Can pharmacy majors take the assistant medical and licensed medical exams?
It will be held at 3 stations at 17:20 on May 25th.
You can contact me for more details. 05 Collection of examinations on the practical skills of traditional Chinese medicine and the combination of Chinese and Western medicine
Highlights of the examination on the practical skills of traditional Chinese medicine and the combination of traditional Chinese and western medicine (selected from the resources of the Ai Ai Yi Chinese Medical Forum)
First stop
Clinical Questions and Answers of the Hunan Regional Traditional Chinese Medicine Practical Skills Examination
Kidney deficiency, low back pain, excessive Feng Shui and edema, chest pain, blood stasis in the heart, chest pain, phlegm congestion, headache, excessive liver yang, and increased thirst and constipation. Treatment methods and prescriptions for hypochondriac pain, liver and gallbladder damp-heat type, hot stranguria, stroke with qi deficiency and blood stasis type, and stomach pain with liver qi invading the stomach type.
Diagnosis of diarrhea and dysentery, asthma and wheezing, external cough and internal cough, classification and identification of stranguria syndrome, diagnosis of acute pyelonephritis, diagnosis of acute bronchitis, diagnosis of appendicitis, diagnosis of rheumatoid arthritis , medication principles for acute left heart failure, typical clinical manifestations of angina pectoris, general treatment of angina pectoris, what are premature ventricular contractions? What are the characteristics of its electrocardiogram? The clinical significance of microscopic hematuria, increased serum potassium, increased blood sugar, grading of fundus changes in hypertension, and what are the skin lesions of rheumatic fever? What are the three syndromes of cerebral hemorrhage? What are the x-ray characteristics of pneumothorax?
Second stop
Moving dullness, finger incision and needle insertion, thyroid palpation, clamping and needle insertion,
1. Pupillary light reflex
2. Inspection of the tongue body (the term tongue body is rare); what are the symptoms of tongue ecchymosis?
1． Physical examination of anterior cervical lymph nodes
2. Physical examination of sublingual veins
Indirect percussion of the lungs, the significance of an enlarged tongue, etc.
Please demonstrate how to detect Murphet's sign.
Please demonstrate how to use lightning cupping. (The examiner asked: How long should the cupping cup be kept)
Direct diagnosis of the lungs
Clamping needle acupuncture method
1. Physical examination of anterior cervical lymph nodes
2. Physical examination of sublingual veins
1 Spleen palpation 2 Heart palpation 3 Acupuncture with finger incision 4 Acupuncture with clamping method
Initial diagnosis of liver
Tongue examination Key points of examination
1. Measure blood pressure
2. Examine the content of tongue. Main symptoms of fat tongue and tooth marks
1. Check neck resistance, Brucella sign
2. Clamping acupuncture method
1. Palpation of thyroid gland
2. Finger-cut acupuncture method
1. Examination of voice tremor
2. Demonstration of Cunkou pulse diagnosis
Pulmonary diagnosis, superior liver border diagnosis, and cardiac dullness border diagnosis
1. Demonstrate and describe the palpation of cervical lymph nodes and precautions;
2. Demonstrate and describe the finger-incision acupuncture method. Which needle is suitable for the finger-incision acupuncture method?
Practical skills, lung auscultation. What is the meaning of burning mountain fire and cooling the sky?
Third stop
Characteristics of peptic ulcer pain and precautions for taking iron supplements for iron deficiency anemia
Medical history collection
Chest pain in the front Three years
Chest pain with headache
1. Patient collection: The patient is 65 years old, dizzy and palpitating for 2 years, worsening for 1 day
2. Iron deficiency Issues that should be paid attention to when taking medication for sexual anemia
3. What is the content of medical ethics standards
1. Consultation: Male, 42 years old, with polyphagia, weight loss, and polyuria for more than one month
2. The main symptoms, treatment methods and prescriptions of insomnia due to heart and spleen deficiency
3. Treatment of medical staff who violate medical regulations
1. Medical history collection: Male, 60 years old, hemiplegia, speech difficulty, speech and tongue crooked for 6 months. (Remember to differentiate it from cerebral hemorrhage)
2. Diagnostic criteria for acute glomerulonephritis. (Hypertension, proteinuria, and hematuria must be mentioned)
3. The social harm of receiving red envelopes.
1. Female, 31 years old, with frequent, urgent and painful urination for 5 years, which worsened for 5 days
2. X-ray manifestations of pneumothorax
3. For doctors Opinions on receiving "red envelopes"
1. Consultation: Male, 42 years old, with polyphagia, weight loss, and polyuria for more than one month
2. The main symptoms, treatment methods and prescriptions of insomnia due to heart and spleen deficiency
3. Treatment of medical staff who violate medical regulations
1 Edema (acute nephritis)
1. Male, 15 years old, with blood in urine and swollen eyelids for 4 days
2 , the significance of elevated serum glucose
3. About "kickback"
1. Male, paroxysmal left chest pain for 1 year
2. Kidney deficiency and low back pain Main symptoms, treatments, prescriptions
3. Main hazards of receiving red envelopes
1. Male, 12 years old, edema for 2 days
2. Intravenous administration of penicillin Precautions
3. Main contents of medical ethics standards
1. Male, 17 years old, cough and expectoration for 3 days
2. Heart-blood stasis type The clinical manifestations, treatment methods and prescriptions of chest paralysis
3. Evaluation and assessment methods of medical ethics and medical style
1. Male, abdominal pain and diarrhea for 10 days
2. What is sinus heart rate? Normal ECG performance?
3. How to deal with the results of doctors’ medical ethics assessment?
1. Medical history collection: Male, 60 years old, hemiplegic, speech difficulty, and speech and tongue distortion for 6 months. (Remember to differentiate it from cerebral hemorrhage)
2. Diagnostic criteria for acute glomerulonephritis. (Hypertension, proteinuria, and hematuria must be mentioned)
3. The social harm of receiving red envelopes.
1. How should a patient who has complained of stomach pain for a week be consulted based on the current history, past medical history and other hospitalization medical records?
2. How many red blood cells are there in "microscopic hematuria" during urine sediment test? (I forgot the specific question, but this is probably what it means), clinical significance?
3. (Medical Ethics and Medical Style) How do you view the issue of doctors receiving "red envelopes"?
In addition, other friends wrote medical records of damp-heat abdominal pain and damp-heat dysentery, describing the characteristics of sinus rhythm, demonstrating liver palpation, etc. . . . . .
1. Female, 31 years old, with frequent, urgent and painful urination for 5 years, which worsened for 5 days
2. X-ray manifestations of pneumothorax
3. For doctors Opinions on receiving "red envelopes"
1. Consultation: Male, 42 years old, with polyphagia, weight loss, and polyuria for more than one month
2. The main symptoms, treatment methods and prescriptions of insomnia due to heart and spleen deficiency
3. Treatment of medical staff who violate medical regulations
1. Male, 15 years old, with blood in urine and swollen eyelids for 4 days
2. The significance of elevated serum glucose
3. Regarding "kickbacks"
Medical record collection: Male, 55 years old, tired of greasy food for one month, accompanied by nausea, vomiting, and abdominal pain
Reply
Chest paralysis Dialectical treatment.
Collection from patients
The patient was an 18-year-old female who had fever, vomiting, and diarrhea for 3 days.
Medical history collection: Male, 60 years old, hemiplegic, speech difficulty, speech and tongue crooked for 6 months. (Remember to differentiate it from cerebral hemorrhage)
2. Diagnostic criteria for acute glomerulonephritis. (Hypertension, proteinuria, and hematuria must be mentioned)
3. The social harm of receiving red envelopes.
Kunming
The first stop, syndrome differentiation and treatment:
Dialysis (upper or middle elimination), dizziness (phlegm turbid and cloudy), yin-yellow (cold) Dampness), cough (phlegm and dampness accumulates in the lungs), chest pain and heart pain (deficiency of heart yin)
Second stop, physical examination and basic operations:
Baby's sign, Hoffmann Symptoms, lung percussion, liver and spleen palpation, lymph node palpation, hand and foot examination, heart buckle examination, auscultation sequence and content, tongue examination content (tongue body, tongue coating, sublingual collaterals), main syndrome of pathological tongue coating ,
The third stop, clinical defense:
1.
Requirements: Please follow the standard hospitalization medical record requirements and describe orally how to inquire about the patient's current medical history and related medical history around the chief complaint.
1. Female, 30 years old, had fever with nasal congestion and runny nose for 3 days
2. Female, 22 years old, with facial edema for 3 days
3. Male, 65 years old, had dizziness and palpitations for 10 years, which worsened in 2 months
4. Female, 45 years old, had recurrent nocturnal epigastric pain for 2 months
5. A 56-year-old man suffered from recurrent dizziness for 5 years and left limb weakness for 1 day.
Two. 1. What are the clinical symptoms of iron deficiency anemia?
2. What are the electrocardiographic characteristics of premature ventricular contractions?
3. Key points for diagnosis of acute appendicitis?
4. What are the symptoms and characteristics of spleen and stomach deficiency?
5. What are the main symptoms, treatment and prescriptions of diabetes mellitus?
Three. Medical Ethics and Medical Style
Mainly about the social harm and treatment of red envelopes and kickbacks.
. History collection
Male, 24 years old, coughing for two months and hemoptysis for one week.
What is the diagnosis? Bronchiectasis?
Second stop:
1. Physical examination of anterior cervical lymph nodes
2. Physical examination of sublingual veins
Third stop:
1. Consultation: Male, 42 years old, with polyphagia, weight loss, and polyuria for more than one month
2. The main symptoms, treatment methods and prescriptions of insomnia due to heart and spleen deficiency
3. Handling of medical staff who violate medical regulations
Thank you for your selfless dedication of your test questions for everyone’s convenience. Here is a small summary:
Third stop: 1. Medical history collection : Male, 60 years old, hemiplegic, speech difficulty, and speech and tongue distortion for 6 months. (Remember to differentiate it from cerebral hemorrhage)
2. Diagnostic criteria for acute glomerulonephritis. (Hypertension, proteinuria, and hematuria must be mentioned)
3. The social harm of receiving red envelopes.
First stop: Stroke (liver and kidney yin deficiency type)
Second stop: Direct diagnosis of the lungs
Clamping needle insertion method
p>
The third stop: 1. Female, 31 years old, with frequent, urgent and painful urination for 5 years, which has worsened for 5 days
2. X-ray manifestations of pneumothorax
3. Opinions on doctors accepting "red envelopes"
Tianjin
1 Spleen palpation 2 Heart palpation 3 Acupuncture with finger incision 4 Acupuncture with clamping method
Case writing 1 Cough (deficiency of yin and dryness of the lungs) 2 Dysentery (dampness and heat) 3 Edema (deficiency of spleen and yang)
Medical history inquiry 1 Edema (acute nephritis)
Medical ethics 1 Medical ethics assessment method 2 The hospital’s handling of medical ethics assessment results (linked to rewards and punishments/promotions, year-end assessments, etc.)
First stop: edema (feng shui flooding type)
Second stop: initial liver diagnosis
Key points of tongue examination
Third stop: 1. Male, 15 years old, with hematuria and swollen eyelids for 4 days
2. Elevated serum glucose The significance of
3. About "kickback"
Freshly released test questions (students who have just left the examination room)
First stop: edema (deficiency of spleen yang) type)
Second stop: 1. Take blood pressure
2. Look at the contents of tongue. Main symptoms of fat tongue and tooth marks
Third stop: 1. Male, paroxysmal left chest pain for 1 year
2. Main symptoms, treatment methods and prescriptions of low back pain due to kidney deficiency
3. Main hazards of receiving red envelopes
First stop: Chest paralysis (Qi and Yin deficiency type)
Second stop: 1. Check neck resistance and Brucella sign
2. Clamping acupuncture method
p>The third stop: 1. Male, 12 years old, edema for 2 days
2. Precautions for intravenous administration of penicillin
3. Main contents of medical ethics standards
p>
First stop: hypochondriac pain (liver and gallbladder damp-heat type)
Second stop: 1. Palpation of the thyroid gland
2. Finger-cut acupuncture method
Third stop: 1. Male, 17 years old, coughing and sputum for 3 days
2. Clinical manifestations, treatment methods and prescriptions of chest pain with heart-blood stasis type
3. Evaluation and assessment methods of medical ethics
First stop: Asthma (cold asthma)
Second stop: 1. Examination of voice tremor
2. Demonstration of Cunkou Pulse Diagnosis
The third stop: 1. Male, abdominal pain and diarrhea for 10 days
2. What is sinus heart rate? Normal ECG performance?
3. How to deal with the results of doctors’ medical ethics assessment?
The significance of indirect percussion of the lungs and enlarged tongue
Tianjin
1 Spleen palpation 2 Heart palpation 3 Digital acupuncture 4 Clamping Methods of acupuncture
Case writing 1 Cough (deficiency of yin and dryness of the lungs) 2 Dysentery (dampness and heat) 3 Edema (deficiency of spleen and yang)
Medical history inquiry 1 Edema (acute nephritis)
Medical Ethics 1 Medical Ethics Assessment Method 2 The hospital’s handling of medical ethics assessment results (linked to rewards and punishments/promotions, year-end assessments, etc.)
First stop: Stroke (liver and kidney yin deficiency, wind yang, etc.) (interference) medical record writing
Second stop: 1. Demonstrate and describe the palpation of cervical lymph nodes, precautions;
2. Demonstrate and describe the finger-cut acupuncture method, and point out What type of needle is suitable for incision acupuncture?
Third stop: 1. How should a patient complaining of stomach pain for a week be consulted based on the current medical history, past medical history and other hospitalization medical records?
2. How many red blood cells are there in "microscopic hematuria" during urine sediment test? (I forgot the specific question, but this is probably what it means), clinical significance?
3. (Medical Ethics and Medical Style) How do you view the issue of doctors receiving "red envelopes"?
In addition, other friends wrote medical records of damp-heat abdominal pain and damp-heat dysentery, describing the characteristics of sinus rhythm, demonstrating liver palpation, etc. . . . . .
Case summary:
Li, female, 55 years old, married. First consultation on December 23, 2000.
The patient was usually irritable and irritable, and had recurring epigastric pain for 4 years, which recurred or worsened every time due to satiation or poor mood. Taking Chinese and Western medicines successively can provide temporary relief. Yesterday, after a dispute with a neighbor, I developed severe swelling and pain in the epigastrium, swelling and pain in both flanks, frequent belching, and uncomfortable bowel movements, so I came to see a doctor. T: 36.5℃, P: 75 times/min, R: 20 times/min, BP: 125/80mmHg. She has clear consciousness, red tongue, thin white coating, and stringy pulse. Physical examination: slight tenderness under the xiphoid process. Gastroscopy showed mucosal congestion, edema, and mottled red and white appearance.
Requirements: Based on the above case summary, complete the written syndrome differentiation and treatment on the answer sheet.
Reference answer:
Bases for disease differentiation: The patient is usually irritable and irritable. The liver governs dispersion and dispersion, while happiness is high. If the mood is not comfortable, the liver qi will be stagnated and cannot be dissipated. When diarrhea occurs, the stomach is invaded and causes pain. The hypochondrium is the dividing line of the liver, and the qi circulates and wanders a lot, so the pain attacks the hypochondrium. The qi movement is unfavorable and the liver and stomach qi are inverse, resulting in abdominal distention, belching, and long sighs. Qi stagnation leads to abnormal bowel conduction, resulting in uncomfortable bowel movements. The disease is caused by Qi separation but not much dampness and turbidity, so the fur is often thin and white. The disease belongs to the liver and mainly causes pain, so stringy pulse is seen.
Basics of Western medicine diagnosis: 1. There are gastric symptoms such as epigastric distension and pain, extending to both flanks.
2． Physical examination showed slight tenderness under the xiphoid process.
3． Gastroscopy: The mucous membrane is congested, edematous, mottled, red and white.
Admission diagnosis:
TCM diagnosis: stomach pain
Past energy invading the stomach
Western medicine diagnosis: chronic superficial gastritis
Treatment method: soothing the liver and regulating qi
Recipe: Bupleurum soothing liver powder
Bupleurum 15g, Citrus aurantium 15g, peony 15g, Cyperus cyperus 5g
Chuanxiong 15g, Yuanhu 15g, Yujin 15g, Amomum villosum 15g
Tangerine peel 15g, licorice 15g
First stop: Chest Bi (qi and yin deficiency type)
No. Second station: 1. Check neck resistance and Brucella sign
2. Clamping acupuncture method
Third station: 1. Male, 12 years old, edema for 2 days
2. Precautions for intravenous administration of penicillin
3. Main contents of medical ethics standards
First stop: hypochondriac pain (liver and gallbladder damp-heat type)
Second stop: 1. Palpation of thyroid gland
2. Incision and acupuncture method
Third stop: 1. Male, 17 years old, cough and expectoration for 3 days
2. Clinical manifestations, treatments, and prescriptions of chest paralysis with heart-blood stasis type
3. Evaluation and assessment methods of medical ethics and medical style
First Station: Asthma (cold asthma)
Second station: 1. Examination of voice tremor
2. Demonstration of Cunkou pulse diagnosis
Third station: 1 , male, abdominal pain and diarrhea for 10 days
2. What is sinus heart rate? Normal ECG performance?
3. How to deal with the results of doctors’ medical ethics assessment?
The first stop, syndrome differentiation and treatment:
Dialysis (upper or middle elimination), dizziness (phlegm turbid and cloudy), yin yellow (cold and damp), cough (phlegm and dampness accumulation) lungs), chest pain and heart pain (deficiency of heart yin)
Second stop, physical examination and basic operations:
Basic sign, Hoffmann sign, lung percussion, liver and spleen Palpation, palpation of lymph nodes, palpation of hands and feet, cardiac auscultation, order and content of auscultation, content of tongue examination (tongue body, tongue coating, sublingual collaterals), main syndrome of pathological tongue coating,
The third stop, clinical defense:
1. Requirements: Please follow the standard hospitalization medical record requirements and describe orally how to inquire about the patient's current medical history and related medical history around the chief complaint.
1. Female, 30 years old, had fever with nasal congestion and runny nose for 3 days
2. Female, 22 years old, with facial edema for 3 days
3. Male, 65 years old, suffered from dizziness and palpitations for 10 years, worsening for 2 months
4. Female, 45 years old, had recurrent nocturnal epigastric pain for 2 months
5.
A 56-year-old man suffered from recurrent dizziness for 5 years and left limb weakness for 1 day.
Two. 1. What are the clinical symptoms of iron deficiency anemia?
2. What are the electrocardiographic characteristics of premature ventricular contractions?
3. Key points for diagnosis of acute appendicitis?
4. What are the symptoms and characteristics of spleen and stomach deficiency?
5. What are the main symptoms, treatment and prescriptions of diabetes mellitus?
Three. Medical Ethics and Medical Style
Mainly about the social harm and treatment of red envelopes and kickbacks.
One of my colleagues examined the case yesterday
Patient Zhao XX had fever and cough for a day.
Others
The basis for disease differentiation is: wind-heat attacks externally, the defense surface is out of harmony, and the heat evil and the defense yang add up, so there is fever, sweating, and slight wind. Wind-heat radiates to the surface, and evil radiates to the lung system, causing the lung qi to lose its circulation, resulting in nasal congestion and sneezing, and lung qi going up and down, resulting in a slight cough. Wind-heat evil gas fumes in Qingdao and causes sore throat. A red tongue tip, thin white fur, and a floating pulse are symptoms of wind-heat attack. (Integrated Traditional Chinese and Western Medicine 7 points, Traditional Chinese Medicine 10 points) Western medicine diagnosis basis: (Integrated Traditional Chinese and Western Medicine 8 points, Traditional Chinese Medicine 7 points, 5 points for teacher training) 1. Fever, bad wind for 1 day; 2. Nasal congestion, sneezing, sore throat, slight cough ; 3. Pharyngeal congestion, small tonsils, clear breath sounds in both lungs, and no wet or dry rales; 4. Chest X-ray: T: 38.6°C. Chest X-ray: No abnormality in heart and lungs. Blood routine: WBC6.0×109/L, neutral 70%. Diagnosis: (7 points for integrated traditional Chinese and Western medicine, 8 points for traditional Chinese medicine, and 6 points for apprenticeship) TCM diagnosis: cold, wind-heat syndrome. Western medicine diagnosis: upper respiratory tract infection. Treatment method: Xinliang relieves the symptoms. (5 points) Prescription: Yinqiao San combined with Conggu Platycodon Decoction. (Integrated Chinese and Western medicine 8 points, Chinese medicine 10 points) Yinghua 15g Forsythia 15g Platycodon 6g Almond 10g Reed root 10g Licorice 6g Mint 6g Gardenia 10g tempeh 10g Nepeta 10g Fangfeng 10g Burdock 10g Instructions: decoction in water, 1 day agent. 150ml each time, 2 times a day.
The first stop, syndrome differentiation and treatment:
Dialysis (upper or middle elimination), dizziness (phlegm turbid and cloudy), yin yellow (cold and damp), cough (phlegm and dampness accumulation) lungs), chest pain and heart pain (deficiency of heart yin)
Second stop, physical examination and basic operations:
Basic sign, Hoffmann sign, lung percussion, liver and spleen Palpation, palpation of lymph nodes, palpation of hands and feet, cardiac auscultation, order and content of auscultation, content of tongue examination (tongue body, tongue coating, sublingual collaterals), main syndrome of pathological tongue coating,
The third stop, clinical defense:
1. Requirements: Please follow the standard hospitalization medical record requirements and describe orally how to inquire about the patient's current medical history and related medical history around the chief complaint.
1. Female, 30 years old, had fever with nasal congestion and runny nose for 3 days
2. Female, 22 years old, with facial edema for 3 days
3. Male, 65 years old, had dizziness and palpitations for 10 years, which worsened in 2 months
4. Female, 45 years old, had recurrent nocturnal epigastric pain for 2 months
5. A 56-year-old man suffered from recurrent dizziness for 5 years and left limb weakness for 1 day.
Two. 1. What are the clinical symptoms of iron deficiency anemia?
2. What are the electrocardiographic characteristics of premature ventricular contractions?
3. Key points for diagnosis of acute appendicitis?
4. What are the symptoms and characteristics of spleen and stomach deficiency?
5. What are the main symptoms, treatment and prescriptions of diabetes mellitus?
Three. Medical Ethics and Medical Style
Mainly about the social harm and treatment of red envelopes and kickbacks.
. History collection
Male, 24 years old, coughing for two months and hemoptysis for one week.
What is the diagnosis? Bronchiectasis?
Patient Zhao XX had fever and cough for one day.
Others
The basis for disease differentiation is: wind-heat attacks externally, the defense surface is out of harmony, and the heat evil and the defense yang add up, so there is fever, sweating, and slight wind. Wind-heat radiates to the surface, and evil radiates to the lung system, causing the lung qi to lose its circulation, resulting in nasal congestion and sneezing, and lung qi going up and down, resulting in a slight cough. Wind-heat evil gas fumes in Qingdao and causes sore throat. A red tongue tip, thin white fur, and a floating pulse are symptoms of wind-heat attack.
(Integrated Traditional Chinese and Western Medicine 7 points, Traditional Chinese Medicine 10 points) Western medicine diagnosis basis: (Integrated Traditional Chinese and Western Medicine 8 points, Traditional Chinese Medicine 7 points, 5 points for teacher training) 1. Fever, bad wind for 1 day; 2. Nasal congestion, sneezing, sore throat, slight cough ; 3. Pharyngeal congestion, small tonsils, clear breath sounds in both lungs, and no wet or dry rales; 4. Chest X-ray: T: 38.6°C. Chest X-ray: No abnormality in heart and lungs. Blood routine: WBC6.0×109/L, neutral 70%. Diagnosis: (7 points for integrated traditional Chinese and Western medicine, 8 points for traditional Chinese medicine, and 6 points for apprenticeship) TCM diagnosis: cold, wind-heat syndrome. Western medicine diagnosis: upper respiratory tract infection. Treatment method: Xinliang relieves the symptoms. (5 points) Prescription: Yinqiao San combined with Conggu Platycodon Decoction. (Integrated Chinese and Western medicine 8 points, Chinese medicine 10 points) Yinghua 15g Forsythia 15g Platycodon 6g Almond 10g Reed root 10g Licorice 6g Mint 6g Gardenia 10g tempeh 10g Nepeta 10g Fangfeng 10g Burdock 10g Instructions: decoction in water, 1 day agent. 150ml each time, 2 times a day.
Answer sheet
Case summary
Zhao Moumou, male, 56 years old, cadre, first diagnosed on 2002-01-03.
I usually like good wine and strong flavor. I was depressed due to the loss of my spouse six months ago. Three months ago, I felt dry mouth and tongue, irritable and irritable. I drank more water and urinated in large quantities. No diagnosis and treatment was given. In the past week, the symptoms worsened, and she felt tired and weak, her physical signs decreased, and repeated scabies appeared on her skin, so she came to see a doctor. T: 36°C, P: 85 times/min, R: 18 times/min, BP: 17.3/12kPa. She is conscious, has a fat body, has a red tongue, less coating, and a thready and weak pulse. More boils can be seen on the skin of the back and limbs. No other positive signs were seen. Laboratory tests: fasting blood glucose 7.6mmol/L, 2-hour blood glucose 12.3mmol/L, triglyceride 3.2mmol/L, urine glucose (-).
Chief Complaint
Chief Complaint: Main Symptom (or Sign) Time
Requirements: Comprehensive and prominent, concise, reflect the characteristics of the disease, and be able to derive the first diagnosis.
Example: Polydipsia, polydipsia, and excessive urination for 3 months, which worsened for 1 week.
Example: Three months ago, the patient gradually developed dry mouth, irritability, increased drinking water, and excessive urination due to improper diet and emotional stimulation. No diagnosis and treatment was given. In the past week, the symptoms had worsened, and she felt weak and emaciated. Sores and boils appeared repeatedly on the skin of her back and limbs, so she came to see a doctor. Present symptoms include: dry mouth and tongue, polydipsia and polydipsia, frequent urination, fatigue and weight loss.
Example: I am usually fond of alcohol and heavy flavor, which leads to failure of spleen and stomach transportation and transformation, accumulation of internal heat, dryness and body fluids, coupled with emotional stimulation, qi stagnation and fire, burning lungs and stomach Yin and body fluids. Quench your thirst. Therefore, in clinical symptoms, symptoms of thirst include excessive thirst, frequent urination, and weight loss. Lung heat is blazing and fluid consumption damages body fluids, resulting in dry mouth and excessive thirst. The lungs are mainly used to treat the joints, and dryness and heat damage the lungs. If the joints are not treated properly, the water will not turn into body fluids and will flow downwards, so there is frequent urination. As time goes by, dryness and heat will consume Qi and Yin, and Qi and Yin will be deficient, which can lead to fatigue and weakness, and a thready and weak pulse. Internal knots due to dryness and heat, burning of Yin Yin, obstruction of veins and stasis, accumulating toxins into pus, resulting in sores and boils; red tongue with less coating, and thready and rapid pulse are signs of dryness and heat damaging body fluids.
Diagnostic basis of Western medicine
Requirements: The diagnostic basis is sufficient and complete, clear and organized, and consistent with the clinical data of the case.
Example: 1. Aged 56 years old, with slow onset.
2. Diabetic symptoms such as polydipsia, polyuria, and weight loss.
3. Fasting blood sugar was 7.6mmol/L, and 2 hours after meal blood sugar was 11.3mmol/L.
Admission diagnosis
The diagnosis of Chinese and Western medicine disease names and Chinese medicine syndrome types is accurate, comprehensive, standardized and complete.
Example
Admission diagnosis
Traditional Chinese medicine diagnosis: Diabetes disease
Shangxiao-Lung heat and body fluid injury
Diabetes disease complicated by sores and boils - accumulation of heat and poison
Western medicine diagnosis: type 2 diabetes
Type 2 diabetes complicated by skin infection
Treatment
Requirements: Accurate and complete.
Example: Clear away heat and moisten the lungs, detoxify and promote body fluids
Prescriptions
Requirements: accurate prescription and medication (and/or acupoint selection, technique, etc.), and drug dosage , Correct usage and reasonable compatibility.
Example: Xiaoke recipe addition and subtraction
Pollen 30g, Coptis 10g, Rehmannia glutinosa 15g
Pudzu 15g, Ophiopogon japonicus 15g, Anemarrhena 10g
Adenophora 12g, Shuanghua 15g, Gongying 15g
Decoction in water and take 1 dose per day
Acupuncture prescription
Prescription:
Feishu Geshu Under the epigastrium, Quchi, Thenar and Xuehai are treated with acupuncture without moxibustion. The Shu points on the back are tonic and diarrhea-reducing. Use the purgative method at Quchi, Thenar and Xuehai points, and the tonic method at Taixi point.
Signature: ****** The relevant requirements of the "Standards for Medical Records of Traditional Chinese Medicine" (2000 Edition);
2. Clear organization, smooth language, highlighted points, and standard use of medical terminology; the content of the medical records is objective and accurately reflects the patient's condition;
3. The handwriting is neat and tidy, with no alterations or typos.
Medical case examples
Medical case 1
Guo, female, 50 years old, married, worker. 2001-06-08 First diagnosis.
Two years ago, I developed right flank pain and back pain after eating a full meal. Later, it was often caused by greasy diet and was never diagnosed and treated. The symptoms worsened a week ago and could not be relieved on their own, so I came to see a doctor today. Symptoms: pain in the right hypochondrium, accompanied by back pain, nausea, bitter mouth, chest tightness, anorexia, red urine, and dry stools. I usually like spicy food. T37°C, P80 times/min, R18 times/min, BP 120/70mmHg, conscious, flushed face, Murphy's sign ( ), no rebound pain and abdominal muscle tension, liver and spleen not palpable, red tongue with yellow coating Feeling greasy and stringy pulse. WBC 10.8×109/L, neutral 78%, lymph 22%, Hb120g/L, B-ultrasound showed: gallbladder wall thickening. Liver function is normal.
Basics for disease diagnosis and syndrome differentiation:
Usually like to eat spicy and thick food, damp-heat accumulates in the liver and gallbladder, the liver collaterals are out of harmony, and the gallbladder is not drained, so the pain in the right hypochondrium is connected to the back, and the mouth is bitter. . Damp-heat resistance causes abnormal lifting and lowering, resulting in chest tightness, dullness, and nausea. Heat evil damages the body fluid, so the urine is red and the stool is dry. A red tongue, yellow and greasy coating, and stringy pulse are symptoms of liver and gallbladder dampness and heat.
Acupuncture prescription
Prescription:
Riyueqiemen Yanglingquan Xingjian Xiaxi
Technology: only acupuncture without moxibustion, Purgative method.
Medical Case 2
Li Moumou, male, 10 years old. First consultation on October 9, 2001.
Dyspnea has been recurring for 2 years, and it occurs again for 2 hours after catching a cold. Over the past 2 years, the patient had experienced nasal itching, sneezing, and runny nose due to colds, followed by difficulty breathing, mainly exhalation, wheezing in the throat, dry cough with little phlegm, and chest tightness, which resolved spontaneously over time. In the past six months, attacks have become more frequent than before, with an average of one attack per month without systemic treatment. The patient now has difficulty breathing, wheezing in the throat, fullness and tightness in the chest and diaphragm, a dull complexion, and is thirsty and prefers hot drinks. The tongue coating is white and slippery, and the pulse is stringy and tight. Have a history of allergy to penicillin and erythromycin. His mother had a similar medical history when she was a child and has not had an attack in 20 years. T37.8°C, P110 times/min, R21 times/min, BP130/75mmHg. Development is normal, lips are purple, three concave signs are seen, lungs are hypervoiceless percussion, full of wheezing, heart rate is regular, heart rate is 110 beats/min, no murmur is heard, and liver and spleen are not heard. The brightness of both lungs on chest X-ray increased. The bronchial provocation test was positive one year ago. IgE0.05g/L (normal range 0.0001～0.099/L).
The basis for disease diagnosis and syndrome differentiation:
Cold phlegm in the lungs, which is caused by colds, causes rising phlegm to block Qi, and the airway is not smooth, resulting in difficulty breathing and wheezing. If the lung qi is blocked and cannot be released, the chest and diaphragm will be full and stuffy. If the yin is too strong inside, the yang energy cannot be expressed, so the complexion becomes dull and sluggish. The cause of the disease is cold, and there is no internal heat, so the mouth is not thirsty and the patient likes hot drinks.
The tongue coating is white and slippery, and the pulse is stringy and tight, all of which are signs of excessive cold.
Acupuncture Prescription
Prescription:
Zhongfu Tiantu Tanzhong
Kong Zuitaiyuan Pianli
Manipulation: combined with acupuncture and catharsis.
Medical Case 3
Chen Moumou, male, 43 years old, cadre, married. First consultation on February 8, 222.
Over the past five years, I have had dull or worsening pain in my stomach due to fatigue or eating disorders. I have taken a variety of Chinese and Western medicines for treatment, but all of them had no obvious effect. Seven days ago, I developed a dull pain in the stomach due to fatigue. I like to be warm and press, have loose stools, and feel tired and indigestive. My limbs are tired and my hands and feet are not warm. Then he came to see a doctor. T: 36.1 °C, P: 76 times/min, R: 18 times/min, BP: 120/75mmHg. She has clear mind, thin body, pale tongue, white coating, and weak pulse. Pain under the xiphoid process. Gastroscopy showed mucosal congestion, edema, mottled red and white.
The basis for disease diagnosis and syndrome differentiation:
The spleen and stomach are the organs of the storehouse, responsible for receiving and transporting water and grains. Repeated overwork or eating disorders can cause spleen yang deficiency. The middle Jiao is deficient and cold, so there is a dull stomachache, and the patient prefers warmth and pressure. If the spleen and stomach are deficient and cold, transportation and transformation will be abnormal, so there will be poor appetite and less food. The spleen controls the muscles and moves the limbs. If the middle yang is weak, the movement will be ineffective, and the muscles and tendons will lose their warmth and nourishment, resulting in fatigue and lukewarm hands and feet. Spleen deficiency produces dampness, so the stool is loose and thin. A pale tongue, white coating, and a deep and weak pulse are all signs of spleen and stomach deficiency and insufficient Qi.
Acupuncture prescription
Prescription:
Zhongwan, Qihai, Neiguan, Zusanli, Gongsun
Manipulation: use both acupuncture and moxibustion, tonifying method. Medical Record 4
Huang, male, 22 years old, student, unmarried. First diagnosis on April 1998.
I felt cold on the way out and felt unwell all over my body after returning home, with fever, aversion to cold, and sore throat. Seven days later, I noticed swollen eyelids, followed by swollen face and limbs, and red urine. I asked a Chinese medicine doctor for diagnosis and treatment. Symptoms: fever, slight aversion to wind and cold, soreness of limbs, no sweat, thirst, upset, sore throat, edema all over the body, oliguria and yellow urine, and constipation. T: 38.2°C, P: 100 times/min, R: 19 times/min, BP: 130/80mmHg. She was conscious, listless, slightly red complexion, congested pharynx, and had II degree swollen tonsils. The tongue is red, the coating is yellow and greasy, and the pulse is floating and rapid. Urinary protein, red blood cells, granular casts 0 to 1. 24-hour original protein quantification 2.0g. Routine blood test showed no abnormality. Phase microscopy of urine red blood cells: polymorphic type accounts for 80% and homogeneous type accounts for 20%. BUN6.0mmol/L, SCr130μmol/L.
Basics of disease and syndrome differentiation
After going out and feeling wind and cold, the wind evil attacks the outside and combines with the lungs internally. The lungs lose their circulation and fall, and the water channels are blocked, resulting in wind and water blockage, and Feng Shui. Pulsation, overflow of skin, causing edema. Wind evil attacks the surface, and the defense surface is out of harmony, so mild aversion to wind and cold, sore limbs, and fever are seen; wind-cold transforms into heat and attacks the throat, so sore throat is seen; evil heat damages body fluids, so thirst and constipation are seen; evil heat disturbs the mind. , you will see upset; evil heat tends to the lower burner, and the heat will damage the cells, so you will see red urine. A red tongue, yellow and greasy coating, and a floating and rapid pulse are all signs of evil heat on the surface and water-dampness stopping internally.
Basics of Western medicine diagnosis:
1. Have a history of acute upper respiratory tract infection.
2. There are symptoms and signs such as edema of the eyelids, face and body, hematuria.
3. Urinary protein ++, red blood cells ++, granular casts 0 ~ 1; 24-hour urine protein quantification 2.0g; urine red blood cell phase microscopy showed: polymorphic type accounted for 80%, homogeneous type accounted for 20%.
Hospital diagnosis:
Traditional Chinese medicine diagnosis: edema
This answer was modified by the respondent at 17:25 on May 25