I wonder if the baby would have continued its spinand flipped downward. I agree with Emily to continue to moxa even if baby flipped.After many years, I never question what the baby is doing. Most of the time, if the moxa doesn’t work, I usually find out later onthat there was a reason for the baby’s position. (i.e. one time the baby’s cord was around its neck). I think they have more innateknowledge than we understand.Ann ClearyAnn ClearyNew Yorker Article on Covid and Pre-eclampsia (and Rise in Stillbirths)NewSep 12 2ReactI thought some of you might find this interesting, it also touches peripherally on the increase in still births.https://www.newyorker.com/science/annals-of-medicine/why-a-life-threatening-pregnancy-complication-is-on-the-riseReplyEmily RieffelNewSep 161ReactThanks for posting this, Ann! Definitely interesting and worth watching in the next several years as the longer-term population-level effects of Covid become more apparent. Also, a great springboard to outreach about our medicine in relation to pre-eclampsia
2 earlier comments 1 teacher remarkAnn Cleary34 week pregnant patient, gestational diabetes, 3 weeks post covidAug 14ReactHi, I have a patient "on loan" to me from a colleague who is traveling. She is currently 34 weeks pregnant, will be week 35 when Isee her next, and doctors want to induce at week 39 because they deem the baby large.At the end the first trimester she got a cold, and doctor's prescribed an inhaler. She also had covid fairly mildly 3 weeks ago. Sheused the inhaler prevenatively during covid and since because she is experiencing chest tightness and sensation of not getting agood breath. She currently uses inhaler about 1x a week and she experiences elevated heart rate with the difficulty breathing.There is no cough. She gets full easily, and has acid reflux about 1x a week, w/w garlic + onions (pungent).She sweats easily since having covid and currently gets waves of heat during which she sweats.H/o eczema that flared during her pregnancy, currently it is red and hot looking on her neck along the left large intestine channel.Will also occur on the yang side of the wrists and eyelids.Appetite is low, bowels are dry and difficult, b/w magnesium and psyllium husk but if not managed, she will skip a day. Thirst isnormal, but she pees frequently, 1 x hour and 1-2 x a night.She has lower abdominal and low back cramping.Tongue is red, thin white moss at root that is geographically peeled.pulses are 5-6 beats per breath, (Isn't a slightly fast pulse normal in pregnancy, so how much weight to put on the speed here indetermining if the cuns are soft or slippery?)floating/ slippery? floating/slippery?deep wiry mid-depth wiry r>ldeep faint deep faintMedications: baby aspirin and daily lovenox injections because diagnosed with factor V Leidin disorder, Synthroid (also dx withhypothyroid early in pregnancy), and NPH insulin injection nightly.I have diagnosed her with rebellious lung and stomach qi causing heat above, poor quality blood not nourishing the muscles, andblood fluid disharmony.My plan is gzjhpxrt and dgsys, but I have some questions/ concerns. First, the soft quality on a speeding up pulse says heat in theupper jiao, and in a non-pregnant person I would think of something like yue bi tang. I do not feel comfortable using ma Huangwith her, but I am concerned about gzjhpxrt being too hot on a person who is already very hot above. We are also at peak heathere right now in Los Angeles. Or will it bring the heat down through the middle? Asked another way, if I am right that this isyangming (supported by the pulses), should I be using a shi gao method or the hpxr method? Or do I need a chai hu method, afterall there are these flashes of warmth with sweating througout the day and chest tightness?Should I treat the branch first or can I combine root and branch (a formula for the asthma symptoms with dgsys) at the sametime? Finally, what about her medications? If the herbs work well, the insulin may cause her body to store too much sugar tooquickly. I will have her monitor for easy bruising, but I also wonder about the large dose of bai shao with two different bloodthinners.Your experience and wisdom much appreciated.Sharon Weizenbaum,Caroline RadiceReplyCaroline RadiceAug 15 1ReactTotally in agreement with Sharon'd advice and do keep us posted on how it goes! Definitely tricky to be called in on the 9thinning....
ReplyAnn ClearyAug 15React@Caroline Radice Thank you, I’ll update.Caroline Radice ReplyAnn ClearyNewSep 25React@Caroline Radice @Sharon Weizenbaum Hi all, I wanted to give an update on this case. I delayed giving herbs, first because I wasout of bai zhu the next time she came in, but also because so many of her symptoms had gone away completely withacupuncture. I watched and waited another 2 weeks probably when improvements in her remaining symptoms (flashes of heat 2xa day and blood sugar) had plateaued, and she reported a new symptom: very strong nocturnal charlie horse in her hamstrings.Also, her pulses had gotten very big and floating in the cuns and nearly absent in the chis. I gave her dgsys with reduced ze xie(frequent urination), huang qin 9g, and xuan fu hua 9g. Her pulses went back into place immediately and slowed, cramps resolved,heat flashes stopped, and sugar stayed stable. (I actually got nervous about how much the pulses had slowed — 6bpb to 4 bpb/ 90bpm to 70bpm —but Caroline was able to reassure me). She went to half dose of the formula 6 days before her induction, andstopped completely 3 days before. She had a healthy vaginal birth, 20 hours from induction to birth. Thanks to you both for yourhelp with this case.Caroline Radice,Sharon WeizenbaumAnn ClearyStillbirth Sequela: Acute Kidney Failure followed by HBPJun 24 | EditedReactCalling all angels for advice on this case. Especially looking for if I am appropriate for using shi gao in this formula.42 year old robust woman, 2 months post partum. Seeking treatment due to hypertension and swelling as séquela to kidneyfailure due to uterine and internal hemorrhage after still birth mid- April. Blood pressure ranges from 144-154/ 90-98. Herpersonal best since all of this was 122/ something closer to normal that I missed writing down.(I put OB and GYB history at the bottom of everything, followed by the table of for sure signs, and have tried to focus on currentpicture here for simplicity. Current medications are baby aspirin, atenolol (beta blocker) and amlodipine (CA channel blocker).)She is achey all over in her upper body at the surface, including abdomen, upper torso, neck and shoulders. Tension HAs at gb 20 and gb 14, they donot seem correlated to spikes in HBP that she has noticed. This begins at 4pm and is sometimes there when she wakes up the next day, sometimesresolved with sleep. B/w week on a beach in Mexico, w/w work and being in a city. She also experiences foot swelling, w/w walking. When this occurs,the dorsum of her feet turn red.No particular sensations of hot or cold currently, though she was very cold at time of kidney failure and first few weeks home from hospital. Noaversion to heat, h/o enjoying saunas followed by the cold pool. Sweats a lot in any kind of weather, mostly her armpits. No aversion to wind.Thirst is unclear--she was drinking near a gallon a day in preparation for post partum thirst and breast-feeding (!!). She had her 1 gallon water bottlewith her and said now I can only drink this, which was 1/4, or 32 oz. This seems normal to me, though google says average fluid intake for adults is 45ozper day. Urination 4-5 day, large amount, pale yellow, including 1x nocturia around 3-4am.Decreased appetite, normal bowels daily.H/o panic attacks better with child's pose on a cold floor.Pulses are fast:RightWiry deepSlippery most superficialDeep wiryLeftFull/ poundingWiry full most superficialWiry deeperTongue is red with white wet moss and teethmarks.Warm abdomen, tight costal margins, positive oketsu bilateral, hard around navel, bow tie.Sharon Weizenbaum,Candace Jania,Caroline Radice,Claudia Citkovitz
Mixed excess deficiency, primarily excessDx: sp qi xu and kidney qi xu causing water swelling, liver qi constraint with liver yang rising, systemic blood stasisYangming shaoyang taiyin (shaoyin) taiyangI am unclear about the sweating...she does not have aversion to heat or excess thirst, but with the full slippery right guan I am currently working withthe hypothesis that this is yangming heat. Is it possible to have sweating from two etiologies at once? The acheyness at the surface, HAs that start at theocciput and sweating point to taiyang. Either way, I see a separation of yin and yang due to severe fluid/ blood loss causing yang to float up out of theblood (full excess pulses, HAs and pain at the top when yang should be going down, sweating, HPB), affecting the entire circle.This is my idea currently:Chai gui zhi tang + shi gao+ fu ling and other flavors.Chai hu 24Huang qin 9Ban xia 12Dang shen 9Sheng jiang 9 (go higher to steam fluids better?)Zhi gan cao 6Da zao 20Gui zhi 9Bai shao 9Shi gao 25(Zhi mu 9?)Fu ling 9Xu duan 9Chuan niu xi 9Bai zhu 9 (cang zhu?)Any and all feedback greatly appreciated.Gyn history: regular cycle every 28, occasional mild cramps, 3-4 days bleeding bright red blood, 2 fibroids discovered (tangerine and golf ball) when shefirst had eggs frozen. Fibroid removal caused thinning one side of uterus.OB history: 4 years of IVF, husband discovered to be completely sterile, brother-in-law donated sperm. Mild covid 2 months prior to stillbirth. Scheduledc-section due to thin uterine wall, but noticed no movements 1 day after a well check that had been normal, the following day discovered her daughterhad passed away. C-section performed that same morning, seemed to go well but 1-2 hours later began to hemorrhage due to clotting issues anduterus not contracting. Stabilized and 1-2 hours later began again. They inserted a balloon and she stabilized. 1-2 hours later became freezing cold,extremities blue and chest muscles seized, CT revealed hypovolemic shock was due to internal bleeding. Given plasm and blood transfusion. Operationto remove blood from between the organs and a dissolvable band was placed around the uterus. Woke the next day completely swollen (described it asWilly Wonka scene), AKI confirmed. Worked with a top doc on that subject who happened to be working at that hospital who was aggressive in gettingher off of dialysis, so she only did 10 x over a month. Genetic tests confirmed for atypical HUS which can cause microclotting in kidneys, but she had noother signs prior to AKI so her kidney doctor (and me, too, fwiw), think AKI due to severe hemorrhaging. She used ice and binding to deal with milk thatcame in for the first 3 days, on the 4th day they gave her a medication.Sign/ symptom meaningsweats too much Too much water leavingsweats mostly from armpits shaoyin (heart)Thirst unclear (32 oz) normal ?1 x nocturia pee leaving at night (kidney?)pee 4-5x day, large amount normal?appetite reduced poor t&tAcheyness upper body includingabdomenStagnation at the surfaceupper body acheyness begins at 4starts at time of sun going down/ yangming notgoing downTension HA forehead in evening stagnation forehead at nighttension HA includes GB 20 Stagnation shaoyang/ taiyangsometimes lasts all night ?Pains better with R&R woodpains w/w city, work woodFeet swellingwater leaving blood/ tissue, poor fluidmetabolismw/w walking Body unable to contain, hold updorsum feet red with swelling not coldh/o panic attacks h/o heart affectedh/o panic attacks better with cold floor heart soothed by coolpulses fast heatright cun wiry deep excessright guan slippery, most superficial yang stuck in middleright chi deep wiry excessLeft cun full pounding too much yang stuck at the topleft guan wiry, full, most superficial excessLeft chi wiry deeper excessred tongue not coldwhite wet coat excess cold fluidsteethmarks Sp qi xuwarm abdomen not cold on the surface
1 teacher remarktight costal margins woodbow tie def lower jiaohard navel and bilateral oketsu Poor blood qualitySharon Weizenbaum Jun 241ReactHi Ann,Thanks for the case. I want to first comment on the diagnostic process. This is something quite different than what I am teachingin the GMP so I'm wondering about it. I would not come to your conclusions based on the signs and symptoms. I have correctionsbelow and, in the future, If you are going to write up a case using the GMP methods, please use the diagnostic manual so it's doneaccording to those teachings. Do you have that? It will really help you to stay on track.It's unclear if she still has water swelling and what her body type is. This makes it hard to be sure about her. However,diagnostically what I would start with is that she is very deficient, especially kidney and, after a lot of blood loss, blood deficient. Iwould start her with a few days of Sheng Hua Tang and then follow with Gui Zhi Jia Long Gu Mu Li Tang possibly to work with thesurface weakness, sweating and Yang rising. I would add herbs and foods to replenish blood such as Huang Qi and Dang Gui(Dang Gui Bu Xue Tang) Once stabilized in terms of BP, do more to support Kidneys.1. I don't assign organs or conformations to the location of a symptom 2. I teach to evaluate pulse based on diagnosis rather than coming to conclusions based on pulse3. I teach to leave normal and historic- now not happening - things out4. I am not sure how you concluded that the swelling was due to water coming out of blood. Water swelling is just wateraccumulation. You have to do the diagnosis to see why. Also, does she still have water swelling or has that diminished?I made corrections below.Pains better with R&R rest and relaxation are different from each other. Is it w/w stress? That would be wood. Is it w/w tired =deficiencyn/ symptom meaningsweats too muchs too much sweat coming outsweats mostly from armpits sweat from armpit1 x nocturia urine coming out @ nightpee 4-5x day, large amount normal?appetite reduced poor t&tAcheyness upper body including abdomenStagnation at the surface of upper bodyupper body acheyness begins at 4 w/w afternoonHA head stasisforehead & GB 20 forehead and GB 20 head stasisPains better with R&R woodpains w/w city, work woodFeet swelling water acc in feetw/w walking water acc in feet w/w walkingw/dorsum of foot red heat on dorsum of footpulses fast I don't teach this as heatright cun wiry deep this can be so many other things not excessright guan slippery, most superficialright chi deep wiryLeft cun full poundingleft guan wiry, full, most superficialLeft chi wiry deeperred tongue heatwhite wet coatcold fluidsteethmarks Sp qi xu
1 reply Replywarm abdomen normaltight costal margins woodbow tie def kidneyhard navel and bilateral oketsu blood stasisDanielA difficult case of prolapseNewJun 20ReactEllie 37,she is a friendly and sweet-natured person.Her body type is thin and tall, she has a fair complexion that looks healthy maybe slightly sallow/yellow. She has well-definedsymmetrical facial features. Her face is a little shiny and may be oily.Ellie presents in the clinic with lower abdominal and sacral pain, urination and bowel issues which are both distressing andchallenging to manage. The issues follow from the birth of a first child who is now 20 months old. Her pregnancy was good withsome nausea and back pain in the third trimester. Labour was not good; Ellie had large urine retention that wasn't treated duringlabour which meant there was a large obstruction she had to push against.After more than 20 hours of labour, the decision was made to continue with vaginal birth. During the birth, there was significantdamage to the organs and muscles of the lower abdomen. This trauma includes significant muscle tears, cystocele bladderprolapses (level 2), cystocele rectocele prolapse (Level 2), uterus prolapse (level 2), significant blood loss, and pain. Both thephysical and emotional trauma to Ellie was significant. Ellie has a lot of anxiety/PTSD related to birth trauma.From the western medical side, the is no current follow-up, a surgical ‘mesh’ which was once offered in these cases has beendiscontinued due to repeated complications.The gynaecological team also discharged her. but she is waiting for a re-referral to discuss her bladder. She sometimes self-catheters the bladder but is not sure how often to do this. She will see a private consultant and discuss other surgical options andthe possibility of future children.--------------One of her main concerns is pain, which is mostly located around the coccyx sacrum and anus but can also be more generalisedaround the lower abdomen.The pain comes in different types, which can include; aching, pressure and heaviness, burning sensations, and at more acutetimes can be agonising spasmodic pain.The additional concern is that both urination and bowel movements can be painful and unsatisfying and incomplete.Bowel movements can be loose or constipated and feel incomplete.Urination can also be incomplete and she will sometimes self-catheter.She has gone through a lot of talking therapy to help here but felt like this has currently reached its usefulness for her, and sowants to try acupuncture and herbs to help ease pain, calm and stabilise the heart/mind and make her feel more in control, helpher heal and also regain the energy needed for a young family._________________________________________Some Medical history*Some upper epigastric pain on occasion.*Asthma manages with a preventative (steroid) inhaler, ventline is rarely used.
*History of irregular heartbeat and tachycardia. A severe onset in her 20s but medical heart checks came back ok, symptoms didcalm down.*History of migraine headaches with sudden and severe onset (4years ago), MRI suggested blood vessel in the brain might needsurgery. But on the second opinion, they decided it was a congenital ‘wiggly’ vessel which was fine. As soon as pregnancy startedthe headaches stopped.Give it a name Subjective symptoms CM ideasPain in the lower abdomensacrum and anusaching, pressure andheaviness, burning sensations,and at more acute times canbe agonising spasmodic painTrauma, Blood stasis & qideficiency in the lowerabdomen,Bladder ProlapseIncomplete and painfulurinationTrauma to Tai Yang organ.Chong mai /ren maiAnal ProlapseIncomplete, painful, andinconsistent bowelmovementsloose/constipationTrauma to Yangming organ.Shao Yang not moving freelyUterine prolapse Pressure pain, painful periodsTrauma, Bai Gong or UretusChong mai /ren mai, & bloodstasis.Stress and anxiousnessPTSDFear of not being in controlWorried about things.Stress anxiousness,Sadness, anger,Shao Yin imbalance Ht and Kidnot connected. AsthmaSome tightness in the chestAnd shortness of breath onoccasionZhong Qi xuTai yin not descendingLow appetiteForgetting to eat not reallyenjoying eatingTai Yin / Yangming Qi xuPules,LCun----- Weak/Deep soggyGuan --- Tight thinChi--- Tight thin longRCun----- deep weak thinGuan --- pounding strong deepChi--- Tight wiry – long TightACU: Lu 7 Kid 6 Du 20 Liv 3 Kid 3, (future BL 32 33 du 2 du 4 bl 23)Herbs ?I have not yet prescribed herbs and she is quite nervous about taking herbs.With that in mind, I might think to start with something like Dang Gui Bai Shao Gan Cao on thier own.Then other ideas in my mind areBu- Zhong qi tang, Gui Zhi Fuling Wan
4 replies 41 more comment1Fuzi formulas seem to be advocated but we can’t use fuzi here in the UK, we also have no animal products here.A tricky case. I guess what Im seeking are ideas that might be helpful or important in a case like this, (which is new territory forme). Some herb idea to starts off with. Some acupuncture ideas and even some resources that could be useful for her.Thanks DanReplyAnn ClearyNewJun 24ReactHi Dan, an interesting case. I recently watched @Candace Jania ’s talk on long covid and she talks about the Kiiko style acupunctureshe uses for abdominal reflexes. I was familiar with some Kiiko ideas years ago and this got me curious again. I have been usingthem all week, including on a prolapse patient with good results. She has a chart in her notes and a video demo, but I would addthat if you google (or maybe this in her notes too) you will see that there is a reflex for tailbone injury that uses lung 8. This wouldlikely fit your patient. It is a nice gentle way to treat that traumatized area. It is surprising the number of people with tailboneinjury once you start asking! And releasing the reflexes is very fun work in clinic bc everyone gets to see the results right there andthen.My prolapse patient had gotten a surgery to string things up with her own tendons, but her cervix was again starting to sag whenshe started treatment. Now that she is pooping regularly it is back to better again (though there is still plenty we are working on).So I think if you can get the yangming to go down, there is a good change you can get the other side of the circle to go up and helpthe prolapse. I don’t see tongue info or abdominal findings here, please share if you have them!Candace JaniaReplyEmily RieffelNewJun 24 2ReactOther acupuncture ideas: possibly moxa and/ or e-stim on the Ba Liao sacral foramen points to address local blood stasis (BL 32 --> BL35, mixed frequency), plus treatment with needles/ moxa at Sishencong & Du 20 to lift qi and help her spirit. I also use LR5quite often to treat pelvic pain.If you think that there is any Cold in her Uterus, moxa can be so helpful. She can even try toilet bowl moxa at home! Basicallymake a non-flammable raft to float in the toilet, and light moxa cones on it to smoke the tailbone and lower yin while sitting.I commonly refer back and forth with a talented pelvic floor physical therapist, as treatment with both modalities together seemsto really benefit patients.Emily RieffelHerbs and efficacy of hormonal contraceptionNewJun 14ReactHello all,Every now and then, I am asked whether herbs can interfere with the efficacy of hormonal contraceptives. I usually say that theevidence is not available, and advise a secondary barrier method just to be on the safe side. Are any of you aware of research inthis area, and/or have relevant clinical experience?Thanks in advance!
ReplyAnn ClearyNewJun 24ReactI haven’t been practicing that long, but so far none of my herbal patients have gotten pregnant while on birth control. Also no onehas ever asked, so thanks for the question, it never occurred to me! Just judging by how much progesterone changes the pulse(albeit I’m thinking of exogenous progesterone in fertility patients, which is a very different dose), it seems difficult that we wouldbe able to override that. Though I would like to think we can. :)1 reply1 replySage Staggs (she/her)Any wisdom on low dose aspirin in pregnancy?Jun 13ReactMost of my prenatal patients are over 35, and therefore are recommended to take low dose aspirin during pregnancy to preventpreeclampsia. While we have all learned ways to predict and prevent preeclampsia from Sharon, my patients don't all take herbsduring pregnancy and many of them ask me whether they should take the aspirin or not. Until now I've said it's not something Ican advise them on, but I do worry that there may be risks. A brief search returned results showing that regular dose aspirin isdangerous in pregnancy, but not low dose aspirin. Does anyone have any more information about the benefits vs risks of low doseaspirin in pregnancy, or ideas of how to talk about this with patients? Especially for patients who may not be interested in takingherbs. My patients are often quite healthy (normal blood sugar and blood pressure, good weight gain, they exercise, etc) andeating a nutrient dense diet during pregnancy so I don't consider them in a high risk category for preeclampsia, but many of themare advanced maternal age and/or have gone through IVF which technically places them there. ReplyAnn ClearyJun 24ReactCurious to hear what the more experienced practitioners say. I always considered this Western med taking a page out of our bookby looking to treat systemic crappy blood, albeit, as you point out, not selectively or based on diagnosis.ReplyCandace JaniaJun 29 1React@Ann Cleary @Sage Staggs (she/her)I have been posed with this question from patients many times as well.. It is difficult to council them on this currently, because iftheir doctor is prescribing it and you tell them not to take it and then they get pre-eclampsia later down the road, you can beliable.I just talk to them. I ask them to talk to their doctor about it more if they are uncomfortable. I tell them that baby aspirin wasprescribed widely for preventing heart attacks just to find conflicting data years later. I do tell them that I do not like theblanket/non-differentiated advice that ALL WOMEN go on it after 35. If they do not want to take it, I refer them to the website forthe Brewers diet for pre-eclampsia and to discuss this option with their OBGYN. I also talk to them about CM and its impact onpre-eclampsia. In the end, it is their choice to make with their OB. I just present them with things to think aboutAnn Cleary,Sage Staggs (she/her)Suzanne Connolepersitent genital arousal disorderMay 17React
3 earlier comments1 reply 1Hello fellow gynecology practitioners!I recently had two women ask me about a symptom I had not encountered before. It seems to have a name on the internet of"persistent genital arousal disorder". Basically they both report a constant feeling, very localized to the clitoris, of being "on". Moreirritating than pleasurable, but not at all pain or discomfort, very clearly stimulated. They are very different cases. Without doingthe whole case here, one is a young woman who I have just started with, S he has large fibroids and her diagnosis is more qi stasisand blood deficiency causing the blood stasis. The other is perimenopausal woman that I know well but is not a patient. She haschronic health conditions, Lyme, thyroid et, and presents as deficient mostly with many food intolerances, very cold, pale andtired.I'm curious to know if any one else has seen this symptom and connected it anything or seen it improve.My guess is poor circulation to the extremities, but I would think that might cause more numbness rather than increasedsensation. ReplyAdam BroderJun 6ReactThere was a discussion recently in the GMP re: dreams of a sexual nature. I can’t recall the pathomechanism that was tied to it butperhaps this presentation is linked in some way? Sorry that I can’t remember specifics but maybe someone else does?ReplyAndie XuNewSep 1 | EditedReactHi Suzanne,The cases you described reminds me of a case study from Dr. Lu Zhizheng's book. It was a young women with excess libido, wasdx "flower madness " . According to Dr. Lu, in this case it was caused by chronic liver (qi and channel) stagnation, thentransforms into pathological fire in both heart and liver. This case also have SS of mental obsessiveness and sexual addiction,hence the heart. There was yellow and smelly discharge and thick yellow tongue coat. He used Long dan xie gan tang with ji guanhua and chuan lian zi, in short term, to clear damp heat and direct the heart fire downwards.Clinically, I have seem excess libido/ with women with sexual trauma, esp. if the trauma happened during teenage years. In thecases I saw, it presents with the ministerial fire blazing up and KD is often deficient, so I often intend to direct the fire downwardwithout using cold herbs....Also reading your cases, would feng sui dan + rou gui feel good as a formula?Just my 2 cents, hope it might be helpful.Kind Regards,AndieSuzanne Connole
2 repliesAnn ClearyHow to Interpret a Newly Strange PeriodMay 12ReactHi all,I’d love to hear your thoughts on this. I have been treating a mother of a 5 year old for 1 month who has had severe LBP for about2 years. (3 years if you count the first episode that went away and came back.). She is tiny and wiry and has a lavender puffytongue with a geographic white coat, peeled sides. She had “fire-hydrant” milk post partum so I see this as blood loss postpartum.She also has severe jaw tension from her anxiety meds and cramps before her regular period, which is pain free once it arriveswith dark squishy clots. The back pain easily goes into a sharp stabbing spasm. I have made minimal strides with the LBP but shedid not have cramps leading up to her first period since treatment, only sore boobs. Her tongue is getting pinker.I have been giving her versions of xiao jian zhong tang/ shen qi wan with chai hu and gzflw incorporated for the blood stasis.She came in yesterday so excited to tell me about her period bc I had warned her that she might get a weird period as we treat thestasis, and that it could be the first month of treatment or the third. But what she described was definitely not what I wasexpecting: it was very light and instead of blood it was mostly clear mucus with some small red clots here and there with brownspotting at the end. This was not the purge of stasis that I thought would happen. Her tongue was still puffy, but could this be apurge of cold damp? Or is this a sign of wrong treatment? I am inclined to take in stride since there have been improvements, evenif minimal, but curious to hear if others have seen this and how you would interpret?ReplyEmily RieffelMay 12 2ReactSuper-interesting case! I have not encountered similar, but am excited to hear others’ thoughts. Perhaps this flow was showing anunderlying KD Qi vacuity that had been obscured by some of the blood stasis you clearedReplySuzanne ConnoleMay 12ReactInteresting! the jaw tightness and cramps before but not with the period make me thing the liver blood is dry and that is a bigfactor. This could then also explain the back pain/spasms. So I'm thinking more softening/blood nourishing. But there is a puffytongue and this type of period makes me think Dang Gui Shao Yao San, where blood and water are not integrated together. Arethere any other signs that point to water out of right relationship?I agree that since you have seen some really key improvement, you are on a good course.Sage Staggs (she/her)XCHT causing nausea and insomnia, where did I go wrong?May 10ReactHello helpful fellow WPC students and teachers!I'm a bit stumped about what I'm missing with this case. My patient reports waking in the night with nausea and feelingoverheated after taking a modified XCHT (we tested removing the herbs and the symptoms abated, then reintroducing and thesymptoms recurred). I'm confused because this formula can clear heat and descend the stomach, so why is the oppositehappening with her? Am I way off base with my prescription? This was a virtual consult so no pulse or palpation.Here is the case, followed by the prescription:
Case R Simkover 4/19/2232 FHPVPMSDysmenorrheaDigestive issuesHPV Not sure- latent pathogen?- could be heat, stasis, cold?Insomnia Yang out of r/rAnxiety Yang out of r/rPMS Wood stagnationdysmenorrhea Womb blood stasisacne Could be taiyang/surface, YM blocked, yang out of r/r, pivot issue…perfectionist Wood stagnation? Metal issue?Panic attacks Yang out of r/rExercises a lot- needs it to feel okay Could be wood stagnationED hx Earth issue?Food intolerances T/TSugar cravings Earth issue?neck/shoulder tension Blood def/mm not nourishedJaw pain shaoyangLikes ice water, craves chewing ice ST heat ?Freq urination Leakage? Ki qi def?Urinary leakage Ki qi defSleepy after meals Earth issueCold h/f Yang not reachingGas and bloat T/T, MJ stasisconstipation LI stasisSoft stools Damp? earthBM skips LI stasishemorrhoids Could be spleen def, blood issue?Hay fever Poor surface processingFrequent HAs Yang out of r/r, local stagnationclots Womb blood stasisPuffy tongue Spleen def, damp?pale/orange tongue Blood defSl red tip Yang out of r/rThicker white coat toward back Damp cold in middle/lowerV thin coat at tip/front Yin def aboveMid cycle and premenstrual spottingPivot issueXCHT mod (granules):chai hu 9huang qin 9ban xia 9dang shen 9da zao 6Wood stagnation/pivot issuesWomb blood stasis, blood deficiency (crappy blood)Weak earthKi qi def (?)
3 earlier comments 1 teacher remarksheng jiang 9zgc 4gou ji zi 9ai ye 6bai shao 6dang gui 6chuan xiong 3huang qi 9yuan zhi 6Dosage: 4 scoops, 2x/dayThanks in advance for offering your insights!JPEG | 673.2 Kimage2JPEG | 666.2 Kimage3JPEG | 612.5 Kimage0Sharon Weizenbaum May 142ReactHi Sage,Yes, pulses would be helpfulYou are right that I don't see Chai Hu as a "raising herb" as much as a pivot opening herb that then allows for upward movement. Iwould not suggest trying to figure out which herb is at issue but rather, what am I missing about the pattern.The moss on her tongue is striking to me as well as the thirst for cold/ice. You wrote "food intolerances" which, for me is not asymptom but a statement that she gets symptoms. What symptoms? Even without this information though, I see the digestiveblock as a first step so she can receive the other herbs. With a digestive block like this, the herbs could easily cause thesesymptoms. I would think of BXXXT as this is a mixed hot and cold. See how far you get with that.A few other things: What is her constitution like? complexion?I don't understand the use of Huang Qi here. Also Aiye. In your mind, what is the cause of the bleeding?Pictures can be deceiving but her tongue doesn't look so pale to me. I put some thoughts in bold with the symptom analysisbelow. I noticed that a lot of the symptom meanings were followed by question marks. I want to encourage you to ask questions ifyou have a question mark! Please feel free to use the forum in the GMP for this. If you have that many questions, please ask! Also Inoticed that there were quite a few diseases in the symptom list. So it's good to see that these are not symptoms so they can't tellyou much.HPV What are symptom?Insomnia Yang not rooting at nightAnxietyShen affectedPMSWood related (PMS by itself doesn't mean stasis. It is also a diagnosis and not a symptom. what aresymptoms?)dysmenorrhea Womb blood stasisacne Issue on skin of face (describe sores as there is a wide variety of acne)perfectionist What is your sense?Panic attacksshen affected (but what is symptom? this is diagnosis and panic attacks are experienced in a lot ofdifferent ways)
3 repliesReplyExercises a lot- needs it to feelokayWhat is symptom that feels better with exercise?ED hx what is ED? Eating disorder? What are current symptoms?Food intolerances Not a symptom. what is the symptomSugar cravings Earth issue?neck/shoulder tension muscles not nourished in neck.Jaw pain what does pain feel like? often tight so muscles not nourished in jawLikes ice water, craves chewingiceST heat ? yesFreq urination urine comes out too oftenUrinary leakage urine leaksSleepy after meals Earth issueCold h/f Yang not reachingGas and bloat T/T, MJ stasis what location? epigastric or abdomen?constipation LI stasisSoft stools stools softBM skips LI stasishemorrhoids stasis at anusHay fever what are symptoms?Frequent HAs More info needed, how frequent, where, how bad,clots Womb blood stasisPuffy tongue damppale/orange tongue Blood defSl red tip Yang out of r/rThicker white coat toward back Damp cold in middle/lowerV thin coat at tip/front Yin def aboveMid cycle and premenstrualspottingBlood coming out when shouldn't ReplySuzanne ConnoleMay 172ReactHi again. I think it might be great to actually start another post about the HPV. this comes up a lot in practice without directsymptoms in the local area. But, with Sharon's voice in my head, I have tried very hard to ignore the diagnosis and try and explainwhy the cervix would be abnormal based on the whole picture. It is really hard! if we think about it as abnormal cells grow whenthere is abnormal circulation to an area it can start to unfold.Ineke van der HamNo SubjectNewMay 92ReactThis probably is a late addition to the discussion, but I thought it to be too interesting not to mention. There is an old study (2014)by Terjussen et al, done among 28.192 Norwegian women, showing an 24 % less risk on pre-eclampsia by eating organicvegetables: Results from the prospective Norwegian Mother and Child Cohort Study, BMJ Open 4(9)e006143.2014.PMID25208850