A Case of Modified Yunü Decoction for Unexplained Intractable Headache with Acne
Wang, female, 23 years old. She came to Beijing from Shandong seeking treatment for unexplained intractable headache and acne. The patient developed a headache whenever she dressed even slightly warmly or after exercise, and also napped and woke with headache; during attacks the pain was severe and unbearable, and for years she had relied on Western analgesics to relieve it. Her palms were hot, she sweated poorly after exercise, body hair was excessive, and facial acne was severe. Her mouth was dry and thirsty but she drank little; she was prone to constipation. Chronic nasal congestion and discharge. The tongue was slender with red edges and scant coating; when exposed to cold she produced much phlegm, yellow-green in color. She was easily nervous. She had taken hormones for years, so that stopping them caused amenorrhea, lasting as long as a year at its longest. During menstruation she was dizzy; she had body odor, abundant earwax, chronically damp ear canals, and occasional tinnitus. Breast distension and lower abdominal pain; frequent urination with scanty, dark-yellow urine. Pelvic effusion and excessive vaginal discharge. The right cun pulse was floating and rapid.
On the first visit, the pattern was differentiated as a combined disease of two yang channels, with excessive heat in the Taiyang and Yangming. The prescription was Mahang Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) combined with Shengjiang San (Ascending-Descending Powder), modified.
Zhi Mahuang (honey-fried Ephedrae Herba) 6g, Sheng Shigao (Gypsum fibrosum) 30g, Sheng Gancao (Glycyrrhizae Radix) 6g, Xingren (Armeniacae Semen) 10g, Pian Jianghuang (Curcumae longae Rhizoma) 6g, Chao Jiangcan (fried Bombyx batryticatus) 10g, Chanyi (Cicadae Periostracum) 6g, Shu Dahuang (processed Rhei Radix) 6g, Chishao (Paeoniae Radix rubra) 10g, Qiancao (Rubiae Radix) 10g, Taoren (Persicae Semen) 6g, Honghua (Carthami Flos) 3g
Three doses; continue if effective.
After three doses, the headache eased and no new acne appeared, though the old scars could not fade; nasal congestion and discharge ceased. The patient felt her strength had declined after taking the medicine. She then added that she had a years-long history of polycystic ovary syndrome and asked for the prescription to be adjusted. Since she could not attend in person, pulse diagnosis and other data were unavailable.
The formula was changed to modified Yunü Jian (Jade Maiden Decoction).
Sheng Shigao (Gypsum) 30g, Shengdi (Rehmanniae Radix recens) 30g, Zhimu (Anemarrhenae Rhizoma) 9g, Maidong (Ophiopogonis Radix) 9g, Tianhuafen (Trichosanthis Radix) 12g, Mudanpi (Moutan Cortex) 9g, Jinyinhua (Lonicerae Flos) 12g, Baimaogen (Imperatae Rhizoma) 30g, Diyu Tan (carbonized Sanguisorbae Radix) 12g, Huaihua (Sophorae Flos) 9g, Qiancao (Rubiae Radix) 6g, Puhuang Tan (carbonized Typhae Pollen) 6g, Kunbu (Eckloniae Thallus) 12g
Three doses; continue if effective.
After taking the medicine, the patient's years-long refractory headache was cured; thereafter the headache basically did not recur. It occasionally returned once or twice, and the patient recovered after taking one or two doses of this formula. Seeing her condition basically cured, she stopped after taking three more doses.
Three months later, misled by others, she underwent moxibustion, which caused five-center heat (heat in the palms, soles, and chest), especially severe while sleeping; the heat in her palms and soles became unbearable. She returned for follow-up. At that visit the tongue was red, the throat sore, and urination difficult, requiring straining and waiting. I prescribed modified Qinghao Biejia Tang (Sweet Wormwood and Turtle Shell Decoction):
Biejia (Trionycis Carapax) 15g, Qinghao (Artemisiae annuae Herba) 9g, Shengdi (Rehmanniae Radix recens) 12g, Zhimu (Anemarrhenae Rhizoma) 6g, Mudanpi (Moutan Cortex) 9g, Zexie (Alismatis Rhizoma) 12g, Cheqianzi (Plantaginis Semen) 15g, Danggui (Angelicae Sinensis Radix) 6g, Chishao (Paeoniae Radix rubra) 6g, Digupi (Lycii Cortex) 6g, Manjingzi (Viticis Fructus) 15g, Huainiuxi (Achyranthis bidentatae Radix) 9g, Shegan (Belamcandae Rhizoma) 6g, Chantui (Cicadae Periostracum) 6g, Yujin (Curcumae Radix) 9g
Three doses. I instructed her that after seeing effect, she should drop the herbs other than the Biejia-Qinghao core and continue for a while to expel the remaining pathogen.
In this case the patient showed a full picture of internal heat, yet she often misled herself into taking health measures such as moxibustion that hindered recovery—a very common phenomenon. When patients undertake health measures like moxibustion, they should consult their attending physician first.