Fatigue for one month

First Visit Date	20/01/2012	M / F	M
Patient Name	Mr. D. G	Ages  : 67
Date of Birth	(D)     xx       (M)      xx   (Y)       1945
Address
	Confidential
Contact Tel	Confidential

★Chief complaint		Fatigue for one month
★Key points of patient condition
The patient just finished his holiday from Africa; He stayed there around two months. He had laryngotracheal, trachea, branches irritation condition for one month (December 2011), heavy cough at night, had yellow sputum and phlegm; he took 2 lots of antibiotics to treat this but no help. He had some chest oppress in the morning but this goes after 2 hours, he always felt quite weak, poor muscle tone, slow recovery, Poor sleep, nail problem and hand trembling, 5 centers hot sensation at night, appetite is ok, frequent urination at night, defecation is normal. Left side leg suffered from atrophy when he 28 ages, imbalance of both leg leads to he can’t stand for a long time accompanied with degenerative toe at L. foot. Tongue: yellow coating, dry   Pulse: Thready / deep Lifestyle: He was a priest just retired a couple of years. Very little alcohol. Tea and coffee.
TCM disease / pattern	Qi and Blood deficiency underlying Spleen qi deficiency
The Selected Healing Points	·         Zhusanli(+): To strengthen SP/ST middle jiao, promote circulation of qi and blood, benefits to make blood ·         Taixi (+): Yuan point of KI, to nourish KI yin and congenital essence to generate blood. ·           Four gates : To regulate circulation qi and blood ·         Hegu(even): yuan point of LI channel ·         Taichong(+): yuan/earth/shu- stream point of LV channel Heaven/Earth needle(I-ching needle method): To Balance yin/yang of body , promote circulation of qi and blood ·         Zhongwan(+) with Moxa: front Mu point of stomach ·         Quanyuan(+) with Moxa: front Mu point of small intestine .All Needle retaining time: 30 minutes

Explanation:

腎氣不固證與氣陷證：二者均屬虛證，均可見下焦的病症，如泄瀉，少腹脹等。但腎氣不固證可由氣陷證發展而來，部由脾氣虛而累及腎氣虛，出現脾腎氣虛的腎關 不固，二者在病機上有一定的聯繫。然而腎關不固證，可反映在腎氣無以溫煦脾土而出現脾腎兩虛的 「五更泄瀉」 症，與氣陷證的久泄不禁有別；又可見因腎氣不足，下關不固，膀胱不約，州都之水液不藏，水泉不止而見小便失禁，遺溺及老年人夜尿增多等症，還可表現為因房 室不節，精元虧損，腎氣虛而精關不固，則見遺精，滑精，淋濁等症。故兩證的鑑別要點是：一、腎氣不固證的病變部位主要在下焦腎，而氣陷證在中焦脾胃。二、 腎氣不固證臨床表現以腎氣無以溫煦助運，氣化失司，下關不固的症狀為主，每每伴有腰膝痠軟；而氣陷證是以脾氣不升，中氣下陷的症狀為主，每每伴有神疲納 呆。

本證因中氣下陷而脾虛失運，中焦化源匱乏，氣不生血而導致血虛，出現氣血兩虛的眩暈，心悸。同時，由於中氣 下陷，元氣不足，會造成氣不攝血而發生出血，如便血，月經過多等等。

脾氣不升，中氣下陷上，故與脾胃關係非常密切。然而氣屬陽，脾氣不升，進一步會造成脾陽不振而見水濕逗留，聚濕生痰的痰飲內停等病症。中氣下陷，進一步由 脾及腎，造成腎氣不固而見遺溺，小便失禁等症。老年人夜尿增多等症.