tiredness

Record of first visit

Record of first visit: 26/11//08 Name:

Gender: Male Date of Birth: 01/06/88

Chief complains: tiredness

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Descriptions

Asking

Present illness complains:

Patient felt very tired in recent 2 weeks. The tiredness began since he was busy for his study recently. He often felt sleepy and tired in the whole day, especially when he waked up in the morning. Normally, he felt more tired after he finished his job, and had better energy in the night. Also, he had red eyes and he is easy to be angry recent 2 weeks. In recent 5 years, he slept from 1-2am to 9am in the next day, and watch movies in the late night. He has many dreams during sleeping normally. In addition, he has busy and stressed life in the day time in recent 2 years. He has delayed defecation, but the stool is in the normal form. He has normal urination. He has no chill and fever, no sweating, no palpitation, or tinnitus, or headache.

Past History: NAD

Lifestyle: Busy student life

Family history: NAD

Inspection

General: 7/10 vitality

Others: Patient looks tired with red eyes, and the complexion is lack of luster

Tongue : Red tongue body, less coating, and red tips on front part of the tongue

Auscultation/olfacation

Sound: NAD

Odours: NAD

Palpation

Body area: NDA

Pulse: Fast and taut, Chi part is deep

Case Summery

WS

Definition

Fatigue is physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease. It is the body's way of signaling its need for rest and sleep. But when fatigue becomes a persistent feeling of tiredness or exhaustion that goes beyond normal sleepiness, it is usually a sign that something more serious is amiss.

Physically, fatigue is characterized by a profound lack of energy, feelings of, muscle weakness and slowed movements or central nervous system reactions. Fatigue can also trigger serious mental exhaustion. Persistent fatigue can cause a lack of mental clarity (or feeling of mental "fuzziness"), difficulty concentrating, and in some cases, memory loss.

Cause and symptoms

Fatigue may be the result of one or more environmental causes such as inadequate rest, improper diet, work and home stressors, or poor physical conditioning, or one symptom of a chronic medical condition or disease process in the body. Heart disease, low blood pressure, diabetes, end-stage renal disease, iron-deficiency anemia, narcolepsy and cancer can cause long-term, ongoing fatigue symptoms. Acute illnesses such as viral and bacterial infections can also trigger temporary feelings of exhaustion. In addition, mental disorders such as depression can also cause fatigue. A 2002 report suggests that a disorder called hypocalcaemia may be a frequent cause of fatigue.

A number of medications, including antihistamine, antibiotics, and blood pressure medications, may cause drowsiness as a side effect. Individuals already suffering from fatigue who are prescribed one of these medications may wish to check with their healthcare providers about alternative treatments.

Treatment

The treatment of fatigue depends on its direct cause, but there are several commonly prescribed treatments for non-specific fatigue, including dietary and lifestyle changes, the use of essential oils and herbal therapies, deep breathing exercises, traditional Chinese medicine, and color therapy.

Dietary changes

Inadequate or inappropriate nutritional intake can cause fatigue symptoms. To maintain an adequate energy supply and promote overall physical well-being, individuals should eat a balanced diet and observe the following nutritional guidelines:

• Drinking plenty of water Individuals should try to drink 9 to 12 glasses of water a day. Dehydration can reduce blood volume, which leads to feelings of fatigue.
• Eating iron-rich foods (i.e., liver, raisins, spinach, apricots). Iron enables the blood to transport oxygen throughout the tissues, organs, and muscles, and diminished oxygenation of the blood can result in fatigue.
• Avoiding high-fat meals and snacks. High-fat foods take longer to digest, reducing blood flow to the brain, heart, and rest of the body while blood flow is increased to the stomach.
• Eating unrefined carbohydrates and proteins together for sustained energy.
• Balancing proteins. Limiting protein to 15-20 grams per meal and two snacks of 15 grams is recommended. Not getting enough protein adds to fatigue. Pregnant or breastfeeding women should eat more protein.
• Getting the recommended daily allowance of B complex vitamins.
• Getting the recommended daily allowance of selenium, riboflavin, and niacin. These are all essential nutritional elements in metabolizing food energy.
• A 2002 report suggested that calcium and Vitamin D supplementation can lessen fatigue symptoms in person with hypocalcaemia-caused fatigue.
• Controlling portions. Individuals should only eat when they're hungry, and stop when they're full. An over-stuffed stomach can cause short-term fatigue, and individuals who are overweight are much more likely Lifestyle changes

Lifestyle Change

If stress is an issue, a number of relaxation therapies and techniques are available to help alleviate tension, including massage, yoga, aromatherapy, hydrotherapy, progressive relaxation exercises, meditation, and guided imagery. Some may also benefit from individual or family counseling or psychotherapy sessions to work through stress-related fatigue that is a result of family or social issues.

Essential oils

Aromatherapists, hydrotherapists, and other holistic healthcare providers may recommend the use of essential oils of rosemary, eucalyptus blue gum, peppermint, or scots pine oil to stimulate the nervous system and reduce fatigue. These oils can be added to bathwater or massage oil as a topical application. Citrus oils such as lemon, orange, grapefruit, and lime have a similar effect, and can be added to a steam bath or vaporizer for inhalation.

TCM

In traditional Chinese medicine, this disease is categorized as yu zheng (depression syndrome), internal injury of the spleen-stomach, xu lao (consumptive disorder), and tong zheng (pain syndrome)

Aetiology and Pathology

It is commonly believed that chronic fatigue syndrome is closely related to heat-dampness pathogens, which tend to invade deficient visceral organs, in particular the spleen and stomach, causing damp-heat accumulation and internal accumulation of damp-heat pathogens. When the patients are infected with a virus or catch a cold, the internal and external pathogens work together to cause damages to the spleen and stomach, and the internal damp-heat pathogens progress to hinder the normal flow of qi and disturb the heart and other visceral organs, resulting in a wide series of chronic fatigue symptoms. On the other hand, hold that the etiology of chronic fatigue syndrome is due to long-term anxiety, exhaustion, and mental fatigue. And chronic fatigue syndrome could also result from stagnation and depression of the liver-qi

Diagnosis

Diagnosis: Fatigue

Syndrome Differentiation: Qi deficiency, liver qi stagnation, and deficient heat up flaming, underline kidney yin deficiency

Explaination:

Patients has busy student life, and he has late sleeping habit for long time. His life style decided that his Qi has been more consumed than others, and it leads qi deficiency. Also, he is stressed for his study recently, which cause liver qi stagnation. The stagnation of liver qi aggravated the deficiency of qi, and resulted his fatigue symptoms recently. On the other side, recent irritability of the patient shows his the liver qi stagnation which caused liver heat, the up flaming of liver heat cause the redness of his eyes. Chi part weak pulse and dryness and redness of the tongue show the yin deficiency of kidney, and it also caused by long term “late sleeping” habit, which consume yin and qi. The red spots on the tongue tip show the deficient of the heart heat. Furthermore, a lots dream during sleep show the kidney yin can not nourished up flaring of heart fire. And the disharmony of heart fire and deficiency of kidney yin cause the sleeping problem, which in turn aggravated the tiredness of the patient.

Treatment

Principles: nourish kidney yin, depress the deficient heart fire, soothing liver qi, and tonify general qi

Methods:

Needling: ShenMen, YinXi, TaiChong, TaiXi, ZuSanLi, SanYinJiao

Explaination: TaiChong: soothing liver qi TaiXi: tonify kidney yin, and nourish heart yin, ZuSanLi: tonify qi and blood , SanYinJiao: harmonize liver and kidney

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Life Style Advice: Sleep before 11pm, and calm down mind by meditation and TaiJi

Conclusion

Patient got better sleep and less dream the day after the treatment, and he felt more energy in the next couple of days. He is still easy to be irritable due to his stressed daily life, but it is slightly less than before.

Follow up consultation

Patient did not catch the follow up consultation because his coming exams.

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