Course: Clinic Theater 2

Class #: 2

August 1, 2008

Me: Pain in leg/hip, assistance recovering from surgery

Shen: intermittent migrating pain on rt side post total right hip replacement
surgery.

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PT: LH, female

Chief Complaint

Date:

Full anterior hip replacement (lateral/posterior more common, but anterior

doesnt cut the muscles), 12 days ago. Wants help healing from surgery. Pain
wanders from place to place, but the places are consistent.
Used to train horses, show and compete when she fell off of said horses,
usually fell on right side.

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History

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Dx: Degenerative (trauma induced) osteoarthritis, bone spurs in the hip between
socket and acetabulum. Arthritis on inside of head.

Anterior hip replacement stretches the muscle a lot. Cannot stretch the leg
backward very far as will possibly dislocate the hip anteriorly. Her replacment
has metal on metal, no plastic, 30 year lifespan for this device. No significant
pain post surgery afterwards, though lots of meds at first, then needed less and
less pretty quickly. Day 3 taking oral only.

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Has been doing PT, walking around the block, going up and down stairs. No
atrophy. Did a lot of workout prior to the surgery to strengthen the leg.
No hx of osteoarthritis in her family. ACL surgery on right knee 15 yrs ago.
Same reason and history applies.
Sx: sweating spontaneous, light sweating. Very little blood loss. Blood tests
daily, was on period last week.

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Taking Yin Bai Yao, started Sat pre surgery. Power herbs blood movers for
traumatic injury. Wearing support hose on right, lovanox injection daily for DVT
prevention.
Swelling? No
Sweating? A little
Full weight bearing? Yes. More pain rather than limited movement. Cannot do
abduction (leg backwards) during healing.
Happy? Yes
Pain? Dull, deep achey. 9-9.5 when its really bad. Pain worst in evening.
Location: Along glutes, feels like spasming deep and achey usually in evening.
Also along the thigh. Lateral lower leg fibula right at the top. Between tib/fib
to top of the ankle. Acupressure helps. Decreases daily, however. Takes meds in
anticipation of the pain as recommended by hospital.
Gallbladder and Stomach predominantly, some on the Liver channel.
Cannot currently test ROM or pain threshold since she is healing.
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BM: some constipation (hydrocodone and anesthesia), but using chinese herbs to
assist. Da cheng qi tang purgative and qi movers.
Urination: fine, not a frequent urge (usually has some frequency post children)
Appetite: reduced, some nausea. Eating regular meals, but abt 50% less
Sleep: cdnt sleep due to itching from the morphine. Taking Ambien right now.
Dream a lot.
Complexion: pale.
Full on left, slightly wiry, a little choppy but pretty strong. Very weak in the 3rd
positions. Perimenopausal.

Tongue

Pale top and bottom, pale lips, pale gums. Probably post surgical and post
period.

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Pulse

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Traditionally: pale, qi deficient looking (history of very bad periods has lost 1
pint in the past)
Local qi/blood stagnation at incision site
General qi/blood xu post surgery
Kid Liv yin xu
Stagnation in the GB, ST, LV channels.

Diagnosis

Trauma from surgery

TX principles

Tonify Qi/blood from Xu, move Qi/Bld for Yu

Recommend Chinese diet therapy
Scalp acupuncture on MS 6/7 contralaterally
SP 21, LV 8, SP 6(ton Qi, move/bld blood), SP 3, GB 34 (ton bld, nour tnd/sin,
move Qi), perhaps GB 35
LI 10 (ton Qi)
GB 30, Huan Zhong (rt side)
Ashi points

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Points/Therapies

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Pattern Diff

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Herbal prescription:
Already on blood thinners, so no qi/bld movers (because that thins blood and
increases risk of bleeding). Nourish blood/qi, restoration of tissues
Fu Yuan Huo Xue Tang 62
Bai Ji-6
Yan Hu Suo-8
Gu Sui Bu-8
Total : 84g
3g bid

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Shen Chat

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Many different schools of pulse/tongue dx. Therefore our chart leaves it open to that.

Charting
Medical past history:
Ask if patient has recd western dx for this condition.Ask if patient recd acupuncture for this.

Tongue:
tongue body and coating should both be described.

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Vital Signs:
Texas regulations require that we monitor the vital signs, though no guidelines have really been
provided to us by the regulatory board. Dont specify how or how often. Per AOMA: take vitals
for first visit and then as needed. I.e., if say have fever, take temp; if have palps, take pulse; if
have hypertension, take bp each time.

TCM Disease DX and Differentiation

Abbreviations on AOMA charting form

Bp = blood pressure
T = temperature
R = respiration rate
Others neurological testing, ab palpation, etc.

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Diagnoses would be
Bi syndrome, traumatic injury, wasting syndrome, asthma
This is not a western style dx we dont have the equipment or training for that! There are also
legal reasons: we are alternative healthcare providers, not primary.

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TCM Differentiation would be

Qi blood stag, spleen qi xu, etc

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Never take someone elses disease dx as your own (exception: clinic supervisors) use previous
dxs as part of the history (either current or past). Dont just accept someone elses judgment, but
look at the evidence and make your determination.

Should be a consistency of all chart elements sx should support the disease dx and
differentiation. Treatment principles should be based on the dx and diff, the solutions to them.

Points and Methods

Document fully!!!
Points:
Have all points clearly listed. Very important especially from a litigation standpoint,
moreso than TCM Diff/DX. Record them faithfully.
Methods:
Include methods as well as points/areas e-stim, moxa, cupping, reducing/tonification.
Also record Qigong, Tuina, Reiki, Shiatsu, etc. as well as areas, time.
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Includes not only points used, but also

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