Facial wrinkles for 3 years

CHIEF COMPLAINT:	Facial wrinkles for 3 years
DESCRIPTION: (4 diagnostic methods)
A) Asking
Present illness complaints:	She indicated facial wrinkles getting more around the mouth , intakes vitamin C and E oral supplement everyday , she felt very stressful for her lifestyle, likes to take sunshine bath around one hour per day if good weather , nasal congestion a long time , difficult to fall asleep if wake up in midnight , numbness and dull pain at finger and shoulder (both side) normal appetite ,sleep, urination , defecation(a little bit hard stool discharge not very smooth) ,sweating when do heavy job at day time , prefer sweet , spicy foods.
Past history including past health conditions and other previous illness:	NAD
Life Style:	part time job for 5 working days
Family history:	Father : high cholesterol , mother : cancer died
Menstruation, marital & obstetrical history / Men’s sexual health	single ,never married
B) Inspection
General:	Vitality :6/10
Others:
Tongue:	Purple dim color , no coating
C) Ausculation / Olfaction
Sound:	lower voice
Odours:	NAD
D) Palpation
Body Areas:	NAD
Pulse:	R - Rapid , hesitate      L : rapid ,week at chi
DIAGNOSIS:
A) Patients condition is classified	Aetiology (  v   )                                Fundamental Substances (  v   ) Zangfu (   v  )                                Jingluo (    v   )
B) Diagnostic Conclusion
TCM Disease:	Facial wrinkles
TCM type/pattern:	qi and blood def. due to lung & spleen disharmony ,
C) Explanation:
TREATMENT:
A) Treatment Principle	Strengthen spleen ,regulate qi and blood , smooth liver qi
B) Treatment Method
1. Needling
Select techniques:	Filiform ( v    )                 three edged needle (    )                      plum blossom (    )                      intradermal (    )
Select Acu-points and Manipulation:	dingchuan ,chengjiang ,jiachenjiang ,taichong ,hegu xuehai,zusanli,  sanyinjiao , yinhsiang even method
Explain the reasons for your selection:	chengjiang : local point to strengthen qi and blood circulation ,jiachenjiang : local point to strengthen qi and blood circulation Dingchuan EX-BW1; local point to strengthen qi and blood circulation Yinhsiang : open channel to treat nasal obstruction taichong : smooth LV –qi circulation xuehai : tonify blood circulation zusanli : strengthen qi&blood sanyinjiao : nourish 3 yin meridians of LV/SP/KI hegu: for dispelling cold  symptom-complex
2. Moxibustion
Select techniques:	moxa cone (  )             moxa roll (  )                indirect moxa (  )
Select Acu-points:
Explain the reasons for your selection:
3. Cupping	N/A
Select techniques:	Stationary (   )            mobile (  )
Select Acu-points retention time:
Explain the reasons for your selection:
4. Microsystem
Select Microsystems:	Ear (     )               hand (    )       foot  (    )          scalp (    )          nose (    )    brow (    )             dentition (    )
Points	.
Diagnosis is confirmed by across checking with at least one other Microsystems system:
Explanation the reasons of your selecting:
5. Lifestyle Advice:
	Take appropriate sleep and rest, Drink more water  Keep fresh and clean air environment Prevent injury from UV by SPF 30 + cream

 

  

 

 

Case Conclusion

  She indicated that facial wrinkles getting more around the mouth , to intake vitamin C and E in order to promote metabolism of the body everyday , she felt very stressful for her lifestyle,It will disturb qi flow of liver due to emotion change and impare the function of middle jiao ,she likes to do sunshine bath around one hour per day if good weather , that UV light can damage skin layer made more wrinkles occurrences , nasal congestion for a long time , difficult to fall asleep if wake up in midnight , numbness and dull pain at finger and shoulder (both side), normal appetite ,sleep, urination , defecation(a little bit hard stool discharge not very smooth) ,sweating when do heavy job at day time , prefer sweet , spicy foods.

The diagnosis is facial wrinkles , syndrome differentiation is qi and blood deficiency due to lung & spleen disharmony , my treatment principles aids to strengthen spleen ,promote circulation of qi and blood , smooth liver qi , all apply needles to take even method manipulation and retaining needles for 30 minutes ,

This is my first time to time take dingchuan ,chengjiang ,jiachenjiang points by 0.5 cun needles for facial , she got very nervous .The patient no any further treatment due to our school will have study break for two weeks .

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Jing Luo of TCM

Jing Luo

INTRODUCTION

"Jing luo", is  issued by ( Huang Di Nei Jing-The Yellow Emperor's Classic of Internal Medicine) in the ancient Chinese medical text, 

1. Jing meridians act as the interior. Those which branch off horizontally are luo meridians
2. Jing means to pass through orpathway and refers to the vertical channels. Luo means network and refers to the networks that branch off from the vertical channels (Jing).
3. Both Jing and Luo mean link or connection, and they are bound closely together to form channels.
4. Jing Luo are the main channels of communication and energy distribution in the body, there is a distribution network for the fundamental substances of Qi , blood , jing , ye (body fluid) throughout the body
5. This distribution network called the Meridian System looks like a giant web, linking different areas of our body together.
6.  Its pathways make up a comprehensive yet complex body map that supplies vital energy to every part of the body.

 Philosophically, the Meridian System explains how we live, and why we become sick., link interior Zang Fu organs with various tissues of superficial areas of the body. In this way they allow for internal adaptation to external change.They connect different superficial areas of the body.The Jing Luo are more external than the Zang Fu Organs. When pathogens penetrate the body from the Exterior, they usually penetrate the superficial channels and then the main channels and finally the Zang Fu Organs. Jing Luo cover the entire body.

CONTENT

Distribution of the Jing Luo ( Meridians)

Merdians(Jing)

• 12 Regular Meridians - Connect with Zang Fu Organs. Carry mainly Ying (Nutritive Qi) and Blood.

• 12 Divergent Meridians - Provide more functional contacts between Yin and Yang channels,Reinforce the circulatory network of 12 Primary Meridians
• 12 Muscular Meridians(sinews regions) - 1st line of defense and adaptation , province of Wei QI energy ,to connect with all the bones and control them to ease flexing and extending of the joints and normal motion of the body
• 12 Cutaneous(skin) Meridains -- the body superficies on which the functions of the 12 Regular Meridians are reflected, and the sites where the Qi of the collaterals spreadsthe most superficial part of the body tissues, they render protection to the organism.
• 8 Extra Vessels - CV, GV and Chong Mai originate in Kidney Organ. The others connect with Principal channels,strengthen association between channels and control, store and regulate Qi and blood of channels (reservoirs). Carry mainly Yuan Qi.
  

Collaterals(Luo)

• 15 Luo Meridians - Link Primary Meridians with surrounding tissues, Link Yin and Yang coupled pairs , it communicate exterior and interior that allows Wei Qi to move in towards the Boold, and the Blood towards the Wei Qi.
• Superficial Collaterals
• Minute Collaterals

The sub-meridian system (superficial channels) has the main functions of maintaining normal function providing for adaptation to changes in the external environment. This adaptation can often occur without the circulation of Qi in the main Meridians being too affected.

There is much disagreement regarding the pathways of the Luo and Tendinomuscular channels. In any case, these channels do not have their own points but share points of the Primary Meridians. The flow of Qi through these channels is affected by needling points on the Principal channels.

Pattern of the Meridian flow direction

The 12 Meridians have lateral and symmetrical distribution on the head, face, trunk and limbs.

• The 6 yin meridians are distributed on the inner side of the limbs and on the chest and abdomen.
• The 6 yang Meridians are distributed on the outer side of the limbs and on the head, face and trunk.

The 12 regular meridians runs in an regular manner: These meridians have their own principles of distribution

1. The 3 Yin Meridians of hand     run from the chest to the hand.
2. The 3 Yang Meridians of hand  run from the hand to the head.
3. The 3 Yang Meridians of Foot  run from the head to the foot.
4. The 3 Yin Meridians of Foot     run from the foot to the abdomen

The order and arrangement of the three yang meridians for both arms and legs are as follows:
a) Yang Ming -- anterior position.
b) Shao Yang -- middle position.
c) Tai Yang -- posterior position.

The order and arrangement of the three yin meridians are as follows:
a) Tai Yin -- anterior position.
b) Jue Yin -- middle position.
c) Shao Yin -- posterior position.


Characteristics of Meridian
 The meridian flow of Qi in the body. The pattern includes exterior towards interior, interior towards exterior, arm towards leg, and leg towards arm, etc.

Exterior towards Interior, Interior towards Exterior. e.g

• The Lung and Large Intestine Meridians are yin and yang organs and have an interior-exterior relationship.

Arm towards Leg, Leg towards Arm.

• The Arm Large Intestine Meridian (Yang Ming) flowing towards the Leg Stomach Meridian (Yang Ming).
  

12 Divergent Meridians

• The 12 Divergent Meridians are the branches which derive from,enter, leave and join the 12 Regular Meridians which, in turn, reach the deeper parts of the body through these branches.

• The Yang Divergent meridians join the Yang regular meridians: the Yin Divergent Meridians connect the interiorly-exteriorly related the Yang Divergent Meridians, thus they are named "Six Confluences".
  

• Strengthen the connections between the Zang and Fu organs by the distribution of branching out from the 12 Regular Meridians.
  
• They bring the 12 Regular Meridians and all parts of the body closer, and extend the scope of indications of the acupoints

The 8 Extra Meridians
The 8 Extra Meridians are the Governor Vessel, Conception Vessel, Thoroughfare Vessel, Belt Vessel, Yin Link Vessel, Yang Link Vessel, Yin Heel Vessel, Yang Heel Vessel. Unlike the 12 Regular Meridians, none of them pertain to the Zang-Fu organs. And they are not exteriorly-interiorly related. Their courses are unique, and hence, they are called extra meridians.

 They contain two main functions.
(1) They can strengthen the relationships among the 12 Regular Meridians. The 8 Extra Meridians communicate with the other meridians which have the related aspects and the similar functions. They assume the responsibility to control, store the Qi and blood of each meridian and regulate Yin and Yang.
(2) The 8 Extra meridians can regulate the Qi and blood of the regular meridians, when the Qi and blood of Zang-Fu organs are vigorous,
 the 8 Extra Meridian can store them; while the body needs them for its activity, they can be supplied by The 8 Extra Meridians.

Acupoints of the Thoroughfare, Belt, Heel and Link Vessels pertain to the Twelve Regular Meridians and the Conception and Governor Vessels. The Conception and the Governor Vessels which have their own acupoints together with the 12 Regular Meridians are called "the Fourteen Meridians". The Fourteen Meridians contain the regular courses, symptoms and their own acupoints, they are main parts of the system of the meridians. They are basic factors for acupuncture treatment and classification of medicinals according to the meridians on which their therapeutic action is manifested.

Application of the Meridian Theory

  The Meridian System is:

1. the process through which our body grows;
2. the explanation how disease continues and develops;
3. the methods by which our body is treated;
4. the place where disease occurs;
5. the concept where philosophy begins,
6. the target where successful outcome should be achieved."

This saying illustrates the importance of the meridian theory in human physiology, pathology, diagnosis and therapeutics in TCM.

Physiological application
"The Meridians move the Qi and Blood. As a result, Yin and Yang get regulated. Tendons and bones get nourished. Joints get facilitated."
Meridians work like a network system, transporting and distributing qi and blood.
They link up organs, limbs, joints, bones, tendons, tissues and skin, and provide communication between the body's interior and exterior.
Through a healthy Meridian System, Qi and Blood successfully warm and nourish different organs and tissues, and maintain normal metabolic activities.
Meridians are essential in supporting the flow of nutritive Qi inside the blood vessels and the flow of protective Qi around them.
Strengthen the body's immunity, protect against external anything evil that causes disease and assist in regulating yin and yang

Pathological application
In Chinese Medicine, the "evils" (pathogenic influences) transform and progress along the meridians to attack the body and cause disease or illness. They are classified in TCM as wind, fire, dampness, dryness, cold and summer heat. Sometimes, the evil travels from one organ to other, but it can proceeds from the exterior to the interior of the body.

Disharmony of one organ can also affect other organs because of their interconnections through the Meridian System. For instance, liver disharmony can influence the stomach, and stomach disharmony can influence the spleen. Moreover, organ disharmony inside the body will show pathological changes along the Meridian channel with which it is associated. For example, liver disharmony can cause lower chest pain, because the liver meridian passes through lower chest region. Kidney disharmony can cause groin pain, because the kidney meridian crosses the groin area. Ulcers on the tip of tongue can suggest heart disharmony since the heart meridian has branches at the tip of tongue.

Diagnostic Application
Because of the special properties of meridians, disharmony and imbalance in the body can be diagnosed according to the meridian and its corresponding organ. Headaches, for example, are classified according to their affected painful spots and the distribution of the meridians in that area. Pain in the forehead indicates a Yang Ming Meridian type headache, while pain in both sides of head indicates a Shao Yang Meridian type headache. Back and neck pain is a Tai Yang Meridian type headache, and pain in the top of head indicates the Jue Yin Meridian type headache. Such specific diagnoses help tailor individual treatment plans allowing for the best outcome for relief of the headache.

Meridian differential diagnosis is essential for both herbal treatment and acupuncture therapy. In TCM, herbal medicines are chosen specifically for treating certain meridians and their corresponding organs. Moreover, some herbs have meridian guiding properties, which help potentiate the therapeutic effects of specific organs and meridians. In this way, meridians allow for an individually tailor-made herbal treatment plan according to a patient's disharmony pattern.

Similarly, understanding meridian selectivity is important for optimal therapeutic outcomes with acupuncture. For example, a headache in the forehead region is diagnosed as Yang Ming Meridian disharmony. Acupuncture points in Arm Yang Ming Meridian such as Hegu (the depression on the dorsum of the hand between the first and second metacarpal bones, at the level of the middle of the second metacarpal bone) can be selected to treat this type of headache. Another common example is a stomach ache (indigestion, dyspepsia). Since the stomach belongs to the Leg Yang Ming Meridian, the corresponding acupuncture point of Zusanli (located: one finger-breadth lateral to the anterior crest of tibia) can be chosen to relieve this pain.

SUMMARY

Jing Luo Function:

• meridians and collaterals belongs to internal organs(Zang-fu) and exteriorly to all the extremities

•  as organic corresponding network between internal organs and body surface.

•  the human body is an organic whole. Meridians and collaterals serve as the route of Qi and blood, Yin and Yang, all of which keep the body in a well-balanced condition.

the Meridian System remains an important and integral part of Traditional Chinese Medicine, and the application of herbal therapies and acupuncture continues to be essential in restoring the balance of health in our bodies.

      1. Observation of Needling Sensation: Acupuncture produces sensation of soreness, numbness, distension or heaviness. This sensation   usually goes to the distal region along a definite pathway.
      2. The Summary of the Therapeutic Effects of Acupoint: The acupoints which have similar clinical effects are regularly lined on the same course.
      3. Reference of the Pathological Phenomenon on the Body Surface: When there appears the disorder in a certain organ, then on the corresponding areas of the body surface appear tenderness, tubercles, skin rash and changes of the skin color, this is also another way of discovering the system of meridians.
      4. Suggestions from knowledge of Anatomy and Physiology:With the help of anatomy. Chinese doctors in ancient times got to know the position, the appearance and some physiological functions of internal organs, and observed the tunnellike and the cordlike structures are distributed over the body and connected with four limbs as well. The phenomenon of the circulation of blood can be seen in same blood vessels.

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Knees( both side)and left Elbow joint Pain for 3 years

Case : female 58 ages first visit date :25/09/2009

The patient has suffered from the knees dull pain at both side , left later side elbow for 3 years, she felt very stiffness sensation at night and early morning ,she squat down her leg unsmoothly and pain getting worse when the season change(wind cold) suddenly ,prefer warm massage and 30 minutes light exercise to relieve pain in the morning , left back and waist dull pain ,fixed pain on local area ,she look a pale complexion and difficult to bending of her leg(both) , no swelling , no hot sensation ,she also take 2 tablets of Panadol due to got headache , some prescribe western medicines to treat this syndrome by GP.normal appetite , no chill& fever ,short of breath (a little), sleep time around 6 hours and wake up 1 ~ 2 times during sleep ,yellow urine , defecation is normal , a little bit stress , anxiety from his family , in general , this case diagnosis as Painful Bi syndrome due to some reasons as follows :

• pain of limbs (elbow/knees) is usually caused by invasion of wind , cold , dampness,which occur dull pain , fixed pain due to blood circulation coagulate by pathogenic factor cold and qi and blood stagnation on local area , it fails to nourish the tendons , ligament ,sometime leads to numbness.

• left back and waist dull pain ,fixed pain on local area in relation with yang qi fail to propel and warm up the upper back and waist cause qi and blood stagnation ,

• weak and short of breath (not serious) in movement or exercise pertains to deficiency and cold syndrome
• pale complexion due to decline of qi and blood fail to nourish face
• pale ,thin white coating due to insufficiency of qi and blood fundamental substances
  

My treatment principle aid on disperse wind /cold and promote circulation of qi & blood ,relax and activate tendons ,clear the collaterals to relieve pain, strengthen spleen

Select points & techniques:

• Xiyan : All knee disorders - pain, inflammation
• Heding: knee pain, stiffness, tension.
• Yanglingquan : is the Hui-Meeting Point of the sinews (muscles,ligaments, tendons)
  

• Yinglingquan : he sea & water point of spleen ,to relieve pain in the knee.
• Xuehai : sea of blood to promote circulation of blood ,remove blood stasis
• Lianqiu :xi-cleft point , to treat lateral knee issues.
• Quchi :pain and inflammation, atrophy, tremors - expels wind dampness from the channel.
• Waiguan +Zulingqi : 8 confluent point of Dai mei and Yang-linking channel to promote circulation of qi and blood to stop pain and headache

reinforcing method with TDP

During first treatment she felt some qi movement on local area(both knees) due to apply to TDP (warm and relax tendon ) to alleviate pain , she also have headache but not serious , I do manipulation moderate to strengthen needle sensation at Zulingqi point , she felt electric transmit feeling upward from dorsal of leg, she felt soreness and heaviness of left forearm when needle puncture at Quichi& Waiguan,All apply needles retaining around 40 minutes to promote circulation of qi and blood to relax tendons , collaterals,and channel function ,the patients satisfied with this treatment and also make an appointment after study break , twice per week to my clinical times

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Fullness abdominal for 2 weeks

Date of first visit: 17.Mar.2009 Gender: F Age: 52

Chief complaint/s(chronic or acute): Fullness abdominal for 2 weeks

Description (4 diagnostic methods):

A) Asking:

She has suffered from.fullness abdominal for 3 months

All the time she felt distention of her abdominal.

When she desire defication but can not do completely. Feel still somting inside with uncomfortable..Also she feel hot sensation of her face.

Her sleep is turibid (wake up 2~3times during sleep)

Prefer to a lot of warm water.

The symptom is relieved by rest, drinking warm water and takes less food.

Present Symptoms:

: Good appetite, no chill & fever, no abnormal sweating, no thirsty (prefers warm water), stool (once per day, with form, hard push out), normal urination, easy to feel tired,

Past history:

12 years ago she got injury of her neck( c-5,6,7)

Life Style: No smoking, house wife

Family history: NAD

Menstruation, marital & obstetrical history / Men’s sexual health

Menopause( 4 years ago) married with 3 children

B) Inspection: General: Little bit fat body shape, normal face complexion, vitality:6~7/10

No limitation of movement.

Tongue: Tongue Body: pink(pale) Tongue coating: thin,white, slippery

C) Auscultation/Olfaction:

Sound: low voice

Odours: NAD

D) Palpation:

Body Areas: normal

Pulse: weak and deep

Case Summary

Definition:

Abdominal distention refers to distention and fullness which occur in both the upper and lower abdomen. The stomach and spleen are located in the upper abdomen, while the small and large intestines are in the lower. Dysfunctions of these four organs may lead to abdominal distention.

WMS:

Abdominal Distention is the actual “physical” finding that the abdominal area is larger than normal. It can be caused by three different things: air, fluid and tissue.

There are continuous and intermittent distentions.

Continuous distention is swelling of the abdomen for a considerable period of time, with no signs of relief. The cause can be one of four things.

· Enlargement of an organ within the abdomen

· A tumor in the abdomen

· An increase of fluid around the organs in the abdomen

· Obesity

Intermittent distention can come and go and is usually triggered by ailments which inhibit proper digestion, and cause an accumulation of fluid or gas within the digestive system.

Distention Causes

One common cause is irregular digestion. When the digestive system is working properly, food is digested by chemical reactions and broken down into components. From these components the body obtains nutrients and energy to use as fuel.

Food that is not broken down is considered waste and is eliminated from the body. Some of the waste comes in the form of odorless gases and are easily handled by the intestinal canal.

When the body is not digesting properly, sulfur-bearing gases are produced and accumulate in large pockets. These gases stretch the intestinal canal producing the painful effect of bloating.

TCM Aetiology and Pathology

According to TCM, there are three causes that lead to Fullness abdomonal

(1) Irregular or excessive food intake impairs the stomach and intestines, causing dysfunction of transportation and transformation, thus the retained food is stagnated and blocks the flow of Qi, causing abdominal distention.

(2) Because of the weakened function of the spleen and stomach or ageing, long illness, and general debility, the spleen and stomach fail in their transporting functions, so the circulation of Qi in the stomach and intestines is impaired, resulting in abdominal distention.

(3) Abdominal operations may disturb the circulation of Qi in stomach and intestines, leading to abdominal distention.

TCM Diagnosis:

Fullness Abdominal

Syndrome Differentiation:

Spleen and stomach qi deficiency.

Explanation:

Abdominal distention is common in clinic.Distention and fullness are likely to occur in both the upper and lower abdomen.The ST is located in the upper abdomen,while the small and large intestines are in ,they jointly complete the stroge, Qi Def. of the SP and ST results in dysfunction of transportation and transformation.In this patientc symptoms are when she desire defication but can not do completely. Feel still somting inside with uncomfortable. Its related transportation and transformation function disorder of the spleen and the stomach

Treatment Principles:

Tonyfy Sp/ST Qi to promote transportation and transformation functions

Points and Therapies:

Filiform needles for the following points:

Zusanli(+), zhongwan,(+) qihai,(+) tianshu(0)

Explanations:

Zhongwan(Front-MU)/ Zusanli(Lower HE) :this combination to regulate the function of the stomach and intestine in order to maintain normal flow of Qi add relive distention.

Qihai: tonify Qi.

Tianshu:restors and harmonizes the flow of Qi in large intestine and desolve stagnation

Life Style Advice

l Massage around low abdominal area make circle right to left.

l Take meal regulary

l Have regular exercises. Movement, especially in the morning before breakfast, encourages bowel activity

l Eat natural fresh foods. Packaged foods contain more preservatives and are harder to digest.

l Avoid foods that are too cold or too hot. They increase the air intake during a meal.

l Avoid caffeine. It acts as a stimulate and can overexcite the digestive system.

Case Conclusion

The patient was KIWI people. I am very worried with this patient with communication for diagnosis.

But it’s no problem because she know well Chinese medicines even acupuncture. She have experience with other student in our school..she know acupuncture is very effective for humen disease.

The points and manupulationmethods I used for this patient are proved to be helpful to the illness because the patient does not came for 2^nd treatment. It’s means fully recoverd her symptoms. So I would apply them to other patients again.

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Pain in epigastria for 10 days

Date of First Visit: 23. June. 09	Name: xxxx
Age : 53	Gender: Female
CHIEF COMPLAINTS : Pain in epigastria for 10 days
DESCRIPTIONS (4 diagnostic methods)
A) Asking
The patient suffers from discomfort in epigastria for 10 days. There was some problem came up two weeks ago and the patient was worried and stressed about it. Then one day, it suddenly appeared after she had a dinner with severe cramping pain in the stomach. She had nausea and few times of vomiting. After the cramping pain has been relieved, she started having poor digestion and bloated sensation after eating. No aggravating factors for epigastric pain. Frequent belching and acid regurgitation present. No chill. No fever. Dry mouth and throat. Hard to fall asleep (sleeping well otherwise). Poor appetite. Normal urination. Fatigue. Constipated for 3 days. (Stool is usually loose.) Depressed.
Past illness history: NAD
Life style: Busy, stressed, likes coffee
Family history: NAD
Menstruation, marital & obstetrical history: Married with 2 children. 15yrs, 3/28-30, 23 Jun 09 (early menstruation). Dark colour menses, no PMS
B) Inspection
General : Vitality 7/10. Dim complexion. Slim body. Normal body movement Other : NAD Tongue : Pink dim tongue with white coating
C) Auscultation / Olfaction
Sound : Normal voice, Normal breathing Odours : NAD
D) Palpation
Pulse : Taut, weak in general Body areas : NAD

CASE SUMMARY

DIAGNOSIS

A) Diagnosis Epigastric pain

B) Syndrome Differentiation Liver qi stagnation attacking stomach

C) Explanation

Anxiety, anger and mental stress damage the liver, causing failure of the liver in dominating free flow of qi, adversely attacking the stomach, impeding its activity and hindering its qi descending, then pain appears. Without any unusual food intake, the epigastric could possibly be caused by emotional stress that she has been suffering so far. For the last few weeks, the patient has gone through emotionally hard situation and I personally think that this problem has been developed due to her mental stress and anxiety. Once stagnant liver qi attacked the stomach, she started getting frequent belching, acid regurgitation, and poor appetite, bloated sensation after eating and poor digestion. Also due to anxiety and stress, she has difficulty in falling asleep too. Pink dim tongue body with white coating and taut weak pulse also indicate weak middle jiao qi and interior syndrome due to emotional factor.

TREATMENTS

A) Treatment Principles - Relax the mind and spirit, soothe the liver qi and strengthen the middle jiao

B) Treatment Methods

1. Needling

Prescription : - Zhongwan+ / Neiguan- / Zusanli+ / Tianshu+ / Taichong-

Explanations : - Zhongwan is the Luo point of the stomach and it can harmonise the middle jiao qi as well as strengthen it. Neiguan is to relax the mind. Taichong is used for soothing the liver qi in order to remove the stagnation in the liver. Zusanli produces qi and blood and promotes its circulation and also strengthens the spleen and stomach. Tianshu, the front-mu point of large intestine is used to promote the bowel movement.

2. Moxibustion

Prescription :

Explanations :

3. Cupping

Prescription :

Explanations :

4. Electro Acupuncture

Prescription :

Explanations :

5. Microsystems

Select microsystems : Ear ( ), Hand ( ), Foot ( ), Scalp ( ), Nose ( ), Other ( )

Prescription :

Explanations :

6. Life Style Advice

Eat light food frequently in small amount each time

FOLLOW UP CONSULTATIONS

Date: 30 June 09

Treatment Number: 2

TCM Disease	Epigastric pain
TCM type/pattern	Liver qi stagnation attacking the stomach
Current condition/changes	Epigastric pain is still present with bloated full sensation. No acid regurgitation but frequent belching. Dry mouth with thirst. She had defecation but still got a feeling of unfinished. T: Pink tongue with white coating P: Moderate taut
Treatment Principle	same
Prescription	Add Xiawan
Explanation (if any Adjustments)	Xiawan for belching by descending the stomach qi
Lifestyle Advice (if any Adjustments)

FOLLOW UP CONSULTATIONS

Date: 03 July 09

Treatment Number: 3

TCM Disease	Epigastric pain
TCM type/pattern	Liver qi stagnation attacking the stomach
Current condition/changes	No distenstion in epigastria, heavy sensation (dragging down) presents. Dry mouth. Dry stools. Normal urination. Good appetite. T: Dim tongue with white coating P: moderate
Treatment Principle	Same, “clear heat”
Prescription	Zhongwan, Xiawan, Neiting, Zusanli, Sanyinjiao
Explanation (if any Adjustments)	Zhongwan is the Luo point of the stomach and it can harmonise the middle jiao qi as well as strengthen it. Xiawan is for belching by descending the stomach qi Zusanli produces qi and blood and promotes its circulation and also strengthens the spleen and stomach. Neiting to clear heat and Sanyinjiao to nourish yin fluid and harmonise the middle jiao.
Lifestyle Advice (if any Adjustments)

EPIGASTRIC PAIN

TCM DEFINITION
Epigastric pain refers to a syndrome manifested by frequent pain over the epigastric region and close to the cardia, so in ancient times, it was also named “cardiac pain” or “cardioabdominal pain”. It is commonly seen in acute and chronic gastritis, stomach or duodenal ulcer, functional stomach pain in modern medicine.
TCM ETIOLOGY and PATHOGENESIS
(1) Irregular food intake, raw and cold food and hunger injure the spleen and stomach, causing failure of the spleen in transportation and transformation and failure of the stomach qi in descending, then pain appears. (2) Anxiety, anger and mental depression damage the liver, causing failure of the liver in dominating free flow of qi, adversely attacking the stomach, impeding its activity and hindering its qi descending, then pain appears. (3) Generally, lowered functioning of the spleen and stomach, due to invasion of pathogenic cold, which is stagnated in the stomach, causes failure of the stomach qi in descending, then pain occurs.
DIFFERENTIATION
1. Food retention
Clinical manifestation
Distending pain in the epigastria, aggravated on pressure, belching with fetid odour, anorexia, pain aggravated after meals, thick sticky tongue coating, deep forceful or rolling pulse.
2. Attack of the stomach by the liver qi
Clinical manifestation
Paroxysmal pain in the epigastria, radiating to the hypochondriac regions, frequent belching, nausea, acid regurgitation, abdominal distension, anorexia, thin white tongue coating, deep taut pulse.
3. Deficiency of the stomach with stagnation of cold
Clinical manifestation
Dull pain in the epigastria, which may be relieved by pressure and warmth, regurgitation of thin fluid, general lassitude, think white tongue coating, deep slow pulse
TREATMENT PRINCIPLE
Clear heat, harmonise middle jiao qi, remove stagnation, calm the mind, warm and tonify SP/ST, remove cold stagnation
ACUPUNCTURE TREATMENT
- Primary points: Zhongwan, Neiguan, Zusanli - Additional points: (1) Neiting, Tianshu (2) Qimen, Taichong (3) Qihai, Pishu, Gongsun

CASE CONCLUSION

The diagnosis of this case is epigastric pain and the syndrome differentiation is liver qi attacking stomach due to mental stress and anxiety.

I gave her three treatments and at the third visit, most of patient’s symptoms appeared to be improved (only heaviness sensation inside the stomach is remained, appetite has been improved). I have used Xiawan and Neiting with the basic prescription of Zhongwan, Neiguan, Zusanli, Tianshu, Taichong. However it was still difficult for me to resolve her dry mouth and throat by needling.

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Neck and right shoulder pain for 2 days

Date of first visit : 14/8/09 Gender : F

Age : 19

Chief complaint : Neck and right shoulder pain for 2 days.

Description :

A. Asking

The patient has suffered from neck and right shoulder pain for 2days. When she does not move, pain is dull but when she moves her shoulder, pain is sharp.

She thinks a reason of pain is bad sleeping position 2days ago. There are no radiating pain, and she does not know what makes it worse or batter.

She hasn't got any injury about shoulder, and she did not use her shoulder too much. She does not feel any pain when I press the shoulder and neck.

No chill and no fever, no headache, no dizziness, good appetite, good sleeping, no dream, normal urination and defecation, no thirsty, no dry mouth, prefer to drink cold water.

Past history : NAD

Lifestyle : 1 soju(眞露)/days, 10 pieces/1 day, stressful life.

Menstruation, Martial & obstetrical history : 13 7/29, serious pain before and during period.

B. Inspection

General : red cheeks

Others : NAD

Tongue : greasy, thin white coating, pink tongue.

C. Auscultation/Olfaction

Sound : NAD

Odours : NAD

D. Palpation

Body ares : NAD

Pulse : slippery

Case summary

Diagnosis : Neck and right shoulder pain.

Syndrome : Qi and blood statgnation

Treatment principle : remove qi and blood stagnation

Point : Tian zhong, bing feng, ashi point.

Explanation : Since she got this problem, there was no injury or over use of shoulder, just the temperature was so cold, and she slept with bad position, those two thing made qi and blood stagnation on local area.

Bing feng, Tian zhong, ashi point : local point for promoting qi and blood stagnation on local area to relieve pain.

Definition

Shoulder pain involves any pain in or around the shoulder joint.

WMS

Alternative Names

Pain - shoulder

Considerations

The shoulder is the most mobile joint in the human body. The rotator cuff in the shoulder is made up of four tendons. These tendons give the shoulder a wide range of motion.

Any swelling, inflammation, tearing, or bony changes around these tendons causes pain when a person tries to move the arm above the head, behind the back, or straight out in front.

Common Causes

The tendons pass underneath a rigid bony arch in the shoulder. The most common cause of shoulder pain is when the tendons become trapped under this arch. The compressed tendons become inflamed or damaged, a condition called rotator cuff tendinitis. This can occur from general wear and tear as you get older, an activity that requires constant shoulder use like baseball pitching, or an injury.

TCM

The shoulder pain can be caused by obstruction of wind, cold, dampness, phlegm, or qi and blood stagnation. Deficiency of LV and KD, deficiency of Qi and blood, or Qi and blood stagnation can also be the reason of shoulder pain.

The main symptoms are inability to move, such as feel pain when doing back ward rotating, sever pain at night.

There are 4 stages to get recover. Firstly pain in getting sever, secondly pain get reduced but muscle get harder(contract), third, pain all gone but mescle still get contracted, and fourth, muscle get recover and problem all gone.

If the patient have treatment, problem wii gone within 8 months, but if not, it will take 1~2years.

Case conclusion

I treated this patient just once and next day morning, pain was gone. May be the problem is just 2days, short time, so treatment was very effective, I think. Actually I prepared lifestyle advice for her when I get home, but when I woke up in the next morning and she text me she got recover. So I did not put my life style advice in here because lifestyle advice was useless for the patient.

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