Case History

After twice failing to graduate from university, Mr. B began to experience inner restlessness, insomnia, and the inability to concentrate, all of which prevented him from re-taking the examination. He tried to compensate for his lack of concentration by taking stimulants like guarana products (a dried paste prepared from the seeds of Paullinia cupana and used as an astringent) and consuming as many as 15 cups of coffee daily. His stools became loose and foul-smelling, and he suffered from flatulence. The wide tongue showed a yellow, greasy, and dry coating. His pulse was excessive (shi) and rapid (shuo).

Analysis. In this case, the excessive study and thinking, as well as the severe disappointment at not graduating, gave rise to heat in the Heart. Surprisingly, this was not visible on the tongue. Rather, the tongue reflected only the abuse of guarana and caffeine. Those two substances can, if taken in excess, injure the Kidney yin and the fluids through enhanced diuresis. The injury to the Kidney yin resulted in a disturbance in the harmonious communication between the Kidneys and the Heart, which is reflected in his inner restlessness and insomnia.

The yellow, dry, greasy coating reflects the intense heat in the lower burner that has injured the fluids. This is visible in the cracks as well as in the thinned coating in the center of the posterior third of the tongue body. The smelly, loose stools were the result of a retention of damp-heat in the Large Intestine; here, the heat is more dominant than the dampness. The full and rapid pulse confirms that this condition is one of excess.

Discussion. The appearance of a dry, rough coating is caused by damp-heat wherein the heat is more dominant than the dampness. Here, the heat injured the fluids in the Stomach, resulting in the dry, rough coating. In this case, it is important to clear the heat and increase the fluids. The patient was therefore given dietary counseling, and encouraged to eat more moistening foods, like pears, and less hot and spicy foods.

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