▲Cai Limin, a famous traditional Chinese medicine doctor in Guangdong Province, former president of Dongguan People's Hospital, secretary of the Party Committee, chief TCM physician of the Department of Traditional Chinese Medicine Orthopedics, expert with special government allowance of the State Council, professor and doctoral supervisor of Guangzhou University of Chinese Medicine, and top-notch professional and technical talents in Dongguan City. He has been engaged in clinical, teaching and scientific research in orthopedics and traumatology for nearly 40 years, won 7 provincial and municipal science and technology progress awards, published more than 50 papers, participated in 2 invention patents, and won many honors such as the May Day Labor Medal of Guangdong Province and the "Excellent President of Guangdong Hospital".
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】
Liang, female, 50 years old, was first diagnosed on August 1, 2019.
【Pathogenesis】The patient had low back pain with numbness in both lower limbs without obvious cause 2 days ago, radiating from the buttocks and the posterolateral side of the thigh to the posterolateral side of the calf, which was aggravated after activity, and could be relieved after rest, without fatigue and claudication, etc., without special treatment, the patient now went to our hospital for outpatient treatment for further systematic diagnosis and treatment. Since the onset of the disease, the patient's weight has not changed significantly, and he is prone to sweating, especially on both feet. [First Diagnosis Syndrome] Symptoms: The patient is conscious, energetic, dark-complexed, bright-eyed, and moderately physical. Plain easy to sweat, feet are worse, poor sleep, dry mouth, abdominal pain, yellow urine, rotten stool, 2 lines a day. The tongue is dark red, yellow and greasy, and the pulse is tight. Physical examination: centered, no deformity, lumbar 4, 5 spinous processes and a little tenderness between the spinous processes, bilateral paravertebral tenderness, bilateral femoral nerve traction test (-), bilateral lower limb straight leg elevation test 30° (+), strengthening test (+), bilateral Thomas sign (-), bilateral figure 4 sign (-), skin hyposensation behind both calves, normal skin sensation in the remaining lower limbs, normal muscle strength and muscle tone in both lower limbs, physiological reflexes present, and pathological reflexes not elicited.
Western medicine diagnosis: lumbar intervertebral disc herniation. TCM diagnosis: lumbar paralysis (damp heat betting, rheumatic obstruction pattern). Treatment: clear away heat and dampness, dispel wind and channels. Prescription: Si Miao Tang Formula plus dispelling wind and channeling medicine: Coix seed 30g, hyssop 15g, Atractylodes atractylodes 10g, Phellodendron phellodendron 10g, Duhuo 15g, parsnip 15g, chicken blood vine 30g, Yanhusuo 15g, red peony 15g, eleuthero 30g, Rhizome 30g, licorice 5g. A total of 7 doses, 1 dose per day, decoction in water. After returning home, the patient is instructed to rest in bed, wear a waist circumference to move on the ground, and avoid bending over to bear weights and sitting for a long time.
【Follow-up process】
Second diagnosis: On August 8, 2019, the patient's low back pain with numbness in both lower limbs improved significantly after taking the medicine, the tongue was light red, the moss was slightly yellow, and the pulse was stringy. Prescription: Coix seed 30g, hyssop 15g, Atractylodes atractylodes 10g, Phellodendron phellodendron 5g, Duhuo 15g, Parsnip 15g, Chicken blood vine 30g, Yanhusuo 15g, Licorice 5g. A total of 7 doses, decoction method is the same as before. Third diagnosis: On August 15, 2019, the patient's low back pain with pain in both lower limbs almost disappeared, and there was still a little numbness in both lower limbs, a pale red tongue, a slight yellow moss, and a stringy pulse. The patient was instructed to continue to wear the waist circumference for 1 week, and appropriate lumbar back muscle function exercises, such as planks, arched waist exercises, and swallow exercises. After 1 year of follow-up, no recurrence was observed.
【Language】
Lumbar intervertebral disc herniation is a common clinical disease, many diseases, one of the common causes of low back and leg pain, its main clinical symptoms are low back pain and lower limb pain, the cause of which is the lumbar intervertebral disc after degenerative lesions, due to various reasons caused by partial or total rupture of the fibrous annulus, nucleus pulposus protrusion, and secondary aseptic inflammation, edema or adhesions, compression and stimulation of nerves or spinal cord, resulting in radiating pain in the waist and lower limbs, a large part of the clinical cases of low back and leg pain belong to lumbar intervertebral disc herniation, the understanding of the disease in traditional Chinese medicine is scattered in "paralysis", " low back and leg pain" and other discussions.
The disease is mostly caused by the deficiency of the body's righteous qi, the imbalance of camp and health, the emptiness of the meridians, the poor flow of qi and blood, and the wind, cold, and dampness to enter the body. "Quasi-Evidence Adjudication" said: "All paralysis, wind, cold and dampness are hybrid, and the yin of its meridians is also violated." If there is more wind, it will be painful, and if it is wet, it will be heavy, and the good will be weakened by the camp guards, and the intestines are not dense, and the wind and cold and dampness will be attacked by the void, and the righteousness will be hindered by evil. It cannot be preached, so it stays, qi and blood coagulate, and it becomes paralyzed for a long time. The chapter of "Lingshu Honzang" says: "Blood harmony is the popularity of meridians, the camp restores yin and yang, the muscles and bones are strong, and the joints are clear." "Neijing" cloud: "The pulse is astringent and the day is paralyzed, the paralysis is heavy in the bones, the blood is clotted but not flowing when it is in the pulse, the tendons are bent and not stretched, the inside is not benevolent, and the skin is cold." "Medical Forest Correction Error" said: "There is stasis in the paralysis syndrome". Paralysis syndrome is often a stubborn disease, mostly caused by the blockage of evil qi and unfavorable meridian qi, and the treatment of rheumatism should follow the principle of "treating wind and blood first, and blood and wind will self-extinguish".
For damp heat bet and rheumatic obstructive lumbar disc herniation, Professor Cai Limin often uses Si Miao Tang Formula and dispelling wind and circulation medicine to clear away heat and dampness, dispel wind and invigorate blood circulation. The patient in this case, a 50-year-old female patient, had four diagnoses and references, and the disease belonged to the category of "paralysis syndrome", the patient's muscles and bones were unfavorable, and the patient's long-term residence in Lingnan was a place of dampness and heat, and the dampness and heat gathered in the lower coke caused paralysis and low back pain. Damp heat blocks the qi machine, and if the fluid cannot be carried up, there will be dry mouth, and the qi machine will not be smooth and the face will be dark and rotten, and the qi deficiency will be easy to sweat. Combined with the symptoms and tongue and veins, it can be diagnosed as lumbar paralysis, and the syndrome type is damp and heat, and rheumatism obstructs the meridians. The treatment method is to clear away heat and dampness, dispel wind and invigorate blood circulation. There is a cloud in "Medical Prescription Examination": "Atractylodes is better than dryness and dampness, and cork is better than heat." "You can give four wonderful soup and dispelling wind and channeling medicine. In the formula, the source of the atractylodes atractylodes dryness and dampness, the spleen and spleen are dehumidified, the cork goes down to the scorch to remove the dampness and heat of the liver and kidneys, the coix seed enters the Yangming stomach meridian to dispel dampness and heat and benefit the tendons, the oxknee tonifies the liver and kidneys and leads the power of all medicines to go straight into the lower coke, accompanied by the lone life, parsnip, chicken blood vine, Yanhu Suo, the lone life is hard and slightly warm, good at treating the wind, removing the long-term paralysis, and the sex is good to go down, in order to get rid of the wind, cold and dampness between the coke and the muscles and bones; The wind of the wind and the victory of the wet, the chicken blood vine, the extension of the husuo to nourish the blood and invigorate the blood, implying the meaning of "treating the wind first and treating the blood, and the blood and the wind will destroy itself". Licorice blends all kinds of medicines, and is used for medicinal purposes.
In this case, the treatment was based on syndrome differentiation and treatment, and there was no recurrence after 1 year of follow-up.
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 Director: Cai Limin, Chief TCM Physician]