Case Study TCM

RECORD OF FIRST VISIT

Date of First Visit: 12 Aug 2008 Name: XXX

Date of Birth: 54yrs Gender: male

CHIEF COMPLAINT: Insomnia for 2months

DESCRIPTIONS (4 Diagnostic methods)

A) Asking

Present illness history: The patient has suffered from Insomnia for 2 months. It would be waken from sleep about 1-2am. After waken going to toilet. Also patient has had night sweating. Recently, he has suffered from blurry eyes and flow out tear from eyes as well. No S.O.B, No Back pain, No knee pain, No palpitation, Normal digestion

He feel easy to thirsty(bitter taste), Normal feces, urination 2time per da

Past illness history: he has got a Diabetes but now is gone

Life style: busy school life, no smoke, no drink. Regular coffee drinker

Family history: NAD

Menstruation, martial & obstetrical history: married with one son,

B) Inspection

General: medium height and figure, vitality 7/10, Red colour face, very hard(Neck, Shoulder, Back area)

Tongue: Red tongue body, white coating

C) Auscultation/Olfaction

Sound: normal

Odours: NAD

D) Palpitation

Pulse: Irregular pulses(cun mai), taut

Body areas: NAD

CASE SUMMARY

DEFINITION

Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake. Insomniacs have been known to complain about being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.

WMS

Although there are several different degrees of insomnia, about three types of insomnia have been clearly identified: transient, acute, and chronic.

1. Transient insomnia lasts from days to weeks. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation
2. Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
3. Chronic insomnia lasts for years at a time. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include sleepiness, muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as though they were happening in slow motion, whereas moving objects seem to blend together.^[

TCM ETIOLOGY and PATHOGENESIS

Insomnia is often caused by emotional or psychic disturbances. Anxiety and anger make the Liver depressed, and the depressed Liver qi may be transformed into fire, which interferes with the normal functions of the Heart. Excessive anxiety may also impair the Heart (mind) and the Spleen, and insomnia occurs due to inadequate supply of nutrients and blood to the Heart.

In the aged and the patients suffering from chronic diseases, qi and blood are insufficient to nourish the Heart, thus leading to palpitations and insomnia. Qi deficiency may also involve the Heart and the Gallbladder, impairing one's sleep and making one vulnerable to fright. Consumption of Kidney essence may break down the normal balance between the Heart and the Kidneys, and incoordination between the Heart and the Kidneys may also be manifested as insomnia.

Syndrome Differentiation

According t the pathogenesis, insomnia can be classified into the following syndrome patterns:

1. Depressed Liver with exuberant fire: Insomnia accompanied by irritability, irascibility, thirst, yellow coating, and stringy, rapid pulse.

2. Incoordination of the Heart and the Kidneys: Insomnia accompanied by dizziness, tinnitus, dryness in the mouth, heat sensation in the palms and soles, palpitations, forgetfulness, lumbar aching, reddened tongue, and thready, rapid pulse.

3. Deficiency both the Heart and the spleen: Dreamful sleep with early waking, palpitations, forgetfulness, dizziness, lassitude, lack of strength, anorexia, pallid complexion, and thready, weak pulse.

4. Deficiency of the Heart ad the Gallbladder: Dreamful sleep with wakefulness, susceptibility to fright, and stringy, thready pulse.

TCM DIAGNOSIS

A) Diagnosis: Insomnia

B) Syndrome Differentiation : Qi and Blood Stagnation & Liver Qi stagnation

C) Explanation: The patient shows liver Qi stagnation type Insomnia symptom such as Insomnia accompanied by irritability, irascibility, thirst, yellow coating, and stringy, rapid pulse . Another Symptom from Qi and Blood stagnation is typically caused by A vesanic condition by stagnation of qi and blood obstructing channels and collaterals and further resulting in the disconnection between the brain –qi and qi of zang and fu organ TREATMENT or temples

Treatment principles :

Open Pacify the Liver, eliminate stagnation, calm the Mind

B) Points and Therapies

An mian, Tai chong, Shen men, San yin jiao, YinTang, Shen ting

C) Explanation

An mian : Calms the spirit and pacifies the Liver

Taichong (Liv3) : pacifies the Liver and eliminates stagnation.

Shen men: Calms the spirit

Regulates and tonifies the Heart

San yin jiao : Tonifies the Spleen and Stomach,Resolves dampness, Harmonises the Liver and tonifies the Kidneys, Regulates menstruation and induces labour, Harmonises the lower jiao, Regulates urination and benefits the genitals, Calms the spirit, Invigorates blood, Activates the channel and alleviates pain

.Shenting( Du24) : In combination with Taing and Yanglingquan relieve stagnation of Liver-Qi stagnation

Taiyang and yintang are for relieve headache

LIFESTYLE ADVICE

l relieve stress and gain more qi

l suitable execise

l avoid spicy and greasy food

CASE CONCLUSION

I finished this case with 1 treatment. The patient said the Insomnia is a perfect cured after treatment, And the Blurry eyes has gone after cured, flow out tear as well. So I recommend to visit again when a same symptom reoccur.

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Case Study TCM

RECORD OF FIRST VISIT

Date of First Visit: 26/08/2008	Name: Ock
Date of Birth: 45 years		Gender: Female
CHIEF COMPLAINTS : The left elbow pain for 3 years.
DESCRIPTIONS (4 diagnostic methods)
A) Asking
Present illness history : The patient has been suffering from a left elbow pain for 3 years. The pain occurs gradually 3years ago. (No any injury history. Just slow onset). And recently she felt tired then the pain became more serious. Location of pain is on lateral side of left elbow. Characteristics of pain are sharp with heaviness and radiate to middle finger. The heaviness of arm make hard to lift up her arm (limitation of movement). The pain normally occurs in the morning. She is easily tired, sometimes feels dizziness. Serious headache for 15 years. (about once a month). The headache accompany with nausea for 2 days. Characteristics of pain are sharp on whole head. Present symptoms: chill and fever- no sweating- normal sleeping – normal(11pm-7am) Urination – 3~4 /day. Stool – 1/ day Appetite and digestion –normal(likes healthy food). Drink - prefer to drink cold water.
Past illness history : pediatric jaundice.
Life style : busy for housewife. No smoking and drinking, no exercise.
Family history : NAD
Menstruation, marital & obstetrical history : 15 3~4/28 Pain on abdominal, scanty menstruation, sometimes has clots in blood, little purple color, accompany with dizziness.
B) Inspection
General : Pale complexion, slim body Tongue : pink tongue body with scanty coating. Slightly tremor.
C) Auscultation / Olfaction
Sound : NAD Odours : NAD
D) Palpation
Pulse : little sluggish pulse(slow and thready) Body areas : NAD

CASE SUMMARY

DIAGNOSIS

A) Diagnosis : elbow pain

B) Syndrome Differentiation : Qi stagnation and blood stasis underlined blood deficiency.

C) Explanation

The patient show symptoms of blood deficiency and blood stasis. The blood deficiency leads to fail of malnutrition of whole body, which is manifested by pale complexion and tiredness. And blood deficiency fails to supply nutrition to head, tendons and tongue. So make headache, dizziness and pink tongue body with scanty coating. Blood deficiency can make blood stasis. And blood stasis also can make the some blockage on the meridian then leads to pain. And menstruation also related with blood, if patient have dysfunction of blood such as the blood deficiency and the blood stasis, can make to dysfunction of menstruation, which is scanty menses, pain on abdominal, clots in blood and purple color of blood.

TREATMENTS

A) Treatment Principles Remove Qi stagnation and blood stasis, dredging the collateral, tonify blood.

B) Treatment Methods

1. Needling

Prescription :

- Quchi, Shousanli, waiguan, houxi (both), xuehai, sanyinjiao, Zusanli, geshu

Explanations :

- Quchi, shousanli, waiguan, : promote qi and blood circulation (open channel) - Zusanli : promote circulation of qi and blood, produce blood - Xuehai : promote circulation of blood - sanyinjiao, geshu: produce yin and blood - houxi :open channel for neck, shoulder and arm.

4. Life Style Advice

Avoid handling heavy objects. Do not overstrain by reducing a exercise

Elbow pain (WMS)

DEFINITION

This article describes aching or other discomfort in the elbow that is not related to direct injury.

ETIOLOGY and PATHOGENESIS

1.Tendinitis Lateral epicondylitis (tennis elbow) : The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured, especially with repetitive motions of the forearm, such as using a manual screwdriver, washing windows, or hitting a backhand in tennis play. Tennis elbow results with inflammation of the tendons causing pain over the outside of the elbow, occasionally with warmth and swelling but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day. Repeated twisting motions or activities that strain the tendon typically elicit increased pain. X-rays are usually normal but can reveal calcium deposits in the tendon or reveal other unforeseen abnormalities of the elbow joint. The treatment of lateral epicondylitis includes ice packs, resting the involved elbow, and antiinflammatory medications. Antiinflammatory medications typically used include aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) such as naproxen (Naprosyn), diclofenac (Voltaren), and ibuprofen (Motrin). Bracing the elbow can help. Simple braces for tennis elbow can be found in community pharmacies and athletic goods stores. Local cortisone injections are given for persistent pain. Activity involving the elbow is resumed gradually. Ice application after activity can reduce or prevent recurrent inflammation. Occasionally, supportive straps can prevent reinjury. In severe cases, an orthopedic surgical repair is performed. Medial epicondylitis (golfer's elbow) : Medial epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer's elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition. X-rays for epicondylitis are usually normal but can indicate calcifications of the tendons if the tendinitis has persisted for extended periods of time. The usual treatment involves ice packs, resting the elbow, and medications including aspirin and other NSAIDs. Examples of NSAIDs include naproxen (Naprosyn), diclofenac (Voltaren), and ibuprofen (Motrin). With severe inflammation, local corticosteroid (cortisone) injections are sometimes given. Using a strap can prevent reinjury. After a gradual rehabilitation exercise program, return to usual activity is best accompanied by ice applications after use. This helps to avoid recurrent inflammation. 2.Olecranon bursitis Olecranon bursitis (inflammation of the bursa a the tip of the elbow) can occur from injury or minor trauma as a result of systemic diseases such as gout or rheumatoid arthritis, or it can be due to a local infection. Olecranon bursitis is typically associated with swelling over the tip of the elbow, while range of motion of the inner elbow joint is maintained. 3.Fractures The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Fractures generally require immobilization and casts and can require orthopedic pinning or open joint surgery. 4.Sprain A sprain is a stretch or tear injury to a ligament. One or more ligaments can be injured during a sprain. This might occur when the elbow is hyperextended or simply jammed, such as in a "stiffarm" collision. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. Treatment involves rest, ice, immobilization, compression, and antiinflammation medications.

Elbow pain (TCM)

ETIOLOGY and PATHOGENESIS

TCM ETIOLOGY: Bi syndromes or Blockage syndromes Bi syndromes are caused by weakness of defensive qi, dysfunction of the pores, when one is wet with perspiration and exposed to the wind, wading in water or dwelling in damp places for a long time. So the meridians and collaterals are obstructed by wind, cold and damp pathogens. The results are blockages syndromes. There are different types of Bi syndromes, such as wandering Bi, painful Bi, fixed Bi and wind damp heat Bi. TCM PATHOLOGY (1) Wandering Bi Main Manifestation - Wandering pain in the joints, especially the wrist, elbows, knee and ankles, limitation of movement, chills and fever, thin and sticky tongue coating, superficial and tight or superficial and slow pulse. (2) Painful Bi Main Manifestation – Severe pain in all of the body or in the joints, alleviated by warmth and aggravated by cold, fixed localization, but no local redness and hotness, thin and white tongue coating, string-taut and tense pulse. (3) Fixed B Main Manifestation – Numbness and heavy sensation of the limbs, soreness and fixed pain of the joints, aggravated on cloudy and rainy days, white and sticky tongue coating and soft pulse. (4) Heat Bi Main Manifestation – Arthralgia involving one or several joints, local redness, swelling and excruciating pain with limitation of movement, accompanied by fever and thirst, yellow tongue coating, rolling and rapid pulse.

FOLLOW UP CONSULTATION

Patient Name: Ock Treatment Number: 3

TCM Disease: elbow pain

TCM type/pattern: Qi stagnation and blood stasis due to blood deficiency

Date:29/08/08, 02/09/08

Current conditions/changes:

It is much improved in pain of the elbow after first treatment. but in second treatment, it becomes a little worse condition after menstruation. The patient feels more heaviness on her arm.

Treatment adjustment: Quchi, Shousanli, waiguan, houxi, xuehai, sanyinjiao, zusanli, geshu

Explanation:

CASE CONCLUSION

First visited day I focus on the pain, so I choose all points for relieve the pain which is local point(quchi, shousanli, waiguan, houxi) and a-shi point. And second visited day I mainly focus on the blood deficiency then focus on the pain. Because the patient feels the elbow pain is relieve much but start to feel heaviness on arm. (no any complain about elbow pain but complain about heaviness on arm). So l choose some points for tonify blood(sanyinjiao, zusanli, xuehai, geshu) and some points for relieve the pain.

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Case Study TCM

Name of Student clinician: Se Hyeong Jung

Name of Supervisor: Jessica

Date of Birth: xx.xx.1982 Gender: M

Chief complain: Common Cold for 2 days

Descriptions (4 diagnostic method)

A) Asking: He has been suffering from cold for 2 days. He played soccer in a heavy rain 3 days ago. And than he diretly go to bed without shower. 2 days ago he got running nose and blockage of nose at the same time. And also he got a cough. Next day he got silghtly fever and chill after took a shower.

No headache, no sweat, appetite is not good because he dosen’t want to eat any food. Normal urination and defecation. Sleep well and no dream.

Past history: NAD

Life style: drink alchool 2 times for a week and smoking half pack of cigarette for a week.

Family history: NAD

Menstruation:

B) inspection:

General: Normal body condition 7/10

Tongue: Thin body and white tongue coating.

C) Auscultation/Olfaction:

Sound: Hoarse Voice.

Odour: NAD

D) Palpitation:

Body area: NAD

Pulse: Deep pulse.

Case summary

WMS: Acute viral nasopharyngitis, or acute coryza, usually known as the common cold, is a highly contagious, viral infectious disease of the upper respiratory system, primarily caused by picornaviruses (including rhinoviruses) or coronaviruses.

Common symptoms are sore throat, runny nose, nasal congestion, sneezing and cough; sometimes accompanied by 'pink eye', muscle aches, fatigue, malaise, headaches, muscle weakness, and/or loss of appetite. Fever and extreme exhaustion are more usual in influenza. The symptoms of a cold usually resolve after about one week, but can last up to two. Symptoms may be more severe in infants and young children. Although the disease is generally mild and self-limiting, patients with common colds often seek professional medical help, use over-the-counter drugs, and may miss school or work days. The annual cumulative societal cost of the common cold in developed countries is considerable in terms of money spent on remedies, and hours of work lost.

The primary method to prevent infection is hand-washing to minimize person-to-person transmission of the virus. There are no antiviral drugs approved to treat or cure the infection. Most available medications are palliative and treat symptoms only. Megadoses of vitamin C, preparations from echinacea, and zinc gluconate have been studied as treatments for the common cold although none has been approved by the Food and Drug Administration or European Medicines Agency.

Definition: Cough, a main symptom of the lung problems, may result either from attack by exogenous pathogenic factors disturbing the dispersion of qi of the lung, or from disorders of the lung itself or other diseased zang-fu organs affecting the lung

TCM aetiology and pathology

1) Invasion by the exogenous pathogenic factors

2) Internal injury

3) Dryness of the lung with deficiency of yin

TCM diagnosis: Common Cold

Syndrome differentiation: Wind-Cold

Explanation: Invasion of the body surface by pathogenic wind and cold impairs the dispersing function of the lung and affects the nose, causing nasal obstruction and discharge. Pathogenic cold is of yin nature, which is likely to damage yang. Impairment of superficial yang is manifested by exterior symptoms such as fever and chill. Thin white coating and deep pulse are the signs showing the invasion of the lung and superficial defensive system by pathogenic wind and cold

Treatment principle: Expel cold and wind, relieve exterior symptoms.

Points: Fengmen, Lieque, Fengchi, Hegu

Moxa on Fengmen.

Explanations:

Fengmen : Eliminate wind cold and to relieve chills and fever.

Lieque: promote the dispersing function of the lung and to check cough.

Fengchi: Eliminate wind and cold

Hegu: Eliminate the pathogenic factors and relieve the exterior symptom.

Follow-up consultation

Lifestyle Advice

Skmoking is broken our body immune system so smoker getting easily illness thennon-smoker. Therefore, patient should be quit to smoking.

Eat healthy food three times for a day. And the patient has a rest.

Case conclusion

The patient received 1 treatment in total. At first he improved a lot because is the acute case.So he didn’t come to clinic anymore. I will use that treatment method this kind of patient.

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Case Study TCM

RECORD OF FIRST VISIT

Name of Student Clinician: Eva Kim Name of Supervisor: Leigh

Date: 13/May/08 Name: Miss C

Gender: F Age: 17

Chief Complaint: Irregular menstruation for 5 years

Description (4 diagnostic methods):

A) Asking: Patient has suffered from irregular menstruation for 5 years. It occurred suddenly for 2-3 days before the menarche. Pain was very severe in the lower abdomen and the hips, back, thighs and knees. Since then, she has experienced irregular cycles and lots of dark clots during each period. Usually menstruation occurred every 9-10 days and bleeding lasted at least 7-8 days each time. During menstruation, the patient suffered from anemia, vertigo, severe fatigue and headache. She took medication for anemia and pain relief frequently but the result was not very good. She exercises almost every day but takes too much sweet food instead of nutrient meals.

Present symptoms: irregular cycle, heavy bleeding, headache, vertigo, anemia, abdominal pain, lumbago, leg pain, fatigue

No fever/no chill/no sweat/ normal appetite/prefers cold water/normal urination/ severe constipation (scanty and hard stool every 4 days)/ good sleep

Past history: NAD

Lifestyle: No smoking, no drinking

Family history: Father-healthy, Mother-hypertension

Menstruation, Marital & obstetrical history: Single, never pregnant, 12, 7-8/10, dark and scanty blood on the 1^st and the last day, otherwise bright red clots only (no watery blood at all). Last menstruation: 5 days before the 1^st visit

B) Inspection:

7/10, dark complextion, normal posture and movement

Tongue: Purple swollen body with teethmarks

C) Ausculatation/Olfaction

Sound: Normal, speaks clearly and breathe normally

Ordours: Normal

D) Palpitation:

Body areas: Normal

Pulse: Taut and wiry in general

CASE SUMMARY

Definition: Irregular menstruation refers to the abnormal changes of menstrual cycle, quantity and color of bleeding accompanied by other symptoms. The common conditions are predated or postdated menstruation and irregular menstrual cycle. It is often found in menstrual disorders due to hypophyseal or ovarian dysfunctions.

WMS: Irregular periods aren't unusual. They affect about 30% of women in their reproductive years. An irregular period is any type of bleeding that is abnormal when compared to your usual menstrual cycle. This can include a late period, an early period or bleeding between periods. It can also appear as particularly heavy bleeding (menorrhagia) or scanty bleeding. Many women also experience irregular periods in the form of a missed period, continuous periods, or periods that occur twice in one cycle.

Causes of irregular menstruation

Irregular menstrual periods are usually the result of hormonal signals that have been thrown out of sync. In order to produce a period, your body makes hormones, like estrogen and progesterone. These hormones are kept in the hypothalamus, pituitary gland, and ovaries inside your body. In order to trigger ovulation and menstruation, these parts of the body need to send signals to one another. Sometimes, these signals get crossed or skipped, causing irregular periods.

But what causes these hormone signals to get out of whack? Well, there are actually a number of things that can easily cause your hormone levels to change.

• Pregnancy: If you are pregnant, your body will begin producing different levels of hormones. This will cause numerous pregnancy symptoms, including an end to your period.
• Stress: Stress is a common cause of irregular periods. If you are fatigued, worried, or anxious this can cause your hormones to become unbalanced.
• Diet: A poor diet or extreme weight loss or gain can also affect your hormones. Women with anorexia or bulimia often have no period or irregular periods.
• Exercise: Intense exercise can wreak havoc on your body, often causing irregular periods.
• Menarche: the cycles after a girl's first period may be irregular for some time. It can take up to 3 years to get regular periods.
• Menopause: Menopause causes changes in your hormone levels, and is often signaled by irregular periods.
• Hormonal Birth Control: Birth control pills and irregular periods sometimes go hand in hand. It can take a while for your body to adjust to the new levels of hormones delivered by hormonal birth control.

Complications
For most women, an irregular period is nothing to be worried about; the majority of women will eventually develop a regular cycle with regular periods. Sometimes though, underlying complications can be the cause of these period problems. If you are noticing particularly irregular periods, or have gone a year or more with missed periods, see your health care professional. If you experience extreme cramping, heavy period bleeding, dizziness, nausea, or fainting you should also visit with your health care provider.

Polycystic Ovary Syndrome

Polycystic ovary syndrome, or PCOS, is a fairly common complication, affecting about 10% of all women. PCOS causes cysts to form on the ovaries, interfering with regular ovulation. Symptoms of this syndrome include: excessive hair growth, weight gain, acne, dandruff, high blood pressure, and infertility. If you display any of the symptoms, you may want to make an appointment to get checked for PCOS. Left untreated, it can lead to other more serious complications, including endometriosis, heart disease, and ovarian cancer.

Inflammatory Bowel Disease

Inflammatory bowel disease causes inflammation of the lower intestines (also known as the bowel). It is linked with irregular periods, and may also be accompanied by symptoms of weight loss, abdominal pain, and diarrhea. Inflammatory bowel disease can become severe, and sometimes requires hospitalization or surgery. If you have any of these symptoms, ask your doctor to check you for inflammatory bowel disease.

Treating Irregular Periods

Depending on the cause of your irregular periods, there may or may not be much you can do about them. If you have only been experiencing irregular periods for a short time (less than 7 months), it is likely that your periods will become regular again on their own. However, if there is an underlying medical condition that is causing your irregular periods, then receiving treatment for the condition should help to get your periods back on track. If you find that irregular periods are becoming annoying, there are some things that you can try to help regulate your hormones.

• Reduce your stress levels. Take time to meditate, relax, or just hang out. This may help put your cycle back on track.
• Get help for your eating disorder. If you are anorexic, bulimic, or if you suffer from other types of disordered eating, you must seek help. Not only will these eating disorders interrupt your menstrual cycle, but they can also severely affect your liver, bowel, throat, and heart functions.
• Don't over exercise. While it is important to exercise regularly and keep fit, exercising too much can be problematic. If you are an endurance athlete, try to cut back on your training a little bit, until your irregular periods return to normal.

Medical Treatment There are a few medical treatments which may be helpful in regulating your period:

• Hormonal Contraceptives: Hormonal contraceptives are often used to help regulate menstrual cycles. These contraceptives combine estrogen and progesterone and maintain your body's hormones at specific and balanced levels. They are available by prescription and come in oral, patch, ring, and injectable forms.
• Hormone Supplements: If you have a specific hormone problem, such as overproduction of testosterone, hormonal supplements may be able to help regulate your periods. Speak with your health care provider for more information.

TCM Etiology, Pathogenesis and Syndrome Differentiation

1. Predated Menstruation: caused by long-standing Qi stagnation due to mental depression or worrying or by accumulation of heat in uterus

l Blood heat

l Qi deficiency

2. Postdated Menstruation: caused by retention of pathogenic cold in the uterus or by the feebleness of Yang and deficiency of blood

l Blood Deficiency

l Cold in blood

l Qi stagnation

3. Irregular menstrual cycle:

l Liver Qi stagnation

l Kidney Deficiency

TCM Diagnosis: Irregular menstruation

Syndrome Differentiation: Qi and blood stagnation

Explanation: A lot of purple blood clots during menstruation indicate that the patient has qi and blood stagnation. This is also supported by other symptoms like lumbago and severe abdominal pain. Her busy life style possibly caused Liver Qi stagnation disturbing the spleen and resulted in fatigue, weakness, poor appetite and severe constipation. Due to this reason, patient started taking lots of sweets and this weakened her spleen and the body worse. The Spleen’s weak function in transforming and transporting caused irregular cycle and heavy bleeding that led to anemia and vertigo. The Kidney and Bladder meridian goes through the thighs and legs and caused pain in the area. The pulse was taut and wiry in general due to qi and blood stagnation while the tongue was purple due to blood stasis. The teethmarks indicate general qi deficiency.

Treatment Principle: Remove Qi and Blood stagnation, tonify the spleen and relieve pain

Points and Therapies:

Needling: filiform

Acu-point : Sanyinjiao(+), Guanyuan(+),Zusanli(+), Qihai(+), Xuehai(+), Taichong(-)

Explanation:

Sanyinjiao: The Crossing Point of Spleen, Kidney and Liver Meridian, use filiform to regulate the energy of Liver, Spleen and Kidney and resolve blood disorder with reinforcing method

Guanyuan: use filiform to strengthen the middle-jiao and maintain general body health with reinforcing method

Zusanli: He Point of Stomach Meridian. Use filiform to tonify the Spleen and strengthen its transporting and transforming function with reinforcing method

Qihai: use filiform to activate the flow of qi and maintain health with reinforcing method. Good for abdominal pain and irregular menstruation

Xuehai: use filiform to activate the flow of blood and to treat irregular menstruation with reinforcing method

Taichong: Shu and Yuan Point of Liver. Use filiform to sooth Liver and to remove Qi stagnation with reducing method

FOLLOW UP CONSULTATION

Patient Name: Miss C Treatment Number: 5

TCM Disease: Irregular menstruation

TCM type/pattern: Qi and blood stagnation

Date: 10/Jun/08

Current conditions/changes: On the next day of the 1^st treatment, patient experienced severe fatigue. She took a nap for hours and began to improve her diet properly. She stopped taking all kind of sweet stuff and took meal 3 times a day. After 2nd treatment, she had normal defecation. She went to toilet every day and her defecation had nothing abnormal. A few days after 3^rd treatment, she had menstruation with much less pain and clots (this time, mens came back in 25 days). There was neither lumbago nor leg pain. After 4^th treatment, everything was normal and she felt quite healthy. So she decided to continue the treatment till the cycle is fixed perfectly.Tongue: Pale swollen body with teethmarks and white greasy coating

Pulse: deep, weak and thready

Treatment Principle: Remove Qi and Blood stagnation, tonify the spleen and relieve pain, tonify the body health

Prescription:

Same as the 1^st treatment

Explanation:

Same as the 1^st treatment

Lifestyle Advice:

Regular exercise, no more sweet food, more nutrient and regular meal with fresh fruits and vegetable, better rest at night time rather than watching TV late.

Name of Student Clinician: Eva Kim

Name of Supervisor: Leigh

CASE CONCLUSION

My diagnosis was irregular cycle combined with dysmenorrhea, caused by Qi and Blood stagnation. The result of the 1^st treatment was good, and I selected same points till the patient felt a change in her body condition. As a result of strengthening the function of the spleen, she experienced normal defecation after the 2^nd treatment and I found that my selection of acupoints was right. I continued the same treatment once every weak and the patient experienced a greatly improved cycle (25^th day after the previous period) and no pain in the body after 3^rd treatment.

While treating the patient for approximately one month, I did not need to change treatment method. Each time, the patient got slightly better and symptoms were healed one by one.

As the treatment result was unbelievably good, I will use the same method and points to other patients with similar syndromes. However, it is very important that patient has a strong belief in TCM treatments. As all the healing method is related with and influence patient’s mind state and emotion, acupuncture treatment might also heal better those with a belief in the science of TCM.

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