Depressionangerirritability

Traditional Chinese
Medicine Cases

The cases are for educational purposes and not for self
diagnosis and treatment. Please see a professional for a
proper assessment and treatment.

34 year old, Caucasian female
CC: Depression, anger, irritability
The patient has been feeling not very emotionally stable for the past few months. She is an
artist, and now she feels that she cannot do the things she wants to do, because she has to spend
her entire time taking care of her children. She does not have a lot of patience with her
children, although she loves them very much. She always feels irritable. Her husband is away
at work most of the day, and she feels the entire responsibility of raising the kids is on her. She
doesn’t seem to get any time to do more creative work, such as her art projects and yoga or
other recreational activities.

Medications: None, except Calcium, and occasional use of Ibuprofen for neck pain
Surgeries: C-section 2000, and 2003

Other: Chronic low back and neck pain, elbow pain, constipation, cold intolerance, fatigue and
low energy, low libido, falling hair, cloudy urination and constipation with hemorrhoids,
insomnia, PMS, and menstrual cramps

History:
The patient was in a car accident 13 years ago and has a chronic low back pain, and neck pain
since. Her low back pain seems to have increased after childbirth, and lifting the children and
doing household chores seems to aggravate the pain.   She has recently developed a pain in the
elbows for the past 4 months in both elbows, which does not allow her to lift anything. She feels
that this may be related to carrying the children as well. The pain comes and goes, and like her
low back pain is aggravated by lifting, and doing household chores.

She also has eczema on her ankles, which initially started with damp weather, but now it comes
with any weather change. Other findings include, tinnitus, cloudy and frequent urine, low
libido, low energy and fatigue, feeling of cold, and cold intolerance and falling hair. She also
has constipation and hemorrhoids for 10 or 15 years. Eating high fiber foods seem to help with
the constipation. She can’t eat rich foods, and restaurant food, which give her gas and
bloating, heartburn and digestive problems. She tends be worry a lot, and is overly protective
of her children. She doesn’t sleep well because of her children waking up at night. Each month
before her cycle, she experiences breast swelling and distention, menstrual cramps, emotional
changes and PMS. Her last cycle was 22 days ago. Generally her cycle lasts 7 days, and is 28-
35 days cycles. There are not much clots, although she does have cramps.

Tongue: Puffy, slightly pale, red tip
Pulse:
Right side: Thready, slightly rapid        Left side: Thready, slippery, slightly rapid

TCM Diagnosis: Kidney deficiency, qi and blood stagnation
Treatment Principle: Tonify kidney, move qi and blood

Western Approach:
Essentials of diagnosis for hypothyroidism include, weakness, fatigue, cold intolerance,
constipation, weight change, depression, menorrhagia, and hoarseness. Others include dry skin,
bradycardia, delayed return of deep tendon reflexes, anemia. T4 and RAI uptake are usually
slow, and TSH is elevated in primary hypothyroidism. Hypothyroidism may be due to primary
disease of the thyroid gland itself or lack of pituitary TSH. Mild hypothyroidism often escapes
detection without screening. Early and frequent symptoms are fatigue, lethary, weakness,
arthralgias or myalgias, muscle cramps, cold intolerance, constipation, dry skin, headache and
menorrhagia. Physical findings may be few or absent. Features may include thin, brittle nails,
thinning of the hair, pallor, with poor turgor of the mucosa.

Laboratory findings reveal the FT4 may be low or low normal. TSH is increased with primary
hypothyroidism, but is low or normal with pituitary insufficiency. Other laboratory
abnormalities may often be seen, which include increased serum cholesterol, liver enzymes, and
creatine kinase, increased serum PRL, and hyponatremia, hypoglycemia and anemia. Some
clinically euthyroid patients have mildly elevated levels of serum TSH, 5-10 mlU/L, without any
other manifestations of hypothyroidism; serum FT4 levels are normal. Such patients are said to
have “sub-clinical hypothyroidism”.

Western Treatment:
Levothyroxine is the treatment of choice. It is partially converted in the body to T3, the more
active thyroid hormone. In patients taking a certain daily dose of levothyroxine, significant
serum T4 levels are seen within 1-2 weeks, and near maximum levels are seen within 3-4 weeks.
Before therapy with thyroid hormone is commenced, the hypothyroid patient requires at least a
clinical assessment for adrenal insufficiency, which would require concurrent treatment. It is
important to stress to the patient that levothyroxine therapy must be continued for life and that
regular periodic dosage reassessments will be required. Women with hypothyroidism may require
increased does of T4 during therapy with oral estrogen. Each patient’s dose must be based upon
careful clinical assessment. Although serum TSH levels can be helpful in determining optimal
dosing, it is important not to rely entirely on this test alone.

Acupuncture: Ub 17, 18, 23, 25, 40, 57, SI 3, Kid 3, Sp 4, Liv 3, neck ashi points, Gb 20,
Ub10, Li 4.

Explanation of Points:
UB 17 Influential point of blood, invigorates the blood, dispels stasis
UB 18 Back Shu point of the liver, spreads liver qi, regulates and nourishes liver blood,
pacifies wind, benefits the sinews
UB 23 Back Shu point of the kidney, tonify kidney, fortify yang, benefits essence, firms kidney
qi, regulates water passages and benefits urination, strengthens lumbar region
UB 25 Back shu point of large intestine regulates intestines, transforms stagnation, alleviates
pain, strengthen lumbar region
UB 40 He Sea and Earth point of UB Benefits lumbar region, activates channel and alleviates
pain, benefits the bladder
UB 57 Relaxes the sinews, activates the channels and alleviates pain, treats hemorrhoids
SP 4 Confluent point of Chong Mai Harmonize middle jiao, regulates qi, resolves damp, calms
the spirit, regulates chong
SI 3 Confluent point of Du benefits the occipital area, neck, back, regulates du

Liv 3 Spreads liver qi, regulates menstruation, regulates lower jiao
LI 4 Activates channels and alleviate pain, restores yang
GB 20 Activates channels and alleviate pain
UB 10 Activates channels and alleviate pain
Kid 3 Tonify kidney, strengthens lumbar spine

Herbal Formula: Yin Yang Huo 9g, Shan Zhu Yu 9g, Rou Chong Rong 12g, Ba Ji Tian 12g,
Suo Yang 9g, Qiang Huo 9g, Qin Jiao 9g, Wei Ling Xian 12g, Ze Lan 9g, Huai Niu Xi 9g, Gan
Cao 6g, Tao Ren 12g, Hong Hua 9g, Gui Zhi 6g

Explanation of Formula:
Yin Yang Huo Tonifies kidneys and fortifies yang, frequent urination, painful cold low back,
joint pain, low libido, menstrual irregularities due to deficient liver and kidney and ascendant
of liver yang

Shan Zhu Yu Tonifies and augments the liver and kidneys with low back pain, retains leakage
for excessive urination

Rou Chong Rong Tonifies kidney, strengthens yang, urinary incontinence, cold pains in the
low back, moistens intestines and facilitates passage of stool.

Ba Ji Tian Tonifies kidneys and fortifies the yang, low libido frequent urination, cold and
painful low back, strengthens sinews and bones, disperses wind and expels cold damp

Suo Yang Tonifies kidney and fortifies yang, low libido, nourishes blood, augments the
essence, and strengthens sinews, moistens the intestines and unblocks the bowels for constipation

Qiang Huo Unblocks painful obstruction and alleviates pain, especially in upper limbs and
back. Guiding herb to Tai Yang and Du

Qin Jiao   Dispels wind damp and relaxes sinews, moistens intestines and unblocks the bowels

Wei Ling Xian Dispels wind damp, unblocks the channels and alleviates pain, promotes
movement of qi in the channels

Ze Lan Promotes the movement of blood and menstruation, invigorates blood and dispels stasis
for pain due to injury

Huai Niu Xi Invigorates blood, expels blood stasis, dysmenorrhea, strengthens the bones and
sinews, benefits joints for pain and soreness affecting the low back

Gan Cao Moderates spasms and alleviates pain, moderates and harmonizes the formula

Tao Ren Breaks up blood stasis, including menstrual disorders, and trauma, moisten the
intestines for constipation

Hong Hua Invigorates the blood, unblocks menstruation, dispels blood stasis and alleviates
pain.

Gui Zhi Warms the channels and disperses cold, for painful obstruction in joints and
limbs, and dysmenorrhea due to cold obstruction, warms and facilitates the flow in the blood
vessels for dysmenorrhea

Sources:

Tierney, L., McPhee, S., Papadakis, M. 2005 Lange Current Medical Diagnosis and
Treatment. Lange Medical Books/McGraw Hill, New York, NY 2005

Beers M.H. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research
Laboratories, Whitehouse Station, N.J. 1999

Deadman P. A Manual of Acupuncture. Journal of Chinese Medicine Publications, England,
2001

Yeung H.C. Handbook of Chinese Herbs. Institute of Chinese Medicine, Rosemead, CA, 1996

Yeung H.C. Handbook of Chinese Herbal Formulas. Institute of Chinese Medicine,
Rosemead, CA, 2004

Benskey, D. Chinese Herbal Medicine: Materia Medica Revised Edition. Eastland Press Inc,
Seattle, Washington,

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