HT 0333 Case study Part I
Case 1
A 50 year old female patient complains of right hypochondriac region distending pain
for 6 months, poor appetite and losing weight. She was diagnosed liver cancer by MRI &
Biopsy three months ago and had surgery to remove tumor. Right now, she is planning
Chemo-therapy which will last for 3 months. She needs an herbal prescription to help her
finishing her Chemo-therapy (usually, Chemo-therapy will cause digestive symptoms,
WBC decrease, fatigue). Please write down your herbal prescription for this patient.
Two years later, this patient feels her right hypochondriac region discomfort and pain
again. Other symptoms include lassitude, poor appetite, palpitation, worries, dry mouth,
malar flush, red tongue less coating, wiry and thready pulse. What is your herbal
prescription (In each case, please write the name of representative formula, your
modification and dosages).
Weight loss etc suspect cancer here. This particular person has liver cancer. Use
anticancer herbs prior to surgery. After surgery, tonify qi and blood and spleen.
Build up before chemo/radiation. After chemotherapy starts, continue to build qi
and blood and spleen qi as they will have digestive problems. Chemo causes bone
marrow and blood xu. After chemo, do detoxification treatments. Use strong
dissolve mass and antistasis herbs now. Can add deep tissue massage as well. If
the patient goes to terminal stage, use the strong dissolve mass and antistasis
herbs also.
Generally, no herbs before/during/after for a couple of days around
chemotherapy.
Formula example
Gui pi tang – calm shen herbs here so have to remove suan zao ren (they don’t
need help getting to sleep!), yuan zhi. Long yan rou is fine as it nourishes heart.
When a patient first gets the dx, give them liver qi and heart nourishing herbs.
When they get to the denial stage, soothe liver qi and anti anger. When they hit
bargaining stage will go to the acceptance stage, preparing for possibility of death.
Cancer pts usually for aggressive cancers will get 1-3 years. If catch earlier or less
aggressive, takes 3-5 years.
Gui zhi tang works well. Has dang gui in it. ba zhen tang good also, but have to
take out harsh herb and add gentler herbs like dang gui. Add bone marrow/+
white blood cell herbs. most common herb for immunity is huang qi, mushrooms
like ling zhi (looks like wood – hard to eat), xiang gu (shitake - edible), yun zhi
(also hard to eat). All contain polysaccharides which stimulate immunity.
Mushrooms are very rich in polysaccharides. Fu ling also is a fungus which will
boost immunity.
Post chemo treatments by a couple of days use the mushrooms. Eat berries for the
anti-oxidants. You could use gou qi zi and other berries from TCM for the same
purpose. Ba zhen tang, gui pi tang to tonify qi and blood and add the mushrooms
above.
Digestive problems with n/v because chemo drugs affect the brain and cause
nausea. Also stops the digestive enzymes from processing properly. Ban xia, zhu
ru etc for nausea. Shen qi, shan zha, mai ya to stimulate digestion. If a cancer
patient eats too much will get bloating, so can give lai fu zi.
Don’t use herbs that don’t match the syndrome!
Niu zhen sha? Stimulates wbc’s. Could also add ren shen into the mix.
2nd part of case 1:
Remission post chemo – you go back repeatedly to do a body scan for cancer
again. In this case, came back 2 years later and found cancer. The case gives a
good description of what happens when it comes back. Some patients don’t want
to go through chemo again, so they decide to accept death.
Blood stasis evident, toxins, liver overacting on spleen, liver qi stagnation/spleen
qi xu, ki yin xu. What formula? 1) Liver yin xu with hypochon, Lv/ki yin xu = qi
ju di huang wan. 2) blood stasis = bie jia and other soften masses/remove stasis
herbs. Could use e zhu, but is strong and could harm. Add some liver qi soothing
herbs – yu jin, he huan pi. Gou qi zi. Add ling zhi which treats palps, clam shen,
nourish heart, stimulate immunity. Add dang gui to nourish dang gui. Xiao yao
san can be modified with less chai hu – 3-6 g, remove fu ling and bai zhu because
they are too drying.
Analyze the cases – add herbs for each symptom, but analyze the herbs to make
sure they don’t hurt any other symptoms!
Case 2
A 52 year old male patient complains of right upper abdominal distending pain and
jaundice for one month, nausea and poor appetite, dislike greasy food. He was just
diagnosed liver cancer (7x8cm tumor, unsuitable for surgery). He had 5 days of Chemotherapy through liver artery. Other symptoms include abdominal distension, dry mouth
and bitter taste in the mouth, loose stool, yellow urination, weak limbs and lassitude, dark
red tongue with yellow greasy coating, thready and wiry pulse. Please write an herbal
prescription for this patient.
Two months later, he had local area radiation. Meanwhile, he continued taking herbs.
Right now, he finished months of western medicine treatment. His tumor was shrunk to
2.7 cm. He feels tired, emotional depressed, dry mouth, no good appetite, pale tongue
with less coating, thready and weak pulse. Please write an herbal prescription for longterm treatment.
This guy has either lv or gb problem. Could also be pancreatic cancer with tumor
pressing on the bile duct. Sometimes if cancer is too big will avoid surgery. One
tx is to go thru inguinal artery and pump chemo directly to the site of tumor.
You can see d/h excess and blood stasis in this case. Patient is in pain and has a
tumor. d/h is the jaundice. Abdominal distention etc are all from damp heat.
Jaundice is very toxic. Pt has loose stools also from d/h. Too much d/h can
damage spleen which likes to be dry. Dark red tongue = blood stasis. Thready
wiry pulse. Wiry = pathogens (?). Thready because long term d/h has consumed
yin. Be careful not to damage yin here. Take damp heat stasis and sp qi/lv yin xu
into account.
Pain + jaundice = yin chen hao tang, but not use because has da huang and this pt
has loose stool and more damp. Herbs for liver damage: yu jin, fu ling. Add some
huang qin for the heat. Hypochon pain and mass – bie jia, yu jin, chuan lian zi,
yan hu suo.
Need another formula for a different time - either add xi yang shen or give yi
guan ? Xi yang shen, niu zhen zi, ling zhi, fu ling and give later – during chemo?
What? Add some digestive herbs .
Or, give antijaundice, get ‘em feeling better. Then give them a different formula
when they feel better. Could also give different formulas for morning/night – one
for damp heat jaundice in the morning afternoon, then the yin xu formulas for
night time.
If feel bad after lunch during chemo, which is really common, give sheng mai san
modified(?).
Nourishing yin herb can cause damp accum – shu di for - example will be too
sticky.
Tumor is shrinking post chemo, jaundice and d/h are gone. Qi and blood are now
damaged. Still has stasis – tumor is shrinking but is there. Qi yin xu signs in the
case: tired, pale tongue, weak pulse with little coating, emotional depression.
Yi guan zhi, qi ju di huang wan is the base formula. Add bie jia to soften the
masses. Add ling zhi to help immunity, niu zhen zi, gou qi zi. He huan pi
emotional depression. Digestive stimulant herbs for the appetite. You could also
modify Xiao Yao San.
Look up the antidepressant herbs.
Case 3
A 65 year old male patient complains of lower limbs edema for 6 months. He was
diagnosed nephritis one year ago. Other symptoms include cold limbs, aversion to cold,
lower back pain and weakness, lassitude and palpitation. The tongue is dark pale with
teeth marks and purple spots, and the pulse is weak. What is your disease and syndrome
diagnosis, treatment principle and herbal prescription.
Suspect Ki xu based on age and edema. Cold limbs and aversion to cold cd be
yang xu or full cold. Low back pain/weak can be ki xu and blood stasis.
Lassitude/palps can be fluid retention. Tongue is dark with TMs can be blood
stasis with fluid retention. Pulse is weak so xu. Ki sx, cold sx, xu sx = kidney
yang xu with water retention which is messing with the heart.
Tonify kidney yang and resolve the fluids. Jin gui shen qi wan is the basic
formula for kidney yang xu, now add drain fluids. Remember the purple tongue –
blood stasis, so add dan shen or yi mu cao for instance.
If you use a classic formula, use small doses of the tonification herbs so they
don’t clog/cloy. Huang qi is fine, so it bai zhu. Shu di huang and mu dan pi –
consider dosage. Fu zi too.
Case 4
A 53 year old female patient complains of frequent urination accompanied with lower
limbs edema, frequent reoccurrence for one year. She was diagnosed as chronic
polynephritis. She has taken antibiotics for a long time, but her urination test still shows
protein (+-), WBC>500/ul, RBC>250ul. Now, she is looking for herbal treatment. Other
symptoms include lower back and knees weakness, dry mouth, restlessness, dry stool.
The tongue is dark red with white coating, and the pulse is thready, wiry and slippery.
What is your disease and syndrome diagnosis, treatment principle and herbal
prescription?
Polynephritis is kidney + urethra affectation. Nephritis is just kidney. Protein in
urine because kidneys are damaged. Blood too. Lo back/knee weak = kidney, but
pain only cd be stasis. Dryness is yin xu. This is both lin syndrome and edema.
Looks like kidney yin xu and yin xu heat + chronic nephritis. WBC reflects the
heat toxin – dryness and high blood count. Pulse is thready and she’s 53 – yin xu
very very likely. Wiry is the excessive toxin. Who knew!
Zhi Bai Di Huang Wan + would work if modified for the Kidney yin xu. Bai hua
she she cao (big, like 15g), ban bian lian for the infection. Yi mu cao for the dark
tongue/stasis. Dry stool, already have shu di, could add huo ma ren.
Avoid over-nourishing yin and over-clearing the toxins.
Case 5
A 45 year old male patient complains of impotence for 3 years. He had a history of
staying in the cold water during the war in 1950s. His symptoms include no sex drive,
cold and damp in scrotum, listlessness, somnolence. The pulse is slow and weak. What is
your disease and syndrome diagnosis, treatment principle, herbal prescription?
Not exactly a recent case study. This dude would be more like 80 now. Looks like
Ki yang xu with cold damp retention. Not pure yang xu, but some excess too.
Modify You Gui Wan, which is usually for older people. This guy has been in
cold water for a long time and has PTSD – listlessness/somnolence. Reduce dang
gui and shu di cuz is too sticky. Add cold/damp herb like rou gui. Somnolence is
treated by western meds with caffeine, Ritalin, etc. Herbally, you use ginseng and
wu jia shen (Siberian ginseng) – ginseng is no longer all that strong as it is
harvested too early. Pulse is slow and weak due to adrenal fatigue (ki yang xu).
Use large dosages of huang qi, wu jia shen. Add herbs for impotence – yin yang
huo, lu rong and such. Add a little he huan pi and will be fine.
Case 6
A 23 year old male patient complains of seminal emission for 3 months, lower back
soreness. The tongue coating is thin, and the pulse is long. What is your disease and
syndrome diagnosis, treatment principle, herbal prescription?
No weak pulse – not that deficient. Kidney is weak but not necessarily deficient.
Think about astringent herbs – ki weakness unable to consolidate, or even ki
unable to consolidate. Jin Suo Gu Jing Wan + astringent herbs (tu su zi, etc.). Add
du zhong etc for lower back soreness.
Long pulse can be chronic illness, or nothing much specific wrong and you find
this in younger people. Pulse gives basic information, but you can’t usually rely
on this alone.
Why are we going through this hell? So we know that you can’t always match the
case to the book. Nothing is that clear unfortunately.
Case 7
A 45 years old female patient complains of depression for 2 years. Her symptoms include
listlessness, melancholy, sadness, crying, restlessness, chest tightness alleviated by
sighing, bitter taste in the mouth and dry mouth, heat sensation in the palms and soles,
insomnia and dream-disturbed sleep, lassitude, dry stools, scanty menstrual flow with
light color. The tongue is pale with thin white coating, and the pulse is thready and wiry.
What is your disease and syndrome diagnosis, treatment principle and herbal
prescription?
Case 8
A 54 years old male patient complains of abdominal distending pain and a touchable soft
and fixed abdominal mass for 3 days. He had a history of abdominal surgery due to
bowel obstruction 7 years ago. This time the symptoms happened again due to bad diet
(not completely cooked meat, beers, cheese, etc) in the weekend party. Other symptoms
include nausea and vomiting, poor appetite, no gas, constipation. The tongue is red with
yellow greasy coating, and the pulse is wiry and slippery. What is your disease and
syndrome diagnosis, treatment principle, and herbal prescription?
HT 0333 Case study Part II
Case 1
A 14 year old female patient complains of purpura on lower limbs for 2 years. Two years
ago, the patient began to have bleeding spots with dark color on the lower limbs without
any noticed reason. The blood test showed that blood platelets were low (30x10 9 /L).
She was diagnosed thrombopenic purpura by bone marrow test. She has steroid
treatment, only temporary increasing blood platelets. Currently, her other symptoms
includes fatigue, poor appetite, abdominal dull pain, dry stools, skin spots without pain or
itching, pale tongue with thin white coating, deep thready pulse. What is your diagnosis
and herbal prescription (In each case, please write the name of representative formula,
your herbal prescription and dosages).
Case 2
A 55-year-old female patient complains of lassitude, thirsty, hungry and frequent
urination in large amount for 1 year. She was diagnosed diabetes (type II) and without
good result by western medications. Currently, her other symptoms include palpitation,
restlessness, weakness of knees, dry stools, numbness of limbs. The tongue is red and
dry, and the pulse is wiry and slippery. Please write your diagnosis and herbal
prescription.
Case 3
A 32 years old female patient complains of overweight. She gains 30 pounds in two
years. For the last two years, she has been in a highly stressful life and her metabolism
has been changed. She is hungry and feels hot all the time. Other symptoms include
difficult and sticky bowel movements, depression, heavy sensation of the body, fatigue,
lassitude. The tongue is red with greasy yellow coating and teeth marks, and the pulse is
slippery.
Case 4
A 35 year old female patient complains of migraine headache, repeat attack for 10 years.
She was diagnosed angioneurotic headache. She relies on tranquilizer and pain
medications to relieve her symptoms. Last several weeks, her symptoms were getting
worse even with medications. Currently, her other symptoms include lassitude,
listlessness, dizziness and palpitation, one week early menstrual circle with lingering
bleeding and large amount. The tongue is pale dark and swollen, and the pulse is thready
and wiry. What is diagnosis, and herbal prescription?
Case 5
A 59 years old male patient complains of lumbar soreness and pain with weakness in the
knees for one year. Pain attacks were often caused by fatigue or climatic changes. Three
days ago he had pain again due to carrying a heavy load. Other symptoms include
difficulty in moving lower back, tinnitus, cold limbs. The tongue is pale dark with purple
spots, and thin white and sticky coating, and the pulse is deep, slow, wiry and slippery.
What is your diagnosis and herbal prescription?
Case 6
A 29 year old female patient complains of left lower back, buttock and limb severe
radiating pain and numbness for 5 months, symptoms getting worse by over activities,
relieving by resting or gentle stretching. She was diagnosed sciatic pain. Other symptoms
include local heat sensation, stress and slight irritability. The tongue is pale red with
purple spots, and greasy and yellow coating, and the pulse is wiry, choppy and slippery.
What is your diagnosis and herbal prescription?
Case 7
A 19 year old male patient complains of eyelid drops and weak body for 3 years. Three
years ago, he slept in a cold-damp place for several hours and woke up with symptoms of
eyelids drops, difficult talking and swallowing, choking by drinking water. He was then
diagnosed as myasthenia gravis. His symptoms are slowly getting worse, although he
continues taking western medicine. Currently, his other symptoms include difficult
walking and raising eyelids, difficult chewing and swallowing, symptoms getting worse
in the afternoon, spontaneous sweating, easy catching cold. The tongue is pale, and the
pulse is deep and slippery. What is your disease and syndrome diagnosis, and herbal
prescription?
HT 0333 Case study Part III
Case 1
A 46 years old female suffered from tinnitus for one year.
The patient stated he fainted one day last summer due to exhaustion from guiding and
coaching students preparing college entrance examinations. After which, she noticed a
continuous ringing of both ears. The ringing was not loud. She was able to alleviated the
ringing somewhat by pressing the tragus. She also has insomnia and weakness soreness
of the lower back, hot flush at night. Her sense of hearing diminished and all symptoms
worsened if she has stress and is exhausted. The patient presented with a sallow
complexion and a BP of 130/80. There was no evident abnormality inside the ear. The
tongue was slightly deep red with a thin yellow coating, and the pulse was thready, wiry,
and weak in the Chi region. What is your disease and syndrome diagnosis, treatment
principle, and herbal prescription with dosage?
Case 2
A 41 years old male come to your office and complains of sudden tinnitus and deafness
for the past 3 days. Three days ago, the patient became very angry, and then he felt a
ringing sensation in the left ear similar to the sound of the sea. He also felt a distending
and obstructing sensation inside the ear, followed by a sudden loss of the hearing. He has
job related stress for the last several weeks, insomnia and bitter taste in the mouth. ENT
examination showed hearing loss without pathological change of the ear drum. The
tongue is red with yellow coating, and the pulse is wiry and rapid. What is your disease
and syndrome diagnosis, treatment principle, and herbal prescription with dosage?
Case 3
A 67 years old male presents with muscle rigidity, tremor and a slowing of physical
movement for the last three years. He was diagnosed Parkinson’s disease and his
symptoms are slowly getting worse although he is in medications. He has a history of
head trauma by a car accident 10 years ago. He also has lower back and knee weakness
and pain, loss of hearing, poor memory, fatigue and general weakness, loss of appetite.
The tongue is pale, and the pulse is weak and thread. What is your disease and syndrome
diagnosis, treatment principle, and herbal prescription with dosage?
Case 4
A 48 years old female visits your office and presents with profuse sticky and smelly
sweating for the last two years. She had a very stressful life and went through divorce
two years ago. Since then, she noticed her symptom of profuse smelly sweating. She is
also irritable and feels hot all the time. She also has headache, bitter taste in the mouth
and yellow urine. Her blood pressure is 150/95 mmHg. The tongue is red with yellow
coating, and the pulse is wiry and rapid. What is your disease and syndrome diagnosis,
treatment principle, and herbal prescription with dosage?
Case 5
A 58 years old female comes to your office and presents with dizziness and extreme
fatigue for the last 8 months. The CBC showed low WBC and low neutrophils and she
was diagnosed neutropenia three months ago. She is pale and also has lower back and
knee weakness and soreness, poor appetite and loose stools. The tongue is pale with thin
white coating, and the pulse is weak and thread. What is your disease and syndrome
diagnosis, treatment principle, and herbal prescription with dosage?
Case 6
A 38 years old female complains of low grade fever for the last several months. She has
a stressful life and is irritable all the time. Her period is irregular and painful with dark
menstrual flow and clots. The other symptoms include insomnia, bitter taste in the mouth,
breast distension, moodiness. The tongue is dark red with yellow coating, and the pulse is
wiry. What is your disease and syndrome diagnosis, treatment principle, and herbal
prescription with dosage?