Coining therapy
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A 54-year-old woman presents with fever, shortness of breath, and chest pain. On examination, linear bruises are seen on her back consistent with a folk remedy called "coining" used to relieve symptoms. While coining may provide partial relief, the presenting symptoms could indicate serious underlying medical conditions like pneumonia or pulmonary embolism that require diagnosis and treatment. The patient's care should involve pursuing these potential diagnoses through further evaluation rather than focusing on the folk remedy.
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Coining therapy
- 1. A previously healthy 54 year old woman presents with a fever of 38.50 C, shortness of breath and pain in the chest which is worse on breathing. Your junior colleague comes to you and says she looks like she’s been clawed by a leopard! This is what is revealed when you go to examine her back. •Describe & interpret the picture •How should you proceed in terms of ongoing care ?
- 3. The picture shows what is usually referred to in western medical practice as ‘coining’. It is widely used as a folk remedy in SE Asian communities where it is referred to as ‘cao gio’ (Vietnamese), ‘gua sha’ (Chinese) and ‘kerikan’ (Javanese). The linear subcutaneous ecchymoses seen in this picture are clearly artefactual, because nothing in medicine produces such a symmetrical appearance. The ‘coining’ technique uses a smooth edged instrument such as a coin or spoon which is rubbed firmly along the skin which is usually lubricated with an oil or ointment. The intention is to produce the deep bruise and so relieve symptoms. Assess this clinical scenario on its merits. Even if there is partial relief of symptoms with the coining this should not prevent pursuit of serious diagnoses. Fever, SOB and chest pain could represent a number of possible medical diagnoses which include pneumonia, pulmonary embolus and pericarditis. There is little to be gained by focussing on or denigrating this folk remedy, and it has limited downside. Two additional comments: There is another such therapy called cupping, where circular ecchymosis is produced by placing a heated cup on the back which produces a vacuum effect (and subsequent bruise) as it cools. Both therapies have occasionally raised misplaced concerns about non-accidental injury in children.