“I wake up before dawn with burning and have to drink.”
Burning that wakes him
A year and a half of burning that ebbs with the kitchen's hours and that omeprazole quietens without solving.
- Patient
- Man, 44
- Occupation
- Cook; split shifts, dinner at midnight
- Medication
- Omeprazole on and off, self-prescribed.
- History
- Normal gastroscopy eighteen months ago.
- Habits
- Picks at food while cooking. Two beers after his shift.
- Vitals
- BP 138/86 · afebrile · BMI 28
1 · The consultation
You have 20 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
Before finishing“«It has been like this for a year and a half, more or less the same. I swallow fine, I have never vomited, and my weight is not dropping — I have put on three kilos.»”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 3)
Case solved
Reasoned solution
Pattern: Stomach Heat. Supporting signs: Ravenous hunger, eats a lot and fast, Strong thirst for cold drinks, Bad breath and tender gums, Yellow, dry coating, Rapid pulse, full in the middle position.
The deciding clue: Ravenous hunger: He eats a lot, fast, and goes back for more. Yin deficiency is hungry but fancies nothing..
Safety: Stable dyspepsia, a normal gastroscopy and no digestive red flags: this calls for clearing Stomach Heat and fixing the schedule.
Treatment: Clear Stomach Heat, Descend Stomach Qi; Drain Fire. Points: ST44, CV12, LI11.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Stomach Heat. Supporting signs: Ravenous hunger, eats a lot and fast, Strong thirst for cold drinks, Bad breath and tender gums, Yellow, dry coating, Rapid pulse, full in the middle position.
The deciding clue: Ravenous hunger: He eats a lot, fast, and goes back for more. Yin deficiency is hungry but fancies nothing..
Safety: Stable dyspepsia, a normal gastroscopy and no digestive red flags: this calls for clearing Stomach Heat and fixing the schedule.
Treatment: Clear Stomach Heat, Descend Stomach Qi; Drain Fire. Points: ST44, CV12, LI11.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
