Professional Empowerment for Practitioners

SAACMA 2019 Case Studies

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15 Case Studies

In the CPD cycle 1 July 2017 to 30 June 2019

Available 1 April to 30 June 2019

Level of CPD activity – 1.A.2


“SAACMA 2019 Case Studies”

Prepared by Dr Wang Shiping

Offered by

SAACMA via www.saacma.co.za  Members Area

CEUs will be awarded once participants have completed the
Multiple Choice Questionnaire for 15 Case Studies in www.classmarker.com

Classmarker test period: 1 April 2019 to 30 June 2019

Pass rate - 80%

Case Study 1

A man works outside in the sun every day. On a particular day it was very hot He drank a lot of cold water and he was also sweating a lot. That night he got a fever and chills, he felt nauseous and vomited. During the night he had diarrhea 8 times, tenesmus - and being very thirsty, he drank cold water. The next day, he went to the hospital. His wbc: 10860/Hp, his stools were sticky, and rbc and wbc could be found in it.

His pulse was rapid and strong, and his tongue was yellow and greasy.   

Select the disease

A he caught a cold   

B affected by wind and heat    

C acute stomach and intestine inflammation   

D heatstroke

Select the syndrome differentiation

A wind and cold invade the surface

B wind and heat invade the channels and collaterals

C dampness and heat gather in the stomach  

D dampness and toxins invade digestive system

Select the appropriate method of treatment

A clear away wind and cold from the surface

B clear away wind and heat from the surface

C detoxify and expel dampness from the digestive system

D clear away wind, eliminate damp heat and detoxify

What recommendations should be given to the patient?

A avoid catching cold again

B avoid cold and fresh food for several days

C avoid fruit for one month

D take the medication until the fever is over

Case Study 2

An old man, 78 years old, has been smoking for 30 years. At 47 years of age he started coughing. 5 years later he was coughing seriously every day – he was asthmatic, short of breath. His coughing produced a lot of phlegm and contained fluid. Recently, he has had chest pressure and pains, palpitations and insomnia, difficult breathing, oedema of the feet, short urination, lips are cyanotic. His pulse is deep and week. His tongue is white and greasy.
X-ray photo: chronic bronchitis and pneumonectosis, but heart enlarged with prolonging to the left; ECG: ⑴pulmonary P wave; ⑵Ⅱdegree of ventricle-atrium blockage; ⑶ right ventrium and auricle enlargement; Ultrasonic cardiogram: heart maladjustment with weak movement; wbc: 8000/Hp, rbc: 7.0*10(12); CO2 combination: ↑; O2 partial pressure: ↓

Select the disease

A chronic bronchitis

B edema caused by chronic kidney disease

C pulmonale caused by special bacteria and viruses

D Cor pulmonale      

Select the syndrome differentiation

A wind and cold entered lungs

B dampness and cold invaded the lungs

C spleen and lungs are too weak to clear away phlegm

D dampness accumulation and the kidneys are too weak to accept qi from the lungs      

Select the appropriate method of treatment

A clear away the dampness and strengthen qi of lungs

B clear away wind and warm lungs

C eliminate phlegm and detoxify

D depressing qi and relieve asthma, tonify kidney and spleen

What recommendations should be given to the patient?

A avoid catching cold and flu

B don’t take pungent, cold and fresh food;

C do proper exercises every day and breathe with abdominal muscles

D all recommendations above

Case Study 3

A man, 54 years old, works as a government official, likes drinking alcohol and eating meat and sea food. At the hospital he was diagnosed with diabetes, high blood pressure, middle degree of fatty liver and hyper-lipeamia. His blood sugar is always high, up to 10mmol/ml before eating and after a meal it can be 19mol/ml. He is obese, he feels weak, without energy (qi), and likes to sleep. He readily catches a cold and flu, and can cough with much phlegm. He experiences pain in his back and lumbar area, his knees are weak and he experiences dream-disturbed sleep. He is taking western medicine to control his high level of sugar, cholesterol and hypertension, but not with good results. His tongue is fat with teeth marks, his pulse is forceful but empty when heavily pressed.

Select the disease

A diabetes

B hypertension  

C hyper-lipeamia

D all mentioned above

Select the syndrome differentiation

A weakness of spleen and lung qi with damp and phlegm

B wind and cold invade the channels and collaterals with phlegm

C liver wind rising caused by damp and phlegm combining with qi deficiency of spleen, kidney and lung  

D kidney qi and yin both deficiency

Select the appropriate method of treatment

A expel wind and eliminate damp and phlegm

B strengthen qi of spleen and lungs

C calm down liver wind and strengthen qi and eliminate phlegm   

D regulate kidney yin and yang

What recommendations should be given to the patient?

A stop drinking

B avoid fat and sweet

C body movement is necessary

D all above mentions   

Case Study 4

A man, 57 years of age, working as a government official, dislikes vegetables and fruit, but likes smoking, alcohol and sea food. Two years ago, the skin on both his arms, down to his fingers, felt tight and numb. And then his speech became affected due to the rigidity and tightness of his tongue. He went to the hospital to be examined. His blood pressure was high at 180/120mmHg; his uric acid is at 580umol/ml, and his cholesterol levels were high. CT and MRI show: cerebral ischemia, short blood supply from basal and vertebral arteries, softening brain essence. The patient felt uncomfortable: headache, dizzy, accompanied with nausea, vomiting, tinnitus. He also experienced aching muscles, numbness and difficult movement. After more than 20 days in hospital his condition has not improved and he wanted the TCM doctor to treat him. His appetite was normal, and he presented with dizziness, headaches and shaking hands. His tongue was greasy and yellow, pulse was thready and rapid.

Select the disease

A cerebral infarction  

B high blood pressure

C hyper-lipeamia       

D all mentioned above   

Select the syndrome differentiation

A obstruction of qi, phlegm, blood stasis in the channels and collaterals

B inner liver wind caused by blockage of qi, phlegm and blood stasis     

C liver and kidney deficiency

D spleen and kidney deficiency

Select the appropriate method of treatment

A clear away heat and eliminate dampness, calm down liver wind

B promote blood movement and expel blood stasis

C regulate yin and yang of liver and kidney

D calm down liver wind and eliminate dampness, phlegm, blood stasis    

What recommendations should be given to the patient?

A stop drinking; avoid fat - vegetables and fruits are suitable

B proper movement is necessary

C have his condition checked at regular intervals

D all mentioned above    

Case Study 5

A young man, 27 years old, married. One year ago he was diagnosed in hospital with mediastinal tumor. The pain in his sternum gradually increased. He began to cough with thick phlegm, sometimes the phlegm had traces of blood. He had a low fever, hoarse voice, night sweating. CT & MRI show:  tumor under the sternum in the mediastinum and attaching to chest aorta – looking like a crab covering the aorta and the bronchea. Therefore, no surgeon could operate and remove the tumor. The pathological report shows: a malignant tumor of low differentiation of small cells. Because he does not have the option of an operation, he has to choose the treatment of Chinese medicine. His face is flushed, he angers very quickly and other symptoms include thirst for cold drinks, low fever of 37.5 to 38 degree, insomnia or dreamfulness. His tongue is deep red with thin fur, the pulse is long, forceful and rapid.  

Select the disease

A pulmonory inflammation

B pulmonary carcinoma

C mediastinal cancer with blockage of pneumonia  

D bronchoeclasis  

Select the syndrome differentiation

A pulmonory dryness caused by yin deficiency

B dryness, blood stasis, phlegm accumulation with poisoning

C hot poisoning combining with blood stasis and phlegm

D yin deficiency caused by hot poisoning

Select the appropriate method of treatment

A clear away heat and detoxify, activate blood circulation and eliminate blood stasis and phlegm, soften tumor  

B open the lung way and calm down lung qi, relieve cough

C clear away heat and protect yin from injury

D clear away heat and relieve bleeding

What recommendations should be given to the patient?

A stop smoking, alcohol

B don’t eat pungent foods, beef, goat meat, sea food, etc

C take more grains than meat

D all mentioned above    

Case Study 6

A male, 21 years old, got arrhythmia as a sequela of viral myocarditis a year ago. He often has palpitations, aggravated by overstrain, short breath, feeling of oppression in the chest, spontaneous sweating worsened by exertion, lassitude, insomnia, dreamfulness, dry mouth and tongue, dry and red tongue without coating, irregular rapid and thready pulse.

ECG: irregular heart beat QRS: 98 times/minute, frequent atria-premature systole: 15-23 times/minute combining with occasional ventricular premature systole: 3-5 times/minute, V1, V2, V3: ST-T inverted, low plain or biphasic.


Select the disease

A myocarditis causes sequela

B neurosism of heart

C coronary heart disease

D other heart disease


What is the syndrome differentiation?

A heart qi and yin both deficiency

B qi deficiency of spleen and heart

C heart and kidney have no good communication

D liver and kidney yin deficiency


Select the appropriate method of treatment

A replenish Qi, nourish Yin, calm Shen

B strengthen qi of heart and spleen, and calm shen

C create communication between kidney and heart

D reduce fire from heart and liver


What recommendations should be given to the patient?

A keep the suitable rest

B eat soft food which is easy to be digested

C relax and focus on good emotions

D all mentioned above

Case Study 7

A male, 55 years old, presents with dull and distending pain in the chest. It occurs from time to time without fixed place. It has happened repeatedly over the past 5 years and it was aggravated 3 days ago after a quarrel with someone, accompanied by distension in the epigastrium. He feels better after burping or hiccup. His tongue coating is thin and white; his pulse is wiry and thready.

ECG: V1, V3 ST-T low plain, T wave bicuspid.

Select the disease                                  

A myocardiac ischemia

B chest Bi

C chronic gastritis

D both A and B

Select the syndrome differentiation

A qi deficiency and blood stasis

B qi stagnation with indigestive food

C qi and blood stagnation

D qi and blood deficiency                                 

Select the appropriate method of treatment

A remove Qi stagnation, improve Qi and blood circulation and relieve chest pain     

B improve blood circulation and relieve pain

C remove qi stagnation and relieve pain

D strengthen qi and blood of spleen and heart

What recommendations should be given to the patient?

A keep the suitable rest

B take the soft food which is easy to be digested

C keep the good emotions and relaxation

D all mentioned above   

Case Study 8

A young girl, 16 years old, is a high school student. One month ago, she suffered from tonsillitis. After treatment with anti-biotics, she felt fine. Then she experienced acute joint pains. Her joints were reddish and swollen with aversion to cold and wind. A hospital examination shows her temperature is 37.5cc degree; the heart beat is 115/min. Both her knees are swollen and she refuses to touch them. Sometimes her joint pains moved to her elbows, shoulders and back. Report: her blood deposit: 24mm/h, Reumatoid factor: negative, wbc: 9000/mm3; rbs: 4.0*10(12)/mm3; her tongue is red with thin coating; pulse is floating, wiry and rapid.

Select the disease

A acute rheumatic arthritis

B rheumatoid arthritis

C flu

D cold

Select the syndrome differentiation

A wind and cold  invade channels and collaterals with damp

B Bi syndrome caused by wind, damp and heat blockage of channels and collaterals

C wind and cold transfer from surface to the internal organs

D damp and heat poisoning block the channels and collaterals

Select the appropriate method of treatment

A expel wind, clear away damp and activate blood circulation

B warm channels and collaterals, eliminate damp and detoxify

C dredge the channels and collaterals, stop pain and strengthen qi of spleen

D tonify kidney yang and eliminate damp

What recommendations should be given to the patient?

A keep warm and don’t catch cold  

B don't take pungent and cold food

C sleep all the time and don't move

D avoid bathing related joints

Case Study 9

A female, 47 years old, works in the factory and 5 years ago she got a strange illness. Her muscles became hard and she moved with difficulty. At the hospital the doctor diagnosed her condition as connective tissue disease, and gave her steroids as a treatment. However, her condition worsened. All her muscles became rigid – her body felt numb without pain. Her face has a strange appearance: wax-like skin, stupor complexion without emotional expressing; her complexion is bright without cracks. She complains that she feels very uncomfortable - she can’t go to work. She does not eat well; she has a full and expanding feeling in her abdomen. She does not sleep well due to the discomfort of her whole body. She has an aversion to cold and easily catches a cold. She can’t hold anything in her hands, because her fingers are too tight. Lab report: blood deposit: 20mm/h; wbc: 8000/mm3; rbc: 4.5*10(12)/mm3; Hb: 13g/mm3; IgG: IgM and IgA:↑. Antibody: ANA: 1:80; dsDNA: slight +, Jo-1: +. Her pulse is deep and weak; her tongue is pink with a thin white coating.

Select the disease

 A derma-sclerosis  

 B overlapped syndrome

 C disease of mixed connective tissue

 D SLE


Select the syndrome differentiation

A warm, dredge channels and collaterals, activate blood stasis and improve qi circulation and strengthen kidney yang

B regulate ying and wei and warm surface

C replenish qi and blood, activate blood stasis

D harmonize lungs, spleen functions, strengthen kidney yang

What recommendations should be given to the patient?

A avoid wind, cold and flu

B usually do exercises and move her joints slowly

C take soft food and half full enough every time

D all mentioned above  

Case Study 10

A female, 49 years old, works in a nursery school. Her menstruation stopped half a year ago. Recently, she has been feeling irritable, and gets angry very quickly. On a day when she quarrelled with her husband she got visual and auditory hallucinations – she could hear a singing voice or see shadows everywhere, and she got scared to go out or stay at home alone. Sometimes she talked to herself but nobody understood wat she was saying. Her family members sent her to see the doctor in the psychiatric hospital. She was diagnosed with schizophrenia. Her pulse is wiry, long and weak if pressed strongly; her tongue is pink, big and thin greasy coating.

Select the disease

A schizophrenia

B menopause neuro-psychoria  

C neurosis

D chronic encephalitis.

Select the syndrome differentiation

A phlegm and fluid rise and disturb the upper orifice

B qi and blood deficiency following phlegm and fluid disturbing orifice    

C blood stasis and phlegm obstruct shen

D spleen and kidney yang deficiency with indigestion

Select the appropriate method of treatment

A replenish qi and blood, regulate spleen and kidney; expel phlegm and fluid, and open the orifice  

B warm spleen and kidney yang, and calm shen

C activate blood stasis; promote qi circulation, and open the orifice

D harmonize yin and yang; regulate organic functions

What recommendations should be given to the patient?

A feel happy instead of angry;

B let her family members be silent around her - not irritated

C avoid pungent food

D A and B both are proper

Case Study 11

A male, 45, after eating a huge meal, with a lot of meat and drinking alcohol, got colic pain in the epigastrium at midnight. Also nausea, vomiting, constipation, and then fever – and slight jaundice happened the next morning. His pain could be relieved by Atropine injection. Ultrasonic wave B diagnosis: acute cholecystitis accompanied by cholelithiasis. Report: wbc >15000/mm3, N: 90%, His tongue was red, dry with thin and yellow coating and his pulse was wiry, forceful and rapid.                                                              

Select the disease

A acute cholecystitis with cholelithiasis

B acute gastritis

C acute pancreatitis

D acute gastroentestitis

Select the syndrome differentiation

A wind and heat invade stomach and intestines

B blockage of heat and damp in middle burner

C stomach qi comes up abnormally

D internal organic functions disharmony

Select the appropriate method of treatment

A clear away heat, detoxify, eliminate damp and relieve pain and jaundice

B harmonize the organ functions, relieve pain and eliminate jaundice

C clear away heat and damp, relieve pain and dredge channels and collaterals

D detoxify, expel wind and eliminate damp, relieve pain and jaundice

What recommendations should be given to the patient?

A stop taking food for 2 or 3 days

B eat soft foods that would be easy to digest

C avoid meat and alcohol in the future

D A and B both are right

Case Study 12

A male patient, 57 years old, liked drinking alcohol and eating pungent foods and sea food. Half a year ago, his right foot became very painful and the beat in superficial blood vessels disappeared. He experiences hot pain in this limb, and gangrene-like necrosis. He feels irritable; experiences much pain, especially at night. The wound on his foot starts ulcerating, a smelly pus appears. The wound won’t heal. He can’t sleep, he is thirsty and constipated. His tongue is red with yellow thick coating; the pulse is wiry, strong and rapid.

Select the disease

A inflammation caused by bacteria and viruses

B thromboangiitis

C gangrene caused by blood stasis

D blockage of arteries and veins

Select the syndrome differentiation

A blockage of blood vessels by blood stasis, poisoning and heat, accompanied by yin deficiency  

B poisoning and heat damage yin; wind and damp invade channels and collaterals

C yin deficiency and blood heat damage the vessels

D wind, dryness and heat damage yin and blood vessels

Select the appropriate method of treatment

A expel wind, clear away heat and tonify yin

B detoxify, clear away heat, and activate blood stasis accompanied by tonifying yin  

C moisten body fluid, promote blood and qi circulation, relieve pain

D detoxify, clear away heat and damp and remove blood stasis, relieve pain

What recommendations should be given to the patient?

A avoid pungent food, alcohol, smoking and seafood

B keep cleaning wound avoiding pollution and infection

C massage the ill limb with the purpose of promoting blood circulation

D all mentioned above

Case Study 13

A male, 58 years old, has suffered from hepatocirrhosis for 3 years. He developed a mass in the right hypochondrium, red threads can be seen on the cheeks, red marks on both his thenar eminences, 2 red nevi on his left arm, he has a dark and lusterless complexion, and he can feel stabbing and distending pain in the hypochondrium after a meal. His tongue is dark purple with ecchymosis, and his pulse is wiry and unsmooth.

Lab test: anemia, serum albumin: reduced, serum globulin: increased,

Ultrasonic wave B: hepatotrophy with moderate hardness, splenomegaly with hardness

Select the disease

A hepatocirrhosis

B chronic hepatitis

C chronic hepatoma

D hepatocirrhosis caused by parasites

Select the syndrome differentiation

A Qi stagnation and blood stasis  

B spleen and kidney deficiency with dampness

C disharmony between liver and spleen

D liver tumor accompanied by food indigestion

Select the appropriate method of treatment

A soften tumor and improve digestive function

B harmonize the functions of internal organs

C improve Qi movement, remove blood stasis, soften mass and relieve pain     

D strengthen spleen and kidney and activate blood circulation

What recommendations should be given to the patient?

A avoid alcohol and poisoning drugs for liver

B take the food with high level of vitamins and proteins

C take the medicine to protect liver from further damage

D A and B both are proper

Case Study 14

A male patient, 48 years old, working as a teacher, is always emotional. After several days of hard work, he could sense that his vision has deteriorated rapidly. He couldn’t identify small things. At times he saw a straight line changing into zigzag line. He could see one black point in the middle of his vision. An eye check-up showed that the yellow spot was not clear, as if covered by something. He got tired easily, his appetite was not good, his stools were frequently soft. His pulse was weak and wiry and his tongue was greasy and white.

Select the disease

A weak vision

B illness of yellow spot  

C middle inflammation in retina

D atrophic optic nerves

Select the syndrome differentiation

A dampness caused by spleen deficiency and blood stasis

B kidney and liver yin deficiency   

C damp and wind invade channels and collaterals

D qi stagnation and blood stasis

Select the appropriate method of treatment

A eliminate damp by strengthing spleen; remove blood stasis; improve vision by tonifying liver and kidney

B tonify liver and kidney to improve sight

C clear away wind and damp; strengthen liver and kidney

D clear away heat and damp; strengthen liver and kidney

What recommendations should be given to the patient?

A have good rest; don’t work much at night

B avoid taking pungent food, alcohol and smoking

C after reading for 45 minutes, rest for 10 minutes

D all mentioned above

Case Study 15

A girl of 16 years old only started menstruating half a year ago. She caught flu during her travels in November 2015. When she returned, she had a high fever of about 39cc degrees every day. She was brought to the hospital for treatment and was treated with a medicine infusion for one week, however, her body temperature remained high. She was hospitalized for further check-ups and treatment. Her blood report: wbc: >50000/mm3, in which there were many young cells with different cell nucleus, but rbc lower than 3.0*10(12)/mm3. Marrow puncture report: a lot of original young wbc, marrow reproduction was active. X-ray photo: the lungs manifestation show pneumonia with neutral granulocytes invasion, with much effusion in the bronchea. Her blood deposit was abnormally rapid; blood inosine,urea and uric acid were unusually high. Clinical observation: durable high fever more than 38 or 40 degree without chills; the face was flushed; thirsty with cold drinking, scattering of small points of purpural bleeding in whole body under the skin; coughing without phlegm accompanied by chest pain; headache in the morning. Her tongue was deep red without coating; the pulse was deep, strong and rapid.

Select the disease

A acute communicable disease

B acute pneumonia

C acute marrow leukaemia  

D sunstroke

Select the syndrome differentiation

A wind and heat come from outside to surface and then to qi

B blood heat poisoning accompanied with qi fire

C heat poisoning injured yin and yang

D yin deficiency cause inner liver wind

Select the appropriate method of treatment

A tonify yin and calm down liver wind

B detoxify, clear away heat from blood and qi

C protect yin from demage after eliminate heat and poisoning

D tonity yin and promot yang for supporting organic function

What recommendations should be given for the patient?

A supply enough water, energy, vitamins and salts from infusion

B reduce the body temperature with ice bags

C keep silent in the ward

D all of the above


If you'd like to download the PDF version please click here - http://saacma.co.za/wp-content/uploads/2019/03/CPD-15-Case-Studies-SAACMA-2019-CPD-cycle-2017-2019.pdf

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