“I bloat almost every day and I have had no energy for a year.”
Bloating that collapses with work
Daily bloating and low energy have interfered with work and everyday life for the past year.
- Patient
- Man, 52
- Occupation
- Team lead at an accountancy firm; eight or nine hours seated
- Medication
- Daily omeprazole for two years, self-started
- Allergies
- None known
- History
- Venous thrombosis in the leg three years ago
- Habits
- Eats out five days out of seven. No exercise.
- Vitals
- BP 132/84 · no fever · stable weight
1 · The consultation
You have 16 minutes. Each question or examination costs 2. Choose carefully what to ask.
Questions
Examination
2 · The tongue
3 · The pulse
Describe the pulse on each axis.
4 · The pattern
5 · Differential diagnosis
You're torn between two patterns. Which is it?
Which finding decides it?
6 · Case twist
Patient update“I forgot to say: I have taken an anticoagulant for two years, for an arrhythmia my cardiologist follows.”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 4)
Case solved
Reasoned solution
Pattern: Liver invades Spleen. Supporting signs: Distension that appears with tension, Alternating stools, Sighing and tightness in the flanks, Red tongue borders, Wiry pulse.
The deciding clue: Better on holiday: On a two-week holiday he eats anything and does not bloat at all..
Safety: Correct. Being anticoagulated is not a contraindication: treat with fine needles, pressure on withdrawal and avoiding vascular areas. What changes is the technique, and it must be said out loud.
Treatment: Move the Liver Qi and support the Spleen, starting with the former; Move before tonifying: with Qi stuck, tonifying bloats further, Fine needles and pressure on withdrawal, because of the anticoagulant. Points: LV3, LV14, ST36, SP6.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Liver invades Spleen. Supporting signs: Distension that appears with tension, Alternating stools, Sighing and tightness in the flanks, Red tongue borders, Wiry pulse.
The deciding clue: Better on holiday: On a two-week holiday he eats anything and does not bloat at all..
Safety: Correct. Being anticoagulated is not a contraindication: treat with fine needles, pressure on withdrawal and avoiding vascular areas. What changes is the technique, and it must be said out loud.
Treatment: Move the Liver Qi and support the Spleen, starting with the former; Move before tonifying: with Qi stuck, tonifying bloats further, Fine needles and pressure on withdrawal, because of the anticoagulant. Points: LV3, LV14, ST36, SP6.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
