Shoulder pain for several years

Date of first visit: Mar 16, 2009

Name: Mrs Age: 67yrs Gender:Female

Address & Contact No. :

Chief complaints

Shoulder pain for several years

Descriptions (4 diagnostic methods)

A: Asking

Current condition	There was no injury happened. She doesn’t remember when the pain started. The pain is always there. Massaging the area with hot water makes her feel better. Her appetite is not bad and eats quite a lot. She likes spicy food and doesn’t drink water too much. She has no problem with urination because she had an operation for frequent urination 10 years ago. She has a normal defecation. Normally she goes to bed at 12 and wakes up at 5 but she is difficult to go to sleep and easy to wake up. She wakes up often during the night and has a lot of dreams. She has no sweating, aversion to cold and cold in 4 limbs. Low back pain
Past history	She has an inflammation in ST and took a medicine 2 years ago.
Life style	Pensiveness, worry, angry. Her husband is sick and lives in a rest house. Her family is in Korea and lives alone now Playing golf regularly
Family history	Mum and granddad with hypertension
Menstruation	NAD

B: Inspection

General	Short and thin, vitality 6/10
Others	NAD
Tongue	Teeth marks, thin white coating

C: Auscultation/ Olfaction

Sound	Tinnitus on the right ear for 4~5years
Odour	NAD

D: Palpation

Body area	NAD
Pulse	Slippery

Case Summary

Definition: Pain in the shoulder which may be aching, dull, or stabbing in character. In the case of a sudden occurrence, the pain may be severe with the upper arm and the elbow involved.

There is atrophy of the muscles in the shoulder with more than two sensitive tender points. For instance, under the acromian or in the anterior part of the shoulder.

Both active and passive movements of the shoulder joint are limited, especially abduction, external rotation and elevation.

WMS

Description: What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility has its price, however. It may lead to increasing problems with instability or impingement of soft tissue resulting in pain. You may feel pain only when the shoulder is moved, or all of the time. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Causes: A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might experience soreness after activities such as painting, lifting or playing a sport, which require you to lift

your arms. Or you may not remember any specific injury.

The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.

Teatment: Treatment generally involves altering activities, rest and physical therapy to help you improve shoulder strength and flexibility. Medication may be prescribed to reduce inflammation and reduce pain. If medication is prescribed to relieve pain, it should be taken only as directed. Injections of drugs may also be used to treat pain. Surgery may be required to resolve shoulder problems; however, 90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise and medication. Certain types of shoulder problems, such as recurring dislocation and some rotator cuff tears may require surgery. Common sense solutions such as avoiding overexertion or overdoing activities in which you normally don't participate can help to prevent shoulder pain.

TCM

Etology & Pathology

1.Wind-cold : Acute pain in the shoulder joint that is aggravated by exposure to cold and application of het, a feeling of cold

2.Damp-cold : Ache in the shoulder region that may extend to the scapula region, a feeling of heaviness, numbness, coldness on palpation.

3.Stagnation of Qi and stasis of Blood : Pain in the shoulder joint, rigidity of the shoulder, a feeling of distention

TCM diagnosis : Shoulder pain

Syndrome differentiation : Qi and Blood stasis underlying SP and KD Yang deficiency.

Explanation:

She has the symptoms of KD yang deficiency, marked by low back pain, tinnitus and cold in 4 limbs.

KD yang is primary yang so it could affect SP yang deficiency and she has the symptoms of SP yang qi deficiency, marked by teeth marks ,being tired all the time and aversion to cold.

SP deficiency causes the poor function of transformation and transportation and the reason of the pain in the shoulder area is the SP deficiency.

Treatment principle:

1. Circulate the Qi and Blood on the local area

2. Tonify SP and KD yang

Treatment Points and their roles:

1. Bingfeng, Naoshe, Tianshong : as local points

2. Houxi : as a distal point

3. Mingmen : Supports the LR, tonifies blood and KD and expels wind

4. Shenshu : tonifies and harmonises the KDs and strengthen the loins and benefits the ears and eyes.

5. Pishu : tonifies and harmonises the SP

Life style advice

1. Keep doing exercise, but walking instead of golf.

2. Massage the area gently for the good circulation of Qi and Blood.

3. Try to free from stress and worry by making friendship.

4. Treat Insomnia. (advised her to have an acupuncture treatment for that)

Follow up

1. First follow up at Mar 19, 2009

Not much changed. Taking the points as same as before

2. Second follow up at Mar 23, 2009

The shoulder pain has much improved, but Tinnitus is getting worse on the right.

Points : + Tinghui and Taixi.

Chronic cough for 3 years

Date of first visit: 05/3/2009

Name: Mr Mike Lee Gender: male Date of birth: 1/2/1959

Chief complaints: Chronic cough for 3 years

Description (4 diagnostic methods)

A. Asking

Present illness complaints: Mr Lee is 50 years of old. He has suffered from the chronic cough for 3 years. He was infected with a chronic cough from a person who had a cold. He has a cough on and off. He expectorates scanty and sticky phlegm occasionally. He has a tidal fever in the afternoon, itching throat but no sweating. He sleeps less time than average people’s but falls asleep immediately. He doesn’t separate cold or warm drinks. He has good appetite, normal defecation and yellowish urination. He took herb medicine for about forty days at the first time of the cough without western medication.

Past history: TB in the lung about 20 years ago and cured completely.

Lifestyle: Staying awake, alert status, pleasant, appreciates ecstatic beauty of nature, and busy

Family history: His father died of colonoma.

Marital history: Married with 2 children

B. Inspection

General: Vitality 9/10

Others: NAD

Tongue: Slightly red color with swollen, thin white coating

C. Auscultation/Olfaction

Sound: NAD

Odours: NAD

D. Palpation

Body areas: NAD

Pulse: thin and weak

CASE SUMMARY

Definition:

Chronic cough is usually defined as a cough lasting more than three weeks. Chronic cough is not a disease in itself; rather it is a symptom of other disorders.

WMS

Description:

Cough is a common presenting complaint in the frontline physician’s office, but in most patients the symptom is self limiting. In others, symptoms may persist from weeks to years and are associated with significant morbidity. Successful treatment depends on finding the cause and initiating specific therapy. The most common causes are cigarette smoking, asthma, post-nasal drip, GERD or post-viral respiratory tract infection. Multiple causes in the same patient are common. When the cough persists in spite of specific or empiric therapy and either the physician or the patient is dissatisfied with the diagnosis or treatment, referral to a specialist should be considered.

Causes:

(1) Cigarette smoking is the most common cause of chronic cough.

(2) Asthma; which is a disease of airways, resulting in difficulty breathing or wheezing.

(3) Postnasal drip and sinus problems; This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis.

(4) Gastroesophageal reflux disease (GERD); Some foods may increase reflux.

(5) Infections such as bronchitis or pneumonia; These infections can be caused by virus, bacteria or fungus.

Treatment

The treatment of cough is determined by the causes; Asthma – steroids and bronchodilators, GERD - selecting foods to take, Nasal or sinus problems – decongestants or antihistamines, Infections- antibiotics. However, patients may get symptomatic relief from over-the-counter cough medicines containing guaifenesin and/or dextromethorphan, drinking lots of water, inhaling steam, and using cough lozenges. In severe cases a doctor may prescribe codeine, which is an effective cough suppressant. It is very important to obtain a chest x-ray if a chronic cough is prolonged. For the minority of patients in whom this diagnostic approach is unsuccessful, consultation with a pulmonary specialist is appropriate.

TCM

(1) Invasion by the exogenous pathogenic factors

The lung dominates Qi and is regarded as an umbrella protecting the five Zang-organs. It governs respiration and associates with the skin and hair externally. Once the lung is attacked by the exogenous pathogenic factors the lung Qi is blocked and fails to descend, thus resulting in cough. The exogenous pathogenic factors attacking the lung is divided into two types: wind-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 caused by deficiency of yin with dryness of the lung leading to failure of Qi of the lung to descend; and caused by the deficiency of the spleen which gives rise to internal dampness whose excessive accumulation produces phlegm.

SYNDROME DIFFERENTIATION: 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: Lung yin deficiency (with dryness)

Explanation:

There are several manifestations of Lung yin deficiency (with dryness) such as scanty and sticky phlegm, a tidal fever in the afternoon, itching throat, red color tongue with swollen, thin white coating and thin and weak pulse. Some manifestations like cough, itching throat and thin white coating are relevant to wind-cold syndrome.

Treatment Principles:

Nourish yin. Eliminate dryness and descend lung qi.

Points, Therapies and Explanations:

Feishu BL13 & Zhonhfu LU1; To nourish lung yin and regulate lung qi

Lieque LU7; To be connect with conception vessel to descend lung qi and

relieve cough

Zhaohai KID6; Combining with Lieque to nourish yin and clear the throat.

Pishu BL20; To regulate the qi of middle jiao.

Dingchuan EX-BW1; To stop a cough

Life Style Advice

Do regular exercises to strengthen body

Take appropriate sleep and rest

Drink more water

Keep fresh and clean air environment

CASE CONCLUSION

The patient’s chief complaint is to have a chronic cough for three years. The diagnosis is Cough and the syndrome differentiation is Lung yin deficiency (with dryness). It results interior functional impairment in the lung leading to failure of Qi of the lung to descend which causes cough. The treatment principle is to nourish yin and to descend qi. The chosen points are Feishu BL13 , Zhonhfu LU1, Lieque LU7, Zhaohai KID6, Pishu BL20, and Dingchuan EX-BW1.

Acid reflux for over 1 year

Name of Student clinician: Minjung Shin Name of supervisor: Mei

Age : 50 years Gender : Female

Chief Complains : Acid reflux for over 1 year

Description (4 diagnostic methods)

A) Asking

- Present illness history : She has suffered from the acid regurgitation for over 1 year. It started with stress from work. It generally gets worse at night and after taken greasy and oily food. She has takes 2 tablets of “ Losec ” everyday after have dinner, it makes her feel better.

Accompanying symptoms are stiffness of shoulder ( tenderness on the Jianjing – both side ), nape ( Fengchi ), anxiety and nausea. Also, she is infected with a Hepatitis C virus for a long time and the side effect symptoms that are suspected to be related with the HCV are orange color urination and hair falling down.

- Present Symptoms : Good appetite, No chill and fever, No abnormal

sweating, No feels thirst and prefers warm drink ( Mixed for cold and hot water ), Sleeping is good with vivid dreams ( dreams about busy things, feels tired after wakes up, sleeping 7 hours – 11pm~6am ), Urine ( normal amount, orange color of urine without foam, fish smell ), Loose stool ( 1~2 times per day, strong smell without indigested food, no abdominal pain ), Myopia, Nausea, Acid reflux, Cold foot and hands, Stressful, Emotional, Irritability, Depression, Tinnitus ( right side ), Dry eyes.

- Past history : Currently infected with Hepatitis C Virus

- Life style : Smoking, No drinking, Fast eating, Stressful

- Family history : Mother : stroke, high blood pressure

Father : high blood pressure

- Menstruation, marital & obstetrical history : Menopause 6 years, married, have two sons and three daughters. – all natural childbirth.

7 days

13 years-------- ( Menarche at 13 years old, 28 days cycle, 7 days

28 days duration, Menopause 6 years )

Scanty menses, dark color, watery ( light menses ), sore back and lower abdominal pain before menarche.

B) Inspection

General : Sallow complexion, 6/10 vitality, normal movement

Tongue : Purplish tongue body with thick yellow coating, and crack on the middle

C) Auscultation / Olfaction

Sound : Speak clearly, breath is normal

Odor : NAD

D) Palpation

Pulse : Right side – deep and thready

Left side – deep and taut

Body areas : Tenderness on the both side of Jianjing and Fengchi

CASE SUMMARY

DIAGNOSIS

A) Diagnosis : Acid reflux

B) Syndrome Differentiation : Liver Qi stagnation invades Middle-jiao

C) Explanation

She has suffered from the acid regurgitation due to stress.

This pattern is usually caused by emotional problems that affect such as stress and depression. These emotions, over a long period of time, cause Liver Qi to stagnate and this interferes with Spleen function.

The Liver’s function of ensuring the smooth flow of Qi has a deep influence on the emotional state. If this function is impaired, the circulation of Qi is obstructed, Qi becomes restrained giving rise to emotional stress and anxiety, accompanied by such stiffness of shoulder and nape, irritability, anxiety, depression, purplish tongue body, sleeping with vivid dreams, and taut pulse.

Long term of Liver Qi stagnation can generate heat (yellow tongue coating) to consume of Yin such as blood. If Liver blood is deficient, there may by myopia, dry eyes, and hair falling down.

Hepatitis virus infection usually refers as Liver related problems and blood stasis which may lead to impairment of Spleen Qi. If it invade the Spleen, it obstructs the transformation and transportation of food and prevents Spleen Qi from flowing upwards and resulting in loose stool, acid reflux aggravated by over taken greasy or oily foot, cold four limbs, feels tired after wakes up in the morning, sallow complexion, low voice, and deep-thready pulse.

If stagnation of Liver Qi invade the Stomach preventing the downward movement of Stomach Qi and resulting in nausea, and acid regurgitation.Heat in the Stomach burns the fluids, hence odour in the mouth (foul breath), thick yellow coating, and crack on the middle of tongue.

She Kidney Qi is also deficient due to various factors such as from ageing, using drugs for long term and smoking when she was young. These long term factors damage the Kidney. The deficient of Kidney Qi will leads symptoms of tinnitus, urine disorder (orange color of urine without foam, fish smell), and deep-thready pulse.

TREATMENT

A) Treatment Principles :

- Sooth Liver Qi, promotes circulation of Qi, activate Qi, remove stasis, strengthen Middle-jiao and tonify Kidney to stop acid reflux.

B) Treatment Method

1. Needling

Prescription : Taichong LV-3 (-), Zhongwan Ren-12 (+), Sanyinjiao SP-6 (+),

Zusanli ST-36 (+), Qihai Ren-6 (+), Taixi KD-3 (+),

Tianshu ST-25 (+)

Explanation : Filiform needling (reinforce and reducing methods applied) technique chosen to regulating meridians for sooth Liver Qi, promotes circulation of Qi, activate Qi, remove stasis, strengthen Middle-jiao and tonify Kidney to stop acid reflux.

► Taichong (LV-3 ) (reduce) ; is the Yuan – ( Source ) Point of Liver

Meridian, it used sooth Liver and regulate flow of Qi..

► Zusanli (ST-36) (reinforce) ; the He-(Sea) Point of the Stomach

Meridian, is promote Qi an blood to maintain health and Zhongwan

(CV-12) is the Front (Mu) points of Stomach and Converging point of

the Fu-Organs to regulate Stomach and strengthen Spleen.

► Sanyinjiao (SP-6) (reinforce) ; is the Crossing Points of Three Yin

Meridians such as Kidney, Liver and Spleen, it used for strengthen

Spleen, Liver and Kidney.

► Tianshu (ST-25) (reinforce) ; Front (Mu) point of Large intestine,

it important point for regulate to Middle-jiao of Spleen and Stomach.

► Qihai (CV-6) (reinforce) ; for dysfunction of Spleen to tonify Spleen.

► Taixi ( KD-3) (reinforce) ; the Yuan-(Source) and Shu-(Stream) Point of the Kidney Meridian, is reinforce method to tonify Kidney.

6. Life Style Advice

► Eat smaller, more frequent meals.

► Limit your intake of acid-stimulating foods and beverages.

► Don't eat within two to three hours before bedtime.

► Elevate your head a few inches while you sleep.

► Maintain a reasonable weight.

► Don't wear belts or clothes that are tight fitting around the waist.

► Don't smoke.

► Don't drink alcohol.

► Relax.

► Keep a heartburn record.

Acid Reflux

DEFINITION

Acid reflux, commonly called heartburn, is a condition in which the liquid contents of the stomach flow upward into the esophagus, the muscular canal that connects the throat to the stomach. This causes a burning sensation that can damage the inner lining of the esophagus.

TCM ETIOLOGY and PATHOGENESIS

The common causes of acid reflux are immoderate eating and drinking, emotional upsets, psychic trauma, overstrain affection of cold, etc. However, these causative factors lead to acid reflux only when the Spleen and Stomach are dysfunction. Although the Spleen and Stomach are the organs chiefly involved in this disorder, other organs may also be affected, particularly the Liver.

Diet - Sweet/greasy/hot & spicy or bad quality food

Exterior pathogen invasion - Cold invade Middle-Jiao

– Deficient Yang Qi turns to turbid dampness causing acid

Emotion - Liver attacks Stomach (sour flavour)

- Spleen creates damp/phlegm which creates acid

Deficiency Middle Jiao - Congenital dysfunction, retention of food, can’t transform or transport which creates acid

WMS – Acid Reflux

DEFINITION

This is common condition and abnormal one. In which acid in the stomach rises up into the esophagus. This occurs because the valve separating the contents of the stomach from the esophagus does not function properly.

CAUSE

A number of factors may contribute to the appearance of acid reflux. Obesity, smoking, pregnancy and the consumption of certain types of foods (such as spicy foods) may all be involved. Genetic factors may also predispose a person to getting acid reflux. The condition develops when the passage of food from the throat, through the esophagus and into the stomach is disrupted. One cause of this disruption may be a hiatal hernia, a condition in which the upper part of the stomach projects upward into the esophagus. Another possible cause of acid reflux is a malfunctioning esophageal sphincter, the valve between the esophagus and stomach that controls the flow of food from the mouth into the digestive system.

TREATMENT

Physicians normally recommend lifestyle modifications, whether or not recommending drugs to treat GERD.

► Foods

- Eating within 2-3 hours before bedtime.

- Coffee, alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux.

- Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these may help. Fat also delays stomach emptying.

- Acidic foods: tomatoes and tomato-based preparations; citrus fruits and citrus juices.

► Drug treatment

- Proton pump inhibitors (such as omeprazole, pantoprazole, lansoprazole, and rabeprazole) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.

- Gastric H₂ receptor blockers (such as ranitidine, famotidine and cimetidine) can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a number needed to treat of eight (8).

- Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase pH).

- Prokinetics strengthen the lower esophageal sphincter (LES) and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing Long QT syndrome.

- Sucralfate (Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.

► Posture and GERD

In adults, a slouched posture is an important factor contributing to GERD. With a slouched posture there is no straight path between the stomach and esophagus; muscles around the esophagus go into a spasm. Gas and acidity get blocked in the spasm, causing coughing and other asthma-like symptoms.

PREVENTION

People with heartburn should avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, and alcohol.

Both caffeinated and decaffeinated coffee increase acid secretion.

· All carbonated drinks increase the risk for GERD.

· Although physicians often advise patients with GERD to cut down on fatty foods, studies are finding no evidence that a low-fat or high-fat meal make any difference in symptom exacerbation. Better studies are needed to confirm this. In any case, as a rule, it is always wise to avoid saturated fats (which are from animal products), and cut down on all fats if one is overweight.

· Increasing protein may help strengthen muscles in the muscle valve. Patients should choose low-fat or skim dairy products, poultry, or fish, in such cases.

· Whole grain products rich in selenium may have some protective role against dangerous cells changes in Barrett's esophagus.

· Patients should have a diet rich in fruits and vegetables, although avoid acidic vegetables and fruits (e.g., oranges, lemons, grapefruit, pineapple, tomatoes).

Follow up Consultations

Date: 01 / 09 / 2008 , 13 / 09 / 2008

Treatment Number : 2, 3

TCM Disease : Acid reflux

TCM Type / Pattern : Liver Qi stagnation invades Middle-jiao

Current Condition/changes:

- After 1^st treatment, acid reflux and nausea are much getting improved than before. Suggest to her stop taking medication during the acupuncture treatment.

- Tongue : Purplish tongue with thick white coating, crack.

- Pulse : Right - deep and thready Left – deep and taut

Treatment Adjustment: Sooth Liver Qi, promotes circulation of Qi, activate

Qi, remove stasis, strengthen Middle-jiao to stop acid reflux.

Prescription Adjustment: Jianjing GB-21 (-), Fengchi GB-21(-),

Jingbailao EX-HN-15 (-)Ganshu BL-18 (+), Pishu BL-20 (+),Geshu BL-17 (+)

Explanation:

► Jingbailao ( EX-HN-15 ) (reduce) ; It located on the nape, reducing methods to promote circulation of Qi and blood in local area to reduce nape pain.

► Jianjing ( GB-21 ) (reduce) ; The Crossing Point of Sanjiao Meridian, Gallbladder Meridian, Stomach Meridian and Yang Link Vessel, it used reduce method for promote circulation of Qi and blood in the local area to treat shoulder pain.

► Fengchi ( GB-20 ) (reduce) ; The Crossing Point of Gallbladder Meridian and Yang Link Vessel, used reduce method for promote circulation of Qi and blood in the local area and release nape pain.

► Ganshu ( BL-18 ) (reinforce) ; the Front-(Mu) Point of the Liver, it used for strengthen Liver.

► Pishu ( BL-20 ) (reinforce) ; the Front-(Mu) Point of the Spleen, it used for strengthen the Spleen.

► Geshu ( BL-17 ) (reinforce) ; the Front-(Mu) Point of the Geshu, it used for nourishing blood to treat dizziness.

Lifestyle Advice (if any adjustments): Same as before

Name of Student Clinician: Minjung Shin

Name of Supervisor: Xing Mei Xie

Follow up Consultations

Date: 20 / 10 / 2008

Treatment Number : 4

TCM Disease : Acid reflux

TCM Type / Pattern : Liver Qi stagnation invades Middle-jiao

Current Condition/changes:

- Loose stool is improved. Hot sensation of 5 centers, sometimes has night sweating. Tongue body is change purplish to dim, but tongue coating is change to yellow again

- Tongue : Dim tongue with thick yellow coating, crack.

- Pulse : Right - deep and thready Left – deep and taut

Treatment Adjustment: Sooth Liver Qi, promotes circulation of Qi, activate

Qi, remove stasis, strengthen Middle-jiao to stop acid reflux.

Prescription Adjustment : Zhaohai KD-6 (+),Quchi LI-11 (-)

Explanation:

► Zhaohai ( KD-6 ) (reinforce) ; the One of the Eight Confluent Points of the Kidney Meridian, this point linking with the Yin Heel Vessel, it reinforce method to nourishing Yin to treat hot sensation in the five centers and night sweating.

► Quchi ( LI-11 ) (reduce) ; the He-(Sea) Point of the Large intestine Meridian,

It regulates nutritive Qi and blood, and clear away heat.

Lifestyle Advice (if any adjustments): Same as before

Name of Student Clinician: Minjung Shin

Name of Supervisor: Xing Mei Xie

Follow up Consultations

Date: 03 / 11 / 2008, 10 / 11 / 2008, 17 / 11 / 2008, 24/ 11 / 2008

Treatment Number : 5, 6, 7, 8

TCM Disease : Acid reflux

TCM Type / Pattern : Liver Qi stagnation invades Middle-jiao

Current Condition/changes:

- She’s symptoms are much improved. Less stress, a bit form in the stool, no

more acid regurgitation, nausea, no hot sensation in the 5 centers and night

sweating. But some tinnitus is still there. And she’s tongue coating changed

thick-yellow to thin-white without crack

- Tongue : Dim tongue with thin white coating.

- Pulse : Right - deep and wiry Left – deep and weak

Treatment Adjustment: Sooth Liver Qi, promotes circulation of Qi, activate

Qi, remove stasis, strengthen Middle-jiao to stop acid reflux.

Prescription Adjustment: Same as before

Explanation: Same as before

Lifestyle Advice (if any adjustments): Same as before

Name of Student Clinician: Minjung Shin

Name of Supervisor: Xing Mei Xie

Case Conclusion

She has acid reflux and nausea due to Liver Qi stagnation invades Middle-jiao from stress, and she received 8 treatments in total. My treatment principle was sooth Liver Qi, promotes circulation of Qi, activate Qi, remove stasis, strengthen Middle-jiao and tonify Kidney to stop acid reflux.

She was keep taking the medication while the acupuncture treatment. I had to make sure that the effectiveness of the acupuncture treatment by asking her to stop taking the medication during acupuncture treatment after 2^nd treatment, otherwise I couldn’t know my treatment make to improve the symptoms or medication is help to her release the symptom. After quitting the medication, she assures that the symptoms really have improved with the acupuncture treatments. She is very happy with the results and that she could quit medication with the acupuncture treatment. She is very relaxed and can feel her stress is relieved day by day with the treatments as well as long term problems of acid reflux and nausea has improved very quickly.