Epigastric Pain for 6 months

Record of first visit

Date of first visit: 01/09/2008

Name: Ms.Fan

Gender: female

Age: 42

Chief complaints: Epigastric Pain for 6 months

Descriptions (4 diagnostic methods)

A: Asking

Current condition:

This patient claims that she has abdominal distending pain for nearly 6 months. She took Chinese herbal medicine before and felt better.

After that the pain came back again. She has indigestion although her appetite is good. She has lots of gas, especially when she eats those food contains proteins. In the afternoon she feels very tiredness.

No chills and fever. No headache, no sweating, no thirsty, prefer warm drinking. Normal urination. Normal defecation. Sleeping is good but sometime nightmare dream.

Past history: Palpation when little, thyroid,

Life style: Single mum with busy working,

Family history: Father has liver and GB problem- Gall Bladder stone,

Menstruation: 12, 6-7 / 28, with dark color clots, dizziness at he first 2 days,

B: Inspection

General: Both eyes are swollen due to Thyroid,

Others: NAD

Tongue: Dim, little teeth marks,

C: Auscultation/ Olfaction

Sound: NAD

Odour: NAD

D: Palpation

Body area: NAD

Pulse: slippery and weak,

Case Summary

Diagnosis

A) Diagnosis: epigastric pain,,

B) Syndrome differentiation: Liver qi stagnation attack spleen, underlying spleen qi deficiency,

C) Explanation:

Due to emotional changes, the liver qi stagnated. The liver qi stagnation attacks the spleen and stomach. The liver meridian goes through the hypochondriac, so it causes hypochondriac pain, indigestion, poor appetite, heaviness of the body, tiredness, loose stool, and gas.

Treatment

(A)Treatment principles

Soothe the liver, strengthen the spleen, harmonize the stomach,

(B) Treatment Methods

Zhong wan, Ri yue, Tai chong, Nei guan, Zu san li, Nei Guan,

Reducing and reinforcing,

(C) Explanation

Zhong wan(CV12) is to strengthen the spleen, harmonize the stomach.

Ri yue is to release the liver qi stagnation on the hypochondriac.

Tai Chong (LR 3) is to soothe the liver qi. Nei guan is to descend the rebellious stomach qi and harmonize the stomach.

Zusanli (ST36) is to regulate the flow of qi and blood.

(D) Life style advice

Balance the emotions and control the temper, think always positive and broadminded.

TCM

Epigastric pain, refers to a syndrome manifested by frequent pain over the epigastric region and close to the cardiac, so in ancient time, it was named “ cardiac pain”. It is commonly seen in acute and chronic gastritis, stomach or duodenal ulcer, functional stomach pain in modern medicine.

Etiology and pathogenesis

1, irregular food intake, raw and cold food and hunger injure the spleen and stomach, causing failure of the spleen in transportation and transformation and failure of stomach qi in descending, then the pain appears.

2, anxiety, anger and mental depression damage the liver, causing failure of the liver in dominating free flow of qi, adversely attacking the stomach, impeding is activity and hindering its qi descending, then the pain appears.

3,General lowered functioning of the spleen and stomach, due to invasion of pathogenic cold, which is stagnated in the stomach, causes failure of the stomach qi in descending, then the pain occurs.

Differentiation

2, Attack of the stomach by the liver-qi,

Manifestation: paroxysmal pain in the epigastrium, radiating to the hypochondriac region, frequent belching, nausea, acid regurgitation, abdominal distension, anorexia, thin, white tongue coating, deep, taut pulse.

Treatment

Principle: The points of liver and stomach meridians are selected as the primary points with the reducing manipulation to remove the stagnation of liver qi, to pacify the stomach and relieve the pain.

Prescription: Nei guan, Qimen, Tai chong, Zhong wan, Zu san li,

Explanation:

Qi men is the front Mu point of the liver and Tai chong is the yuan –primary point of the liver meridian. This combination is used to remove the stagnation of liver-qi, regulate the flow of qi and relive pain.

Zu san li and Nei guan and Zhong wan are to pacify the stomach, relieve pain, descend perversive qi and stop vomiting.

Case Conclusion

This patient has excessive thyroid signs when I diagnosed her, and her emotional changes are not normal due to her marriage life. Sometime she falls into sadness and sometimes gladness. Always she is easy to criticize things. And her digestion problem is related to her emotions. She came only one treatment. So I need to trace her for the result. I will use this method to treatment Liver qi stagnation attacking stomach. From this case I have learned that we not only treat patient’s physical problem but also their emotional problems.

Sinus obstruction with headache for 6-8 months

Record of first visit

Date of visit 10/09/08

Gender M

Age 30

____________________________________________________________________________________

Chief complaint :Sinus obstruction with headache for 6-8 months

DESCRIPTIONS

ASKING Numb face and headaches for 6-8 months, the headaches are behind the eyes and in the temple region generally the right side, pain can be quite sharp and strong. He first notice his face going numb when having cold a beer on an empty stomach, the face goes numb mainly in the area of both cheeks and brow, the feeling is heavy and dull ache with reduced feeling to touch, No type of weather seems to affect it he has noticed it gets much worse while driving and only recently it has started to occur after eating sweet food this also produces phlegm in his sinus (nose becomes blocked and heavy) In the morning he can get phlegm out of his sinus but very small amount and white colour. He also often gets dizzy and has permanent floaters in his vision. No chill or fever

His right ear feels like he has fluid in his ear drum, has ok appetite, often feels low energy and wakes up tired and a heavy feeling in his limbs particularly the legs. Once he has done some exercise he is ok. He often gets cold feet with a general adversion to cold, he often has an achey lumbar with no record of injury, no tinnitus, also has a pimple like skin rash around the mid of his back area, he said it comes and goes with no regular pattern. His sleep is okay but very dreamy and often has night sweats (very Bad in summer). Slight palpitations thirsty and prefers cold water. His defication is irregular and loose not much smell, urination 7+ per day but not at night.

His doctor has recently prescribed antibiotics which he is now taking

Present illness Na

Previous history High colesterol

Maritial Lives with partner un married

Family history Mother passed away from melanoma (4 years ago- grief), father high colesterol

Lifestyle Non smoker drinks 15 beers per wk reg exercise

INSPECTION

General body Vitality looks slightly pale 7/10

Tongue Pale corpulent not much coating on the middle and slight yellow greasy coating only on the rear

Pulse Right slippery moderate, weak chi deep

Left slippery moderate, weak chi deep

AUSCULTATION

Sound/Odours Normal

PALPATION

Abdomen Palpation numb feeling around brow and nose and beneath eyes.

· TCM Disease:	Sinusitus
· TCM type/pattern:	Phlegm retention in local area Sp and lu qi def, underlying kd yang def
· C) Explanation:	The phlegm retention In the local area has been caused by the weak lung qi which may have been caused by (grief) and also through the mother child relationship, the lungs mother is the sp. So if the mother is sick eventually so will the child, The spleen being impaired through over thinking and lifestyle and diet. Also he has some kd yang def signs if the kd yang warming and steaming function is weak then his symptoms can result in cold limbs and slightly frequent urination and achey lumbar also night sweating.
TREATMENT:
A) Treatment Principle	Eliminate local phlegm stagnation and tonify sp and kd,
B) Treatment Method
1. Needling
Select techniques:	Filiform ( * ) three edged needle ( ) plum blossom ( ) intradermal ( )
Select Acu-points and Manipulation:	Xing xiang, yin tang, tai yang, hegu, zhong wan, qi hai, fenglong

Resons for

point selection To use local points as he doesn’t have any other major lung qi signs so treat the local area and strenthern the mother to treat the child.

This was his first time using acupuncture unfortunately for him and me the recommended points were

ying xiang, yin tang for local area qi stimulation and phlegm reduction, tai yang and hegu for his headaches, zusanli for his sp qi, qi hai for his kd and fenglong to eliminate phlegm.

Lifestyle advice Avoid damp foods like dairy and wheat, also avoid cold drinks try some light exercise like walking. Ginger tea in the morning and warm meat like lamb would be good. Also deep breathing over a bowl of steaming water with eucaliptis oil in it can relieve the symptoms.

Follow up treatments treatment 2-4

He hurt his back snowboarding and had pain in the hypochondriac region and lumbar but could not locate any specific ashi points, Also is still has headaches and same nunb pressure on forehead and temporal region, Antibiotics has no effect yet.

Ming men, Shen Shu, Pi Shu, Fei Shu, Dachang shu, Yao tong dian(moving lumbar for 10 min) fenglong.

Third and fourth treatment no yao tong dian.

Treatment 5 Still has some frontal and lateral headaches and feels dizzy walking, still eye floaters, red eyes and hypochondriac pain, also complained of tight feeling in legs and still nasal congestion.

Yin tang, ying xiang, shangxing, hegu, yangling quan, tai chong, fenglong

I chose shang xing for his headache, tai chong for his red eyes and stimulating the GB and LR, Yang ling quan for his tendons.

This treatment he found a very strong feeling on his forehead and relief from pressure In his sinus.

The following treatments I included zulingqi (draw GB heat down) and zang men as his pain in the hypochondric region has become more constant, also as he has high cholesterol,

I palpated his GB channel and there was great tenderness all along the channel.

With having little improvement previous I have decided to use more gallbladder points, by the 7^th treatment his sinus has improved greatly and he has hardly any numb feeling and his smell has improved, his energy has increased and eyes not as many black spots or as red.

Case Conclusion: This patients results were a little slow in coming as he hurt is back and this changed the treatment focus from the original complaint. I also discovered that if I manipulate (ying xiang and yin tang) the needles with quite strong manipulations while asking him to breathe deeply it seems to have a good effect combining this with shangxing he had a great relief of pressure so will try this combination in the future. I have found it very interesting that once we started to use the gallbladder points that he had a quick response to an improvement in his sinus and headaches, I have found that palpating along the meridian useful and will use this again to aid me in my diagnosis. Also I found using yao tong dian effective with his acute lumbar pain as the patient could feel an immediate improvement I think this is good for patient confidence and achieves a good result and am looking forward to using this again in the future.

Western medicine

Definition Sinusitis is an infection or inflammation of the lining of the air filled cavities in the skull, these cavities are located above the eyebrows in the forehead behind the nose and just below the eyes. The most common cause or this condition is thought to be a viral, fungal, bacterial infection of the respiratory tract leading to obstruction. There are four types of sinusitis depending on its location, maxillary (cheeks area) frontal (behind and above eyes) ethmoid (between the eyes) sphenoid (eyes and vertex).

The standard treatment is to usually prescribe antibiotics in the acute (4-12 weeks) The first 7 days it is thought to be viral infection and is often confused with the common cold, then after 7 days, 30 to 50% of the cases seem to be in a bacterial stage (antibiotics have effect) and then later on if this has no success then anti-inflamatorys and corticosteroid nasal sprays are prescribed. A recent study in britian has found that nasal corticosteroids work no better than a placebo {1}

Cronic (12 wks) or more sinusitis is more difficult to treat and saline nasal sprays and nasal irrigation using a “neti pot” are often far more effective than weeks of antibiotics. The other option is surgery to remedy the problem.

Here is some instruction on how do the nasal irrigation.

http://www.brown.edu/Student_Services/Health_Services/Health_Education/general_health/sinusitis.htm

One or 2 minutes a day spent performing nasal irrigation is often more effective than weeks and weeks of antibiotics, decongestants, and cortisone nasal sprays, and has none of the side effects of these medications. Even if you do require medications or surgery, the improved cleanliness of the sinuses makes it more likely that these treatments will be effective.

How do I irrigate? First, it is important not to use common table salt to irrigate the nose on a regular basis, because it contains certain chemicals such as iodine and "anti-clumping" additives that can be harmful if used frequently. You can use Kosher salt (found in most groceries right along with the table salt) or sea salt found in health food stores.

With a measuring spoon, add 1 teaspoon of salt to the Neti Pot and fill it with warm tap water. Stir very thoroughly. The salt water usually doesn't sting but the salt particles will if they are not dissolved well. You can use a little less than a teaspoon at first if it feels more comfortable, but after a few days there should be no discomfort at all and you can mix it a little stronger.Lean over the sink, tilt your head to one side (it should be almost flat-one ear up and one ear down), and put the spout of the Neti Pot into the upper nostril. Pour the salt water slowly into your nose while you continue breathing through your mouth. The water will flow into the upper nostril, turn the corner at the back of the nose, and trickle back out the lower nostril. When the pot is about half empty, stop, turn your head the other way and repeat the process.Let the water drip out, then gently blow your nose. You will probably need to blow it several times in the next few minutes as your sinuses drain.

How often should I irrigate? After you do this a while, you'll find what works best for you (and it does vary from one person to the next). Start off irrigating once in the morning and once in the evening. There is no harm in doing it 3 to 4 times a day and it may be useful to do so if you have a lot of drainage. If after a week or so your nose seems much clearer and you are not having much drainage during the day, reduce it to just one irrigation in the morning. You may continue this indefinitely, or you may only irrigate when you feel the congestion or postnasal drip is recurring.

Hot Compresses Hot compresses to the sinuses also help as they promote movement of the tiny hairs that line the nasal cavity, cleaning mucus and pus. Simply moisten a facecloth with warm water and lay across forehead (above the eyes) and/or cheekbones for 5 minutes three times a day. Placing a dry facecloth over the heated wet one will help retain heat for the full 5 minutes.

1. {1} ^ Ian G. Williamson et al. (2007). "Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis". JAMA 298: 2487–2496. doi:10.1001/jama.298.21.2487. PMID 18056902.

Syndromes causing sinusitis

Wind heat of lung mainly caused by weather changes

Deficiency of spleen/stomach

Mainly caused by greasy and spicy foods and over thinking.

Deficiency of cold lung qi

Mainly caused by chronic illness

Stagnated heat of the gallbladder

Mainly caused by emotions

tiredness

Record of first visit

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

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

Chief complains: tiredness

-----------------------------------------------------------------------------------------

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

.

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.

5

Shoulder Pain

Record of first visit: 12/09/08

Name:

Gender: Male

Date of Birth: 01/06/61

Chief complains: Shoulder Pain

Descriptions

A: Asking

Present illness complains: He got shoulder pain from his job 4 years ago. He needed to carry the heavy thing on both shoulder at that time. Also, he often use computer in that period. Now, he felt heaviness, sore and stabbing pain on both shoulders. The pain radiates from “jianJing to JianLiao, to TianZong. Left shoulder has limited movement. The uncomfort feeling reduced after massage and hot compression, and aggravated in cold and damp weather, or after using computer. He has no chill and fever and sweating. He has normal defecation, urination. Generally, he has good appetite and prefer taste of sweet and cold drink.

Past History: NAD

Lifestyle: Retired and relaxed life

Family history: NAD

B:Inspection

General: 8/10 vitality

Others: the tendon around the medial border of the left shoulder is enlarged and swollen

Tongue: Dim color, less and dry coating, with crack on the central, teeth mark on the edge of tongue

C:Auscultation/olfacation

Sound: NAD

Odours: NAD

D: Palpation

Body aears: NDA

Pulse: slippery

Case Summery

WS:

Definition: Frozen shoulder, or adhesive capsulitis, is a condition that creates pain and stiffness in the shoulder joint — severely limiting your ability to move your shoulder normally.

Cause: Frozen shoulder may be the result of inflammation after a shoulder injury or shoulder surgery. In most cases, however, frozen shoulder develops for no apparent reason in individuals over age 40. It's also more likely to appear in women.

Symptoms:

Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side.

Phase two - the 'frozen', stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.

Phase three - the 'thawing', recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal, or near normal

Treatment: It includes Anti-inflammatory painkillers, Ordinary painkillers, Shoulder exercises, Physiotherapy…

A steroid injection ,which brings good relief of symptoms for several weeks in some cases. Steroids reduce inflammation.

Surgery, an operation is sometimes considered if other treatments do not help. Techniques that are used include:

.Manipulation. This is a procedure where the shoulder is moved around by the surgeon while patients are under anaesthetic..Arthroscopic capsular release. In this procedure the tight capsule of the joint is released with a special probe.

TCM:
Aetiology and Pathology

Bi syndrome cause chronic pain, especially it is characterised as throbbing or stabbing, is a sign of Qi and Blood Stagnation. It occurs due to Blood deficiency. Blood nourishes Qi and Qi moves Blood, so when blood is deficient, stagnation of Blood will occur. Qi and Blood Stagnation can in turn be related to weakness of the Liver, Kidney, Spleen and Heart, which in turn can be caused by emotional stress, over strain, lack of adequate sleep and nutrition, and disturbed body rhythm. In some situations Bi syndrome can be triggered by invasion of the channel system by pathogenic Wind, Cold, Damp and/or Heat, known as Bi syndrome. Bi syndrome is usually a chronic disorder, but may be acute or have occasional flare-ups brought on by current pathogenic invasion. In chronic situations, a situation where Pathogenic Wind Cold or Wind Heat enters the body without causing immediate symptoms. It then incubates in the body for some time, emerging later towards the Exterior and giving rise to tiredness, weakness, muscle and joint pain and sleeplessness.

Differentiation of Patterns of Disharmony

The following patterns could apply to a patient with bi syndrome, either singly or in combination:

Deficiency Patterns

-Deficient Spleen leading to Deficiency of Qi and Blood

Fundamental to the replenishment of Qi and Blood is the Spleen’s functions of transforming food, producing Blood and nourishing the tissues. When Spleen is deficient, Qi and Blood will be deficient.

-Deficient Yin of Kidney and Liver

When Kidney and Liver Yin are deficient, empty Heat will rise causing headache, anxiety, insomnia, muscular weakness and low back pain.

-Deficient Liver Blood

When Liver Blood is deficient, there will be mental restlessness, muscular weakness,spasms and cramps.

-Deficient Yang of Kidney and Spleen

When Yang is deficient there will be cold and obstruction. Deficient Spleen Yang will lead to deficiency of Qi and there will be breathlessness, tiredness,lack of appetite and oedema. Deficient Kidney Yang will lead to low sexual vitality, low back pain, oedema and lassitude.

Excess Patterns:

Stagnation of Qi and Blood

When Blood is deficient it will fail to nourish Qi and Qi will fail to move Blood. Thus Qi and Blood will stagnate, causing localised obstruction and sharp, stabbing or throbbing pain.

Invasion by Pathogenic Wind

When Wei Qi is deficient Pathogenic Wind can enter the channels and lodge in the muscles and skin. Wind patterns are characterised by numbness, spasms, convulsions, dizziness or pain that consistently changes in intensity and location. Wind tends to effect the upper part of the body, particularly the head, neck and face, as well as the outermost parts of the body, such as the skin and the muscles. Wind can combine with Cold, Heat and Damp, potentiating their effects and enabling them to invade the body more easily.

Shao Yang Syndrome

When the Pathogenic Factor remains lodged between the Exterior and the Interior the person will be subject to alternating chills and fevers, sore throat, muscle and joint pain and irritability.

Latent Pathogenic Factor

When a person’s vitality is low at the time of invasion of Pathogenic Wind, the pathogen may be driven to the Interior, usually as Heat or Damp Heat, where it will weaken Qi and/or Yin. In this condition the person is predisposed to further invasion of exterior pathogens, leading to a cycle of invasion and deficiency.

Comprehensive patient resources are available at www.patient.co.uk

Diagnosis

A, Diagnosis: Frozen Shoulder

B, Syndrome Differentiation: Qi and blood stagnation underline spleen deficiency

C, Explanation: Patient’s shoulder got injury 4 years ago, it causes local qi and blood stagnation. Also, the dim color tongue and slippery pulse show qi and blood stagnation. Shoulder stabbing pain shows the local blood and qi stagnation. The teeth mark and preferring the taste of sweet shows the spleen

deficiency, and the deficiency of spleen cause dampness retention, which cause the heaviness on the shoulder.

Treatment:

A, Principles: promote qi and blood circulation, and tonify the spleen

B, Methods:

Needling: Local, JianYu,Jianjing,JingbaiLao, a shi points

Distal: Zu San Li, YinLinQuan

Explanation: JianYu,Jianjing,JingbaiLao, a shi points , promote local qi and blood circulation; Zu San Li and YinLinQuan can tonify the spleen and reduce the dampness.

Life Style Advice: Avoid cold and sweet food, eat herb like, ShanYao, QianShi…exercise shoulder, “climbing up” , keep body warm and use hot compression on shoulder…