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Example of case presentation

Main Presenting
Symptoms of Hypertension
» Systolic BP ≥ 140 mmHg or diastolic BP ≥
90 mmHg on three separate occasions
» Headache
» Dizziness
» Swelling sensation of the head
» Tinnitus
» Blurred vision
» Forgetfulness, lack of concentration
» Insomnia, palpitations
» Lack of energy

TCM Aetiology & Pathology There are three main patterns that pertain to hypertension: » Liver fire flaring: Liver qi stasis causes Liver fire to flair up » Liver Yang rising and Kidney Yin deficiency: deficient Kidney yin fails to suppress Liver yang » Obstruction of Phlegm and Dampness: Spleen qi deficiency produces phlegm and dampness which prevents lucid qi and clear yang from ascending .

Case Study 50 year old female presenting with High Blood Pressure for 1 year .

Patient Details and Social History Age: Occupation: Marital Status: Children: Smoker: Exercise: Weight: Alcohol Consumption: 50 Interior designer (full time) Married 3 daughters aged 21.she doesn’t have time 80 kg (ideal weight is 65 kg) 1-2 glasses of wine 6/7 . 19 and 14 No No .

1 mmol/L (normal range is 3. she is 80kg and should be 65kg . went to the GP who tested her blood pressure and informed her it was high at 145/90 mmHg » Cholesterol was also high – 7.5) » The GP has given her 3 months to reduce her B/P to normal levels » She is a little stressed with juggling work and family » She is overweight and her GP has asked her to lose 15kg.Presenting Symptoms » 1 year ago.9 – 5.


Some minor Emotions: bloating especially the week before her periods Anxiety when stressed which can make her hyperventilate and occurs approximately once per month. She also sighs a lot . Headaches: Nil Dizziness: Approximately once per week her head feels like it’s spinning for a second Tinnitus: High pitched.Presenting Symptoms Chest Pain: Nil Cont. mild heart palpitations when stressed Waking 4 times per week at about 3am and it takes Chills & Fever: her about an hour to fall back to sleep Digestion: Nil Occasional nausea when stressed. three times per week for Palpitations: approximately one minute Insomnia: Yes.

Perspiration: Nil Urination: Slight incontinence on sneezing and sometimes frequent urination (up to 8 times per day) Stools: Mostly hard and dry (sometimes pellet-like). She occasionally has a normal bowel motion.Presenting Symptoms Thirst: Nil Cont. coinciding with her period once per month Energy Good Levels: 28 day cycle. 5 day period. heavy 2nd and 3rd day Menstruatio especially lately n: A little dry Daily lower back pain – worse during the day Skin: and worse for walking or carrying the shopping Muscular: .

. chocolate.Diet: Breakfas t: Lunch: Dinner: Snacks: Porridge Salad and ham roll Pasta. nuts. ice cream. bananas Family History: Mother is on medication for high blood pressure and has had a stent put in. meat. vegetables Biscuits.

red tip Pulse: Wiry. GB + and KD - . central cracking. Tongue: Red body. full. slightly scalloped and swollen edges. no coating.Presenting Symptoms Cont.

Physical Examination » A Citizen Blood Pressure Monitor (Model #CH403C) was used twice a day for seven days » The patient was seated and rested for approximately 5 minutes before the measurements were taken » The measurements began on Monday 12 th September. 2011 (all measurements in mmHg) MON TUES WED THUR S FRI SAT SUN AM 132/95 129/84 138/90 137/90 135/92 128/84 124/83 PM 146/95 118/77 143/91 141/92 143/93 142/92 142/88 .

OF TIMES IN THE WEEK Systolic ≥ 140 mmHg 6 Diastolic ≥ 90 mmHg 9 » This table shows that a diagnosis for hypertension can be made according to the WHO as there are more than 3 occasions that the systolic or diastolic blood pressures are equal to or higher than 140 mmHg and 90 mmHg respectively.Results BLOOD PRESSURE NO. .

Diagnosis Disease Name: Dizziness Syndrome TCM Pattern: Obstruction of Phlegm and Dampness with Kidney Yin Vacuity Western Medicine Diagnosis: Essential Hypertension .

TCM Summary Phlegm and Dampness Kidney » Overweight » Cholesterol » Lumbar pain » Slight incontinence on sneezing » Frequent urination » Swollen tongue Yin Deficiency » Dry bowel motions » Skin a little dry » Palpitations & Insomnia » Tongue red body. no coat. central cracking » Pulse signs – kidney deficient .

TCM Summary Cont. Spleen Liver » Scalloped and swollen tongue » Overweight and cholesterol » Dizziness » Sighing » Nausea (SP/ST) » Bloating » Stress » Dry skin (liver blood) Heart » Insomnia » Palpitations Gall Bladder » Anxiety » Tongue: red tip » Tinnitus » Pulse signs – GB excess .

resolve Phlegm and Dampness » Remove obstruction » Nourish Kidney Yin .Treatment Principle » Strengthen the Spleen.

Warm LU. SP. ST   Sheng Jiang Acrid. ST   Chen Pi 5g Acrid. Neutral HT. ST Sweet. Warm 5g LU. Slightly Cold LU. Bland. SP. LU. SP. resolves stasis and helps with phlegm transformation Resolves dampness and strengthens the Spleen Benefits the Spleen and harmonises the Middle Harmonises the Spleen and Stomach . ST Dries dampness and transforms phlegm Harmonises the Stomach and directs rebellious Qi downward Clears Gall Bladder heat and harmonises the Stomach Regulates the Qi. Bitter. SP.Herbal Medicine Wen Dang Tang (modified): Ban Xia 15g Zhu Ru 15g Acrid. Warm LU. ST   Gan Cao 5g Sweet. Neutral HT. SP   Fu Ling 10g Sweet.

PC.Herbal Medicine Cont. Clears Heat and cools the Blood Bitter. LR   Nourishes Yin and tonifies the Kidneys   Invigorates the Blood Tonifies the Blood Calms irritability due to Blood Heat   Sweet. Bitter HT. LU. ST dryness   Transforms phlegm-heat . Sweet. Cold Nourishes the Yin & moistens KD. ST alleviates constipation   Salty. KD   Cool. Slightly Cold Moistens the Intestines & HT. Wen Dang Tang (modified): Shu Di Huang 20g Dan Shen 15g Mai Men Dong 5g Xuan Shen 5g Sweet. Slightly Tonifies the Yin and clears Heat Bitter. Slightly warm LR. LU.

Special point to remove Phlegm Calms the Heart Tonifies the Spleen Invigorates Yuan Qi to all the Zang Increases circulation of Kidney Qi (will strengthen Yin) Strengthens the ascending function of the Spleen and disperses Damp Earth and He Point Regulates the circulation of Qi and Blood Cools the Blood and Internal Heat . Soothes the Liver and Gall Bladder.Acupuncture Treatment 1: KD 3 LR 3 SP 6 ST 40 CV 6 LI 11 Earth & Yuan Point Tonifies the Kidneys. pacifies empty Fire and strengthens the lumbar area of the back Earth and Yuan Point. nourishes Kidney Yin. Takes neutral Earth Qi into the Liver to soothe and regulate its function Harmonises Earth and Wood and therefore clears the middle jiao Calms Fire due to empty Liver Yin Nourish Kidney Yin and Liver Yin Tonifies the Spleen Luo Point.

After the treatment it was 142/94 mmHg. We continued recording her blood pressure twice per day for the following week. . She also received a treatment using the above mentioned acupuncture points which were retained for 30 minutes. This would be followed by a second acupuncture treatment.Treatment 1 On Saturday 24th September the patient started taking the herbal formula. Her blood pressure before the treatment was recorded at 137/85 mmHg.

Reduce chocolate intake. seaweeds. »Exercise at least three times per week such as yoga or walking. potato. »No white processed grains such as white rice or pasta. blackberries and blueberries. mung beans and their sprouts. black sesame seeds and small amounts of egg and pork. spirulina. barley. tofu. string beans. Replace with wholegrains which have a lower Glycaemic Index. wheatgerm. watermelon and other melons. . »No sugary foods such as biscuits. kidney beans. »Foods which nurture Kidney Yin include millet. »No bananas as these are contraindicated in phlegm damp conditions. black beans. Suggest at least 3 alcohol-free days per week.Diet & Lifestyle Advice After the first treatment we felt it was necessary to give our patient some diet and lifestyle advice »No cold foods such as ice cream. »Greatly reduce alcohol consumption which readily converts to sugar in the body.

central crack. GB position had also improved but was still slightly excessive T: Red body. slightly scalloped and swollen edges. red tip – basically no change although it seemed like the red tip was more pronounced .Treatment 2 The patient was given a second treatment on Saturday 1st October. no coating. Prior to the treatment we measured her pulse and checked her tongue: P: Wiry but overall less forceful. KD position had improved in strength.

. The diastolic measurement has only decreased by 1 from 9 times ≥ 90 mmHg to 8 times ≥ 90 mmHg. OF TIMES IN THE WEEK Systolic ≥ 140 mmHg 2 Diastolic ≥ 90 mmHg 8 The systolic measurement has dramatically changed from 6 times ≥ 140 mmHg to only 2 times ≥ 140 mmHg.Her blood pressure recordings since the first treatment were noted as follows (25/09/11 – 01/10/11): MON TUES WED THUR S FRI SAT SUN AM 135/90 144/97 139/90 135/86 117/81 132/89 128/85 PM 141/91 136/97 138/94 139/95 131/86 135/96 127/83 BLOOD PRESSURE NO.

balances Yin & Yang. calms the Shen and restores the nourishing aspects of Yin internally .Treatment 2 The same acupuncture points and treatment protocol were used as in Treatment 1 except LI 11 was changed to PC 6 in order to calm the Shen. KD 3 Tonifies the Kidneys Nourishes Kidney Yin LR 3 Regulates the function of the Liver and Liver qi throughout the channel Harmonises Earth and Wood and therefore clears the middle jiao Nourishes Kidney Yin and Liver Yin Tonifies the Spleen SP 6 ST 40 CV 6 PC 6 Luo Point. Special point to remove Phlegm Calms the Heart Tonifies the Spleen Invigorates Yuan Qi to all the Zang Increases circulation of Kidney Qi (will strengthen Yin) Strengthens the ascending function of the Spleen and disperses Damp Master point of Yin Wei Mai.

.Treatment 2 Blood Pressure Reading: Before Treatment After Treatment 131/85 mmHg 127/73 mmHg We were very happy with these results and hope that with ongoing treatment she may avoid blood pressure and cholesterol medication.

T.Reference List Bensky. X. Chinese Herbal Materia Medica. third edn. Maciocia. 2008. Healing with Whole Foods: Asian Traditions and Modern Nutrition. & Rogers. & Chen. C. 2002.. 1989. Chen. 2nd edn. & Stoger. Berkeley CA. Eastland Press. Clavey. Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research. J. Point Location & Point Dynamics Manual. Australia. North Atlantic Books. P. Sydney.. S. G. 2004. Pritchard. Australian College of Acupuncturists Ltd. Elsevier Churchill Livingstone. CA. C. 2009. D. . The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. 2011. E. UTS. USA. Seattle. Third Edition. London. Disease States 1: Lecture Notes. Art of Medicine Press. Qu. Rogers.

Question and discussion .