Herbal Practice Exam – Clinical Case Studies #5

CASE 1

Use the following information to answer questions 1-2:

A 58-year-old woman has been suffering from pain of the stomach and abdomen with acid regurgitation for 3 years. The pain is sometimes better and sometimes worse.

Patient Information:

The day she came to the clinic, she also had:

• chills
• body ache
• sore low back
• headache
• dizziness
• Tongue: white coat
• Pulse: Floating (Fu) and Tight (Jin)

Question 1: Which is the best TCM diagnosis?

CASE 1

Use the following information to answer questions 1-2:

A 58-year-old woman has been suffering from pain of the stomach and abdomen with acid regurgitation for 3 years. The pain is sometimes better and sometimes worse.

Patient Information:

The day she came to the clinic, she also had:

• chills
• body ache
• sore low back
• headache
• dizziness
• Tongue: white coat
• Pulse: Floating (Fu) and Tight (Jin)

Question 2: Which is the best acupuncture treatment?

CASE 2

Use the following information to answer questions 3-4:

A 38-year-old man has been suffering from epistaxis for more than 8 years. He had been to the hospital 5 times and has taken a lot of Chinese and Western medicine to no avail.

Patient Information:

• he experiences epistaxis every 3-5 days
• profuse bleeding
• dull, greenish complexion
• emaciation
• fatigue
• sore and hot lower back
• Tongue: red with little coating
• Pulse: Wiry (Xuan) and Thready (Xi) overall and the right Chi position was Large (Da) and Rapid (Shuo)

Question 3: Which is the best TCM diagnosis?

CASE 2

Use the following information to answer questions 3-4:

A 38-year-old man has been suffering from epistaxis for more than 8 years. He had been to the hospital 5 times and has taken a lot of Chinese and Western medicine to no avail.

Patient Information:

• he experiences epistaxis every 3-5 days
• profuse bleeding
• dull, greenish complexion
• emaciation
• fatigue
• sore and hot lower back
• Tongue: red with little coating
• Pulse: Wiry (Xuan) and Thready (Xi) overall and the right Chi position was Large (Da) and Rapid (Shuo)

Question 4: Which is the best acupuncture treatment?

CASE 3

Use the following information to answer questions 5-6:

A 51-year-old woman has been suffering from headache for more than 20 years that would come on after sexual intercourse or hard work. She felt it as distention in the head that might ‘crack’. The pain at the vertex was the worst.

Patient Information:

• nausea
• irritability
• cold limbs
• soreness and coldness in the lower back
• if she lay down with her head lower than her feet, her headache would improve
• Tongue: dark with a thin, white coat
• Pulse: Wiry (Xuan)

Question 5: Which is the best TCM diagnosis?

CASE 3

Use the following information to answer questions 5-6:

A 51-year-old woman has been suffering from headache for more than 20 years that would come on after sexual intercourse or hard work. She felt it as distention in the head that might ‘crack’. The pain at the vertex was the worst.

Patient Information:

• nausea
• irritability
• cold limbs
• soreness and coldness in the lower back
• if she lay down with her head lower than her feet, her headache would improve
• Tongue: dark with a thin, white coat
• Pulse: Wiry (Xuan)

Question 6: Which is the best acupuncture treatment?

CASE 4

Use the following information to answer questions 7-8:

A 36-year-old woman suffered from palpitations for 1 year. It has worsened over the past 20 days.  

Patient Information:

• mild night sweats
• dizziness
• poor memory
• dry throat
• irritability
• fatigue
• scanty menses
• Tongue: pale with a thin, white coat
• Pulse: Thready (Xi) and Weak (Ruo)

Question 7: Which is the best TCM diagnosis?

CASE 4

Use the following information to answer questions 7-8:

A 36-year-old woman suffered from palpitations for 1 year. It has worsened over the past 20 days.  

Patient Information:

• mild night sweats
• dizziness
• poor memory
• dry throat
• irritability
• fatigue
• scanty menses
• Tongue: pale with a thin, white coat
• Pulse: Thready (Xi) and Weak (Ruo)

Question 8: Which is the best acupuncture treatment?

CASE 5

Use the following information to answer questions 9-10:

A 14-year-old boy suffered from soreness of low back and knees, fatigue, and proteinuria for 2 years. He developed skin rash of the whole body. He was diagnosed by his Western doctor with scarlet fever and received antibiotics treatment. The skin rash disappeared, but the proteinuria remained.

Patient Information:

• shortness of breath
• fatigue
• soreness of low back and knees
• loss of appetite
• yellow urine
• dry stool
• furuncles on his face
• Tongue: red tip with a thin, white coat
• Pulse: Thready (Xi) and Slippery (Hua)

Question 9: Which is the best TCM diagnosis?

CASE 5

Use the following information to answer questions 9-10:

A 14-year-old boy suffered from soreness of low back and knees, fatigue, and proteinuria for 2 years. He developed skin rash of the whole body. He was diagnosed by his Western doctor with scarlet fever and received antibiotics treatment. The skin rash disappeared, but the proteinuria remained.

Patient Information:

• shortness of breath
• fatigue
• soreness of low back and knees
• loss of appetite
• yellow urine
• dry stool
• furuncles on his face
• Tongue: red tip with a thin, white coat
• Pulse: Thready (Xi) and Slippery (Hua)

Question 10: Which is the best acupuncture treatment?

CASE 6

Use the following information to answer questions 11-12:

A 54-year-old woman suffered from High Blood Pressure for 15 years. She often had headache and dizziness and has fainted several times. 

Patient Information:

• in the past week, the headache and dizziness became worse
• hot sensation of the face
• 5-centre heat
• sleeplessness
• dream-disturbed sleep
• edema of the lower limbs
• pain and dark color to the skin of the legs
• blood pressure was 200/100mmHg
• Tongue: thin and yellow coat
• Pulse: Wiry (Xuan)

Question 11: Which is the best TCM diagnosis?

CASE 6

Use the following information to answer questions 11-12:

A 54-year-old woman suffered from High Blood Pressure for 15 years. She often had headache and dizziness and has fainted several times. 

Patient Information:

• in the past week, the headache and dizziness became worse
• hot sensation of the face
• 5-centre heat
• sleeplessness
• dream-disturbed sleep
• edema of the lower limbs
• pain and dark color to the skin of the legs
• blood pressure was 200/100mmHg
• Tongue: thin and yellow coat
• Pulse: Wiry (Xuan)

Question 12: Which is the best acupuncture treatment?

CASE 7

Use the following information to answer questions 13-14:

A 58-year-old man has suffered from paralysis for 1 year.

Patient Information:

• his gait is waddling, and he needs a cane to walk
• his body is very overweight
• he has Down’s Syndrome
• sleepiness
• difficulty speaking
• loose bowel movements
• sluggish movement and countenance
• when he spoke, his answers were slow and not always relating to the subject at hand
• Tongue: big with a white, greasy coat
• Pulse: Deep (Chen) and Wiry (Xuan)

Question 13: Which is the best TCM diagnosis?

CASE 7

Use the following information to answer questions 13-14:

A 58-year-old man has suffered from paralysis for 1 year.

Patient Information:

• his gait is waddling, and he needs a cane to walk
• his body is very overweight
• he has Down’s Syndrome
• sleepiness
• difficulty speaking
• loose bowel movements
• sluggish movement and countenance
• when he spoke, his answers were slow and not always relating to the subject at hand
• Tongue: big with a white, greasy coat
• Pulse: Deep (Chen) and Wiry (Xuan)

Question 14: What are the best acupuncture points to treat the root (not the paralysis locally)?

CASE 8

Use the following information to answer question 15:

A 40-year-old man has suffered from stomachache for 5 years.

Patient Information:

• distention and pain of the stomach often radiated to the lower back
• frequent nausea with occasional vomiting
• belching
• fatigue
• internal vexation
• palpitations in the abdomen
• cold
• Tongue: white coat, wet, puffy
• Pulse: Big (Da), Wiry (Xuan) and Tight (Jin) especially in Chi position

Question 15: Which is the best TCM diagnosis?

CASE 9

Use the following information to answer questions 16-17:

A 45-year-old man has suffered from severe pain of the back and lower back for more than 3 months. He was diagnosed with sciatic pain. 

Patient Information:

• he received physiotherapy, massage, acupuncture and western medication without relief
• dull pain of the low back and left leg along the Bladder meridian
• aside from the pain, he had no other symptoms
• Tongue: white coat
• Pulse: Wiry (Xuan), Tight (Jin) and Weak (Ruo) in the Chi positions

Question 16: Which is the best TCM diagnosis?

CASE 9

Use the following information to answer questions 16-17:

A 45-year-old man has suffered from severe pain of the back and lower back for more than 3 months. He was diagnosed with sciatic pain. 

Patient Information:

• he received physiotherapy, massage, acupuncture and western medication without relief
• dull pain of the low back and left leg along the Bladder meridian
• aside from the pain, he had no other symptoms
• Tongue: white coat
• Pulse: Wiry (Xuan), Tight (Jin) and Weak (Ruo) in the Chi positions

Question 17: Which is the best acupuncture treatment?

CASE 10

Use the following information to answer questions 18-19:

A 45-year-old man suffered from heaviness and fatigue of the lower limbs for 7-8 years and spontaneous sweating for 5-6 years. 

Patient Information:

• severe heaviness and fatigue from his low back to his feet
• he couldn’t even lift his legs
• serious sweating below the waist, but no sweating above the waist
• loss of appetite
• fullness in the Stomach
• dry mouth without desire for drinking.
• even taking 3000-4000 mL of water didn’t relieve his thirst
• Tongue: coating was greasy, and had a combined yellow and white colour

Question 18: Which is the best TCM diagnosis?

CASE 10

Use the following information to answer questions 18-19:

A 45-year-old man suffered from heaviness and fatigue of the lower limbs for 7-8 years and spontaneous sweating for 5-6 years. 

Patient Information:

• severe heaviness and fatigue from his low back to his feet
• he couldn’t even lift his legs
• serious sweating below the waist, but no sweating above the waist
• loss of appetite
• fullness in the Stomach
• dry mouth without desire for drinking.
• even taking 3000-4000 mL of water didn’t relieve his thirst
• Tongue: coating was greasy, and had a combined yellow and white colour

Question 19: Which is the best acupuncture treatment?

CASE 11

Use the following information to answer question 20:

A 46-year-old man suffers from cough for 30 years and asthma for 20 years. It has been worse for 4 years. 

Patient Information:

• especially in the winter, he has cough with phlegm and asthma that is often worse after eating
• edema of the face, limbs and abdomen
• sweating on the head
• cold feet
• lips, tongue, face and fingers are purple
• Tongue: thick, yellow, greasy coat
• Pulse: Wiry (Xuan) and Slippery (Hua)

Question 20: Which is the best TCM diagnosis?

CASE 12

Use the following information to answer question 21:

A 36-year-old woman has her period every 50 days.

Patient Information:

• fatigue
• cold of the lower abdomen
• likes to drink warm drinks
• she often has a sore throat
• Tongue: thin with a white coat
• Pulse: Slow (Chi) and Weak (Ruo)

Question 21: Which is the best TCM diagnosis?

CASE 13

Use the following information to answer question 22:

A 36-year-old woman suffered from lower abdominal pain for 10 years.

Patient Information:

• with her period
  • lower abdominal pain
  • distention in the breasts
  • painful sensation on her thighs
  • period blood is purple with clots
• bowel movements were dry
• Tongue: thin, white coat
• Pulse: Wiry (Xuan)

Question 22: Which is the best TCM diagnosis?

CASE 14

Use the following information to answer question 23:

A 39-year-old woman has suffered from headaches for 20 years. The headaches attack 1-2 times/month. 

Patient Information:

• pain is on the vertex, forehead, temples and sometimes to the orbit and eyeballs
• always gets it when she is on her period
• pain is dull and achey
• for 20 years, the headache has been getting worse and attacks every 2-3 days
• other symptoms include:
  • fatigue
  • lassitude
  • yellow complexion
  • dream disturbed sleep
• Tongue: thin with white coat
• Pulse: Thready (Xi), Wiry (Xuan) and Weak (Ruo)

Question 23: Which is the best TCM diagnosis?

CASE 15

Use the following information to answer question 24:

A 48-year-old woman has been suffering from diarrhea for over 1 year. One year ago, she had diarrhea due to unclean food which cleared up with medication. After working under a lot of stress and very hard, the diarrhea attacked again. 

Patient Information:

• at 3 o’clock in the morning, she has:
  • abdominal pain
  • borborygmus
  • heavy and sagging sensation in the abdomen
  • urgent diarrhea
  • pain is relieved with defecation
  • stool is loose with no pus or blood
  • appetite is normal
  • Tongue: red sides with yellow coat on the root
  • Pulse: Wiry (Xuan) and Slow (Chi)

Question 24: Which is the best TCM diagnosis?

CASE 16

Use the following information to answer question 25:

An 18-year-old man suffered from edema for 8 years. He was diagnosed with glomerular nephritis 8 years ago. He received many treatments, but the symptoms just worsened. 

Patient Information:

• very serious chronic edema
• feelings of cold
• aversion to heat
• fatigue
• thirst without desire to drink
• headache
• neck stiffness
• nasal obstruction
• sweating easily with exertion
• soreness of the low back
• Tongue: slight yellow coat
• Pulse: Floating (Fu), Rapid (Shuo), and Thready (Xi)

Question 25: Which is the best TCM diagnosis?

CASE 17

Use the following information to answer question 26:

A 68-year-old woman suffered from vomiting for 1 week. She has had Kidney disease for many years. One week ago, she went to the hospital due to uremia. 

Patient Information:

• severe vomiting (even food and medicine)
• whole body edema
• abdominal distention
• scanty urination
• dizziness on exertion
• a feeling of cold
• cold limbs
• Tongue: dark and swollen with a white, moist coat and tooth marks

Question 26: Which is the best TCM diagnosis?

CASE 18

Use the following information to answer question 27:

A 38-year-old woman had suffered from sore and dry throat for 3 years.

Patient Information:

• always has dryness, pain, and a burning sensation in her throat
• oppression of the chest and hypochondrium
• nausea, vomiting, and breast pain during her period
• itching of the vagina
• profuse leucorrhea
• dream disturbed sleep
• Tongue: sticky, yellow tongue coat
• Pulse: Wiry (Xuan), Rapid (Shuo), and Slippery (Hua)

Question 27: Which is the best TCM diagnosis?

CASE 19

Use the following information to answer questions 28-30:

Mr. Penez has had tinnitus for 10 years.

Patient Information:

• tinnitus is intermittent
• aggravated by exercise and stress
• partly relieved by applying pressure around the ear
• low back pain
• Tongue: mild red
• Pulse: Thready (Xi)

Question 28: Which is the best TCM diagnosis?

CASE 19

Use the following information to answer questions 28-30:

Mr. Penez has had tinnitus for 10 years.

Patient Information:

• tinnitus is intermittent
• aggravated by exercise and stress
• partly relieved by applying pressure around the ear
• low back pain
• Tongue: mild red
• Pulse: Thready (Xi)

Question 29: What is the treatment principle that you will choose?

CASE 19

Use the following information to answer questions 28-30:

Mr. Penez has had tinnitus for 10 years.

Patient Information:

• tinnitus is intermittent
• aggravated by exercise and stress
• partly relieved by applying pressure around the ear
• low back pain
• Tongue: mild red
• Pulse: Thready (Xi)

Question 30: Which is the best acupuncture treatment?

CASE 20

Use the following information to answer questions 31-33:

Ms. Jones is 43-years-old and has suffered from recurrent Urinary Tract Infections for 2 years.

Patient Information:

• dull low back pain that is worse with exertion
• clear urine that requires her to get up several times during the night
• feels cold all of the time
• Tongue: normal with a white coat
• Pulse: Weak (Ruo)

Question 31: Which is the best TCM diagnosis?

CASE 20

Use the following information to answer questions 31-33:

Ms. Jones is 43-years-old and has suffered from recurrent Urinary Tract Infections for 2 years.

Patient Information:

• dull low back pain that is worse with exertion
• clear urine that requires her to get up several times during the night
• feels cold all of the time
• Tongue: normal with a white coat
• Pulse: Weak (Ruo)

Question 32: What is the treatment principle that you will choose?

CASE 20

Use the following information to answer questions 31-33:

Ms. Jones is 43-years-old and has suffered from recurrent Urinary Tract Infections for 2 years.

Patient Information:

• dull low back pain that is worse with exertion
• clear urine that requires her to get up several times during the night
• feels cold all of the time
• Tongue: normal with a white coat
• Pulse: Weak (Ruo)

Question 33: Which is the best acupuncture treatment?

CASE 21

Use the following information to answer questions 34-36:

Mr. London is a 58-year-old truck driver complaining of sore throat that has persisted for months. 

Patient Information:

• hot palms and soles
• throat pain is usually worse at night
• Tongue: red without coat
• Pulse: Thready (Xi) and Rapid (Shuo)

Question 34: Which is the best TCM diagnosis?

CASE 21

Use the following information to answer questions 34-36:

Mr. London is a 58-year-old truck driver complaining of sore throat that has persisted for months. 

Patient Information:

• hot palms and soles
• throat pain is usually worse at night
• Tongue: red without coat
• Pulse: Thready (Xi) and Rapid (Shuo)

Question 35: What is the treatment principle that you will choose?

CASE 21

Use the following information to answer questions 34-36:

Mr. London is a 58-year-old truck driver complaining of sore throat that has persisted for months. 

Patient Information:

• hot palms and soles
• throat pain is usually worse at night
• Tongue: red without coat
• Pulse: Thready (Xi) and Rapid (Shuo)

Question 36: Which is the best acupuncture treatment?