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
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