Professional Empowerment for Practitioners

SAACMA 2021 Case Studies

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15 Case Studies with Multiple Choice Questions Evaluation in www.classmarker.com Available for CPD until 30 June 2021 Answer the Multiple Choice Questions on Syndrome Differentation and Treatment only. The Disease and Herbal Prescription are supplied as references. “SAACMA 2021 Case Studies” Supplied 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 June 2021 to 30 June 2021 Pass rate - 80% Case Study 1 On 13 February 2020 a 68 year old female patient came from Wuhan City. She had low fever about 37.8 degrees,aversion to cold, cough without phlegm, chest pain, tired, thirsty and drinking only a little water. Her body felt heavy, and she had a bad appetite. Her tongue was white, thick, and had a greasy cover. Her pulse was weak and rapid. She was hospitalized right away. The next day, her condition was more serious than before: temperature 39.5degree, coma and delirium, asthma, difficult breathing, stagnant chest, nausea and vomiting, thirsty, diarrhea. X-ray showed: pulmonary consolidation, cloudy fog-liked change, pneumonia. She has respiratory failure – a raise in co-co2, and partial pressure of O2 came down. The coronavirus test was positive. 1. Disease (supplied as reference) Coronavirus pneumonia 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. dampness, heat and toxins invading the body, occupying spleen and lungs channels and collaterals; lung qi blockage and lung can’t regulate qi and body fluid; qi and yin deficiency but dampness and phlegm blocked the orifice B. damp and wind invade channels and collaterals C. dampness and heat together in the stomach 3. Treatment (select the correct answer – 3 alternatives supplied) A. harmonize lungs, spleen functions, strengthen kidney yang B. clear away heat and damp, detoxifying; open the orifice and awaken heart shen; harmonize the lung and spleen qi C. clear away wind, eliminate damp heat and detoxify 4. Herbal prescription for the patient (supplied as reference) sangbaipi, xinren, yiyiren, pugongying, qinhao, shuzi, tinlizi, gualouke, hexiang, huashi, shigao, kuangdonghua, dongguaren, bibaye, shegan, gancao. Zixue dan   Case Study 2 21 April 2001 - a male patient, working as a professor at the Sichuan University in the department of Physics suffered from bladder inflammation. He had lower backache and frequent urination. He went to a party that night, and drank alcohol. Several days later, he had strong urinary bleeding, frequent urination, and urinal pain. Lab test: urinary, wbc++++, RBC++++, Pro+++, cast++, ultrasonic wave showed: there were about 5 tumors in his bladder wall. Biopsy shown: these were submucosal squamous cell carcinoma of bladder. The patient’s face was flushed, thirsty, and he liked to drink cold water. The color of his urine was same as tea’s color. He had lower back pain. His tongue was dry and red; and the pulse was thin and rapid. 1. Disease (supplied as reference) Bladder cancer 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. blockage of heat and damp in middle burner B. damp and heat invade kidney and bladder’s channels and collaterals; heat and damp invade blood and collaterals with toxins; blood stasis with yin deficiency C. dampness accumulation and the kidneys are too weak to accept qi from the lungs 3. Treatment (select the correct answer – 3 alternatives supplied) A. clear away heat and damp, detoxifying; tonify yin, promote blood circulation and stop bleeding B. detoxify, expel wind and eliminate damp, relieve pain C. eliminate phlegm and detoxify 4. Herbal prescription for the patient (supplied as reference) pugongying, jinyinhuaten, xiaoji, xueyutan, oujue, puhuang, baimaogen, huashi, shengdihuang, mudanpi, zhizi, danggui, xuanghecao, yiyiren, zhuye, baihuasheshecao, banbianlian, longkui, bayezha, huzhang, hongdoushan,gancao   Case Study 3 A female patient, 45 years of age, suffered a lot in her life since her child had died in a car accident. Now she experiences palpitations, insomnia, and her emotions can change very rapidly; she cried and laughed irregularly. She has tidal fever and night sweating. Her tongue is fresh red, and thin yellow fur. Her pulse was fine, deep and slow. 1. Disease (supplied as reference) Depression 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. yin deficiency and yang predominant; heart shen was disturbed B. kidney qi and yin both deficient C. liver wind rising caused by damp and phlegm combining with qi deficiency of spleen, kidney and lung 3. Treatment (select the correct answer – 3 alternatives supplied) A. calm down liver wind and strengthen qi and eliminate phlegm B. nourish yin and suppress yang; calm down heart shen C. strengthen qi of spleen and lungs 4. Herbal prescription for the patient (supplied as reference) baihe, zhimu, zaoren, fushen, wuweizi, wumei, shengdi, maidong, guiban, hehuangpi, chishi, gancao   Case Study 4 A 75 year old male patient - he has been a smoker since his teenage years. Last year, he felt discomfort in his chest, pain and stagnant. He got a low fever, 37.5-38.8 degree, aversion to cold and then he started to cough and spit much phlegm. X-ray showed: his lungs spread a lot of small masses. Lab test showed: wbc 14300/mm3, n 80%, L17%, eosinophils 3%, biopsy of living tissue: small cells of peripheral lung cancer with low differentiation. He had bloody phlegm and short breath asthma. He and his relatives refused chemical therapy and radiotherapy. Therefore, he was transferred to tumor section of TCM and treatment. The patient’s temperature was 38.5 degree, fever and flush face, emaciated, cough with bloody phlegm, poor appetite, thirsty liked to drink water, chest stagnated painful and yellow, sticky phlegm, short breath, asthma. Tongue was red, and dry with white and thick fur, pulse was forceful and rapid. 1. Disease (supplied as reference) Pulmonary Carcinoma 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. heat, toxins and damp phlegm accumulation blocking qi; lung qi stagnated; blood stasis B. yin deficiency cause inner liver wind C. weakness of spleen and lung qi with damp and phlegm 3. Treatment (select the correct answer – 3 alternatives supplied) A. tonify yin and promote yang for supporting organic function B. calm down liver wind and strengthen qi and eliminate phlegm C. clear away heat and detoxify; eliminate damp and phlegm; guide qi downwards, relieving asthma, soften tumors 4. Herbal prescription for the patient (supplied as reference) sangbaipi, xinren, huangqin, yuxincao, baijiangcao, pugongying, tinlizi, shuzi, gualoushi, qinhao, shigao, tianhuafen, chonglou, baihuasheshecao, yiyiren, dongguaren, bibaye, kuangdonghua, ziwan, huzhang, dilong, bihu, gancao   Case Study 5 A villager from Nanba, Kunming City, 36 years of age, female. She got full pain in her breast, and she could touched several masses in her both breasts, more her left than her right. X-ray shown: there were 6 small tumors in the left; 3 ones in the right. The biggest one is about 4cm diameters; the smallest is about 0.2cm. But all the tumors were clear with obvious edges. Normally, she was very easily angered, irritable. Sometimes she had much menstruation bleeding but sometimes a little. She had aversion to heat, she was tired, thirsty, constipated, and experienced tidal fever and night sweats. Her tongue was red and flushed with thin yellow coating; her pulse was fine and rapid. 1. Disease (supplied as reference) Hyperplasia of mammary lobules 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. spleen and kidney deficiency B. liver and kidney yin deficiency and yang predominant; liver qi irregular and phlegm accumulation blockage in liver channels and collaterals C. damp and wind invade channels and collaterals Z 3. Treatment (select the correct answer – 3 alternatives supplied) A. nourish yin and suppressing yang predominance; move qi and eliminate blood stasis, and soften masses B. eliminate damp by strengthening spleen; remove blood stasis C. calm down liver wind and eliminate dampness, phlegm, blood stasis 4. Herbal prescription for the patient (supplied as reference) biejia, guiban, jiazhu, dangui, jinbanxia, jiehe, lizhihe, chuanliezi, xuanshen, tiandong, kunbu, haizao, zhuru, siguakuo, xiakucao   Case Study 6 Male 78 year old patient, smokes and suffers from chronic bronchitis -, coughing and spitting phlegm. 2 months ago, he caught a cold and his condition got worse. From that time on, he had shortness of breath, asthma, stuffy chest, chest aches, premature heart beats, and he was too weak to spit phlegm (much thick phlegm), he had bad appetite, abdominal fullness, edema in the feet. Tongue: thick grease fur. Pulse: slippery and slow. Diagnosis: pulmonary and heart disease, respiratory failure, heart failure, respiratory function: 4 degrees and heart function:3 degrees. 1. Disease (supplied as reference) Pulmonary heart disease 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. qi stagnation and blood stasis B. dryness, blood stasis, phlegm accumulation with poisoning C. lungs, spleen and kidney deficiency, kidney can't get qi from lungs; dampness and phlegm accumulation in the lungs 3. Treatment (select the correct answer – 3 alternatives supplied) A. guiding lung qi downwards; supplement kidney and absorb qi from lung; promote spleen and lung B. harmonize the functions of internal organs C. clear away heat and protect yin from injury 4. Herbal prescription for the patient (supplied as reference) sangbaipi, taoren, gualouke, shuzi, tinlizi, shanyao, renshen, chenxiang, dangui, kuangdonghua, tusizi, yiyiren, baizhu, dongguaren, bibaye, cheqianzi gaocao   Case Study 7 Ten days after a 37 year old woman had given birth, she felt her vision was degenerating suddenly when she got angry about something. At the hospital she saw an ophthalmologist. Her vision was only 0.05. Fundus examination showed: her yellow spots were obscure; percutaneous pigments disorders in the fundus; peripheral veins and arteries were unclear. She suffered from yellow spot disorder. During the delivery of her baby she bled a lot and then her HB went down to 6g/L. After birth she had no good emotion for her husband. Now her sight was injured from bad emotion; she couldn’t read, and she was not able to identify distant objects. She had no good sleep; she was always nervous, experienced lassitude, emaciation, bad appetite, always diarrheas. Her pulse was forceful less, big and middle empty, slow. Tongue was big, pale with teeth marks; fur was thick, white and greasy. 1. Disease (supplied as reference) Maculopathy 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. poisoning and heat damage yin; wind and damp invade channels and collaterals B. both liver and kidney deficiency; both qi and blood deficiency; spleen deficiency with damp and blood stasis blocked channels and collaterals C. yin deficiency cause inner liver wind 3. Treatment (select the correct answer – 3 alternatives supplied) A. strengthen liver and kidney qi and yin; tonify spleen qi and clear away damp and phlegm; strengthen qi and blood, eliminating blood statis B. expel wind, clear away heat and tonify yin C. detoxify, clear away heat from blood and qi 4. Herbal prescription for the patient (supplied as reference) renshen, baizhu, chenpi, fulin, chuanxiong, dangui, shanyao, tusizi, shudi, shanyurou, gouqizi, sangshenzi, chushizi, chongweizi, taoren, danshen, puhuang, yujin Sangjishen, cheqianzi   Case Study 8 A 24 year old male university student usually got irritable and was easily angered. Normally he had an aversion to heat, was thirsty and liked to drink cold water. He had dry and red eye conjunctiva, he did not sleep well, experienced dreadfulness and insomnia. He had several small masses in his chest. Sometimes he felt full pain and refused to touch them which were middle hardness; and he had yellow urine. His pulse was large, forceful and rapid; his tongue was red, dry with yellow thick fur. 1. Disease (supplied as reference) Male Breast Lobule Hyperplasia 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. yin deficiency cause inner liver wind B. liver and kidney yin deficiency and liver yang predominant; liver qi stagnation with phlegm blocked liver channels and collaterals C. blood stasis and phlegm obstruct shen 3. Treatment (select the correct answer – 3 alternatives supplied) A. nourish liver and kidney yin and suppress liver yang, remove liver qi stagnation and eliminate phlegm, soften masses B. warm spleen and kidney yang, and calm shen C. detoxify, clear away heat from blood and qi 4. Herbal prescription for the patient (supplied as reference) shudi, shanyao, shanzhuyu, goujuzi, chuanliezi, juhe, lizhihe, xiangfuzi, jinyinzi, xuanhusuo, kunbu, haizao   Case Study 9 The 4 year old son of farmers in Fuhai village, became sick with fever. At first he had an aversion to cold. The next day his temperature shot up to 39.5 degree; he was thirsty and liked to drink cold drinks. Then he was hospitalized and infused with antibiotics. He got nasal bleeding at noon or at night. Lab test: his wbc was about 50000/L, 80% wbc was premature young and deformed, Hb = 8.0g/L. Bone puncture exam: acute Myelogenous leukemia. For a whole week, he had high fever of about 38.5~40.0 degrees from every afternoon until evening. He was thirsty and liked cold drinks, and he was constipated. His fingermarks were deep red and long. His tongue was red and dry; the coating was thick and yellow. His pulse was string, long length and rapid. 1. Disease (supplied as reference) Myelogenous leukemia 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. heat and wind with toxin invade qi and blood; yin has been injured B. qi and blood deficiency C. qi deficiency of spleen and heart 3. Treatment (select the correct answer – 3 alternatives supplied) A. clear away heat, detoxifying, nourish yin and save body fluid B. reduce fire from heart and liver C. strengthen qi and blood of spleen and heart 4. Herbal prescription for the patient (supplied as reference) shuiniujiao, shengdi, mudanpi, chishao, baimaogen, gouteng, tianhuafen, xuansheng, baiwei, tiandong, biejia, guiban, qinhao, shigao, yinchaihu, huangqin, chonglou, banbianlian, hongdoushan, xueyutan, tongbian, gancao.   Case Study 10 A female patient, 42 years old, felt as if her body became heavier and heavier. Her skin felt tight, and harder and harder - her skin was thick with wrinkles disappearing and the color of the skin was bright. She felt cold, aversion to cold. Her appetite was bad; she felt swollen in the abdomen; she was too weak to discharge faeces; she got bad memory, pain in the waist, lassitude, emaciation, dreamfulness, insomnia. Her tongue was pale with teeth marks, white and thick greasy coating. Her pulse was deep, weak and slow. Lab test: wbc:5000/L, rbc: 140*mula10(12)/L, IgG(--),IgA(--), IgM(+), IgE(+); CRP(+), ANA+, anti-scl-70(+); anti Jo-1(+-). 1. Disease (supplied as reference) Systematic Sclerodermapathy 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. qi deficiency of spleen and heart B. qi stagnation with undigested food C. Spleen and kidney yang deficiency with coldness, and phlegm accumulation; qi stagnation and blood stasis 3. Treatment (select the correct answer – 3 alternatives supplied) A. strengthen qi and blood of spleen and heart B. tonify spleen and kidney yang; warm and promote qi flow, remove blood stasis C. create communication between kidney and heart 4. Herbal prescription for the patient (supplied as reference) mahuang, guizhi, huangqi, dangui, chuanxiong, luhancao, lujiaoshuang, jixueteng, honghua, taoren, buguzhi, zhike, baizhu, fabanxia, hongshen, dafupi, gancao Case Study 11 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 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: ↓ 1. Disease (supplied as reference) Cor pulmonale 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. dampness and cold invaded the lungs B. spleen and lungs are too weak to clear away phlegm C. dampness accumulation and the kidneys are too weak to accept qi from the lungs 3. Treatment (select the correct answer – 3 alternatives supplied) A. depressing qi and relieve asthma, tonify kidney and spleen B. eliminate phlegm and detoxify C. clear away wind and warm lungs 4. Recommendations to the patient: (supplied as reference) avoid catching cold and flu don’t take pungent, cold and fresh food do proper exercises every day and breathe with abdominal muscles.   Case Study 12 A 26 year old female patient worked as a hotel receptionist. She had tonsillitis on 16 March 2015, with a fever 39 degrees. The inflammation in her throat was painful and she found it difficult to swallow. Her tonsils were swollen at 3 degrees with ulceration secretion. After infusion with antibiotics 3 times, she was healed but she got arthritis in her right ankle, cold feeling, red and swelling pain, supraventricular premature heart beats, ST-T showed injury variability, paroxysmal AF, ventricular rate: 62--126/min, AF: 98--177/min. The patient felt emaciated, dizzy, syncope, bad appetite, irregular menses, heavy menstruation, movable arthritis. X-ray showed: right ankle osteoarthritis; the heart enlarged to both sides as a shoe. Her pulse was rapid and weak, strong or weak different replacement appeared; the tongue was red, dry without fur. 1. Disease (supplied as reference) Viral Cardiamyositis 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. yin deficiency and yang predominant; wind, cold and damp Bi; heart qi and blood deficiency, shen disturbed B. obstruction of qi, phlegm, blood stasis in the channels and collaterals Y C. spleen and kidney yang deficiency 3. Treatment (select the correct answer – 3 alternatives supplied) A. promote blood movement and expel blood stasis B. nourish yin and suppress hyperactive yang, calming down shen, regulating heart beats C. replenish qi and blood, activate blood stasis 4. Herbal prescription for the patient (supplied as reference) shudi, shengdi, baishao, maimendong, chuanhuanglian, qinhao, digupi, biejia,guiban, longgu, muli, nvzhenzi,yinchaihu, baiwei. Case Study 13 A 17 year old school boy went to the countryside for studying agriculture in the fields. After a month he suffered with arthritis. His right knee and ankle were painful, red and swollen. He had low fever, aversion to cold, bad appetite, full abdomen, diarrhea. He went to the hospital. Lab test: ESR: 80mm/h, wbc: 9000/mm3; Hb: 14g/L; n: 68%; L: 20%; eosinophile granulocyte: 17%; macrophage: 3%. IgG:+; IgM:+; IgA:(-); IgE:(-). Antibody: ANA (-). 1. Disease (supplied as reference) Rheumatic Arthritis 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. wind, cold and damp blocked channels and collaterals, and changed into heat with toxin B. wind and cold transfer from surface to the internal organs C. blockage of heat and damp in middle burner 3. Treatment (select the correct answer – 3 alternatives supplied) A. tonify kidney yang and eliminate damp B. detoxify, expel wind and eliminate damp C. clear away heat and damp, relieve pain 4. Herbal prescription for the patient (supplied as reference) fangfeng, biexie, wujiapi, jianghuang, yiyiren, baizhu, huangbai, shenghuangqi, weilinxian, xuanhusuo, wushaoshe, luhancao, ruxiang, muyao, gancao. (qui bi tan).   Case Study 14 A female patient, 54 years of age, felt a pain in her shoulder, lower back, articulational sacroiliacs. She had a stiff neck, pain and stiff arthritis in the morning and felt better after movement. CT showed: spinal thoracolumbar joints and lumbosacral joints adjoining; reduction or disappearance of joint spaces. Tab test: ESR 80mm/h, wbc 5.5*10(9)/L, Hb 14g/L, RBC 5.50*10(6)/mm(3), rheumatoid factors: +, CRP: +. She had aversion to cold, lassitude, emaciation. She got more pain in winter and bad weather. Her tongue was pale with teeth marks at the tongue edge and watery white coating; her pulse was weak, slow. 1. Disease (supplied as reference) Ankylosing spondylitis (AS) 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. dampness accumulation and the kidneys are too weak to accept qi from the lungs B. spleen and kidney yang deficiency; wind, cold and damp blocked channels and collaterals C. blockage of blood vessels by blood stasis, poisoning and heat, accompanied by yin deficiency 3. No treatment was supplied for this case 4. Herbal prescription for the patient (supplied as reference) fangfeng, chuanxiong, baizhu, fuling, lujiaoshuang, luhangcao, xuanhusuo, sangjisheng, shudi, tusizi, guizhi, buguzhi, ruxiang, muyao, gancao, Weilinxuan, shufuzi. (juan bi tan addition and subtraction). Case Study 15 A 28 year old male patient liked to eat fried crabs and drink alcohol, and he smoked. In the spring of 2015, he got flu, he coughed without phlegm. He was suffering from tonsillitis. X-ray showed: diaphragm tumor which looked like a crab occupying his chest. The crab’s feet attached at his bronchia, aorta, and esophagus. The patient was coughing without phlegm, had a dry throat and short, hoarse breathing. The biopsy result: carcinoma of the human epithelium. The conclusion of surgical consultation: as the result of the tumor attached with many important organs and stomach veins, etc. they refused to do big operation for him. Therefore, he was transfer to the tumor section of TCM. The patient was acutely ill with fushed complexion, emaciation, wbc: 8000/m3, n62%, L25%. X-ray photo: the tumor was irregular, 12.5cm2, it could be touched with hands; it was of middle hardness, and he could feel pain during heavy pressing. He felt thirsty, dry lips, throat, and mouth. The temperature: 37 degree. His coughing could spit fresh red blood; hard stool. He always had insomnia, irritation and palpitation. Dry and deep red tongue without fur, rapid and thin pulse. 1. Disease (supplied as reference) Diaphragm cancer 2. Syndrome differentiation (select the correct answer – 3 alternatives supplied) A. yin deficiency; blood and dry phlegm stagnation blocked channels and collaterals; dryness heat and toxin invade channels and collaterals B. dampness and toxins invade digestive system C. spleen and kidney deficiency with dampness 3. No treatment was supplied for this case 4. Herbal prescription for the patient (supplied as reference) shuiniujiao, shengdi, danpi, chishao, hanliancao, pugongyin, jinyinhuaten, baihuasheshecao, tenligen, yiyiren, tianhuafen, chonglou, bayuezha, chuanbeimu, yuxincao, baijiangcao, cebaiye, huofen, qindai, baimaogen, dongguaren, bibaye, hongdoushan, bihu.
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