“I struggle to sleep and sometimes my heart races.”
Insomnia and palpitations
Her sleep has become irregular and the palpitations increase her unease when it is time to go to bed.
- Patient
- Woman, 45
- Occupation
- Office clerk, split shift
- Medication
- None prescribed. Valerian some nights, self-medicated.
- Allergies
- None known
- History
- Appendectomy at 20. No admissions since.
- Habits
- Two coffees a day, the second mid-afternoon. Non-smoker.
- Vitals
- BP 118/76 · afebrile
1 · The consultation
You have 14 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“Last night I had chest pain that went down my left arm, and a lot of breathlessness while sitting.”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 5)
Case solved
Reasoned solution
Pattern: Heart Yin deficiency. Supporting signs: Insomnia, Palpitations, Night sweats and flushes, Red tongue without coating, Thin, rapid pulse.
The deciding clue: No coating: Fluids or Yin are short. Points to deficiency, not excess..
Safety: Correct. Chest pain radiating to the arm with dyspnoea at rest gets referred, however well built the pattern is.
Treatment: Nourish Yin and calm the Shen; Gentle tonification, no strong dispersal. Points: HT7, HT6, KI6, SP6, PC6.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Heart Yin deficiency. Supporting signs: Insomnia, Palpitations, Night sweats and flushes, Red tongue without coating, Thin, rapid pulse.
The deciding clue: No coating: Fluids or Yin are short. Points to deficiency, not excess..
Safety: Correct. Chest pain radiating to the arm with dyspnoea at rest gets referred, however well built the pattern is.
Treatment: Nourish Yin and calm the Shen; Gentle tonification, no strong dispersal. Points: HT7, HT6, KI6, SP6, PC6.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
