Case Study TCM

RECORD OF FIRST VISIT

Date of First Visit: 26/08/2008	Name: Ock
Date of Birth: 45 years		Gender: Female
CHIEF COMPLAINTS : The left elbow pain for 3 years.
DESCRIPTIONS (4 diagnostic methods)
A) Asking
Present illness history : The patient has been suffering from a left elbow pain for 3 years. The pain occurs gradually 3years ago. (No any injury history. Just slow onset). And recently she felt tired then the pain became more serious. Location of pain is on lateral side of left elbow. Characteristics of pain are sharp with heaviness and radiate to middle finger. The heaviness of arm make hard to lift up her arm (limitation of movement). The pain normally occurs in the morning. She is easily tired, sometimes feels dizziness. Serious headache for 15 years. (about once a month). The headache accompany with nausea for 2 days. Characteristics of pain are sharp on whole head. Present symptoms: chill and fever- no sweating- normal sleeping – normal(11pm-7am) Urination – 3~4 /day. Stool – 1/ day Appetite and digestion –normal(likes healthy food). Drink - prefer to drink cold water.
Past illness history : pediatric jaundice.
Life style : busy for housewife. No smoking and drinking, no exercise.
Family history : NAD
Menstruation, marital & obstetrical history : 15 3~4/28 Pain on abdominal, scanty menstruation, sometimes has clots in blood, little purple color, accompany with dizziness.
B) Inspection
General : Pale complexion, slim body Tongue : pink tongue body with scanty coating. Slightly tremor.
C) Auscultation / Olfaction
Sound : NAD Odours : NAD
D) Palpation
Pulse : little sluggish pulse(slow and thready) Body areas : NAD

CASE SUMMARY

DIAGNOSIS

A) Diagnosis : elbow pain

B) Syndrome Differentiation : Qi stagnation and blood stasis underlined blood deficiency.

C) Explanation

The patient show symptoms of blood deficiency and blood stasis. The blood deficiency leads to fail of malnutrition of whole body, which is manifested by pale complexion and tiredness. And blood deficiency fails to supply nutrition to head, tendons and tongue. So make headache, dizziness and pink tongue body with scanty coating. Blood deficiency can make blood stasis. And blood stasis also can make the some blockage on the meridian then leads to pain. And menstruation also related with blood, if patient have dysfunction of blood such as the blood deficiency and the blood stasis, can make to dysfunction of menstruation, which is scanty menses, pain on abdominal, clots in blood and purple color of blood.

TREATMENTS

A) Treatment Principles Remove Qi stagnation and blood stasis, dredging the collateral, tonify blood.

B) Treatment Methods

1. Needling

Prescription :

- Quchi, Shousanli, waiguan, houxi (both), xuehai, sanyinjiao, Zusanli, geshu

Explanations :

- Quchi, shousanli, waiguan, : promote qi and blood circulation (open channel) - Zusanli : promote circulation of qi and blood, produce blood - Xuehai : promote circulation of blood - sanyinjiao, geshu: produce yin and blood - houxi :open channel for neck, shoulder and arm.

4. Life Style Advice

Avoid handling heavy objects. Do not overstrain by reducing a exercise

Elbow pain (WMS)

DEFINITION

This article describes aching or other discomfort in the elbow that is not related to direct injury.

ETIOLOGY and PATHOGENESIS

1.Tendinitis Lateral epicondylitis (tennis elbow) : The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured, especially with repetitive motions of the forearm, such as using a manual screwdriver, washing windows, or hitting a backhand in tennis play. Tennis elbow results with inflammation of the tendons causing pain over the outside of the elbow, occasionally with warmth and swelling but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day. Repeated twisting motions or activities that strain the tendon typically elicit increased pain. X-rays are usually normal but can reveal calcium deposits in the tendon or reveal other unforeseen abnormalities of the elbow joint. The treatment of lateral epicondylitis includes ice packs, resting the involved elbow, and antiinflammatory medications. Antiinflammatory medications typically used include aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) such as naproxen (Naprosyn), diclofenac (Voltaren), and ibuprofen (Motrin). Bracing the elbow can help. Simple braces for tennis elbow can be found in community pharmacies and athletic goods stores. Local cortisone injections are given for persistent pain. Activity involving the elbow is resumed gradually. Ice application after activity can reduce or prevent recurrent inflammation. Occasionally, supportive straps can prevent reinjury. In severe cases, an orthopedic surgical repair is performed. Medial epicondylitis (golfer's elbow) : Medial epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer's elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition. X-rays for epicondylitis are usually normal but can indicate calcifications of the tendons if the tendinitis has persisted for extended periods of time. The usual treatment involves ice packs, resting the elbow, and medications including aspirin and other NSAIDs. Examples of NSAIDs include naproxen (Naprosyn), diclofenac (Voltaren), and ibuprofen (Motrin). With severe inflammation, local corticosteroid (cortisone) injections are sometimes given. Using a strap can prevent reinjury. After a gradual rehabilitation exercise program, return to usual activity is best accompanied by ice applications after use. This helps to avoid recurrent inflammation. 2.Olecranon bursitis Olecranon bursitis (inflammation of the bursa a the tip of the elbow) can occur from injury or minor trauma as a result of systemic diseases such as gout or rheumatoid arthritis, or it can be due to a local infection. Olecranon bursitis is typically associated with swelling over the tip of the elbow, while range of motion of the inner elbow joint is maintained. 3.Fractures The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Fractures generally require immobilization and casts and can require orthopedic pinning or open joint surgery. 4.Sprain A sprain is a stretch or tear injury to a ligament. One or more ligaments can be injured during a sprain. This might occur when the elbow is hyperextended or simply jammed, such as in a "stiffarm" collision. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. Treatment involves rest, ice, immobilization, compression, and antiinflammation medications.

Elbow pain (TCM)

ETIOLOGY and PATHOGENESIS

TCM ETIOLOGY: Bi syndromes or Blockage syndromes Bi syndromes are caused by weakness of defensive qi, dysfunction of the pores, when one is wet with perspiration and exposed to the wind, wading in water or dwelling in damp places for a long time. So the meridians and collaterals are obstructed by wind, cold and damp pathogens. The results are blockages syndromes. There are different types of Bi syndromes, such as wandering Bi, painful Bi, fixed Bi and wind damp heat Bi. TCM PATHOLOGY (1) Wandering Bi Main Manifestation - Wandering pain in the joints, especially the wrist, elbows, knee and ankles, limitation of movement, chills and fever, thin and sticky tongue coating, superficial and tight or superficial and slow pulse. (2) Painful Bi Main Manifestation – Severe pain in all of the body or in the joints, alleviated by warmth and aggravated by cold, fixed localization, but no local redness and hotness, thin and white tongue coating, string-taut and tense pulse. (3) Fixed B Main Manifestation – Numbness and heavy sensation of the limbs, soreness and fixed pain of the joints, aggravated on cloudy and rainy days, white and sticky tongue coating and soft pulse. (4) Heat Bi Main Manifestation – Arthralgia involving one or several joints, local redness, swelling and excruciating pain with limitation of movement, accompanied by fever and thirst, yellow tongue coating, rolling and rapid pulse.

FOLLOW UP CONSULTATION

Patient Name: Ock Treatment Number: 3

TCM Disease: elbow pain

TCM type/pattern: Qi stagnation and blood stasis due to blood deficiency

Date:29/08/08, 02/09/08

Current conditions/changes:

It is much improved in pain of the elbow after first treatment. but in second treatment, it becomes a little worse condition after menstruation. The patient feels more heaviness on her arm.

Treatment adjustment: Quchi, Shousanli, waiguan, houxi, xuehai, sanyinjiao, zusanli, geshu

Explanation:

CASE CONCLUSION

First visited day I focus on the pain, so I choose all points for relieve the pain which is local point(quchi, shousanli, waiguan, houxi) and a-shi point. And second visited day I mainly focus on the blood deficiency then focus on the pain. Because the patient feels the elbow pain is relieve much but start to feel heaviness on arm. (no any complain about elbow pain but complain about heaviness on arm). So l choose some points for tonify blood(sanyinjiao, zusanli, xuehai, geshu) and some points for relieve the pain.