Chinese Medicine: - Case Study Example

 Chinese Medicine: Case study The patient is a 46-year-old female who presented to the Asante Clinic with abdominal bloating and sense of distentionof the upper abdomen, especially following food. On interrogation, she also committed that she has loss of appetite and loose, watery stools with evident undigested food particles in it. She herself had inspected the stools to report such. She has bowel movements two to four times every night. She has cold limbs per her own report, and she feels chills. She is feeling fatigued and listless. Her abdominal symptoms feel better with pressure and heat over the area. She has a sensation of aching along the hypochondrium. Limbs feel weak, but his urination is clear without any problems. She feels depressed and is having mood swings. There is a sensation of lump in the throat. The patient is irritable, and for the past few months, the patient is having alternating diarrhoea and constipation. The tiredness is very prominent. Main Symptoms and Duration of Disease: The significant past history is notable for an ileostomy done in June 2007. For the last 6 months, the patient is suffering from loose or watery loose stools that contain undigested food particles. Before that, she was having a somewhat alternating pattern of diarrhoea and constipation with pellet like stool fragments. The diarrhoea, however, persisted and has become worse over a period of last three months. This surge of loose stools with undigested food elements happens in the early hours of the morning, and at present she passes somewhere between two to four stools per night. This is accompanied by a sensation of bloating and abdominal distention in the upper abdomen and a sensation of lump in the throat. Although the urine is clear, she often feels tired, weak, and fatigued the next morning. Her extremities feel cold. Her mood is depressed, and she is feeling low. There are mood swings and an aching sensation along the hypochondrium. History of Present Illness: The patient’s illness dates back to a diagnosis of colorectal cancer in June 2007. This diagnosis followed a history of prolonged constipation for many months. The colorectal cancer was treated with hemicolectomy and ileostomy. Following the surgery, these symptoms started and had persisted for 7 months now. These symptoms are getting worse over time, and this progressive worsening is particularly prominent in terms of loose bowel movements at night. The patient feels, since the surgery, her bowel function has definitely deteriorated, and her stomach remains persistently bloated and distended. The ileostomy bag has created a social isolation, and this has affected her already depressed mood and irritability. Since the abdominal distention is very pronounced after eating and has often caused discomfort in the epigastric region and hypochondrium, she does not feel like eating, and over and above that, she has loss of appetite. Weakness and coldness in the extremities are easily sensible, and she feels tired and fatigued. Although there is no sense of nausea, there are a sense of mass in the throat and a feeling of heaviness in the epigastrium and hypochondrium. The cold symptoms of chilliness and cold limbs and epigastric discomfort feels better with application of heat. Anamnesis: Chicken pox. Constipation and diarrhoea at menarche. Personal History: The patient was born and had lived in London all her life. She is divorced and works in Administration. The environment where she works is brightly lighted. She had chicken pox as child; however, she also received all vaccinations in childhood. She started to experience constipation and diarrhoea along with mood swings at onset of menses at age 13. Except for the constipation, the client feels her health was good. Her diet had improved over the years including more raw foods in the diet, such as, fruit and vegetables. She does not drink or smoke. She has no children. The patient was on contraceptive pill when married, however, stopped using it once divorced. Family History: Both the mother and father of the patient are alive. The mother has irritable bowel syndrome. The father is hypertensive. She has two siblings, all born healthy. The other siblings are robust, and the patient is not as robust as them. Uncle on the mother’s side died of colon cancer 20 years ago. Physical Examination: Inspection: The patient has a pale white complexion. She is moving slowly. The patient looks and sounds very tired and fatigued. The voice is low. Tongue Pale, swollen, and wet. Coating Slightly greasy, thin, white coating. Pulse Weak, slow, and deep. Auscultation and Olfaction No odour, breathing is normal, no cough. Differentiation and Analysis On observation of patient’s physical condition a bright white facial complexion indicates fear (1. G. Maciocia, 2004, p50 box 3.9) with a pale tongue indicates a deficiency of yang, qi, or blood. (2. G.Maciocia, 2004. p43). The fatigue and lack of strength with physical coldness in hands and feet are caused because qi is not reaching its targets through stagnation of liver qi (3. G. Maciocia, 2004, p343, box 39.10). The symptoms of loose and watery stool with undigested and unabsorbed food/fluids are also caused by deficiency of energy and heat in stomach; this energy and heat enable food to be digested and promote stomach qi. Cold affects and impairs the digestive function that causes failure of spleen qi to rise and also causes downward migration of cold-dampness, which is affecting the limbs. This results in no force in the warming and transporting of the yang qi (Maciocia, G., 2005, p. 243). The emotional experience of the operation has impacted and caused qi of zang fu to stagnate resulting in depression and mood swings with sensation of a lump in throat, which indicates liver/heart/lung qi stagnation. The aching feeling along hypochondrium indicates liver disharmony. The pulse being deep/empty and weak indicates an internal cold condition with qi/yang deficiency (Maciocia, G., 2005, p. 244). The tongue proper was pale and red with slightly /thin white coating. These indicate spleen/liver disharmony. Abdominal and epigastric distension after eating, loss of appetite, loose and watery stools containing undigested food can be correlated to spleen disharmony. Since the spleen is in charge of transforming and transporting food, diet plays an extremely important role in spleen disharmonies. The spleen is said to prefer warm and dry foods. By “warm” is meant warm in terms of both temperature and food energy (Maciocia, G., 2005, p. 245). The patient has now irregular dietary habits and excessive use of mind. The impairment of spleen transformation and transportation function causes the various digestive symptoms, such as, abdominal distention, loose stools, or lack of appetite. As the spleen is responsible for transporting food-qi to the four limbs, when spleen qi is deficient, the limbs will be deprived of nourishment and feel weak. The spleen also transports food-qi throughout the body, hence the tiredness, lassitude, and fatigability experienced by the patient. The patient, however, does not have dampness symptoms, perhaps, due to the fact that the symptoms have not been present for a prolonged period of time (Maciocia, G., 2005, p. 246). Otherwise, the inability of spleen-qi in transforming fluid would have led to stagnation or dampness that would have obstructed the chest and epigastrium resulting in the typical sensation of oppression. The spleen-yang fails to warm the body, hence the patient feels chilliness and cold limbs. The tongue is pale from the deficiency of yang and wet because the impairment in the spleen function of fluid transportation leads to accumulation of fluids in the tongue. The deficiency in the yang is also reflected by deep and slow pulse. The liver qi is responsible for the smooth flow of qi throughout the body. When liver qi stagnates in the abdomen, it often disturbs the spleen function of transformation and transportation (Maciocia, G., 2005, p. 215). In Chinese Medicine terms, it is said that liver invades the spleen or liver and spleen are not harmonized. In 5-elements terms, this corresponds to wood overacting on earth. When the stagnation of liver qi predominates, there is constipation with dry, difficult, and bitty stools. When the deficiency of the spleen predominates, there are loose stools. The distention and pain in the abdomen is caused by stagnation of the liver qi in the abdomen. Distention is the most characteristic symptom of stagnation of qi (Maciocia, G., 2005, p. 227). There may be some pain too, but this is not severe. This pattern is usually caused by emotional excess, such as frustration and resentment. Final Diagnosis: 1. Spleen yang deficiency. 2. Liver qi stagnation. Secondary Factors: 1. Emotional disturbance. 2. Surgery. Treatment: Principles: The liver is harmonized and the spleen is tonified. Points: Qimen LIV-14, Zhangmen LIV-13, Yanglingquan G.B.34, Taichong LIV-3, QiHai Ren-6, Zhongwan Ren-12, Zusanli ST-36, Sanyinjiao SP-6. Method: Reducing for points to harmonize the liver (LIV-14 and 13, G.B.-34, LIV-3), reinforcing for points to tonify the spleen. Explanation: LIV-14, harmonizes liver and tonifies the spleen. LIV-13 harmonizes both liver and spleen. GB-34 promotes smooth flow of liver qi and calms abdominal pain with Qihai Ren-6. LIV-3 promotes smooth flow of liver qi and calms abdominal pain. In combination with Yanglingquan GB-34, Ren-6 stops abdominal pain and moves qi in the abdomen. Ren-12 and ST-36 tonify the spleen. SP-6 tonifies the spleen, regulates liver, harmonizes liver and spleen, and stops abdominal pain (Cheng, D.A., 1996, p. 76). For spleen yang deficiency, the principle is to tonify and warm spleen yang. The points are Zhongwan Ren-12, Zusanli ST-36, Sanyinjiao SP-6, Taibai SP-3, Pishu BL-20, Weishu BL-21 and Yanglingquan SP-9, Shuifen Ren-9, Shuidao ST-28, Sanjiaoshu BL-22. If there is dampness these should all be reduced. This is a reinforcing method where Moxa must be used. SP-3 is source point of the spleen and tonifies spleen qi (Liu, G.W., 2000, page 84). References Maciocia, G., (2007). Practical Diagnosis In Chinese Medicine. Churchill Livingstone Maciocia, G., (2005). The Foundations of Chinese Medicine: A comprehensive Text for Acupuncturists and Herbalists. Churchill Livingstone. Liu, G.W., (2000). Clinical Acupuncture & Moxibustion. Tianjin Science Cheng, D.A., (1996). Acupuncture and Moxibustion, Formulas and Treatment- Blue Poppy Press Read More