“I wake up drenched with my heart racing.”
Flushes that wake her
Fourteen months without a period and nights that have become the worst part of the day.
- Patient
- Woman, 52
- Occupation
- Librarian
- Medication
- None. She declined hormone therapy.
- History
- Last period fourteen months ago. Normal thyroid.
- Habits
- Two coffees in the morning. Walks half an hour a day.
- Vitals
- BP 122/74 · 68 bpm at rest
1 · The consultation
You have 18 minutes. Each question or examination costs 2. Choose carefully what to ask.
Questions
Examination
2 · The tongue
3 · The pulse
Describe the pulse on each axis.
4 · The pattern
5 · Differential diagnosis
You're torn between two patterns. Which is it?
Which finding decides it?
6 · Case twist
Before finishing“«The palpitations only come with the flush, never walking or climbing stairs. No chest pain and no breathlessness. I had an ECG last year and it was fine.»”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 5)
Case solved
Reasoned solution
Pattern: Heart and Kidney not communicating. Supporting signs: Flushes with palpitations, Wakes anxious before dawn, Cannot fall back asleep, Red tongue tip on a peeled body, Thin, rapid pulse, agitated above.
The deciding clue: The flush comes with palpitations: Her heart races **with** the heat. If the Yin failure stayed below, the chest would be quiet..
Safety: Palpitations that only appear with the flush, with no pain, no exertion and no syncope: this is the unanchored Shen, treated by reconnecting Heart and Kidney.
Treatment: Nourish Kidney Yin, Calm the Shen, Connect Heart and Kidney; Anchor and nourish. Points: KI6, HT6, SP6, HT7, KI3.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Heart and Kidney not communicating. Supporting signs: Flushes with palpitations, Wakes anxious before dawn, Cannot fall back asleep, Red tongue tip on a peeled body, Thin, rapid pulse, agitated above.
The deciding clue: The flush comes with palpitations: Her heart races **with** the heat. If the Yin failure stayed below, the chest would be quiet..
Safety: Palpitations that only appear with the flush, with no pain, no exertion and no syncope: this is the unanchored Shen, treated by reconnecting Heart and Kidney.
Treatment: Nourish Kidney Yin, Calm the Shen, Connect Heart and Kidney; Anchor and nourish. Points: KI6, HT6, SP6, HT7, KI3.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
