Show Notes
TK asks TC about a pair of cases that exemplify important aspects of treating dizziness and vertigo
Chapters
- (00:00:00) - Cass #1
- (00:18:33) - Case #2
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Episode Transcript
[00:00:03] Speaker A: Hi everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history and treatment strategies to use in the clinic. Let's get into it.
Hello everybody, and welcome to the Nervous Herbalist. My name is Travis Kern and I am here with Travis Cunningham.
And we are going to talk to you guys today about some case studies that are connected to dizziness and vertigo. Yes. What do we got? T.
Yep.
[00:00:36] Speaker B: So I've got two cases for us today.
And like in similar other previous shows, I have one simple case, relatively simple case, and then one that's a little bit more complex.
[00:00:52] Speaker A: All right, well, let's start with a simple one so we can re hit some of the important highlights from the theory discussion.
[00:00:57] Speaker B: Okay.
[00:00:58] Speaker A: And then we'll go into the more complex one.
[00:01:01] Speaker B: So this case is a person who came in. Actually the chief complaint is insomnia.
But one of the key symptoms is the feeling of dizziness or the feeling of unsteadiness that this person's had. And this feeling has been with her throughout the years, like over the course of the last few years. But it gets better and then it gets worse.
And it's been particularly noticeable for her.
[00:01:35] Speaker A: The dizziness part.
[00:01:36] Speaker B: The dizziness part. So it is a. It is like a. Even though it wasn't her chief complaint, it's a very relevant part of the case. Okay, so the history is the patient reports difficulty both falling and staying asleep, feeling fatigued.
And this has been present the last two weeks.
Once she falls asleep, she can usually stay asleep, but it takes about an hour or two hours to fall.
And sometimes the patient will also wake up early around 5am which will leave her feeling very tired the rest of the day.
So she has this history of feeling lightheaded on and off for many years.
And she says this feeling has gotten distinctly worse over the last few weeks within the same timeline of the sleep.
[00:02:27] Speaker A: So the sleep problem that she came in for was new though. Like this hadn't been. This wasn't like multi year, not a chronic thing. Okay.
[00:02:33] Speaker B: Nope. That's unusual for her. But she later told me that she had been. She had gotten a variety of testing done, including a CAT scan and tests for pots to try to understand why she was feeling lightheaded. And they had all come back inconclusive.
[00:02:51] Speaker A: Okay. Yeah.
[00:02:52] Speaker B: So, okay, so other symptoms. The patient has felt warmer recently.
The. Despite the seasonal movement into cooler temperatures. I should probably mention the date. So this was November of last year. 2025, 1114. 2025. And this is a 40 year old female.
She has thirst, she has urination. That can be frequent and urgent.
And she's also noticed some acid reflux at night after she lays down to sleep, which again, is atypical for her. It's not something she has often, but has been there more the last couple of weeks. Okay, so I checked the pulses next, and the pulses were the first two positions. Well, the first position on each side was relatively superficial, so the cun positions are superficial.
The rest of the pulse is relatively deep.
Okay, and then.
[00:04:02] Speaker A: And in general, what does that indicate to you?
[00:04:05] Speaker B: It indicates there's something going on on the surface, but maybe there's also a piece of the pathology that. Well, if there's depth to the pulse and their superficial official nature to the pathology, there's likely a water component to what's going on. Like there's something superficial happening, but there's also some kind of water or dampness that's changing the depth of the pulse in certain places.
[00:04:32] Speaker A: Got it. So you feel that pulse and your mind is already thinking like, there's probably a water thing here.
[00:04:37] Speaker B: Right.
[00:04:37] Speaker A: Okay.
[00:04:38] Speaker B: All right, so check the abdomen. The abdomen. There is a sort of like. It feels like there's like a water balloon type of thing around the stomach, the epigastric area where it's not quite like a hard pee or a hard glomus, where you feel like the line of the tissue that's really pulled taut and is prominent, but it feels like something is there, but that something is softer. Like it yields to pressure and it's distinct from the tissue directly around it.
[00:05:11] Speaker A: So it's something. It feels like a substantive mass, for lack of a better term. Yeah, but it's not hard.
[00:05:18] Speaker B: But it's not hard.
[00:05:19] Speaker A: Got it.
[00:05:20] Speaker B: So I don't know how they would treat this in traditional fukushin, but I usually see this in water patterns where there's water pooling in the stomach. I also asked the patient if she had recently drank water and she said no.
So that's another indicator because you can have false positives on the abdomen with splash sound water if they've just had
[00:05:42] Speaker A: a big glass of water.
[00:05:43] Speaker B: If they've just drank water.
[00:05:44] Speaker A: Yeah, right, right, sure. And so the soft pee, in contrast to the hard pee, the one that has more cleared ridges, edges and stuff, is the hard pee showing that things are actually more. There's dryness in the fluid problem?
[00:05:58] Speaker B: Usually, yeah. Usually there's dryness for hard pee, either excess or deficient dryness in the middle jowl and Then for soft pee, there's either stagnation or you can see soft pee in some deficiency patterns as well.
[00:06:13] Speaker A: Got it. But wetter nonetheless. Got it. Okay, so we've got this pulse that's indicating a damp pee fluid metabolism issue.
And then the abdomen check seems to also support that.
[00:06:25] Speaker B: Right. And there's a little more detail in the abdomen. So there is a water splash sound.
Right. Also.
And this patient has a distinct coolness in the temperature of the skin, kind of just below the epigastric area between, let's say, CV15 and the umbilicus. So that that area there is distinctly cooler than the rest of the abdomen.
[00:06:51] Speaker A: Got it. Any, like, clamminess or anything like that too, or just cool?
It's.
[00:06:56] Speaker B: It. It actually was a little. A little bit clammy. You can tell that the surface is open, that she's able to sweat. She's. There's like a little bit of light perspiration.
[00:07:06] Speaker A: Got it. Okay, so now armed with the pulse and the abdomen.
[00:07:10] Speaker B: Yeah.
[00:07:11] Speaker A: What next?
[00:07:12] Speaker B: So I wrote the formula Wuling San, straight up.
And I find that. I think I mentioned this before, but I find that the abdominal pattern for Wuling San often has this feeling of coolness to the skin, which I don't know is written in any textbooks, but it's something that I've noticed. You can see that, of course, with other formulas, but with Wuling San, there tends to be a coolness in that area, sort of between the epigastric and the umbilicus. Sometimes it's a little bit more like surrounding the umbilicus, like where we would imagine the small intestine to be.
[00:07:47] Speaker A: Yeah.
[00:07:47] Speaker B: But in this case, it was a little further up.
[00:07:50] Speaker A: So did she have thirst in the distance? She did have thirst, yeah.
[00:07:54] Speaker B: Yep.
[00:07:54] Speaker A: And then urinary difficulty.
[00:07:56] Speaker B: Yep.
[00:07:57] Speaker A: And in her case, the urinary difficulty was what? Just infrequency or frequency or what?
[00:08:01] Speaker B: Hers was urgency and urgency. Frequency. So she would drink and then have to quickly pee and then go. And then have to quickly go again.
[00:08:10] Speaker A: Got it. Yep. Okay, so we've got all the. All the core indicators, symptom side, for Wuling San thirst, urinary difficulty.
Then we have the objective signs that are indicating a fluid metabolism problem. And then additionally on the abdomen, your added observation that there's that sort of epigastric coolness further underlines Bulling San.
[00:08:31] Speaker B: Correct.
[00:08:32] Speaker A: Okay, so how much did you give her?
[00:08:34] Speaker B: I gave her, let's see, 8 grams, twice a day in granules. So standard dosage for Wuling sound, nothing different. Eight grams twice a day for five days. She was going to come back and see me. She'd already made another appointment. And this is when we were transitioning away from her insurance company. So we were kind of ending treatment with a bunch of people, Right?
[00:08:57] Speaker A: Yeah.
[00:08:57] Speaker B: And this person's treatment was going to. She was trying to get in and kind of use up her benefit before.
Before the that timeline. So she had already made another appointment five days from this one. And so I just wrote the formula for five days.
[00:09:16] Speaker A: Because you knew that she'd be back in.
[00:09:17] Speaker B: Exactly.
[00:09:18] Speaker A: Okay. And then the standard doses for Wuling San, just for everybody. These are, of course, the ratios we use in granule.
[00:09:24] Speaker B: Yeah. So I use Guager 6, Fuling 9, Baiju 9, Jiuling 9, and Zishya 15.
[00:09:33] Speaker A: Okay. And then so that those ratios at 8 grams twice a day. So five days later she comes back in, which was already scheduled. Normally, if that hadn't been the case, you would have just given it to her for a week.
[00:09:42] Speaker B: Yeah, a week or two weeks, you know, depending on the case. I, Wuling San, I feel pretty confident in diagnosing now, so I would feel comfortable giving that for longer if I. If I needed to.
[00:09:56] Speaker A: And it's. It's super well tolerated by basically everyone. Yeah.
[00:09:59] Speaker B: Yes.
[00:09:59] Speaker A: It's incredibly rare to give Wuling San to someone and have them, like, have weird digestive response.
[00:10:05] Speaker B: Right? Yeah. Yeah.
[00:10:06] Speaker A: Okay. So she came back five days later,
[00:10:08] Speaker B: came back five days later, and she noticed a dramatic improvement in her sleep, her lightheadedness, basically everything nice.
She had no reflux after the first two days of taking it, her sleep dramatically improved, and the feeling of lightheadedness, or like her uneasiness with her orientation was way better.
And she was most impressed by that changing, actually, because that had been the thing that had been there kind of for years. She sort of gotten used to being slightly disoriented frequently, and this had dramatically changed that, like within just a few days.
She was also.
She said she was less nauseous than she was before, which we didn't discuss in the first appointment. She didn't tell me she was nauseous, and I didn't ask. For whatever reason, she spoke at length about her sense of relief that that orientation was improving. And with such a short time on the medicine.
So you wouldn't typically think of Wulingsan being an insomnia formula, right?
[00:11:21] Speaker A: Of course. Yeah.
[00:11:22] Speaker B: But in this case, you have a direct impact on fluid metabolism, which makes it easier for the fire phase to Calm down. Right. And there we know too that in this case there is some kind of temperature influence that the Wuling San pattern is having. The person's reported that she was feeling warmer, so she doesn't have a fever necessarily, but she's been feeling warmer recently despite it being cold. Like this is in November.
Right.
And there's this accumulation of water that's taking place in the middle jiao, which then makes it harder for the heart and kidney to communicate. One of the main things that can obstruct heart and kidney from communicating is middle jiao problems. So that could be a digestive thing, that could be like a Shay Shintong pattern. Right.
Or it could be that the water is actually accumulating there for one reason or another. And if you get rid of whatever's stopping that, it can help the person to sleep better.
[00:12:30] Speaker A: Yeah.
[00:12:30] Speaker B: And I believe, believe difficulty with sleep is in one of the Wulingsan lines in the Shanghan Lun.
[00:12:36] Speaker A: Right. But of course, relative to the dizziness component of things.
Right. So her chief complaint of course was insomnia, but we're talking about it in this context because it also helped with this sense of disorientation that she had.
[00:12:50] Speaker B: Correct.
[00:12:50] Speaker A: Which was sort of expected but incidental to the chief complaint, which is to say like the goal was to get her to sleep better, but in giving her this water metabolism improver. Right. We were able to mess with or improve, change the disorientation or. Why do you think that aspect happened? Is it still just a hard kidney not communicating?
I think correction that changes the disorientation.
[00:13:18] Speaker B: I think there is a dynamic. So from a five phase point of view, I think there is a dynamic between fire and water is being corrected and the orientation of dizziness is the result of water's influence on fire.
This, this kind of thing. So if we went back to the, the 19 lines on pathology, Right. We didn't see any lines that mentioned water, but we did see a bunch of lines that mentioned muddled consciousness, upsurge and things like that belonging to fire.
And again, teaching, the way that I was taught to interpret those is to be very broad in the interpretation. So there may be an aspect of the fire phase that's being affected, but the fire phase can be affected by itself and deficiency by any of the other four phases and can have symptoms as a result of that. Right. So I'm thinking of that being part of that relationship.
[00:14:21] Speaker A: Got it. Okay.
So did you continue the Wuling San?
[00:14:25] Speaker B: Yeah, so I gave it to her for two more Weeks.
And then this is when we were discontinuing with her insurance. So I had a phone follow up with her.
Let's see, 12, 5.
So this would have been a little more than two weeks after the last appointment.
The patient reported a continued improvement of all the symptoms. She was especially happy about the improvement in her balance and sense of steadiness, which had been a problem for years.
She was doing really well. She'd actually been off of the herbs for just a few days and was still doing fine. So at this stage, I told her, let's go off of the herbs.
If the symptoms recur or come back, please give me another call immediately. But otherwise, let's try out without any herbs.
I did. So this was again, early December. I did have a contact with her in early 2026. I think it was the first or second week of January and would have been the second week actually, and she hadn't had a recurrence of those symptoms. She contacted me for a different thing, but I did follow up with her and confirmed that it didn't continue or it hadn't up to that point. Now we're speaking to you now. The first week of February in 2026. So there hasn't been that much time that's passed for a chronic problem, but at least up to now, that's been a pretty good, I think, result.
[00:15:56] Speaker A: Mm. Yeah. Okay. So basically, three weeks. Three weeks of Wu Ling San.
[00:16:02] Speaker B: Yep.
[00:16:03] Speaker A: Fundamentally, as far as we know, corrected the disorientation, dizziness, and also helped her sleep.
[00:16:09] Speaker B: Yes.
[00:16:09] Speaker A: Which, of course, was the thing that she really wanted in the end.
[00:16:11] Speaker B: Right.
[00:16:12] Speaker A: Yeah.
That's pretty cool. I would say, just to add to context as well, because I was thinking about it when you were. When you said that we were transitioning away from insurance. Not that this is specifically related to dizziness, but if you're listening out there and you're thinking, wait, do they use insurance for herbs? The answer is, no, we don't, because no insurance companies pay for herbs. But when patients come in for acupuncture visits, and we bill for acupuncture, we do herb consultations with people at the same time. So we sort of do double duty.
Some people think that that's giving away herb consultation for free. We think it's a way to get people what they need while also using their insurance.
I think, like, you know, inquiring minds can disagree for sure, but what it meant in this particular patient's case is that we weren't accepting her insurance anymore for acupuncture, which Meant she wasn't coming into the office.
[00:17:02] Speaker B: Right.
[00:17:03] Speaker A: To get acupuncture, which is when we then talk about herbs.
So that's fundamentally what was happening there. So if you're wondering, like, wait a minute, I'm not using insurance for herbs. That's. That's right. That's because you can't, which is really unfortunate. It's also worth noting though, on the business side of things that people who have FSAs and HSAs, so flex spending accounts and health savings accounts, they can often use that money to pay for custom herb formulations.
You might just need to write a letter for their FSA manager to say, hey, this has been custom prescribed for my patient.
And so that's one of the ways that people can use money that they have to pay for herbs and also to potentially pay for the herb consultation as well. We know for sure they can do it with the herbs consultation. Sometimes the administrators are a little bit more sticky about, but it's definitely within the rules to use FSA HSA money for custom prescribed herbal formulas, right? Yep. PSA for the people sa.
All right, well, how about you take us into the complicated case? Okay, so maybe also lay out, like, is this complicated symptom wise or are there other aspects that made it complicated symptom wise?
[00:18:44] Speaker B: It's not so complicated.
This is complicated because this is a person who I don't want to reveal, but it's somebody who I've known for a long time. And the case was done over the phone for the most part. So at one point in time I was able to meet with them in person and evaluate them, but the vast majority of the case was distal.
And.
Yeah, so that's what makes it complicated. I didn't have pulses or abdomens or anything like that to really be able to work, but it still is a good case, I think, for what we're talking about.
[00:19:21] Speaker A: Okay, so walk us through it.
[00:19:23] Speaker B: So this is a 65 year old male, and this. The first time I made contact about this particular thing was in November, early November in 2022. So this is a few years ago.
The history is two months prior to the conversation, the patient experienced an extreme episode of vertigo.
They were driving in their car to meet an agent for one of their business trips.
And this guy started to feel his sense of balance alter, which was not something he had experienced before.
He pulled over on the highway just in time for the vertigo to really kick in. And it was like the. He. It's like he was doing cartwheels, like the room was spinning and he was flipping, like his awareness was flipping up and down. This is how he described it.
Very intense. He opened up the door and vomited and then just like, did whatever he could to, like, breathe. And. And within five or 10 minutes, the experience gradually abated. It was pretty extreme and scary because he was driving and he's never had
[00:20:36] Speaker A: anything like this before.
[00:20:37] Speaker B: He had never had anything like this before at all. Now he. This person context would be there was a little extra stress in his life. He's getting ready for retirement, and so he was trying to finish things up this year and getting ready for retirement and feeling pressure and all of that stuff. So that could be a little bit relevant.
Since the initial episode, the patient had experienced two more instances like the one that I just described within the two months that the preceding the first incident and the conversation that I had with them, though not quite as intense and not while he was driving.
So one of them, I think, happened at work. The other one happened when he was at home.
In between the flares or the dramatic vertigo experiences, there was a sort of gradual feeling or a, let's say a constant feeling of disorientation, low grade disorientation, like a hue, if you will, of uneasiness.
And that feeling also, I think people experience these things and then they're more aware of, like, how am I.
Is it. Is it happening again? Like, there's a little bit of this kind of thing that happens to people. So he was experiencing that and that made him not very confident about driving and things like that, which was a big deal because he would, for the last part of his time at work, he was doing these business trips. So he did go to his PCP and was diagnosed with Meniere's disease. And he was given basically acute medication to manage the flares if he felt like it was acutely coming on. I think they gave him something like diazepam. So pretty, pretty strong thing to manage the acute flares. But then they didn't really give him anything to manage the chronic nature of the condition other than dietary advice. And the dietary advice was like, avoid sodium.
[00:22:50] Speaker A: Yeah, you know, of course, yeah. Because they're like playing. They're thinking blood pressure is a component and all that stuff.
[00:22:56] Speaker B: Yeah.
So this is the context by which I was talking to this person. So with inquiry, the patient reported generally running cooler in temp, but having periods of feeling warm or hot, particularly if they get overheated. They can feel. They can kind of.
He actually said he gets flushes of heat, like almost.
And typically at Night, almost like a hot flash, but he didn't use that language. I think generally men have a harder time saying that they have hot flashes, but similar experience. Urination was hesitant. The patient has an enlarged prostate, so he gets up three to four times a night to pee and has a little bit of inhibition with the urination sleep. The patient has extremely vivid dreams.
And he has night terrors or fighting dreams where he's like in a battle and wakes himself up shouting or whatever. It's kind of an interesting thing. Told me some interesting stories about that.
And then bowel movements, generally pretty normal one time a day, but he can skip days. And it could be a little on the drier side, more dry than wet.
Um, and I inquired about palpitations. He gets some palpitations occasionally, especially brought on by exercise, but they're not very frequent, like maybe once a month or something like that.
[00:24:40] Speaker A: Okay.
[00:24:42] Speaker B: Wasn't able to feel the pulses or check the abdomen because of the distance. Right.
So the first formula that I wrote him was Chaihu ja Longgu mulitang without the dahuang.
I probably could have left the dahuang in at a very low dose, but I chose not to.
[00:25:03] Speaker A: Why?
[00:25:04] Speaker B: Because I didn't. I. I didn't.
I wasn't able to evaluate him in person, so I wanted to be a little more careful.
And usually if I'm being careful, I will take the dahuang out just because most people don't need it today unless there's very clear dry constipation as an active thing.
[00:25:27] Speaker A: So, like, it's ongoingly dry?
[00:25:29] Speaker B: Ongoingly dry, constipated.
There's a little bit of a tendency for that in this patient, but it's not active, so I don't want to push the bowels too much.
[00:25:43] Speaker A: So without having pulse and without having abdomen, why reach for a chaihu formula?
What about the symptom set is telling you that?
[00:25:51] Speaker B: So if it's acute. Right. We talked about if the vertigo is acute, it's likely either a xiaoyang disharmony connected to a xiaoyang disharmony or a water pathology. And then there's tendencies for which water pathologies, which formula patterns tend to be in play, Wuling San being one of them.
But this patient didn't have particularly strong thirst. There was a urinary thing going on, sure. But there wasn't any other. Or there wasn't any other orientation around water being an issue.
And I think I didn't write this down, but I'm pretty sure I inquired about sloshiness in the belly and things like this. Things that would make me think more Wuling san or like that.
Palpitations could be treated by either formula, but it's again, kind of rare. Like, it's not a. He's not having palpitations daily or every week.
[00:26:47] Speaker A: Even so, the absence of thirst, lack
[00:26:50] Speaker B: of palpitations, and the dryness, the general tendency and dryness for the bowel doesn't. Doesn't suggest that fluid metabolism. Doesn't suggest pure fluid metabolism.
[00:27:01] Speaker A: Gotcha. So you reach. So you're thinking shaoyang disharmony, therefore chai Hutong formula, and then this particular one because, you know, versus Xiaochai Hutong or something. Sure.
[00:27:11] Speaker B: Well, there's extremely vivid dreams.
So extremely vivid dreams with a heat presentation that tends to get worse at night.
Right. So the patients tends to be cold, but worse, there's flushes of heat at night.
That makes me think Yang is having a tendency to float and needs the guizhi longgu and muli together, that kind of combination. So that could be guizhi ja longgu mulitang. That could be guizhi gan sao longgu mulitang.
That could be chaihu jia longu mulitang. Because chaihu jia longu mulitang also has guager in it. Right? Right.
It just hit all of the things the best, if that makes sense.
[00:27:58] Speaker A: Yeah. Because, I mean, you could get guizhu longu and muli and guijer jia longu mulitang, but then you wouldn't have the
[00:28:03] Speaker B: chaihu, you wouldn't have the chaihu, and you wouldn't have naturally, the fooling.
Right. The other thing that's in Caihu Jai Long Gumu tong is fooling.
So it also treats difficult urination.
And I like if there's a prostate issue, I like the fact that we have a higher dose of muli with the salty flavor to soften. So if there's a hardness, that's in this case the prostate, but somewhere in the body that's preventing fluids from moving. Yeah, right. I like the idea of adding the salty in there.
So that could be a bunch of different formulas, but if we have alternating hot and cold, if we have sleep dysfunction, if we have urination issues, Chai hu jalong gu mulitang hits all of those automatically. Rather than having to build a formula from three formulas, you can just use one. Yeah.
[00:29:00] Speaker A: Which is always from our point of view. The simpler approach is the better one.
[00:29:04] Speaker B: Yeah.
[00:29:05] Speaker A: Cleaner, Tighter. Okay. So how long. What was the dose and how long did he take it for?
[00:29:10] Speaker B: So I gave this formula at a higher dose. I did eight grams. This was a granule, but I did eight grams three times a day for 14 days.
[00:29:18] Speaker A: Okay. Because of the intensity of the symptoms.
[00:29:20] Speaker B: Because of the intensity of the symptoms.
[00:29:22] Speaker A: Okay.
[00:29:22] Speaker B: And I wanted. I wanted to tell the patient this is a strong dose of the formula and mean it. Right. And chai hu jia longgu mulitang is a larger formula automatically. So it's one that if we're treating accurately, if we're using the ratio of 5 to 1 as a rough equivalency with granule to bulk, you really have to increase the dosage of it for it to be anywhere close to a bulk dosage. And even then, you know, you can argue that it's not as strong.
[00:29:55] Speaker A: It's still going to be less strong. But at least we're trying to approximate the bulk dosage.
[00:30:00] Speaker B: Trying to approximate it. I will say the only dosage thing that I shifted here is I upped the dosage of fooling and guager.
[00:30:10] Speaker A: Okay.
[00:30:10] Speaker B: Which is something that I will do.
Fooling. Because of the intensity of the.
The water symptoms, especially with the hesitant urination.
And the wager, I just upped to 12, which is the palpitation dose of wager.
[00:30:30] Speaker A: Got it.
[00:30:30] Speaker B: Yeah. Okay.
[00:30:31] Speaker A: Up from nine.
[00:30:33] Speaker B: Up from nine. Nine. Fooling. I went up to 24, which is more mimicking the dosage of fooling in Lingui. Sao Zao Tong. So this is kind of like the.
The fluids, the fluid accumulation is doing something to aggravate the mind.
Right. And because this is an upsurge condition that has to do with some kind of fluid thing, fooling is also like bland and sweet. So it's not too.
It's not going to flush the fluids out. Extremely. It's going to kind of calmly, softly open them.
[00:31:09] Speaker A: Yeah. Bland's going to leech them.
[00:31:11] Speaker B: Exactly.
[00:31:12] Speaker A: Yep. Okay, so how long?
[00:31:15] Speaker B: Two weeks.
[00:31:15] Speaker A: Two weeks. And then what did we get?
[00:31:18] Speaker B: So reevaluation in two weeks. The patient has not experienced a vertigo flare in the last two weeks, so. So that's positive. Now, keep in mind, within two months, he had experienced three flares. So it's not that unusual for him to go two weeks without a flare. Right, Right. But he also noticed that the dizziness and steadiness was better chronically. So that low grade feeling of unsteadiness had improved.
[00:31:48] Speaker A: Right.
[00:31:50] Speaker B: Additionally, his sleep had gotten a little deeper. He was still having the night terror things. But he said he's waking fewer times at night and. And urinating less at night. Right. So I'm counting that all as a positive.
[00:32:04] Speaker A: Yeah. I mean, the results, it sounds like, at least initially, is that the disharmony is beginning to restore itself. Yes. And the fluid side of it, though, not wooling level fluid problem.
[00:32:19] Speaker B: Right.
[00:32:20] Speaker A: Is also starting to adjust a little bit.
Okay.
[00:32:22] Speaker B: Yep.
[00:32:23] Speaker A: So then What?
[00:32:24] Speaker B: So then two weeks. So I refilled for two weeks and then followed up on 12, 5.
And at this time, the patient caught a cold and I had to treat him for the cold.
[00:32:40] Speaker A: Yeah.
[00:32:40] Speaker B: Interestingly enough, the dizziness and vertigo symptoms did not get worse during the cold or after the cold.
[00:32:48] Speaker A: That's good.
[00:32:49] Speaker B: So that was pretty cool.
[00:32:51] Speaker A: Were you using Chai formula to treat the cold?
[00:32:53] Speaker B: I was also helpful then. Also helpful? Yeah. I wrote down here. I used a triple yang method. So probably Chai who Gwazer Tong plus go again. Or Chai who GW Ganjung Tong, something like that.
[00:33:04] Speaker A: Yes. I mean, he's still getting that Chihu harmonizing effect.
[00:33:08] Speaker B: Right.
[00:33:09] Speaker A: Just relative to the cold now.
[00:33:10] Speaker B: Right.
[00:33:11] Speaker A: Okay, that's good.
[00:33:11] Speaker B: Yep.
[00:33:12] Speaker A: So it gets better from the cold.
[00:33:14] Speaker B: Gets better from the cold. And then I sort of lost track of him after that for basically the next six months.
And then the next time I talked to him about this particular issue was in the summer.
Let's see.
7:27. So a little more than six months later, actually.
And in the time in between, he hadn't been experiencing vertigo at all.
[00:33:44] Speaker A: Nice.
[00:33:45] Speaker B: And the dizziness or the unsteadiness, the low grade stuff, had mostly been gone.
[00:33:51] Speaker A: Okay.
[00:33:52] Speaker B: But a week before I started talking to him, he started to experience the unsteadiness again.
And then he had a vertigo flare.
And then this is what prompted him to reach out to me specifically about this.
[00:34:06] Speaker A: So basically a month's worth of the original formula stopped the pattern.
[00:34:15] Speaker B: Yep.
[00:34:15] Speaker A: For all intents and purposes, for about six months.
[00:34:18] Speaker B: Yep.
[00:34:19] Speaker A: Okay. So then the unsteadiness reasserts, the flare occurs, they reach back out.
Was there any changes in the background? Because you mentioned in the beginning that there was like, stress and stuff that was leading to this. Lots of travel.
Was there an inciting incident to the flare?
[00:34:35] Speaker B: This time there wasn't.
[00:34:36] Speaker A: So it just seemingly came out of nowhere.
[00:34:38] Speaker B: Yeah. And in a way, the opposite. This person retired in between that time. Right. They were preparing to retire before, but they had met their retirement date by then and were adjusting to, like, this is the summertime. It's their favorite time of year. So you wouldn't expect this kind of thing to come back from stress alone, unless you think about the stress that people go through when they retire, which, you know, is a whole other conversation. Their sort of their drive in life and all this kind of thing.
But the other way that I'm making sense of the flare at this time is this is around when Yang starts to float seasonally.
[00:35:25] Speaker A: Yeah. And it starts to become pernicious.
[00:35:28] Speaker B: It can become pernicious, Yang. Exactly. So I'm thinking that the flare is connected actually to that.
So let me talk about what's happened. So the patient experienced a flare of vertigo again. This time he was at home, but a similar situation occurred. The room was spinning, and he did. Ended up vomiting.
He did say that it wasn't as intense as the experiences six months prior, but he also had medication to take acutely for it, so.
[00:35:58] Speaker A: Well, I mean, the room is still spinning, he still vomited.
[00:36:01] Speaker B: Yeah. So it's pretty bad.
Yeah. Yeah.
[00:36:05] Speaker A: He.
[00:36:05] Speaker B: And then he mentioned he had been feeling a little unsteady a week or so beforehand, which he noticed when he would drive his car to the gym. So he'd be. Which isn't that far away from his house, but it's like he would be concerned about, like, ooh, am I going to be okay?
[00:36:21] Speaker A: Yeah.
[00:36:22] Speaker B: But then he would just kind of like, breathe and move through it. And it was. It didn't end up flaring, but eventually, apparently, it did.
So because I wasn't in person, I wrote him exactly the same formula.
I sent it to him this time for three weeks, in which time I would be visiting and could check him out in person this. This particular place that he lives. So, um, I was able to reevaluate with the patient in person this time. He had been taking the herbs for three weeks.
There had been no flares since that time, but there was still a low grade feeling of unsteadiness. Mm.
The urination symptoms were the same as before.
So still having to get up at night, basically that when he was on the herbs, they were helpful, but not. It didn't feel like they were as helpful this time for the urination stuff.
[00:37:18] Speaker A: Okay.
[00:37:20] Speaker B: But there had been no vertigo flare other than the first one that we mentioned. And he said that he was feeling better on the herbs overall.
Take that for what you will. I checked the pulse this time because I was in person. The pulse, to my surprise, was very deep and deficient.
Very shu.
There was a little bit of tension in the right chair.
So that was the only big feature in the pulse.
Everything else was deep and very deficient. Very weak feeling.
Basically what I did is I wrote him shenchiwan at this point. So my, my thought was we treated, likely treated the, the acute flare sh presenting with this triple Yang Xiaoyang pattern.
[00:38:17] Speaker A: Right.
[00:38:18] Speaker B: And then we need to treat the deficiency underneath that.
[00:38:22] Speaker A: Particularly indicated by the very deep pulse.
[00:38:25] Speaker B: Particularly indicated by the very deep and weak pulse.
[00:38:28] Speaker A: Yes, Got it. Okay, so shinxiwan standard numbers.
[00:38:31] Speaker B: Shenchiwan standard numbers. Yep.
[00:38:34] Speaker A: For how long?
[00:38:35] Speaker B: I gave this to him for a month.
[00:38:37] Speaker A: Okay.
[00:38:38] Speaker B: Shenzhen pattern is not going to change quickly.
[00:38:40] Speaker A: Eight grams twice a day.
[00:38:41] Speaker B: Eight grams twice a day.
[00:38:43] Speaker A: Okay, what'd we get?
[00:38:45] Speaker B: So at the end of that time, I checked back in with him. He said the feeling, basically he was doing better. The feeling of unsteadiness that was low grade had improved. He felt an improvement in his energy level.
He was still getting up at night one to two times, but an improvement from the three to four.
And he actually said he's feeling a little bit better about his transition into retirement. Just sort of feeling better about his life.
So at this time I chose to discontinue the treatment and told him to reach back out if there was a further problem.
[00:39:27] Speaker A: So considering the many formulas that exist to treat deficiency patterns, why Shenshiwan?
[00:39:36] Speaker B: Yeah, for a few reasons.
Firstly, you know, it's been said that Shenzhen is the formula that is the quintessential representative for male bodied people deficiency. So it's, it's kind of the goal, if you have a goal formula to get somebody on chronically who's a male bodied person. Shen Shiwan is a good, good one to shoot for because it treats cold water, it treats deficiency in the blood. Right. There's a lot of herbs to build up the blood, the Shanyao, the Shanjuyu, the Shang Di, all building up the blood. It does a little bit of blood movement with the Mu Dan PI. Right. And the Guizhi you could say, moves the blood a little bit, but it's mostly tonifying and strengthening and helping all of the different aspects of where the male body physiology tends to go off.
[00:40:34] Speaker A: Right, right. But a lot of times those blood nourishing aspects are difficult for wetter people, weaker digestive people to actually metabolize.
So that's what you mean with sort of like getting to Shenzhuan.
[00:40:49] Speaker B: Exactly.
[00:40:50] Speaker A: Can't just maybe open the door with it.
[00:40:52] Speaker B: Yeah. So let's say I examine that person's pulses and situation and it was very deficient, very weak, and the digestion was weaker and wetter. I would start with Zhen Wu Tong then. Right. Because that's not Shenzhuan, the water side
[00:41:08] Speaker A: of the deficiency problem.
[00:41:10] Speaker B: Yeah. And there's not as much material moistening or building in that formula. It's easier for the body to tolerate if there's weaker digestion. Yeah.
[00:41:21] Speaker A: With maybe over time getting to Hsinchuan, if the digestion stabilizes.
[00:41:26] Speaker B: Correct. Yeah. So if the digestion gets better, then we could go to Shenziwan after. Yeah.
[00:41:32] Speaker A: Okay, so then the patient has reported back, like, no return of these symptoms.
[00:41:39] Speaker B: The patient has.
During the time that I was talking to them about this, they reported no symptoms. So the next time I had seen them, which was about six months later, they were good. They didn't have any unsteadiness, they didn't have any problem with the dizziness, anything like that. The last time I saw this person, which was a couple months ago now, they actually reported to me that some of that unsteadiness had started to come back.
So they probably need to be treated again more chronically.
[00:42:13] Speaker A: Yeah.
Okay, well, maybe we'll have more updates to add to that into the. Into the future. But I think we've got a decent spread of examples of how some of the formulas we talked about in the theory section can be used and applied in real life patient cases. Any other summary bits or components to add?
[00:42:34] Speaker B: Yeah. The reason that I wanted to share this last case, despite it not being the perfect case to share, given there's not diagnostic parameters for the first parts of it and stuff, is to illustrate a learning point for me around treating the chronic nature of these patterns and how important that is and likely that you would need to treat it. Like, I think we could probably get this person to a point where they're not experiencing that unsteadiness or that dizziness, but they might have to take that Shen Shi Huan formula for a long time. Months and months and months, and maybe at a lower dose toward the end, but it would be a good formula to keep them on for a really long time. Now, the patient has to be compliant in that, right?
[00:43:20] Speaker A: Yeah.
[00:43:21] Speaker B: And the only place we talk about compliance a lot with our residents and things like that, you and I don't struggle to have our patients be compliant very much anymore. Right.
[00:43:33] Speaker A: Yeah. It might be that you could eventually shift this person to the actual one. Yeah. So to go from the granule to the actual wine and then that could be, you know, long term administration. Because of course, like, that's likely why it's a one.
[00:43:51] Speaker B: Yes.
[00:43:51] Speaker A: In the first place is because people would need to take it for a long time. And it's much easier to get compliance out of someone if they just have to chew up three little honey pills two times a day or something than to actually drink granules constantly.
[00:44:03] Speaker B: Yep.
[00:44:03] Speaker A: Nice.
Okay, well, I think that wraps it up for our case studies. As always, thanks for listening to the Nervous Herbalist. If you guys have any questions or suggestions for topics, you can send us a [email protected] we'd love to hear from the listeners. And as always, please rate and review us wherever you find your podcasts, and we will catch you next time. I'm Travis Kern.
[00:44:26] Speaker B: I'm Travis Cunningham.
[00:44:27] Speaker A: Talk to you later.
[00:44:28] Speaker B: Talk to you later.
