formulation assignment

[Guest guest]

Please critique the following case, diagnosis and questions so I may refine

this exam.

 

CHIM 1 Midterm - Fall 2003

 

Female, 28, presents with chronic asthma since childhood. She uses an

inhaler often multiple times a day and has been hospitalized on several

occasions for emergency cortisone treatment. She is often wheezing audibly,

especially upon exertion if she fails to use her inhaler. She has chronic

phlegm congestion in her chest, often thick and difficult to expectorate,

but only yellow when she has a cold. She does not smoke cigarettes but

does smoke a small amount of marijuana. Her chest often feels tight,

moreso during an acute attack. Her attacks are also set off by allergies

to dust, mold, cats and certain grasses, as well as stress, especially due

to frustration.

 

Her energy level is OK, but she speaks softly and with effort, it seems.

She has chronically loose stools with foul odor that alternates with

constipation in the form of sluggish stools and also recurring vaginal

discharge that can become thick, yet is typically white. She also has

painless, inflamed hemorrhoids and frequent foul gas. Her periods are

irregular and her PMS manifests as breast tenderness and moodiness. She

rarely has cramps or clots or any other menstrual sx. She does yoga

regularly, but still feels tight a lot. She is a lacto-ovo vegetarian

mostly and craves sweets often. She has a good appetite, but often feels

bloated and " stuck " in the lower abdomen. She is very active, yet does not

easily become toned. She gains weight easily when sedentary.

 

The patient falls asleep easily and stays asleep, waking rested. Her moods

are upbeat and friendly except during PMS when she can be irritable,

frustrated, depressed and sad. She does not sweat excessively or at night,

but her body odor can be strong. Her skin is dry as is her hair, but she

also can get pus filled acne, especially during PMS. She often feels cold,

especially hands and feet. She reports no EENT problems or any other sx

of note.

 

Her tongue is puffy, dusky pale, toothmarked, with a slightly thick, greasy

dirty coat in the rear. Her pulse is thin on the left and slippery, but

forceless on the right. It is weak on deep pressure in the right guan and

more superficial and wiry in the left guan.

 

The patients arrives when her period is 14 days late, but she is not

pregnant. Her PMS is pretty " out of control " , particularly her moods, but

this is not her chief complaint. She is currently wheezing after biking to

your office and has been wheezy all week. She did use her inhaler before

the ride. However she is not having a full blown attack, which typically

only happen when she gets bronchitis subsequent to a cold. Her phlegm is

white but thick and difficult.

 

You diagnose the patient with Wheezing due to Spleen and Lung Qi Xu with

phlegm congestion. However her other symptoms suggest dampheat in the

lower jiao, liver qi constraint. While the patient is energetic, her

digestive problems, easy weight gain, painless hemorrhoids and poor muscle

tone also suggest spleen xu and sinking as does tongue and pulse. There

appears to be an element of yang xu with the coldness, but kidney

involvement does not appear significant despite the chronicity of the

disease. The phlegm may be white, but the thickness of sputum, the

dirtiness of the tongue coat, the chronicity of the illness and tendency to

turn yellow with infection all suggest brewing heat that should be

addressed in some fashion.

 

Questions

 

What are your treatment principles?

 

Will your Rx have a root or branch, excess or deficiency emphasis?

 

Choose one or more good base rx to address your primary treatment

principles - cite your sources?

 

As necessary, choose one or more good 2ndary rx to address your secondary

treatment principles - cite your sources?

 

As necessary, write the herbs you would delete and explain why.

 

Are there combinations you would add to the base formula(s) to address

secondary patterns or treat specific acute symptoms - write the herbs and

the symptoms or patterns they are addressing in your formula - cite your

sources?

 

If, and only if, there are no adequate base formulas for your patient, what

combinations would you choose to address your treatment principles - write

the herb combinations and the symptoms or patterns they are addressing in

your formula - cite your sources?

 

Write your final formula below with all additions, deletions and one day

dosages for all the herbs chosen:

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre minds " --

Albert Einstein