▲Fu Xiaoyun, a famous traditional Chinese medicine doctor in Guangdong Province, chief traditional Chinese medicine physician of the Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), the heir of the second batch of old Chinese medicine experts in the country, and the instructor of the famous Chinese medicine physician in Guangdong Province, has high diagnosis and treatment skills in hypertension, hyperlipidemia, cerebrovascular accident, lumbar intervertebral disc herniation, cervical spondylosis, facial paralysis, neurosis, etc.
The medical case is a record of the clinical practice of traditional Chinese medicine, which reflects the specific application of reason, law, prescription and medicine in the process of diagnosis and treatment, and is the manifestation of the thinking process of doctors in diagnosing and treating diseases. The cases of famous doctors in the past dynasties are treasures in the treasure house of traditional Chinese medicine. We launched the column "Talking about Medicine with Cases", in order to inherit the essence, inspire our generation, and make progress together.
【Basic Information】
Patient Zhai, male, 52 years old. First visit on March 14, 2020.
【Pathogenesis】The patient had a history of chemotherapy and radiotherapy for nasopharyngeal carcinoma for 6 years. He was admitted to the hospital with the main complaint of "sudden syncope, accompanied by dark eyes, and lasting more than 10 seconds of consciousness". With dizziness, blurred vision, vomiting 1 time, non-coffee-colored stomach contents, non-projectile, accompanied by tinnitus, slightly difficult to swallow hard objects, no hearing loss, no slurred speech, no choking cough from drinking water, no hemiplegia, no hemibody numbness, no headache, limb twitching, symptoms last for about 1 hour and then slightly relieved. Symptoms of [first diagnosis syndrome]: the patient suddenly fainted, awake for more than 10 seconds, and the blood pressure was low at the time of consultation, 50/30mmHg, and the blood pressure fluctuated at 95-110/55-73mmHg under the continuous pumping of dopamine, and the effect was not good. At the initial diagnosis, the patient felt numbness on the left side of the face, cough, white sputum, chills, night salivation, and night sweats. The tongue is pale and pale, with weak pulses.
【Syndrome Differentiation and Treatment】Traditional Chinese Medicine Diagnosis: Syncope Syndrome (Spleen and Kidney Yang Deficiency). Western medicine diagnosis: orthostatic hypotension. Treatment: Tonify the kidneys and warm the yang, invigorate the qi and strengthen the spleen. Prescription: Prescription with Guili Zhong Pill + Wu Zhu Yu Tang plus or minus. 15 grams of aconite (fried first), 8 grams of cinnamon shreds, 30 grams of codonopsis, 30 grams of astragalus, 10 grams of dried ginger, 10 grams of fried atractylodes, 8 grams of boiled licorice, 10 grams of Evodia, 10 grams of jujube, 10 grams of cimicifuga, 10 grams of angelica, 5 grams of tangerine peel, 10 grams of Bupleurum chinensis. 3 doses, 1 dose per day, decoction in water.
【Follow-up process】
Second diagnosis: On March 17, 2020, the patient suddenly fainted once in the past 3 days, conscious, hazy eyes, awake for more than 10 seconds, low blood pressure, numbness on the left side of the face, dry cough, no phlegm, cold feeling in the pharynx, stomach acceptance, mushy stool, dry mouth, sleep, and dreams. The tongue is light, pale and thick, and the veins are thin. Prescription: 15 grams of aconite (first decoction), 8 grams of cinnamon silk (lower later), 30 grams of codonopsis, 30 grams of astragalus, 10 grams of dried ginger, 10 grams of fried atractylodes, 8 grams of boiled licorice, 10 grams of Evodia, 10 grams of jujube, 10 grams of cimicifuga, 10 grams of angelica, 5 grams of tangerine peel, 10 grams of Bupleurum chinensis, 15 grams of Huoxiang, 10 grams of nutmeg. 3 doses, 1 dose per day, decoction in water. Third diagnosis: On March 20, 2020, the patient did not faint in the past 3 days, his blood pressure was still low, orthostatic hypotension, shortness of breath, palpitations, cough, less sputum and white color, more saliva, stomach was acceptable, the stool was pasty or watery, not formed, sleep was acceptable, and nocturia was 2-3 times. The tongue is pale and pale, with thin pulses. Prescription: 15 grams of aconite (first decoction), 8 grams of cinnamon shreds, 10 grams of red ginseng (stewed), 30 grams of astragalus, 10 grams of dried ginger, 10 grams of fried atractylodes, 8 grams of boiled licorice, 10 grams of evodia, 10 grams of jujube, 5 grams of tangerine peel, 10 grams of bupleurum chinensis, 15 grams of Huoxiang, 10 grams of nutmeg. 3 doses, 1 dose per day, decoction in water. Fourth diagnosis: On March 23, 2020, the patient had no fainting seizures, cough, no or little sputum, itchy throat, more saliva, dry mouth, stomach and stool, less amount of forming, sleep and dreams. The tongue is light, pale, and the veins are thin. Prescription: 15 grams of aconite (decoction first), 5 grams of cinnamon silk (lower later), 30 grams of codonopsis, 30 grams of astragalus, 10 grams of dried ginger, 8 grams of boiled licorice, 10 grams of Evodia, 10 grams of jujube, 10 grams of cimicifuga, 10 grams of angelica, 5 grams of tangerine peel, 10 grams of wood butterfly, 10 grams of coltsfoot, 10 grams of bellflower. 7 doses, 1 dose per day, decoction in water. The patient is instructed to self-administer Guili Zhong Pill. Fifth diagnosis: On March 30, 2020, the patient had a cough with no or little phlegm, itchy throat, a lot of saliva, a stomach, smooth stools, a small amount of unformed, sleep, dreams, nocturia, and chills. The tongue is pale and pale, with thin pulses. Prescription: 20 grams of aconite (decoction first), 10 grams of cinnamon silk (lower later), 30 grams of codonopsis, 30 grams of astragalus, 15 grams of dried ginger, 8 grams of boiled licorice, 10 grams of Evodia, 10 grams of jujube, 10 grams of cimicifuga, 10 grams of angelica, 5 grams of tangerine peel, 10 grams of bellflower, 20 grams of mountain firewood meat. 5 doses, 1 dose per day, decoction in water.
【Language】
This case belongs to the category of "syncope syndrome" in TCM internal medicine. The syncope syndrome is caused by a variety of reasons, with qi and organ reversal, elevation disorder, qi and blood yin and yang discontinuity as the basic pathogenesis, and sudden fainting, unconscious, or accompanied by cold of the limbs as the main clinical manifestations of an acute syndrome. The pathogenesis of the syndrome is mainly the sudden reversal of the qi and the upward and downward movements, and the qi and blood yin and yang are not in harmony. As "Jingyue Quanshu • Rebellion" said: "Those who are in turmoil are exhausted, and those who are against are chaotic, that is, the qi and blood are also chaotic." "The viscera to which the lesion belongs is mainly in the heart, involving the brain (clear body), and is closely related to the liver, spleen, kidneys, and lungs. The empirical evidence of syncope is most closely related to the liver, and the deficiency of syncope is most closely related to the lungs and spleen.
The patient has been ill for a long time and has a weak constitution, weak kidney yang, spleen and stomach deficiency and cold, qi and organs are not connected, Qingyang does not rise, the middle qi is trapped, the blood does not reach, the gods are not nourished, and the hair is a sign of qi deficiency and convulsion. And the heart is the main god, and the heart disease is the god is useless, and it causes fainting. The kidney is the root of vitality, and the kidney deficiency and essence qi cannot be injected, causing the gods to lose their nourishment, and the hair is a sign of convulsion. Nourishing the kidneys and warming the yang, invigorating qi and strengthening the spleen are the treatment rules of this disease. Pseudo Wu Zhu Tang Wenzhong dissipates cold and promotes yang, with Guili Zhong Pill to replenish kidney and warm yang, warm and spleen, the two parties cooperate to jointly improve the efficacy of warming the kidney, helping Yang and dissipating cold, and the patient's clinical symptoms are significantly alleviated after medication, and continue to take Guili Zhong Pill to consolidate the curative effect.
Zheng reiterates:
Due to the different constitutions and conditions of each person, the treatment plan in this case is only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the treatment plan in this case must not be completely copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition. ■
[Source: Dongguan People's Hospital, Medical Guidance: Fu Xiaoyun, Chief TCM Physician]