female age 48 (full case format)
CC: Waking 2-3 am parched with dry mouth at night, no saliva, does not feel hot. This got noticeably bad starting in September. Dry eye is worse along with parched at night.
Interstitial cystitis (intermittent). Urgency and not much comes out, bladder hurts/feels tight.
Dizzy/head pressure or lightheadedness. Hx: Heat sensitivity since traveling in Greece 8 years ago where she had heat exhaustion. After her trip to Greece, while driving on a sunny January day she had an episode of dizzy/head pressure for a month. Pressure in forehead and zygoma area and dizzy - unstable feeling and had to pull over (not vertigo/no room spinining). After vacation to Brazil, it lightened up. Acupuncture helped. She still has blips of this dizzy/head pressure or lightheadedness often triggered by sun.
Appearance and Demeanor:
Thin/fit, slightly petite and proportional, pretty +4, average bone structure, moderately thin hair, bright eyes +2, slight redness left cheek +1, polite +7, aware +7.
Morphology and Flesh: Fit body, Flesh is light/soft.
Skin: Skin not dry.
Lifestyle: focused attorney (commercial real estate law - not stressful work, esp working from home), more on introverted side, exercises a lot, loves traveling, reading. Not/rarely bored. More librarian type, but she can get reactive with her daughter (in college but at home because of COVID). More on soft spoken side but not shy. Resourced.
Perspiration: Very little sweating even with exercise, will sweat if runs over an hour, doesn’t get red in face.
Body temp: Hates heat and humidity, not bothered by VT cold weather, cold hands and feet (feet colder to touch), likes cool mist of forest. Wears sunglassses AND visor in sun. Feels like she needs to be sheltered from the sun as it triggers Sx. Used to be ok with sun – grew up in FL.
Dream environment = 50’s fall
Thirst: thirsty, not excessively in day time, more thirsty at night, not always quenched by drinking, if drinks too much water gets bloated.
Urination: normal/smooth, except with IC when there is urgency, discomfort and not much comes out.
GI: Constipation – usually hard bound stools, every 2-3 days, uses Miralax as needed.
Reflux since COVID, feeling of indigestion in epigastrium.
Appetite is ok, doesn’t eat big meals, bloated in upper belly lately.
Doesn’t feel good with sugar, hates fruit, drinks wine.
Big burning painful canker sores front of tongue 10x yearly.
Sleep: Falls asleep fine, wakes 2-3 am parched, falls back asleep then wakes constantly/every half hour. Energy not good since she hasn’t been sleeping well. Was fine before September.
Other body: Dry eye for 2 years, uses drops in morning and night. Worse with this issue of being parched at night.
Floaters occasionally with sunshine.
hx of occular migraines “sunray” treated with OBC
GYN: No problem getting pregnant (once by choice - colicky baby), periods ok (on OBC) cramps and PMS Not bad.
Emotions: Frustrated with her health, as she is good at taking care of herself. Wakes frustrated in morning.
Signs: fleshy heel, Lu 10 is not sunken.
Hara: weak low belly, slightly taut upper belly, ticklish R hypochondriac and St 25.
P: R guan is stronger, L guan is weak and thin and sometimes taut.
T: Red tip, pale purple with pale sides
GB: red tip tongue, sleep issues/hyperactivity at night, can be reactive
P: intelligent, attorney, introverted, focused
SJ: polite, aware, light open flesh, dizzy/lightheaded worse with sun/bright, wears sunglasses and visor, (likes cool mist forest), cold hands and feet (feet colder), focused, bright eyes +2, sl red left cheek, floaters?
Heart: Hates heat, cold doesn’t bother her, thirsty and not quenched?, hyperfunction?
UB: female, urinary issues?, dry eye?
K: fleshy medial heel, pale purple tongue, dizzy, symmetrical/pretty +4 , easy to get pregnant, pain at SI 14, pale purple tongue
SI: weak low belly, thin hair
Lung: reflux, nausea, bloated, hates humidity?, bloated if drinks too much?
Stomach: thin, moist/not dry skin?, constipation?
LI: dry constipation, never bored, thin
Spleen: Hates humidity, bloated if drinks too much
*I thought some sx could be more than one channel, so I put those in both with a ? for my second choice. Is this an ok way to do this? I also put a question mark by a couple I wasn’t sure about.
GTITR: Lack of available fluids esp at night. Wakes parched at night, thirsty at night and dry eye worse.
Main Tx ideas: Liv+, UB+, SI+, St+ (all taken except SI+)
Other Tx ideas: P+, Sp+ (Sp+ wasn’t good, but maybe in future after dealing with dampness)
10/9 Liv+ no change in CC but felt good after tx. 3 days later woke nausea and blip of lightheadedness, constipation cleared out and stool wasn’t dry. some reflux/indigestion upper ab.
10/14 Sp+ nausea for1 1/2 days, but less dry, lightheaded on and off, reflux ok, taking miralax for constipation.
10/23 K+ mostly the same, no nausea or lightheadedness, good energy in day. Then 4 days post treatment SO dehydrated even in daytime, thirsty, constipated, had blip with interstitial cystitis, felt like UTI - feels like has to go, but not much urine.
10/30 Liv+ R and P+ with teishin - felt good, more balanced than previous. a little less dehydrated starting 4 days later. 15% less intense. Started taking herbs the day after the treatment. IC calmed down some, bladder hurts, muscular pain and tight. bloated after eating sometimes, and after drinking.
11/9 Lu+ she initially reported her main sx of being parched at night was the same or slightly better, had a headache that evening (which she attributed to a blood draw that same day). She reported a blip in interstitial cystitis - urgency and not much urine comes out. they found bacteria in her urine and she ended up on antibiotics. She had a biopsy of her salivary gland to test for Sjogren’s and had a bruised, numb lip and couldn’t eat. By the time she came in 11/16 she was super parched at night like it was a month ago (we had made some progress) and she was quite constipated.
11/16 UB+ and it helped her urinary sx but not her chief complaint. (she was also on antibiotics) She later reported that had bad reflux all week. She received the diagnosis of Sjogren’s.
When she came in she also had pain at about SI14 on the R, which has come and gone in the past.
She emailed me yesterday to say that she had some improvement - the reflux is down and she is less dry at night.
I will see her again tomorrow and my top ideas are SI+ (which Kristin suggested when I presented, and maybe I should have done that last week) esp if she still has that pain around SI 14.
Maybe Liv+/SI+ since she has done very well with Liv+ (constitutionally at least) in the past.
P+ is still on the short list, mainly because she is woken at night parched, and has red tip tongue. Maybe Liv+/P+
St+ again is also definitely on the list.
Discussion and thoughts on this case:
I didn’t go to UB+ initially because she isn’t hot when she wakes parched. The results were not remarkable, but I may consider it again down the line.
I was honing in on the 6 Conformations here, maybe too much.The Yangming and Taiyin, as well as Jueyin, was what I saw for her. I was seeing the Yangming as blocked so I wanted to unblock the Yangming and give her Taiyin fluids. But even though I wrote Yangming xu for her diagnosis, I got stuck on Yangming block as being XS (yes George, on purpose this time). Her fluid balance is off and she is clearly not absorbing fluids. After re-watching the Advanced class this week, I have been able to absorb (on purpose, George) more of Toby’s wise words and discussion about thin people with constipation and not absorbing fluids.
I clearly was off with my Taiyin choices Sp+ and Lu+ from her response. I took Sp+ even though she was having nausea (doh!). Maybe Sp+ would be ok if my timing was better, as she did have some less dryness that week. Lu+ was wrong for her (the direction!) and St+ was so much better - even though she seems to be dry inside (dry constipation, parched?) and her lovely skin is not dry (not greasy). She seems to be either dry inside damp outside, or double dry. And she has some retention of not absorbed/pathological fluids inside, which may be partly why she did well with St+. Maybe she could be considered double damp Sp XS while she has the pathological fluids inside (nausea, hates humidity, bloated if drinks too much) but it’s a bit of a stretch.
I was leaning towards the parched mouth as inside dry since she is not absorbing fluids. But maybe since St+ helped it shows that it is outside dry. UB+ didn’t help - since it’s Taiyang I would have thought UB+ would be helping fluids on the outside, but I recall Toby saying it is the whole body.
It seems like she has dry and damp inside!
So thinking 6 conformations, maybe she needs Yangming supplementation with St+ and LI+ to improve/strengthen her digestive functioning/constipation and clear pathological fluids before potentially hitting her again with Taiyin fluids Sp+.