CASE STUDIES - exam revision / entire cases 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
xiao yao san === LR qi stag + str SP
face down - head
DU.20 === subd LR yang GB.8 === migrain / move qi+bld LR.3 \+ LI.4 === move LR qi stag BL.18 === cl. fire / spr. LR qi / pacify LR
================================== *DU.20 ^ip-subd.LR yang + desc qi *GB.8 ^ip-migrain *LR.3 (yuan) LI.4 (yuan) BL.18 (bs-LR)
================================= => stress > LR qi stag > heat > consumes fluids > LR not anchored > LR yang rising >> migrain
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 === sp qi def mod fa ban xia === damp-phlegm mu li === calm mind long gu === calm mind
face up - leg - ST.40 === trans phl+D / cl. phl HT / calm mind - ST.36 === ton sp qi / res D / calm mind - PC.5 === calm mind / disp phl - HT.7 === calm mind / reg+ton HT - SP.9 === res D / "open water passage" ============================= *ST.40 (luo) ^ip-phlegm *ST.36 (he.sea) *PC.5 HT.7 (yuan, shu.st) *SP.9 (he.sea) ===================================== => const. SP def > unable to prod bld + qi > fail to nour. HT >> anxiety + HT cond's
=> cons. SP def
> accum. damp + phl MJ
> phl effects HT
» c. spiritual symptoms of HT
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
face up - hand
SI.1 === "activ lact" / swollen breast LR.3 \+ LI.4 === move LR qi / cl. fire CV.17 === bene breast / promo lact / dist breast ST.36 === ton SP/ST / LRoverSP / nour bld+yin / cl fire / treat ST ch - swollen breasts / calm mind > depression ================================ SI. 1 (j.well) ^ip-lact. LR.3 (yuan) + LI.4 (yuan) ^ip-LR qi stag CV.17 ^ip-breast cond's+lact (sea-qi, mu-pc) ST.36 (he.sea-st, sea-water.grain) =========================== => stress > LR qi stag > gen heat >> heat in LR/GB
… LR qi stag
> block qi flow
> block flow of milk in breasts
» insuf. lact + swollen breasts
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
lui wei di huang wan=== kid yin def w def heat
face down - foot
KI.3 == ton yin > cl. def heat
KI.6 + LU.7 == cl. throat w dry - ton yin
KI.6 + SJ.6 == constipation - cl. H in SJ (deep in body)
BL.23 == ton yin / activ qihua > noc enur
=============================
KI. 3 (yuan, shu.st)
*KI. 6 (con.flu-yinqiaomai)
LU. 7 (luo, con.flu-c.vessel)
KI. 6 (con.flu-yinqiaomai)
SJ. 6 (j.riv, fire.pt)
BL. 23 (bs-KI)
===================================== *consti KI yin def (no info for eti?) > KI yin def > not able to control HT fire > HT fire blaze >> def heat + red tongue tip
> KI yin def
no fluids > heat
> constipation
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 === ki yin + jing def
face up - foot
KI.3 === ton yin
SP.6 === supp SP, LR, KI / reg store Bld + KI jing
GB.39 === weakness limbs
LR.8 === reg LJ / ton KI / nour bld + yin / invid bld + bene ute
CV.4 === str. orig Qi + bene essence / ton KI / bene Ute
======================== KI. 3 (yuan + shu.st) SP. 6 (x-SP,LR,KI) GB. 39 (influ-marrow/jing) LR. 8 (he.sea + water pt) CV. 4 (meet CV-SP,LR,K + mu-SI)
============================== => congen KI Jing def > KI yin def > bld def > bld stasis
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 fa ban xia === damp-phlegm
face down - foot
KI.6 + BL.62 == insom > cl. H, unobst qi, calm mind PC.6 == cl. H / calm mind LR.3 + LI.4 == move LR qi stag =========================== KI.6 (con.flu-YinQM) BL.62 (con.ful-YangQM) PC.6 (luo-PC + con.flu-Yin linking) LR. 3 (yuan) + LI.4 (yuan) ^ip-LR qi stag
=============================
=> stress/worry
> LR qi stag
> heat
…heat
> disturbs shen
> HT fire *focus here bec CC is insom
case 7.
female
FEEL SICK 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
face up - wrist
PC.6 === desc ST qi > stop vom
CV.6 === ton true yin + yang / disp damp / ton qi
ST.25 === ^ip-GI disease / supp SP/ST > resolve damp / rem damp stag
SP.9 === - ^ip-damp / reg water passages > damp / reg MJ > damp
ST.36 === reg MJ / rem stag / transf. damp / ton qi > emaciation d. def
============================ PC.6 (luo-PC + con.flu-Yinlink) CV.6 "sea of qi" ST.25 (Mu-LI) ^ip-GI disease SP.9 (he-sea + water pt) ST.36 (he.sea + earth pt + sea-water/grain)
============================= => inv of path > attack SP > SP qi def > SP yang def >> cold + damp accum MJ
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
***SU ZI JIANG QI TANG === asthma d. COLD DAMP
ind/ asthma due cold damp
- expel phlegm, desc reb qi
- warm KI
~stop asthma + wheeze d. KI not grasp LU qi (exc above, def below)
face down - wrist crease (med, rad side)
- **asthma 3’s
- BL.13
- BL.23
- KI.3
LU.9 == reg LU qi / res phlegm
*BL.13 == disp LU / stop asthma
*BL.23 == ton KI / rem damp / rep Ki yin + yang
*KI.3 == invig true yang
ST.40 == ^ip-phlegm / cl. damp + phlegm LU > alle cough/wheeze
============================= LU.9 (yuan + shu.st) BL.13 (bs-LU) BL.23 (bs-KD) KI.3 (yuan + shu.st) ST.40 (luo-ST)
***BL.23 (1.5 lat to ming men btw L2/3)
============================ => congen or fatigue + cold > KI yang def > cold + damp > impair SP qi > LU qi def >> accum phlegm LU
> KI yang def > SP impaired > TT impaired > turbid fluid ascend to LU > damp-phlem accum LU
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
face down - shoulder GB.21 === reg qi + activ ch + alle pain LI.15 \+ SJ.14 === allev pain + bene shoulder BL.11 === bene bone + jts GB.34 === bene sinews + jts / activ ch + alle pain
GB.21 (^ip-bld stasis) LI.15 (^ip-shoulder pain) SJ.14 (^ip-shoulder pain) BL.11 (influ-bone) GB.34 (influ-tendons + he.sea + earth-GB) =================================== => trauma > obst merid > disrupt flow qi + bld > c. blockage >> pain = qi stag >> numb = bld stasis (not nour mus, nerves)
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
face down - head *GB.20 === disords of brai - windstroke > loss speech cl. wind, bene head, activ ch + alle pain DU.15 === bene tongue + muteness / elim wind LR.3 \+ LI.4 === rem stag *face up Sp.10 === invig bld + dispel stasis
GB.20 (^ip-cl.wind) DU.15 (^ip-speech) SP.10 "sea of blood" ============================== > LR qi stag > heat > gen int wind > bring bld to top + block >> cerebral thrombosis
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
*SP.3 === elim damp (esp in mus + jts)
*KI. 3 === nour yin +cl def heat, ton KI yang, str Lumbar
KI.7 === reg sweat, drain damp + cl DH, str Lumbar
SP.9 === rem damp “open water passage”
ba xie === local points knuckles RA, cl H + disp swelling
*SP.3 (yuan / shu.st /earth-SP)
*KI. 3 (yuan / shu.st / earth-KD)
KI.7 (j.river / metal-KD)
SP.9 (he.sea / water pt-SP / ^ip-damp “open water passage”)
ba xie === (8 extra pts)
============================= => attach WH (2 yrs ago) > now def of yin & yang (yin more predom.) > accum WDH jts >> RA
… yin def
> bld def
» scanty period, tingling legs, floaters
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
long dan xie gan tang === LR yang rising
chai hu shu dan tang === LR qi stag
*DU.20 + *KI.1 === top/bottom - subd yang rise / draw down + ton
GB.8 === ^ip-migraine - move qi + bld
LR.3 + LI.4 === LR qi stag - move LR qi
============================= DU.20 ^ip-subd LR yand + desc qi KI.1 (j.well, wood pt-KI) GB.8 ^ip-migraine LR.3 (yuan-LR) LI.4 (yuan-LI)
=========================== => lifestyle > LR qi stag > LR + KI yin def (exhuasted) > LR yang rising >> meniere's disease
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
yu nu jian ?? == ST heat + st yin
- cl. heat
- rem stag
- reg bld
ST.44 === cl. H ST ch + alle pain
CV.12 === epi pain ^all dis of ST - st reflux
SP.10 === invig bld + disp stasis / cool bld
ST.21 === epi pain
SP.1 === Stop bleed (in 15 mins)
================================ ST.44 (y.spring / water pt-ST) CV.12 (mu-ST / influ-Fu organs) *SP.10 "sea of bld" ST.21 SP.1 (j.well + wood pt-SP)
========================== => lifestyle > stag > heat >ST heat > bleeding
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
Gui Zhi tang === WC
- gui zhi + bai shao === harmon ying + wei, rel WC ext
- sheng jiang + gui zhi === transf yang
- bai shao + Da zao === transf yin
LI.20 === open orifice (nose) LU.7 === cl W + C in LU BL.2 === cl W + C / rel pain DU.23 === cl W + C ST.36 === ton qi (yin + yang)
=========================
LI.20 (meet-LI,LU) *loc nose
LU.7 (luo-LU, con.flu-CV)
BL.2 loc start eyebrow
DU.23 (sun si miao-ghost)1 cun post to ant hairl
ST.36 (he.sea, earth.pt-ST, sea-water/grain)
=================== Rx plan treat 3 days > review > if pt ss worse >> suggest return for Rx
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
Si Wu tang === bld stasis + bld def
SP.10 === reg bld flow SP.6 === reg mens ST.25 === reg mens SP.4 PC.6 === chongmai - reg mens
============================ SP.10 "sea of bld" SP.6 (meet-SP,KI,LR) ST.25 (front.mu-LI) SP.4 (luo-SP, con.flu-penetrating v) PC.6 (luo-PC, con.flu-Yinlink v)
======================
Rx plan:
> treat 3 months
> review
