The following is a case history sent by Jason Smith, a practitioner in Spain.

The patient is a 20-year-old girl seeking help because she had a bronchitis three years ago and ever since then she has been very prone to catching colds that always end in bronchitis and pneumonia. Enquiring about how it started, her first bronchitis was after studying very hard to be admitted in university. In the mornings, she coughs and expectorates some phlegm.

She feels cold in general with very cold feet although her hands are always very hot; in the past months she started having a feeling of heat rising up to the head being worst during the acute attacks of bronchitis. Three months ago, she started sweating at night (face and forehead). She also has a dry mouth at night. She used to like warm drinks but now she feels thirsty and needs cold drinks.

Recently she lost weight, losing as much as 10 kg (22 lb) in only three months. She has a pale face but with malar flush (red cheekbones). Her lips are purple. She has bad sleeping habits (goes to bed at 5 am and gets up 2 pm) and for the past three months she wakes up in the middle of her sleep for no apparent reason.

When she has colds she always has a fever, sore throat, profuse sweating, cough and green nasal mucus occasionally with blood. Always shows aversion to wind.

She now feels tired and her legs feel sometime heavy. Her bowel movements are regular (twice a day) but she occasionally has constipation. Her urine is pale but the first one in the morning is dark. She suffers from abdominal fullness after eating. Her appetite is decreased, and she complains that her “stomach is closed”. Has had Candida infections in the past.

In the past three months, she has been getting lower back pain as well as spontaneous sweating and occasional tinnitus.

She feels depressed and her mental state fluctuates, sometimes crying for no reason.
She suffers from throbbing headaches on the lateral sides of head lasting 2 days with nausea: this happens once a month, sometimes with the period but not always. Lately she has experienced floaters.

Her period has always been very irregular (coming between every 15 and 45 days) and extremely painful (before and during) with stabbing pain alleviated by heat. The period lasts 8 days with profuse bleeding (the first four days with heavy bleeding, not much on the 5th day, and profuse the last three days). The menstrual blood is red with clots; brown the last day. She started taking the pill two months ago and her last period was very scanty with brown bleeding.

The tongue is pale and slightly swollen on the sides but slightly red and without coating in the centre. There is a sticky-yellow, rootless coating on the root. The tip is red.

Diagnosis

There are many patterns involved:
1) Deficiency of Lung-Qi (spontaneous sweating, propensity to catching colds).
2) Phlegm in the Lungs (cough and expectoration of phlegm in the morning. This is a residual pathogenic factor that has lingered ever since her first invasion of Wind three years ago with her first bronchitis, and that accounts for the repetitive bronchitis and pneumonia.
3) Kidney deficiency (lower backache, tinnitus, getting thinner, rootless and lack coating). This is a deficiency of both Kidney-Yin and Kidney-Yang as evidenced by the simultaneous cold and hot feelings.
4) Stomach-Yin deficiency with mild empty Heat (tongue red without coating in the middle)
5) Spleen-Yang deficiency (tiredness, abdominal distension).
6) Liver-Blood deficiency (floaters, pale sides of the tongue)
7) Liver-Blood stasis (menstrual clots, purple lips, painful periods)
8) Liver Qi stagnation (moodiness, crying, depression)
9) Liver-Yang rising (throbbing headaches) that is probably due to the Blood deficiency and
Kidney-Yin deficiency
10) Cold in the Uterus (period pain alleviated with application of heat). The Cold in the Uterus leads to Blood stasis.
11) Damp-Heat in the Lower Burner (feeling of heaviness of the legs, candida infection, sticky-yellow coating at the root of tongue).

Treatment
There are many patterns and therefore many treatment options. I decided to start by eliminating the residual pathogenic factor in the Lungs because that is the pattern that is causing the most morbidity. After that has been cleared, I would proceed to treat the other underlying patterns.
She has been given Central Mansion (Three Treasures remedy) to tonify Spleen-Qi, Stomach-Yin and Lung-Qi together with Resolve Phlegm (Little Treasures remedy) to treat the residual pathogenic factor. She has been treated for the past 5 months and she has only had one cold that did not progress any further. The next step will be strengthening the Kidneys.

Note
Note that although Resolve Phlegm is part of the pediatric range Little Treasures, it eliminates residual Phlegm in the Lungs and it can indeed be used in adults.
Finally, please note also how there are four Liver patterns: Liver-Qi stagnation, Liver-Blood stasis, Liver-Yang rising and Liver-Blood deficiency. It is common for the Liver to manifest with several patterns simultaneously: this does not happen with other organs.