Case Study with Thomas Avery Garran

Responses

1. 

   Thomas October 7, 2024

   Hi All,
   Here is the case for Wednesday.

   Case Study Class 9 Oct 2024
   Gender: female
   Age: 52
   Height: 5’ 7”
   Weight: 145 lb
   Ethnicity: Chinese
   Occupation: self-employed/retired

   Chief complaint: pain in the ribside
   Symptoms: occasional cough, sensation of and ability to expel phlegm from the throat
   Brief history: patient had 2 children (25 and deceased). Menarche at 13.
   Diet and Lifestyle: Cooks almost all meals, eats very healthy diet, occasional alcohol consumption, over last year or so not getting much exercise (moved to the US from China 2 years ago).
   Sleep: sleeps very well, can sleep for 8-12 hours, generally feels rested in the morning.
   Energy: generally good.
   Appetite: good, but can be low occasionally, cooks most meals with good attention to diet.
   Stool: 1-3 X/day, occasional diarrhea, generally loose and sometime difficult. Usually stinky with regular farting
   Thirst: forgets to drink water, not thirsty
   Urine: 6–9 X/day, mostly unremarkable
   Menstruation: regular (32–40 days), scant with occasional heavy flow. Few, if any, clots, often none. Little of no menstrual pain or discomfort of any kind. (Mom menstruated until she was 59)
   Basic observations: Patient is in reasonable physical health, has started to get regular exercise but irregular to this point. Patient is slightly over-weight, holding most of this in her stomach area. Patient often as skin issues, particularly in the summer when itchiness can lead to scratching and open sores. Stopped eating dairy products, which seems to have cleared her skin.
   Pulse: n/a
   Tongue: slightly red with red “prickles,” moderately thick white coat

2. 

   Thomas October 10, 2024

   Here is the entire case presented last night:

   Case Study Class 9 Oct 2024
   Gender: female
   Age: 52
   Height: 5’ 7”
   Weight: 145 lb
   Ethnicity: Chinese
   Occupation: self-employed/retired

   Chief complaint: pain in the ribside
   Symptoms: occasional cough, sensation of and ability to expel phlegm from the throat
   Brief history: patient had 2 children (25 and deceased). Menarche at 13.
   Diet and Lifestyle: Cooks almost all meals, eats very healthy diet, occasional alcohol consumption, over last year or so not getting much exercise (moved to the US from China 2 years ago).
   Sleep: sleeps very well, can sleep for 8-12 hours, generally does not feel rested in the morning.
   Energy: generally good.
   Appetite: good, but can be low occasionally, cooks most meals with good attention to diet.
   Stool: 1-3 X/day, occasional diarrhea, generally loose and sometime difficult. Usually stinky with regular farting
   Thirst: forgets to drink water, not thirsty
   Urine: 6–9 X/day, mostly unremarkable
   Menstruation: regular (32–40 days), scant with occasional heavy flow. Few, if any, clots, often none. Little of no menstrual pain or discomfort of any kind. (Mom menstruated until she was 59)
   Basic observations: Patient is in reasonable physical health, has started to get regular exercise but irregular to this point. Patient is slightly over-weight, holding most of this in her stomach area. Patient often has skin issues, particularly in the summer when itchiness can lead to scratching and open sores. Stopped eating dairy products, which seems to have cleared her skin.
   Pulse: bowstring and slippery
   Tongue: slightly red with red “prickles,” moderately thick white coat

   Dx: liver constraint with spleen/lung qi vacuity leading phlegm accumulation
   Explanation: This is a relatively straightforward case of liver constraint with a confounding phlegm accumulation pattern due to spleen and lung qi vacuity.
   Ribside pain: this is a classic liver qi symptom. When the liver qi is constrained, it does not flow normally and there can be distention and pain in the ribside.
   Cough with phlegm: The coughing and expectoration of clear to white phlegm is a clear indication of lung qi vacuity.
   Frequent stool with occasional diarrhea: This is a clear sign of spleen qi vacuity. The spleen is vacuous and can not hold the stool. Additionally, this has led to accumulation of dampness that has transformed into phlegm.
   The slightly red tongue with prickles and moderately thick white coating, are common in this pattern. The reddening suggests that there is some heat developing from the liver constraint, the prickles suggest liver constraint with some blood stasis, and the coating shows the dampness/phlegm accumulation.
   Formula: Unnamed Formula
   houpo (厚朴) magnolia bark 12g
   qingpi (青皮) immature tangerine peel 10g
   baishao (白芍) white peony 12g
   chaihu (柴胡) bupleurum 6g
   skullcap (北美黃芩) Scutellaria lateriflora 10g
   fuling (茯苓) poria 12g
   elecampane (土木香) Inula helenium 10g
   zhi yuanzhi (製遠志) polygala, prepared 10g
   gancao (甘草) licorice 6g