Case 16: Ovarian Cyst Case

Female, 46 years old. 09/03/2011 1st Office Visit

General appearance: Her body is plentiful, and her skin is pale yellow with an unremarkable complexion.  Her facial complexion is also pale yellow and slightly dusky with pigmented macules.  She has big eyes with double eyelids and the area underneath her eyes are is slightly puffy and dark.    

Relevant Medical Hx: She says that lately her complexion doesn’t not look as healthy.  She also notices that after prolonged periods of sitting, when she gets up she feels a sinking feeling that has an uncomfortable pressure in her abdomen.  An ultrasound diagnosed an ovarian cyst on her right side (40mmx35mmx52mm).  Other symptoms she feels are that when she rotates her trunk she easily gets dizzy,; she has a low appetite,; her bowel movements are dry and she has poor sleep and wakes easily and has difficulty falling back asleep.  Her menstrual cycles are regular, but she has pre-menstrual breast distention and achy joints all over her whole body.  Her menstrual cycle lasts for 5 days, and the color is dusky.  Previously she has been healthy but with a history of breast lobular hyperplasia.  

Physical Examination: The tip of her tongue is red, and the coat is greasy and moist.  The abdominal diagnosis and leg diagnosis are normal.

Formula: Sheng ma huang 5g, Rou gui 10g, Sheng gan cao 5g, Jiang ban xia 10g, Chen pi 10g, Fu ling 10g, Cang zhu 10g, Hou po 10g, Zhi ke 10g, Dang gui 10g, Chuan xiong 10g, Bai shao 10g, Bai zhi 10g, Jie geng 10g, Gan jiang 10g, Zhi fu pian (fu zi) 10g, 7 bags, 1 bag take for 2 days, take after meals.

9/17/2011 2nd visit: After taking this formula, the discomfort in her abdomen was alleviated, her complexion became healthier-looking, she felt that her body had strength, and her spirit was good!  But her throat became dry, and her stools were also still dry, so in the original formula the zhi zi was taken out.  She was prescribed 15 bags and was instructed to take 1 bag every 2 days after meals.  

11/26/2011 3rd visit: On 11/14/2013 she had another ultrasound that showed the right side ovarian cyst was gone.  But now her work stress is extremely high and she has been having experiencing insomnia and dreaming a lot.  He appetite is okay, and both her bowel movements and urination are normal.  Her tongue is dusky and pale.  She was prescribed 15 bags of the above formula and was instructed to take 1 bag every 3 days. 

Case notes:

1. “A plentiful body, skin macules, dark and puffy under the eyes” symptoms of a 46 year old woman when combined with the clinical manifestation of an ovarian cyst, pre-menstrual body and joint aches and dusky menstruation, consider a Wu Ji San constitution.  

2. A Wu Ji San body constitution with “a feeling of abdominal sinking and pressure after prolonged sitting” is considered as cold and damp flooding the lower body.  You can use Ma Huang Fu Zi Gan Cao Tang to stimulate the tone of the pelvic floor.  Dr. Chen Rui Chun uses Dang Gui Shao Yao San to treat uterine prolapse.  They are different approaches that have the same result.  

Case 17: Premature Ovarian Failure

39 year old female

General appearance: The patient has a fat body, and her face is yellow and edematous.  She is 156cm (5’1”) tall and weighs 61kg (134lb).

Chief Complaint: She has had irregular menstrual cycles for five years and insomnia for three years.

Relevant Medical Hx: In the past five years, she has had irregular menstruation.  She says, “sometimes Sometimes my menses starts and doesn’t stop, or sometimes it just doesn’t start at all.”  She underwent a Western medical exam was diagnosed will with premature ovarian failure.  She has suffered from insomnia for 3 years.  Other symptoms include fatigue, aversion to wind, aching in all joints, and her back is especially averse to cold.  This summer she took Lu Tai Gao and afterwards she felt that her whole body was dry.  About 2 months prior to this visit, she woke up in with whole body sweats and; her menstrual flow had started and it was very heavy.  Her appetite is normal, and bowel movements and urination are regular.  Her previous history includes uterine fibroids and gallbladder polyps.

Family History: Her father has diabetes and coronary artery disease.  

Physical examination: Her tongue is pale red, the coat is greasy, both of her legs have mild edema, and the skin on her legs is dry.  

Formula: jing jie 15g, fang feng 15g, chai hu 15g, huang qin 5g, ban xia 10g, dang shen 10g, sheng gan cao 5g, dang gui 10g, chuan xiong 15g, bai shao 30g, bai zhu 15g, fu ling 15g, ze xie 15g, gan jiang 10g, da zao 20g, 15 bags, decoct w/ ith water, every bag take for 2 days.

1/3/2012 2nd visit: After taking the herbs, the sweating ceased, her complexion improved, and her sleep has improved.  She still feels an aversion to cold, and there has been no change in her fatigue.  Her appetite and bowel movements are unchanged.  The edema in both of her leg are also unchanged.  She was prescribed told to take the original formula for another 15 bags.  

2/21/2012 3rd visit: The aversion to cold had decreased.  She had menstrual cycles on 1/6/2013 and again on 2/12/2013,; the flow was moderate.  In the original formula, fu ling was increased to 20g, and she was prescribed 15 more bags.  

4/14/2012 4th visit: Her menstruation is now regular, and her body strength, spirit, and complexion are good, and her sleep has improved.  The edema has also resolved.  Her tongue is dusky and pale red.  She was prescribed to continue taking the formula for 15 bags.  

5/21/2012 5th visit: Her menstrual cycles are now essentially regular, but she is sensitive to the sun. She was prescribed the original formula with the addition of 5g of bo he for 15 bags. 

Case Notes: Jing Fang Chai Gui Tang ordinarily treats these area condition where middle-aged women have a marked yellow face.  It has the effect to improve sleep, promote strength, lighten aversion to cold, stimulate low appetite, and stimulate sexual desire.  It is affective effective in beautifying one’s complexion with regards to skin macules and anemic appearance.  This case illustrates that by improving the entire body’s constitution, naturally it the formula will improve the weakness of the ovarian function. 

Case 18: Mammary gland hyperplasia

27 year old female.

General Appearance: Her body is relatively thin, and her skin is white and her face is pale red.  She is 5’3” (160cm) and weighs 110 pounds (50kg).  

Relevant Medical Hx: Premenstrually her breasts are swollen and painful, and she has noticed a lump in her left breast for many years.  She is constipated, and her stools are formed like chestnuts.  She easily feels dizzy.  Her appetite and sleep are normal.  Her menstrual cycles are regular, but pre-mensespremenstrually she has abdominal pain.  The flow is light, and the color is dusky.  She had adolescent acne and also bleeding hemorrhoids.    

Color Doppler imaging results: Both of her breasts have lobular hyperplasia and enlargement of the mammary ducts.  Her left breast has a fibrous tumor.  

Physical Examination: The skin of her legs are dry, and the hair is coarse. 

Formula: dang gui 15g, gui zhi 15g, bai shao 30g, gan cao 5g , sheng mai ya 30g, gan jiang 5g , da zao 30g, mai ya tang 50g (take with the cooked decoction) 

20 bags.  Every week take 5 bags then stop taking for 2 days

2/13/12 2nd visit: She did not add mai ya tang to her formula.  But after taking the herbs, her premenstrual breast pain and theher difficulty in bowel movements both improved.  But However for the past few days, she was passing blood in her stool.  Also thepremenstrual abdominal pain hasd decreased.  But she had overworked and afterwards havingd abdominal pain, smelly leucorrhea,; she was easily feeling dizzy easily , and her legs were cramping.  The tip of her tongue iwas red.  

Formula: gui zhi 15g, chi shao 15g, mu da pi 15g, tao ren 15g, bai shao 15g, fu ling 15g, huai niu xi 30g, sheng gan cao 5g, 15 bags. Every week take 5 bags, stop for 2 days

3/5/2012 3rd visit:  After taking the formula, her bowel movements were unobstructed.  She did not have cramping and slept well, but the breast distention occurred again.  

Formula: gui zhi 10g, rou gui 5g, bai shao 30g, gan cao 5g, gan jiang 5g, da zao 30g, sheng mai ya 30g, mai ya tang 50g (take with the cooked decoction) 15 bags, every week take 5 doses, stop for 2 days

4/16/2012 4th visit:  Premensestrually her breasts were mildly swollen, but there was no pain.  She was instructed to continue the previous formula with these following modifications: bai shao 15g, addition of 15g chi shao and 15g of tao ren for 15 bags, every week take 5 bags then stop for 2 days. 

5/28/12 5th visit: Her left breast fibrous tumor was removed on 5/13/12.  It seems that the premenstrual breast distention has cleared up, but her bowel movements awere relatively dry.  

Formula: gui zhi 10g, rou gui 5g, bai shao 30g, gan cao 5g, gan jiang 5g, da zao 30g, sheng mai ya 30g, mai ya tang 50g, (take with the cooked decoction), tao ren 15g, 15 bags.  Every week take 5 bags, stop for 2 days.

6/18/2012 6th visit:  Her menstruation was advanced by three days and her premenstrual breast distention was gone.  Her bowel movements arehave been unobstructed.  The tip of her tongue was red and had a greasy coating.  She was prescribed the original formula for 20 bags and every one bag take for 2 days.  

Notes: In cases of breast distention and pain, Dr. Huang typically associates itthese cases with Chai Hu -type formulas and as well as formulas like Xiao Jian Zhong Tang.  Chai Hu -type formulas include Si Ni San, Jie Yu Tang, Ba Wei Huo Xue Tang, Chai Gui Gan Jiang Tang, and Da Chai Hi Tang.  Xiao Jian Zhong Tang can be modified with the addition of dang gui or dang shen along with Dang Gui Si Ni Tang.  Construction of the formula depends on the severity of the breast distention, and you can add 30-50 grams of sheng mai ya.