▲Li Huilin, a famous traditional 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, doctoral supervisor, instructor of academic experience inheritance 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】
Hu, female, 48 years old, first visited on January 18, 2022.
【Onset】2 months ago, the patient had insomnia without obvious cause, difficulty falling asleep, shallow sleep and easy to wake up, and difficulty falling asleep after waking up, so he went to the local hospital for treatment, and was given oral alprazolam 0.3mg, and his sleep improved after taking the drug, but once the drug was stopped, it was difficult to fall asleep, so he came to seek treatment with traditional Chinese medicine. [First diagnosis syndrome] symptoms: the patient is listless, if the sleeping pill is stopped, insomnia, difficulty falling asleep, dreamy, shallow sleep and easy to wake up, difficult to fall asleep after waking up, severe sleepless all night, palpitations, emotional irritability, chills, Naco, two stools, pale tongue, tooth marks, thin white moss, thin pulse. Menstrual history: Last menstrual period: January 15, 2022, normal menstruation for more than 10 days, light red, dripping.
【Syndrome Differentiation and Treatment】Traditional Chinese Medicine Diagnosis: Insomnia (Heart and Kidney Yang Deficiency, Heart and Kidney Lack of Communication). Treatment: Warm and replenish yang, traffic yin and yang. Prescription: Right Gui Pill plus or minus.
7 doses, 1 dose/day, decoction in water, warm in the morning and evening. The patient is instructed to abstain from eating raw and cold food, regulate emotions, exercise appropriately, and work and rest regularly.
【Follow-up process】
Second diagnosis: On January 28, 2022, the patient had no palpitations, chills, emotional state was less than before, and his sleep improved, and he stopped taking "alprazolam", slept for about 6-7 hours a night, his tongue was light and fat, there were tooth marks, the lichen was thin and greasy, and the pulse was thin. 2. The prescription is to attach tablets and magnets, add 20g of coix seeds, 10g of magnolia bark, 14 doses, and the decoction method is the same as before. Half a month later, the patient was able to sleep peacefully without the help of medication. Other uncomfortable symptoms basically disappeared, and the physical condition was significantly better than that at the initial diagnosis.
【Language】
The patient is a female in her 50s, who is in the middle of menopause, and although the complaint is insomnia, it is still a manifestation of premenopausal and postmenopausal evidence. The patient's body is deficient in yang, kidney yang is deficient, a true yang is not hidden, uneasy in its position, floating outside, yang does not intersect yin and insomnia; In addition, the Yin and Kidney Meridians are the hub for the Wei Qi to enter and exit the Yin and Yang, and the Kidney Yang is insufficient, the Wei Qi is deficient, and if the Yin cannot be entered, the Sleep will not be sleek. Kidney Yang deficiency, spirit, body loss of warmth, so mental malaise, Chills, Wei Yang can not enter the yin at night, so it is difficult to fall asleep; the kidney is the innate foundation, so the yin and yang of the kidney is imbalanced, and it is easy to affect other visceral lesions, and the kidney yang deficiency can not warm and nourish the heart yang, resulting in the deficiency of the heart and yang, and the heart and pulse are not nourished, so the heart palpitations are seen; the liver is the main drain of the blood, which is the foundation of the woman's acquire, the liver blood is insufficient, and the menstrual blood disorder is disordered if the liver qi is derelict in its duties, and the emotions are easily excited, combined with the tongue and pulse, the pathogenesis of this case is the heart and kidney yang deficiency, the heart and kidney are not connected, and the treatment should be warm and replenish the yang qi, and the traffic is yin and yang, and the prescription is added and subtracted from the right gui pill, and the aconite in the formula, the antler gum, Cinnamon nourishes the Yuan Yang in the kidney, dissipates the cold in the warmth, Rehmannia nourishes the kidney Yin, wolfberry and mountain corn nourish the liver and kidney, and yam nourishes the qi and nourishes the Yin, which has the effect of nourishing the yin and benefiting the kidney, nourishing the liver and the spleen, filling in the lean marrow, and taking the meaning of "seeking yang in the yin". Cuscuta seeds, Eucommia ulmoides strengthen the waist and knees, nourish the liver and kidneys; Angelica sinensis nourishes blood and blood, and the products of the kidney are combined to nourish the essence and blood; incense is attached to soothe the liver and relieve depression; Bupleurum and white peony can not only soothe the liver and relieve depression to cure the liver and use it, but also soften the liver and benefit the yin to nourish the liver body; the vitality can transform the Yuanyang, and the astragalus is added to replenish the vitality and help the vitality of the Yuanyang; the cinnamon branch and licorice pass the yang to warm the heart and yang, stop the throbbing, and the keel and oyster are heavy to reduce the adversity to converge the floating yang, and the licorice can help the Zhongzhou neutralize the qi, and the combination of various medicines makes the heart, The kidney yang qi is reinvigorated, the operation of the health qi returns to normal, the upper and lower intersects, the yin and yang are combined, and the effect of warming yang and calming the nerves is played.
The second diagnosis of the patient alleviated the symptoms, the tongue was light and fat, there were tooth marks, the moss was thin and greasy, the pulse was thin, and there was a sign of yang deficiency and dampness. The symptoms of the patients in the third diagnosis were alleviated, combined with the tongue and pulse, so the attached tablets and magnets were removed, and coix seeds and magnolia bark were added to enhance the function of dispelling dampness.
Professor Li Huilin commented: Insomnia is one of the common clinical syndromes, although it is not a critical disease, it often hinders people's normal life, work, study and health, and can aggravate or induce palpitations, chest paralysis, dizziness, headache, stroke and other syndromes. Intractable insomnia brings long-term pain to patients, and even forms a dependence on sleeping drugs, which can cause iatrogenic diseases. By adjusting the functions of the body's internal organs, qi, blood, yin and yang, traditional Chinese medicine can often significantly improve sleep conditions without causing drug dependence and iatrogenic diseases, so it is quite popular.
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]