CASE STUDIES - Dx / RxT / Fx Flashcards
case 1.
18 yr, female
MIGRAINE w flashing lights
(since early teens)
funny taste === Heat LR/GB flashing lights === LR yang rising vom === LR/ST better/ after vom === vom initiates LR qi flow worse/ perior + exams === LR qi stag
Tx;
dark red === heat
purple sides === LR stag
thin wh coat === acute
Px:
taut === LR qi stag
hesitant === stag
LR yang rising = branch
d. LR qi stag = root
- subd. LR yang = branch
- free flow LR qi = root
Tian ma guo teng yin === LR yang rising)
or
chai hu shu gan tang === LR qi stag
case 2.
female
ANXIETY exacerbated to PANIC ATTACKS
+ co-morbid DEPRESSION
(since young, ex past 2 yrs)
since young === const. SP def loose stools === SP def wakes night in panic === SP def > qi + bld def > HT qi + bld def >> anxiety + HT cond's palp === HT qi + bld def SOB === Qi def dizzy ===== phl nausea === accum. MJ poor energy/easy tired === SP qi def poor app === accum MJ
tx
dark red === heat
wh greasy thick === damp + phlegm
moist === damp
px
sunken
wiry === LR qi stag
auri acu - shenmen
damp-phlegm - accum. in MJ = branch
d. SP def = root
- resolve damp + phlegm = branch
- ton. SP = root
- calm mind = branch
si jun zi tang (4 gentleman) == ton sp
> mod:
mu li == calm mind
long gu === calm mind
fa ban xia === damp phlegm
case 3.
30yr female
INSUFFICIENT LACTATION + TENDER BREASTS
(3 weeks)
new baby/stressful to cope === LR qi stag
not enough sleep === SP qi def >fail make bld/qi/milk
poor app (but still eats) === LR/SP
small amount milk === LR qi stag > blocking flow of milk
breast swollen/painful === LR qi stag w Heat
emotional/teary === LR qi stag
hypo pain === LR qi stag
bitter taste === Heat LR/GB
red dry eyes === Heat LR to eyes
Tx
red === heat
sl yel coat === heat
Px
forceful === full/exc
wiry === LR qi stag
LR qi stag > blocking flow of milk
(w LR heat)
- free flow LR qi > to facil. lactation
- cl. Heat
chai hu shu gan tang === LR qi stag
case 4.
female
low grade RECURRENT SORE THROAT
(once or twice per month)
better/
w good sleep === bec nour yin
gargle salt water === salt for KI
light sleep === yin def wake to toilet === KI def mouth + tongue ulcers === fire sore swollen gums === KI yin def (w fire) denies chills/fever constip === yin def
tx pale === not full heat sl. enlarged === thin wh coat === red tip === HT fire (bec KI yin not controlling HT fire)
px
deep chi === KI yin def
gen. deep === interior, def
thready === yin def
KI yin def (w def Heat)
- nour KI yin
- cl. def heat
liu wei di huang wan == ki yin def w def heat
case 5.
25 yr, female
NO MENSES
(3 years)
menses delayed until age 19 === def KI jing irreg === Ki def - LR qi def scanty === bld def - congeal. bld - cold obst > poss bec congen jing def > jing builds bld dizzy === yin def tinnitus === yin def sore loins === ki def weak legs === ki def HA - dull === def > not enough to move - tension === stag/bld stasis
tx
light red === norm, bld def
little coat === yin def
px
deep === qi def
feeble (weak) === qi def
KI jing def, KI yin def
» Bld def
- ton KI
- support Jing
- nour bld
liu wei di huang wan == ton ki yin + jing
case 6.
female
INSOMNIA
(3 mths)
hard to get to sleep = HT yin def wake every night 3am = LR time - HT def mind busy (restlessness) = HT fire stressful home = LR qi stag irritable = LR qi stag - HT yin def sore eyes = LR
tx
purple (esp sides) = LR qi stag
red tip = HT fire
thin wh coat = acute
px
taut (L guan) = LR qi stag
deep (L cun) = HT Qi def
auri acu - shenmen
LR qi stag (w Heat)
> Heat disturbing HT shen
- free flow LR qi (reg LR qi)
- cl. Heat
chai hu shu gan tang === LR qi stag
mod
mu li === calm mind
long gu === calm mind
case 7.
female
FEEL SICK / UNCOMFORTABLE when eating
progressed to DIFFICULTY SWALLOWING
(onset 1 year ago)
intolerant to COLD = cold syndrome
cold limbs = SP yang def
loose stools = SP Qi or Yang def
emaciated + weak = SP Qi def
tx
pale = cold
swollen = damp
thin wh coat = ext path
px
thin = bld def (d. sp qi def > not prod bld)
weak = qi def
(deep weak = sp + ki yang def, ret damp - p46 DxTB)
# moxa SP yang def (w Cold-Damp accum MJ)
- ton SP yang
- dispel Cold + Damp
li zhong tang === sp yang def
case 8.
female
BRONCHIAL ASTHMA agg/ fatigue or cold
(8 yrs)
difficulty breathing, unable to lay flat (cough up wh sputum) = LU qi def > accum phl LU waist/knees - painful weak = KI yang def limbs cold = SP yang def dislike cold = Ki yang def dizzy = KI def tinnitus = Ki def freq urine - KI yang def
obs- panting, lift shoulders to breath unable to lay flat = LU qi def > accum phl LU gurgling sound in throat = phlegm, damp legs sl. swollen = KI yang def
tx swollen = damp from yang def pale = cold scalloped = SP qi def greasy wh coat = damp cold
px
deep = qi + yang def
thin = qi + bld def (deep thready - p44 DxTB)
(deep weak = sp + ki yang def, ret damp - p46 DxTB)
# moxa KI yang def w COLD-DAMP-PHLEGM accum in LU
- warm KI yang
- expel cold, damp + phlegm
you gui wan === KI yang def
or
***SU ZI JIANG QI TANG
(asthma d. cold damp)
- expel phlegm / desc reb qi
- warm KI
- stop asthma + wheeze (d. KI not grasp LU qi = exc above, def below)
case 9.
16yr male
whiplash injury LHS LOWER NECK + SHOULDER
d. cycling accident (recent years)
(3mths ago bike accident again onto LHS)
post upper LHS shoulder
worse/ on moving GH jt
ss still present after 3mths == stag merid
aching (from shoulder to wrist) == qi stag
numbness (ant forearm) == bld stasis
obs
swelling LHS neck == qi stag + bld stasis
tenderness - spinous process c7 + post sup LHS shoulder == stag
unable to raise LHS arm ant more that 140* == stag
RHS shoulder == NAD
WM
-ve: fracture or displacement
Dx: whiplash injury - cervical spine + soft tiss injury - shoulder
prev Rx: physio + corisone injections, chiro, homeopath
tx
norm bond
thin wh coat == NAD
px
sl. wiry == Qi stag
electro
Qi stag + bld stasis
d. cycling injury
- move Qi + bld
si wu tang === bld stasis
case 10.
50yr Male
FELT FAINT
HA, NUMBNESS, HEAVINESS, DIFFICULTY MOVING
(after getting up in morning)
... (by noon s/s much worse) SEVERE HA === qi + bld stag UNABLE TO MOVE RHS arm + leg === wind block merid (paralysis) SPEECH IMPAIRED === wind inv CHOCKED + COUGHED when drinking === wind invasion denies nausea/vom
WM dx: CEREBRAL THROMBOSIS = bld stasis
obs conscious but speech imparied RHS arm + leg paralysed w decr mus strength === bld stasis > fail to nour reflexes present (deep + superficial) \+ve extensor plantar response RHS (babinski) \+ve superficial sensory impairment RHS === bld def d. stasis > fail to nour
tx dark red === heat w ecchymosis (purple dots) === bld stag dry === exc heat / yin def yellow === exc heat
px
wiry === LR qi stag
wind stroke - in meridian
d. bld stasis
- move qi + bld stag
- extinguish wind
si wu tang === bld stasis
case 11.
39 yr female
RHEUMATOID ARTHRITIS
(2 yrs)
acute stage lasted weeks
fever === WH
sm jts swollen, hot, painful === WH
after acute attack === EPF
some pain and swelling subsided, never completely === EPF deeper in bod
sm jts swollen, sore, not very hot to touch = WD inv joints
morning aches everywhere (incl LBP very stiff) === damp
after 1-2 hrs stiffness + ach subside expt hands === damp
period reg but flow scanty === yin def > bld def
tingling in legs === yin def > bld def
floaters in eyes === yin def> bld def
night sweats occasionally === KI yin def heat
tinnitus === yin def
tx sl. pale === *dampness from yang def swollen sides === damp yang def (ADR === *sp qi def / LR yang rise / LR fire) root no spirit = ?
px weak (esp both rear) === Ki yin + yang def
WIND-DAMP accum
(w KI yin + yang def)
- elim dampness
- ton KI yin + yang
du huo ji sheng tang == WD w KI def
case 12
29yr male
SEVERE DIZZINESS, sl DEAFNESS, TINNITUS
(1 yr)
WM dx: MENIERE’S DISEASE
dizzy === LR yang rising / yin def sl deafness === tinnitus === yin def night sweat === yin def exhausted HA's - throbbing, temples === LR yang rise (ha, dizz, tinnitus) w flickery eyes === wind
Tx
sl red = heat
coating to thin = yin def
px
empty (deep level) =qi & yang def
wiry (both rear) = LR & GB / phlegm / pain
LR + KI def > LR yang rising
(d. LR qi stagnation)
- subd. LR yang
- rem stag
- ton yin
liu wei di huang wan === LR + KI def
tian ma guo teng yin === LR yang rising
chai hu shu gan tang === LR qi stag
branch === tian ma guo teng yin
(LR yang rising
*branch === ban xia bai zhu tian ma tang
(menieres d. liver yang rising)
case 13.
male
EPIGASTRIC PAIN
(6 yrs)
WM dx: DUODENAL ULCER
recurrent stinging pain (upper RHS quad) === MJ length of attacks varied alleviated/ by eating + painkillers ===ST fire pain varied in intensity fixed location === stag burning === fire sharp === stag increases w pressure === exc cond, accum indigestion === food retention sour regurgitation === food retention gnawing hunger === ST fire bloody stools === heat in bld \+ve occult blood stools === heat in intestines poor app === weak SP/ST, DH MJ
tx
sl yel === heat
dark red body === heat
px
thin = bld def?
string taut = stag
Bld stasis
w ST heat
- cl. heat
- rem stag
- reg bld
yu nu jian === ST heat
si wu tang === bld stasis?
entrance exam case 1.
24yr female
BLOCKED NOSE
(3 days)
cl nasal discharge === WC HA - RHS eyebrow === ext wind inv (H or C) body aches === wind aversion Wind + cold === WC invasion pref warm drinks === cold syndrome app decr. === lethargy === wei qi attack path
tx
thick wh ===
pink body === NAD
px
floating === ext synd
WIND-COLD invasion
- clear wind
- disp cold
fx
Gui Zhi tang ==WC
- harmon yin + wei
- rel WC ext
entrance exam case 2.
36 yr female
INFERTILITY
(1yr)
irreg period === bld stag cycle btw 24 + 30 days bleed 5 days day 1 dysmenorrhea severe (double over) === stag (bld) colour - dark read day 1 === bld stag - bright red following days === heat d. stag? - dark red-black clots 20c size === bld stag bleed amount === NAD feels cold day before period === cold synd? tired after period === bld def, qi def?
tx
thick wh = damp
dark red bod = heat
px
thready = yin def
deep = internal, def bld + qi?
Bld Stasis
- reg bld flow
fx
Tao Hong Si Wu Wan
- reg bld + menses
- ton bld
