Case Study: MJ

Beth Harrington

Jana Bricker

Lorel Zaide

Patient Information

• Ethnicity: Filipino

• Age: 25

• Blood Pressure: 110 / 70

• Pulse: 77

• Height: 5’2”

• Current weight: 80 lbs

• Youngest of 3 children (Mother was 30 years old at conception)

• Full-time student (Nursing)

• Newly married (6/2008)

• New mother (son born 10/2008)

Primary Concern

• MJ was recently diagnosed with Hyperthyroidism / Graves Diseasefollowing the birth of her first child (10/2008)

She lost 30 lbs throughout 2009 despite increased food intake. She also suffersfrom:

• Tremors

• Insomnia

• Thermo-regulation instability

• Dry skin & hair loss

• Dizziness & photophobia

• Muscle atrophy

MJ’s thyroid levels were first checked in January, 2009 and were within normallimits at that time

MJ’s primary concern right now is to gain / normalize weight

Medical History

• Graves Disease, recently diagnosed

T3 count: 1100 (normal range 200-400)

TSH level: 0

No presentation of goiter

No presentation of exopthalmos

• Excellent childhood and adult health

• Healthy pregnancy with “typical” symptoms

• Uncomplicated childbirth

• 3 weeks of heavy postpartum bleeding, followed by 3 weeks of

spotting

HyperthyroidismGraves Disease

• Definition:

• Most common form of hyperthyroidism

• Occurs when immune system mistakenly attacks your

own thyroid gland causing it to overproduce thyroxin

• Rarely life threatening

• Develops at any age

• Develops in both males and females

• More common among women after 20 years old

HyperthyroidismGraves Disease

• Symptoms may include:

• Anxiety

• Irritability

• Difficulty sleeping

• Fatigue

• A rapid or irregular heartbeat

• A fine tremor of your hands or fingers

• An increase in perspiration

• Sensitivity to heat

• Weight loss, despite normal foodintake

• Brittle hair

• Enlargement of your thyroid gland(goiter)

• Change in menstrual cycles

•Frequent bowel movements

•Excess tearing and sensation ofgrit or sand in either or both eyes

•Reddened or inflamed eyes

•Widening of the space betweenyour eyelids

•Swelling of the lids and tissuesaround the eyes

•Light sensitivity

•Ulcers on the cornea

•Double vision

•Limited eye movements

•Blurred or reduced vision

•Reddening and swelling of skin

HyperthyroidismGraves Disease

• Causes:• Unknown according to mayoclinic.com

• Genetic predisposition (wikipedia)

• Possibly viral or bacterial infection that may trigger anti-bodies to cross-reactwith the human TSH receptor (wikipedia)

• Cause of Post-Partum Graves Disease is unclear

• Risk Factors:• Family history of disease (Uncle and Aunt)

• Stress

• Pregnancy

• Smoking

• Complications:• Heart Problems – rapid heart rate, heart rhythm disorders, congestive heart

failure

• Brittle Bones – osteoporosis due to thyroid hormone interfering with body’sability to incorporate calcium into bones

• Thyroxic crisis – sudden intensification of S&S, leading to fever, rapid pulse,delirium

Medications & Supplements

• Methimazole (15g/8hrs)

For hyperthyroidism

• Propranolol

For palpitations / tremors

Objective

• Petite, emaciated

• Thin, dry skin

• Mood swings, anxiety, poor memory

• Alert but reserved, stands/sits with arms folded acrosstrunk, polite, good sense of humor, poised and well-groomed

Subjective

• Body Temperature Hot with all over hot flushes

• Perspiration Perspires with light exertion / spontaneous)

• Chest / Abdomen SOB, chest tightness, palpitations

Bloated and “gassy”

• Head & Body Achy upper back / traps

Occasional temporal HA

Lumbar pain

Hand tremors

Dry skin & head hair

Hair loss

Decreased flexibility

Subjective (continued)

• Appetite / Thirst Excessive appetite - she feels like she’s eating all the time

Increased thirst. Replaces water with soda and milk

Craves salty foods

• Stool / Urine No concerns with either. 2 BMs per day / formed.

Urine is pale yellow

• Vision / Hearing Dry, itchy eyes

Decreased eyesight

Floaters

Dizziness

Poor memory

Subjective (continued)

• Sleep Difficulty falling asleep

Sleeps 4-5 hours & wakes un-refreshed

Wakes to urinate and eat

Vivid / Frequent dreams

• Reproductive Amenorrhea since pregnancy

Low libido

• Constitution Extreme fatigue: energy = 3/10

Pulse & Tongue

• Pulse

Wiry, rapid, empty, thin

More slippery on right, especially deep KD pulse on left

• Tongue

Red with darker tip, center crack, scalloped

No coat (brushes tongue)

No subs

Quiver

Palpatory Data

• Clammy, warm hands

• Warm all over

• Hypotonic muscles

• Brittle hair

Assessment & Diagnosis

• Root: KD Essence Xu, Qi & Yin Xu To nourish the fetus, MJ's uterus drained both her ”Sea of Qi,"

specifically Yin energy, and her ”Sea of Blood," depleting SP, KD, HT,LV  blood. The pregnancy weakened her Qi and she had no chance ofreplenishing prior to giving birth and subsequently depleting even moreblood and Qi. She then bled for 6 weeks postpartum.

• Branch: LV Yang Rising Confirmation: Tongue, pulse, heat, temporal HA, amenorrhea, tremors,

dizziness, floaters

• Treatment Principle Tonify / Nourish Essence, Qi & Yin and descend LV Yang

Five Phase

Supine Protocol

• SP4: Luo Connect, Master of Chong Mai

Fortifies SP, harmonizes middle jiao, abdominal distension, insomnia, restlessness

• PC6: Luo Connect, Couple of Chong Mai

Insomnia, palpitations, harmonizes ST, clears heat

• KD3: Shu Stream, Yuan Source

Nourishes KD Yin & clears deficiency heat, tonifies KD yang, anchors Qi & benefits the LU

• GB41: Master of Dai Mai

Spreads LV Qi, benefits chest, benefits eyes

• SJ5: Couple of Dai Mai

clears heat, expels wind, HA, dizziness, tightness of the chest, hand tremor, back and

shoulder pain

Supine Protocol (continued)

• CV17: Mu of PC, Point on Sea of Qi

SOB, goiter prevention (Deadman indication)

• SP10: Sea of Blood From Deadman: “’…if blood stasis is not transformed, new blood cannot be generated’.

This refers to situations where blood stasis has pooled outside the channels, leadingdirectly to blood deficiency as sufficient blood is no longer available to nourish the body.This complex pattern of hemorrhage with both consequent blood stasis and blooddeficiency is commonly encountered after childbirth and profuse uterine bleeding.”

• LV3: Shu Stream, Yuan Source, 4 Gates

Needled toward LV2 to descend LV Yang and drain heat

Spreads LV qi, subdues LV yang, extinguishes wind, nourishes LV blood and LV yin, HA,dizziness, SOB, dry throat with desire to drink, internal heat with thirst, amenorrhea,emaciation, insufficiency of qi

• CV4: Gate of Origin

Fortifies original Qi & benefits essence, nourishes SP & KD

Supine Protocol (continued)

• Yintang:

Used for dizziness, insomnia, agitation, restlessness, pacifies wind

• ST36: He-Sea, Point on Sea of Water & Grain

Supports correct Qi and fosters original Qi, Nourishes blood & Yin, clears fire &calms spirit

• SP6: Three Yin Intersection

Harmonize LV and tonifies KD, regulates menstruation, calms spirit, invigoratesblood

• LV13: Front Mu of SP

Spreads LV qi, harmonizes LV and SP, regulates mid and low jiaos, fortifies SP.Use for abdominal distention, emaciation, agitation and heat with dry mouth,propensity to anger

Prone Protocol

• UB18: Back shu of LV

Spreads LV qi, regulates and nourishes LV blood, pacifies wind, benefits eyes and sinews,SOB, dry mouth, itchy eyes, dizziness, lumbar pain, pain of back and shoulders

• UB20: Back shu of SP

Used for abdominal distention, thin body despite much eating, lumbar pain, pain of backand shoulders

• UB21: Back shu of ST

Used for abdominal distention, thin body despite much eating, contraction of sinews, backpain

• UB23: Back shu of KD

Tonifies KD, benefits essence, nourishes KD yin, firms KD qi, benefits the eyes, strengthenslumbar region

Prone Protocol (continued)

• DU4:

Clears heat, tonifies KD, benefits lumbar spine

• Amnian:

Insomnia, dizziness, HA, palpitations, restlessness/agitation

• LU7: Luo Connecting, Master of Ren Mai

Diminished qi, SOB, sweating, thirst, HA, poor memory, palpitations, pacifieswind

• KD6: Coupled point of Ren Mai

Nourishes KD, clears deficient heat, insomnia, dizziness, dry throat, amenorrhea

Auricular Protocol

• Thyroid Gland (Chinese)

• Thyroid Gland (French)

• TSH

• Point Zero

• Shenmen

• Endocrine Point

• Brain

• Additional Thoughts:

Treatment Frequency:

• 1x Supine / 1x Prone / 1x Auricular per week (3x total/wk) for 6 weeks as pt schedule allows

Tui Na for back pain following supine treatment

Tui Na for insomnia following prone treatment

Bleed ST45 (in place of heat clearing points) if MJ is particularly agitated

Herbal Recommendation

• Er Xian Tang - Two Immortals Decoction

Contents:

• XIan Mao - Curculiginis Rhizoma (6-15g)

• Yin Yang Huo - Epimedii Herba (9-15g)

• Bai Ji Tian - Morindae Officinalis Radix (9g)

• Dang Gui - Angelicae Sinensis Radix (9g)

• Huang Bai - Phellodendri Cortex (4.5-9g)

• Zhi Mu - Anemorenna Rhizome (4.5-9g)

Actions - Tonifies KD Yin/Yang/Jing, clears KD deficiency fire, regulates ChongMai and Ren Mai.

Nutritional Recommendations

• Drink more water! Cut down / eliminate dairy and soda

• Avoid heat engendering foods, i.e. sugar and artificial sweeteners, caffeine,

alcohol, etc.

• From Healing With Whole Foods:

Specifically for hyperthyroidism - Eat fresh wheat germ, wheat berries (in food or

tea), and mung beans. These nourish Yin (particularly HT & KD Yin)

Foods which nurture KD Yin:

• Millet, barley, tofu, string bean, black bean, black soybean, kidney bean, watermelon

(all melons), blackberry, mulberry, blueberry, potato, seaweed, spirulina, black

sesame seed, crab,

• Also: eggs, pork, cheese in small amounts