Internal Medicine Final Exam Case Studies

Question 1

Western Medicine Diagnosis?

Patient: Mr. Li, 62
Symptoms: Difficulty swallowing solids, regurgitates immediately after meals, weight loss.
History: Retired professor, history of anxiety, eats spicy food.
TCM Diagnosis: Qi stagnation with phlegm and blood stasis, underlying yin deficiency.
Treatment Principle: Move qi, resolve phlegm, invigorate blood, nourish yin.
Points: Ren 17, BL 17, PC 6, ST 36, Ren 22.

Answer 1

Dysphagia Occlusion Syndrome

Question 2

Western Medicine Diagnosis?

Patient: Mr. Wu, 57
Symptoms: Abdominal bloating, poor appetite, edema, distention worsens at night.
History: Alcohol use, hepatitis.
TCM Diagnosis: Spleen and kidney yang deficiency with blood stasis.
Treatment Principle: Warm yang, move qi, transform dampness.
Points: Ren 4, UB 23, SP 6, ST 36, GB 25.

Answer 2

“Drum Distension” or Ascites

Question 3

Western Medicine Diagnosis?

Patient: Mei, 32
Symptoms: Frequent stools with mucus and blood, abdominal cramping, fever.
History: Ate street food before onset.
TCM Diagnosis: Damp-heat ______.
Treatment Principle: Clear heat, resolve dampness, regulate intestines.
Points: ST 25, ST 37, LI 11, SP 9.

Answer 3

Dysentery

Question 4

Western Medicine Diagnosis?

Patient: Han, 52
Symptoms: Puffy face and legs, tiredness, poor appetite.
History: Lives in humid environment, poor diet.
TCM Diagnosis: Spleen yang deficiency with water retention.
Treatment Principle: Warm spleen, promote urination, resolve dampness.
Points: SP 9, Ren 9, ST 36, BL 20, BL 22.

Answer 4

Edema

Question 5

Western Medicine Diagnosis?

Patient: Leo, 67
Symptoms: Dribbling urination, difficult flow, lower abdominal pain.
History: History of prostate enlargement.
TCM Diagnosis: Damp-heat in bladder.
Treatment Principle: Clear heat, resolve dampness, promote urination.
Points: Ren 3, SP 9, BL 28, BL 39.

Answer 5

Urine Retention

Question 6

Western Medicine Diagnosis?

Patient: Anna, 29
Symptoms: Frequent painful urination, burning sensation, hematuria.
History: Recently had a UTI.
TCM Diagnosis: Heat ______.
Treatment Principle: Clear heat, promote urination.
Points: Ren 3, SP 9, SP 6, LI 11, BL 28.

Answer 6

Stranguria

Question 7

Western Medicine Diagnosis?

Patient: Mr. Zhang, 61
Symptoms: Joint pain moves between limbs, worse with cold weather.
History: Long-standing arthritis.
TCM Diagnosis: Wind-cold-damp _____.
Treatment Principle: Expel wind, cold, and damp; unblock channels.
Points: Ashi, LI 11, ST 36, SP 9, BL 23.

Answer 7

Bi Syndrome

Question 8

Western Medicine Diagnosis?

Patient: Amelia, 26
Symptoms: Weak legs, difficulty walking, muscle wasting.
History: Post-viral recovery.
TCM Diagnosis: Lung heat damaging body fluids.
Treatment Principle: Clear heat, nourish yin, moisten dryness.
Points: LU 5, ST 36, LI 11, SP 6, BL 13.

Answer 8

Wei Syndrome

Question 9

Western Medicine Diagnosis?

Patient: Michael, 48
Symptoms: Low back pain, worse in cold weather, stiff.
History: Manual laborer, exposed to damp environments.
TCM Diagnosis: Cold-damp invasion.
Treatment Principle: Warm yang, expel damp, unblock channels.
Points: BL 23, DU 4, SP 9, ST 36, Yaoyan.

Answer 9

Lumbago

Question 10

Western Medicine Diagnosis?

Patient: Quinn, 38
Symptoms: Inability to maintain an erection, low libido, fatigue, cold limbs.
History: Long work hours, little sleep, overwork.
TCM Diagnosis: Kidney yang deficiency.
Treatment Principle: Tonify kidney yang, warm lower jiao.
Points: Ren 4, BL 23, KI 3, DU 4, SP 6.

Answer 10

Impotence

Question 11

Western Medicine Diagnosis?

Patient: Brian, 31
Symptoms: Frequent night emissions, insomnia, dizziness.
History: Overthinking, long-term stress.
TCM Diagnosis: Heart and kidney disharmony.
Treatment Principle: Clear heart fire, tonify kidney, secure essence.
Points: HT 7, BL 15, KI 3, Ren 4, SP 6.

Answer 11

Seminal Emission

Question 12

Assessment (TCM Diagnosis)?

Dysphagia Occlusion Syndrome (Ye Ge) Subjective: Mrs. Zhang, 58, reports feeling of obstruction in the throat, nausea, and inability to swallow food even though hungry. Objective: Red tongue with scanty coating, thin and rapid pulse. Plan:
(Acupuncture) Ren 22, KI 6, SP 6, Ren 17, LU 10

Answer 12

Assessment: Yin deficiency with dryness and internal heat.

Question 13

Assessment (TCM Diagnosis)?

Hiccoughing and Belching
Subjective: Weak hiccups, abdominal bloating, cold sensation. Objective: Pale tongue, white moist coat, deep slow pulse. Plan (Acupuncture): Ren 13, ST 36, Ren 12, PC 6, Moxa at Ren 6

Answer 13

Assessment: Cold in the stomach.

Question 14

Assessment (TCM Diagnosis)?

Vomit
Subjective: Morning nausea, fatigue, poor appetite. Objective: Pale tongue with teeth marks, deep/slow/weak pulse. Plan (Acupuncture): ST 36, Ren 12, Ren 6, BL 20, BL 21

Answer 14

Assessment: Spleen and stomach yang deficiency.

Question 15

Assessment (TCM Diagnosis)?

Drum Distension / Ascites
Subjective: Abdominal bloating, visible veins, stabbing pain. Objective: Dark purple tongue, choppy pulse. Plan (Acupuncture): SP 10, BL 17, LI 4, LR 3, Ren 6

Answer 15

Assessment: Blood stasis in the abdomen.

Question 16

Assessment (TCM Diagnosis)?

Diarrhea
Subjective: Loose stools, fatigue, low back soreness. Objective: Pale swollen tongue, deep weak pulse. Plan (Acupuncture): BL 23, Du 4, Ren 4, ST 36, KI 3

Answer 16

Assessment: Kidney yang deficiency.

Question 17

Assessment (TCM Diagnosis)?

Constipation
Subjective: Dry stools, dizziness, palpitations. Objective: Pale tongue, thin weak pulse. Plan (Acupuncture): ST 25, SP 6, BL 20, BL 21, ST 36

Answer 17

Assessment: Blood deficiency.

Question 18

Assessment (TCM Diagnosis)?

Dysentery
Subjective: Loose stools with pus, fatigue, poor appetite. Objective: Pale tongue, thready weak pulse. Plan (Acupuncture): Ren 6, ST 36, SP 6, BL 23, Du 4

Answer 18

Assessment: Spleen and kidney yang deficiency (chronic dysentery).

Question 19

Assessment (TCM Diagnosis)?

Abdominal Mass
Subjective: Intermittent distention, movable abdominal lumps. Objective: Normal tongue, wiry pulse. Plan (Acupuncture): LR 3, LI 4, ST 36, Ren 6, GB 34

Answer 19

Assessment: Qi stagnation.

Question 20

Assessment (TCM Diagnosis)?

Edema
Subjective: Swelling of lower limbs after walking, heaviness. Objective: Swollen tongue, greasy coating, slippery pulse. Plan (Acupuncture): SP 9, Ren 9, BL 22, ST 28, SP 6

Answer 20

Assessment: Damp retention.

Question 21

Assessment (TCM Diagnosis)?

Urine Retention (Long Bi)
Subjective: Post-surgery urinary retention, dull lower abdominal pain. Objective: Purple tongue, choppy pulse. Plan (Acupuncture): SP 10, BL 17, Ren 3, BL 28, LR 3

Answer 21

Assessment: Blood stasis obstructing bladder.

Question 22

Assessment (TCM Diagnosis)?

Stranguria
Subjective: Cloudy milky urine, burning pain with urination. Objective: Red tongue with sticky coat, rapid thin pulse. Plan (Acupuncture): BL 23, KI 6, SP 6, Ren 3, BL 28

Answer 22

Assessment: Chyluria from kidney yin deficiency with damp-heat.

Question 23

Assessment (TCM Diagnosis)?

Bi Syndrome
Subjective: Fixed and heavy joint pain, worse in humidity. Objective: Swollen joints, greasy tongue, slippery pulse. Plan (Acupuncture): ST 36, SP 9, BL 20, Ashi, GB 34

Answer 23

Assessment: Damp Bi syndrome.

Question 24

Assessment (TCM Diagnosis)?
Wei Syndrome
Subjective: Progressive limb weakness, post-stroke. Objective: Pale tongue, deep thin pulse. Plan (Acupuncture): BL 18, BL 23, ST 36, GB 34, KI 3

Answer 24

Assessment: Liver and kidney deficiency.

Question 25

Assessment (TCM Diagnosis)? Lumbago Subjective: Sudden lower back pain post-lifting, stabbing. Objective: Purple tongue with petechiae, wiry choppy pulse. Plan (Acupuncture): BL 17, SP 10, BL 23, Ashi, Yaotongxue

Answer 25

Assessment: Qi and blood stagnation from trauma.

Question 26

Assessment (TCM Diagnosis)? Impotence Subjective: Impotence and irritability, recent stress. Objective: Red tongue with yellow coat, wiry pulse. Plan (Acupuncture): LR 2, LI 11, Ren 3, KI 3, SP 6

Answer 26

Assessment: Liver qi stagnation transforming into fire.

Question 27

Assessment (TCM Diagnosis)? Seminal Emissions Subjective: Frequent spermatorrhea *especially during the daytime*, fatigue, cold limbs. Objective: Pale tongue, deep weak pulse. Plan (Acupuncture): DU 4, Ren 4, BL 23, KI 7, SP 6

Answer 27

Assessment: Kidney yang deficiency.

Question 28

TCM Diagnosis? Case Study: Nocturnal Emission Patient: Jonathan W., 29 Occupation: Graduate student Date: March 27, 2025 Subjective: Patient reports waking several nights a week from vivid dreams accompanied by involuntary ejaculation (nocturnal emission). Feels fatigued during the day, irritable, and complains of difficulty falling asleep. He also notes night sweats and occasional dizziness. He admits to long hours of study, poor sleep habits, and frequent use of stimulants (coffee and energy drinks). Objective: Tongue: Red with scanty coating, slight cracks in the center Pulse: Thin and rapid Face appears slightly flushed; reports dry throat and heat in the palms and soles Mild dark circles under the eyes

Answer 28

Assessment: TCM Diagnosis: Kidney Yin Deficiency, causing loss of control over essence Pattern differentiation: Yin fails to nourish the Heart and Liver → Heart fire disturbs the spirit → Essence not secured → Nocturnal emission

Question 29

TCM Diagnosis? Patient: Male, 60 years old Chief Complaint: Red, swollen, painful joints in the fingers and wrists History: Long-standing joint pain which recently flared up with intense heat, swelling, and limited motion. Joints feel hot to the touch, worse with warmth, better with cool compresses. Tongue: Red with yellow coating Pulse: Slippery and rapid Acupuncture Points: LI11, DU14, SJ5, LI4, Ashi points

Answer 29

Heat Bi (Re Bi) – Heat Predominant TCM Diagnosis: Heat Bi (Re Bi) Treatment Principle: Clear Heat, dispel Wind-Damp, relieve pain

Question 30

TCM Diagnosis? Patient: Male, 42 years old Chief Complaint: Severe knee pain and stiffness, worse in the cold History: Works outdoors; pain started after long exposure to winter conditions. The knees feel cold to the touch. Applying warmth helps. No redness or swelling. Tongue: Pale with white coating Pulse: Tight and deep

Answer 30

Painful Bi (Tong Bi) – Cold Predominant Diagnosis: Cold Bi (Tong Bi) Treatment Principle: Dispel Cold, warm the channels, relieve pain

Question 31

TCM Diagnosis? Patient: Female, 35 years old Chief Complaint: Migrating joint pain for 3 weeks History: Pain began after hiking in windy weather. Pain moves between shoulders, elbows, and wrists. No redness or swelling. Occasionally aversion to wind. Tongue: Thin white coating Pulse: Floating Acupuncture Points: LI4, SJ5, GB20, UB12, Ashi points

Answer 31

Wandering Bi (Xing Bi) – Wind Predominant Diagnosis: Wind Bi (Xing Bi) Treatment Principle: Expel Wind, unblock channels, relieve pain

Question 32

TCM Diagnosis? Patient: Mei Lin, 35 Chief Complaint: Intermittent abdominal distention and soft mass that comes and goes. Subjective: Mass appears with stress, accompanied by distending pain in the lower abdomen and hypochondria. The discomfort often eases after rest or emotional release. Objective: Tongue: Normal color, thin white coating Pulse: Wiry Palpation: Soft mass, mobile, no fixed location Plan (Acupuncture): LR 3, LI 4, GB 34, Ren 6, ST 36

Answer 32

Assessment: Abdominal Mass, Qi stagnation – Ju Syndrome (Qi Phase)

Question 33

TCM Diagnosis? Patient: Mr. Zhao, 52 Chief Complaint: Fixed, hard abdominal mass with dull pain. Subjective: Mass has been growing slowly over the past year. Pain is localized and worsens at night. Appetite is poor; reports dark complexion and weight loss. Objective: Tongue: Purple with dark spots Pulse: Choppy and deep Palpation: Firm, immobile mass in left lower quadrant, tender to pressure Plan (Acupuncture): SP 10, BL 17, LR 3, ST 36, Ren 6

Answer 33

Assessment: Abdominal Mass, Ji Syndrome (Blood Phase)

Question 34

TCM Diagnosis? Patient: Zhang Wei, 27 Chief Complaint: Sudden swelling of face and eyes after catching a cold. Subjective: Facial swelling began overnight following exposure to cold wind and rain. He also has fever, chills, and body aches. Reports difficulty urinating and mild shortness of breath. Objective: Tongue: Thin white coating Pulse: Floating and tight Plan (Acupuncture): LI 4, LU 7, TB 5, BL 12, BL 13, LI 6, DU 26

Answer 34

Assessment: Yang Edema due to Wind-Water Invading Exterior *Dispel wind, release exterior, open water passages

Question 35

TCM Diagnosis? Patient: Li Hua, 60 Chief Complaint: Chronic leg swelling with fatigue and cold limbs. Subjective: Gradual onset over several months. Worse in the evening. Also has poor appetite, loose stools, and aversion to cold. Lower legs are puffy and press in with a pit that slowly rebounds. Objective: Tongue: Pale, swollen, teeth marks Pulse: Deep and weak Plan (Acupuncture): Ren 4, Ren 6, BL 20, BL 23, ST 36, SP 6, Ren 9, ST 28

Answer 35

Assessment: Yin Edema due to Spleen & Kidney Yang Deficiency *Warm yang, tonify Spleen/Kidney, promote urination

Question 36

TCM name: Includes disorders Western medicine labels spasms of thecardiacsphincter, hiatal hernia, esophagitis, esophageal diverticulosis, esophageal cancer and other functional disorders of theesophagus.In patients who are middle-aged or older the possibilityof cancershould be considered during diagnosis.

Answer 36

Dysphagia Occlusion Syndrome (YeGe)