Editor's Note: Please visit www.acupuncturetoday.com for Dr. Li's previous articles on various study tips for passing the NCCAOM licensing exam.
Tip #1
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather. The patient also complains of a feeling of fullness the chest, cough, chills, and the desire for warm drinks. The patient's complexion is bluish-white, the pulse is tight and slippery, and the tongue is swollen with a sticky, white coating. What is the most appropriate treatment for this patient?
A. SP-3 (Taibai), ST-36 (Zusanli), ST-40 (Fenglong), LU-7 (Lieque), and UB-20 (Pishu)
B. CV-17 (Shanzhong), ST-40 (Fenglong), PC-6 (Neiguan), UB-13 (Feishu), and LU-6 (Kongzui)
C. UB-13 (Feishu), LU-1 (Zhongfu), LU-5 (Chize), LU-6 (Kongzui), and LU-10 (Yuji)
D. ST-36 (Zusanli), LU-7 (Lieque), LU-9 (Taiyuan), UB-13 (Feishu), and GV-12 (Shenzhu)
Case analysis
Tight and slippery pulse suggest cold-dampness, which is excess. Swollen with a sticky, white coating indicates cold-phlegm, which is excess. Rapid breathing and wheezing that is made worse during cold weather suggests cold pattern. A feeling of fullness in the chest indicates Lung Qi stagnation by cold-phlegm. Cough is the sign of Lung Qi rebellious. Chills and the desire for warm drinks are the signs of cold pattern. Bluish-white complexion suggests cold with stagnation, which is excess. Overall, this case is cold and excess pattern. Treatment strategy should focus on draining instead of tonifying.
Option A is for SP pattern and should be out because this case is Lung pattern.
Option B is draining treatment and should be used for excess pattern.
Option C is for Heat pattern.
Option D is tonifying treatment and should be used for deficiency pattern.
Therefore, Option B is the best choice.
Tip #2
Follow the pattern instead of symptoms. Take this case study as an example. A patient has insomnia, dream-disturbed sleep, headache, bitter taste in the mouth, and distending pain in the ribs. The pulse is wiry. What is the prescription?
A. Extra point an mian, BL-15 (xin shu), BL-23 (shen shu), HT-7 (shen men), SP-6 (san yin jiao), KI-3 (tai xi)
B. BL-18 (gan shu), BL-19 (dan shu), GB-12 (wan gu), HT-7 (shen men), SP-6 (san yin jiao), extra point an mian
C. HT-7 (shen men), BL-18 (gan shu), BL-19 (dan shu), GB-20 (feng chi), SP-6 (san yin jiao), extra point an mian
D. ST-36 (zu san li), HT-7 (shen men), SP-6 (san yin jiao), extra point an mian, BL-21 (wei shu)
Case analysis
Wiry pulse indicates LV/GB disorders. Insomnia and dream-disturbed sleep are the signs of Shen disturbance. Headache here is possibly related with LV/GB disorders. Bitter taste in the mouth suggests heat/fire. Distending pain in the ribs is the sign of LV Qi stagnation. Overall, the pattern for this case is LV/GB fire rising w/LV Qi stagnation.
The points prescription in option A seems to treat HT and KD disharmony.
The The points prescription in option B seems to treat LV/GB disorder.
The points prescription in option C seems to treat HT/LV/GB disorder.
The points prescription in option D seems to treat HT and SP deficiency.
All four options include points that can treat insomnia and dreams such as extra An Mian and HT-7. However, we follow the pattern instead of the symptoms for Chinese medicine case study. The pattern for this case is LV/GB disorder. Therefore, the answer for this case is B (LV/GB fire rising).
Tip #3
Find the key words. After two treatments for seasonal allergies, a patient presents for a third session complaining of purulent nasal discharge, irritability, dizziness, and a bitter taste in the mouth. The patient's face is red, the eyes are bloodshot, the pulse is wiry, slippery, and rapid, and the tongue is red with a sticky, yellow coating. What is the most appropriate treatment for this patient?
A. LI-4 (Hegu), LV-2 (Xingjian), GB-15 (Toulingqi), GB-43 (Xiaxi), and LU-7 (Lieque)
B. LI-4 (Hegu), LI-11 (Quchi), CV-12 (Zhongwan), UB-20 (Pishu), and SP-9 (Yinlingquan)
C. LI-4 (Hegu), LI-11 (Quchi), LI-20 (Yingxiang), LU-7 (Lieque), and LU-10 (Yuji)
D. LI-4 (Hegu), LI-11 (Quchi), LI-20 (Yingxiang), Bitong (Extra), and GV-23 (Shangxing)
Wiry, slippery and rapid pulse indicate damp-heat w/stagnation (possible LV stagnation). Red with a sticky and yellow coating suggest damp-heat. Purulent nasal discharge is the sign of dampness. Irritability is caused by heat disturbing the Shen. Dizziness is due to uprising heat affecting the head. A bitter taste in the mouth is the sign of heat or fire. Red face and bloodshot eyes are the signs of heat (possible LV heat here.). Overall, this case seems to be Damp-heat in the LV and/or GB channel with LV and GB heat. GB and LV are like brothers that can affect each other.
Option A is possibly correct.
Option B is out due to no points from LV/GB channels.
Option C is out due to no points from LV/GB channels.
Option D is out due to no points from LV/GB channels.
Therefore, we choose option A for this case.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
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