Clinical case reviewed in 2015 SHL webinar 3 with Dr. Feng

Ms. Li Zhen, 38 years old

1st consult, April 24th, 2014

The patient suffered from a depression for 3 years, which worsened over the 4 months prior to consultation, often accompanied by fright, anxiety and insomnia. She would take 2 pills of Diazepam a night and would still only sleep for 4 hours, she took Chinese medicine (mostly blood nourishing and calming herbs) for 2 months without any relief.

She frequently suffered from sweating, nervousness, chest oppression, stomach heat, shortness of breath, dry mouth with slight bitter taste, profuse menstrual flow, anemia, white tongue coating which was greasy at the root and a wiry, thready pulse.

Six syndrome: Tai yang Shao yang Yang ming Tai yin concurrent syndrome

Formula pattern: Chai Hu jia Long Gu Mu Li qu Qian Huang jia Zhu He Huan Tang pattern

2nd consult, May 8th, 2014: Her dry mouth and bitter taste resolved, the stomach heat improved, however she still experienced poor sleep and relied on sleep medication, with fright and anxiety episodes, passing stools twice a day, chest oppression, back soreness, pulling and soreness in the left shoulder blade, regular menstruation, white tongue coating with a greasy root and a thready, wiry pulse.

Six syndrome: Shao yang Tai yang Tai yin Yang ming concurrent syndrome

Formula pattern: Dang Gui Shao Yao San and Gui Zhi Gan Cao Long Gu Mu Li plus Chai Hu He Huan Pi Tang pattern

3rd consult, May 15th, 2014: The patient came after contracting a cold. After she stopped taking the sleeping medication, on the 1st night she did not sleep at all, on the 2nd night she slept for 5 hours, and ever since she would sleep between 5-6 hours a night, her emotions were more stable and she no longer felt frightened or anxious.

Note: Initially, this patient presented with a Chai Hu jia Long Gu Mu Li Tang pattern. After taking the formula her syndrome was still a Tai yang Shao yang Tai yin Yang ming concurrent syndrome, however the symptoms presented as a Dang Gui Shao Yao San modified pattern.

Dang Gui Shao Yao San was described in the《Jin Gui Yao Lue· On Pregnancy Disorders》line 5:

“If there is urgent abdominal pain during pregnancy, Dang Gui Shao Yao San governs.”

《金匮要略·妇人妊娠病》第5条：妇人怀妊，腹中绞痛，当归芍药散主之。

In the 《Jin Gui Yao Lue· On Miscellaneous Gynecological Disorders》line 17:

“For all abdominal disorders and pain, Dang Gui Shao Yao San governs.”

《金匮要略·妇人杂病》第17条：妇人腹中诸疾痛，当归芍药散主之。

These clauses describe a Tai yin internal deficient cold blood deficiency with abundant rheum patterns. In Chinese medicine, blood deficiency causes malnourishment to the spirit and water rheum harassing upwards can disturb the mind, resulting in insomnia. Therefore Dang Gui Shao Yao San is appropriate to nourish the blood and expel rheum.