| 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. 86 year old, Caucasian female CC: Neck pain, started 2 months ago, on the left side. The pain radiates down to the upper arm, and recently moving to the right side. Treatments received for present condition include physical therapy and pain medication Vicodin. Medications: Iron for anemia, Norgesic, Vitamin D for calcium absorption, Provera hormone replacement, Lipitor for high cholesterol, Microzide for hypertension, Estrace hormone replacement used to prevent osteoporosis, Vicodin for pain relief, Altace for hypertension Surgeries: None Other: The patient has osteoporosis, and a minor arrhythmia. She has a history of breast lumps in both breast but on different occasions. She also has anemia, high blood pressure, and high cholestoral. She has no other major illnesses. History: The patient has been experiencing neck pain for the past two months. The pain started on the left side of the lateral side of the neck, and radiated down to the upper arm. For the past couple of weeks, the pain is moving around to the right side of her neck. She has a very limited range of motion, approximately 20 degrees, at which point the pain is aggravated. She also experience headache that radiate to the vertex and are associated with her neck pain. She also has low back pain and knee pain, and tinnitus. She frequently experiences dizziness, especially in the morning. Her muscles generally feel tight. Her energy varies day to day. Some days she has a lot of energy, and may not need to take her usual afternoon nap, other days her energy is less. She has trouble getting up out of bed in the morning, especially during the cold weather. The PIPs in her hands are painful and deformed. She exercises regularly which include stationary bicycle and walking. Tongue: Pale, thin white coating Pulse: Right side: Thready, wiry Left side: Thready, irregular TCM Diagnosis: kidney essence deficiency, qi and blood deficiency, wind damp bi Treatment Principle: Tonify kidney essence, nourish the blood, drain damp, subdue wind. Western Approach: Osteoarthritis (Degenerative Joint Disease): An athrophy with altered hyaline cartilage and characterized by loss of articular cartilage and hypertrophy of bone, producing osteophytes. OA is the most common articular disorder, begins asymptomatically in the 2nd and 3rd decades and is extremely common by the age of 70. Primary generalized OA involves the distal and proximal interphalangeal joints, 1st carpometacarpal joints, intervertebral disks and zygaphophyseal joints in the cervical and lumbar vertebrae, 1st metatarsophalangeal joint, hip and knee. Subsets of primary OA include erosive, imflammatory OA and rapidly destructive OA of shoulders and less often of hips and knees in the elderly. The pathophysiologic process of OA is progressive. Triggered by change in the microenvironment, the chondrocytes undergo mitosis and increase synthesis of proteoglycans and type II collagen. Then Synthesis of bone by subchondral osteoblasts increases, presumably prompted by, intercellular communication by cytokines between chondrocyte and osteoblast. With increased bone formation in the subchondral area, physical properties change, the bone becomes stiffer with decreased compliance and microfractures occur, followed by callus formation, more stiffness, and more microfractures. Finally bony cysts form in the marrow below the subchondral bone. Bony cysts result from extrusion of joint fluid through the hyaline cartilage clefts into the marrow, with fibroblastic and osteoblastic cellular reaction. OA of the cervical and lumbar vertebrae may lead to myelopathy or radiculopathy. However, the clinical signs of the former are usually mild. At the disk level, marked thickening and proliferation of the anterior longitudinal ligaments result in transverse bars encroaching on the anterior spinal cord. Hypertrophy and hyperplasia of the ligamentia flava often compress the posterior cord. Radiculopathy is less frequent because the anterior and posterior nerve roots, ganglia, and common spinal nerve are well protected in the intervertebral foramina, where they occupy only 25% of the available and well cushioned space. Western Treatment: Physical fitness is of utmost importance. Daily stretching exercises are the best form. Immoblization for relatively short periods of time can accelerate and worsen the clinical course. There is no evidence that NSAIDs, which are widely used, have any long term benefit on OA. Acetaminophen in does of up to 1g qid is a useful analgesic and is generally safer than NSAIDs. COX-2 inhibitors control inflammation and decrease pain with fewer gastrointestinal side effects. Muscle relaxants in low doses occasionally provide temporary relief when muscles strained by attempting to support OA joints. Drug therapy is the least important aspect of optimum management, and only accounts for 15% of a total program. Commercial preparations of Hyalgan and ARTZ by injection, resulted in measurable improvements using clinical radiological, and laboratory criteria. Laminectomy, osteotomy, and total joint replacement should be considered when conservative fails. In addition to an exercise program, transcutaneous electrical nerve stimulation and local rubs are other adjunct therapies. Acupuncture: Kid 3, Sp 6, GB 20, GB 21, GB 39, UB10, UB 11, Ashi points, Luo Zhen Cupping on neck and shoulders. Explanation of Points: GB 20 Stiff neck GB 21 Pain and rigidity of neck GB 39 Influential point of marrow for osteoporosis, neck pain Sp6 Strengthen spleen resolves damp, tonifies kidney/yin/blood, move blood, stops pain UB 10 Neck rigidity UB 11 Influential point of bone for osteoporosis and neck pain Kid 3 Tonifies kidney, benefits essence Herbal Formula: Modified Duo Huo Ji Sheng Tang Qiang Huo 9, Du Huo 9, Sang Zhi 20, Fang Feng 6, Yan Hu Suo 6, Dang Gui 15, Chuan Xiong 6, Bai Shao 12, Shu Di Huang 12, Du Zhong 15, Sang Ji Sheng 10, Tu Si Zi 12, Ba Ji Tian 10, Yin Yang Huo 9, Ji Xue Teng, Huai Niu Xi 9, Fu Ling 9, Zhi Gan Cao 6, Chen Pi 9, Dan Shen 12 Explanation of Formula: Qiang Huo Dispel wind, cold and dampness, relieves pain in the upper part of the body Du Huo Dispel wind dampness, relieve pain Sang Zhi Anti rheumatic and anti spasmodic, relieves pain in the upper part of the body Fang Feng Dispels wind, cold and dampness, relieves spasms Yan Hu Suo Invigorate blood, removes stasis, analgesic and sedative Dang Gui Nourish and invigorates blood, for anemia and blood stasis Chuan Niu Xi descends blood, and prevents the blood from rising to head with liver yang rising, benefit low back and knees Bai Shao Nourish blood, and relieve spasms Shu Di Huang Nourish blood and essence Du Zhong and Sang Ji Sheng tonifies and nourishes liver and kidneys Sang Ji Sheng Dispel wind and cold, strengthens sinews and bones, nourish blood Tu Si Zi Nourish kidney essence Ba Ji Tian & Yin Yang Huo Nourish kidney, strengthen bones and tendons, dispel wind and dampness Ji Xue Tang Invigorate and tonify blood, clear the channels and collaterals Huai Niu Xi Invigorate blood, nourish liver and kidney to strengthen bones and tendons Fu Ling and Chen Pi Strengthen spleen, dry damp Dan Shen Invigorate blood Zhi Gan Cao Harmonize the formula 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 |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |