Course: Clinic Theater 2

Class #: 3

Date:

8/8/08

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
Chief Complaint

Current History

DJ, 18yo, male

Pain and tightness in chest and upper back for about 10 days
Low energy
Stress
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 isnt 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 7or 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: cant get clear answer
BM? Ok 1ce to 2ce daily.
Uriation: ok
Energy: 6-7/10
Vision: floaters, getting more and more. He knows thats related to liver.
(Could be deficiency, but could also be Qi stagnation)
Eating regularly? No. Doesnt 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
Page 1 of 3

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
Points/Therapies

Soothe liver, move Qi in UJ, strengthen MJ

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

Needles used

K 26 Comfortable Chest used by western practitioners for emotional

imbalances.
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

Clinic Theater 2 Summer 2008

http://www.CatsTCMNotes.com
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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!
Youll 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 dont show on Tuesdays. Monday, Saturdays and Fridays are the best days of the week, with
Saturday being the best, though students dont like treating on weekends. So bear that in mind too: if
you cant 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 dont 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 orformula + extra ingredients with
grams each, grams total, grams per day oringredients 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.
Clinic Theater 2 Summer 2008
http://www.CatsTCMNotes.com
Page 3 of 3