Huang Huang Classic Formula Case Studies – Premenstrual Anxiety, Edema, and Menopause

In the Spring of 2015, 2nd year student Gabi Masek translated the following case studies.

Case 19:  Pre-menstrual Anxiety

The patient is female, 47 years old.   April 1, 2012 was her first office visit.

General Appearance:  Her body appears robust, the skin color is slightly pale, her face is flushed and her lips are bright red.

Relevant Medical History:  3 days before her menstrual cycle comes she gets a headache for the last 3 years; every month she has it.  The headache is worse on the left side.  Her menstrual cycles are regular and the volume and color are normal but with a small amount of blood clots.  She easily experiences insomnia and her disposition is prone to irritability and anger.  Her appetite is strong; both urination and bowel movements are regular.  In the past she’s been healthy.  Her father suffered from diabetes.  The tongue is light red with a thin coating.

Formula:  Jiang ban xia 10g, Fu ling 10g, Zi su geng 10g, Hou po 10g, Zhi ke 10g, Huang qin 5g, Zhi zi 10g, Lian qiao 20g.  Gave her 7 bags and instructed her to take 1 bag each day.

May 13 was her second visit.  She took the medicine for 7 days and the pre-menstrual headaches and insomnia were the same as before.  The tongue was tender, red and slightly soft with a thin clean coating. 

Formula:  Gui zhi 15g, Bai shao 30g, Gan cao 5g, Sheng mai ya 30g, Gan jiang 5g, Hong zao 30g, Mai ya tang 50g* (taken with the cooked decoction).  Gave her 10 bags for 2 weeks; each week she would take 1 bag a day for 5 days and stop taking it for 2 days.

*It’s likely this is divided into 5g doses and added to each bag.

June 10 was her third visit. Her last menstrual period was May 19.  The pre-menstrual headache didn’t occur and her sleep improved. To the formula, add dang gui 10g and give 15 more bags.  Each bag of the formula was taken for 2 days.  

Case Notes:  This case is an example of pre-menstrual anxiety. At the first visit. Dr. Huang observed the following symptoms: a red face and lip redness, headache, insomnia, impatience, and being prone to anger. Because of the psycho-emotional symptoms, Dr. Huang decided to start by regulating the spirit using Chu Fan Tang, but to no avail.  The second visit his perspective towards treatment changed because of the pale skin, the tongue that was tender and soft with a thin and clean coating, and a good appetite.  Combined with her father’s history of diabetes, he used this to guide his perspective to determine the patient’s constitution. She has a gui zhi constitutional tendency so modifying Jian Zhong Tang achieved good results.

Case 20:  Edema, Easy Perspiration, Fatigue, and Knee Pain 

Patient is a female, 62 years old.  December 12, 2011 was her first visit.

General Appearance:  Her body is short and plump with the appearance of edema.  Her skin color is an indistinct yellow-white, the eyes have bags and are relatively deep-set, and her hair is grey.  Height is 156cm (5’ 7”) and weight is 78kg (~172lbs).  

Chief Complaint: Edema, easy to perspire, and both knees are painful.  This is accompanied by fatigue and poor sleep for the last 13 years.

Relevant Medical History:  The patient’s symptoms began when she was 49 years old.  In 1998 she began menopause. During peri-menopause, her perspiration became abnormal.  When the night sweating became severe she would wake at night and find the 2 layers of quilts were wet through.  During the day she also perspires and when she exercises or after eating she perspires even more heavily, although when she doesn’t exercise there’s also constantly a small amount of perspiration coming out.  The sweat is not yellow and not sticky.   During the day she is exhausted.  She walks slowly and laments, “it seems like I’m 80 years old and already move like an old lady”.  Her waist, the small of her back and below have a feeling of cold, both knees are painful and the lower limbs have edema.  There is no thirst and her appetite is good, she’s able to eat and never has abdominal distention.  She always controls her diet for fear that eating too much will make her fat.  Her bowel movements are generally soft with lots of flatulence.

After turning 49 her weight increased by an extra 20kg (44lbs), her sleep became poor and she would wake up easily.  She says, “when watching TV I can fall asleep but when I go to bed however, it’s difficult to fall asleep.”  

She’s had hypertension for 10 years.  She regularly takes the medication Norvasc that has controlled and stabilized her blood pressure.

She has a history of gallstones and had her gallbladder surgically removed.  There is also a history of the narrowing of the vertebral canal of the lumbar vertebra and a lumbar disc bulge.  She also says that in the summer she has had “ring-like erythema”.  

Physical Exam:  Her stomach is large and soft.  Both lower legs have mild pitting edema.  The tongue is dark with a thin white coating.  The pulse is deep.

Formula:  Fen fang ji30g, Sheng huang qi 30g, Bai zhu 30g, Sheng gan cao 5g, Gan jiang 10g, Hong zao 20g, Sheng ma huang 5g.  She was given 10 bags and instructed that each week she was to take 5 bags and stop for 2 days.  

December 27, 2011 was her second visit: The sweating clearly reduced and her fatigue was lightened.  Her sleep at night improved.  The foot edema decreased and the pain in both knees was lightened; standing and walking became unrestricted.  The lower limb and waist coldness was the same as before. 

After three bags of Chinese herbs, she had intestinal rumbling, increased flatulence and three episodes of diarrhea.  The day after the diarrhea, she had a regular bowel movement.  To the original formula Gui zhi, 15g was added.  She was given 15 more bags and instructed each week to take 5 bags and stop for 2 days.  

January 16, 2012 was her third visit: Her waist and knee pain with the coldness improved and at night she wasn’t spontaneously sweating but during the day the sweat was still excessive.  The lower limbs still had edema and their strength is increasing; she is able to climb stairs.  Her feeling of hunger has lightened.  

She continued taking the above formula for 15 bags, every week taking the formula for 3 days and stopping for 4 days.  

March 5, 2012 was her fourth visit: She is still sweating but the aversion to cold and the leg pain and coldness has improved.  The lower limbs are without obvious edema.  Urination is smooth and bowel movements are regular.  

Formula:  Fen fang ji 30g, Bai zhu 30g, Sheng Gan cao 5g, Ze xie 60g, Sheng huang qi 30g, Gui zhi 20g, Gan jiang 10g, Hong zao 20g.  She was given 14 bags and instructed to take 5 bags each week and stop for 2 days.

April 2, 2012 was her 5th visit: The daytime perspiration is as before and at night there is basically no sweating; the armpits have yellow sweat that has come out for many years.  She says her clothes are colored yellow and washing doesn’t remove it.  When she walks her legs and knees still feel heavy and lack flexibility, but the pain is gone.  This last year her weight has increased.

Formula:  Fen fang ji 30g, Bai zhu 30g, Sheng gan cao 5g, Ze xie 60g, Sheng huang qi 30g, Gui zhi 20g, Gan jiang 10g, Hong zao 20g.  She was given 14 bags and advised that each week she was to take 5 bags and stop for 2 days.

Advice:  If after taking the formula the symptoms reduced then she could take each bag for 2 days.  If there are any problems with abdominal distention then reduce dosage of the formula by half.  

Analysis of Treatment Effects:  The perspiration improved and the knees and legs were lighter.  

May 21, 2012 was her 6th visit: The perspiration appeared to improve and she says “Sometimes when I exercise I sweat as before and it’s still slightly copious.”  Her appetite and sleep are both good, urination and bowel movements are regular; her weight increased by 2 kg with the feeling of fatigue lightening.  When she walks the knees still lack flexibility.  Kept the previous formula and she continued taking it for 14 bags, each bag of the formula was taken for 2 days, so as to consolidate the treatment.

Case Notes

1. This set of symptoms, which includes “edema, sweating easily, fatigue and knee pain syndrome”, is an indication of a Fang Ji Huang Qi Tang constitution. For the details see previous writings on the “Fang Ji Huang Qi Tang Constitution”.

2. The patient said, “when watching TV I doze off but when I go to bed however it’s difficult to fall asleep”. This means that during the day she’s drowsy and at night it’s hard to fall asleep. Because she is overweight and robust, add Ma huang for this symptom.

Case 21:  Menopausal Syndrome

Patient is female, 52 yo December 5, 2011 was her first office visit.

General Appearance:  Her build is moderate and she is short, her skin color is pale yellow and there are bags under her eyes. 

Relevant Medical History:  Her right knee has been sore for more than a month.  She’s aware of tendon pain and when there’s wind the pain is more intense. Walking is difficult.  Both feet are ice cold.  Her shoulders have an aversion to wind and cold.  Now and then there are palpitations and chest oppression with sighing.  Her sleep is poor with lots of dreams.  Her appetite is good and urination and bowel movements are normal.  Her menses ceased one year ago.  There was a period of time in which she experienced hot flashes and sweating.  In the past her body has been healthy.

Physical Exam:  The right knee is swollen and she’s unable to squat.  The tongue is dusky red, the sides are scalloped, and the coating is thin and greasy.  The pulse is deep.  

Formula:  Gui zhi 20g, Zhi fu pian 15g (cooked first for ½ hour), Bai shao 20g, Sheng gan cao 5g, Gan jiang 10g, Hong zao 15g, Bei xi xin 5g.  She was given 7 bags and also advised to eat lamb broth with ginger. 

December 20, 2011 was her second visit: Her period had stopped for a year but after taking the formula it came again.  She menstruated for 4 days.  The menstrual color was red and before menstruation there was also breast distention.  She says that her right knee pain and swelling is improving.  Her sleep has improved, she’s mildly thirsty, and both shoulders still have an aversion to cold.  Currently her lower right leg is still unable to completely bend.  The knee swelling and pain on the right side has lightened.  

The original formula was kept and to it Dang gui 15g was added.  She was given 14 more bags and advised to take 1 bag a day.   She was instructed that once the symptoms were alleviated she could take 1 bag every 2 days, 3 days, 5 days, or 1 week to consolidate the treatment.  

Case Notes:  Menopausal syndrome and its clinical manifestations are due to decreasing ovarian function and decreasing female hormone levels.   Systemic and nervous system changes can occur, such as menstrual changes, pain in the low back and legs, flushed face, hot flashes and sweating, palpitations, lack of strength and emotional lability.  In more severe cases, the emotional disturbances, such as anxiety, depression, irritability and insomnia can significantly affect the quality of life.  Classical Chinese medicine stabilizes the clinical manifestations of menopause and alleviates the associated discomforts through attention to specific physical complaints as well as regulating the patient’s constitution.  Medicines for menstruation from Western doctors improved her symptoms but gave her side effects, She recuperated to her original constitutional state so as to help her body mechanics eliminate various kinds of psycho-emotional illnesses and stabilize her menopause.  This present case is a fairly typical with Gui Zhi jia Fu Zi Tang pattern.  Commonly used menopause formulas:  Geng Nian Fang, Wen Jing Tang, Chai Gui Tang, Wu Ji San, Long Mu Wen Dan Tang, Chai jie Long Mu Tang, Suan Zao Ren Tang, Sheng Xue Tang, and Da Chai Hu He Ling Gui.