Outpatient story| Parkinson's disease patients drooling, can Chinese medicine cure it?

"Please go to the 391 clinic on the 12th." After the outpatient call system was broadcast, the door opened first, and slowly, patient No. 12 was pushed into the clinic by the family's wheelchair.

The patient was an eighty-year-old man, wearing a red stormtrooper suit, wrapped tightly, entered the examination room, trembled and took off his leather hat, and greeted the doctor with a stiff arm: "Director Sun is good!" I'm sick again. The words did not fall, he lowered his head in embarrassment, took out a handkerchief from one side pocket to wipe the corners of his mouth, the family saw that he was slow, and quickly helped to pull down the mask and helped wipe the saliva.

For a moment, the patient looked up, and his voice was a little ashamed: "Doctor, after eating your medicine, I am shaking much better now, I can control it after taking the medicine, but it is drooling, this daytime flow, open mouth to flow; at night also flow, pillow towels are wet, you see what I do?" Prescribe me some medicine! ”

This is a Patient with Parkinson's Disease, who began to tremble in his left hand ten years ago, began to shake when he held the water cup, relaxed and rested and rested, and did not pay attention to it. After half a year, the left leg also began to shake, obviously felt the left half of the body stiff, drinking water and coughing, went to the community to see a doctor to take some medicine, there was no obvious improvement. In the following years, the disease gradually progressed, and symptoms also appeared on the right side. In the past year, in addition to tremors and stiffness, there have been other problems, such as constipation, upright hypotension, and the most embarrassing salivation. Just like today's visit, patients need to keep wiping their saliva, and if they are inconvenient to move, they also need companions to help wipe their saliva, they will feel embarrassed, and even easy to fall into a depressed state.

Looking back at the patient's medical history, combined with the patient's current symptoms, we have a clear judgment of the patient's condition, which is a Parkinson's disease patient, salivation is one of the common non-motor symptoms of Parkinson's disease.

So why do some adults not salivate from the mainstream?

Salivasis refers to the syndrome of saliva overflowing into the corners of the mouth due to excessive saliva secretion or decreased saliva outflow, which is generally divided into physiological salivation and pathological salivation. In infancy and early childhood, tooth growth produces mechanical irritation to the trigeminal nerves of the gums, resulting in increased saliva secretion. This physiological drooling will naturally disappear with age and the depth of the baby's mouth. Pathological salivation is more common in stomatitis, facial neuritis, cerebral palsy, Parkinson's disease and other diseases.

The following are common causes associated with salivation in neurological disorders:

1. Facial paralysis: that is, facial neuritis, salivation occurs due to the inability of the facial nerve to innervate the facial muscles normally and the inability of the lips of the affected side to close.

2. Parkinson's disease: Parkinson's disease is the most important cause of salivation in adults. In patients with Parkinson's disease due to the deterioration of autonomic function and increased saliva secretion, the swallowing function decreases due to muscle stiffness and slow tongue movement.

3. Stroke: some stroke patients can see central facial palsy, paralysis of the lower muscles of the face, and salivation due to the decrease in saliva clearance.

In non-neurological diseases, inflammation of the oral mucosa, gastroesophageal reflux disease and reflux esophagitis, and dental malformations can cause salivation.

1. Oral mucosal inflammation: it is due to the infection and inflammation of oral periodontal tissue and mucosal tissue, resulting in stimulation of salivary glands, and because local pain is more obvious, it affects the full play of the function of swallowing saliva, and can be divided into oral mucosal disease, traumatic ulcer and malignant ulcer caused by tumors according to the cause.

2. Gastroesophageal reflux disease and reflux esophagitis: it is because the acid reflux stimulates the esophagus and throat, resulting in increased saliva secretion.

3. When the teeth are deformed: especially in patients with convex tooth deformities, the anterior teeth protrude forward more obviously, and it is difficult for the lips to completely cover the front tooth surface when sleeping, and the upper and lower lips are often naturally separated, which is easy to salivate.

How does TCM recognize "salivation"?

Classical works of Chinese medicine have long elaborated on this. "Su Qing Pulse" Yun: "Temper is through the mouth, and spleen and harmony can know the five grains." The spleen is not healthy, the wet and turbid fumigation cannot be dissolved, and it overflows in the mouth. "Difficult Passages, Thirty-Four Difficulties" said: "Kidney fluid is saliva". Kidney yang deficiency, congenital deficiency can not be warmed water, then spit saliva. Therefore, salivation is mostly due to liver and kidney insufficiency. The Suqin Paralysis says: "The Fascia of the Main Body of the Liver". The tendons are attached to the bones, connect the muscles and joints, and rely on the blood of the liver to move freely. If the liver blood is deficient, the source of life is scarce, the blood does not nourish the muscles, the tendons and veins are urgent, the muscle movement is lost, and the stiffness is not used. It affects the face, glossopharynx and other muscle groups, resulting in a significant decrease in the range of movement and a weakening or even loss of spontaneous movement, poor swallowing, saliva clearance disorders and excessive oral aggregation. Spills out and can't control itself. The "Su Qing Zhi Zhi Zhi Da" says: "All the winds fall dizzy, all belong to the liver", the wind and evil good deeds change several times, and it is easy to merge with the six adulterous evils as a disease. The Great Treatise on Yin and Yang Should Be Like Su Qing says: "A person is forty years old and the yang qi is half of itself, and the living is decaying." The patient's body is still weak, the function of the internal organs is reduced, and the source of qi and blood is insufficient. Evil qi is easy to take advantage of the void into the network, paralyzing the facial qi and blood, unable to run, the mouth surface is useless, and saliva overflows.

Liver main drainage, irregular qi, depression, clinical manifestations are mostly emotional depression, chest flank or less abdominal distention and pain. Clinically, it can be seen that salivation at the corners of the mouth and frequent urination at night belong to the "dereliction of duty of jinliu infusion", saliva is yin, the liver is "just dirty", and the balance of fluid infusion, whole body qi machine and emotion is released smoothly to the body. Kidney qi is not solid, lost in sealing, can cause loss of sperm, saliva overflow is difficult to collect, frequent urination, slippery sperm, premature ejaculation and other clinical symptoms. The kidney is "water dirty", the main five liquids, with the function of regulating the body's water infusion and discharge. Insufficient yin fluid, yin damage and yang, yang deficiency, kidney yang warm, promote function decline. Abnormal water infusion and excretion of human body water, breaking the balance of water metabolism in the body, saliva is difficult to control, contained in the mouth, the amount is large and overflowing.

What is the difference between drooling during the day and drooling at night?

After many people go to sleep, due to respiratory obstruction (chronic rhinitis, sinusitis, allergies, and deviation of the nasal septum), sleeping position (sleeping on their stomach or sleeping on their sides), etc., they also sleep with their mouths open, and they also experience nocturnal drooling. In non-neurological diseases, patients are often able to consciously control the facial muscles during the day without salivating, so salivation mostly occurs after falling asleep at night.

Salivating in people with Parkinson's disease is related to the severity of their condition. In the light, only nocturnal salivation is seen, and in the heavy case, salivation can be seen during the day or at night, which is related to swallowing dysfunction and unconscious opening of the mouth. In stroke, facial paralysis and other neurological diseases, the decline in swallowing frequency, the closure of the lips is not all the cause of salivation, which has nothing to do with sleep, so salivation can be seen during the day and at night, or because the saliva clearance rate further decreases after entering sleep at night and the sleeping posture may be problematic, which will lead to an increase in saliva at night compared with daytime.

How does TCM treat salivation?

Salivating symptoms are closely associated with patients with hepatic and renal insufficiency. It is mainly based on kidney and yang deficiency, and insufficient liver blood. Warm kidney yang, liver blood for the fundamental treatment. Taking the warm kidney and nourishing the liver as the Dafa, The Party follows the law, the Fang takes the cistanche as the king, the white peony as the subject, the nootropic benevolence, the yam as the accompaniment, the hook vine as the envoy, the tonic qi, blood and yin and yang, and can also supplement the kidney and solid essence.

Another example is the kidney astringent formula, the composition of prescription medicine: maple heart wood, cistanche, astragalus, schisandra, Cangshu and other medicines. Maple heart wood, cistanche as the main medicine, warm kidney tonic yang, yin astringent essence, starting from the spleen and kidney yang qi, stop salivating and astringent nocturia; astragalus, Cangshu healthy spleen dry and wet, so that the cold and wet jin liquid can be warm, so that running in the meridians, metabolism is constant; golden cherry seeds, corn whiskers, schisandra, red peony medicine to enhance the astringent yin closing effect. The whole party tonifies the kidney health, so that the spleen and kidney yang qi are greatly invigorated, the main liquid is returned to its place, and the symptoms of salivation can be treated.