Comprehensive Traditional Chinese Medicine Case Study: Chronic Constipation and Systemic Health Assessment
Patient Overview and Primary Complaint
Patient Profile: The patient is a female university student studying Environmental Design with a specialization in Interior Design (Architecture) at OCAD. She describes herself as a full-time student currently on her last week of vacation.
Primary Complaint: Chronic constipation and significant abdominal bloating.
Timeline of Current Episode:
The patient realized she was severely bloated the day before yesterday in the afternoon.
She ate at and still felt bloated at .
Her last regular bowel movement was approximately ago, which was described as a small amount.
She reported a small bowel movement yesterday and a very small one this morning.
Subjective Feelings:
She feels "full" upon waking and does not experience normal hunger in the morning.
She reports a lot of gas but feels as though "nothing is coming out."
She describes a feeling of incomplete evacuation ( sensation of stool remaining).
Bowel Movement and Gastric Characterization
Effort and Frequency:
This morning, she had to exert significant effort ("pushing") to pass stool.
Yesterday, the effort was minimal, but the output was low.
Stool Quality:
Size: Described as very small, similar to a "petal" or "small medal."
Shape: This morning's stool was a single small chunk; yesterday's was like a "little cone" or a single chunk.
Odor: Described as "really foul" and "foul."
Color: Reported as not dark.
Consistency: It does not stick to the toilet bowl.
Acid Reflux and Burping:
The patient suffers from frequent acid reflux and random burping.
She often feels the taste of acid in her mouth.
She feels a sensation of heaviness in the esophagus.
A family doctor previously suggested this was due to eating too fast; the patient once worried the sensation was cardiac-related (heart pain).
Pineapple Sensitivity:
As a child, the patient loved pineapple. As she aged, it began to cause severe stomach pain.
She once attempted to "conquer" the sensitivity by eating pineapple, resulting in pain so intense she forced herself to vomit.
Two days ago, she consumed a cold mango-pineapple smoothie. Following this, she experienced throat pain and suspects it may be linked to her current constipation and bloating.
Dietary and Fluid Habits
Meal Frequency: She typically eats only per day because she feels full easily.
Appetite: She initially claimed a heavy appetite but corrected this to say she simply "likes the taste of food." She only feels true hunger a day.
Snacking: High frequency of snacking on chips, french fries, and crackers.
Seaweed Consumption: She snacks on both salty and non-salty seaweed frequently.
Fruit: Occasionally snacks on bananas and oranges.
Vegetable Intake: Very low. She likes salad but only eats it "once in a while." She avoids her father's salads because they contain onions, which she dislikes. She consumes a large amount of potatoes.
Fluid Intake:
Preference: Strongly prefers cold water and cold drinks with ice.
Volume: She drinks approximately the volume of one large water bottle, though in school, she refills it up to .
Types: Pop, juice, and fast-food smoothies. She dislikes warm pop because of the taste and mouthfeel of the "fizzle."
Warm Water: Recently she has tried drinking warm water for the constipation based on her father's advice.
Lifestyle, Stress, and Mental Health
Sleep Patterns:
She sleeps approximately (e.g., or ).
She reports "heavy sleeping" but woke up once last night due to a bad dream involving anger and surprise.
Fatigue and Energy:
Reports low energy and significant fatigue upon waking.
She often stays in bed for after waking and does not get up until or .
She falls asleep easily during lectures.
Physical Activity: No gym or formal exercise. She goes for walks most days for a minimum of .
Stress Levels:
On a scale of : She is usually at a during school and currently at a during vacation.
She suffered significant stress recently when her laptop broke before a final critique.
Mental Health: Reported anxiety (undiagnosed) and chronic overthinking. She describes "dissecting everything" in her mind.
Memory: Reports poor concentration and short-term memory issues (e.g., forgetting what she was searching for on her phone or why she walked into a room).
Systemic Symptoms and Physical Findings
Temperature Regulation:
Frequently has cold hands but the feet are often "too warm."
During the interview, her hands were regular/warm but slightly sweaty.
Sweating:
Reports night sweats where she wakes up feeling too hot and must remove blankets.
Sweating occurs primarily on the chest and abdomen area.
Experiences an annoying cycle of being too hot (removing layers), then too cold (putting them back on).
Hair and Skin:
Reports significant hair thinning, specifically at the center of the scalp.
Her hair used to be much thicker (comparing it to her brother's thick hair) but became "stringy" and thin during her first year of university.
Reports dry skin and dry lips upon waking.
Pain and Bruising:
Tends to bruise and bleed easily; reports that even minor bumps or being grabbed hurts more than expected.
Muscle pain in the shoulders and lower back, especially after sitting for long periods at a laptop.
Shoulders feel uncomfortable or painful when pressure is applied.
Head and Ears:
Tinnitus: Occasional high-pitched ringing, usually more severe in the right ear.
Hearing: Claims to have "bad hearing," requiring people to be very loud, though she acknowledges this may be a concentration issue.
Dental: Sensitive gums; cannot bite into cold items like ice cream or popsicles due to intense pain.
Urogenital and Gynecological History
Urination:
Frequency: At least .
Character: Pale yellow (recently) or light yellow (during school). No foam.
Sensation: Sometimes feels an emergency need to go, or feels incomplete after finishing.
Menstrual Cycle:
Menarche: Age (Grade ).
Diagnosis: Polycystic Ovary Syndrome (PCOS).
Regularity: Irregular; often skips one month or sometimes two months.
Duration: .
Flow: Very heavy on the first ; contains dark red/gray clots of varying sizes.
Associated Symptoms:
Severe cramps during the period.
PMS: Extreme irritability, emotional swings (anger, sadness), and nausea before the period begins.
Leukorrhea: White or creamy vaginal discharge; sometimes has a yellow tint and is sticky.
Traditional Chinese Medicine (TCM) Physical Examination
Abdominal Palpation:
The patient is extremely ticklish, making deep palpation difficult.
She reports that during her period, she cannot tolerate any pressure on her abdomen.
She often lifts her underwear away from her skin to alleviate pain, as removing pressure feels better immediately.
Tongue and Pulse:
The practitioners noted the importance of checking the Kidney, Spleen, and Liver channels.
Clinical suspicion of "Lack of Fluid" and potential Kidney/Spleen deficiency, with Liver involvement due to stress.
Questions & Discussion
Q: When you push during a bowel movement, do you sweat?
A: Not a lot of sweat, just a little bit. It is not enough to be noticeable.
Q: Do you feel incomplete afterwards?
A: About . Sometimes I try to go because I know it's there, but it won't come out.
Q: Does the stool stick to the bowl?
A: No.
Q: Do you clench your jaw while sleeping?
A: No, not really.
Q: Do you exercise?
A: No exercise, just walks.
Q: Does it hurt when I press here (abdominal area)?
A: No, it does not hurt, but I am very ticklish. I just can't have anything touching me during my period.