Case 6: Delayed menstruation case 1

Ms. W, age 27. 12/20/2010 first visit.

Physical examination: Her body type is moderate and she is robust, she has a flushed face, thick hair, and double lidded eyes. Her eyes are large and vibrant.

Relevant medical history: When she began attending college her menstruation was irregular, when she was on vacation at home her cycle normalized, and then when she began working it again became irregular. She has not menstruated in more than two months, and occasionally experiences dysmenorrhea despite not menstruating. She is able to sleep well, and her bowels move normally. Her weight is stable and has not changed. Three years ago she went to a gynecology department, where ultrasound found no abnormalities. Her mother and father are healthy and not overweight. 

Physical exam: The tongue is pale red with a moist thin fur. Her face and back have no acne. The skin on her lower legs is not dry but has many fine hairs (These showed up after using a plaster for periostitis of the lower leg in middle school).

Formula: Ge gen 30g, gui zhi 15g, bai shao 15g, sheng ma huang 5g, sheng gan cao 3g, gan jiang 5g, hong zao 20g, dang gui 10g, chuan xiong 15g, 15 bags. Every week take five bags. Take warm after meals, avoid cold and uncooked food.

5/28/2012 second visit: After taking the previous formula the period regained regularity. However she has not menstruated for three months. Gave another 15 bags.

Case 7: Delayed menses case 2

M young woman of 17 years old August 28, 2010 first visit

General appearance: Her body was plump and her skin was white. She had a yellow dusky complexion with thick eyelashes and hair.

Relevant medical history: Her menses was frequently late and for the last 4 months she did not have a flow. She was relatively healthy otherwise.

Physical exam: Her tongue was pale and plump with white fur and below the umbilicus there was abdominal hair.

Formula: ma huang 10g, fu zi10g, bei xi xin 5g, ge gen 60g, gui zhi 15g, bai shao 20g, sheng gan cao 5g, dang gui 10g, chuan xiong 15g, bai zhu 15g, fu ling 15g, ze xie 20g, gan jiang 10g, hong zao 20g, 10 bags, every week she took 5 bags.

March 11, 2012 2nd Visit: In 2010 she took the previous formula and after 20 bags her menses was normal and her cycle was 30-35 days. Her last menses was January 8, 2012. It stopped for 2 months and has not yet come again. She was relatively healthy otherwise. She had acne on her forehead. Her tongue was pale red and the fur was thin and moist. She was given the original formula 15 bags. Each day she took 1 bag, taking it after meals. She was advised to stop taking the formula when her menses started.

April 15, 2012 third visit: Every day she ran for 1 hour. Her weight dropped by 2kg. Her appetite and sleep were good and her bowel movements and urine were normal. Her menses had not yet started. Her tongue was pale red with thin, moist fur. She continued to take the previous formula.

Postscript: After taking 7 bags her menses started and thereafter it was regular. In October I followed up and learned that in August she had gone to the USA to study abroad. Her weight again fell by 8kg, moreover her skin had become fine and smooth and her body hair had decreased.

Case Notes: In the previous case I used Ge Gen Tang combined with Dang Gui Shao Yao San. In this case I furthermore added Ma Huang Fu Zi Xi Xin Tang. She had a strong physique and she was robust thus the herbs in the formula needed to be of equivalent potency.

When comparing this case to a Wu Ji San pattern, the Wu Ji San pattern often has manifestations of poor digestion such as belching and epigastric distention. It also has a neurologic component with symptoms like dizziness, fainting, headache, daytime fatigue and insomnia.

Case 8: Amenorrhea Case 1

Z female, 15 years old. March 18, 2012 first visit.

General appearance: Her body was thin and strong with a slightly dusky skin color. Height 1.65m, weight 45kg

Relevant medical history: She was 13 years old at the time of menarche. Afterward her menses was irregular, it was frequently late, and she had amenorrhea for the past 6 months.  Her stools were dry and hard and she had a bowel movement every few days.

Physical exam: Her tongue was dusky red with greasy fur. Her hands and feet were icy cold.  

Formula: Gui Zhi Fu Ling Wan with niu xi, da huang, ge gen, ma huang, 10 bags, each week she took it for 5 days.

April 15 second visit: Her weight was stable. After taking the formula her menses had not yet started. Her stools changed so that they were easier to pass and every 2-3 days she had a bowel movement. She was otherwise relatively healthy. Her lips were red, and her tongue was red with a thin fur.

Formula: Chai hu 15g, bai shao 15g, zhi ke 30g, sheng gan cao 5g, dang gui 10g, chuan xiong 15g, tao ren 15g, hong hua 10g, 10 bags, each week she took it for 5 days and didn't take it for 2 days.

June 24 third visit:  Her menses arrived on April 25 and May 27. The menstrual color and amount of flow were normal. Her stools were regular and easy. Her appetite and sleep were good. We kept the same formula 10 bags and every week she took 2-3 bags.

Case Notes: The patient was a junior in school, had taken on the responsibility of class leadership and was under a great deal of pressure. She had a Si Ni San constitution but this was a Ba Wei Huo Xue Tang pattern.

Case 9: Amenorrhea case 2

P woman 29 years old night shift worker. December 18, 2011 was her first visit

Appearance: Her body was thin and her skin was yellow, her face had acne, her expression was worried and depressed, her disposition was introverted. Her height was 1.63m and her weight was weight 46kg.

Main complaint: After having an abortion she had amenorrhea accompanied by acne for more than a year.

Relevant Medical History: In September 2010 she had a medical abortion plus DNC. She has had amenorrhea since then. Recently there has been no breast distention, backache or other premenstrual symptoms. Previously when she had a menses she had premenstrual breast distention and dysmenorrhea.  Her mood was worried and depressed, she had difficulty going to sleep, her sleep was light and she was easily flustered. She had frequent and excessive flatulence, her bowel movements were dry and hard, and she had lower leg cramps. 

Family history: Her father had a history of hepatitis and her mother was healthy.

Physical exam: Her tongue was slightly tender and glossy red with little coat. Her abdominal muscles were tight and hard and there was resistance in her rib area.

Formula 1: Dr. Huang spoke with her in an attempt to alleviate her depressed mood, self-criticism, low self-esteem and self-blame. 

Formula 2: chai hu 15g, huang qin 5g, jiang ban xia 15g, dang shen 10g, gui zhi 15g, fu ling 15g, mu dan pi 15g, chi shao 15g, zhi da huang 5g,  long gu 15g,  mu li 15g, tao ren 15g, chuan xiong 15g, gan jiang 5g, hong zao 20g, 15 bags. water decoct, every other day she took one bag.

February 19, 2012 2nd visit: Her menses had not arrived. Her facial acne had slightly lightened and her complexion had obviously improved. Her sleep was better, bowel movements were normal, and her foot cramps had diminished. We kept the same formula 15 bags, every other day she cooked it with water.

March 18, 2012 3rd visit: Her skin color returned to normal and her mood had also brightened. When she came into the clinic she took it upon herself to greet everyone. Her face still had very little acne. After taking the formula her menses came on February 20th and March 18th. Before her menses she had breast distention but did not have dysmenorrhea. The menstrual color was normal and the amount of flow was moderate. Her sleep was sufficient.

Formula: Gui zhi 10g, rou gui 5g, dang gui 10g, chuan xiong 10g, bai shao 30g, fresh gan cao 5g, gan jiang 10g, hong zao 30g, fresh mai ya 30g, malt sugar 50g [divided and taken as a draft], 10 bags. Water decoct and serve.   

Case notes: Regarding the present case the patient type was typical for the Chai hu jia long gu mu li tang constitution. There was a depressed disposition, because of her former pregnancy when the baby stopped developing and she had an abortion. Psychological counseling and hai hu jia long gu mu li tang allowed for the body and mind to be simultaneously regulated.