Herbal Practice Exam – Clinical Case Studies #6

CASE 1

Use the following information to answer questions (1-5):

A 26-year-old patient has sticky, thick, offensive, and yellow vaginal discharge for 8 months.

Patient Information:

• was a University student for 7 years
• lived off of coffee and microwave meals
• feels “mentally drained and physically tired” as University was very stressful
• loose stool since year 2 of her studies – stool is quite foul smelling
• scanty urine
• itchy vulva
• Pulse: Rapid (Shuo) and Wiry (Xuan)
• Tongue: sticky, yellow coat with toothmarks on the side

Question 1: What is the most accurate TCM pattern to treat today?

CASE 1

Use the following information to answer questions (1-5):

A 26-year-old patient has sticky, thick, offensive, and yellow vaginal discharge for 8 months.

Patient Information:

• was a University student for 7 years
• lived off of coffee and microwave meals
• feels “mentally drained and physically tired” as University was very stressful
• loose stool since year 2 of her studies – stool is quite foul smelling
• scanty urine
• itchy vulva
• Pulse: Rapid (Shuo) and Wiry (Xuan)
• Tongue: sticky, yellow coat with toothmarks on the side

Question 2: What is the treatment principle?

CASE 1

Use the following information to answer questions (1-5):

A 26-year-old patient has sticky, thick, offensive, and yellow vaginal discharge for 8 months.

Patient Information:

• was a University student for 7 years
• lived off of coffee and microwave meals
• feels “mentally drained and physically tired” as University was very stressful
• loose stool since year 2 of her studies – stool is quite foul smelling
• scanty urine
• itchy vulva
• Pulse: Rapid (Shuo) and Wiry (Xuan)
• Tongue: sticky, yellow coat with toothmarks on the side

Question 3: What are the etiologies for this case? (choose 2)

CASE 1

Use the following information to answer questions (1-5):

A 26-year-old patient has sticky, thick, offensive, and yellow vaginal discharge for 8 months.

Patient Information:

• was a University student for 7 years
• lived off of coffee and microwave meals
• feels “mentally drained and physically tired” as University was very stressful
• loose stool since year 2 of her studies – stool is quite foul smelling
• scanty urine
• itchy vulva
• Pulse: Rapid (Shuo) and Wiry (Xuan)
• Tongue: sticky, yellow coat with toothmarks on the side

Question 4: In regard to this patient’s symptoms, which of the following pathogeneses is correct?

CASE 1

Use the following information to answer questions (1-5):

 A 26-year-old patient has sticky, thick, offensive, and yellow vaginal discharge for 8 months.

Patient Information:

• was a University student for 7 years
• lived off of coffee and microwave meals
• feels “mentally drained and physically tired” as University was very stressful
• loose stool since year 2 of her studies – stool is quite foul smelling
• scanty urine
• itchy vulva
• Pulse: Rapid (Shuo) and Wiry (Xuan)
• Tongue: sticky, yellow coat with toothmarks on the side

Question 5: Choose the most appropriate treatment plan for this patient.

CASE 2

Use the following information to answer questions (6-8): 

A female comes to your clinic with the complaint of chronic tinnitus.

Patient Information:

• tinnitus is worse with strain and better with pressing
• dizziness
• leukorrhea that is clear
• fatigue
• knees feel weak
• Pulse: Weak (Ruo) and Wiry (Xuan)

Question 6: What is the best TCM diagnosis for this case?

CASE 2

Use the following information to answer questions (6-8): 

A female comes to your clinic with the complaint of chronic tinnitus.

Patient Information:

• tinnitus is worse with strain and better with pressing
• dizziness
• leukorrhea that is clear
• fatigue
• knees feel weak
• Pulse: Weak (Ruo) and Wiry (Xuan)

Question 7: What are your TCM Dietary recommendations?

CASE 2

Use the following information to answer questions (6-8): 

A female comes to your clinic with the complaint of chronic tinnitus.

Patient Information:

• tinnitus is worse with strain and better with pressing
• dizziness
• leukorrhea that is clear
• fatigue
• knees feel weak
• Pulse: Weak (Ruo) and Wiry (Xuan)

Question 8: Select the acupuncture points that are best to treat the main syndrome for this patient.

CASE 3

Use the following information to answer questions (9-11):

A 54-year-old man has the main complaint of insomnia.

Patient Information:

• easily falls asleep but wakes up several times during the night, often with palpitations
• dry throat
• erectile dysfunction for the past two years
• held a very high-profile job for 30 years that has him working incredibly long hours
• Tongue: red with a very thin coating
• Pulse: Weak (Ruo), Thready (Xi), and Rapid (Shuo) in the left distal and proximal positions

Question 9: What is the most accurate TCM diagnosis in this case?

CASE 3

Use the following information to answer questions (9-11):

A 54-year-old man has the main complaint of insomnia.

Patient Information:

• easily falls asleep but wakes up several times during the night, often with palpitations
• dry throat
• erectile dysfunction for the past two years
• held a very high-profile job for 30 years that has him working incredibly long hours
• Tongue: red with a very thin coating
• Pulse: Weak (Ruo), Thready (Xi), and Rapid (Shuo) in the left distal and proximal positions

Question 10: What is the most likely etiology for this patient?

CASE 3

Use the following information to answer questions (9-11):

A 54-year-old man has the main complaint of insomnia.

Patient Information:

• easily falls asleep but wakes up several times during the night, often with palpitations
• dry throat
• erectile dysfunction for the past two years
• held a very high-profile job for 30 years that has him working incredibly long hours
• Tongue: red with a very thin coating
• Pulse: Weak (Ruo), Thready (Xi), and Rapid (Shuo) in the left distal and proximal positions

Question 11: Select the acupuncture points that are best to treat the main syndrome for this patient.

CASE 4

Use the following information to answer questions (12-16):

A 48-­‐year-­‐old female, after years of excessive fatigue, suddenly felt severe, crushing pain on the left side of her chest.

Patient Information:

• has been a labourer for many years
• palpitations
• profuse perspiration that lasted four hours
• continuous pain in left chest
• shortness of breath
• dizziness
• cold body and limbs
• ECG shows acute inferior myocardial infarction, occasionally accompanied by ventricular premature beat
• diagnosed by her Western doctor with coronary heart disease and acute inferior myocardial infarction
• Tongue: pale purple
• Pulse: Deep (Chen), Thready (Xi)

Question 12: What is the most accurate TCM patterns to treat today?

CASE 4

Use the following information to answer questions (12-16):

A 48-­‐year-­‐old female, after years of excessive fatigue, suddenly felt severe, crushing pain on the left side of her chest.

Patient Information:

• has been a labourer for many years
• palpitations
• profuse perspiration that lasted four hours
• continuous pain in left chest
• shortness of breath
• dizziness
• cold body and limbs
• ECG shows acute inferior myocardial infarction, occasionally accompanied by ventricular premature beat
• diagnosed by her Western doctor with coronary heart disease and acute inferior myocardial infarction
• Tongue: pale purple
• Pulse: Deep (Chen), Thready (Xi)

Question 13: Which treatment principle will you choose?

CASE 4

Use the following information to answer questions (12-16):

A 48-­‐year-­‐old female, after years of excessive fatigue, suddenly felt severe, crushing pain on the left side of her chest.

Patient Information:

• has been a labourer for many years
• palpitations
• profuse perspiration that lasted four hours
• continuous pain in left chest
• shortness of breath
• dizziness
• cold body and limbs
• ECG shows acute inferior myocardial infarction, occasionally accompanied by ventricular premature beat
• diagnosed by her Western doctor with coronary heart disease and acute inferior myocardial infarction
• Tongue: pale purple
• Pulse: Deep (Chen), Thready (Xi)

Question 14: What is the most likely pathogenesis for her TCM presentation?

CASE 4

Use the following information to answer questions (12-16):

A 48-­‐year-­‐old female, after years of excessive fatigue, suddenly felt severe, crushing pain on the left side of her chest.

Patient Information:

• has been a labourer for many years
• palpitations
• profuse perspiration that lasted four hours
• continuous pain in left chest
• shortness of breath
• dizziness
• cold body and limbs
• ECG shows acute inferior myocardial infarction, occasionally accompanied by ventricular premature beat
• diagnosed by her Western doctor with coronary heart disease and acute inferior myocardial infarction
• Tongue: pale purple
• Pulse: Deep (Chen), Thready (Xi)

Question 15: Select four acupuncture points that are best to treat the main syndrome for this patient. (Select 4)

CASE 4

Use the following information to answer questions (12-16):

A 48-­‐year-­‐old female, after years of excessive fatigue, suddenly felt severe, crushing pain on the left side of her chest.

Patient Information:

• has been a labourer for many years
• palpitations
• profuse perspiration that lasted four hours
• continuous pain in left chest
• shortness of breath
• dizziness
• cold body and limbs
• ECG shows acute inferior myocardial infarction, occasionally accompanied by ventricular premature beat
• diagnosed by her Western doctor with coronary heart disease and acute inferior myocardial infarction
• Tongue: pale purple
• Pulse: Deep (Chen), Thready (Xi)

Question 16: What is a current and immediate danger with this patient?

CASE 5

Use the following information to answer questions (17-20):

A 30-year-old patient named Jackson presents with abdominal pain for 11 years that has been worsening for the past 9 months.

Patient Information:

• pain is in his entire abdomen and occasionally into the back
• his diet was always greasy and rich
• pain is heavy and burning, moves around, and is worse after eating
• trouble keeping weight on, and in the past has had diarrhea 5-8 times/day
• 1-2 bowel movements/day which are often small in amount and feel incomplete
• occasional mucous in his stool, but denies any blood
• cramps and sensations of nausea
• occasional front and temporal headaches prior to bowel movements, which is often relieved by defecation
• bitter taste in the mouth after meals
• in the morning, he often awakes to belching, a bitter liquid in the mouth, and foul The liquid is watery and light green to blackish in colour.
• occasional low-pitched and high-pitched ringing in his ears
• occasional itchy skin with a mild, red rash
• all symptoms are worse with spicy and greasy foods
• feels warm overall and is easily frustrated and angered
• avoids confrontation at all costs
• he has had no big stress over the past year
• had an endoscopy 3- months ago which was negative
• family history consists of an uncle having a similar condition who died at 50-years-old
• diet is bland at this point as it is all he can handle
• poor appetite and fatigue
• appears thin and malnourished looking
• sclerae are slightly red and yellowish, and his eyes are occasionally watery and itchy
• currently has a stye on his upper eyelid of his right eye
• upon palpation, he is very tender over the left upper and lower quadrants as well as the hypochondriac region on the right side under the 10th rib
• Tongue: red body, some greasy, yellow coat, some areas have little coat, red prickles on the sides and tip
• Pulse: Wiry (Xuan), Slippery (Hua), and Forceful (You Li) at the surface and Deficient (Xu) below

Question 17: You would diagnose him as having:

CASE 5

Use the following information to answer questions (17-20):

A 30-year-old patient named Jackson presents with abdominal pain for 11 years that has been worsening for the past 9 months.

Patient Information:

• pain is in his entire abdomen and occasionally into the back
• his diet was always greasy and rich
• pain is heavy and burning, moves around, and is worse after eating
• trouble keeping weight on, and in the past has had diarrhea 5-8 times/day
• 1-2 bowel movements/day which are often small in amount and feel incomplete
• occasional mucous in his stool, but denies any blood
• cramps and sensations of nausea
• occasional front and temporal headaches prior to bowel movements, which is often relieved by defecation
• bitter taste in the mouth after meals
• in the morning, he often awakes to belching, a bitter liquid in the mouth, and foul The liquid is watery and light green to blackish in colour.
• occasional low-pitched and high-pitched ringing in his ears
• occasional itchy skin with a mild, red rash
• all symptoms are worse with spicy and greasy foods
• feels warm overall and is easily frustrated and angered
• avoids confrontation at all costs
• he has had no big stress over the past year
• had an endoscopy 3- months ago which was negative
• family history consists of an uncle having a similar condition who died at 50-years-old
• diet is bland at this point as it is all he can handle
• poor appetite and fatigue
• appears thin and malnourished looking
• sclerae are slightly red and yellowish, and his eyes are occasionally watery and itchy
• currently has a stye on his upper eyelid of his right eye
• upon palpation, he is very tender over the left upper and lower quadrants as well as the hypochondriac region on the right side under the 10th rib
• Tongue: red body, some greasy, yellow coat, some areas have little coat, red prickles on the sides and tip
• Pulse: Wiry (Xuan), Slippery (Hua), and Forceful (You Li) at the surface and Deficient (Xu) below

Question 18: Your most accurate treatment principle would be to:

CASE 5

Use the following information to answer questions (17-20):

A 30-year-old patient named Jackson presents with abdominal pain for 11 years that has been worsening for the past 9 months.

Patient Information:

• pain is in his entire abdomen and occasionally into the back
• his diet was always greasy and rich
• pain is heavy and burning, moves around, and is worse after eating
• trouble keeping weight on, and in the past has had diarrhea 5-8 times/day
• 1-2 bowel movements/day which are often small in amount and feel incomplete
• occasional mucous in his stool, but denies any blood
• cramps and sensations of nausea
• occasional front and temporal headaches prior to bowel movements, which is often relieved by defecation
• bitter taste in the mouth after meals
• in the morning, he often awakes to belching, a bitter liquid in the mouth, and foul The liquid is watery and light green to blackish in colour.
• occasional low-pitched and high-pitched ringing in his ears
• occasional itchy skin with a mild, red rash
• all symptoms are worse with spicy and greasy foods
• feels warm overall and is easily frustrated and angered
• avoids confrontation at all costs
• he has had no big stress over the past year
• had an endoscopy 3- months ago which was negative
• family history consists of an uncle having a similar condition who died at 50-years-old
• diet is bland at this point as it is all he can handle
• poor appetite and fatigue
• appears thin and malnourished looking
• sclerae are slightly red and yellowish, and his eyes are occasionally watery and itchy
• currently has a stye on his upper eyelid of his right eye
• upon palpation, he is very tender over the left upper and lower quadrants as well as the hypochondriac region on the right side under the 10th rib
• Tongue: red body, some greasy, yellow coat, some areas have little coat, red prickles on the sides and tip
• Pulse: Wiry (Xuan), Slippery (Hua), and Forceful (You Li) at the surface and Deficient (Xu) below

Question 19: What is three of the most likely etiologies for this patient?

CASE 5

Use the following information to answer questions (17-20):

A 30-year-old patient named Jackson presents with abdominal pain for 11 years that has been worsening for the past 9 months.

Patient Information:

• pain is in his entire abdomen and occasionally into the back
• his diet was always greasy and rich
• pain is heavy and burning, moves around, and is worse after eating
• trouble keeping weight on, and in the past has had diarrhea 5-8 times/day
• 1-2 bowel movements/day which are often small in amount and feel incomplete
• occasional mucous in his stool, but denies any blood
• cramps and sensations of nausea
• occasional front and temporal headaches prior to bowel movements, which is often relieved by defecation
• bitter taste in the mouth after meals
• in the morning, he often awakes to belching, a bitter liquid in the mouth, and foul The liquid is watery and light green to blackish in colour.
• occasional low-pitched and high-pitched ringing in his ears
• occasional itchy skin with a mild, red rash
• all symptoms are worse with spicy and greasy foods
• feels warm overall and is easily frustrated and angered
• avoids confrontation at all costs
• he has had no big stress over the past year
• had an endoscopy 3- months ago which was negative
• family history consists of an uncle having a similar condition who died at 50-years-old
• diet is bland at this point as it is all he can handle
• poor appetite and fatigue
• appears thin and malnourished looking
• sclerae are slightly red and yellowish, and his eyes are occasionally watery and itchy
• currently has a stye on his upper eyelid of his right eye
• upon palpation, he is very tender over the left upper and lower quadrants as well as the hypochondriac region on the right side under the 10th rib
• Tongue: red body, some greasy, yellow coat, some areas have little coat, red prickles on the sides and tip
• Pulse: Wiry (Xuan), Slippery (Hua), and Forceful (You Li) at the surface and Deficient (Xu) below

Question 20: You would most likely choose which of the following point combinations:

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 21: What is the name of the TCM Illness(es) that this patient has? (Select 2)

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 22: What is the most accurate TCM pattern(s) to treat today?

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 23: What is the treatment principle?

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 24: What is the etiology for this case?

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 25: Is there a secondary TCM pattern to treat once the first one(s) have been ameliorated?

CASE 6

Use the following information to answer questions (21-26):

Your patient complains mostly of diarrhea with accompanying nausea, stomachache, cold, and chills for the past week.

Patient History:

• diarrhea and abdominal pain occurring on and off for over 10 years
• diarrhea most frequently occurs after eating wheat products
• stool can be pasty and sometimes contain a clear mucous
• bearing down sensations and Stomach pains worsen after a bowel movement
• she tries to ‘keep her diet clean’ with lots of salad and fruit
• addicted to Coca Cola and drinks up to 2 litres/day and 2 glasses of red wine with dinner daily
• urine is clear and frequent
• does not perspire
• lassitude
• retains water around face and eyelids
• depressed with little inclination to speak
• allergic to dust and animal hair
• diagnosed by Primary Care Physician with IBS and anemia
• takes Imodium and painkillers regularly
• lived on the West Coast of Canada for 20 years
• has had one abortion in the past
• her father had psoriasis and rheumatoid arthritis
• mother had weak digestion her entire life and had a nervous breakdown in her 40s
• period normally 30-35 days and last 7-10 days (mostly consisting of spotting) with pale menses

Current Patient Information:

• slim build
• sallow complexion
• wine and cola currently worsening symptoms
• eating lots of salads to try to improve health overall
• diarrhea immediately following a meal accompanied by heavy head, dull Stomach pain, distension, gas, bloating, borborygmus, and a bearing down sensation
• Stomach pain can be sharp at times
• heat and pressure help ease the symptoms
• diarrhea 3 to 4 times/day
• diarrhea is watery, has no smell, and contains undigested food
• loss of appetite
• no taste in mouth and watery saliva
• achy muscles and joints
• diarrhea, nausea, and abdominal pain worsening
• period is one week overdue with no chance of pregnancy
• recently divorced and move to Calgary to be with new partner
• lots of stress and trouble adjusting to the cold Calgary weather – symptoms worse since moving
• Pulse: Moderate (Huan), Slow (Chi), Soggy (Ru), Thready (Xi) on the right, and Deep (Chen), Weak (Ruo), Slow (Chi) and Thready (Xi) on the left
• Tongue: pale with a thick, white coat

Question 26: What are the best acupuncture points to select for this patient?

CASE 7

Use the following information to answer questions (27-31):

Coen was born at 42 weeks and had a seizure within the first 24 hours of birth and 6-12 Petit Mal (Absence) seizures within the first 3 months of birth.

Patient Information:

• in hospital during first two weeks after birth, an ECG indicated edema of the brain and an MRI revealed moderate damage to the cortex and brain stem
• upon returning home with parents, he was unable to nurse, having become accustomed to a feeding tube
• upon the use of a nipple shield, Coen started breastfeeding
• over the next 3 months, Coen appeared fine, with good reflexes, muscle tone, and a bright spirit
• after 3 months, he began to have seizures with 10 recorded during a 24-hour ECG
• the doctor prescribed Phenobarbital for 8 days in a row. During this, Coen became irritable and cried easily. The seizures increased to 15/day after the medication.
• after this, Coen became unable to hold his head up longer than a few minutes while resting on his belly, and if tired, could not hold his head up for more than a minute
• it became evident that Coen was not nursing very often or long – he was neither gaining weight nor growing at the expected rate for his age
• he had a weak appetite and limited capacity for food
• squirming hands and feet
• frequent loose stool
• pale urine
• pale face
• Pulse: Weak (Ruo)
• Tongue: pale

Question 27: What of the following is not a TCM Illness for this case?

CASE 7

Use the following information to answer questions (27-31):

Coen was born at 42 weeks and had a seizure within the first 24 hours of birth and 6-12 Petit Mal (Absence) seizures within the first 3 months of birth.

Patient Information:

• in hospital during first two weeks after birth, an ECG indicated edema of the brain and an MRI revealed moderate damage to the cortex and brain stem
• upon returning home with parents, he was unable to nurse, having become accustomed to a feeding tube
• upon the use of a nipple shield, Coen started breastfeeding
• over the next 3 months, Coen appeared fine, with good reflexes, muscle tone, and a bright spirit
• after 3 months, he began to have seizures with 10 recorded during a 24-hour ECG
• the doctor prescribed Phenobarbital for 8 days in a row. During this, Coen became irritable and cried easily. The seizures increased to 15/day after the medication.
• after this, Coen became unable to hold his head up longer than a few minutes while resting on his belly, and if tired, could not hold his head up for more than a minute
• it became evident that Coen was not nursing very often or long – he was neither gaining weight nor growing at the expected rate for his age
• he had a weak appetite and limited capacity for food
• squirming hands and feet
• frequent loose stool
• pale urine
• pale face
• Pulse: Weak (Ruo)
• Tongue: pale

Question 28: What is the most accurate TCM pattern(s) to treat today?

CASE 7

Use the following information to answer questions (27-31):

Coen was born at 42 weeks and had a seizure within the first 24 hours of birth and 6-12 Petit Mal (Absence) seizures within the first 3 months of birth.

Patient Information:

• in hospital during first two weeks after birth, an ECG indicated edema of the brain and an MRI revealed moderate damage to the cortex and brain stem
• upon returning home with parents, he was unable to nurse, having become accustomed to a feeding tube
• upon the use of a nipple shield, Coen started breastfeeding
• over the next 3 months, Coen appeared fine, with good reflexes, muscle tone, and a bright spirit
• after 3 months, he began to have seizures with 10 recorded during a 24-hour ECG
• the doctor prescribed Phenobarbital for 8 days in a row. During this, Coen became irritable and cried easily. The seizures increased to 15/day after the medication.
• after this, Coen became unable to hold his head up longer than a few minutes while resting on his belly, and if tired, could not hold his head up for more than a minute
• it became evident that Coen was not nursing very often or long – he was neither gaining weight nor growing at the expected rate for his age
• he had a weak appetite and limited capacity for food
• squirming hands and feet
• frequent loose stool
• pale urine
• pale face
• Pulse: Weak (Ruo)
• Tongue: pale

Question 29: What is most accurate treatment principle for this patient?

CASE 7

Use the following information to answer questions (27-31):

Coen was born at 42 weeks and had a seizure within the first 24 hours of birth and 6-12 Petit Mal (Absence) seizures within the first 3 months of birth.

Patient Information:

• in hospital during first two weeks after birth, an ECG indicated edema of the brain and an MRI revealed moderate damage to the cortex and brain stem
• upon returning home with parents, he was unable to nurse, having become accustomed to a feeding tube
• upon the use of a nipple shield, Coen started breastfeeding
• over the next 3 months, Coen appeared fine, with good reflexes, muscle tone, and a bright spirit
• after 3 months, he began to have seizures with 10 recorded during a 24-hour ECG
• the doctor prescribed Phenobarbital for 8 days in a row. During this, Coen became irritable and cried easily. The seizures increased to 15/day after the medication.
• after this, Coen became unable to hold his head up longer than a few minutes while resting on his belly, and if tired, could not hold his head up for more than a minute
• it became evident that Coen was not nursing very often or long – he was neither gaining weight nor growing at the expected rate for his age
• he had a weak appetite and limited capacity for food
• squirming hands and feet
• frequent loose stool
• pale urine
• pale face
• Pulse: Weak (Ruo)
• Tongue: pale

Question 30: Which of the following points may be unnecessary in treatment?

CASE 7

Use the following information to answer questions (27-31):

Coen was born at 42 weeks and had a seizure within the first 24 hours of birth and 6-12 Petit Mal (Absence) seizures within the first 3 months of birth.

Patient Information:

• in hospital during first two weeks after birth, an ECG indicated edema of the brain and an MRI revealed moderate damage to the cortex and brain stem
• upon returning home with parents, he was unable to nurse, having become accustomed to a feeding tube
• upon the use of a nipple shield, Coen started breastfeeding
• over the next 3 months, Coen appeared fine, with good reflexes, muscle tone, and a bright spirit
• after 3 months, he began to have seizures with 10 recorded during a 24-hour ECG
• the doctor prescribed Phenobarbital for 8 days in a row. During this, Coen became irritable and cried easily. The seizures increased to 15/day after the medication.
• after this, Coen became unable to hold his head up longer than a few minutes while resting on his belly, and if tired, could not hold his head up for more than a minute
• it became evident that Coen was not nursing very often or long – he was neither gaining weight nor growing at the expected rate for his age
• he had a weak appetite and limited capacity for food
• squirming hands and feet
• frequent loose stool
• pale urine
• pale face
• Pulse: Weak (Ruo)
• Tongue: pale

Question 31: If your initial treatment Acupuncture points weren’t quite effective and Coen was still getting daily seizures, what may you consider doing?

CASE 8

Use the following information to answer questions (32-36):

A 63-year-old woman sought help with a left sided abdominal ache and constipation that occurred after over-eating at a restaurant the day before.

Patient History:

• has suffered bouts of intestinal complaints including diarrhea and easily fatigued following the surgical removal of her thyroid gland due to Grave’s Disease
• severe PMS mood swings that have greatly affected her relationships
• Tongue: slightly thickened body, yellow-white coating, red sides

Question 32: What are the most accurate TCM Illnesses in this case? (Select 2)

CASE 8

Use the following information to answer questions (32-36):

A 63-year-old woman sought help with a left sided abdominal ache and constipation that occurred after over-eating at a restaurant the day before.

Patient History:

• has suffered bouts of intestinal complaints including diarrhea and easily fatigued following the surgical removal of her thyroid gland due to Grave’s Disease
• severe PMS mood swings that have greatly affected her relationships
• Tongue: slightly thickened body, yellow-white coating, red sides

Question 33: What is the primary diagnosis for this case?

CASE 8

Use the following information to answer questions (32-36):

A 63-year-old woman sought help with a left sided abdominal ache and constipation that occurred after over-eating at a restaurant the day before.

Patient History:

• has suffered bouts of intestinal complaints including diarrhea and easily fatigued following the surgical removal of her thyroid gland due to Grave’s Disease
• severe PMS mood swings that have greatly affected her relationships
• Tongue: slightly thickened body, yellow-white coating, red sides

Question 34: What is the secondary diagnosis for this case?

CASE 8

Use the following information to answer questions (32-36):

A 63-year-old woman sought help with a left sided abdominal ache and constipation that occurred after over-eating at a restaurant the day before.

Patient History:

• has suffered bouts of intestinal complaints including diarrhea and easily fatigued following the surgical removal of her thyroid gland due to Grave’s Disease
• severe PMS mood swings that have greatly affected her relationships
• Tongue: slightly thickened body, yellow-white coating, red sides

Question 35: Why does her tongue have this presentation?

CASE 8

Use the following information to answer questions (32-36):

A 63-year-old woman sought help with a left sided abdominal ache and constipation that occurred after over-eating at a restaurant the day before.

Patient History:

• has suffered bouts of intestinal complaints including diarrhea and easily fatigued following the surgical removal of her thyroid gland due to Grave’s Disease
• severe PMS mood swings that have greatly affected her relationships
• Tongue: slightly thickened body, yellow-white coating, red sides

Question 36: Please choose the best point line to be added to her Acupuncture point prescription:

CASE 9

Use the following information to answer questions (37-40):

Mr. Tic is 78 years old. Last June, he experienced swelling and weakness in his ankles and knees and a fever or 102 degrees.

Patient History:

• diagnosed with Lyme’s disease after blood testing and a clinical inspection by his PCP
• was put on doxycycline for 10 days which worked for a few months
• pain returned and he was put on a 60-day course of antibiotics
• pain receded, but then extreme pain in his right knee and angle drove him to seek help again
• he was prescribed prednisone to decrease the inflammation
• he is often fatigued and pain is worse when tired
• frequent urination
• digestion has become poor since all of the antibiotics – loose stool and difficulty digesting some foods
• pain is a level ‘12’ on a 10-point scale in his right knee, ankle and foot
• Pulse: Forceful (You li) and Rapid (Shuo) in the proximal positions; Weak (Ruo) and Deficiency (Xu) Guan positions
• Tongue: scallops and red

Question 37: What are the most accurate TCM diagnosis in this case?

CASE 9

Use the following information to answer questions (37-40):

Mr. Tic is 78 years old. Last June, he experienced swelling and weakness in his ankles and knees and a fever or 102 degrees.

Patient History:

• diagnosed with Lyme’s disease after blood testing and a clinical inspection by his PCP
• was put on doxycycline for 10 days which worked for a few months
• pain returned and he was put on a 60-day course of antibiotics
• pain receded, but then extreme pain in his right knee and angle drove him to seek help again
• he was prescribed prednisone to decrease the inflammation
• he is often fatigued and pain is worse when tired
• frequent urination
• digestion has become poor since all of the antibiotics – loose stool and difficulty digesting some foods
• pain is a level ‘12’ on a 10-point scale in his right knee, ankle and foot
• Pulse: Forceful (You li) and Rapid (Shuo) in the proximal positions; Weak (Ruo) and Deficiency (Xu) Guan positions
• Tongue: scallops and red

Question 38: What is the best treatment principle for this case?

CASE 9

Use the following information to answer questions (37-40):

Mr. Tic is 78 years old. Last June, he experienced swelling and weakness in his ankles and knees and a fever or 102 degrees.

Patient History:

• diagnosed with Lyme’s disease after blood testing and a clinical inspection by his PCP
• was put on doxycycline for 10 days which worked for a few months
• pain returned and he was put on a 60-day course of antibiotics
• pain receded, but then extreme pain in his right knee and angle drove him to seek help again
• he was prescribed prednisone to decrease the inflammation
• he is often fatigued and pain is worse when tired
• frequent urination
• digestion has become poor since all of the antibiotics – loose stool and difficulty digesting some foods
• pain is a level ‘12’ on a 10-point scale in his right knee, ankle and foot
• Pulse: Forceful (You li) and Rapid (Shuo) in the proximal positions; Weak (Ruo) and Deficiency (Xu) Guan positions
• Tongue: scallops and red

Question 39: Why do antibiotics affect the digestion?

CASE 9

Use the following information to answer questions (37-40):

Mr. Tic is 78 years old. Last June, he experienced swelling and weakness in his ankles and knees and a fever or 102 degrees.

Patient History:

• diagnosed with Lyme’s disease after blood testing and a clinical inspection by his PCP
• was put on doxycycline for 10 days which worked for a few months
• pain returned and he was put on a 60-day course of antibiotics
• pain receded, but then extreme pain in his right knee and angle drove him to seek help again
• he was prescribed prednisone to decrease the inflammation
• he is often fatigued and pain is worse when tired
• frequent urination
• digestion has become poor since all of the antibiotics – loose stool and difficulty digesting some foods
• pain is a level ‘12’ on a 10-point scale in his right knee, ankle and foot
• Pulse: Forceful (You li) and Rapid (Shuo) in the proximal positions; Weak (Ruo) and Deficiency (Xu) Guan positions
• Tongue: scallops and red

Question 40: Why is the pulse Forceful (You li) and Rapid (Shuo)?