Case study answers (in bold typeface)
Mr. Zhang (male, 52) underwent a vasectomy 15 years earlier. Following this procedure heexperienced pulling pain in his left testicle and lower abdominal quadrant. This was oftendiagnosed as testiculitis, but it was never treated successfully. Upon inspection, his lefttesticle was swollen and resisted pressure. It had a glossy appearance and was moveable.He reported his urine was yellow or red and had frequent urge to urinate. His tongue wasred with a thick greasy and glossy coat. The pulse was short, sunken and wiry. WBC 12.5x 109.
What organ(s) are in charge of the area Mr. Zhang is seeking help for?
LIVER, (also possible: Small Intestine area)
What type of general diagnosis would you give?
liver qi stagnation
Of the regulating qi formulas we covered, which one is most suitable to treat this problem?
Ju He Wan
This is a relatively straightforward case, although, of course, various practitioners may use different formulas.
Ms Wang at 40 years old had a history of duodenal stomach ulcers. She commonly feltbloated felling in the stomach region and would constantly belch, especially after eating.It would become so severe she would have to wait awhile for them to subside.The stools were thin and soft and her appetite was slightly off. Her tongue was fat andsoft with a white coating. Her pulse was wiry and slippery.
What diagnosis fits Ms. Wang’s condition?
Do you think this is a hot or cold condition? Deficient or full?
Even though the symptoms appear to be full or even heat related, in fact this is a cold condition. This can be seen through the tongue, appetite, stools and chronic, lingering nature of this illness.
What formula would you give for this patient?
Xuan Fu Daizhe Shi Tang(remember this formula is given for epigastric (heart region) related bloating, fullness, distension, burping, etc., but due to spleen deficiency)
Take some time to flesh out the differences between Xuanfuhua Daizheshi tang (spleen def--contains renshen), Banxia Xiexin tang (has heat and cold--has huangqin, huanglian, ganjiang, renshen) and Jupi Zhuru Tang (uses Zhuru and chenpi to scour phlegm and/or heat in gallbladder, stomach systems).
What is the same basic formula of these and what /why are the modifications?
What herbs could be added, if any, to provide more comprehensive treatment?
Actual formula given: xuanfuhua 9g, dangshen 9, banxia 9, da zhe shi 15, zhi gancao 6, dazao 12, zhike 9, guang muxiang 6, houpo 9.
---Think of other possible herbs that might help with Ms Wang’s symptom: for example, zhizi, huanglian, sheng jiang, haipiao shao, etc…..