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.
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