Vertigo for 10 years

Consulting Date: 30/4/2009 Name: Tina

Gender: female Age:55

Chief complains: Vertigo for 10 years

Description ( 4 diagnostic methods )

A: Asking

Present illness complaints:

The patient has suffered vertigo for 10 years , accompanied with nausea , short of breath, headache , she can not stand during happening interval , this signs onset are 3 or 4 times every year , she takes western medicine to treat this symptoms, she was very busy for her job , she wake up early and sleep late at 0:30 am , she always has poor quality sleep , easy wake up and difficult fall asleep again , easy be frightened , poor memory , hair lose and whitish within 4 years , normal urination and hard stool defecation , normal appetite , no chill & fever , no sweating, thirsty prefer to cold drinks

Past history: Nephrectomy( R .kidney removal) 8 years ago

Lifestyle: full time Job

Family history: hypertension (mother)

B: Inspection

General: 7/10 vitality

Others: NAD

Tongue: pale tongue body, thin whitish greasy coating,

C: Auscultation/Olfaction

Sound：NAD

Odours: NAD

D: Palpation

Body areas: slim

Pulse: weak at chi(both side) , deep/slow (right side), thin (left side)

WMS:

Vertigo, or dizziness, is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in balance (equilibrium). It also may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

Vertigo usually occurs as a result of a disorder in the vestibular system (i.e., structures of the inner ear, the vestibular nerve, brainstem, and cerebellum). The vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. Benign paroxysmal position vertigo (BPPV) is a common cause for dizziness

Vertigo Causes

Vertigo, or dizziness, usually results from a disorder in the peripheral vestibular system (i.e., structures of the inner ear). Dizziness also may occur as a result of a disorder in the central vestibular system (i.e., vestibular nerve, brainstem, and cerebellum). In some cases, the cause of vertigo is unknown.

Other Vertigo Causes

• Cardiovascular disorders (e.g., bradycardia [slowed heart rate], tachycardia [rapid heart rate])
• Central nervous system (CNS) disorders (e.g., stroke [brain attack], brain hemorrhage)
• Head trauma
• Migraine (30–50% of patients experience vertigo)
• Multiple sclerosis (MS; may occur when demyelination affects the brainstem or cerebellum)
• Orthostatic hypotension (sharp decrease in blood pressure upon rising from a lying or sitting position to a standing position; caused by diabetes, dehydration, and anemia)
• Systemic diseases (e.g., kidney disease, thyroid disorders)
• Tumors that affect the central vestibular system (e.g., acoustic neuroma)

Medications that may cause temporary ototoxicity include the following:

• Anticonvulsants (e.g., phenytoin, carbamazepine)
• Antidepressants (e.g., clomipramine, amoxapine)
• Antihypertensives (e.g., labetalol, enalapril)
• Loop diuretics (e.g., bumetanide, furosemide)
• Pain relievers (e.g., aspirin)
• Prescription and over-the-counter cold medicines
• Quinine (e.g., chloroquine, quinidine)

TCM:

Kidney deficiency

• When kidney essence becomes depleted, production of brain marrow declines. The brain loses nourishment and the result is dizziness. Furthermore, the ear is the surface opening of the kidney and as the kidneys also produce marrow for bones, tinnitus and soreness of the back and knees develop concomitantly.
  On examination, the tongue is red with scanty fur. The pulse is thready, fine and rapid.

Deficiency in qi and blood

• As defective qi circulation causes a disturbance to the function of the brain and insufficiency of blood leads to a lack of nourishment, the result to the brain is dizziness. Exertion consumes more qi and so triggers an attack. Other presentations of qi deficiency include fatigue, a reluctance to speak, sleepiness and lack of appetite.

• On examination, the tongue is pale. The pulse is fine and rapid.

Flood of cold-dampness

• The syndrome results from the retention of coldness and dampness evils, and damage to the kidneys. The evils not only obstruct the orifices in the head, leading to dizziness, they also bring manifestations of patterns of cold, such as a low body temperature, fatigue and lack of affect (emotion). Kidney damage is usually involved in this condition, so the individual may experience pain and a cold sensation in loin area, or frequent urination at night.

• On examination, the tongue is pale, and coated with white and moist fur. The pulse is deep, weak and fine.

Disturbance of liver-yang

• This pattern is usually triggered by an emotional disturbance, which gives rise to hyperactivity of liver-yang and generates wind evil. The symptoms that result include dizziness, headache, insomnia and nightmares. Moreover, due to yang excess, individuals can also experience heat symptoms, such as a flushed face, blood-shot eyes, a bitter taste in the mouth and a dry throat.
• On examination, the tongue is red and coated with yellow fur. The pulse is taut and rapid.

Obstruction by viscous phlegm

• When phlegm remains in the head and causes obstruction of orifices, normal qi flow will be affected. The individual experiences dizziness, fatigue, and heaviness and throbbing in the forehead. When phlegm stays inside the organs, symptoms such as chest discomfort, nausea, vomiting and poor appetite develop.
• On examination, the tongue is pink, and coated by white and greasy fur. The pulse is uneven and slippery, or may be taut.

Diagnosis : Vertigo
Syndrome differentiation :kidney deficient due to cold , dampness , phlegm

Therapeutic Principles :

Tonify kidney , spleen organs , eliminate dampness , disperse cold phlegm evils , smooth qi flow of liver

Therapeutic Point :
bai-hui: extinguishes wind and boosts the marrow
shen-ting: insomnia,headache,dizziness,rhinorrhea with turbid discharge.
shen-men : to treat amnesia,insomnia
nei-guan: ,to treat vomiting and nausea,hiccup,manic-depressive
shen-mai: to treat headache,dizziness,insomnia,aching pain in the lumbocrural region.
zu-shan-li :Strengthens SP and disperses Dampness.
feng-long : remove dampness
zhongwan: Regulates ST Qi and disperses Dampness
Pi-shu :strengthen spleen function
shen-shu, Strengthens kidney ,to treat dizziness and vertigo, tinnitus

hegu: for dispelling cold symptom-complex

taichong :smooth qi flow of liver

Lifestyle advice: Avoid intaking from cold nature of foods and drinks ,try to take a regular rest or outing to reduces stress from busy job , early to go to sleep before 11 pm in order to make new blood and detoxination in liver ,regulate and tonify kidney, spleen, stomach organs by intaking the chinese herb to nourish blood and qi

Case conclusion

Vertigo,the syndrome results from the retention of coldness and dampness evils, and damage to the kidneys ,she had suffered vertigo and accompanied with other symptoms such as tinnitus , insomnia ,she has stress from her busy job for a long time , at the moment , she had surgery R. kidney removal , in TCM , R side pulse Chi portion in relation with Vital gate (kidney) that dominate the Qi energy , afetr removal of R .kidney it will impare kidney yang fundermental , she also prefer cold nature foods and drinks , it will damage the yang qi and decline the kidney function step by step , The kidney yang fail to warm middle jiao lead to deficiency of qi and blood of the body , When phlegm remains in the head and causes obstruction of orifices, normal qi flow will be affected this is another reason causes a disturbance to the function of the brain and insufficiency of blood leads to lack of nourishment of the body, the result to the brain is dizziness. deficiency of qi and blood of the body which gives rise to hyperactivity of liver-yang and generates wind evil. The symptoms that result include dizziness, headache, insomnia and nightmares

.

Follow up consultation

11/05/2009 , 18/05/2009

She felt insomnia still onset and frequent urination at night , blood pressure at 140/80 to 155/85 , stiff neck /back feeling in the morning but not serious .The 2'nd treatment therapeutic point was selected follow as previous principle , When the needle is inserted intoHouxi (SI ,3), the patient is asked to move the neck. After withdrawal of the needle, cupping is applied to local acupoints. , sanyinjiao to strengthen the three yin meridians of liver , spleen , kidney to tonify zang organs

Cough for 2 weeks

Record of first visit: 13/04/2009 Name: Daniel

Gender: Male Ages : 24

Address : XXXXXX auckland city

Chief complains: Cough for 2 weeks
WMS : allergy cough

Description (4 diagnostic methods)

A. Asking

Present illness complaints: He has suffered from the cough for 2 weeks. He was infected from his young brother have common old. He has come and gone for about 2 weeks or so now. dry and itching throat ,no sputum , slightly nasal congestion with clear nasal discharge , likes to warm drinks ,no chill or fever , no headache , no any pain feeling ,no sweating. His sleeping time around 6 hours ,but falls asleep right away . normal appetite, he felt abdominal fullness and easy belching after meal ,normal defecation and yellowish urination. He has taken some prescribe medicines to treat this syndrome by GP .

Past history: NAD.

Lifestyle: Full time student and part time job for 5 working days

Family history:. NAD

Marital history: Single , never married

B. Inspection

General: Vitality :8/10

Others: NAD

Tongue: Slightly red color , thin yellow coating

C. Auscultation/Olfaction

Sound: lower voice

D. Palpation

Body areas: NAD

Pulse: thin and weak

Cough

In TCM, cough can be classified as either exterior or interior cough. Exterior cough arises from external pathogens whereas interior cough arises from a combination of imbalance in the internal system and invasion of phlegm and/or fire. In making a diagnosis, the Physician takes into consideration the time of the day when cough is most frequent, characteristics of the cough, phlegm and coughing sound. Under exterior cough, the three major classifications are wind-cold, wind-heat and wind-dryness. Under interior cough, it can be classified as phlegm-dampness, phlegm-heat, deficiency in Lung Yin and Liver Fire invading lungs.

(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.

(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.

The treatment protocol:
Exterior cough: expel wind and relevant pathogen (such as cold, heat and dryness) + restoring lung movement of qi Interior cough: expel pathogen (such as phlegm and fire) + restoring internal organ balance

TCM Diagnosis: Cough

Syndrome Differentiation:Def. of Lung qi invade b y Wind Cold evils underlying Spleen qi def.

Explanation:

Individuals present with nasal itching, sneezing, congestion, and a watery discharge. Symptoms are usually triggered by being exposed to wind or a cold temperature in the morning. Systemic symptoms include pallor, shortness of breath, and aversion to cold.Some manifestations like cough, itching throat and thin white coating are relevant to wind-cold syndrome.

Treatment Principles:

To warm up the lungs and aid the protective qi, eliminate wind /cold evil and ventilate the nasal passages..

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 Combining with Lieque to nourish yin and clear the throat.

Pishu : regulate the qi of middle jiao, strengthen spleen function

Dingchuan EX-BW1; alleviate and stop a cough

Life Style Advice

Do regular exercises to strengthen body resistence

Take appropriate sleep and rest

Drink more water

Keep fresh and clean air environment

WMS

Definition:

Rhinitis (allergic and non - allergic) may also cause a cough that is related to post-nasal drip (phlegm draining from the back of the nose into the throat). However, this may be a very different cough from others cough and more of a throat clearing type of cough. Allergic rhinitis will respond to various allergy treatments, while non-allergic rhinitis may only respond to decongestants or various prescription nasal sprays.

What makes us cough?

A cough probably begins with irritation of nerves in the respiratory tract. The irritation may come from a plug of mucus in the airway, for example, or from exposure to a chemical aerosol such as hair spray, or postnasal drip, or from a number of other causes.

Cough is a symptom

Acute cough and chronic cough are symptoms of conditions that may require medical attention. Hundreds of conditions can cause cough; about a dozen conditions are the most frequent causes.

The cause of cough may not be immediately apparent. In the case of chronic cough, more than one cause may simultaneously be at work. A full medical examination and laboratory tests may be necessary to arrive at a correct diagnosis and effective treatment. In the greatest majority of cases, the specific cause of cough can be diagnosed and successfully treated with therapy specific for the cause. Specific therapy is so often successful that there is a limited role for nonspecific medicines.

CASE SUMMARY

After first treatment he felt some improvement to alleviate fullness , but still no improvement for allergy cough when he take a bus or walk on public plaza , even study in school, he still intakes western medicine to alleviate cough

Follow up treatment :

15/04

Due to his cough sign still there ,I adjust some point to treat cough , improve the circulation of lung qi and warm up the lungs , also strengthen the circulation of qi and blood in ST/SP

ying-xiang: nasal discharge, any nose a/or sinus issues, rhinitis, sinusitis, allergies.

feng-chi : eliminate exterior wind evil

zusanli :strengthen the circulation of qi and blood in ST/SP

18/04

Cough has alleviated after 2'nd treatment , he indicated he still takes some western medicine , I can't make sure by acupuncture or western medicine which is effective during this period . I insist that some point still need to keep going on this time in order to regulate and strengthen his internal qi & blood circulation .fei-shu , pi-shu , fengchi , baihui leique point only

Nasal Bleeding for 3 days

Consulting Date: 25/5/2009 Name: Wang

Gender: male, Age: 20

Chief complains: Nasal Bleeding for 3 days

Description ( 4 diagnostic methods )

A: Asking

Present illness complaints:

The patient suffered nasal bleeding for 3 days , due to he got common cold one week ago , he felt dryness of lips , throat , mouth and sore eyes , a bit acne on the face especially on the forehead, he feels tiredness after study . No chill and fever, No headache, no cough and sputum , thirst prefer warm drink. normal appetite , yellowish urine , normal defecation but a little bit hard stool, sweating is normal, sleep is good. Patient began to eat vegetarian about 15 years .

Past history: NAD

Lifestyle: full time Student

Family history: NAD

B: Inspection

General: 8/10 vitality

Others: NAD

Tongue: Red tongue body, thin yellow coating,

C: Auscultation/Olfaction

Sound：NAD

Odours: NAD

D: Palpation

Body areas: slim

Pulse: slippery (right side), taut (left side)

Case Summary

Definition: Nose bleeding can be caused by:

(1) local problems: physical injuries of the nose, broken skull, tuberculosis, inflammation of the sinus area like common cold, or bleeding after surgeries and thinning of the mucus membrane by long term usage of nasal sprays of steroids,cancer in the nose,

(2) systemic problems:acute leukemia, hemophilia, or aplastic anemia, excessive muscle tension, blood vessel problems like hypertension, hardening of the blood vessels, heart diseases that increase the pressure in the veins, lack of vitamin K, long term usage of blood anticoagulants like warfarin, aspirin etc.

(3) high altitude, cold and allergy can also cause nose bleeding.

(4) low platelet count as in primary thrombocytopenia

WMS:

Nose bleeding occurs when the delicate blood vessels in the nose rupture. There are many causes to the rupture of the blood vessels. Some of the common reasons include:

- Injury or trauma caused by picking of the nose

- Injury caused by a hard knock to the nose

- Sneezing too hard or too frequently.

- Breathing of very dry air

- Sensitive nose which is more prone to bleeding due to thin blood vessels

- One of the likely causes may be due to the picking of the nose or that his nose is more sensitive and prone to bleeding

TCM:

Pathogenic fire may disturb the blood and cause extravasation.
Mild cases will only have rapid pulse due to acceleration of blood circulation. In severe cases, the blood vessels and collaterals may be damaged, manifesting various hemorrhagic symptoms, such as vomiting of blood (hematemesis), nose bleeds (epistaxis), blood in the urine or stool, excessive menstrual flow, skin eruptions, external boils and ulcers, etc. The common syndrome caused by fire (heat) at the early stage is exterior-heat syndrome.

Main clinical manifestations: fever, mild aversion to cold, headache, sore throat, thirst, yellowish urine, dry stool, red tip and sides of the tongue, superficial and rapid pulse, etc. These symptoms are due to the invasion of fire (heat) on the body surface which consumes body fluids.

TCM diagnosis: nasal bleeding

Syndrome differentiation: Heat retention in Lung

Therapeutic principles: Disperse wind, clear away heat, moisten dryness and stop bleeding

Explanation:

• The nose is the opening of the Lungs, respiration occurs through it. If Lung Qi is strong, breathing will be clear and the sense of smell will be sharp. This is why when the Lungs are invaded by external pathogens the nose clogs, there can be sneezing, and smell is inhibited. If there is heat in the Lungs there may be bleeding, and the sense of smell may be lost.
  

• lung Control meridians and the 100 blood vessels The Lungs govern Qi, and Qi is essential for the Heart to circulate blood. Both the Lungs and Heart control the circulation of blood in the blood vessels. The Lungs however, also control the circulation of Qi (Ying) within the meridians. Therefore the Lungs control the circulation of Qi in the blood vessels and meridians. If Lung Qi is strong the circulation will be good and the limbs will be warm, if not the hands will be cold.
• Generally if the Lungs are being attacked by excessive pathogenic factors the pores will clog and there will be no sweat (Wind/Cold)

Therapeutic Point

Yin tang: epistaxis, rhinorrhea with discharge, infantile convulsion, stop bleeding

Quichi :Clearing heat and dispelling the wind , regulating ying blood, lowering the adverse flow of qi and activating the collaterals.

Taiyuan: Regulating the Qi of lung and promoting blood circulation

Hegu: clearing heat and inducing sweating for dispelling cold or bringing down a fever in the treatment of exterior symptom-complex.

Dazhui :Clearing away heat and toxic material, relieving the exterior syndrome and activating yang, tranquilizing the mind, and keeping the lung-qi pure and descendant.

Lifestyle advice:

reduce the stress, regulate liver and gallbladder organs prevent the liver fire attack lung, early to go to sleep before 11 pm

avoid intaking the chily and greasy food.

ask TCM doctor to taken herbal medicine to nourish the lung prevent dryness evil .

Case conclusion

This patient got the common cold one week ago , the pathogenic factors of wind cold attck the lungs ,it blocks the qi and blood circulation of the lungs , Pathogenic fire may disturb the blood and cause extravasation( nasal bleeding) ,he felt a little improvement after 1'st treatment , the principle be used as disperse wind, clear away heat, moisten dryness and stop bleeding, but still bleeding onset on early morning next day , bleeding is coming out during no any obvious feeling but not very serious.

Follow up consultation

28/05/2009

The 2'nd treatment therapeutic point was selected follow as previous principle , the neiting , tianshu(front mu point of large intestine) ,zusanli point are added in order to regulathe the function and clear away heat of the stomach , sanyinjiao to strength the three yin meridians of liver , spleen , kidney prevent dryness attcking the lungs.