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COMPS practice Without herbs > Zang Fu Case Studies > Flashcards

Zang Fu Case Studies Flashcards

1
Q

what is the pattern? what s/sx support this? how do you TX?

  • 45 yo male
  • CC: palpitations
  • occasional forceful beating of heart for no apparent reason
  • palpitations occur when resting
  • no chest pain, no dizziness
  • normal blood pressure
  • MD performed EKG, listened to heart with stethoscope, pronounced no abnormal findings, and said palpitations were due to stress
  • pt admits to having more work-related stress over past 6 months
  • as a result, his eating habits have been poor, and he has lost hours of sleep
  • pale tongue, toothmarks
  • soft pulse
A

HT Qi Vacuity with underlying SP Qi Vacuity

  • palpitations at rest, so heart is weak: HT Qi Vacuity
  • toothmarks, soft pulse: Qi Vacuity
  • poor food intake leads to difficulty making Qi: SP Qi Vacuity

TX: HT 5 for palpitations
HT 6 if sweating
HT 7 if Qi Vacuity sweating

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2
Q

what is the pattern? what s/sx support this?

  • 59 yo female
  • CC: insomnia
  • insomnia of 3 months duration, since beginning of what she calls “power surges”
  • falls asleep easily, but awakens in middle of night feeling warm & sweaty
  • on a few occasions has soaked the sheets with sweat
  • irregular menstruation during the past year (sometimes early, sometimes late, sometimes heavy, sometimes light)
  • has not had any period for 6 weeks
  • during “power surges” feels hot overall, sweats profusely from her face & head, and feels urgent need for cool air
  • low back pain
  • red tongue with redder tip & scanty coating
  • fine, rapid pulse
A

HT Yin Vacuity & KD Yin Vacuity

  • night sweats, red tongue with scanty coat, rapid pulse: Yin Xu
  • wakes at night: HT Yin Xu
  • low back pain, aged 59: KD Yin Xu
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3
Q

what is the pattern? what s/sx support this? what is the pathomechanism?

  • 55 yo female
  • CC: pain in upper back & neck
  • pale complexion with darkish hue
  • short of breath
  • pain on & off in neck & shoulders, between shoulder blades, and sometimes in upper abdomen
  • no digestive complaints
  • pain can be severe at times, and when it is, she sweats a lot from face & armpits
  • long history of chronic bronchitis every winter for past 15 years
  • thin, rough pulse
  • pale red tongue, dusky towards front, darkish red spots on tip
A

HT Blood Stasis

  • choppy pulse: blood not circulating in upper jiao
  • dark complexion, dusky tongue: stasis
  • sweating from face & axilla: HT
  • for women, HT attacks feel like upper back pain

Pathomechanism:

  • winter cold affects LU Qi, leads to 15 years of phlegm
  • phlegm obstructs LU Qi & HT Qi
  • obstructed qi leads to obstructed blood, and blood stasis
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4
Q

what is the pattern? what s/sx support this?

  • 12 yo boy
  • CC: lack of communication
  • mother brings 12 yo son with down’s syndrome
  • he has been getting progressively more difficult to communicate with for the past 5 months
  • he can no longer speak clearly, as if his tongue is too big for his mouth
  • rattling sound in back of throat
  • sometimes vomiting, which usually happens a day after eating ice cream, his favorite food
  • seems “floppy” and lethargic most of time, adn doesn’t seem to know where he is
  • not able to see much of his tongue but it looks wet with a greasy coat, and has crack that reaches tip
  • slippery pulse
A

Phlegm Misting the HT Orifices, with underlying SP Qi Deficiency & Cold

  • wet tongue: SP Qi Deficiency leads to lack of transformation of fluids
  • slippery pulse: accumulation
  • communication issues: blockage of HT
  • ice cream: cold
  • vomiting, rattling sound in throat, greasy tongue coat, midline crack reaching tip: Phlegm Misting HT Orifices
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5
Q

what is the pattern? what s/sx support this? how do you TX?

  • 43 yo female
  • CC: palpitations
  • on & off fluttery feeling in chest
  • history of respiratory allergies
  • full-time student, spends a lot of time trying to study
  • disturbed sleep; wakes up several times each night, usually at 1am, and again at 3am
  • pale tongue, scalloped edges, thin white coat
  • wiry pulse, hollow, thin in right cun, soft in right guan
A

Blood Vacuity with underlying SP Qi Vacuity that’s unable to support blood

  • disrupted sleep: blood not anchored in LV
  • pale tongue: blood vacuity
  • hollow pulse: vacuity
  • scalloped tongue: SP Qi Xu
  • allergies: LU Qi Xu somewhere along the line
  • combo of SP Qi Xu & LU Qi Xu means that there is impaired manufacture of Qi & Blood

TX: HT 5 or HT 7 and SP 6, Inner 4 Gates (LI 11 + LV 3), SP 3

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6
Q

what is the pattern? how do you TX?

  • 34 yo male
  • CC: abnormal urination
  • 3 days ago, for no apparent reason, pt began to feel restless & developed a hot-dry sensation all over body
  • yellow urine, scanty
  • no change in frequency
  • excessive sweating, but no aversion to cold
  • irritable & vexed
  • thirsty for cold drinks
  • dream disturbed sleep
  • dry stool
  • no abdominal pain
  • overall good health
  • red complexion
  • red tongue, slightly thick & dry yellow coat
  • slippery, rapid pulse
A

SI Replete Heat (branch of another underlying pattern)

TX: Promote Urination (guide heat out through urination)

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7
Q

what is the pattern? how do you TX? what is the pathomechanism?

  • 30 yo female
  • CC: fatigue
  • soft spoken
  • mononucleosis with extremely sore throat & swollen tonsils since 2 months ago, following stressful period at work
  • fever & chills
  • sx gradually improved over time, with no TX other than resting
  • although throat sx gone, still persistent fatigue & SOB (can only swim half the amount of laps she could before becoming ill)
  • pale tongue
  • weak pulse
A

LU Qi Vacuity

TX: Tonify LU, Supplement, Boost LU Qi

Pathomechanism: wind-heat as initial insult, heat consumes & damages Qi over time

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8
Q

what is the pattern? what s/sx support this? how do you TX?

  • 5 yo boy
  • CC: wheezing
  • hx of asthma
  • wheezing after upper respiratory infection
  • 100 degree fever, some chills, sore throat
  • lots of clear nasal discharge
  • breathing with accessory muscles (SCM, raising shoulders, abdominal expansion)
  • underdeveloped upper body
  • bluish shadows under eyes
  • seems whiny & clings to mother
  • frequent urination
  • currently taking inhaled corticosteroids for past week as “preventative measure”
  • twin sister is vibrant strong child who is never sick, has no issues with urination, and has never had asthma
  • pale tongue, red tip
  • rapid pulse, floating in right cun, deep and weak in chi
A

Today: Wind Heat Invasion

Underlying problem: KD Failing to Grasp LU Qi due to KD Jing Vacuity

  • underdeveloped body, blue shadows under eyes: Jing Vacuity
  • asthma, straining to breathe: LU Qi Xu

TX: KD 7 + LU 8

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9
Q

what is the pattern? what s/sx support this?

  • 34 yo female
  • CC: constipation
  • “sluggish bowels”: has a BM once every other day, but can go 2 days without BM; occasionally will go every day, but feels an incomplete sensation
  • feels hotter in later part of day, but “normal” in morning & early afternoon
  • feels like she needs to pant at night, but has no sweating
  • dry hair, dry skin
  • dry sensation in throat that is not quenched by drinking water
  • pale tongue but orangish, smooth with thin coat
  • deep pulse
A

LI Intestinal Humor Depletion of Blood & Yin

  • constipation: LI issue
  • orange hued tongue, dry skin, dry throat not quenched by drinking water: blood deficiency
  • panting, no tongue coat, feels hotter in later part of day: yin vacuity
  • dryness: blood vacuity AND yin vacuity
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10
Q

what is the pattern? what s/sx support this? how do you TX?

  • 36 yo male
  • CC: painful, frequent bowel movements
  • diagnosed with ulcerative colitis 6 years ago
  • frequent painful BM every day, sx worse in morning
  • occasional hemorrhoids, which are painful & bleed
  • diet is 100% take-out food from the deli, or prepackaged (never cook meals at home)
  • reluctant to change diet bc no time
  • stressful lifestyle, long hours at work, trying to make time for wife & daughter
  • greasy, yellowish tongue coat in rear, teethmarks
  • rapid, slippery pulse
A

LI Damp Heat

TX: Clear Heat, Drain Damp, Stop Bleeding

  • tenesmus/ungratifying BM, painful BM, sticky yellow tongue coat, slippery rapid pulse, blood & mucus in stool: LI Damp Heat
  • about equal amount damp & heat bc both blood & mucus in stool
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11
Q

what is the pattern? what s/sx support this?

  • 34 yo female
  • CC: feeling hot
  • feeling of heat in chest
  • irritability
  • no period for 3 months
  • heat sensation worst in late afternoon
  • night sweating from neck & chest
  • dry throat
  • red cheeks
  • red tongue, dry yellow & thin coat
  • rapid pulse
A

LU Yin Vacuity

  • feeling hot, dry throat, red tongue with thin coat: yin xu
  • sweating from neck & chest: LU issue

(irritability is the one sx you don’t follow anywhere)

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12
Q

what is the pattern? what s/sx support this?

  • 41 yo female
  • CC: cough for 8 months
  • 8 months ago: accident while vacuuming basement, and was sprayed in face with debris; started coughing the next day; started as a rapid, dry cough; difficult to catch her breath
  • over the next week: cough developed into a deep phlegmy cough; clear, yellow, green or brown phlegm; most profuse in mornings, when it was clear & stringy; SOB with mild exertion
  • currently: cough only phlegmy in morning; yellow or brown phlegm; spasmoid episodes of coughing the rest of day
  • overall: feels hot, sweats a lot (mostly from chest & head), prone to constipation, red complexion
  • long, narrow & stiff tongue, red body, yellow sticky coating in center
  • rapid & slippery pulse
A

Phlegm Heat Obstructing LU

  • sweating on face, red complexion: HT
  • color assortment of phlegm, slippery rapid pulse, red tongue, yellow sticky tongue coat: Phlegm Heat in LU
  • SOB bc of accumulation in LU
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13
Q

what is the pattern? what s/sx support this? how do you TX?

  • 22 yo female
  • CC: nausea
  • nausea worse in mornings, better after she eats
  • no appetite in morning due to nausea
  • abdominal distention & discomfort
  • often eats salads & drinks soda or sweet tea with ice
  • slightly pale, puffy face
  • acne, which is not red, but is composed of pus-filled papules around jaw line & forehead
  • swollen tongue, teethmarks, slimy white coat
  • soggy pulse
A

Dampness due to SP Qi Vacuity (or SP Qi Vacuity with Damp Encumbrance)

  • pus-filled acne, swollen tongue, slimy tongue coat, puffy face: dampness
  • soggy pulse: combo Qi Xu & dampness
  • abdominal distention: SP Qi Xu
  • teethmarks: Qi Xu
  • nausea worse in morning bc Yang has not risen yet, and Yang is not transforming damp & yin

TX: Boost SP Qi, Resolve Dampness

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14
Q

what is the pattern? what s/sx support this? how do you TX?

  • 34 yo male
  • CC: abdominal pain
  • pain in upper, middle and especially lower left part of abdomen - starting 10 days ago, after a day-long BBQ party
  • pain not very severe, and duration of pain attacks is not long
  • location of pain not always in same place
  • BM after pain attacks, pain partially relieved after release
  • stool NOT loose
  • poor appetite
  • abdominal distention worse after eating
  • no nausea, no thirst
  • tongue slightly red, thick yellow greasy coat
  • wiry, slippery pulse
A

Food Stagnation

  • wiry pulse: stagnation / lack of flow of qi
  • feels better after BM: Food Stagnation (as opposed to vacuity, which feels worse after BM)
  • thick tongue coat, excess slippery pulse: repletion
  • pain comes & goes: Qi Stagnation

Tx: Stimulate Descending of ST Qi, Remove/Resolve Food Stagnation

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15
Q

what is the pattern? what s/sx support this?

  • 74 yo female
  • CC: chronic diarrhea
  • long hx of very weak digestive system
  • often diarrhea after eating many foods
  • 2 days ago after eating: pain & distention in upper abdomen, without nausea or vomiting; diarrhea that evening
  • ever since: diarrhea/loose stool 4 or 5 times a day, clear & watery with undigested food
  • cold in abdomen, especially below umbilicus
  • no fever, no aversion to cold
  • hands & feet are cold
  • low appetite
  • borborygmous
  • no thirst
  • fatigue
  • SOB & palpitations with slight activity
  • dark dusky tongue, wet coat
  • thin, forceless, deep pulse
A

HT & KD Yang Vacuity

  • cold limbs: Yang Vacuity (not enough Yang to warm extremities)
  • dark tongue: cold congeals and prevents good blood flow to head
  • watery diarrhea: food not transforming (SP Yang is never independent of KD Yang)
  • forceless (or feeble) pulse = Yang Vacuity
  • no nausea, no vomiting: rule out ST pattern
  • no thirst: rule out heat
  • no fever or aversion to cold: rule out external invasion
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16
Q

what is the pattern? what s/sx support this?

  • 44 yo male
  • CC: toe pain
  • “hammer-toes” for last 5 years: 2nd & 3rd toes are flexed at interphalangeal joints, and are painful when he walks while wearing shoes, so he wears flip-flops more often
  • painful gums
  • bad breath
  • acid reflux
  • big appetite
  • dry stools
  • red tongue, dry yellow coat
  • wiry, rapid pulse
A

ST Heat / Fire

  • dry, yellow coat: rule out ST Yin Vacuity, since there is still a tongue coat
  • 2nd & 3rd toes affected: ST channel
17
Q

what is the pattern? what s/sx support this? how do you TX?

  • 29 yo male
  • CC: low back pain
  • low back pain for 3 years
  • disc herniations at L3-L4, L4-L5, L5-S1
  • pain not severe, but chronically annoying, especially when he gets up in morning
  • obese, weighs 300 lb
  • red, flushed cheeks all the time
  • sweats with little or no exertion
  • always fatigued, no matter how much sleep
  • loose stools
  • pale, puffy tongue, teethmarks, white coat
  • weak pulse
A

Center Qi Fall / SP Qi Fall (due to SP Qi Vacuity)

  • disc herniations: Center Qi Fall
  • loose stool, fatigue: SP vacuity
  • low back pain: too much Yin flooding middle jiao, so Yang cannot penetrate down to & come back up from Ming Men

TX: Fortify SP, Boost Center Qi, Upbear Yang

Du 20

18
Q

what is the pattern? what s/sx support this? how do you TX? what is the pathomechanism?

  • 32 yo female
  • CC: vaginal discharge
  • copious vaginal discharge for 9 years that is clear, watery, and only disappears with onset of menses
  • diet of mainly salads, yogurt, bagels & cream cheese since college; never eats home cooked meals
  • fatigue, overall weakness that is worse with exercise
  • slightly dusky pale/purple tongue, puffy, thick white coat
  • weak pulse overall, especially right guan
A

SP Yang Deficiency with Damp & KD Yang Deficiency

TX: Warm the Yang (restart the pilot light)

  • clear discharge: vacuity cold
  • vaginal discharge: KD Yang Xu (discharge only “seems” to disappear with onset of menses)
  • thick white tongue coat: damp cold
  • fatigue, weakness: SP vacuity
  • weak pulse: deficiency

Pathomechanism: cold damp food is sinking down into low jiao

19
Q

what is the pattern? what s/sx support this? how do you TX?

  • 39 yo female
  • CC: fatigue
  • 1 yr HX of Hepatitis C
  • fatigue
  • bitter taste in mouth
  • low appetite
  • rib-side pain
  • irritability
  • alternating heat & aversion to cold sensations
  • loose stools, alternating with constipation
  • pale tongue, thick greasy yellow coat closer to edges, red spots where coat is thickest
  • wiry pulse left guan, weak pulse right guan
A

1) LV Overacting on SP (aka LV-SP Disharmony)
2) Shao Yang Disharmony
3) LV-GB Damp Heat

TX: Harmonize Shao Yang, Harmonize LV/SP

SJ 5, GB 34, SP 9

  • wiry LV pulse, weak SP pulse, alternating diarrhea & constipation
  • alternating hot & cold: Shao Yang Disharmony
  • greasy tongue: damp
  • red spots, yellow tongue coat: heat
  • along edges of tongue: LV-GB area
  • fatigue: Damp Heat (but not in SP/ST, or there would be stinky stool and yellow jaundiced skin)
20
Q

what is the pattern? what s/sx support this? how do you TX?

  • 65 yo female
  • CC: painful diarrhea
  • painful diarrhea
  • diagnosed with IBS 5 years ago
  • symptom free most of time
  • diarrhea after anger & arguments with son
  • during episodes: abdominal distention & pain, diarrhea up to 6 times a day
  • fullness in chest relieved by sighing
  • nausea when angered
  • vomiting sometimes when angered
  • dusky-pale tongue
  • fine, wiry pulse
A

Wood Overacting on Earth (aka LV Overacting on SP & ST) with Underlying Blood Deficiency

TX: Calm LV & Strengthen SP & ST (then SP will make more blood and LV will distribute it)

LV 14, LV 3, ST 36, SP 9 , SP 6 to strengthen SP & ST

UB 18, UB 20, UB 21 Back Shues

ST 41 to descend ST Qi

  • SX worse with stress/anger: LV issue
  • diarrhea: SP issue
  • nausea & vomiting: LV-ST Disharmony
  • abdominal distention & pain: LV-SP Disharmony
  • note: tongue & pulse don’t match DX
21
Q

what is the pattern? what s/sx support this? how do you TX?

  • 29 yo female
  • CC: insufficient lactation
  • currently 8 weeks postpartum, had a 45-hour long labor
  • now has trouble nursing
  • MD says she is not producing enough milk, so using formula but eager to breastfeed
  • lusterless hair
  • very pale & dry lips
  • pale sides of tongue
  • thin pulse
A

LV Blood Vacuity

TX: Tonify LV Blood

  • breastmilk is manifestation of LV Blood (that’s why women who breastfeed don’t menstruate)
  • pale sides of tongue: Blood Xu in LV area
  • postpartum, long labor, pale complexion, dry lips: Blood Xu

Note: KD Jing & LV Blood come from same source

22
Q

what is the pattern? what s/sx support this? how do you TX?

  • 70 yo male
  • CC: pain in hypochondrium
  • 2 weeks ago: caught bad cold with fever & phlegmy cough; SX have since disappeared
  • yesterday: suddenly developed severe pain in right hypochondrial & intercostal regions, with a hot burning sensation; pain has been continuous without relief
  • HX of coronary artery disease, so he took heart medication, which did not relieve pain
  • this morning: went to emergency room, hospital evaluation revealed groups of small red papules filled with pus in a band around 5th intercostal space on right side of chest
  • now feels restless, irritable, feverish all over
  • no palpitations
  • HA in temples
  • yellow, scanty urine
  • dry stools
  • red tongue, thick dry yellow greasy coat
  • rapid, slightly slippery pulse
A

Heat in Ying Level (which describes pathomechanism) or LV-GB Damp Heat

  • greasy tongue, slippery pulse, pus-filled papules: Damp & Heat
  • ribside fullness & pain: LV-GB Damp Heat
  • temporal HA: LV issue
23
Q

what is the pattern? what s/sx support this? how do you TX?

  • 37 yo male, attorney
  • CC: “tune-up” treatment
  • agitated during intake: says he “just wants a tune-up. what is with all these questions?”, stands up & threatens to leave
  • red face when agitated
  • however, as quick as he stood up, he sits back down, tell you he is suddenly dizzy & has a pounding HA
  • red tongue, thin yellow coat
  • thin, wiry & rapid pulse
A

Heat leading to LV Yang Rising with Wind

TX: Settle the LV, Subdue the Yang, Extinguish Wind,

LV 8, LV 3, UB 18, SP 6, KD 3, Du 16, GB 20

  • sudden unconsciousness: wind
  • dizzy, easily angered: LV Yang Rising
  • wiry, rapid pulse: LV Yang Rising
  • red tongue, red face: heat
24
Q

what is the pattern? what s/sx support this? how do you TX?

  • 58 yo woman
  • CC: numbness of feet
  • numbness in feet for 5 years, but it is getting worse
  • “pins & needles” sensation on soles of feet, but mostly just numb
  • occasionally, numbness moves up into hamstrings
  • floaters in eye
  • tongue deviated to left, trembling
  • pale tongue, with even paler sides
  • thin pulse
A

LV Blood Vacuity Causing Wind

TX: Nourish LV Blood, Subdue Wind

LV 8, LV 3, SP 6, KD 3, UB 17, UB 18, UB 20, UB 23, LI 4, GB 20, Du 16, Du 20

  • floaters, pale tongue, thin pulse: Blood Xu
  • deviated tongue, trembling: Internal Wind
  • numbness: could be LV Blood Vacuity Causing Wind, LV Yang Rising Causing Wind, LV Blood Vacuity, or Blood Stasis
25
Q

what is the pattern? what s/sx support this? how do you TX?

  • 79 yo male
  • CC: urinary difficulty
  • diagnosed with prostatitis 4 years ago
  • difficulty starting stream of urine, hesitancy, dribbling
  • some pain when urinating
  • urine sometimes cloudy
  • chronic low back pain, not due to injury
  • pale tongue, puffy with teethmarks
  • weak, deep pulse
A

Insecurity of KD Qi, with Dampness Blocking UB

TX: Tonify/Secure KD, Astringe Essence, Drain Damp (by Unblocking Urine)

  • dribbling post-stream = Insecurity of KD Qi
  • cloudy urine, pain when urinating, puffy tongue: Dampness
  • pale tongue with teethmarks, weak pulse: Qi Deficiency
  • urinary difficulty, low back pain: KD Xu
26
Q

what is the pattern? what s/sx support this? how do you TX?

  • 60 yo female
  • CC: pain with urination
  • recurrent interstitial cystitis for past 10 years (pain in bladder & urethra that is not due to bacteria)
  • sometimes blood in urine
  • MD says no cancer of bladder
  • cystitis & bloody urine generally occur 2x a year
  • during an attack, urination becomes frequent, urgent, and painful
  • low back pain
  • red tongue, yellow greasy coat thicker in middle & back
  • slippery, forceful pulse
A

UB Damp-Heat

TX: Clear Heat, Resolve Dampness, Open Water Passages of Low Burner

SP 9, SP 6, LI 11

Xi Clefts: KD 5, SP 8

  • yellow greasy tongue coat: Damp-Heat
  • thick tongue coat in back: UB area
  • burning with urination, blood in urine, frequent urgent urination: UB Damp-Heat
27
Q

what is the pattern? what s/sx support this?

  • 45 yo female
  • CC: perimenopause
  • perimenopausal SX: afternoon & evening heat effusion, night sweats, dry mouth & throat
  • cold feet
  • lumbar pain
  • decreased libido
  • aversion to cold when not feeling heat effusion
  • slightly red tongue, scanty fur
  • deep, fine, forceless pulse
A

KD Yin Vacuity & KD Yang Vacuity

  • mixed hot & cold signs: Yin Xu & Yang Xu
  • deep, fine, forceless pulse: KD Yang Xu
  • red tongue, scanty fur: KD Yin Xu
  • lower libido: possibly KD Yang Xu
28
Q

what is the pattern? what s/sx support this? how do you TX?

  • 52 yo male
  • CC: swelling / edema
  • puffy on face, especially under eyes
  • swelling in upper libs
  • feels cold all over
  • does not urinate a lot
  • scanty urine
  • pale, puffy tongue, slightly flabby
  • forceless pulse, especially in cun & chi positions
A

KD Failing to Absorb/Grasp Qi (aka KD Failing to Grasp LU Qi), or Yang Edema

TX: Tonify & Warm KD, Aid KD to Grasp Qi

  • forceless pulse, esp. in cun & chi positions: upper & lower jiao weak (water metabolism is off in LU & KD)
  • puffy face, puffy tongue: edema
  • scanty urination: water accumulating in upper jiao
29
Q

what is the pattern? what s/sx support this? how do you TX?

  • 37 yo male
  • CC: low back pain
  • 4 days ago: slight fever & aversion to cold (still has those SX)
  • distention in epigastrium & abdomen
  • low appetite
  • nausea
  • excessive saliva, accompanied by diminished sense of taste
  • pain & soreness in low back since 4 days ago
  • heavy sensation, restriction of movement in low back
  • head, shoulders, knees all feel heavy & restricted
  • pink-red tongue, moist white coat
  • slightly floating pulse, slippery & thin but not weak in left chi
A

Exterior Wind Cold Damp

  • distention in epigastrium & abdomen, bland taste, heaviness: Dampness
  • aversion to cold, fever, floating pulse: Exterior condition

COMPS practice Without herbs (3 decks)

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