CASE REVIEW(1)--澳大利亚中医留学生作业

CASE REVIEW
Patient: Bed 23. 78yr female.
Initial presentation: 2007 visit to outpatients with repeated cough since 2006.
Primary symptoms: chronic reoccurring cough. Coughing with phlegm and bloody
sputum, chest pain, palpitations, headache, swollen lymph glands, fever, dizziness,
stomach ache, abdominal distension, scanty urination.
Tongue: bright red, thick white coat
Pulse: Xi Hua - thready
Hospital treatment: Admittance to inpatients for investigation reveals bronchial
tumour in lower left lung. Patient is prescribed TCM and advised of nutritional
regime to help her condition. Further investigation reveals that the tumour has
migrated to the lymph nodes.
Prognosis: poor
TCM Diagnosis: Lung Qi stagnation, Spleen deficiency, Phlegm accumulation.
Pathogenesis: The balance of Qi in the body can be upset by many factors. Finding
the root cause to an imbalance is the key to any medical treatment. Bleeding can
result from the stagnation of Qi and Blood and the failure of the Spleen to control the
Blood. An interruption in the transportation and transformation of fluids by the Spleen
will result in the accumulation of phlegm. In this case we see the formation of masses
in the Lungs. The Lungs should receive pure fluids from the Spleen and further purify
the fluids and distribute them throughout the body. The retention of phlegm in the
Lung inhibits the normal descending of Qi and instead the Qi adversely rises,
resulting in cough. This blockage is also demonstrated by pain, chest distress and
distension, and the adverse rising of Yang resulting in headache and dizziness.
Without proper dispersal of the fluids, the body and limbs may retain the fluids and
inhibit urination.
TCM Prescription by the Doctor to stop bleeding and relieve cough:
Xian He Cao 30
Sang Bai Pi 20
Zhi Mu 15
Zhi Gan Cao 5
Bai Shao 15
Fu Ling 15
Mai Ya 15
Wu Wei Zi 10
Ce Bai Ye 10
Zhi Zi Tan 10
Pu Huang Tan 10
Bai Jiang Can 15
Shou Gong 4
Lai Fu Zi 15
The primary goal of the formula is to stop bleeding and is accomplished with a
number of herbs. Xian He Cao, together with Ce Bai Ye can astringe to stop bleeding
in the Lung due to heat. The carbonised forms of Zhi Zi and Pu Huang also act to stop
bleeding and cool the blood. Zhi Mu will expel the fire while also nourishing the Yin,
which is damaged by this heat condition. The cough is treated with herbs such as
Sang Bai Pi, Wu Wei Zi, Lai Fu Zi. Phlegm accumulation causing nodules and
masses can be treated using herbs such as Bai Jiang Can and Shou Gong, which may
also help to relieve headache caused by rising Liver wind and relieve pain.
Herbs used to induce urination includes Sang Bai Pi and Fu Ling.
Bai Shao is used to nourish the blood and relieve pain. Treatment with Chinese Herbs,
like any medicine can also have negative effects on the body so we need to nourish
the Spleen in order to utilise all the positive effects of the herbs. The Spleen and
digestion is treated with Fu Ling, Wu Wei Zi, Mai Ya and Lai Fu Zi. Lai Fu Zi, is not
only used as a digestive aid but also used to relieve cough and chest distension. Zhi
Gan Cao will also harmonise the action of the herbs, while reducing toxic effects and
nourish the Qi.
A patient suffering this condition should also be treated to nourish Kidney and
Spleen. As the Lung is already dangerously compromised, the Spleen and Kidney
remain as the main organs for producing Qi.
Future Treatment
Once the bleeding has been stopped, the treatment should aim to nourish the Yin of
the Lung and the Qi of the Spleen and Kidney. A formula such as Sha Shen Mai Dong
Tang or Bai He Gu Jin Tang could be used. A possible formula follows:
Sha Shen 15
Mai Dong 15
Yu Zhu 10
Sang Ye 10
Tian Hua Fen 10
Bian Dou 15
Gan Cao 5
Bai He 5
Fu Ling 15
Sheng Di 15
Bai Shao 15
Jie Geng 10
Wu Wei Zi 15
Shi Hu 15