5, Case Study
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- Case Number 5: A 50-year old patient,
maybe a little bit of kidney, who knows,
presented with hearing loss
and tinnitus
that persisted for four years.
So four years is most likely
some sort of deficiency as part of it.
Hearing loss and tinnitus,
gee, that's usually liver or kidney.
Now you can have hearing loss
from kidney Yang, or liver Yang rising,
you can have tinnitus from, um,
and you get hearing loss from
the kidneys just depleting
cause they rule the ears,
and same with tinnitus,
you can have liver yang rising, or
kidney being weak.
Of course, there's more styles than that,
but those are the main, guys.
One year ago in the late fall,
so that's turning into kidney time,
this is when the energy
is depleting in the atmosphere,
her hearing loss worsened,
and she developed a sensation
of blockage in the ears. OK, well,
you know what, fall is a bit of etiology there.
Alright, so blockage in the ears, I already
mentioned what that can be.
She always thought it was related
to allergies, and maybe even dairy.
OK, so, she's got some allergies, so that
can be lung, or spleen or kidney,
that's your Wei Qi, guys. She
did a round of prednisone,
and that would be deficiency
and usually heat,
which helped with the hearing loss
and the tinnitus.
After stopping prednisone the symptoms
returned after four to five days.
Western medicine diagnosed
her with Meniere's disease,
which is almost always kidney,
yin deficiency of Liver Yang rising,
it just could be aware of that,
but of course, it isn't always.
She had a history of eczema and allergies,
well, that would be lung,
or if it's from childhood, that's kidney.
She has high blood pressure,
oh, liver, and/or kidney, together, maybe,
and takes Lotrel to control it.
At the visit, her blood pressure
117/80, which is fine.
Her energy was overall slightly low,
so that's deficiency,
She had mildly cold hands and feet,
deficiency, of either Qi or blood, most likely,
cause it's mild, so I'll put
Qi or blood there.
Her core temperature is generally OK,
but she can become cold when it's chilly out.
So again, this is a bit of a deficiency
sign, not a big one.
She was thirsty and craves
room temperature water.
So, thirsty can be dryness
or heat, yin deficiency,
craving room temperature water, so,
that could mean she's go a mild
Yin deficiency or blood deficiency,
because she's not craving cold.
She often wakes hot when sleeping,
that could be Yin or blood deficiency.
Do you remember that, um,
it says blood deficiency [chuckles],
that, of course, blood is an aspect of Yin,
and you can have slight warmth,
slight sweats at night, if anyone out there
has had a blood deficiency,
you know that in the late afternoon,
sometimes you get a bit of flushed and warm,
but you're not in a full Yin deficiency.
So when I see kind of like, these
slight, slight, slight, makes me think of blood,
but sleeps good overall.
She is a little over committed at work,
which probably means Yin deficiency,
cause she didn't say stress,
so probably overworks.
And this is etiology.
She had ongoing left knee pain,
probably meniscus and had muscles
that can easily become tight,
around the shoulders. Well that last part
there, the tight muscles, is liver.
And the knee pain, that can just be an injury,
for just one side, so I'm gonna ignore that.
She had lower intestinal gas
and daily soft bowel movements.
Well, this could be liver, and this
could be spleen deficiency.
About 10 years ago she had fibroids;
oh, I bet that's an etiology,
with heavy bleeding
and had a hysterectomy.
All that heavy bleeding
is gonna cause blood deficiency.
Every once in a while she will get
vertigo and dizziness when standing.
That's orthostatic hypotension,
and that is a deficiency sign.
Thin, wiry, deep, deficient pulse;
so thin is blood deficiency usually,
wiry, liver, deep is deficiency, or internal.
Distal is more floating and active,
so further away is more floating and active.
If they say both distal,
than that makes me think of liver Yang
at the top or some sort of heat
rising into the head, cause
this would be the upper Jiao
when you see distal. Tongue is pale,
some coat and curled.
Pale is deficiency, could be cold,
could be blood deficiency,
could be Qi deficiency. Some coat means
there's a little bit less coat, so that's Yin deficiency,
sounds very mild, curled; so, curled,
when someone puts their tongue out
and the sides actually come up
on the side like this, like curled in,
and it looks tight, ask her relax her tongue,
if they can not and it stays curled,
that's because the liver rules the sides,
it's so tight, or so excess, it's actually
curling in. So that's what that means.
So let's move on to our questions.
Please answer the following questions
about Ms. Ringydingy:
What's a TCM illness in this case?
Well, this one is classical
tinnitus and deafness.
What is her diagnosis?
OK, let's go back and do a little numbering
and get this figured out here.
So, she's had this for four years,
allergies she's had for a very long time,
had prednisone, it helped
and then she went off of it;
energy slightly low; knee pain,
about 10 years before she had fibroids.
Well, hm, I'm going to ignore the allergy
thing cause they didn't really go on about it,
it doesn't seem to be fitting
in the case too much,
so I'm gonna say fibroids was
the first thing that happened,
and then it seems like, so four years ago,
she's had hearing loss and tinnitus,
and then one year ago, everything
worsened, so there's three.
So we can say, it looks like 1. is a blood
deficiency, which we have some supportive signs here,
and than 2. hearing loss and tinnitus,
OK, so she's got all these deficiency signs,
looks like blood deficiency
turning into a Yin deficiency;
alright, so I think a number 2,
I'm going to put blood/Yin deficiency.
And number 3. with this blockage
in the ears and the late fall thing,
where the kidney would
have plummeted at that time,
cause energy goes low, sounds like
the liver Yang rose at that time,
because she had that blocked sensation.
So, let's carry on again,
Diagnosis; well, we have
this figured out already;
so, this woman has blood deficiency,
turning into Yin deficiency,
which is causing liver Yang to rise.
Alright? And, so, which is then,
of course, blocking the ear.
If you ever had that you usually
have this [squeaking sound],
and then real deafness to the ear.
And usually it comes on fast
and leaves fast but it can hang around
for a bit if you have quite low Yin or blood.
Treatment principle? We definitely
wanna be tonifying the blood,
and Yin, and then we wanna ground
Yang and then we also wanna open
ear and get rid of that blocked feeling.
So, etiology and pathogenesis?
Well, we already numbered
everything, so I think fibroids
are going to be our number one guy here.
So, fibroids and that led to a blood
and then you see the Yin deficiency
starting to happen here,
over time, she overworked
also, so overwork,
oops, square, Yin deficiency, OK, such
is gonna make that area worse.
And, she is aging, she's
in her 50s, so I'll put age,
so that's just gonna bring
her Yin down in her case,
which is making all of that worse,
and hard to know if the overwork is also
stressful, and that's why the liver Yang
rose, but regardless, at some point
the liver Yang is gonna rise, so this all
caused a liver Yang rising.
If we're looking at a five element chart,
you guys need to draw it out that way,
here we have wood, here we have water,
our Yin is going down, down, down, down,
and this mother cannot support
the child properly, and up that flies,
the Yang flies upwards and that's what's
happening according to the five element chart.
Five acupuncture points that are possible.
Oh, boy, so many.
So, kidney three, of course,
to tonify the kidneys,
kidney six to tonify kidney Yin
to help ground the Yang,
liver three, of course, that's first
to tonify, liver three reduced,
in the direction of kidney one if
you're using angled to try and bring
the energy down that
would help ground Yang,
gallbladder 41 is my favorite point
to ground Yang in the body;
you'd reduce that one and it pulls
very strongly away from the ears.
Very strong ear point,
I call it distal San Jiao 3.
And when you think about how
gallbladder wraps all around the ear,
and it's a liver Yang rising condition,
so if you use wood, it's even stronger,
you tonify the kidney, and you use
wood points to bring energy down.
CV4 to tonify Yin, you'd be 18-20-23,
those are obvious on the back there,
I've got UB 23 twice, SI 19,
San Jiao 17, even GB2, beautiful points to, as local,
to clear from the ear, but we do need
to open that ear up, so those guys can go in,
San Jiao 3 would be wonderful, too,
to pull that Yang down,
GB 20, 21, are great
to pull Yang down too.
Of course, any other kidney
points that you may like.
If you're doing an exam, stick
to the basics, don't get fancy,
kidney 3, kidney 6, CV 4, done, just get
that done easy. On to the next!