clinic theater 2 - class 3

Course: Clinic Theater 2 Date: 8/8/08 Class #: 3 Followup from last week: called patient, asked how she was doing, what was the result after last treatment (less pain – better in thigh, less in shin, helped for several days then less, taking herbs as given, reports daily improvement) Initials/age/gender DJ, 18yo, male Chief Complaint Pain and tightness in chest and upper back for about 10 days

Low energy Stress

Current History • Pain begins in sternal area, out to mid clavicular line; mid back. Pain is inside. Tightness, stuffiness, s.o.b. Has a lot of physical activities but shortness of breath isn’t worse with activity. Same sensation in upper back. Pain top of shoulder, left lower limb due to bike accident. Getting better over last 10 days. Got hit while riding his bike July 7…or 14th. Some pain lateral L leg. Totalled his bike. Pain scale: 2.5/10

• Had wisdom teeth removed 2 weeks ago, experience mild pain at removal site.

• 1 week ago went to coffee shop, got ‘food poisoning’ with digestive problems. Diarrhea, few cramps. Quick resolution, but left him feeling weak.

• Suffers from anxiety and internal stress. • Has also been doing temp work canvasing/advertising in a neighborhood. • Heart palps: not current, some past history. • Sleep: good, takes melatonin. Some indications that he has trouble going to

sleep. Feels rested at waking. • Emotions: generally happy overall. • Does stress fx app/digestion: can’t get clear answer… • BM? Ok – 1ce to 2ce daily. • Uriation: ok • Energy: 6-7/10 • Vision: floaters, getting more and more. He knows that’s related to liver.

(Could be deficiency, but could also be Qi stagnation) • Eating regularly? No. Doesn’t eat a lot of vegs, eats fruits. Sandwich, bag of

chips. Voice is soft, smiles a lot, shen seems good. Came in sweaty, sipping a drink. Jokes appropriately (2yr history with Shen). Still, seems fidgety and nervous. Lips: seem a little pale. Sighs a lot. Pt says has imbalance in green and yellow chakras. Grad HS recently, had to move out and get a place because mom and b.f. and ‘wanted to do their own thing.’

Clinic Theater 2 – Summer 2008 http://www.CatsTCMNotes.com

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Past History Pain, stress, back pain, pain in arm, pain in wrist. Comes in for pain a lot, seems to

move around. Lifestyle? Qi stagnation?

Pulse Thin, slightly wiry, weak in 1st position. Well rooted, 70-75bpm

Tongue Pale body; thick coat, greasy. Slight yellowing, but drinking tea too…

Pattern Diff 1) Liver Qi Stagnation causing Qi Stagnation in Upper Jiao 2) Qi Xu in Middle Jiao

Diagnosis Chest Bi with chest pain and stuffiness

TX principles Soothe liver, move Qi in UJ, strengthen MJ Points/Therapies Ren 17 – move and tonify Qi

GB 34 – soothe sinews and liver too 4 Gates – move qi and blood, soothe liver P6 – chest tightness/stuffiness SP 6 – convergence of 3yins + blood + couple with P6 for chest problems ST 36 – dampness, spleen/stomach/middle jiao GB 21 – Qi and blood + Ashi for local tension/pain K 26 “Comfortable Chest” – used by western practitioners for emotional imbalances.

Needles used 17 Local qi and blood stagnation at site of bike injury More excess than deficient More interior than exterior More Qi than Blood Talked a lot about emotions, stress, anxiety


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Shen Chat These stats are true for massage therapy (per Karen), acupuncture here and in SA and Houston (per Shen and colleagues), in personal training (per Lisa). Seasons: Clinics in the Summer have the worse turnout. Best is in Spring. Note that for your own clinic! You’ll lose less patients by taking holidays in the summer. Time of day: Mornings and evenings have better patient turnout than in the afternoons, with highest turnout in the evenings. Fewer no-shows and cancellations. Days of the week: Tuesdays are the worst days for retail and services, and that includes acupuncture – people just don’t show on Tuesdays. Monday, Saturdays and Fridays are the best days of the week, with Saturday being the best, though students don’t like treating on weekends. So bear that in mind too: if you can’t get a clinic any other time, choose Saturday! Good business strategy to call your patients and find out how they are feeling, how the treatment affected them, etc. Also, call patients back promptly when they call you. Always tell your patient when he/she needs to come back. Be honest – don’t just encourage them for marketing purposes. And document! Always check with patient during treatment 1. Is he/she still breathing? Alive? 2. Need to adjust stimulation? 3. How is their body temp? Too cold, too hot? 4. Check the heat lamp. Charting Always note methods used during point treatments – arrow up is tonify, arrow down is reduce. Some charts use – and + for same thing. Indicate what pts used moxa (triangle for moxa cone), electrical stim (lightening bolt), cupping (o) GB 34 (lightning bolt) ST 36 (lightning bolt) Chart Qigong, massage, tuina, etc. Herbs and instructions

• Patents – dosage and formula • Powder – name of formula and grams total + per day –or—formula + extra ingredients with

grams each, grams total, grams per day –or—ingredients with grams each, grams total, grams per day

• Raw – same as powder If no herbs prescribed, note it. If they are taking another script, note that too. Note numbers and refills.


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clinic theater 2 - class 3

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