Zang Fu Case Studies Flashcards
1
Q
what is the pattern? what s/sx support this? how do you TX?
- 45 yo male
- CC: palpitations
- occasional forceful beating of heart for no apparent reason
- palpitations occur when resting
- no chest pain, no dizziness
- normal blood pressure
- MD performed EKG, listened to heart with stethoscope, pronounced no abnormal findings, and said palpitations were due to stress
- pt admits to having more work-related stress over past 6 months
- as a result, his eating habits have been poor, and he has lost hours of sleep
- pale tongue, toothmarks
- soft pulse
A
HT Qi Vacuity with underlying SP Qi Vacuity
- palpitations at rest, so heart is weak: HT Qi Vacuity
- toothmarks, soft pulse: Qi Vacuity
- poor food intake leads to difficulty making Qi: SP Qi Vacuity
TX: HT 5 for palpitations
HT 6 if sweating
HT 7 if Qi Vacuity sweating
2
Q
what is the pattern? what s/sx support this?
- 59 yo female
- CC: insomnia
- insomnia of 3 months duration, since beginning of what she calls “power surges”
- falls asleep easily, but awakens in middle of night feeling warm & sweaty
- on a few occasions has soaked the sheets with sweat
- irregular menstruation during the past year (sometimes early, sometimes late, sometimes heavy, sometimes light)
- has not had any period for 6 weeks
- during “power surges” feels hot overall, sweats profusely from her face & head, and feels urgent need for cool air
- low back pain
- red tongue with redder tip & scanty coating
- fine, rapid pulse
A
HT Yin Vacuity & KD Yin Vacuity
- night sweats, red tongue with scanty coat, rapid pulse: Yin Xu
- wakes at night: HT Yin Xu
- low back pain, aged 59: KD Yin Xu
3
Q
what is the pattern? what s/sx support this? what is the pathomechanism?
- 55 yo female
- CC: pain in upper back & neck
- pale complexion with darkish hue
- short of breath
- pain on & off in neck & shoulders, between shoulder blades, and sometimes in upper abdomen
- no digestive complaints
- pain can be severe at times, and when it is, she sweats a lot from face & armpits
- long history of chronic bronchitis every winter for past 15 years
- thin, rough pulse
- pale red tongue, dusky towards front, darkish red spots on tip
A
HT Blood Stasis
- choppy pulse: blood not circulating in upper jiao
- dark complexion, dusky tongue: stasis
- sweating from face & axilla: HT
- for women, HT attacks feel like upper back pain
Pathomechanism:
- winter cold affects LU Qi, leads to 15 years of phlegm
- phlegm obstructs LU Qi & HT Qi
- obstructed qi leads to obstructed blood, and blood stasis
4
Q
what is the pattern? what s/sx support this?
- 12 yo boy
- CC: lack of communication
- mother brings 12 yo son with down’s syndrome
- he has been getting progressively more difficult to communicate with for the past 5 months
- he can no longer speak clearly, as if his tongue is too big for his mouth
- rattling sound in back of throat
- sometimes vomiting, which usually happens a day after eating ice cream, his favorite food
- seems “floppy” and lethargic most of time, adn doesn’t seem to know where he is
- not able to see much of his tongue but it looks wet with a greasy coat, and has crack that reaches tip
- slippery pulse
A
Phlegm Misting the HT Orifices, with underlying SP Qi Deficiency & Cold
- wet tongue: SP Qi Deficiency leads to lack of transformation of fluids
- slippery pulse: accumulation
- communication issues: blockage of HT
- ice cream: cold
- vomiting, rattling sound in throat, greasy tongue coat, midline crack reaching tip: Phlegm Misting HT Orifices
5
Q
what is the pattern? what s/sx support this? how do you TX?
- 43 yo female
- CC: palpitations
- on & off fluttery feeling in chest
- history of respiratory allergies
- full-time student, spends a lot of time trying to study
- disturbed sleep; wakes up several times each night, usually at 1am, and again at 3am
- pale tongue, scalloped edges, thin white coat
- wiry pulse, hollow, thin in right cun, soft in right guan
A
Blood Vacuity with underlying SP Qi Vacuity that’s unable to support blood
- disrupted sleep: blood not anchored in LV
- pale tongue: blood vacuity
- hollow pulse: vacuity
- scalloped tongue: SP Qi Xu
- allergies: LU Qi Xu somewhere along the line
- combo of SP Qi Xu & LU Qi Xu means that there is impaired manufacture of Qi & Blood
TX: HT 5 or HT 7 and SP 6, Inner 4 Gates (LI 11 + LV 3), SP 3
6
Q
what is the pattern? how do you TX?
- 34 yo male
- CC: abnormal urination
- 3 days ago, for no apparent reason, pt began to feel restless & developed a hot-dry sensation all over body
- yellow urine, scanty
- no change in frequency
- excessive sweating, but no aversion to cold
- irritable & vexed
- thirsty for cold drinks
- dream disturbed sleep
- dry stool
- no abdominal pain
- overall good health
- red complexion
- red tongue, slightly thick & dry yellow coat
- slippery, rapid pulse
A
SI Replete Heat (branch of another underlying pattern)
TX: Promote Urination (guide heat out through urination)
7
Q
what is the pattern? how do you TX? what is the pathomechanism?
- 30 yo female
- CC: fatigue
- soft spoken
- mononucleosis with extremely sore throat & swollen tonsils since 2 months ago, following stressful period at work
- fever & chills
- sx gradually improved over time, with no TX other than resting
- although throat sx gone, still persistent fatigue & SOB (can only swim half the amount of laps she could before becoming ill)
- pale tongue
- weak pulse
A
LU Qi Vacuity
TX: Tonify LU, Supplement, Boost LU Qi
Pathomechanism: wind-heat as initial insult, heat consumes & damages Qi over time
8
Q
what is the pattern? what s/sx support this? how do you TX?
- 5 yo boy
- CC: wheezing
- hx of asthma
- wheezing after upper respiratory infection
- 100 degree fever, some chills, sore throat
- lots of clear nasal discharge
- breathing with accessory muscles (SCM, raising shoulders, abdominal expansion)
- underdeveloped upper body
- bluish shadows under eyes
- seems whiny & clings to mother
- frequent urination
- currently taking inhaled corticosteroids for past week as “preventative measure”
- twin sister is vibrant strong child who is never sick, has no issues with urination, and has never had asthma
- pale tongue, red tip
- rapid pulse, floating in right cun, deep and weak in chi
A
Today: Wind Heat Invasion
Underlying problem: KD Failing to Grasp LU Qi due to KD Jing Vacuity
- underdeveloped body, blue shadows under eyes: Jing Vacuity
- asthma, straining to breathe: LU Qi Xu
TX: KD 7 + LU 8
9
Q
what is the pattern? what s/sx support this?
- 34 yo female
- CC: constipation
- “sluggish bowels”: has a BM once every other day, but can go 2 days without BM; occasionally will go every day, but feels an incomplete sensation
- feels hotter in later part of day, but “normal” in morning & early afternoon
- feels like she needs to pant at night, but has no sweating
- dry hair, dry skin
- dry sensation in throat that is not quenched by drinking water
- pale tongue but orangish, smooth with thin coat
- deep pulse
A
LI Intestinal Humor Depletion of Blood & Yin
- constipation: LI issue
- orange hued tongue, dry skin, dry throat not quenched by drinking water: blood deficiency
- panting, no tongue coat, feels hotter in later part of day: yin vacuity
- dryness: blood vacuity AND yin vacuity
10
Q
what is the pattern? what s/sx support this? how do you TX?
- 36 yo male
- CC: painful, frequent bowel movements
- diagnosed with ulcerative colitis 6 years ago
- frequent painful BM every day, sx worse in morning
- occasional hemorrhoids, which are painful & bleed
- diet is 100% take-out food from the deli, or prepackaged (never cook meals at home)
- reluctant to change diet bc no time
- stressful lifestyle, long hours at work, trying to make time for wife & daughter
- greasy, yellowish tongue coat in rear, teethmarks
- rapid, slippery pulse
A
LI Damp Heat
TX: Clear Heat, Drain Damp, Stop Bleeding
- tenesmus/ungratifying BM, painful BM, sticky yellow tongue coat, slippery rapid pulse, blood & mucus in stool: LI Damp Heat
- about equal amount damp & heat bc both blood & mucus in stool
11
Q
what is the pattern? what s/sx support this?
- 34 yo female
- CC: feeling hot
- feeling of heat in chest
- irritability
- no period for 3 months
- heat sensation worst in late afternoon
- night sweating from neck & chest
- dry throat
- red cheeks
- red tongue, dry yellow & thin coat
- rapid pulse
A
LU Yin Vacuity
- feeling hot, dry throat, red tongue with thin coat: yin xu
- sweating from neck & chest: LU issue
(irritability is the one sx you don’t follow anywhere)
12
Q
what is the pattern? what s/sx support this?
- 41 yo female
- CC: cough for 8 months
- 8 months ago: accident while vacuuming basement, and was sprayed in face with debris; started coughing the next day; started as a rapid, dry cough; difficult to catch her breath
- over the next week: cough developed into a deep phlegmy cough; clear, yellow, green or brown phlegm; most profuse in mornings, when it was clear & stringy; SOB with mild exertion
- currently: cough only phlegmy in morning; yellow or brown phlegm; spasmoid episodes of coughing the rest of day
- overall: feels hot, sweats a lot (mostly from chest & head), prone to constipation, red complexion
- long, narrow & stiff tongue, red body, yellow sticky coating in center
- rapid & slippery pulse
A
Phlegm Heat Obstructing LU
- sweating on face, red complexion: HT
- color assortment of phlegm, slippery rapid pulse, red tongue, yellow sticky tongue coat: Phlegm Heat in LU
- SOB bc of accumulation in LU
13
Q
what is the pattern? what s/sx support this? how do you TX?
- 22 yo female
- CC: nausea
- nausea worse in mornings, better after she eats
- no appetite in morning due to nausea
- abdominal distention & discomfort
- often eats salads & drinks soda or sweet tea with ice
- slightly pale, puffy face
- acne, which is not red, but is composed of pus-filled papules around jaw line & forehead
- swollen tongue, teethmarks, slimy white coat
- soggy pulse
A
Dampness due to SP Qi Vacuity (or SP Qi Vacuity with Damp Encumbrance)
- pus-filled acne, swollen tongue, slimy tongue coat, puffy face: dampness
- soggy pulse: combo Qi Xu & dampness
- abdominal distention: SP Qi Xu
- teethmarks: Qi Xu
- nausea worse in morning bc Yang has not risen yet, and Yang is not transforming damp & yin
TX: Boost SP Qi, Resolve Dampness
14
Q
what is the pattern? what s/sx support this? how do you TX?
- 34 yo male
- CC: abdominal pain
- pain in upper, middle and especially lower left part of abdomen - starting 10 days ago, after a day-long BBQ party
- pain not very severe, and duration of pain attacks is not long
- location of pain not always in same place
- BM after pain attacks, pain partially relieved after release
- stool NOT loose
- poor appetite
- abdominal distention worse after eating
- no nausea, no thirst
- tongue slightly red, thick yellow greasy coat
- wiry, slippery pulse
A
Food Stagnation
- wiry pulse: stagnation / lack of flow of qi
- feels better after BM: Food Stagnation (as opposed to vacuity, which feels worse after BM)
- thick tongue coat, excess slippery pulse: repletion
- pain comes & goes: Qi Stagnation
Tx: Stimulate Descending of ST Qi, Remove/Resolve Food Stagnation
15
Q
what is the pattern? what s/sx support this?
- 74 yo female
- CC: chronic diarrhea
- long hx of very weak digestive system
- often diarrhea after eating many foods
- 2 days ago after eating: pain & distention in upper abdomen, without nausea or vomiting; diarrhea that evening
- ever since: diarrhea/loose stool 4 or 5 times a day, clear & watery with undigested food
- cold in abdomen, especially below umbilicus
- no fever, no aversion to cold
- hands & feet are cold
- low appetite
- borborygmous
- no thirst
- fatigue
- SOB & palpitations with slight activity
- dark dusky tongue, wet coat
- thin, forceless, deep pulse
A
HT & KD Yang Vacuity
- cold limbs: Yang Vacuity (not enough Yang to warm extremities)
- dark tongue: cold congeals and prevents good blood flow to head
- watery diarrhea: food not transforming (SP Yang is never independent of KD Yang)
- forceless (or feeble) pulse = Yang Vacuity
- no nausea, no vomiting: rule out ST pattern
- no thirst: rule out heat
- no fever or aversion to cold: rule out external invasion
