5, Case Study

- 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!