Medical History Emily, 36-year old, female. The patient has had edema which is more severe in the lower legs for one year. Three months ago, the patient visited her regular doctor and did a few refine checkup. She has glomerulonephritis and the urinary protein: +++, urinary red blood cell: 150. She has taken wilfordine for more than one month and gotten much better. The urinary protein: +, urinary red blood cell account: 50.
Presenting Symptoms
Inquiring
Recently she has had blurred vision and dizziness, nausea which is worse when standing up. She has dry mouth with bitter, sticky taste, quick temper, a feeling of oppression of the epigastric hypochondraic region, poor appetite, yellowish and scanty urination with no sensation of heat, normal bowel movement with slightly dry stools, dream-disturbed sleep, weakness and soreness of the lower back and knee joints. Regular menstruation with less menses.
Pulse and Palpation
BP: 18.67/11.33kPa. Soft abdomen when palpated, the liver cannot be palpated. Uncomfortable in renal area when being knocked. Pitting depression in the lower legs. Thready and string-taut pulse.
Tongue and Observation
Red and purple tongue body with yellow, greasy tongue coating and thick in the middle.
Redish complexion, overweight.
TCM Diagnosis
Dizziness (liver-wind and turbid phlegm rising, with liver and kidney yin deficiency)
Treatment Principle
Subdue liver yang, remove wind phlegm, restore the spleen and stomach, nourish liver and kidney yin.
Herbal Prescription
Zhen Gan Xi Feng Tang and Bian Xia Bai Zhi Tian Ma Tang with modifications
Tian Ma (Rhizoma Gastrodiae elatae) 10g
Gou Teng (Ramulus Uncariae) 10g(cooked later)
Shi Jue Ming (Concha Haliotidis) 15g
Ci Ji Li (Fructus Tribuli Terrestris) 12g
Shen Long Gu (Os Draconis) 30g(cooked first)
Shen Mu Li (Concha Ostreae) 30g(cooked first)
Bian Xia (Rhizoma Pineliae ternatae) 9g
Shen Bai Zhu (Rhizoma Atractylodis macrocephalae) 15g
Fu Ling (Scerotium Poriae cocos) 20g
Chen Pi (Pericarpium Citri reticulatae) 9g
Ze Xia (Rhizoma Alismatis Orientalis) 20g
Du Zhong (Radix Eucommiae ulmoidis) 10g
Tuo Si Zi (Semen Cuscutae Chinensis) 15g
Sang Ji Sheng (Ramulus Sangjisheng) 15g
Gan Cao (Radix Glycyrrhizae) 6g
Explanation
Tian Ma, Gou Teng, and Shi Jue Ming: extinguish liver-yang and liver-wind.
Shen Long Gu and Shen Mu Li: subdue and soothe the liver-wind.
Chen Pi, Bian Xia and Fu Ling: restore the functions of spleen and stomach, combined with Tian Ma and Gou Teng to remove the wind phlegm.
Fu Ling and Ze Xia (Ze Xia Decoction): are good at strain the phlegm from the urination and make the lucid yang of middle turner and stop dizziness.
Du Zhong, Tuo Si Zi and Sang Ji Sheng: tonify kidney and liver, harmonize and pacify the liver ying and yang.
Gan Cao:has two functions: harmonize all of the herbs, used together with Chen Pi, Bian Xia, Shen Bai Zhu and Fu Ling reinforce the transportation and transformation of spleen and stomach.
Acupuncture Prescription
LR3(taichong), GB20(fengchi), TB5(waiguan), DU16(fengfu), LR2(xingjian), LI4(hegu), KI3(taixi), LR8(ququan), SP6(sanyinjia), PC6(neiguan), ST40(fenglong), ST36(zusanli), RN9(shuifen)
Reducing, even or reinforce method
Explanation
LR3, GB20 and TB5: subdue liver-yang, liver-wind and specific for dizziness
DU16, LR2 and LI4: help subdue liver-wind
KI3, LR8, SP6 and PC6: tonify kidney and liver, harmonize liver ying and yang
ST40, ST36 and RN9: restore the functions of spleen and stomach, remove the wind phlegm from the body
Lifestyle Changes
Maintain balanced emotions.
Reduce overworking and/or excessive sexual activity.
Reduce greasy, sweet, sour foods.
Keep regular eating habit, more vegetables, no excessive consumption of greasy foods or dairy products.
Does mild exercise regularly.
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