Internal Medicine Final Exam Case Studies Flashcards
Western Medicine Diagnosis?
Patient: Mr. Li, 62
Symptoms: Difficulty swallowing solids, regurgitates immediately after meals, weight loss.
History: Retired professor, history of anxiety, eats spicy food.
TCM Diagnosis: Qi stagnation with phlegm and blood stasis, underlying yin deficiency.
Treatment Principle: Move qi, resolve phlegm, invigorate blood, nourish yin.
Points: Ren 17, BL 17, PC 6, ST 36, Ren 22.
Dysphagia Occlusion Syndrome
Western Medicine Diagnosis?
Patient: Mr. Wu, 57
Symptoms: Abdominal bloating, poor appetite, edema, distention worsens at night.
History: Alcohol use, hepatitis.
TCM Diagnosis: Spleen and kidney yang deficiency with blood stasis.
Treatment Principle: Warm yang, move qi, transform dampness.
Points: Ren 4, UB 23, SP 6, ST 36, GB 25.
“Drum Distension” or Ascites
Western Medicine Diagnosis?
Patient: Mei, 32
Symptoms: Frequent stools with mucus and blood, abdominal cramping, fever.
History: Ate street food before onset.
TCM Diagnosis: Damp-heat ______.
Treatment Principle: Clear heat, resolve dampness, regulate intestines.
Points: ST 25, ST 37, LI 11, SP 9.
Dysentery
Western Medicine Diagnosis?
Patient: Han, 52
Symptoms: Puffy face and legs, tiredness, poor appetite.
History: Lives in humid environment, poor diet.
TCM Diagnosis: Spleen yang deficiency with water retention.
Treatment Principle: Warm spleen, promote urination, resolve dampness.
Points: SP 9, Ren 9, ST 36, BL 20, BL 22.
Edema
Western Medicine Diagnosis?
Patient: Leo, 67
Symptoms: Dribbling urination, difficult flow, lower abdominal pain.
History: History of prostate enlargement.
TCM Diagnosis: Damp-heat in bladder.
Treatment Principle: Clear heat, resolve dampness, promote urination.
Points: Ren 3, SP 9, BL 28, BL 39.
Urine Retention
Western Medicine Diagnosis?
Patient: Anna, 29
Symptoms: Frequent painful urination, burning sensation, hematuria.
History: Recently had a UTI.
TCM Diagnosis: Heat ______.
Treatment Principle: Clear heat, promote urination.
Points: Ren 3, SP 9, SP 6, LI 11, BL 28.
Stranguria
Western Medicine Diagnosis?
Patient: Mr. Zhang, 61
Symptoms: Joint pain moves between limbs, worse with cold weather.
History: Long-standing arthritis.
TCM Diagnosis: Wind-cold-damp _____.
Treatment Principle: Expel wind, cold, and damp; unblock channels.
Points: Ashi, LI 11, ST 36, SP 9, BL 23.
Bi Syndrome
Western Medicine Diagnosis?
Patient: Amelia, 26
Symptoms: Weak legs, difficulty walking, muscle wasting.
History: Post-viral recovery.
TCM Diagnosis: Lung heat damaging body fluids.
Treatment Principle: Clear heat, nourish yin, moisten dryness.
Points: LU 5, ST 36, LI 11, SP 6, BL 13.
Wei Syndrome
Western Medicine Diagnosis?
Patient: Michael, 48
Symptoms: Low back pain, worse in cold weather, stiff.
History: Manual laborer, exposed to damp environments.
TCM Diagnosis: Cold-damp invasion.
Treatment Principle: Warm yang, expel damp, unblock channels.
Points: BL 23, DU 4, SP 9, ST 36, Yaoyan.
Lumbago
Western Medicine Diagnosis?
Patient: Quinn, 38
Symptoms: Inability to maintain an erection, low libido, fatigue, cold limbs.
History: Long work hours, little sleep, overwork.
TCM Diagnosis: Kidney yang deficiency.
Treatment Principle: Tonify kidney yang, warm lower jiao.
Points: Ren 4, BL 23, KI 3, DU 4, SP 6.
Impotence
Western Medicine Diagnosis?
Patient: Brian, 31
Symptoms: Frequent night emissions, insomnia, dizziness.
History: Overthinking, long-term stress.
TCM Diagnosis: Heart and kidney disharmony.
Treatment Principle: Clear heart fire, tonify kidney, secure essence.
Points: HT 7, BL 15, KI 3, Ren 4, SP 6.
Seminal Emission
Assessment (TCM Diagnosis)?
Dysphagia Occlusion Syndrome (Ye Ge) Subjective: Mrs. Zhang, 58, reports feeling of obstruction in the throat, nausea, and inability to swallow food even though hungry. Objective: Red tongue with scanty coating, thin and rapid pulse. Plan:
(Acupuncture) Ren 22, KI 6, SP 6, Ren 17, LU 10
Assessment: Yin deficiency with dryness and internal heat.
Assessment (TCM Diagnosis)?
Hiccoughing and Belching
Subjective: Weak hiccups, abdominal bloating, cold sensation. Objective: Pale tongue, white moist coat, deep slow pulse. Plan (Acupuncture): Ren 13, ST 36, Ren 12, PC 6, Moxa at Ren 6
Assessment: Cold in the stomach.
Assessment (TCM Diagnosis)?
Vomit
Subjective: Morning nausea, fatigue, poor appetite. Objective: Pale tongue with teeth marks, deep/slow/weak pulse. Plan (Acupuncture): ST 36, Ren 12, Ren 6, BL 20, BL 21
Assessment: Spleen and stomach yang deficiency.
Assessment (TCM Diagnosis)?
Drum Distension / Ascites
Subjective: Abdominal bloating, visible veins, stabbing pain. Objective: Dark purple tongue, choppy pulse. Plan (Acupuncture): SP 10, BL 17, LI 4, LR 3, Ren 6
Assessment: Blood stasis in the abdomen.
Assessment (TCM Diagnosis)?
Diarrhea
Subjective: Loose stools, fatigue, low back soreness. Objective: Pale swollen tongue, deep weak pulse. Plan (Acupuncture): BL 23, Du 4, Ren 4, ST 36, KI 3
Assessment: Kidney yang deficiency.
Assessment (TCM Diagnosis)?
Constipation
Subjective: Dry stools, dizziness, palpitations. Objective: Pale tongue, thin weak pulse. Plan (Acupuncture): ST 25, SP 6, BL 20, BL 21, ST 36
Assessment: Blood deficiency.
Assessment (TCM Diagnosis)?
Dysentery
Subjective: Loose stools with pus, fatigue, poor appetite. Objective: Pale tongue, thready weak pulse. Plan (Acupuncture): Ren 6, ST 36, SP 6, BL 23, Du 4
Assessment: Spleen and kidney yang deficiency (chronic dysentery).
Assessment (TCM Diagnosis)?
Abdominal Mass
Subjective: Intermittent distention, movable abdominal lumps. Objective: Normal tongue, wiry pulse. Plan (Acupuncture): LR 3, LI 4, ST 36, Ren 6, GB 34
Assessment: Qi stagnation.
Assessment (TCM Diagnosis)?
Edema
Subjective: Swelling of lower limbs after walking, heaviness. Objective: Swollen tongue, greasy coating, slippery pulse. Plan (Acupuncture): SP 9, Ren 9, BL 22, ST 28, SP 6
Assessment: Damp retention.
Assessment (TCM Diagnosis)?
Urine Retention (Long Bi)
Subjective: Post-surgery urinary retention, dull lower abdominal pain. Objective: Purple tongue, choppy pulse. Plan (Acupuncture): SP 10, BL 17, Ren 3, BL 28, LR 3
Assessment: Blood stasis obstructing bladder.
Assessment (TCM Diagnosis)?
Stranguria
Subjective: Cloudy milky urine, burning pain with urination. Objective: Red tongue with sticky coat, rapid thin pulse. Plan (Acupuncture): BL 23, KI 6, SP 6, Ren 3, BL 28
Assessment: Chyluria from kidney yin deficiency with damp-heat.
Assessment (TCM Diagnosis)?
Bi Syndrome
Subjective: Fixed and heavy joint pain, worse in humidity. Objective: Swollen joints, greasy tongue, slippery pulse. Plan (Acupuncture): ST 36, SP 9, BL 20, Ashi, GB 34
Assessment: Damp Bi syndrome.
Assessment (TCM Diagnosis)?
Wei Syndrome
Subjective: Progressive limb weakness, post-stroke. Objective: Pale tongue, deep thin pulse. Plan (Acupuncture): BL 18, BL 23, ST 36, GB 34, KI 3
Assessment: Liver and kidney deficiency.
Assessment (TCM Diagnosis)?
Lumbago
Subjective: Sudden lower back pain post-lifting, stabbing. Objective: Purple tongue with petechiae, wiry choppy pulse. Plan (Acupuncture): BL 17, SP 10, BL 23, Ashi, Yaotongxue
Assessment: Qi and blood stagnation from trauma.
Assessment (TCM Diagnosis)?
Impotence
Subjective: Impotence and irritability, recent stress. Objective: Red tongue with yellow coat, wiry pulse. Plan (Acupuncture): LR 2, LI 11, Ren 3, KI 3, SP 6
Assessment: Liver qi stagnation transforming into fire.
Assessment (TCM Diagnosis)?
Seminal Emissions
Subjective: Frequent spermatorrhea especially during the daytime, fatigue, cold limbs. Objective: Pale tongue, deep weak pulse. Plan (Acupuncture): DU 4, Ren 4, BL 23, KI 7, SP 6
Assessment: Kidney yang deficiency.
TCM Diagnosis?
Case Study: Nocturnal Emission
Patient: Jonathan W., 29
Occupation: Graduate student
Date: March 27, 2025
Subjective:
Patient reports waking several nights a week from vivid dreams accompanied by involuntary ejaculation (nocturnal emission). Feels fatigued during the day, irritable, and complains of difficulty falling asleep. He also notes night sweats and occasional dizziness. He admits to long hours of study, poor sleep habits, and frequent use of stimulants (coffee and energy drinks).
Objective:
Tongue: Red with scanty coating, slight cracks in the center
Pulse: Thin and rapid
Face appears slightly flushed; reports dry throat and heat in the palms and soles
Mild dark circles under the eyes
Assessment:
TCM Diagnosis: Kidney Yin Deficiency, causing loss of control over essence
Pattern differentiation: Yin fails to nourish the Heart and Liver → Heart fire disturbs the spirit → Essence not secured → Nocturnal emission
TCM Diagnosis?
Patient: Male, 60 years old
Chief Complaint: Red, swollen, painful joints in the fingers and wrists
History: Long-standing joint pain which recently flared up with intense heat, swelling, and limited motion. Joints feel hot to the touch, worse with warmth, better with cool compresses.
Tongue: Red with yellow coating
Pulse: Slippery and rapid
Acupuncture Points: LI11, DU14, SJ5, LI4, Ashi points
Heat Bi (Re Bi) – Heat Predominant
TCM Diagnosis: Heat Bi (Re Bi)
Treatment Principle: Clear Heat, dispel Wind-Damp, relieve pain
TCM Diagnosis?
Patient: Male, 42 years old
Chief Complaint: Severe knee pain and stiffness, worse in the cold
History: Works outdoors; pain started after long exposure to winter conditions. The knees feel cold to the touch. Applying warmth helps. No redness or swelling.
Tongue: Pale with white coating
Pulse: Tight and deep
Painful Bi (Tong Bi) – Cold Predominant
Diagnosis: Cold Bi (Tong Bi)
Treatment Principle: Dispel Cold, warm the channels, relieve pain
TCM Diagnosis?
Patient: Female, 35 years old
Chief Complaint: Migrating joint pain for 3 weeks
History: Pain began after hiking in windy weather. Pain moves between shoulders, elbows, and wrists. No redness or swelling. Occasionally aversion to wind.
Tongue: Thin white coating
Pulse: Floating
Acupuncture Points: LI4, SJ5, GB20, UB12, Ashi points
Wandering Bi (Xing Bi) – Wind Predominant
Diagnosis: Wind Bi (Xing Bi)
Treatment Principle: Expel Wind, unblock channels, relieve pain
TCM Diagnosis?
Patient: Mei Lin, 35
Chief Complaint: Intermittent abdominal distention and soft mass that comes and goes.
Subjective: Mass appears with stress, accompanied by distending pain in the lower abdomen and hypochondria. The discomfort often eases after rest or emotional release.
Objective:
Tongue: Normal color, thin white coating
Pulse: Wiry
Palpation: Soft mass, mobile, no fixed location
Plan (Acupuncture): LR 3, LI 4, GB 34, Ren 6, ST 36
Assessment: Abdominal Mass, Qi stagnation – Ju Syndrome (Qi Phase)
TCM Diagnosis?
Patient: Mr. Zhao, 52
Chief Complaint: Fixed, hard abdominal mass with dull pain.
Subjective: Mass has been growing slowly over the past year. Pain is localized and worsens at night. Appetite is poor; reports dark complexion and weight loss.
Objective:
Tongue: Purple with dark spots
Pulse: Choppy and deep
Palpation: Firm, immobile mass in left lower quadrant, tender to pressure
Plan (Acupuncture): SP 10, BL 17, LR 3, ST 36, Ren 6
Assessment: Abdominal Mass, Ji Syndrome (Blood Phase)
TCM Diagnosis?
Patient: Zhang Wei, 27
Chief Complaint: Sudden swelling of face and eyes after catching a cold.
Subjective: Facial swelling began overnight following exposure to cold wind and rain. He also has fever, chills, and body aches. Reports difficulty urinating and mild shortness of breath.
Objective:
Tongue: Thin white coating
Pulse: Floating and tight
Plan (Acupuncture): LI 4, LU 7, TB 5, BL 12, BL 13, LI 6, DU 26
Assessment: Yang Edema due to Wind-Water Invading Exterior
*Dispel wind, release exterior, open water passages
TCM Diagnosis?
Patient: Li Hua, 60
Chief Complaint: Chronic leg swelling with fatigue and cold limbs.
Subjective: Gradual onset over several months. Worse in the evening. Also has poor appetite, loose stools, and aversion to cold. Lower legs are puffy and press in with a pit that slowly rebounds.
Objective:
Tongue: Pale, swollen, teeth marks
Pulse: Deep and weak
Plan (Acupuncture): Ren 4, Ren 6, BL 20, BL 23, ST 36, SP 6, Ren 9, ST 28
Assessment: Yin Edema due to Spleen & Kidney Yang Deficiency
*Warm yang, tonify Spleen/Kidney, promote urination
TCM name:
Includes disorders Western medicine labels spasms of thecardiacsphincter, hiatal hernia, esophagitis, esophageal diverticulosis,
esophageal cancer and other functional disorders of theesophagus.In patients who are middle-aged or older the possibilityof cancershould be considered during diagnosis.
Dysphagia Occlusion Syndrome (YeGe)
