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Case Histories - Menstrual Headaches

A 52-year-old woman suffered from headaches occurring after the period. Her periods were still coming regularly but were rather scanty. Her hair was falling out and her skin was dry. She had never been able to conceive although she tried for many years. She also felt very weary and depressed, especially so after her period. She also lacked any motivation and "everything was an effort". She found it difficult to fall asleep and had had a lump in her left breast for 20 years. Her iron storage level was very low (3). Her pulse was very Weak and Empty on the deep level but also slightly Fine and Wiry on the left. Her tongue was Pale on the sides, had a Heart crack and a rootless coating.

Diagnosis

This is quite a complex condition. The main pattern that emerges is that of Liver-Blood deficiency manifesting with scanty periods, hair falling out, dry skin, infertility, insomnia, a Fine pulse and a Pale tongue on the sides. There are, however, other patterns that manifest with only a few symptoms. The Wiry quality of the pulse indicates that there is some stagnation of Liver-Qi from emotional stress, also evidenced by the Heart crack on the tongue. The stagnation of Liver-Qi was a contributory factor to the development of the breast lump, another being Phlegm (as the lump felt soft to the touch). Yet another pattern is a Kidney-Yin deficiency, again manifesting with few symptoms and principally the emptiness of the pulse at the deep level, the rootless tongue coating and the lack of motivation and exhaustion. The falling hair and dry skin attributed to Liver-Blood deficiency may also be caused by Kidney-Yin deficiency, or this may contribute to them. To sum up, there are two Excess conditions (stagnation of Liver-Qi and Phlegm) and two Deficiency ones (Liver-Blood and Kidney-Yin deficiency). In addition, this may be classified as a case of Mind Weakened, i.e. low spirits, depression, lack of motivation and physical and mental exhaustion.

Treatment

The headaches occurring after the period were her main presenting symptom and they were due to Liver-Blood deficiency. I therefore started by treating her with Precious Sea (a variation of the formula Ba Zhen Tang-Eight Precious Decoction).

After one course (30 days) of this formula, this patient felt a lot better in herself and her headaches disappeared. Her iron storage levels also climbed to 13. The patient is still under treatment and I foresee that she will probably eventually need to change to a formula to nourish Kidney-Yin and Blood.