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Medical Case Study: Foot Fracture and StrainCase Study

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Patient Intake Case Record

Patient's Information

Choi is a male college student, single, 24 years old, and resides on Wichitaw Drive in Freemont, California 94539. He complained mainly of fracture of the fifth metatarsal bone and strain on his left ankle. On interview, patient said that his left foot twisted while playing basketball five days earlier. The dorsum of the left foot is bruised and swollen. The patient added that the pain on his foot was becoming so severe that he is unable to walk around without help.

Medical History

The patient consulted with physician the previous day and was told to get an x-ray examination of his affected foot. X-ray results revealed the fracture earlier described. But the fractures are small and only in a single metatarsal bone. He assured the patient that it would heal in six to 12 weeks without need for surgery or a cast. In the meantime, he needs a foot brace to enable him to walk with some comfort.

He also complained of knee paid on the medial side of his right knee. He said that it was hit by a heavy piece of metal as he was carrying heavy boxes a month earlier. He was fortunate that it did not cause any fracture but only a big bruise on the medio-superior side of the patella. Examination showed bluish veins in the site. He said that knee pain got worse when he played soccer or basketball.

Personal and Family History

The patient did not smoke, drink alcohol or take addictive substances. But he said that his father suffers from hypertension and had high cholesterol levels. His mother also has high cholesterol levels. They are both currently on medication, such as herbs and ibuprofen.

Review of Systems Results

The patient's energy level is normal. On sleep, he wakes up in the middle of the night for no certain reason but is able to return to sleep. On mood -- he is slightly stressed over his studies and their family business. His digestive system is fair. His elimination system is normal. He evacuates once a day and his urination is normal. He also said he has normal appetite, although it can be too much at times. His digestive system appears normal.

Upon examination of the neurological and HEENT systems, no problem was noted. On his skin or lymphatic system, examination revealed sweating on he foot and hand and the left foot bruise. His cardiovascular and respiratory systems are unremarkable. His abdomen appeared normal as well.

Vital Signs -- His temperature was 98 degrees, blood pressure was normal at 110/80. His heart rate was 64. Respiration rate was 60.

Test Results -- His total cholesterol level at 205 mg/dl, HDL at 63 mg/dl, LDL at 130 mg/dL, triglycerides at 60 mg/dLand glucose at 90 mg/dL were all at normal ranges. His left pulse was slippery and deep. The right pulse was identical to the left. His tongue was pink. The coat was TWF. His complexion was slightly dusky under the eyes.

A. Diagnoses of Diseases and Patterns

Basis and Logic

1. Qi and Blood Stagnation -- the patient's left ankle twisted when he fell from a jumps during a basketball game in shooting the ball. Since then, he had difficulty extending and flexing his metatarsophalangeal joints on the affected left foot. The pain gets worse when he walks or puts his weight on it. The lateral side of the affect foot are visibly bruised and swollen, suggestive of qi and blood stagnation.

2. Blocked Channels and the Collaterals

Fractures at the proximal fifth metatarsal bone are common foot injuries, it is a useful subject of research. Professor Shi emphasized that sprains are injuries on the ligaments, tendons or cartilage surrounding the joints. But they exclude bone fracture, dislocation or skin ulceration, which develop from trauma or extreme flexing of the joint. According to Chinese medicine, sprain is an injury of the muscles and tendons. It is called Shangjin. It is considered a disease in that it injures the muscles, tendons and joins. It disturbs the statis of the qi and blood in the affected part. It usually results from strenuous activity such as exercise, games, trauma, torsion or contusion. In ballet dancers and athletes, it appears as a stress fracture. Extreme or unusually difficult physical activity, rigorous training can cause injuries because of repetitive, though minor, trauma. Addressing the condition requires the invigoration of the stasis of the qi and the blood. The channels and the collaterals should be opened. The sinew and the bones need to be strengthened.

Classic methods for acute thraum include jingo die shagwan and huoluoxiaolingdan. These methods provide immediate intervention to injuries without swelling or bruising. Acupuncture and herbal medicines may reduce the duration of normal swelling and bruising.

Jingu die shangwan and Its Properties

1. This consists of tian qi (Radix/RhizomaNotoginseng), a widely known medicinal herb, know for its efficacy in controlling bleeding, restoring circulation, and eliminating stasis, which accounts for bruising and clotting. Twenty percent of jingo content is tian qi.

2. Contents xuerjie (SanguisDraconis), tuxiang (Olibanum) and moyao (myrrha) together suppress stasis of blood. Herbs like dung gui (RadixAngelicaeSinensis) and honghua (FlosCartham) enhance blood circulation.

3. Xuduan (Radix Dipsaci) reduces traumatic swelling and bone injury.

Huoluoxiaolingdan accounts for a smaller portion of the formula. It was first developed in the early part of the 20th century.

Jingu's herbal ingredients are for topical use. Die da zhitonggao is also called Plaster for Bruise. It is likewise used as an analgesic because of its pain-relieving properties.

Directions for Use -- Cut the plaster according to the size of the affected swollen area. Attach it after thorough cleaning of the swollen part or after a shower. This plaster has proved effective not only for traumatized bruising but also for pain and swelling without bruises. A single application can eliminate up to 70% of the bruise after eight hours.

Know the Ingredients of Jitsu

Er cha (Catechu) is the main herb. It reduces pain and swelling

Xue jie (sanguis draconis), mo yao (myrrha), xu duan (radix dipsaci) and hong hua (flos Carthami) trigger blood circulation and break stasis. Dahuang (Radix RhizomaRhei) stimulates circulation and heat.

Herbs, like zhizi (FructusGardeniae), jinynhua (FlosLoniceraeJaponicae) and pu gong ying (HerbaTaraxaci) also clear body heat.

Longgu (OsDraconis) suppresses internal bleeding.

Zheng GuShui is a liniment for contusions, swelling and bruises.

Directions for Use -- It was first used as a cast or wrap for fractures or bone setting. Recently, it can be liberally poured into a gauze and then topically applied on the affected body part. The longer the use, the better is the outcome.

Western Differential Diagnosis:

A metatarsal bone fracture is a cut or break in any of the five metatarsal bones in either foot. These long and thin bones are those between the toes and the ankles. Technically, they are between the tarsal bones and the hind foot and the phalanges of the forefoot.

Active athletes often suffer from fractures, particularly in these parts, because of stress injuries. On account of their anatomy and for mechanical reasons, fractures are the most difficult to treat and heal among bodily injuries. Following surgical treatment, two to 21 months may be needed to seal the fractures. The condition may also need more aggressive treatment.

Their disease names, according to Western medicine, are fractures at the left fifth metatarsal bone (ICD-9 codes 825.35). It is characterized by pain in the joint and in the lower leg (719.46). In comparison, TCM patterns, or pattern syndrome differentiation, consist of qi and blood stagnation and blood stasis on the knees and the left foot.

Treatment

The principle consists of invigorating the qi and blood, relieve pain, promote the healing of the sprain and the fracture, and strengthen the sinews and tendons. The regimen requires acupuncture 10 times thrice a week. Application of the acupuncture treatment learned from Professor Shi produced remarkable improvement. On the second visit, the swelling and the bruises substantially subsided. The patient also said that the pain on his affected foot and knee had likewise largely diminished. After the 10th acupuncture session, he no longer needed a foot brace walking boot or crutches.

Acupuncture applied to knee joint: Nei Xi yan, Xi yan, ST-36, GB-33 and ankle joint: ST-41 and ashi points on the opposite side of GB-40 produces these effects:

1. Regulation of the qi and blood, opening of the channels and collaterals, removal of stagnation and strengthening of the body with ST-36, SP10, Liv 8);

2. relaxation of tendons and muscles and stimulation of the flow of qi and blood (GB-33);

3. Expulsion of cold and relief if pain (Xi Yan (Inner & Outer)

4. Resolution of the swelling and pain in the ankle joint of the foot with ST-41, GB-40,GB 41UB 64,K 6.

Important Reminders

Use the reducing method in puncturing. Add moxibustion afterwards in chronic

cases;

The same points should be punctured but on the opposite side of the affected joint in order to promote… [END OF PREVIEW]

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