▲Li Jiren, Master of Traditional Chinese Medicine (1931.1-2021.3)
Li Jiren, a master of traditional Chinese medicine, after years of clinical practice and academic research, put forward the theory of cold and heat differentiation and treatment of paralysis, focusing on cultivating and replenishing the kidney, emphasizing the identification and treatment of paralysis and impotence with the same disease, and establishing the treatment rules and treatment methods such as invigorating the kidney and filling essence, strengthening the spleen and stomach, nourishing blood and soothing tendons, and summed up a series of experience prescriptions represented by Qingluo drink, warm Luo drink, and treatment of impotence, and now introduces the treatment of impotence as follows.
Composition and efficacy
Composition: Psoralen 20 grams, Morinda officinalis 15 grams, Eucommia ulmoides 15 grams, Millennium Jian 15 grams, Cistanche 15 grams.
Efficacy: It has the function of cultivating and nourishing the liver and kidneys and strengthening the muscles and bones.
Indications: liver and kidney deficiency, liver and kidney yin deficiency, kidney essence deficiency, spleen and kidney yang deficiency caused by muscle and bone weakness, musculoskeletal atrophy and other symptoms.
Fang Ge: There is a famous prescription for the treatment of impotence, and Du Jian calmly makes up for it. Cultivate and tonify the liver and kidneys, strengthen the muscles and bones, and remove the muscles and bones of the muscles and bones.
There are two points to pay attention to when using this prescription, one is to distinguish between the virtual and the real, and those who have empirical evidence, such as damp heat immersion, lung and stomach dryness, etc., should not be used; Second, pregnant and lactating women should be used with caution, if there is a suspicion of the possibility of conception, the drug should be stopped in time, and the prescription should be adjusted after examination.
Analysis of the dialect
Fangzhong psoralen is pungent in taste, warm, non-toxic, returns to the spleen and kidney meridians, and has the effect of tonifying the kidney and aphrodisiac, warming the spleen and stopping diarrhea, and fixing essence and shrinking urine. and treat kidney diarrhea, frequent urination and abortion of human blood. The gas of fire and earth and the sun of heaven can warm water and dirty, which is the key medicine for strengthening fire and benefiting the earth. ”
Morinda can't be replenished by sweetness and warmth, and can be dispersed by bitterness and warmth, which is long in strengthening muscles and bones, calming the five organs, replenishing the wisdom and invigorating qi, so that the spleen and kidney can be nourished, and the deficiency is self-healing, and the muscles and bones are strong. "New Edition of Materia Medica" cloud: "Morinda officinalis, warm but not hot, spleen and appetizing, both beneficial to Yuan Yang, refilling yin water, a real weapon of continuity, has a near-term effect, and has far-reaching merits." Cistanche into the kidney meridian, greasy and soft, tonic but not jun, warm but not dry, slippery but not leaky, so there is a calm name, and the tonic power is good, good at nourishing life, nourishing kidney qi, not only tonifying kidney yang, but also beneficial essence and blood, "Shennong's Materia Medica" said that it "long-term service is fat and light". "Materia Medica" records: "Strong essence and strong marrow, meat cistanche eel two flavors are the end, yellow essence juice pills." The power of service can be ten times greater. ”
Eucommia ulmoides enters the liver and kidney meridians, tonifies the liver and kidneys, strengthens the muscles and bones, and is often used in combination with the above medicines to enhance the effect of tonifying the liver and kidneys and strengthening the muscles and bones. "Compendium of Materia Medica" contains: "Waist and knee pain, good for essence and qi, strong muscles and bones, except for itching and wetness under the shade, residual urination, soreness in the feet, do not want to trample on the ground." Moisten the liver dryness, replenish the liver meridian and wind deficiency. Cover the liver main tendon, kidney main bone, kidney is strong, liver is strong, flexion and stretch utilization, all belong to tendons. Eucommia ulmoides is purple and moist, sweet and slightly pungent, sweet and warm can be supplemented, and slightly pungent can be moistened, so it can enter the liver and tonify the kidney, and the child can make the mother real. "Although the effect of tonifying the kidney and improving the essence is not strong, the combination with other drugs can strengthen its function of producing lean marrow, and at the same time can promote the gradual flow of kidney essence to the blood veins of the affected limb, thereby accelerating the recovery process of the muscle strength of the weak limb. The combination of various medicines warms the kidneys without being rigid, has no disadvantages of moving yin, and has the function of strengthening muscles and bones and benefiting joints.
Clinical application
The source of impotence lies in the deficiency of jin and qi, that is, the jin is not nourished and the qi is not warm. Yangming's stomach is the sea of water valleys, the source of acquired subtle metamorphosis, and the inexhaustible source of acquired metamorphosis in order to nourish the body. Jin Qi comes from Gu Qi, so the impotence originates from the lungs, and its treatment is from the stomach. "Su Wen and the Theory of Impotence" records: "Those who rush the pulse, the sea of meridians, the main infiltration of the valley, and the yang and the light are combined in the main tendon." The meeting of the Yin and Yang Zongzong will be in the Qi Street and Yang Ming will be long, all of which belong to the pulse and the pulse of the governor. Therefore, Yang Ming is void, and the muscles are longitudinal, and the pulse is not leading, so there is no need for foot impotence. ”
The clinical evidence should nourish its source. The stomach is the source of the lungs' jin qi, and if the jin qi is sufficient, the lung qi is compressed, "so the essence is self-generated, the spirit is self-sufficient, the flesh and bone are protected, and the huge qi is flat" ("Su Wen Tang Liquid Mash Theory"). You can choose to use products that nourish qi and nourish the body, rather than being hot. The stomach is full of qi, the water valley is subtle, and the meridians are accessible, and the impotence will gradually heal.
"Su Wen and Treatise on Impotence" records: "Those with impotence are born in the liver, so that the inside is also." "If the liver is depressed and discharged, there is more heat, and the liver is hyperactive for a long time, the kidney water is not enough to cover the wood, and the tendons have no yin to help, and the disease is impotence. Therefore, the treatment should not be limited to warming the kidneys and strengthening the yang, but should "make up for each of its strengths and pass through its Yu, adjust its deficiency and reality, and its obedience and reverse." The muscles, veins, bones, and flesh are each subject to the moon at their own time, and the disease is already sick" ("Su Wen and Impotence"), sparse its blood and qi, make it orderly, and bring peace, and the qi and blood and smooth regulation are precious, and the secrets of yin and yang are precious.
For the treatment of impotence, Li Jiren not only commonly uses the methods of nourishing yin and clearing the lungs, taking yang alone, and purging the south to supplement the north, but also re-nourishes the liver and kidneys. For those who have symptoms of impotence showing skin, muscles, tendons, pulses, and bones (i.e., the "five bodies"), as well as those who have symptoms of paralysis and paralysis, Li Jiren often uses the general method to remove their evil and supplement the method to help them to correct it, supplemented by external treatment methods, regulates qi and blood, strengthens the foundation and cultivates the yuan, and warms and replenishes the spleen and kidney.
Li Jiren's clinical medication has the ability to reuse astragalus, attacking and supplementing at the same time; vine insects are used together, and phlegm and stasis are emphasized; Relax the muscles and channels, and cultivate the characteristics of the liver and kidneys. For those who have been ill for a long time, it is not possible to take ordinary light doses, so large doses of astragalus are mostly used in clinical practice. Li Jiren admired the theory of Xin'an physician Wang Ji's solid foundation and peiyuan, believing that qi is the handsomeness of blood, qi is full of blood, and qi is bloody. Qi replenishment can not only produce blood, but also invigorate blood. Therefore, every time it encounters dysenteric patients, it is mostly based on astragalus, with Wuchuan duan, mulberry parasitism, golden dog spine, fairy grass, epimedium and other products that nourish the liver and kidney, fill the essence and replenish the marrow, and help to replenish the liver and kidney.
If the disease is combined with blood deficiency and blood stagnation, you can also take the method of activating blood and removing blood stasis, relaxing the tendons and channels, and adding chicken blood vine and large blood vine. These two drugs have the function of invigorating blood, and chicken blood vine can also replenish blood, which is the first choice for those who have blood deficiency and blood stagnation. Leech is a flesh and blood product, with the function of invigorating blood and removing stasis and dispelling evil, Li Jiren often according to different conditions, in the liver and kidney, spleen and dampness at the same time, take into account the liver and depression, relax the tendons and activate the blood stasis, to pass as the key.
Case analysis
Ma, female, 27 years old, was first seen on July 9, 2020. Chief complaint: weakness of both lower limbs for 5 years. Medical history: 5 years ago, the patient felt that he walked slowly and his toes drooped, which was not taken seriously and did not attract attention. After the symptoms gradually became apparent, he visited the doctor 2 years ago, and the examination found that the gastrocnemius muscle in the left leg was atrophied. Electromyography on January 15, 2018 showed myogenic damage.
Immediate symptoms: the patient felt weakness in both legs with weakness of both index fingers, obvious swelling in both legs, waist pain, cesarean section 52 days ago, and postpartum symptoms worsened. Slightly chilly, eating, sleeping, and bowel movements are normal. The tongue is light, the tongue coating is thin and white, the tongue is prickly, and the pulse is thin.
Western medicine diagnosed it as inclusion body myopathy, traditional Chinese medicine diagnosed it as dystrophy, and the syndrome differentiation was liver and kidney deficiency and stasis obstruction of vein syndrome. The treatment method is to nourish the liver and kidneys, and chase away the blood stasis and circulation.
Prescription: Psoralen 20 grams, Cistanche 15 grams, Millennium Jian 15 grams, Eucommia ulmoides 15 grams, Morinda officinalis 15 grams, Panshan Dragon 15 grams, Leech 8 grams, Huoxue vine 25 grams, Chicken blood vine 25 grams, Chuanduan 30 grams, Xianmao 15 grams, Mulberry parasitism 30 grams, Dog Spine 30 grams, Xianling spleen 15 grams, Huai Oxknee 15 grams, Black Snake 15 grams, Dilong 15 grams, Papaya 15 grams. Decoction in water, warm dose, 1 dose per day, a total of 30 doses. Advise patients to live a regular life, exercise moderately, maintain a cheerful mood, and avoid staying up late.
At the follow-up visit on August 9, he complained that the muscle strength of his lower limbs was slightly stronger than before after taking the medicine, and he still felt weak. The two-foot pulse is about to rise, but the muscles are still atrophiing. Add 6 grams of whole scorpion, 1 dose a day, decoction, warm, 14 doses.
At the third consultation on August 24, the patient complained that the fatigue was significantly improved after taking the upper dose, and the soreness in the legs was significantly relieved compared with before, and the sweating was still obvious. Add 40 grams of wheat and 10 grams of boiled licorice. 1 dose per day, decoction, warm, 30 doses.
On September 24, the patient complained that the sweating basically disappeared, and the muscles gradually increased, and it was planned to add 30 grams of cornus and 30 grams of yam on August 9, 2020. Decoction, warm, 1 dose per day.
On December 1st, the fifth diagnosis, the patient has been taking decoction regularly, and his strength has improved significantly, which coincides with the winter and the cold days, so he is given the ointment prescription to deal with the aftermath, focusing on regulating the liver, spleen and kidney. Patients are advised to take 1 scoop a day with boiling water and warm at the beginning. After 1 week, once a day in the morning and evening, if you have a cold, fever or stomach upset, you need to stop taking it or go to the outpatient clinic for consultation.
Note: The patient in this case gradually developed muscle atrophy and weakness 6 years ago, and the progress was slow, and he did not think so. When the second child is born, the symptoms worsen. Li Jiren believes that the patient's new postpartum is accompanied by birth trauma and bleeding, and a lot of vitality is also lost during childbirth, and the body is damaged to a certain extent, which directly aggravates the development of the disease. Therefore, at this time, the patient's body is empty, he feels tired, his immunity is greatly weakened, and the symptoms of "emptiness in a hundred joints" appear after childbirth. The liver is the main tendon and vein, the kidney is the main bone and marrow, and the main lumbar spine, for the strong official, the liver and kidney yin essence loss, then the tendons and veins are not nourished, the bone cartila is dry, the waist spine is not lifted, and the strength can not be done, so the limbs or both lower limbs are soreness and weakness.
Li Jiren believes that for the aggravation of muscle atrophy after childbirth, it is necessary to strengthen the function of tonifying the liver and kidneys and strengthening muscles, and always insist on strengthening the spleen and qi. The pathogenesis of impotence is mostly the heat of the five internal organs, the lack of qi and blood, the meridians as the disease, as well as the disharmony between the camp and the guard, and the lack of lower qi. In terms of treatment, although the "Yellow Emperor's Neijing" puts forward the theory of "curing impotence and taking yang ming alone", and modern treatment of impotence is also mostly revered here, but the original text of the "Yellow Emperor's Neijing" finds that the meaning of this sentence is very different from what modern people understand. Li Jiren believes that "the five organs make people impotent", and the treatment of dysentery should start from the five organs, and "adjust its hypocrisy and reality, and its rebellion" is the original intention of the "Yellow Emperor's Neijing". Secondly, there are some treatment methods that are based on the etiology and pathogenesis, such as harmonizing camp and health, tonifying and nourishing qi, etc., which need to be tried and explored in order to open up new ways for the treatment of impotence.
Therefore, in the clinical diagnosis and treatment, Li Jiren not only chose prescriptions for treating impotence, but also strengthened the use of kidney tonic drugs, such as Chuanduan, Mulberry Parasitism, Xianmao, Xianling Spleen, Dog's Spine, Dilong, Oxknee, etc. In addition to focusing on the word "supplement", it also attaches importance to the regulation of qi and blood, and uses chicken blood vine, blood vine and other qi and blood tonic drugs to strengthen the function of blood circulation. Li Jiren believes that insect medicine is a flesh and blood product with unique medicinal properties. It is good at penetrating and walking, following the meridians into the inside, through the meridians and activating the meridians, can disperse the evil and go out, has the effect of searching for wind and removing the meridians, can treat rheumatism for a long time and become impotence, the disease and evil stagnation of the meridians, joints, qi and blood are blocked by the evil qi, phlegm and stasis are obstructed, and the disease symptoms caused by condensation are blocked.
▲ Chicken blood vine
Ye Tianshi pointed out in the "Clinical Guide to Medical Cases": "Rheumatism and evil are left in the meridians, and the upper and lower limbs flow away and are painful. And for decades, it is not possible to do so. All new evils should be dispersed quickly, and old evils should be attacked slowly. "Youyun:" The combination of wind, cold and dampness is paralyzed, and after years and months, external evils remain, and the qi and blood are injured, turning into stasis and condensing phlegm, and mixing the meridians. Therefore, the focus should be on dredging the channels, so that the qi and blood can flow smoothly, and the stubborn paralysis can be relieved. Ye Tianshi believes that evil leaves the meridians, and it is necessary to search for moving medicines, such as borrowing insects and ants to attack the evil knots, and pointed out the effect of insect medicine on the meridians. Li Jiren also uses insect drugs such as leeches, whole scorpions, earth dragons, and black snakes in the treatment of paralysis and impotence, and modern pharmacological research also believes that it has anti-inflammatory, swelling, and promotes peripheral blood circulation. Every time you use it, get more quick results. In the later stage, the ointment was finished, in order to "replenish the winter season and fight the tiger in the coming year".
Zheng reiterates:
Since each person's constitution and condition are different, the prescription and dosage in this case are only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the prescription and dosage in this case must not be copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition. ■
[The content is compiled from: "China Traditional Chinese Medicine News" August 23, 2021 fourth edition, author: Yang Zhe Yijishan Hospital, Wannan Medical College]