Wu Ling San Not working in Kidney Yang Deficiency Edema

[Vilhena]

Hi there Qiologicians. Greetings from Portugal

This is my first topic, and I’m not an very experienced practitioner, so be gentle with me

4 weeks ago I had a patient whose main complaint was generalized edema and headache, since approximately 2 years ago.

The edema started in the lower limbs and in the last year started to be present in upper limbs as well.
Blood analysis revealed a big concentration of salt levels.
In the past she also had Kidney Stones, a recent eco revealed that they’re not present anymore.
She fills very puffy, heavy and with lack of agility.
She also said that her weight keeps increasing no matter the changes she makes in her diet.

The headaches used to appear only when she menstruated, but right now they’re present all the time. Increasing in frequency and intensity, to the point that medication sometimes is no longer effective.
Accompanying headache symptoms: vomits, nausea, dizziness, hearing loss, sudden changes between heat and cold (warm head with cold hands and cold sweat).
Headache location: front of the head (ST channel), temples area (GB channel) and back of the head (GB 20 region).

She usually feels cold and she’s very tired (mentally and physically). She has night sweats but no thirst and has no trouble falling aspleep. Usually awakes 2,3 times per night but go back to sleep without problem.

She did cardiology exams which showed no problems. Nonetheless she has weekly palpitations, sometimes pain in the heart region and in January she had an episode of strong pain in the heart with vomits, control loss of the sphincters, chest paint and hearing loss. The next day this got worse and she had to go to the hospital. Again they did exams, look for stroke markers, but it all came back ok.
Her digestion is good, no reflux, no strange taste in the mought and her apetite is normal.

She has some hearing loss and some lower back pain (I believe it’s because of the excess weight) and she don’t urinate has often has she should.

Her pulse felt very weak and hard to find, specially in the KI positions.

The tongue image is bellow

I felt this could be a good case for a Wu Ling San and after 2 acupuncture sessions (which improved the headaches but had no effect in the Edema) I gave her the formula.
A week later I sent her a message to see how she was doing, and she told me that she had to stop taking it, because she felt more swollen, did more urine retention and started to feel a pain in the Kidney area.
As I said, I’m not that experienced and this was actually my first Wu Ling San prescription, so I got really scared and don’t actually no what to do, or understand the mechanics behind what happened.

Do you ever had similar experiences?

I was planning to see her this week, but I think she got scared and she didn’t replied my last message.

Thank you for your attention.

Best regards,
Ricardo Vilhena

Summary

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[sweiz]

Hi Ricardo,
My thought is that this woman has edema due to kidney Yang deficiency. In this case, the Wu Ling San would be draining without supporting the transformation of water in the correct place (ministerial fire). I would suggest Zhen Wu Tang. This will supplement and consolidate the kidneys while working with the water. Does that seem right to you?

[rappeports]

This looks like a Zhen Wu Tang presentation to me. Not Wu ling san. Cold, pale tongue, night time urination, edema starting in the lower body. Her tongue looks lavender so there may be some blood stasis involved also. In terms of Saam,

[Vilhena]

Hi @sweiz and @rappeports .

That could be a good choice, but I think that in this case there is also a component of Yin Deficiency (the way that the headaches appear). I believe, Zhen Wu Tang is not the best option if you have some heat flaring up, is it not?

Thank you.

Kind regards,
Ricardo

[dcantor]

My first thought was Zhen Wu Tang as well. I would think the headaches, heat in the head, waking frequently at night, and other sx accompanying the headaches could be from deficient Yang floating upwards, in which case Zhen Wu Tang would still be appropriate but you could consider increasing the Fu Zi dosage enough so that it can effectively bring the Yang back into storage in the Kidney, particularly at night. There seems to be a blood deficiency and stagnation component as well, but for me, I would start with a modified ZWT, potentially adding some blood builders and mild movers after seeing how she responds to the base formula.

[Jeffrey]

Interesting herbal case, I wonder how it all turned out? Did ZWT Do the trick, or at least begin to Build kidney yang and support spleen yang a bit? Sounds like a good option to get going. What did you do to her headache? ( so many potential approaches and herbal medicine )
As an herbalist, I always consider Cun/ guan / chi Bilaterally as my primary diagnosis, Followed by auricular confirmations.
( My teacher would always say we are guessing if we don’t follow the pulse.)
From what I gather her middle jiao sounds relatively calm, but again without complete pulse diagnosis it’s hard to know from my side.
With the presentation of headache I would want to know more about R cun. This is of course The lung and the immune system. So we consider Tai yin ( first line of interior defense )but we also have to consider if there is fire, heat, impetuous rhythm here ? If so, I would want to find out if the R chi was long and tight and on what level of deep/jump/shape/quality etc. this of course in some systems related to the Tai yang, UB Area and the head into the neck. Constriction here could show as many things, cv spine pressure, peripheral blood, urinary issues etc.
L cun? If it is scattered and/or weak ? we need to raise it up to command heart blood and to wake up her brain. L chi to me is probably the most important position but certainly not comprehensive with in itself.
Again quality, velocity, depth, shape, here identifies everything from muscular skeletal lower body( lumbar issues) reproductive( stagnation, surgeries, fibroids etc),thyroid- endocrine function, vascular construction etc
All under the umbrella of kidney Yang.
Always a little bit concerning about Tonifying when someone’s presenting with regular headaches, not so much of an issue if it’s just during her menses.
With this limited information I could think of many different strategies to try. Again, this is just an contrast for another way of thinking .
I always want to know about someone’s bowel first before I treat, BP too.
I presume you pressed into her medial tibia above her ankle in order to find out if there was pitting or not? This type of Edema usually points to an issue with cardiovascular, kidney, and/or liver.
If there was deep pitting I would treat that first by itself first before moving forward.
if it was more heart related I would use ;
MAO DONG QING 100g 2sp, 3x pd ( apx 9-10g p day)
If I thought it was more kidney related I would use :
SHUI DING XIANG 50
XIAN FENG CAO 50 2sp, 3x
100 g last about a week.
If no pitting then different story
Again ZWT is reasonable approach especially If the bowel was normal to loose,there was no pitting, end it was confirmed that she actually had kidney and spleen yang xu. Perhaps I’m driving at the importance of a strong diagnosis. And having a strong feeling about your strategy. Always mindful of 中药西用 ,Zhong yao Xi yong, using Chinese herbs in a western way.(mindful of not doing that).
As a case has more confused symptoms the above is especially important. The strongest indication here is the symptom of cold hands and feet leading to Yang xu. If we consider the two formulas SI NI TANG, and SI NI SAN, they both treat the symptom. The etiology on the other hand is very different. The first one of course being Yang xu, the latter being central stagnation to the periphery and/or counter flow to the four limbs. I’m sure once that was clear I would likely add 10 to 15% of that formula to the formula.
I don’t keep ZWT in my pharmacy which is why I wouldn’t use it, but a great formula.

Si ni tang 10
Xiao chai hi tang 20
Ba wei Di huang wan 30
Wu Ling San35
Chuan Xiong cha Tiao San 25
120g. 2sp, 3xpd this will last two weeks

This of course is just one idea based on signs and symptoms much more than an actual diagnosis Of pulse.
Once again, clinic can be complex And difficult. Sa’am and herbal medicine can go side ways.
I know this post is in the rears, but maybe useful to some degree