Headaches, Loose Bowels, Stress… Case

[Esther van Dorst]

53 y/o male. Since 2009 has had atrial fibrillation and a flutter. His heart rate is irregular, and he shakes in his bed. A-fib feels like a kind of raining in the chest. He has a history of ½ marathon running, but he stopped due to this complaints. Although he loves and needs movement. Sudden movement is provoking, and anything that increases heart rate. Sweating is normal. He is coldish, and has cold fingers and toes. Other symptoms: there is a kind of shaking in his arms, and his legs can feel restless when going to sleep; he needs movement for this. Since 2012 at a rate of about 4 times per year for a 5 day period he’ll get red spots on the chest. He mentioned in 2007 there were 3 times where he was dehydrated (diarrhea and vomiting). He drinks a lot water and urinates frequently. Pulse; 68,irregular, deep, thin and weak. Left: 1e sup, easy to push away, sl roll, perhaps a little hollow; 2e deep. Right: 2e thin wiry bigger than left side; 3e deep tight. Abdomen: pi, rikyu, pencil line, cold around belly button, oketsu right side. Muscles pronounced. The sternum, lower portion, has a pronounced dip. I figure out GZjLGMLT could fit, or DGJZT would fit, or SQW aspects as well. Probably I am missing something. Could someone help me further?

[Aaron]

There is a line in the SHL where a blood deficient patient is sweated (which this patient has been doing with his exercise), which leads to tremors. (I think the tremors are partly to the yang surging up and partly due to the temperature difference between the interior and the exterior creating wind). I think he needs his blood tonified and the yang anchored so maybe SQW + TXS.

[laurieayres]

Yes, line 87 talks of sweating a blood collapse patient leading to cold shivers and shaking, but there are wet and dry types of shaking, with the wet types shown in lines 67 and 82 for LGZGT and ZWT respectively, and JG Ch.12 speaking of shaking and intense twitching of eyes and body. The short explanation is that the twitching is like pulsations transmitted by the water; the slightly longer explanation is that as you sweat someone you pull heat out of the blood layer and into the qi layer, leaving the blood and water layers colder and qi layer hotter, this heat (and pressure) differential causes wind to arise resulting in air bubbles rising through the water layer causing irregular sudden movements, which of course relate to wind (and this is one of the many explanations of why BS is in ZWT).Now in this patient I’d agree SQW+TXS sounds like the way to go, but with that amount of heart weakness and cardiac symptoms I’d bump GZ up to 60. If there was just the cardiac symptoms without the wiry R 3rd and the water symptoms of frequent urination and pronounced twitching then ZGCT could be considered.I’d avoid GZJLGMLT as you don’t want to use BS when there is a skipping heart, but with a faint pulse, cardiac symptoms, cold hands and feet and a superficial weak/faint L cun then that structure without the BS could also be considered in GZJNT, and with the wiry R 3rd GZJNT+GZFLW (CS) with GZ also at 60 could be an alternative option if SQW+TXS doesn’t cut the mustard.

[Esther van Dorst]

So you think DGJZT or ZGCT?

[Esther van Dorst]

Doesn’t SQW+TXS need a tight right cun? I think I’ll cut the mustard(???) with the second option.

[Aaron]

I remember Arnaud teaching us that SQW is more for men and ZGCT more for women, so I’d do SQW.

[laurieayres]

It can have it, but doesn’t need one. TXS alone does due to the BZ, but as SQW+TXS has no BZ, then you don’t need the right R cun.

[Esther van Dorst]

You think that would be a good first step?

[Aaron]

I’d try SQW + TXS. There are probably smarter options, but that one makes sense to me.

[Author]

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