Record of first visit
Date of First Visit:
Date of Birth: 49Years Gender: Female
Chief complaint: Left elbow pain for 3 years
Descriptions( 4 diagnostic methods)
A) Asking
Present illness history: She had suffered from dull pain on left medial side of the elbow for 3 years. At that time, she felt the elbow pain when she wrung out the wet clothes. She didn’t have any treatment for these. Recently, the pain is severe. When she lifts something by hand, the pain is aggravated, and is relieved by the rest. The elbow pain area is swollen and she feels pain on pressing.
No fever and chills, no headache, no sweating, good sleep, good appetite, loose stool(1-2times/day), normal urination(a little yellow color), cold limbs. She easily got tired, and feels back pain after long standing or bending waist. She has irritability before menstruation. She also appeals the right knee pain( dull type), and it occurs occasionally and is aggravated when she goes down stair, and no any injury history.
Past illness history: She had the operation for protruded disc(L4) 10 years ago and several facial paralysis
Life style: Busy, piano teacher
Family history: Father- diabetes, low blood pressure
Mother- diabetes, hypertention, facial paralysis
Menstruation, martial & obstetrical history: 12 3-4/30, last menstruation:
B) Inspection
General: normal complexion, medium height, fatty
Tongue: pale body, crack on center, corpulent, a thin, white coating
C) Ausculation / Olfaction
Sound: N/A
Odors: N/A
D) Palpitation
Pulse: R: cun, guan- thready, chi-weak, L: weak
Body areas: swelling on elbow area
E) Physical Examination
Case Summary
TCM Diagnosis: Elbow pain
Syndrome differentiation: Qi and blood stagnation underlying deficiency of kidney yang and spleen qi
Explanation: She overused her arm doing house works and playing piano. So it caused qi and blood stagnation in the local area, and meridians and collaterals are obstructed leading to the pain in local area. Kidney yang is vital yang and is basis of all yang in the body. The yang deficiency makes the body and limbs lost its warming, therefore the patient feels cold limbs. The lumbus is house of kidney. If loses the nutrients from kidney, the pain occurs in lumbus. The dysfunction of spleen cause loose stool. If middle qi is insufficient, the patient feels lack of strength and tiredness. When qi fails to go upwards, there appears corpulent tongue. Deficient qi can cause qi and blood stagnation resulting in local pain
Treatment Principles: Promote qi and blood circulation, remove stagnation and pain, nourish yang and strengthen qi
Points and Therapies: Quze, Neiguan, Yanlingquan, Xuehai, Zusanli, Yinlingquan, Lianqiu, Ashi points
Explanation:
- Quze: Activate meridians and eliminate pain on elbow
- Neiguan: Open Yin link vessel to relieve pain and contraction of elbow
- Yanglingquan: Benefits sinew and joints, and activate the channel and alleviates knee pain
- Xuehai: Promote blood circulation and dispel stasis
- Zusanli: Strengthen the function of spleen and stomach, and promote circulation of qi and blood
- Yinlingquan Strengthen spleen and alleviate pain
- Liangqiu: Stimulate movement of qi and blood, and eliminate knee pain
- Ashi points: Activate qi and blood circulation and relieve pain
Life style advice:
- Regularly exercise to strengthen tendon, muscle and joints
- Try to loose weight
- Avoid greasy, fatty, cold food and drink
TCM Aetiology and pathology:
Due to ill posture of carrying heavy things, improper movement, falling, bruising, traction and over-twisting, tendons and joints are injured, the circulation of qi and blood is stagnated in the local region and meridians and collaterals are obstructed
WMS:
Definition: A sprain is an injury which occurs to ligaments caused by a sudden overstretching (for the muscle injury, see strain). The ligament is usually only stretched, but if it is completely torn, a longer period of immobilization and surgical repair may be necessary.
Degree: The first degree is only a minor tear or stretch of a ligament, The second degree is a tear of a ligament, which is usually followed by pain or swelling, The third degree is a complete rupture, The fourth degree is the most severe and actually breaks the ligament, along with some small bones if severe enough, and requires surgery to repair
Signs and symptoms: inflammation, localized pain, swelling, loss of function, loss of normal limb function, elasticity of ligament decrease
Prevention: Sprains can best be prevented by proper use of safety equipment (wrist, ankle guards), warm-ups and cool-downs (including stretching), being aware of your surroundings and maintaining strength and flexibility. Physical conditioning is the best way to avoid or lessen the degree of sprains
Treatment: 1) Rest: The sprain should be rested. No additional force should be applied on site of the sprain. 2) Ice: Ice should be applied immediately to the sprain to minimize swelling and ease pain. It can be applied for 20-30 minutes at a time, 3-4 times a day. Ice can be combined with a wrapping to minimize swelling and provide support. 3) Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support. 4) Elevation: Keeping the sprained joint elevated above heart level will also help to minimize swelling. Ice and compression (cold compression therapy) will not completely stop swelling and pain, but will help to minimize them as the sprain begins to heal itself. Careful management of swelling is critical to the healing process as additional fluid may pool in the sprained area.
Follow up Consultation
Patient name: Mrs C Treatment No. : 6
TCM disease: Elbow Pain
TCM type/pattern: Qi and blood stagnation underlying deficiency of kidney yang and spleen qi
Current condition/changes: from the second treatment, Moxa on ashi point was applied, and the elbow pain is much relieved. On 4th treatment, she feels weakness of arms and knee, and added some points for tonifying qi, on 5th treatment, she appealed sever knee pain, weak leg and tinnitus, and added some point for resolving liver qi stagnation, tonifying kidney and spleen.
Treatment adjustment:
2nd: - Quze, Neiguan, Liangqiu, Yinlinquan , +Taixi, Moxa on Ashi points(both elbows)
3rd: - Taixi, + Sanyinjiao
4th: - All except Zusanli, and Yanglinquan, + Zhongwan, Xiawan, Qihai, Guanyuan, Shousanli
5th: - All except Yanglinquan, +Shenshu, Pishu, Ganshu, Weizhong, Tinggong, Moxa on Ashi points(elbow) - + resolve liver qi stagnation, Tonify kidney and spleen
6th: - Tinggong, + Mingmen
Case Conclusion:
This is the first case I have treatment for this kind of the pain. She has low vitality, easily gets tired, and typically shows qi and yang deficiency. She appeals the pain on the medial side of elbow and knee.
Whenever the patient receives treatment, the pain is gradually relieved. On the 1st treatment, I focused on promoting qi and blood circulation to relieve the pain on elbow and knee. From the 2nd treatment, I focused on relieving pain and tonifying the underlied deficient syndromes which can be helpful for improving the elbow and knee pain.
During treatment, I also applied moxa on ashi point which is so helpful to relieve the pain and can comfort the patient much better.
I learnt from this treatment that after relieving the pain at a certain degree, treatment for the underlying syndromes can be so effective to improve the patient condition, especially for deficient type patients.
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