Case Study TCM

RECORD OF FIRST VISIT

Name of Student Clinician: Eva Kim Name of Supervisor: Leigh

Date: 13/May/08 Name: Miss C

Gender: F Age: 17

Chief Complaint: Irregular menstruation for 5 years

Description (4 diagnostic methods):

A) Asking: Patient has suffered from irregular menstruation for 5 years. It occurred suddenly for 2-3 days before the menarche. Pain was very severe in the lower abdomen and the hips, back, thighs and knees. Since then, she has experienced irregular cycles and lots of dark clots during each period. Usually menstruation occurred every 9-10 days and bleeding lasted at least 7-8 days each time. During menstruation, the patient suffered from anemia, vertigo, severe fatigue and headache. She took medication for anemia and pain relief frequently but the result was not very good. She exercises almost every day but takes too much sweet food instead of nutrient meals.

Present symptoms: irregular cycle, heavy bleeding, headache, vertigo, anemia, abdominal pain, lumbago, leg pain, fatigue

No fever/no chill/no sweat/ normal appetite/prefers cold water/normal urination/ severe constipation (scanty and hard stool every 4 days)/ good sleep

Past history: NAD

Lifestyle: No smoking, no drinking

Family history: Father-healthy, Mother-hypertension

Menstruation, Marital & obstetrical history: Single, never pregnant, 12, 7-8/10, dark and scanty blood on the 1^st and the last day, otherwise bright red clots only (no watery blood at all). Last menstruation: 5 days before the 1^st visit

B) Inspection:

7/10, dark complextion, normal posture and movement

Tongue: Purple swollen body with teethmarks

C) Ausculatation/Olfaction

Sound: Normal, speaks clearly and breathe normally

Ordours: Normal

D) Palpitation:

Body areas: Normal

Pulse: Taut and wiry in general

CASE SUMMARY

Definition: Irregular menstruation refers to the abnormal changes of menstrual cycle, quantity and color of bleeding accompanied by other symptoms. The common conditions are predated or postdated menstruation and irregular menstrual cycle. It is often found in menstrual disorders due to hypophyseal or ovarian dysfunctions.

WMS: Irregular periods aren't unusual. They affect about 30% of women in their reproductive years. An irregular period is any type of bleeding that is abnormal when compared to your usual menstrual cycle. This can include a late period, an early period or bleeding between periods. It can also appear as particularly heavy bleeding (menorrhagia) or scanty bleeding. Many women also experience irregular periods in the form of a missed period, continuous periods, or periods that occur twice in one cycle.

Causes of irregular menstruation

Irregular menstrual periods are usually the result of hormonal signals that have been thrown out of sync. In order to produce a period, your body makes hormones, like estrogen and progesterone. These hormones are kept in the hypothalamus, pituitary gland, and ovaries inside your body. In order to trigger ovulation and menstruation, these parts of the body need to send signals to one another. Sometimes, these signals get crossed or skipped, causing irregular periods.

But what causes these hormone signals to get out of whack? Well, there are actually a number of things that can easily cause your hormone levels to change.

• Pregnancy: If you are pregnant, your body will begin producing different levels of hormones. This will cause numerous pregnancy symptoms, including an end to your period.
• Stress: Stress is a common cause of irregular periods. If you are fatigued, worried, or anxious this can cause your hormones to become unbalanced.
• Diet: A poor diet or extreme weight loss or gain can also affect your hormones. Women with anorexia or bulimia often have no period or irregular periods.
• Exercise: Intense exercise can wreak havoc on your body, often causing irregular periods.
• Menarche: the cycles after a girl's first period may be irregular for some time. It can take up to 3 years to get regular periods.
• Menopause: Menopause causes changes in your hormone levels, and is often signaled by irregular periods.
• Hormonal Birth Control: Birth control pills and irregular periods sometimes go hand in hand. It can take a while for your body to adjust to the new levels of hormones delivered by hormonal birth control.

Complications
For most women, an irregular period is nothing to be worried about; the majority of women will eventually develop a regular cycle with regular periods. Sometimes though, underlying complications can be the cause of these period problems. If you are noticing particularly irregular periods, or have gone a year or more with missed periods, see your health care professional. If you experience extreme cramping, heavy period bleeding, dizziness, nausea, or fainting you should also visit with your health care provider.

Polycystic Ovary Syndrome

Polycystic ovary syndrome, or PCOS, is a fairly common complication, affecting about 10% of all women. PCOS causes cysts to form on the ovaries, interfering with regular ovulation. Symptoms of this syndrome include: excessive hair growth, weight gain, acne, dandruff, high blood pressure, and infertility. If you display any of the symptoms, you may want to make an appointment to get checked for PCOS. Left untreated, it can lead to other more serious complications, including endometriosis, heart disease, and ovarian cancer.

Inflammatory Bowel Disease

Inflammatory bowel disease causes inflammation of the lower intestines (also known as the bowel). It is linked with irregular periods, and may also be accompanied by symptoms of weight loss, abdominal pain, and diarrhea. Inflammatory bowel disease can become severe, and sometimes requires hospitalization or surgery. If you have any of these symptoms, ask your doctor to check you for inflammatory bowel disease.

Treating Irregular Periods

Depending on the cause of your irregular periods, there may or may not be much you can do about them. If you have only been experiencing irregular periods for a short time (less than 7 months), it is likely that your periods will become regular again on their own. However, if there is an underlying medical condition that is causing your irregular periods, then receiving treatment for the condition should help to get your periods back on track. If you find that irregular periods are becoming annoying, there are some things that you can try to help regulate your hormones.

• Reduce your stress levels. Take time to meditate, relax, or just hang out. This may help put your cycle back on track.
• Get help for your eating disorder. If you are anorexic, bulimic, or if you suffer from other types of disordered eating, you must seek help. Not only will these eating disorders interrupt your menstrual cycle, but they can also severely affect your liver, bowel, throat, and heart functions.
• Don't over exercise. While it is important to exercise regularly and keep fit, exercising too much can be problematic. If you are an endurance athlete, try to cut back on your training a little bit, until your irregular periods return to normal.

Medical Treatment There are a few medical treatments which may be helpful in regulating your period:

• Hormonal Contraceptives: Hormonal contraceptives are often used to help regulate menstrual cycles. These contraceptives combine estrogen and progesterone and maintain your body's hormones at specific and balanced levels. They are available by prescription and come in oral, patch, ring, and injectable forms.
• Hormone Supplements: If you have a specific hormone problem, such as overproduction of testosterone, hormonal supplements may be able to help regulate your periods. Speak with your health care provider for more information.

TCM Etiology, Pathogenesis and Syndrome Differentiation

1. Predated Menstruation: caused by long-standing Qi stagnation due to mental depression or worrying or by accumulation of heat in uterus

l Blood heat

l Qi deficiency

2. Postdated Menstruation: caused by retention of pathogenic cold in the uterus or by the feebleness of Yang and deficiency of blood

l Blood Deficiency

l Cold in blood

l Qi stagnation

3. Irregular menstrual cycle:

l Liver Qi stagnation

l Kidney Deficiency

TCM Diagnosis: Irregular menstruation

Syndrome Differentiation: Qi and blood stagnation

Explanation: A lot of purple blood clots during menstruation indicate that the patient has qi and blood stagnation. This is also supported by other symptoms like lumbago and severe abdominal pain. Her busy life style possibly caused Liver Qi stagnation disturbing the spleen and resulted in fatigue, weakness, poor appetite and severe constipation. Due to this reason, patient started taking lots of sweets and this weakened her spleen and the body worse. The Spleen’s weak function in transforming and transporting caused irregular cycle and heavy bleeding that led to anemia and vertigo. The Kidney and Bladder meridian goes through the thighs and legs and caused pain in the area. The pulse was taut and wiry in general due to qi and blood stagnation while the tongue was purple due to blood stasis. The teethmarks indicate general qi deficiency.

Treatment Principle: Remove Qi and Blood stagnation, tonify the spleen and relieve pain

Points and Therapies:

Needling: filiform

Acu-point : Sanyinjiao(+), Guanyuan(+),Zusanli(+), Qihai(+), Xuehai(+), Taichong(-)

Explanation:

Sanyinjiao: The Crossing Point of Spleen, Kidney and Liver Meridian, use filiform to regulate the energy of Liver, Spleen and Kidney and resolve blood disorder with reinforcing method

Guanyuan: use filiform to strengthen the middle-jiao and maintain general body health with reinforcing method

Zusanli: He Point of Stomach Meridian. Use filiform to tonify the Spleen and strengthen its transporting and transforming function with reinforcing method

Qihai: use filiform to activate the flow of qi and maintain health with reinforcing method. Good for abdominal pain and irregular menstruation

Xuehai: use filiform to activate the flow of blood and to treat irregular menstruation with reinforcing method

Taichong: Shu and Yuan Point of Liver. Use filiform to sooth Liver and to remove Qi stagnation with reducing method

FOLLOW UP CONSULTATION

Patient Name: Miss C Treatment Number: 5

TCM Disease: Irregular menstruation

TCM type/pattern: Qi and blood stagnation

Date: 10/Jun/08

Current conditions/changes: On the next day of the 1^st treatment, patient experienced severe fatigue. She took a nap for hours and began to improve her diet properly. She stopped taking all kind of sweet stuff and took meal 3 times a day. After 2nd treatment, she had normal defecation. She went to toilet every day and her defecation had nothing abnormal. A few days after 3^rd treatment, she had menstruation with much less pain and clots (this time, mens came back in 25 days). There was neither lumbago nor leg pain. After 4^th treatment, everything was normal and she felt quite healthy. So she decided to continue the treatment till the cycle is fixed perfectly.Tongue: Pale swollen body with teethmarks and white greasy coating

Pulse: deep, weak and thready

Treatment Principle: Remove Qi and Blood stagnation, tonify the spleen and relieve pain, tonify the body health

Prescription:

Same as the 1^st treatment

Explanation:

Same as the 1^st treatment

Lifestyle Advice:

Regular exercise, no more sweet food, more nutrient and regular meal with fresh fruits and vegetable, better rest at night time rather than watching TV late.

Name of Student Clinician: Eva Kim

Name of Supervisor: Leigh

CASE CONCLUSION

My diagnosis was irregular cycle combined with dysmenorrhea, caused by Qi and Blood stagnation. The result of the 1^st treatment was good, and I selected same points till the patient felt a change in her body condition. As a result of strengthening the function of the spleen, she experienced normal defecation after the 2^nd treatment and I found that my selection of acupoints was right. I continued the same treatment once every weak and the patient experienced a greatly improved cycle (25^th day after the previous period) and no pain in the body after 3^rd treatment.

While treating the patient for approximately one month, I did not need to change treatment method. Each time, the patient got slightly better and symptoms were healed one by one.

As the treatment result was unbelievably good, I will use the same method and points to other patients with similar syndromes. However, it is very important that patient has a strong belief in TCM treatments. As all the healing method is related with and influence patient’s mind state and emotion, acupuncture treatment might also heal better those with a belief in the science of TCM.