48 y.o Female: Depression, Poor digestion, Fatigue

This female patient came to see me for 3 health concerns.

  1. Depression: All her life, she suffered from depression on and off. However, previous few months, her depression had been quite bad. Every morning, she had to struggle to get up and look for a reason to get through this day. It was hard to motivate herself to do anything. Her emotional difficulty includes sadness, numbness, discontentment, depression, sensitive heart, disconnection, emotional turmoil etc. Her feeling of loneliness was eating her inside out. She was not taking any antidepressant medication; however, she was going to hot yoga classes to make her feel better. Unfortunately, excessive sweating from the hot yoga further depleted her body fluid, which contributed to worsen the symptoms.

  1. Digestive issues: her digestion was messy. She cold have bloating after eating most of anything. Meat was the only thing she did not get bloated. She started having the digestive issues when she had her first child 20 years ago. The digestion was worse with stress, better with not eating.
  1. Fatigue: because she didn’t know what to eat, she started avoiding to eat. She was easily fatigued. She woke up fatigued. She had standing job, and it was very difficult for her to do anything at home after coming home from work. She was physically as well as mentally fatigued.

She also had pains.

  1. Right foot, sole, for almost 2 years. The pain is dull and fixed pain. It is better with rest, and worse with overuse. The pain can be so severe that she sometime had to hop around with the opposite foot.
  2. Left breast pain. There is no lump. The pain is unrelated with menstruation. It is worse with stress.
  3. Lower abdominal pain due to fibroid. Pain occurs after ovulation with stretch. The size of the fibroid is unknown. It was 1 cm over 10 years ago.

Other relevant symptoms:

  • Dislike to wind, cold and damp environment. Exposure to wind can give her headache in the occipital area.
  • Body feels cold. Feet and hands are cold.
  • Blurry vision, poor vision, poor night vision
  • Mild tinnitus or ringing in the ears
  • Metallic taste in her mouth
  • Low appetite due to the bloating issue
  • A soft goiter on the throat
  • Heart palpitation after eating
  • Smelly and incomplete stool
  • Thirst with desire for cold drinks
  • Sleep issues
    • Interrupted sleep due to excessive thoughts
    • Wake up too early, and can’t go back to bed
    • Dreamful
    • Wake up tired
  • Vaginal discharge – one day a month, she had excessive vginal discharge that was colourless, odorless, watery and profuse
  • Lack of libido
  • Menstruation issues
    • Pain in the second day and feeling of heaviness
    • Low back soreness
    • Bloating
    • Moodiness
    • 3 days bleeding with 7 days of spotting to follow
    • Clots
  • Pulse is thready, not rapid
  • Tongue is pale, bite marks, moist, thicker tongue coating at the root and it was geographic.

Jing Fang Diagnosis: Shao Yin, Jue Yin, Tai Yin, Yang Ming with Blood stasis and deficiency

  • Shao Yin – Pain that is worse with overuse, dislike wind, cold and damp
  • Jue Yin – Cold feet/Hands, dislike of cold, tinnitus, metallic taste in the mouth, thready pulse, high stress
  • Tai Yin – internal cold, depression, heart palpitation after eating, bloating, low appetite, soft goiter, profuse vaginal discharge, severe fatigue
  • Yang Ming – thirst for cold, wake up too early,
  • Blood Stasis – fibroids in her lower abdomen, clots in menstrual blood
  • Blood Deficiency – blurry vision, poor vision

Formula 1 November 17, 2018

Chai Hu Gui Zhi Gan Jiang Tang with Long Gu, Fu Ling Yin, Dang Gui Shao Yao San, Zhi Zi, Yi Yi Ren

  • Chai Hu Gui Zhi Gan Jiang Tang is a Jue Yin formula which clears heat in the head and the chest, nourish body fluid to treat dry heat, and consolidates existing body fluid and stop excessive sweating.
    • I added Long Gu to support sweat inhibition because she goes to hot yoga and like sweating out.
  • Fu Ling Yin for her bloating and abdominal distension
  • Dang Gui Shao Yao San for her fibroids in the lower abdomen, and to nourish her blood
  • Zhi Zi is to clear heat from everywhere and calming the spirit
  • Yi Yi Ren is to promote body fluid while releasing pathogenic rheum.

Chai Hu 12g, Gui Zhi 10g, Gan Jiang 10g, Tian Hua Fen 12g, Huang Qin 10g, Mu Li 15g, Long Gu 15g, Zhi gan Cao 6g, Fu Lin 12g, Dang Shen 10g, Zhi Shi 10g, Chen Pi 30g, Sheng Jiang 15g, Dang Gui 10g, Bai Shao 15g, Chuan Xiong 6g, Bai Zhu 10g, Ze Xie 10g, Zhi Zi 15g, Sheng Yi Ren 30g

November 24th Update

After one week, she experienced

  • Less bloating
  • A lot more appetite
  • Sleep is better
  • Fatigue is still there
  • Depression is still there

I continued the same formula, suggested her to start eating.  To treat the persistent fatigue, I added Fu Zi (Bai Fu Pian) 6g.

December 8th 2018 Update

After one week, she experienced

  • Bloating is not worse but it is still there
  • “bad bad anger”
  • Fatigue is still there
  • Depression is still there
  • Pain has not resolved
  • Chest Oppression is a lot better

I continued the same formula with the following modification

  • Eliminate Fu Zi
  • Increased Tian hua Fen to 18g
  • Added Shi Gao 30g
  • Increased Bai Shao and Zhi Gan Cao to 18g each to make Shao Yao Gan Cao Tang.

February 17th 2019 Update

  • Depression is better, but anxiety is worse
  • Joint pain on the left side that wakes her up in there night is new
  • Tinnitus
  • Metallic taste
  • HT palpitation is better

Diagnosis: Three Yin Yang Ming with Blood depletion and Ben Tun syndrome

  • Ben Tun syndrome is exterior Interior concurrent causing dampness in the Brain.
    • Symptoms includes anxiety, insomnia, band-like headache etc

Formula: Gan cao Xie Xin Tang + Gui Zhi Fu Ling Tang w/ Jie Geng, Long gu, Mu Li Zhi Shi

Zhi Gan Cao 10g, Dang Shen 10g, Da Zapo 25g, Huang Qin 10g, Huang Lian 10g, ban Xia 25g, Gan Jiang 10g, Gui Zhi 20g, Fu Ling 25g, Tao Ren 10g, Dan Pi 10g, Jie Geng 12g, Long Gu 30g, Mu Li 30g, Zhi Shi 15g

  • add Shi ago if she has anger

February 28th Up Date

  • Bloating has been back. Will add Fu Ling Yin on the next formula.
    • add, Cang Zhu 15g, Chen Pi 30g, Sheng Jiang 15g
  • The formula seems to be helping for sleeping

Published by Yumi Ridsdale R.TCNP. R.Ac

From Japan. Living in Canada since 2001. I am a registered practitioner of Chinese Medicine with special interest in Classic herbal therapies.

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