Chinese Medicine Treatment of Bloating

Chief Complaint: gas,severe bloating, diminished ability to flatulate
Western Diagnosis: stress
Medical History: Walks daily, married 57yr old but doesn’t live with wife (both are happy in this arrangement) has suffered from clinical depression for years and sees a psychiatrist, average diet not in excess, slim except for protruding stomach, accountant for school which is very stressful, hypochondriac pains
Questioning exam: likes cold fluids, thirsty a lot, healthy appetite but bloats excessively after meals, hard to fall asleep, has anxiety at night, constipated-every 3rd day, poor energy, mind is cloudy most of the time, cold feet all the time, poor memory, lumbago at night, sharp twinges in the heel, leg cramps at night, neck and shoulders get stiff when stressed.
Pulse exam: left-rapid, HT weak and thready, LV wiry, yin wiry and thin
right-rapid, LU thready, SP wiry, yang wiry
Tongue exam: red, peeled, swollen, deep centre crack, deep transverse cracks at middle warmer
OM Diagnosis: excess heat in the middle warmer
wood overacting on earth
qi stagnation
-everything is “stuck” which is why he bloats so excessively, nothing is moving!
Treatment Principle: drain heat, move LV Qi, tonify Sp
Point Prescription: Ki1(first), Ki3,6, LV3+LI4, GB 34, ST36,37
Ren 12, ST25, LV 13,14 PC6, YinTang
DU20 (last)
(and why did you use kidney 1?)
My theory is to needle Ki1 first so that I attract the Qi downwards first, then Du 20 last to balance. I use these 2 points a lot in a needle prescription for hypertension. It works great (as long as the patient is comfortable being poked in his sole) ha ha.
Herbal Formula: I knew herbal formulas were the most important element in this case. Points would help to move the Qi, but I knew herbs would have a more aggressive effect on draining heat so I used granules (KPC)100g
Long Dan Xie Gan Tang-1 tsp w/hot water in the morning
Yue Jue Wan-1 tsp at night
I instructed the patient that the he was to be in charge of the herbs. As soon as his bloating diminshed, he was to cut down (every other day) on Long Dan. But he was to continue with Yue Jue Wan at night until finished.
Lifestyle Prescription: To continue walking as movement is good for this fellow.
see me once a week.
Results: 7 treatments so far, patient reported improvement(bloating minimized) after 1st treatment. After 2nd, he noticed he started to feel less stressed(no matter how busy work was)felt generally happier, he even told his psychiatrist that my treatment was helping him more than the expensive shrink!, 3rd treatment his bowel movements improved almost once a day now. 4th treatment reported a steady improvement in his digestion, way less bloated, can pass gas now. Patient noted that after the first night of taking Yue Jue Wan he could feel things “moving”. 7th treatment now is just a maintenance treatment extended to once a month
Synopsis: Knowing that the Heat diagnosis was a 2 fold issue, excess on the surface but from a yin deficiency underlying. My goal was to treat the branch first(of course)and nourish the yin later.Points would help with that.