| Traditional Chinese Medicine Cases |
The cases below are for educational purposes and not for self diagnosis and treatment. Please see a professional for a proper assessment and treatment. 38 year old, Caucasian female, CC: Abdominal pain radiating to the back The patient has been experiencing these episodes of abdominal pain, which radiates to the back since the age of 13. A recent endoscopy indicated an inflammation. She has been taking Mylanta and Maalox, but does not find much relief. Medications: None, except occasional use of Mylanta and Maalox. Multi-vitamins Surgeries: Gallstones -- 1990 Other: Indigestion, gas, bloating, heartburn, big appetite with a tendency to eat sweet foods, constipation, history of gallstones, menstrual cramps, PMS, delayed menstruation, fatigue, anxiety, stress, worries a lot, feeling of coldness with cold limbs, oily skin, rosacea, insomnia, and dream disturbed sleep. History: The patient has been experiencing an abdominal pain that radiates to the back since the age of 13. She was under a lot of stress while growing up. Her mother was overbearing and always told her she did not do well enough in anything, and that she is not smart or beautiful, and constantly humiliated and criticized her. Later she moved to the United States from Europe, and got married, and shortly after that she was divorced. Her marriage was not a good experience, and her ex-husband was very abusive, similar to that of with her mother. Her pain is aggravated by stress and emotional upset. She also has indigestion, gas and bloating, and is constipated most of the time. She has a very big appetite and tends to crave sweets, although is a not over weight, and is a petite woman. She only has one bowel movement per week. She has always had menstrual cramps since she first began her cycles. Her cycles are slightly delayed with a 30-35 day cycles. She has a lot of stress related to work, and her long daily commute. She worries all the time, and experiences anxiety when in large crowds. She does not feel confident about her self. The patient always feels cold and always has to wear a sweater all the time, and her hands and feet always feel cold as well. She has been diagnosed with rosacea, her complexion is very red on the entire face, except around the eyes, and her skin is very oily. She has to wipe her skin every couple of hours, and even though she washes her hair every day, her scalp is always oily too. The patient has trouble falling asleep, and when she does it is very light and she can wake up upon hearing the slightest sound, and also has a lot of bad dreams. Tongue: Dusky, pale, greasy white coating, slightly puffy, teeth marks Pulse: Right side: thready, wiry Left side: wiry, slippery TCM Diagnosis: Spleen qi deficiency, liver qi stagnation, liver over acting on the spleen and stomach, damp accumulation. Shang Han Lun diagnosis for constipation Line 214: Yang Ming Fu Xiao Cheng Qi Tang Si Ni San Syndrome in Shang Han Lun, Line 318 Reversal due to live and stomach stagnation resulting in depressed yang. Treatment Principle: Tonify spleen qi, sooth the flow of liver qi, harmonize liver and spleen, drain damp Western Approach: Dyspepsia-- A working team defines dyspepsia as a pain or discomfort centered in the upper abdomen. The discomfort may be characterized by or associated with upper abdominal fullness, early satiety, burning, bloating, belching, nausea, retching or vomiting. Patients with dyspepsia often have heartburn as an additional symptom. Dyspepsia occurs in 25% of the adult population and accounts for 3% of general medical office visits. Functional dyspepsia is the most common cause of chronic dyspepsia. Up to two thirds of patients have no obvious organic cause for their symptoms after evaluations. Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying or impaired accommodation to food, or psychosocial stressors. Although benign, these symptoms may be chronic and difficult to treat. Given the nonspecific nature of dyspeptic symptoms, the history has limited diagnostic utility. It should clarify the chronocity, location, and quality of discomfort. Potentially offending medications and excessive alcohol use should be identified and discontinued if possible. Many patients report a fear of a serious underlying condition. Recent changes in employment, marital discord, physical and sexual abuse, anxiety, and depression may all contribute to the development and reporting symptoms. Upper endoscopy is the study of choice to diagnose gastroduodenal ulcers, erosive esophagitis, and upper gastrointestinal malignancy. The optimal cost effective approach to dyspepsia is controversial. Upper endoscopy is indicated in all patients over 45 year of age with new onset dyspepsia, and in all patients with weight loss, dysphagia, recurrent vomiting, evidence of bleeding, or anemia. Western Treatment: General measures include a stable physician-patient interaction is the most important aspect of therapy. Patients require reassurance that the condition is not serious but may be chronic. Alcohol and caffeine intake should be reduced or discontinued. A food diary, in which patients record their food intake, symptoms, and daily events may reveal dietary or psychosocial precipitants of pain. Psychotherapy and hypnotherapy may be of benefit in selected motivated patients. Herbal therapies such as peppermint and caraway may offer benefit with little risk of adverse effects. Acupuncture: SP4, 6, ST 25, 36, Ren 6, 12, Liv 3, LI 4, GB 34, HT 7, GB 13, DU 24 Explanation of Points: SP 4 Confluent point of Chong Mai Harmonize middle jiao, regulates qi, resolves damp, calms the spirit, regulates chong SP 6 Tonifies the spleen and stomach, resolves damp, harmonizes the liver, regulates menstruation, calms the shen, invigorates the blood, activates channels and alleviates pain ST 25 Front Mu point of LI Regulates intestines for constipation, regulate the spleen and stomach for abdominal pain and distention, resolves dampness, regulates qi and blood and eliminates stagnation for dysmenorrhea, irregular menstruation ST 36 He Sea point Harmonizes the stomach, fortifies the spleen and resolves damp, tonifies qi, clears fire and calms the mind, activates the channels and alleviates pain Ren 6 Sea of qi fosters original qi, tonifies qi, regulates and harmonizes blood Ren 12 Front Mu point of stomach harmonizes middle jiao, tonifies stomach and fortifies the spleen, regulates qi, alleviates pain Liv 3 Spreads liver qi, regulates menstruation, regulates lower jiao Liv 14 Front Mu point of liver spreads the liver and regulates qi, invigorates blood, harmonizes liver and stomach LI 4 Activates channels and alleviate pain, restores yang HT 7 Shu Stream, Yuan Source point, earth point, calms the spirit for insomnia GB 13 Root of the spirit, calm the shen GB 34 He Sea point spreads the liver qi and benefits lateral costal region, lcears liver and gallbladder damp heat, harmonizes shao yang DU 24 Courtyard of the spirit calms the shen Herbal Formula: Bai Shao 9, Bai Zhu 9, Bo He 3, Chai Hu 9, Da Huang 3, Chen Pi 6, Chuan Xiong 6, Dan Shen 9, Fu Ling 12, Gan Cao 6, He Huan Pi 9, Huang Qin 9, Lai Fu Zi 9, Shan Zha 12, Suan Zao Ren 12, Xiang Fu 6, Yu Jin 9, Ze Xie 6, Zhi Zi 9 Explanation of Formula: Bai Shao Nourishes blood, regulates menses, alleviates pain due to liver and spleen disharmony Bai Zhu Strengthens spleen, resolves damp, tonifies spleen and augments the qi for fatigue Bo He Allows constraint liver qi to flow freely for constraint liver qi with flank pain, emotional instability and gynecological problems Chai Hu Spreads the liver qi, relieves constraint, chest and flank pain, stifling sensation, emotional instability and gynecological disorders Da Huang Constipation, abdominal fullness Chen Pi Regulate spleen qi, resolve dampness Chuan Xiong Invigorate blood, regulate menstruation Dan Shen Invigorate blood, eliminate stasis for menstrual cramps, calms shen Fu Ling Strengthen spleen, resolve damp, calm shen Gan Cao Tonify qi, harmonize formula He Huan Pi Calm Shen Huang Qin Clear heat, eliminate damp, clear lung heat for rosacea and constipation Zhi Shi Constipation, abdominal distention Shan Zha Oily skin Suan Zao Ren Calm shen, benefit sleep Xiang Fu Regulate qi, for irregular menstruation Yu Jin Regulate qi and blood circulation, menstrual cramps, dispel heat from Pericardium Ze Xie Clear Clear damp heat Zhi Zi Clear Clear damp heat Sources: Tierney, L., McPhee, S., Papadakis, M. 2005 Lange Current Medical Diagnosis and Treatment. Lange Medical Books/McGraw Hill, New York, NY 2005 Beers M.H. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, Whitehouse Station, N.J. 1999 Sun, P. The Treatment of Pain With Chinese Herbs and Acupuncture. Churchill Livingstone, London, UK, 2002 Deadman P. A Manual of Acupuncture. Journal of Chinese Medicine Publications, England, 2001 Yeung H.C. Handbook of Chinese Herbs. Institute of Chinese Medicine, Rosemead, Ca, 1996 Yeung H.C. Handbook of Chinese Herbal Formulas. Institute of Chinese Medicine, Rosemead, Ca, 2004 Benskey, D. Chinese Herbal Medicine: Materia Medica Revised Edition. Eastland Press Inc, Seattle, Washington, 1993 |
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