This content details a patient consultation for a Traditional Chinese Medicine (TCM) viva exam, focusing on a patient presenting with a persistent three-month headache, accompanied by various other symptoms, and exploring their medical history, lifestyle, and TCM-specific diagnostic information.
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so this is your patient information form
you're only allowed to read this speaker
more than others your total time is one
half an hour because addition time
maximum half an hour
okay good morning thank you for coming
into being my patient today for my viva exam
exam
uh you've met dr lee my name is dawn
and dr lee will be my assessor for today
and are you all right with dr lee observing
observing
yeah sure okay great welcome so before
we get started i just wanted to let you
know that a consultation and treatment
generally takes about one and a half
hours and because this is an
exam that assesses both acupuncture and
chinese herbal medicine
i'll be providing both of these
modalities to you today
this is working with your plants sure
does okay great
thank you so is this your first time
visiting sitcm student clinic
yes it is okay welcome and do you have
any questions before we get started
not yet no okay great uh so chinese
medicine takes a holistic approach to
health and we believe that each bodily
system is interconnected
and that every person's situation is unique
unique
so this means that we may need to ask
you many questions before we can make a diagnosis
diagnosis
and is it okay for me to start asking
you questions now yeah sure
okay great so we'll start off by going
through your indemnity and release form here
here
and then your patient information form
the indemnity
and release form says that right here
any information that you share with us
maybe share with other health
professionals to manage your condition
do you have any concerns about that no no
no okay
and after the consultation we will also
offer you some treatment options
so as with all treatments acupuncture
and herbal medicine
may produce side effects so possible
side effects are listed on the form here
and include but not limited to
minor bleeding or bruising minor pain or soreness
soreness
infection nausea vomiting diarrhea
and in rare situations perforation of
internal organs
any pre-existing conditions may also
cause other adverse events
do you have any questions about this
information um
those things don't often happen do they
no they don't
no so don't worry yeah that's fine okay great
great
so the form also says that you may
experience any side effects
and you may need to report them to us in
rare situations you may also need to
contact someone else for example
in an emergency you should call an
ambulance do you understand this
sure do okay and you have any questions
about this form or anything else before
we move on to review the patient
information form
so now i'd like to clarify a few things
from your patient information form
any allergies no okay
family history my mother has had ibs for
20 years
okay any history of surgical operations
or procedures
i did have an appendictomy when i was
ten but that's it
okay uh what about history of tcm
treatment and or adverse reactions to
either acupuncture or herbs
there'd be no adverse reactions i did
get some acupuncture and herbs
just to manage my stress levels that was
when i was finishing my undergrad so
that's like five years ago
all right great all good thank you thank
you so how can i help you today
oh i have a headache okay when did it start
start
uh it's been going for three months now
and the issue is it just hasn't gone away
away
um it restarted gradually over a couple
of weeks
and it's been pretty constant from then
until now
okay and where is this pain located um
it's across my hole for it okay and does
it radiate to any other areas
nope just my whole head it feels pretty heavy
heavy
and tired
okay and how would you describe the
headache describe it um
i guess i just have this dull heavy pain
across my foot
my eyebrows also feel tense okay and is
it constant
or does it come and go it is present
every day
okay and do you find that the pain
varies at different times of the day
yeah um it's normally more severe just
when i wake up
um during the day it's not so bad but it
gets worse again in the afternoon
especially if i'm exhausted okay and do
you know what may have actually
caused the headache for example was it
after an illness an event
or a change in your health or your lifestyle
lifestyle
there's nothing i can think of like i
said it was three months ago so that was
the beginning of winter i'm kind of
surprised because i just began a health kick
kick
at the end of summer and i even changed
my diet to raw foods because they're healthier
healthier
right okay and have you experienced any
headaches before this
not much um i've just had a light
headache that lasted a few hours every
now and then
that's it okay and what factors
aggravate your headache to make it worse
for example certain foods
cold heat changing weather well
also after i eat which is strange
because i have salad most days
okay so is there anything that helps to
relieve the pain
oh panadol normally takes the edge off
if i'm well rested it's not so bad
either i think i need a long holiday
yes a holiday would be good uh but so
anyway you mentioned that the pain
changes in severity
so how would you rate the pain today out
of scale of zero to ten with ten being
the worst
probably a three out of ten okay
and how would you rate the pain when
it's at swiss
easily a six or seven out of ten
how about your eyes and vision have you
noticed any change
well my eyes feel heavy and tired at the
end of each day
and sometimes um my eyes are sticky just
when i wake up
okay and do they burn or do you notice a discharge
discharge
no it's nothing too bad it's just a bit sticky
sticky
when i wake up but it disappears after a
shower no pain or anything
right okay good and any symptoms related
to your ears
hearing even tinnitus i don't think so
actually what is tinnitus it's a ringing
sound in your ears
um no i don't have that i think my ears
my hearing are fine
okay great and do you experience any
nasal or sinus symptoms
now that you mention it i do have a
stuffy dripping nose
uh most mornings okay and what's the
color and consistency of the discharge
consistency um it's clear and watery
and it gets worse when it's raining like
today okay
what about the amount it's not a lot
usually i blow my nose a few times
in the morning and that's about it for
the day
do you experience any dizziness
sometimes uh in the morning again or if
i'm tired
the dizziness actually started at the
same time as my headache so it's been
going for about three months
right okay and is this dizziness that
you mentioned is it worse when you get
up quickly
from a sitting or lying down position no
um it comes and it goes it's worse when
i'm tired but
i don't think it's anything serious okay
um do you feel any stiffness or pain in
your neck or shoulders
um my shoulders are really tense a bit
sore i think it's from the stress i'm um
doing my phd at the moment and that's
obviously challenging
yes no doubt that's a huge challenge so
how do you respond to that kind of stress
stress
um it's hard no i'm always tired
headaches make it worse and then i can't concentrate
concentrate
i often feel foggy headed and i can't
yeah that's not easy huh so do you feel
aches or pains anywhere else in your body
body
no but my whole body feels heavy and tired
tired
it's hard for me to get up and feel
motivated yeah
okay so have you sought any medical
advice regarding your headache
not until now okay uh great so besides
the panadol
are you treating the headache with
anything else
um the penetal helps but i don't like to
take too much
i do also have regular massages um they
can help with the stress
okay good and do you think the messages
help with the headaches
um yeah it's just temporary temp
it's a temporary release but it comes
back normally after a couple of hours
okay and have you had your blood
pressure taken recently or do you have
any history of lower high blood pressure
i had my yearly health check about six
months ago
my blood pressure then um it was 110
over 80.
i think it's always good okay yeah do
you have any other symptoms related to
your headache
i do sometimes feel nauseous after
eating um that can make my headache worse
worse
yeah it can last several hours oh wow yeah
yeah
and is it accompanied by vomiting no
just unfortunately okay good
and any other symptoms that you think
might be related to your headache
all right good thank you so to summarize
johannes came on gradually over a couple
of weeks at start of winter
and then three months ago and shortly
after changing your diet to raw foods
the headache has been constant since
then with tension along your eyebrows
and a heavy dull pain across your forehead
forehead
it's worse in the morning when you are
tired or in cold damp weather
and you also mentioned that the headache
is worse after eating and can be
accompanied with nausea
the only thing that relieves the pain is rest
um and panadol as well oh yes of course
yes and pendle
all right so do you mind if i ask a few
more questions that are not directly
related to your headache
but from a tcm perspective it will help me
me
better understand how your body is
functioning yeah sure
okay great thank you so you mentioned
you experienced nausea after eating
so let's explore that how's your
appetite and digestion
i often don't feel like eating with this headache
headache
i have lots of bloating after i eat plus
the nausea
okay and can you tell me more about your
diet my diet is good
like i mentioned i stick to raw foods
these days
so i sometimes crave chocolate or sugar
okay and how was your appetite and digestion
digestion
before changing your diet i used to have
quite a big appetite i could eat anything
anything
my problems yeah and so what what made
you change to
the raw food diet oh like i mentioned my
mother had ibs
i thought it would be a good idea for me
to improve my diet
obviously i don't want to get ibs in the future
future
a lot of celebrities swear by this diet
thing these days
yeah it's true it's been gaining
momentum prevention is always the best
medicine so do you experience any
abdominal cramps pain
any reflux nope just bloating
and there's an uncomfortable heavy ache
in my
abdomen which normally comes after i eat
okay and are your bowel movements regular
regular
regular every day but a couple of times
a week i do get diarrhea
okay and you notice if any foods in
particular trigger the diarrhea or do
you experience a diarrhea at a
particular time of the day
time of day varies yeah i haven't
and this diarrhea is it watery smelly or
do you notice
undigested food in your stools it's not
watery or smelly
i don't see any undigested food
it's more sticky and loose okay
so are you thirsty and how much water
would you drink each day
i don't feel thirsty but i still carry a
water bottle
everywhere i go actually and so
i guess i don't actually finish it um
maybe i could be drinking more
yeah okay and do you prefer warm or cold drinks
drinks
room temperature or warm is good okay good
good
and how frequently do you need to
urinate and what is the color of your
um urine need to go often every couple
of hours
my urine is pale sometimes slightly
yellow first thing in the morning
okay and do you feel hot or cold
i feel the cold in my hands and feet in
the winter
but i rock up feel okay with that um i
don't sweat
it could be because i'm not exercising
much at the moment i just feel too tired
okay yeah and how would you rate your
energy level from 0 to 10
with 10 being the highest um
when i wake up probably just a 2 out of
10 during the day
up to 5 or 6 but it drops again each night
night
okay what about your sleep patterns how
many hours a night would you get
fall asleep pretty easily normally get
seven to eight hours
um solid sleep but i still wake up tired
okay and what time do you usually go to
bed and what time do you get up
when we go to bed at 11 or 12 get up at
okay and how would you describe your
mood and emotions lately
very stressed uh emotionally flat
and i worry too much about the workload
with my phd yeah that's understandable
of course
uh do you smoke or have you smoked in
the past nope
never have okay
good do you drink tea coffee alcohol
do you like my tea i also have a
coffee a day uh just to energize myself
in the morning kind of needed at the moment
moment
um i have a few drinks socially with my friends
friends
like alcoholic drinks obviously that's
just when i can find the time to
socialize so it's not very much these
days okay
what about exercise do you exercise regularly
regularly
um do a bit of swimming but that's
normally just in the summer
okay great thank you damian this diet
and lifestyle information is
very very helpful do you experience any
lower back pain and weakness
look okay thank you and are there any
other symptoms that you would like to mention
mention
no i think you've covered everything okay
okay
okay great thank you now i'd like to
conduct a quick physical examination to
get a bit more information
about your health so let me measure your
blood pressure
first and then i will conduct a
palpation followed by pulse taking
and tongue diagnosis is that all right
yeah for sure
so if you could please fold up your
sleeve on your right hand
all the way up above your elbow yep at
least two centimeters of burn
fantastic just place your hand
all right everything's so good doing here
here
okay
all right so i'll go with your blood
pressure test i'll just now conduct some
palpation of your forehead and your neck
and shoulders
all right so let me know and describe
the feeling when i
press across and palpate your forehead okay
okay
and what about your your neck and shoulders
shoulders
yeah anytime like you're touching
between my shoulders or my eyebrows
i feel the dolphin okay great thank you
all right
um so now as i mentioned feeling the
pulse and
observing the tongue an important part
yes i'll start off with your right hand
first and then your left hand and then
both hands together
okay thank you and now the focus thank you
okay thank you very much amy and sadova
all right and can we please see your tongue
okay damian is there anything else that
you would like to share or ask before i
speak to my supervisor
okay thank you um you could
maybe go outside and then we'll come
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