Phlegm-Heat in the Lungs - case reference

A 28 year old woman had a cough with profuse yellow sputum which had developed two weeks ago after an invasion of Wind-Heat. She also had a feeling of oppression in the chest and felt slightly hot and thirsty. Her pulse was Slippery and the tongue had a thin-yellow coat.I diagnosed retention of Phlegm-Heat in the Lungs following an acute invasion of Wind-Heat. I prescribed 6 tablets of Ringing Metal a day. I also treated her with acupuncture twice a week. After two weeks the patient felt back to normal and the cough with sputum had gone.NB I chose Ringing Metal rather than Clear the Soul in this case because the cough was acute and a definite after-effect of the invasion of Wind-Heat

Ringing MetalPatterns: Phlegm-Heat in the LungsRinging Metal is used to treat an acute cough with expectoration of profuse, yellow sputum which follows an upper respiratory tract infection. This may occur when someone is unable to fully shake-off an invasion of Wind and is left with a lingering, acute cough. There may also be accompanying symptoms of a feeling of heat, thirst, insomnia and a feeling of oppression of the chest. Ringing Metal is specifically for Phlegm-Heat, and not for Dry-Phlegm-Heat in the Lungs. The latter manifests as a cough that is primarily dry and sounds dry but also with the difficult, occasional expectoration of scanty sputum. In the former case there will be profuse sputum and the cough is not dry.

Clear the SoulPatterns: Phlegm-Heat obstructing the chest and Mind, Lung-Qi not descendingClear the Soul (a variation of Warming the Gall-Bladder Decoction - Wen Dan Tang) is most commonly used for treating emotional tension and anxiety occurring against a background of Phlegm obstructing the Lungs and Heart. However, it can also be used to resolve residual Phlegm-Heat in the Lungs which manifests on a physical level, i.e. with a chronic cough with expectoration of yellow sputum. This condition may or may not have derived from the after effects of an attack of Wind

Phlegm-Heat Obstructing - excess pattern
General Signs & Symptoms:Barking cough, SOB, asthma, chest oppression, yellow/green mucus (main difference from damp-phlegm above)
Tongue:Red, thick sticky yellow coat
Pulse:Slippery, rapid, full
General Treatment Points:
Maciocia Treatment Points w/Valaskatagis commentary, modifications and additions
LU 5 - resolve phlegm
LU 7 - restore descending function of the lungs, alleviate cough
LU 1 - LU Mu, clear excess, asthma, resolve phlegm
ST 40 - resolve phlegm
Could add CV 12 - ST Mu, to assist ST 40 in resolving phlegm
LI 11 - clear heat
LU 10 - clear heat in the lungs

Left elbow pain for 3 years

Record of first visit

Date of First Visit: 13.08.08 Name: Mrs C

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: 09.08.08, a little clots, scanty, married, 2 children

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 4^th treatment, she feels weakness of arms and knee, and added some points for tonifying qi, on 5^th 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:

2^nd: - Quze, Neiguan, Liangqiu, Yinlinquan , +Taixi, Moxa on Ashi points(both elbows)

3^rd: - Taixi, + Sanyinjiao

4^th: - All except Zusanli, and Yanglinquan, + Zhongwan, Xiawan, Qihai, Guanyuan, Shousanli

5^th: - All except Yanglinquan, +Shenshu, Pishu, Ganshu, Weizhong, Tinggong, Moxa on Ashi points(elbow) - + resolve liver qi stagnation, Tonify kidney and spleen

6^th: - 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 1^st treatment, I focused on promoting qi and blood circulation to relieve the pain on elbow and knee. From the 2^nd 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.

On and off parietal headache for 2 years, aggravated 2 weeks

RECORD OF FIRST VISIT

Date of First Visit: 04 Sep 08	Name:
Age : 22	Gender: Female
CHIEF COMPLAINTS : On and off parietal headache for 2 years, aggravated 2 weeks
DESCRIPTIONS (4 diagnostic methods)
A) Asking
Present illness history The patient suffers from a headache for about 2 years. The pain occurs randomly, but mostly in the evenings when she studies or concentrates for hours. It normally starts with dull pain from the vertex and around DU-20 Baihui and radiates to the ear region and the eye balls. She described her pain as electric shock that comes and goes with distending sensation. This can be relieved if she massages and presses along the eyebrows. She does not have any injury on head related to this problem and the most recent pain occurred about 2 weeks ago. No chill/Fever. No dizziness. Little thirstiness (prefers cold drink). Good appetite. She often gets hot sensation on her face while having headache. Spasm on the eyelid (right side). No bitter taste in the mouth. Mild hot sensation in the five centres. Shoulder and lower back pain. Frequent sighing. Mood swings. Dreamful sleep. Hypochondriac pain. Urination is normal and stool is little loose.
Past illness history: None
Life style: Student. Easy going.
Family history: Grandfather had pancreatic cancer.
Menstruation, marital & obstetrical history: Single. 14. Last period on 04-Aug-08. Premenstrual distension. Scanty dark red coloured menses with clots (not always). Leucorrhea in white colour with fishy smell.
B) Inspection
General : Flushed cheeks Tongue : Red tongue with very thin white coating
C) Auscultation / Olfaction
Sound : NAD Odours : NAD
D) Palpation
Pulse : String-taut, weak on Chi Body areas : N/A

CASE SUMMARY

DIAGNOSIS

A) Diagnosis Parietal headache

B) Syndrome Differentiation Hyperactivity of Liver yang underlying Liver and Kidney yin deficiency

C) Explanation

The shortage of Liver yin can implicates Kidney yin, and vice versa. Deficient Liver and Kidney yin results in disharmony between yin and yang. The Liver yang is hyperactive and the qi and blood go up with Liver yang. It resulted in distending pain in head and eyes, hot sensation on the face and the five centres as well as dry throat. Frequent sighing and spasm on the eyelid are all Liver deficiency signs. The excessive yang disturbed the mind so she has got emotional up-and-downs and dreamful sleep. The lumbar could not be filled up due to Kidney yin deficiency, so she has also got lumbar pain. The scanty dark red coloured menses due to Liver yin deficiency and her tongue which is red with very thin white coating shows yin deficiency leading to the deficiency heat. The pulse is taut, showing hyperactivity of Liver yang and weak pulse on the Chi portion also indicates deficiency of Kidneys as well.

TREATMENTS

A) Treatment Principles - Descend the arisen Liver yang, sooth the Liver, and promote flow of qi to stop pain.

B) Treatment Methods

1. Needling

Prescription : - Taichong / Baihui / Yintang / Hegu / Neiguan / Sanyinjiao

Explanations : - Hegu and Taichong are “FOUR GATES”. Hegu is a common point for diseases on the head and face and pain syndromes and with Sanyinjiao, both points are good for tonifying the Spleen to produce more blood which may nourish the marrow, since the brain is the sea of marrow. Taichong soothes the Liver and pacifies Liver yang, therefore, is good to be chosen for a parietal headache. Baihui is a local point that promotes qi circulation to stop pain and Yintang was chosen for her headache that often radiates to the eye region. Neiguan was also chosen for regulation of qi and particularly to pacify the Liver this time.

2. Moxibustion

Prescription :

Explanations :

3. Cupping

Prescription :

Explanations :

4. Electro Acupuncture

Prescription :

Explanations :

5. Microsystems

Select microsystems : Ear ( ), Hand ( ), Foot ( ), Scalp ( ), Nose ( ), Other ( )

Prescription :

Explanations :

6. Life Style Advice

Because the patient and I have been together for years so I know her quite well. Even she told me that she is easy going and does not get stressed easily, but I know that she is pretty sensitive and easily influenced by the environment and atmosphere where she is in. Therefore I recommended her try to calm the mind and not to take things too seriously; otherwise it would build up a mental stress on her. Also I recommended her to try yoga to help maintaining her body and also controlling her mind at the same time.

HEADACHE

DEFINITION

A headache (cephalalgia in western medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache.

TCM ETIOLOGY and PATHOGENESIS

The head is the highest place of the body where qi and blood of zangfu organs and yang meridians of foot and hand gather as well as Du meridian which dominates all the yang of the body flow up. This is why the head is regarded as the converging place of the entire Yang. 1. Invasion of various pathogens and endogenic diseases may directly or indirectly cause derangement of qi and blood, obstruction of meridians and collaterals on the head, leading to headache. Six exogenous pathogens can attack the vertex and inhibit the flowing of lucid yang. 2. Dysfunction of liver in maintaining the free flow of qi and prolonged depression will turn into heat which may go up and disturb the head; yin deficiency of liver and kidney may lead to hyperactivity of liver yang. 3. Constitutional weakness, deficiency of qi and blood as well as malnutrition of brain may result in headache.

DIFFERENTIATION AND TREATMENTS

1. Invasion of pathogenic wind into meridians and collaterals

Clinical manifestation

Headache occurs on exposure to wind. The pain may extend to the nape and back. It is a violent, boring and fixed pain, string-taut pulse, white thin tongue coating. The type also called “head wind”.

Treatment principle

- Expel the exogenous wind and promote qi circulation in meridians and collaterals

Acupuncture treatments

- Baihui / Fengchi / Taiyang (plus+ points depending on the pain area & syndrome differentiation) § Frontal headache: add Yangbai / Yintang / Cuanzhu / Hegu / Neiting § Temporal headache: add Touwei / Shuaigu / Waiguan / Zulinqi § Occipital headache: add Tianzhu / Dazhui / Houxi / Jinmen § Parietal headache: add Sishencong / Taichong / Neiguan / Yongquan 1. Invasion of pathogens: add Hegu / Lieque 2. Hyperactivity of Liver-yang: add Taichong / Sanyinjiao 3. Deficiency of qi and blood: add Qihai / Zusanli / Pishu

2. Hyperactivity of Liver yang

Clinical manifestation

- Headache, vertigo, severe pain on bilateral sides of the head, irritability, hot temper, insomnia, red face, bitter taste in the mouth, string-taut pulse, red tongue with yellow coating.

Treatment principle

- Calm and sooth the Liver and clear heat

Acupuncture treatments

- Refer to the first differentiation

3. Insufficiency of qi and blood

Clinical manifestation

- Lingering headache, dizziness, vertigo, lassitude, lustreless face, pain relieved by warmth and aggravated by cold, overstrain or mental stress, weak, thread pulse, thin white tongue coating.

Treatment principle

Release the Exterior, restore the descending of Lung-Qi, promote fluids and stop cough.

Acupuncture treatments

- Refer to the first differentiation

W.M.S. Researches & Explanations: HEADACHE	(Reference: Wikipedia)
Definition
A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints and may be frequent for many people. The vast majority of headaches are benign and self-limiting. Common causes are tension, migraine, eye strain, dehydration, low blood sugar, hypermastication and sinusitis. Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, and brain tumors. When the headache occurs in conjunction with a head injury the cause is usually quite evident. A large percentage of headaches among women are caused by ever-fluctuating estrogen during menstrual years. This can occur prior to, or even during midcycle menstruation. Treatment of an uncomplicated headache is usually symptomatic with over-the-counter painkillers such as aspirin, paracetamol (acetaminophen), or ibuprofen, although some specific forms of headaches (e.g., migraines) may demand other, more suitable treatment. It may be possible to relate the occurrence of a headache to other particular triggers (such as stress or particular foods), which can then be avoided.
Pathophysiology
The brain in itself is not sensitive to pain, because it lacks nociceptors. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The membrane surrounding the brain and spinal cord, called the dura mater, is innervated with nociceptors. Stimulation of these dural nociceptors is thought to be involved in producing headaches. Similarly the muscles of the head may be sensitive to pain.
Types
There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory. 1. Vascular The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, for some people, disturbed vision. It is more common in women. While vascular changes are evident during a migraine, the cause of the headache is neurologic, not vascular. After migraine, the most common type of vascular headache is the "toxic" headache produced by fever. Other kinds of vascular headaches include cluster headaches, which are very severe recurrent short lasting headaches, often located through or around either eye and often wake the sufferers up at the same time every night. Unlike migraines, these headaches are more common in men than in women. 2. Muscular/myogenic Muscular (or myogenic) headaches appear to involve the tightening or tensing of facial and neck muscles; they may radiate to the forehead. Tension headache is the most common form of myogenic headache. 3. Cervicogenic Cervicogenic headaches originate from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompanied by restricted cervical range of motion, ipsilateral neck, shoulder, or arm pain of a rather vague non-radicular nature or, occasionally, arm pain of a radicular nature. 4. Traction and inflammatory Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Specific types of headaches include: Tension headache, Migraine, Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure), Ictal headache, Cluster headache, "Brain freeze" (also known as: ice cream headache), Thunderclap headache, Vascular headache, Toxic headache, Coital cephalalgia (also known as: sex headache), Hemicrania continua, Rebound headache (also called medication overuse headache, abbreviated MOH), Red wine headache, "Spinal headache" (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure, Hangover (caused by heavy alcohol consumption), A headache may also be a symptom of sinusitis. Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.

Case Conclusion

The diagnosis of this case is parietal headache due to hyperactivity of Liver yang underlying Liver and Kidney yin deficiency. I provided one acupuncture treatment on Taichong, Hegu, Baihui, Yintang, Neiguan, and Sanyinjiao. Baihui worked very well and the patient got the qi gaining sensation during the treatment. For Taichong and Hegu, the patient told me that she got that feeling on one side only, so I gave her more stimulation on the other side. Two days after the first treatment, she told me that she got the same headache but it was very mild and relieved very soon. I suggested her having six treatments but she could not make it due to transport problem.

I would like to use those points (especially Baihui, Hegu, Neiguan, Sanyinjiao) to the similar problem but to change some points according to the syndrome differentiation for each different case. Because this was the first time that this patient has ever had acupuncture, so I wish that she had a positive experience on this treatment.

Right shoulder pain for six months

RECORD OF FIRST VISIT

Date of First Visit: 20/08/2008 Name: xxx

Date of Birth: 47 Gender: male

Chief complain: Right shoulder pain for six months

Descriptions (4 Diagnostic methods)

A) Asking

Present illness history: The patient has been suffering from shoulder pain for six months. The pain is around shoulder and scapular region with stabbing pain on fixed area. It occurs gradually without any injury since he started new business which involve physical work using right hand continuously. The pain is more severe in the morning and evening. He feels pain when he abduct arm and some limitation of movement in retro-flexion of his arm. Aggravated by cold weather. No chill & fever, normal sweating, good appetite, normal defecation & urination, good sleep, thirsty and dry mouth, prefer to drink cold water.

Past illness history: Hypertension (medication for 4 years)

Life style: Busy, no smoking & alcohol

Family history: Father : cirrhosis

Mother : hypertension

Menstruation, marital & obstetrical history: Married with two children

B) Inspection

General: medium height, dim complexion, vitality 8/10

Tongue: Purple body with red tip, crack in center, thin yellow coating

C) Auscultation/Olfaction

Sound: Nothing abnormal detected

Odours: Nothing abnormal detected

D) Palpitation

Body areas: Sharp pain feeling if press the center of scapular

Pulse: L: weak, specially on chi position R : wiry, rapid

CASE SUMMARY

Definition

Sprain and contusion refer to the injuries of soft tissues such as skin muscles, tendons and ligaments, at limbs, joints and body trunk without fracture, dislocation and skin wound. The folk name is “injury of tendons”.

WMS

A sprain is an injury which occurs to ligaments caused by being over stretched beyond their normal capacity and possibly torn. Muscular tears caused in the same manner are referred to as a strain. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary.

Degrees

Although some signs and symptoms can be used to assess the severity of a sprain, the most definitive method is with the use of magnetic resonance imaging (MRI) Sprains are graded in four degrees.

• 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

The typical signs and symptoms associated with a sprain are the cardinal signs of a sprain.

• inflammation
• localized pain
• swelling
• loss of function
• loss of normal limb function
• elasticity of ligament decrease

Although any joint can experience a sprain, some of the more common include:

• the ankle. It is the most common, and has been said that sprains such as serious ankle sprains are more painful and take longer to heal than actually breaking the bones in that area.
• The knee.
• The wrist.
• The toes.

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

• Rest: The sprain should be rested. No additional force should be applied on site of the sprain. If, for example, the sprain were an ankle sprain, then walking should be kept to a minimum.

• 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.

• Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support.

• Elevation: Keeping the sprained joint elevated above heart level will also help to minimize swelling.

Ice and compression 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.

TCM Etiology and Pathogenesis

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.

TCM diagnosis

A) Diagnosis: sprain on right shoulder

B) Syndrome Differentiation: Qi and blood stagnation on local area

C) Explanation:

Sprain and contusion refer to the injures of soft tissues such as skin muscles, tendons and ligaments at limbs joints and body trunk without fracture, dislocation. So, . circulation of qi and blood is stagnated in the local region and meridians and collaterals are obstructed. This patient is using his arm all the time for his job, especially right arm which lead to injures of soft tissues by over using. So, he feel the pain or limitation of the movement. The pain is aggravated in the working or cold weather.

Treatment

A) Treatment principles:

Activate the meridian, dredge the collateral, promote circulation of qi & blood to relieve pain

B) Treatment methods

1. Needling: filiform

Points: Jianjing(GB21), jianzhen(SI9), jianyu(LI15), tianzhong(SI11), waiguan(SJ5)

Explanations :

-Jianjing : the crossing point of sanjiao, gallbladder, stomach, yang link vessel stimulate to treat shoulder pain

-Jianyu : the crossing point of large intestine and yang heel vessel. , locally to release the shoulder & scapular problem, unblock the meridian

-jianzhen : locally to release the shoulder & scapular problem, unblock the meridian

-tianzhong: locally to release the shoulder & scapular problem, unblock the meridian

-waiguan: luo connecting point, one of the eight confluent point that link with the yang link vessel. along the meridian to relieve the upper arm muscle pain and clean the internal heat

( All points are right side)

2. cupping

points: Ashi point, Tianzhong(SI11), Jianyu(LI15), Jianjing(GB21)

Explanations : Activate the meridian, dredge the collateral & stop pain

Life style advice

- Mild exercise which manipulate shoulder muscle before starting work and take

regular breaks from working position.

- Keep the shoulder warm

- Rest. no additional force should be applied on site of the sprain

Follow up consultations

Patient name : treatment number: 2,3

TCM Diagnosis: sprain on right shoulder

TCM disease: Qi and blood stagnation on local area

Date: 03 / 09/ 08, 10 / 09 /08

Current condition/changes:

2^nd treatment: The pain area was some changed from medial side of shoulder pain to lateral side of shoulder and around nape

3^rd treatment: back to medial side shoulder pain and scapular area pain

Treatment principle: Activate the meridian, dredge the collateral, promote circulation of qi & blood to relieve pain

Prescription:

2^nd treatment : – Jian yu, + Jianwaishu, Jianlao, tianzhu

3^rd treatment: - Jianwaishu, Jianlao, tianzhu+ Jianyu,

Explanation: The pain area was changed. So the point was changed accordingly.

Case Conclusion

when patient first visit, the patient feels pain when he abduct arm and some limitation of movement in retro-flexion of his arm. After 2^nd treatment, he can do retro flexion freely and the patient satisfied the treatment. When he came back 3^rd treatment, there’s no more limitation of the movement, but pain was back again.

This case is my first one for shoulder pain, through this, I realize that require some technique about how to do the examination about the pain & movement and I found acupuncture clinic is very effective and I will use the same techniques and methods to other patients again if symptom is same.