32 year old female

lots of information, thanks !

looks like several patterns are going on at the same time

Liver Qi Stagnation - PMS, sighing, ...
Spleen Qi Inisufficiency - fatigue, lactation, floaters, dizzi
Blood Stasis - clots, pain, purple tongue, choppy pulse
Liver Blood and Kidney Yin deficiency

PS
X-boyfriend sounds like a real catch !

Hi Erin,
Has this woman had many western tests done?

Because of the headaches, disturbed sleep, and head injury, I think that a tumor of her ptiuitary gland should be investigated. A prolactinoma is the most common benign growth of the pituitary and can lead to lactation outside of breastfeeding.

Trevor

Hey Erin

She has many symptoms and several patterns happening. Which ever formula or method of treatment you choose you may want to try a large dose of Mai Ya (barley sprout). I have never personally used it but after referring to several texts large doses of this herb (30-60g) per day can decrease/stop lactation. I don't think it has any toxicity issues.

Has anyone had any luck trying to decrease lactation with Mai Ya ?

Ryan Funk

Thanks for the feedback! A tumor hadn't occured to me, so thanks for that suggestion Trevor.
I have decided to treat a liver spleen disharmony causing painful diarrhoea with Tong Xie Yao Fang, and origionally I added 10g of mai ya, but with your suggestion Ryan, I may increase that. hmmm...I wonder if she could just sprout her own barley??
Also I will give shao fu zhu yu tang two weeks prior to menstration.
I'll let you know how it progresses.

Hey Erin

another way you may be able to increase the dosage of Mai Ya is to give her it as a "Tea" that she boils in the morning and sips throughout the day, then give her Tong Xie Yao Fang Separatley as a chinese formula.

Barley Tea won't taste horrible and you will be able to get her to slowly get the dose you want of the Mai Ya !

keep us posted

Ryan Funk

Hey Ryan,
What exactly do you mean by "tea"? Are you talking single herb granular from somewhere like KPC, or china town raw, or can you actually buy mai ya/barley tea somewhere less obscure like say the grocery store?

Hey Erin

what I was thinking of is having your patient make a herbal decoction in the morning and keeping it in a thermos and drinking it through out the day. You could also use a herbal concentrated powder of Mai Ya (use a very high dose though) ! have them take a herbal formula separately from this Mai Ya "Tea".

keep us posted

Ryan

Erin -

If Prolactinemia is the cause of this patient's galactorrhea, it's fairly easy to diagnose by doing a serum prolactin level with her gynecologist. If her prolactin is elevated, in addition to the Mai Ya Tea, consider a modified Xiao Yao San or Jia Wei Xiao Yao San + Chasteberry (Vitex). Vitex (not Man Jing Zi) has been shown in studies to regulate prolactin levels. Also, have her thyroid levels checked - including thyroblobulin antibodies - because prolactin levels can sometimes become elevated in the thyroid is not functioning properly.

Your choice of Tong Xie Yao Feng is a good one, and I would mention also that my teacher Dr. Shen frequently recommended small doses of E Zhu (rhizoma curcumae) - 3-5 grams - for digestive issues where there was a liver/spleen disharmony. He believed that in small dosages this herb "relaxed the nerves" of the intestines. That was his way of saying it was more of a qi regulating herbs in small doses. Also, it goes to the liver & spleen channels, and it will probably help with the blood stasis evident by her clotting at menstruation.

Just some thoughts,

Ray Rubio

Hi Erin,

I like Trevor and ray's Suggestion about ruling out any pituitary tumor or underlying thyroid issue. I also like Ryan's suggestion about giving her 60g of mai ya a day separately from your regular formula. You can have her make a decoction raw mai Ya or get her to mix 12X5 grams of Mai Ya from your KPC pharmacy and drink it as a tea through out the day like Ryan suggested.

I see wood over acting on earth. Basically she is presenting with a deficient Spleen and an excessive stomach (hot stomach). The Liver over acting on Spleen is causing the Spleen Qi deficient signs and the Depressive heat generated from the Qi stagnation has created a hot stomach. Heat in the Liver and stomach channel can cause the milk to run recklessly (just like blood) leading to "weeping breast". She also is exhibiting Blood stasis. Based on her bleeding daily for a year, weak Spleen and stasis I am sure you can find other blood deficient signs.

So you can modify/combine some of the formulas below to treat this pattern
Xiao Chai Hu Tang (Liver Qi stag with depressive heat and def SP and excess ST) - Need to add blood movers
Dan Zhi Xiao yao San - need to add blood movers and more heat clearing herbs (Huang Qin)

Other herbs to add He Huan Pi (insomnia due to Qi stagnation)

Clinically I would put most of my focus on Coursing liver and rectifying Qi and Quickening blood transform stasis. As her sign and symptoms improve i would focus more on strengthening her spleen.

Good luck!!

Lorne
www.acubalance.ca
www.prodseminars.com

I'm not sure if un-sprouted Mai Ya will have the same effect as Sprouted Mai Ya?

I believe the texts say that sprouted Mai Ya has the best effect to slow/stop lactation. Would regular raw mai ya work or would we need to plant it, allow it to sprout for 3-5 days then harvest it and give it to our patients?

anyone has any experience with this?

Ryan Funk

Hi Erin

I'm with Lorne on the Stomach heat here, although I would explore the connection with the Heart as well as the Liver. I often find that with emotional eating their is a component of heat rising up. The desire to eat is a reaction to bring down or quell the fire or heat. Also using the theory that dampness is created by the body as a protective mechanism to insulate itself from heat, you can see how you get her weak Spleen with the big appetite at the same time, her body is trying to protect itself from the stagnation heat from her stress with all that food. Whether or not the heat came the Liver stagnation first or not, for me I find that my patients with emotion issues like this resolve better and for a longer period when I include the Heart heat in the treatment plan.

Kaleb