Date of first visit:
Name: Mr Mike Lee Gender: male Date of birth:
Chief complaints: Chronic cough for 3 years
Description (4 diagnostic methods)
A. Asking
Present illness complaints: Mr Lee is 50 years of old. He has suffered from the chronic cough for 3 years. He was infected with a chronic cough from a person who had a cold. He has a cough on and off. He expectorates scanty and sticky phlegm occasionally. He has a tidal fever in the afternoon, itching throat but no sweating. He sleeps less time than average people’s but falls asleep immediately. He doesn’t separate cold or warm drinks. He has good appetite, normal defecation and yellowish urination. He took herb medicine for about forty days at the first time of the cough without western medication.
Past history: TB in the lung about 20 years ago and cured completely.
Lifestyle: Staying awake, alert status, pleasant, appreciates ecstatic beauty of nature, and busy
Family history: His father died of colonoma.
Marital history: Married with 2 children
B. Inspection
General: Vitality 9/10
Others: NAD
Tongue: Slightly red color with swollen, thin white coating
C. Auscultation/Olfaction
Sound: NAD
Odours: NAD
D. Palpation
Body areas: NAD
Pulse: thin and weak
CASE SUMMARY
Definition:
Chronic cough is usually defined as a cough lasting more than three weeks. Chronic cough is not a disease in itself; rather it is a symptom of other disorders.
WMS
Description:
Cough is a common presenting complaint in the frontline physician’s office, but in most patients the symptom is self limiting. In others, symptoms may persist from weeks to years and are associated with significant morbidity. Successful treatment depends on finding the cause and initiating specific therapy. The most common causes are cigarette smoking, asthma, post-nasal drip, GERD or post-viral respiratory tract infection. Multiple causes in the same patient are common. When the cough persists in spite of specific or empiric therapy and either the physician or the patient is dissatisfied with the diagnosis or treatment, referral to a specialist should be considered.
Causes:
(1) Cigarette smoking is the most common cause of chronic cough.
(2) Asthma; which is a disease of airways, resulting in difficulty breathing or wheezing.
(3) Postnasal drip and sinus problems; This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis.
(4) Gastroesophageal reflux disease (GERD); Some foods may increase reflux.
(5) Infections such as bronchitis or pneumonia; These infections can be caused by virus, bacteria or fungus.
Treatment
The treatment of cough is determined by the causes; Asthma – steroids and bronchodilators, GERD - selecting foods to take, Nasal or sinus problems – decongestants or antihistamines, Infections- antibiotics. However, patients may get symptomatic relief from over-the-counter cough medicines containing guaifenesin and/or dextromethorphan, drinking lots of water, inhaling steam, and using cough lozenges. In severe cases a doctor may prescribe codeine, which is an effective cough suppressant. It is very important to obtain a chest x-ray if a chronic cough is prolonged. For the minority of patients in whom this diagnostic approach is unsuccessful, consultation with a pulmonary specialist is appropriate.
TCM
(1) Invasion by the exogenous pathogenic factors
The lung dominates Qi and is regarded as an umbrella protecting the five Zang-organs. It governs respiration and associates with the skin and hair externally. Once the lung is attacked by the exogenous pathogenic factors the lung Qi is blocked and fails to descend, thus resulting in cough. The exogenous pathogenic factors attacking the lung is divided into two types: wind-cold and wind-heat.
(2) Internal injury
Cough resulted from functional impairment in the Zang-Fu organs, falls into the category of cough due to internal injury caused by deficiency of yin with dryness of the lung leading to failure of Qi of the lung to descend; and caused by the deficiency of the spleen which gives rise to internal dampness whose excessive accumulation produces phlegm.
SYNDROME DIFFERENTIATION: Internal injury
(1) Blockage of the lung by phlegm
Main manifestation: Cough with profuse, white and sticky sputum, stuffiness and chest congestion, loss of appetite, white, sticky tongue coating and rolling pulse.
(2) Deficiency of yin with dryness of the lung
Main manifestation: Dry cough without sputum or with scanty sputum, dryness of the nose and throat, sore throat, spotting blood or even coughing blood, afternoon fever, hot flush, red tongue, thin coating, rapid, and thready pulse.
TCM Diagnosis: Cough
Syndrome Differentiation: Lung yin deficiency (with dryness)
Explanation:
There are several manifestations of Lung yin deficiency (with dryness) such as scanty and sticky phlegm, a tidal fever in the afternoon, itching throat, red color tongue with swollen, thin white coating and thin and weak pulse. Some manifestations like cough, itching throat and thin white coating are relevant to wind-cold syndrome.
Treatment Principles:
Nourish yin. Eliminate dryness and descend lung qi.
Points, Therapies and Explanations:
Feishu BL13 & Zhonhfu LU1; To nourish lung yin and regulate lung qi
Lieque LU7; To be connect with conception vessel to descend lung qi and
relieve cough
Zhaohai KID6; Combining with Lieque to nourish yin and clear the throat.
Pishu BL20; To regulate the qi of middle jiao.
Dingchuan EX-BW1; To stop a cough
Life Style Advice
Do regular exercises to strengthen body
Take appropriate sleep and rest
Drink more water
Keep fresh and clean air environment
CASE CONCLUSION
The patient’s chief complaint is to have a chronic cough for three years. The diagnosis is Cough and the syndrome differentiation is Lung yin deficiency (with dryness). It results interior functional impairment in the lung leading to failure of Qi of the lung to descend which causes cough. The treatment principle is to nourish yin and to descend qi. The chosen points are Feishu BL13 , Zhonhfu LU1, Lieque LU7, Zhaohai KID6, Pishu BL20, and Dingchuan EX-BW1.
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