Name:
Ms. OVERZOVA
Sex: Female
Age: 60
Marital Status: Married
Nationality: Turkmenistan
Date of Admission: March
27, 2017
Companion: Her
daughter and her husband
Date: March
28, 2017 Time: 09:00
a.m.
When she
came to our hospital, she suffered from repeated hot flashes and
sweating at night, accompanied with headache. She had dry mouth
and she preferred the warm water. She was chilly. Her urination
and bowel movement were normal. Physical Examination:
T:
36.3<C R: 20 times/minute P: 80 times/minute BP:
120/80mmHg
The
tongue body was slightly white with white coating. The pulse was
wiry and rapid.
The
patient grew normally with normal body shape. She was alert and
cooperative. She had chronic sick facial complexion. There was
no sign of yellow sclera or yellowish skin and also no
enlargement on the superficial lymph node of her whole body.
Facial features were normal without masses, pressing pains.
The pupils were round and approximately equal in size. The
papillary reaction to light was sensitive. Yet she had blurred
vision. There was no sign of deformity over her both ears
without secreta. There was no pressing pains and her hearing was
normal.
There
was no congestion in her throat and no enlargement over her
thyroid. And the jugular vein was of no engorgement. The
appearance of her trachea was good and in the center. Her chest
was symmetrical. Sound of breathing in the lungs was clear,
without any rhonchi. Rhythm of her heart was 80 times per
minute. Heart rate was regular with no murmurs. Her
abdomen was soft with slight pressing pains, while no rebound
tenderness. There was no sign of deformity over her spine and
her four limbs. There was pressing pain over her neck, shoulder
and waist.
The
meningeal irritation sign was negative.
There were no pathological reflections, but the physiological
reflections existed.
Completed the related examination,
three routine inspection, the function of the kidneys and the
liver, blood fat, blood sugar, anti-O, RF and IMX..
Dr.
Ming, doctor-in-charge, after researching her case, he made the
corresponding treatment strategy according to her condition.
Herbal
tea: one dosage a day and drink twice. Combined with acupuncture
and massage: once a day