Case 10: Infertility due to Genital Infection
Y Female. 32 years old. Her first office visit was on 2010/6/12.
Her general appearance was a medium sized body and white, rosy skin. Her lips were red and moist, and her hair was very black and shiny. Her expression was anxious and uneasy. Her speech was fast, which suggested her heart was not at ease. The patient’s infertility began three years after her marriage. Her vaginal discharge appeared yellow-green colored. Examinations showed second degree cervical erosion and vaginitis. The patient underwent regular Western medical treatment, but it was ineffective. The patient had frequent low back pain. Prior to her period, she experienced dull abdominal pain in her lower left quadrant, but her menstrual flow was normal. Occasionally she would have ulcers and gum bleeding. The patient frequently had insomnia. Her appetite was regular, but her stool tended towards dryness. The practitioner noted her hands and feet were relatively cold and her pharynx was swollen upon physical exam.
Formula: Jīng Jiè 10g, Fáng Fēng 10g, Chái Hú 15g, Lián Qiáo 20g, Bò He 10g, Bái Zhǐ 10g, Jié Gěng 10g, Gān Cǎo 5g, Zhǐ Ke 15g, Huáng Lián 5g, Huáng Qín 10g, Huáng Bò 10g, Zhi Zǐ 10g, Dāng Gui 10g, Bai Shao 10g, Shēng Dì Huáng 15g, and Chuān Xiōng 10g. Dr. Huang prescribed 14 bags.
He advised the patient to take one bag each day, which was decocted in water. Dr. Huang offered some counseling by saying, “The matter of giving birth to a child is a natural path. You cannot demand it. You should let nature take its course.” The patient raised her head and with tearful eyes asked Dr. Huang whether or not she had the ability to give birth. Dr. Huang answered straightforward and said, "You can give birth!"
By the second office visit on 2010/8/14, the patient had taken all the herbs, and all of her symptoms had disappeared and her emotions were stabilized. Dr. Huang prescribed seven more bags of the original formula, which was to be administered every other day. Dr. Huang wrote in a postscript that the patient’s maternal grandmother visited and brought a picture of the baby on 2011/12/6. The patient underwent a c-section on 2011/5/4, because of scanty amniotic fluid. She delivered a full-term, healthy baby boy.
In the case notes it is stated that the combination of herbs in Jīng Jiè Lián Qiáo Tāng is well constructed. When the formula pattern is present, then the formula's efficacy is certain. The formula’s base formulas can be regarded as the combination of Sì Nì Sàn, Huáng Lián Jiě Dú Tāng, and Sì Wù Tāng. Japan's Chinese herbal doctors often use Jīng Jiè Lián Qiáo Tāng for regulating young people's adenocarcinoma. In patients who have this type of constitution, they are more susceptible to having inflamed and swollen glands. They are also more susceptible to getting tonsilitis, tympanitis, conjuctivitis, sinusitis, and acne accompanied with follicle inflammation. The mucus membranes of their five sense organs are also more susceptible to getting swollen and inflamed and their discharge can appear like sticky, thick, yellow pus. Dr. Huang often uses this formula for acne and genital infections in people who have fire Chái Hú constitutions. Amongst that patient population, the formula is very effective for those who have an oily face and a swollen pharynx.
Case 11: Postpartum Edema Case
Y Female. 28 years old. Her first office visit was on 2011/6/21.
The patient had a fat and robust physique. Her facial color was yellow with some spots, and her eyes were alert and lively. Her chief complaint was edema in both lower limbs that was present before and after pregnancy for a period of more than nine months.
According to her medical history, the edema in both her lower limbs emerged when she was six months pregnant, 2010/10. The edema had lasted up until the time of the visit and had not declined even though childbirth took place four months ago. She experienced lower abdominal discomfort and pain after sexual intercourse. Her appetite and sleep were okay. Her thirst was not significant. Her urination and bowel movements were smooth. She also had athlete's foot.
Upon physical examination, her tongue was light red with a scanty coat. Her tongue was also moist. Her calves had pitting edema.
Formula: Zhū Líng 15g, Fú Líng 20g, Zé Xiè 20g, Liù Yī Sàn 15g, Huáng Bò 10g, Zhī Zi 10g, and Lián Qiáo 20g. He prescribed seven bags. The patient was supposed to take one bag each day and decoct the herbs in water.
On her second office visit, 2011/11/1, the patient reported she took the above formula for one week and the edema declined. She refilled her formula and continued to take it to consolidate her treatment. However, for the last three months, her menstrual flow would be heavy and last more than 10 days until it was done. She felt like she had a backache. Her stools tended towards being watery. Occasionally, it would be a few days until she had one bowel movement that was dry and hard. Her tongue was red and her coat was scant.
Formula: Huáng Lián 2g, Huáng Qín 6g, Dǎng Shēn 10g, Jiāng Bàn Xià 12g, Gān Jiāng 6g, Zhì Gān Cǎo 6g, Hóng Zǎo 20g, and Huáng Bò 6g for 20 bags. The patient was directed to take five bags each week and then stop for two days.
(1) In the case notes, this patient is distinguished as having a damp-heat type constitution. The formula used was an experienced formula created by Dr. Huang called Qīng Rè Lì Shī Tāng. He used Zhū Líng Tāng and Zhī Zi Bǎi Pí Tāng Jiā Lián Qiáo as his base formulas. Based on the presence or absence of blood symptoms, one can either add or remove Ē Jiāo. At the second office visit it seemed as if the patient still presented with Zhū Líng Tāng symptoms. Yet, after taking Qīng Rè Lì Shī Tāng, the patient still had a menstrual flow that was heavy, which was accompanied with unregulated stools. Therefore, Dr. Huang changed the formula to Bàn Xià Xiè Xīn Tāng Jiā Huáng Bò. (2) In patients who have a damp-heat type constitution, there are those who appear with more severe dampness or more severe heat. Dr. Huang often uses Zhī Zi Bǎi Pí Tāng as the basic formula, and then looks at differentiating signs in order to combine it with other suitable formulas. In detail, you should refer to the above article, "Qīng Rè Lì Shī Tāng Constitutions".
Case 12: Post Placenta Accreta Surgery and Lower Limb Deep Vein Thrombosis
Z Female. 36 years old. Her first office visit was on 2011/3/19.
Her general appearance was a medium sized body shape with yellow skin. Her facial color was yellow and dusky with tan spots. Her forehead was red and her lips were dusky purple. Her eyes were small. The patient’s height was 153 cm. Her weight was 50 kg.
The patient’s chief complaint was distending pain in her calves. She was unable to walk for more than two months. On 2011/1/19 the patient needed to deliver via c-section, because the placenta was released early and caused fetal distress. The doctors discovered she had placenta accreta. After the patient was discharged from the hospital, her calves frequently had spasms and were painful. Four types of blood coagulation examinations were performed and the results showed increased viscosity of the blood. It was suspected that the lower limbs had deep vein thrombosis and she was given the anticoagulant Warfarin. Her c-section incision was healing well, but there was often pain. When the pain was severe, she would experience pain as soon as her clothes touched her skin. The patient felt like her calves had lumps. At times they would become distended and painful. She'd be unable to walk for a long time, but bending over was still okay. She would easily get heart palpitations after being very hungry. Her sleep was poor and she easily woke up. Her stool was fine and smooth. Every one to two days she'd have a bowel movement. Her menstrual flow amount was scanty and the color was a little black. When she was 15 years old she began having vitiligo in both calves. Her father had a history of a cerebral infarction. Upon physical examination her tongue quality leaned towards a pale tongue body with a thin coat. Her pulse was 108 bpm and it had strength.
Formula: Guì Zhī 15g, Chì Sháo 15g, Táo Rén 15g, Mǔ Dan Pí 15g, Fú Líng 15g, Huái Niú Xī 30g, and Zhì Dà Huáng 5g for seven bags. She was advised that if her daily bowel movements exceeded three times, then she should stop taking the medicine.
Her second office visit was on 2011/4/2. After taking the medicine her calf spasms and distention and pain decreased and her stool was regular. Her dusky red facial color lessened. Her menstrual flow amount increased, but her right lower abdomen had tenderness upon palpation. She continued to take the same formula.
Her third office visit was on 2011/5/24. After taking the herbs all her symptoms clearly improved. Her last menstrual period was 2011/4/27 and the amount was scant. The right lower abdominal pain that was tender upon palpation reduced. During the time she took the herbs her stool did not change. Her sleep was poor. She took seven more bags of the original formula and took two days off between each bag.
Her fourth office visit was on 2012/2/4. Her lower leg distention and pain reduced. The distance she could walk increased and she no longer had cramps. Occasionally she had a headache and her memory was declining. She had a bowel movement once every two days and her stools tended to be dry. Her menstrual period lasted for two days and the flow amount was scanty. Her hands and feet were cold and she had slight right lower abdominal pain.
Formula: Guì Zhī 10g, Ròu Guì 5g, Chì Sháo 15g, Mǔ Dān Pí 15g, Táo Rén 15g, Fú Líng 15g, and Huái Niú Xī 15g. He prescribed 20 bags and told the patient to take two days off between each bag.
Her fifth office visit was on 2012/4/10. Her lower leg distention and pain completely disappeared and her spasms had not reoccurred. Her walking was normal. Occasionally the outside of her thighs felt as if there was a pulling sensation. Her memory was still poor and her sleep was not peaceful. However, this winter she did not get chilblains. During her period her back hurt and the menstrual flow amount was scanty. The right lower abdomen no longer had pain upon palpation. She continued to take the original formula. She took one to two bags every week.
In the case notes, it is stated that Guì Zhī Fú Líng Wán Jiā Niú Xī Dà Huáng Tāng is a frequently used formula by Dr. Huang. He often uses it for body types that are robust and not deficient. These patients exhibit clear blood stasis signs like hyper viscosity of the blood, placenta accreta, endometrial hyperplasia, lumbar disc herniation, sores, benign prostatic hyperplasia, deep vein thrombosis, cerebral infarction, and chronic respiratory disease types of illnesses. For all those conditions, Guì Zhī Fú Líng Wán Jiā Niú Xī Dà Huáng Tāng is a highly efficient formula.