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.

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.

Case Study TCM

Record of First Visit

Name of Student Clinician: Suk Yee Chan Ho Name of Supervisor: Yueping Li

Date of first visit: 10 June 2008 Gender: Female Age: 45

Chief complaint/s(chronic or acute): Severe coughing for one week

Description (4 diagnostic methods):

A) Asking:

Caught cold for one week, running nose with clear nasal discharge, but now turn to yellow sticky discharge. She went to see western doctor and took western medicine 3-4 days ago. After that, fever was gone.

Present symptoms : Sore throat, severe coughing with burning sensation, dry throat, dry mouth, thirsty, warm drinks preferred, bitter taste, aversion to cold, chill, no fever, headache, mostly forehead, sometimes the whole head, whole body aching, feel cold at the back, shoulder and nape, tight chest and sore chest after coughing, hard to cough out phlegm, not feel like to eat and feel tummy full, no belching, no abnormal sweating, no night sweating, normal defecation and urination, usually good sleep but in these 3 days poor sleep, tinnitus always.

Past history:

Heavy uterus bleeding in 2003

Life Style: Fulltime student and a housewife

Family history: NAD 4-5

Menstruation, marital & obstetrical history: 15--------- 4 days ago (6/6/08)

45-55 married with 2 children

Inspection:

General: Tired complexion, normal movement, normal mental state, big figure,

Others: NAD

Tongue: Dim, corpulent, with teeth marks, dry thin white coating

C) Auscultation/Olfaction:

Sound: Nasal sound, difficult breathing because of the nasal obstruction

Odours: No bad odours

D) Palpation:

Body Areas: Cold at upper back and shoulder when palpated

Pulse: Rapid and thin in general

Case Summary

Definition:

Cough, a main symptom of the lung problems, may result either from attack by exogenous factors disturbing the dispersion of Qi of the lung, or from disorders of the lung itself or other diseased Zang-fu organs of affecting the lung. In modern medicine, cough is commonly seen in upper respiratory tract infection, acute and chronic bronchitis and tuberculosis.

WMS:

A cough, also known as tussis is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in violent release of air from the lungs, and usually accompanied by a distinctive sound.

Coughing is an action the body takes to get rid of substances that are irritating the breathing passages. A cough is usually initiated to clear a buildup of phlegm in the trachea. Coughing can also be triggered by a bolus of food entering the trachea rather than the esophagus due to a failure of the epiglottis. Frequent or chronic coughing usually indicates the presence of a disease. Provided the patient is a non-smoker and has a normal chest X-ray, the cause of chronic cough in 93% of all patients is due to asthma, heartburn or post-nasal drip. Other causes of chronic cough include chronic bronchitis and medications such as ACE inhibitors. Coughing can happen voluntarily as well as involuntarily.

TCM Aetiology and Pathology

1. Invasion by the Exogenous pathogenic Factors

The lung dominates Qi and is regarded as an umbrella protecting the five Zang-organs. Upward it connects the throat and has its opening in the nose, governing respiration. Externally it associates with the skin and hair. Once the lung is attacked by the exogenous pathogenic factors, the defensive system of lung is invaded by pathogenic factors; the Qi of the lung is blocked and fails to descend, thus resulting in cough. Since the weather changes in different seasons, the exogenous pathogenic factors attacking the human body are various, cough is therefore divided into two types: wing-cold and wind-heat.

2. Internal Injury

Cough resulted from functional impairment in the Zang-Fu organs, falls into the category of cough due to internal injury such as cough by dryness of the lung with deficiency of yin leading to failure of Qi of the lung to descend; cough caused by the deficiency of the spleen which gives rise to internal dampness whose excessive accumulation produces phlegm. Phlegm damp in return may go up into the lung, causing the dysfunction in descending, cough resulting from stagnation of liver-qi may be turned into fire, flares up and injures the lung fluid, and cough is due to deficiency of liver and kidney-yin, and the dysfunction of the lung in descending and dispersing.

Syndrome differentiation:

Invasion by exogenous pathogenic factors:

1. Wind-cold

Main manifestation:

Cough, itching of the throat, thin and white sputum, aversion to cold, fever, headache, stuffy and running nose, thin white tongue coating and superficial pulse.

2. Wind-heat

Main manifestation:

Cough with yellow and thick sputum, choking cough, thirst, sore throat, fever, or headache, aversion to wind, sweating, thin, yellow tongue coating, floating and rapid pulse.

Internal injury

1. Blockage of the lung by phlegm

Main manifestation:

Cough with profuse, white and sticky sputum, stuffiness and chest congestion, loss of appetite, white, sticky tongue coating and rolling pulse.

2. Deficiency of yin with dryness of the lung

Main manifestation:

Dry cough without sputum or with scanty sputum, dryness of the nose and throat, sore throat, spotting blood or even coughing blood, afternoon fever, hot flush, red tongue, thin coating, rapid, and thready pulse.

TCM Diagnosis:

Cough

Syndrome Differentiation:

Shaoyang Syndrome

Explanation:

Shaoyang syndrome occurs when the exterior evil is not removed and the genuine-qi is insufficient. The genuine-qi and evil qi fight each other between the exterior and the interior. The pathological changes take place between the exterior and the interior.

The patient has caught cold a week ago, and she had taken the western medicine which suppressed the symptom of fever, but had not really removed the exogenous evil. The condition is just the same as the Shaoyang Syndrome.

The manifestations are alternate fever and chill, aching body, aversion to cold, chest distress, reluctant to eat, dryness in throat, mouth and tongue coating. Since the patient’s cold has happened for a week, the evil is not staying in the exterior, but in between half ways. It develops into an internal injury to the zang-fu. So her cough is caused by the dryness of the lung with the yin deficiency, leading to the spleen deficiency which gives rise to internal dampness whose excessive accumulation produces phlegm. Phlegm damp goes up into the lung, generating heat, causing sore throat and difficult to expectorate sputum.

The patient does not like to eat and have full tummy, tight chest, bitter taste because the Shaoyang meridian travels through the chest; the Gallbladder qi, which is suppressed by the evil, invades the stomach, causing the above symptoms.

The rapid and thin pulse indicates the internal heat produced by the yin deficiency. The dim and corpulent tongue body suggests the qi deficiency.

Treatment Principles:

Harmonize Shaoyang

Points, Therapies and Explanations:

Using filiform needles with even method to harmonize the Shaoyang

Zusanli ± ---the He-sea point of the Stomach meridian , supports the genuine qi and fosters the original qi,

Chize ± --- the He-point of lung meridian, clears heat from the lung and descends rebellious qi,

Waiguan ± ---Luo-connecting point of SJ, expels wind and releases the exterior

Yanglingquan ± --- He-sea point of Gallbladder, harmonizes Shaoyang

Life Style Advice

Do regular exercises to strengthen body

Sleep early and wake up early

Eat more vegetables and fruits

Drink more water

Have a fresh air environment

Case Conclusion

The patient’s complaint is severe cough for one week. The diagnosis is Cough and the syndrome differentiation is Shaoyang Syndrome. It is the half-exterior and half-interior syndrome, in which exogenous evil is not yet removed but fighting with the genuine qi in the half way. The patient’s symptoms are fit to this category. The most significant symptom is the alternate chill and fever. Although the patient claimed that she had no fever, it was only suppressed by the antibiotics she has taken for 3 days. The patient is aversion to cold and feels cold, but at the same time, she has sore throat and burning sensation when she is coughing. The treatment principle is to harmonize Shaoyang. So the manipulating method is even. The chosen points are: Zusanli ± Chize± Waiguan ± Yanglingquan ±. Unfortunately, the patient did not come again because she went to see the western doctor. I have no chance to see the result.

Case Study TCM

seonah hong 06010102

RECORD OF FIRST VISIT

NAME OF STUDENT CLINICIAN: SEONAH HONG NAME OF SUUPERVISOR: MAI

DATE: 3/7/08 GENDER:F AGE:23

CHIEF COMPLAINTS: INSOMNIA for 1MONTH

DESCRIPTION ( 4 DIAGNOSTIC METHODS):

ASKING: The patient has suffered from insomnia for 1 month. 1 month ago, she had lots of stress from her school exam. She feels very tired but, she cannot easily fall in sleep. During sleep, she doesn’t wake but has dream a lot. The dream is like busy. She sleeps for 3~4 hours. Sometimes she has headache. No medication or treatment.

Present symptoms: insomnia, sometimes headache, slightly fever, appetite is ok, normal urination, little bit hard defecation, sometimes bitter taste in the mouth, chest depression, tired, cold water drinking, thirst, no palpitation, no swollen, normal sweating

Past history: NAD

LIFESTYLE:, Drinking 2 per month(1 cup of wine)

MENSTRUATION: 15 6/30 Single with no child,

She had menses last month. 6^th~11^th red color with little clots

FAMILY HISTORY: NAD

INSPECTION:

General: 9/10 vitality, free movement, little bit reddish complexion, normal posture

Tongue: Red tongue with thin white little yellowish coating

Auscultation/Olfaction:

Sound: speak clearly and breathing is ok

Odors: NAD

PALPATION:

Body areas: NAD

Pulse: rapid and taut

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case summary

Definition:

insomnia is a condition that makes the patient unable to have normal hours of sleep. it has different patterns: difficulty in falling asleep after retiring, early awakening, inability to sleep again after awakening, intermittent waking through the period of attempted sleep and even inability to sleep all the night.

WMS:

Insomnia is a condition in which people have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. Other people may have the opposite problem, or they have trouble with both falling asleep and staying asleep. The end result is poor-quality sleep that doesn’t leave people feeling refreshed when people wake up.

Insomnia is a common health problem. It can cause excessive daytime sleepiness and a lack of energy. Long-term insomnia can cause you to feel depressed or irritable; have trouble paying attention, learning, and remembering; and not do your best on the job or at school. Insomnia also can limit the energy you have to spend with friends or family.

Insomnia can be mild to severe depending on how often it occurs and for how long. Chronic insomnia means having symptoms at least 3 nights per week for more than a month. Insomnia that lasts for less time is known as short-term or acute insomnia.

Secondary insomnia often resolves or improves without treatment if you can eliminate its cause. This is especially true if the problem can be corrected soon after it starts. Better sleep habits and lifestyle changes often help relieve insomnia. You may need to see a doctor or sleep specialist to get the best relief for insomnia that is persistent or for which the cause of the sleep problem is unclear.

Seonah 06010102

TCM etiology and pathogenesis:

1. Deficiency of Both the heart and spleen qi: anxiety and overwork dmage the heart and spleen. blood is exhausted, the deficient heart can not hold the mind while qi and blood production becomes poor in case of deficiency of the spleen qi. blood deficiency is unable to nourish the heart, leading to insomnia. Difficulty in falling asleep, dreamy, palpitation, poor memory, lassitude, anorexia, sallow complexion, pale tongue with thin coating, thready, weak pulse.

2.Disharmony between the heart and kidney: congenital deficiency, indulgent sexual intercourse, or a chronic illness damages the kidney yin. the kidney water fails to ascend to the heart to check the heart fire. A violent emotional fit can induce flaring of the heart fire which fails to descend to the kidney to control the kidney water, then the heart yang is hyperactive and excess of the heart fire injures the mind and hence insomnia results.-restlessness, poor sleep, dizziness, tinnitus, dry mouth with little saliva, burning sensation of the chest, palms and soles, red tongue, thready, rapid pulse, or nocturnal emission, poor memory, palpitation, lumber pain

3.Upward disturbance of the liver-fire: emotional depression causes the stagnation of qi in the liver. The stagnation qi of long duration is transformed into fire, which flares up and disturbs the mind, and then insomnia occurs.-irritability due to insomnia, dreamy sleep, headache, bitter taste in the mouth, distension in the costal region, string-taut pulse.

4.Dysfunction of the stomach: irregualr food intake damages the spleen and stomach. The accumulated undigested food causes dysfunction of the stomach and insomnia as stated in Internal classics that sleep is disturbed if the function of the stomach is in disharmony-insomnia, suffocating feeling and distending pain in the epigastric region, poor appetite, difficult defecation, sticky tongue coating, rolling pulse.

TCM diagnosis: Insomnia

Syndrome differentiation: Upward disturbance of the liver-fire

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Explanation:

Lots of stress from school exam causes the stagnation of liver qi and disturbing the mind and dreamy sleep so that insomnia occurs. Due to the patient cannot sleep enough, she always feels tired. Liver qi stagnation came from his emotional problem and it transformed to heat. So he has heat symptoms such as red tongue body, reddish complexion, rapid pulse, prefer cold drink. Causes of the liver qi stagnation, the meridian blockage occurs, so that the headache, chest depression present.

Treatment principle:

Regulate the liver qi stagnation and calm the mind

Points and therapy: taichong, shenmen, sishencong, sanyinjiao, anmian, xingjian

sanyinjiao: nourish the liver, pacify the mind

anmian: soothe the mind

Taichong: circulate qi and regulate the liver qi

Shenmen: nourish the mind

Sishencong: calm the mind

Xingjian:calms liver fire and mind

Lifestyle:

l Exercise helps promote good health, and good health allows us to combat common disorders including insomnia. Even light exercise is better than no exercise when it comes to improving your sleep. The best time to exercise is in the morning or afternoon, when people will get a burst of energy from people’s activity and avoid exercising 3 to 4 hours before bedtime, because this can reduce the quality of sleep or promote insomnia. Stretching is a great way to ease into an exercise routine.

l Diet-

A healthy diet can also encourage sleep filled nights. should try eliminating the following foods from diet. They can all contribute to insomnia.

· Coffee

· Tea

· Soda

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· Spicy Food

· Chocolate

· Alcohol

· Have some hobby to get rid of the stress. Don’t think about the school exam

· Foods With Heavy Sauces

take some time to evaluate people diet. Rich foods can slow digestion and leave people feeling uncomfortable at night. Coffee and other stimulants can cause people to wake during the night or experience trouble falling asleep. Processed foods including those filled with refined sugar can cause dramatic fluctuations in blood sugar levels. This can also lead to insomnia.

Conclusion

I had one patient who had insomnia before. His insomnia was because of the Deficiency of Both the heart and spleen qi. Now he is ok with sleep. He said my lifestyle advice was a good information so I was happy to tell the lifestyle advise to this patient as well. She had just one treatment and I will see her again. When I meet her again, the time will be her school exam finished. So I think she will get better soon. Because I think her insomnia is from the stress of school exam. So when the exam finished, I expect that her insomnia also get better. And plus my treatment.