DRU, case study on hemorrhoids & 3rd year student frustration

[Guest guest]

Hi everyone,

 

First, I hoped for comments and suggestions on a case I'm working on. I am

in the middle of my final year of study at Dongguk Royal University (hi

Thomas :> I wondered when you graduated from the school...?) and could use

some clarification on TCM pattern discrimination and therefore formula

prescriptions. I'm focusing my efforts at the moment on herbs and formulas

as the complexity and degree of knowledge for effective treatment is vast.

 

Here is the real-life case:

 

CASE: 56 Year old Man

 

CC: Hemorrhoids for 10 years, off and on. Has had anal fissures. None

currently. Complains of constipation off and on. Worse with stress.

Digestion very sensitive. Has to watch food. Diet is good – no red meat, no

spicy foods, no alcohol, lots of cooked vegetables. If eats something too

heavy, gets gas. Ongoing chronic benign tremors of hands. Hypertension, but

taking medication so mostly controlled. Irritable. Angers relatively easily

and yells when angry, otherwise very sweet man. Tongue: red tip, sides.

Coating slightly thick, thicker in back. Can’t tell color (diagnosis over

phone..). Hemorrhoids protrude out, with bleeding. Itchy, burning.

Pulse: can't tell, diagnosis over the phone.

 

My Diagnosis: Disharmony of Liver and Spleen. Liver Qi stagnation overacting

on Spleen. Constrained Liver Qi causing damp heat, traveling down to anus

and Liver Yang Rising (hypertension). More heat than damp. Stirring of Liver

wind.

 

Treatment Principle: Course Liver Qi, clear heat and damp. Tonify Spleen Qi.

(should I add, subdue Liver Yang and extinguish wind?)

 

Formula: Xiao Yao San + Zhi Tong Ru Shen Tang Jia Wei (formula I got from

Bob Flaws book)

 

Di Yu 9g

Huai Huai Mi 9g

Bai Zhu 9g

Huang Bai 9g

Dang Gui 9g

Bing Lang 9g (Instructor told me this herb too strong)

Fang Feng 6g

Ze Xie 6g

Da Huang 6g

Qin Jiao 6g (Instructor told me this herb isn't right for this patient..)

Tao Ren 6g

Chai Hu (? Hypertension!) 9g (Instructor told me Chuan Lian Zi would be

better choice)

Bai Shao 20g

Fu Ling 9g

Gan Cao (can contribute to increase in blood pressure, but instructor told

me 3g would be ok)

Bo He 6g

Sheng Jiang 2 slices (instructor told me would aggrevate stomach since warm)

 

Should I add herbs to extinguish wind, for the tremors, or is tonifying

Liver Yin good enough? Or will it get too complex? Focus on just the chief

complaint? Does this formula sound good for this patient? Any other

suggestions? Xiao Yao San is no longer Xiao Yao San if you take away the

chief herb, right? So will the synergy of the formula still work? GAH! Help!

 

Any comments on when all this TCM knowledge truly gels? I'm one of the top

students at my school, I work hard, fast learner.

 

Confused and frustrated and hoping for some support,

Thanks in advance for any comments..

Nadia

 

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[Guest guest]

East Dakota wrote:

>

> Hi everyone,

>

> First, I hoped for comments and suggestions on a case I'm working on.

>

Hi Nadia!

 

Is it possible for you to *see* your patient in your student clinic or

whatever? Pulse and tongue are important, maybe more important than

anything else. I never diagnose over the phone.

 

In Florida students have to see their patient's under some supervision,

depending on how far along they are. If it is the student's first

patient the supervisor will most likely be in the room, more experienced

students, the supervisor will be elsewhere but still available.

 

Regards,

 

Pete