▲Li Huilin, a famous Chinese medicine doctor in Guangdong Province, chief physician of the Department of Traditional Chinese Medicine Endocrinology of Shenzhen Hospital of Traditional Chinese Medicine, doctor of medicine, second-level professor, chief physician of traditional Chinese medicine, doctoral supervisor, academic experience inheritance instructor of national old Chinese medicine experts, and leader of the Department of Endocrinology of Shenzhen Hospital of Traditional Chinese Medicine, a national provincial and municipal key specialty. He is good at treating incurable diseases and endocrine and metabolic diseases in TCM internal medicine.
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】
Mr. Li, male, 30 years old, was first diagnosed on September 1, 2021.
【Pathogenesis】The patient complained of elevated blood glucose for more than 1 month, and the fasting blood glucose was 7.8mmol/L and glycosylated hemoglobin was 6.7% in the physical examination in the hospital before 1 month. [First Diagnosis Syndrome] Symptoms: Current symptoms: dry mouth, no desire to drink, no overeating and easy hunger, no obvious weight loss, sleep, normal urination, unformed stool, 2 times a day. The tongue is pale and dark and fat, the moss is thin and yellow and greasy, there are tooth marks on the side of the tongue, and the veins under the tongue are tortuous and smooth. Physical examination: waist circumference 112cm, hip circumference 100cm, weight 79kg, height 163cm, BMI 29.7kg/㎡. Ancillary tests: diabetic autoantibody profile was negative, blood lipid: LDL-c3.7mmol/L. Anamnesis: 1 year history of hypertension, no oral medication, blood pressure 145/91 mmHg.
【Syndrome Differentiation and Treatment】Traditional Chinese Medicine Diagnosis: thirst quenching (phlegm and stasis interconnection), obesity (phlegm and stasis interconnection). Treatment: Promote blood circulation and dispel stasis, dispel dampness and phlegm. Prescription: Add or subtract decoction of decoction and huanglian warm gallbladder decoction. Scalding leech 5g, fly insect 5g, peach kernel 10g, rhubarb 5g (lower back), coptis slices 20g, Fabanxia 15g, tangerine peel 15g, Poria cocos 30g, licorice flakes 10g, bran fried citrus aurantium 10g, ginger Zhuru 15g, jujube 10g, ginger 10g, dried motherwort 30g, bergamot 15g, Chuanxiong 15g. A total of 7 doses, decoction in water, one dose a day, divided into two doses. Western medicine was given oral sitagliptin metformin tablets 1 tablet Bid to control blood sugar. Ask the patient to control their diet and exercise regularly.
【Follow-up process】
Second diagnosis: On September 9, 2021, the recent fasting blood glucose fluctuated at 4.6-6.6mmol/L, the blood sugar was not regularly monitored 2 hours after meals, no dry mouth and polydipsia, sluggishness, loose stools, and one line per day. The weight was 74.7kg, which was 4.3kg lower than the first diagnosis. Prescription: 15g of fried atractylodes with bran and 30g of astragalus in front of the front, 14 doses of additional doses. Ask the patient to control their diet and exercise regularly. Third diagnosis: On September 23, 2021, blood sugar control was acceptable, Naco, normal stool, one line a day, pale and fat tongue, tooth marks on the side, thin and greasy moss, and smooth pulse. The weight was 70kg, which was 9.0kg lower than the first diagnosis. Prescription: Scalding leeches in front are reduced to 2g, Poria cocos is reduced to 20g, Jiang Zhuru is subtracted, and 14 doses are continued. Ask the patient to control their diet and exercise regularly. Fourth diagnosis: October 8, 2021 today's fasting blood sugar was 4.1mmol/L, 2h postprandial blood sugar was 6.1mmol/L, the tongue was light and fat, there were tooth marks, the moss was thin and white, and the pulse was slippery. The weight was 68.2kg, which was 10.8kg lower than the first diagnosis. Prescription: minus bergamot above, continue to take 14 doses, and adjust the hypoglycemic drug to 1 tablet of sitagliptin metformin tablets Qd. Ask the patient to control their diet and exercise regularly. Fifth diagnosis: Today's fasting blood sugar on October 23, 2021 was 4.3mmol/L, the tongue was light and fat, there were no tooth marks, the moss was thin and white, and the pulse was slippery. No acanthosis nigricans was found. The weight was 64.2kg, which was 14.8kg lower than the first diagnosis. Prescription: Subtract the fly worm and leech above, add 10g of woody incense, 30g of Codonopsis, 30g of five-fingered peach, and stop taking the drug after 14 doses, stop taking hypoglycemic drugs, and insist on regular exercise and reasonable diet.
【Language】
The patient is a young male, dry mouth and polydipsia, obesity, four diagnoses and references, traditional Chinese medicine belongs to the category of "thirst and obesity", the syndrome belongs to the phlegm and stasis intertwined, and the pathological factors are phlegm, turbidity and stasis. Professor Li believes that obesity is the longest of all diseases, and that patients can improve blood pressure, blood sugar, and blood lipids by losing weight. Professor Li planned to "arrive at the soup and Huanglian warm bile soup". At the first diagnosis, the phlegm and stasis are very serious, so the fly insect and leech each use 5g, take its function of breaking the blood and chasing the stasis, and not consume the yin blood too much; rhubarb can not only invigorate the blood and dissolve the stasis but also lead the blood downward, help the laxative; accompanied by peach kernels, red peony to strengthen the power of blood circulation, peach kernels also help laxative; Coptis chinensis, Banxia dry and damp phlegm, have the wonderful use of hard work and bitterness; Zhuru clears heat and dissolves phlegm and relieves vomiting; tangerine peel and citrus aurantium regulate the coke qi machine, and the qi line is the operation of the jin liquid, so the phlegm and dampness cannot be born; Poria cocos is damp; ginger, jujube, Licorice can protect the spleen and stomach, licorice reconciles various medicines, and the whole formula works together to dispel dampness and phlegm, regulate qi, activate blood and dispel blood stasis. At the second diagnosis, the patient's stool was loose, sluggish, and the insect drugs were salty and cold, Professor Li added astragalus and fried atractylodes to replenish qi and strengthen the spleen to help transport, pharmacological studies showed that astragalus has the effects of improving insulin resistance, antioxidant and controlling inflammation, and atractylodes was praised as "the first important medicine to replenish qi and strengthen the spleen" by the predecessors. Professor Li often uses bran to fry atractylodes to ease its medicinal properties and enhance the effect of strengthening the spleen. At the third diagnosis, the patient's weight decreased compared with before, and the phlegm and heat in the body were reduced, so the bamboo ru was removed in the anterior middle, and the leech was reduced to 2g. At the time of the fourth diagnosis, the patient's greasy moss has gone, and the phlegm in the body has gradually receded, so a blind bergamot is subtracted. At the fifth diagnosis, the patient's weight dropped to a normal level, and the tongue and pulse diagnosis were not very painful. Professor Li believes that insulin resistance has improved significantly compared with before, so the pathological factors such as leeches, flies, and phlegm stasis in patients are gradually disappearing, and attention should be paid to transporting spleen and qi.
Professor Li Huilin commented: For newly diagnosed patients with type 2 diabetes, in addition to traditional Chinese medicine treatment, regular exercise is also essential, and it is consistent throughout. Traditional Chinese medicine exercises such as Wufowl Opera, Baduanjin, Yijin Jing, Tai Chi, etc. can not only regulate the internal organs, qi, blood, yin and yang, strengthen muscles and bones, but also improve insulin resistance, regulate glucose and lipid metabolism, reduce weight, improve cardiovascular disease risk factors, etc. Stillness leads to the birth of all diseases, and movement eliminates all diseases
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: Shenzhen Hospital of Traditional Chinese Medicine, Medical Guidance: Li Huilin, Chief TCM Physician]