Kong Ying, deputy chief physician of the Department of Hepatology, studied under Yang Zhen, a famous chinese medicine doctor in China, and has a profound experience in the clinical application of Yang's "phase fire gas machine theory" since the division. Intensive study of medical science, tireless, especially for difficult and serious diseases, strive to distinguish detailed and accurate, dispatch prescriptions and use drugs, and clinically accumulate rich experience in diagnosis and treatment.
Hepatic cysts are common benign diseases in the liver, divided into isolated and diffuse, the former is called hepatic cysts, which are divided into single and multiple; the latter is called polycystic liver, which is an autosomal dominant genetic disease. Simple hepatic cysts develop slowly and are often asymptomatic. A few may cause symptoms due to the compression of the surrounding organs by a huge cyst, such as right upper quadrant pain, nausea and vomiting, fever, jaundice, etc. Large cysts with symptoms or complications should be treated.
In Traditional Chinese medicine, there is no record of liver cysts, and the name of symptoms can be attributed to the category of "flank pain". Flank pain was first seen in the Inner Classics, which clearly pointed out that its occurrence was mainly related to hepatobiliary lesions. The "Jingyue Quanshu" further pointed out that the causes of flank pain are mainly most closely related to emotions, diet, room labor, etc., and are divided into two categories: external sensation and internal injury. Flank pain is mainly responsible for the liver and gallbladder, and is related to the spleen, stomach and kidneys. The basic pathogenesis is stagnation, blood stasis, damp heat and humidity, which causes unfavorable drainage of the liver and gallbladder, pain if it is not passed, or insufficient liver and yin, loss of veins, and pain if it is not honored. The "Evidence and Treatment of Hui Supplement and Stress Pain" makes a more comprehensive and systematic description of its treatment principles, saying: "It is advisable to treat liver diarrhea fire as the key, and it is not necessary to suddenly use qi tonic agents, although it is due to deficiency of qi, it is also advisable to supplement diarrhea and administer at the same time." ...... Therefore, where the wood is depressed, and the qi is not discharged, the fire is not crossed, and the swelling is even more afraid of pressing, and when the evacuation is raised to reach it, it is not allowed to use the deflation, so that the more depressed the wood, the more painful it is. ”
Chief Physician Yang Zhen is the third to sixth batch of national old Chinese medicine experts academic experience inheritance work guidance teacher, the first national famous Chinese medicine, Shaanxi Province famous old Chinese medicine teacher. He put forward the "Phase Fire Gas Machine Theory", and innovatively proposed the "Six Types of Phase Fire" and the "Five Theories on The Treatment of Liver". Rich clinical experience, especially good at the treatment of hepatobiliary diseases, simple and complex, summarizing the "ten methods of liver treatment". Now he introduces a case of his identification and treatment of liver cysts from the qi machine to eat the same way.
Medical transcripts
Zhang Mou, male, 75 years old, was admitted to the hospital for "8 years of abdominal pain in the right flank, aggravated in January". 8 years ago, the patient felt that he occasionally had swelling and tingling pain in the right flank, and the upper abdomen was checked to show "multiple cysts of the liver", which was not treated. 5 years ago, the right flank swelling pain worsened, and the re-examination of liver cysts increased and increased compared with before, the largest was 78×90mm, so the "puncture and drainage of liver giant cysts" was performed in the hospital. After regular re-examination, the cyst is still frequent, but it has not enlarged, and the patient still feels the right flank swelling and pain intermittently. In the past 1 month, the above symptoms have worsened with chest pain, and in order to seek treatment from Western medicine in the system, I have come to our department for hospitalization. He has a history of "hypertension" for 35 years, and now he has taken amlodipine besylate tablets orally, and his blood pressure is controlled at about 140/75-90mmHg. The history of "coronary heart disease" for more than 20 years, the history of "arrhythmia-instability atrial fibrillation" for 12 years, the occurrence of "cerebral hemorrhage" in 2008, hospitalization for hemostasis, cranial foramen foramen drainage treatment after the symptoms were alleviated. In 2009, he suddenly suffered from "cerebral infarction", which improved after treatment, leaving minor sequelae such as walking instability and coughing. Immediate symptoms: intermittent right flank swelling pain, chest tightness, chest tingling, palpitation, fatigue, shortness of breath, wheezing, dizziness after activity, stomach swelling, acid reflux, insomnia. Acceptable food, stool 1-2 days / time, dry, frequent urination, incomplete urination, poor night rest.
Physical examination: Blood pressure: 136/102 mmHg. Poor spirits, mild cyanosis of the lips. There is no yellow stain on the sclera of the skin throughout the body. Both lungs (—), small heart, irregular heart rhythm, heart sounds, no pathological murmurs heard. Abdominal flat and soft, no tenderness in the whole abdomen, the upper boundary of the liver is located on the right side of the 5th intercostal area, subcostal failure, subcostal failure, hepatic percussion pain (+), mobile dullness (-), non-swelling of both lower extremities. The tongue is lilac with petechiae, the moss is yellowish and white and slippery, the veins under the tongue are tortuous, and the veins are deep and astringent.
Admission: Liver function: TBIL 22.6umol/L, IBIL 15.0umol/L, DBIL 7.6umol/L; coagulation: INR 1.30, PT-% 60.04%; renal function: UA 483umol/L; type B urinary natriuretic peptide: 322.10pg/ml; electrolyte: K 3.4mmol/L, CA 2.19 mmol/L. Blood count, gastrointestinal tumor markers: no abnormalities. Positive for hepatitis B surface antibody; negative for hepatitis C antibody. ECG: ectopic rhythm, left deviation of the electrical axis 1.Atrial fibrillation 2.ST-T changes. Cardiac ultrasound: 1. Widening of the inner diameter of the aortic and sinuses of the aortic, 2. enlargement of the left atrium 3. Degenerative change of the aortic valve 4. Normal systolic function of the left ventricle 5. A small amount of reflux of the aortic valve, mitral valve, tricuspid valve, pulmonary valve micro-reflux; 6. Arrhythmia. Gastroscopy: reflux esophagitis, gastric erosions. Abdominal ultrasound: mild fatty liver, multiple liver cysts.
Diagnosis of traditional Chinese medicine: 1. flank pain (hepatic depression and stagnation); 2. chest palsy (heart pulse obstruction); 3. palpitations (qi and yin deficiency). Western medical diagnosis: 1. liver cyst (multiple); 2. coronary heart disease Stability angina arrhythmia Atrial fibrillation; 3. Hypertension grade 3 extremely high-risk group; 4. Post-cerebral infarction sequelae period; 5. Lumbar disc herniation; 6. Prostatic hyperplasia with calcification.
Yang Lao consulted the medical records and analyzed the patient after detailed examination: the patient's tongue was lilac with petechiae, the tongue had tooth marks, the moss was white and slippery, the middle root was yellow and greasy, the sublingual vein was tortuous, the blood stasis point could be seen next to the vein, the pulse was thin and astringent, and the left inch was large. Combined with the symptoms, it can be known that the disease is located in the liver and heart; the right flank is bloated and painful and occasionally tingling, and the mood is obvious when the mood is not smooth, which is the image of liver qi depression, stagnation and blood stasis; liver blood, heart main blood, liver has the role of auxiliary cardiac blood, liver qi stagnation affects the function of the main blood vessel of the heart, chest swelling and stinging is heart pulse obstruction; coupled with the patient's old age and long-term illness weakness, there is panic, fatigue, shortness of breath, shortness of breath, wheezing, dizziness after activity; liver qi is reversed to the stomach, and the coke machine is not smooth, then the stomach is full and acid regurgitated. Therefore, the pathogenesis is liver qi depression, qi stagnation and blood stasis, heart pulse stasis and qi and yin deficiency. Treatment when the liver stasis, invigorating blood pulse and with the benefit of qi nourishing yin, the party selected experience fang "liver thinning stasis soup" plus the pulse dispersion "crown heart II.," and add hemp seeds to moisten the intestine, stone calamus aromatized wet turbidity, the specific medication is as follows: vinegar North Chai Hu 9g, white peony 12g, fried citrus fruit 10g, hot licorice 6g, vinegar green peel 10g, vinegar tulip gold 15g, salvia 15g, citron 15g, fried chicken gold 15g, vinegar turtle nail 15g first frying, incense 8g, red peony 15g, safflower 6g, party ginseng 15g, mai dong 15g, Vinegar Schizandra 10g, sautéed hemp seeds 10g, calamus 15g, Sichuan root 15g. 7 pay, fry 400ml, take warmly in the morning and evening on an empty stomach, one dose a day. Fasting spicy and stimulating products to smooth the mood.
The patient's symptoms were significantly relieved after taking the above 7 doses. After taking 7 payments, the pain of the right flank basically disappeared, the spirit improved, the physical strength increased, the walking was steady and powerful than before, and the symptoms of dizziness, chest tightness and panic were significantly improved compared with before. Eat well, two stools are unobstructed, and the night rest is good. With medicine 14 to the hospital, consolidation treatment.
Press: The patient in this case had pain in the right flank for the first time, ultrasonography showed a liver cyst, and the liver cyst increased again shortly after puncture and drainage; Chinese medicine believed that the patient's right flank was swollen and painful, and the chest swelling and stinging pain belonged to the categories of "flank pain" and "chest paralysis" in Traditional Chinese medicine. The pathogenesis lies in liver qi stagnation, blood stagnation, and heart and blood stasis. The treatment also focuses on smoothing the sluggish qi machine. Huang Yuanyu attaches great importance to the qi machine, believing that "the six qi of a person, if he is not sick, he will not see it, and if he is sick, he will see the qi of the qi" "If the hand is yin, the fire is also, and the wood qi is smooth, then the yin heart lord obeys the order and dissolves the wind, and the wood qi is depressed, then the yin heart lord manifests his own true qi." "The liver, spleen and kidneys rise to the left, and the heart and gallbladder and stomach fall to the right, so the disease is always related to the qi machine, the wood qi is not smooth, the lifting is dereliction of duty, and the heart pulse is obstructed." Fang used "liver thinning and stasis soup" plus raw veins to disperse "coronary heart II" to cut. "Liver thinning and stasis soup" is a commonly used recipe for Yang Lao's treatment of liver depression and blood stasis, imitating the method of "Medical Forest Correction", using "four reverse scattering" plus "Qingjindan Xiang Drink" to rationalize qi and invigorate blood, and add chicken inner gold and turtle nails to digest and strengthen the stomach, nourish the yin soft and firm. "Coronary Heart II" is composed of Sichuan root, red peony, safflower, incense, salvia, etc., which can activate blood stasis and relieve pain. Ginseng, mai dong, and schisandra in the raw veins are scattered, one supplement and one run, and the qi nourishes the yin, so that the qi is revived and the qi is replenished. Play together the functions of thinning the liver and strengthening the spleen, rationalizing the qi and invigorating the blood, and achieving a complementary effect.
Dialectical thinking
The cure of all diseases is based on liver thinning. The main liver drains, adjusts the qi machine, and the qi is smooth, and all diseases are eliminated. The key to smoothing the gas machine is to thin the liver. Huang Yuanyu's "Four Sacred Heart Sources" said: "Wood is developed as sex... The wind blows and the wind leaks... All diseases arise because of the depression of wood qi. Those who are born with liver and wood, and those who are not angry enough, often eight or nine times, and wood qi is depressed and not born, it is also a disease. "If the liver and gallbladder are angry and lost, the cardinal is unfavorable, the machine for the human body to rise and fall is blocked, the qi and blood cannot be metamorphosed, and the internal organs are difficult to breathe, then the vitality is difficult to maintain." And blood is the mother of qi, qi is handsome, qi is blood, and stagnation is blood stasis. If liver drainage is normal, the blood runs smoothly without stasis. If the discharge disorder, the gas machine is disordered, or the gas stagnation is not smooth, the blood stasis is not good. It can be seen that liver qi depression is an important cause of blood stasis. The combination of the three parties achieves the effect of soothing the liver and dissolving stasis, and improving the qi and flowing the pulse. This case shows that the use of phase fire gas machine theory, the use of classical prescriptions, the rationalization of gas machine lifting and lowering, accurate dialectical treatment ideas, can achieve good clinical efficacy.
Ying Kong, Master student, deputy chief physician. He has been engaged in clinical medical teaching and research for more than 10 years, and has been awarded the title of "Advanced Member" of Shaanxi Health Care Association, and as an outstanding Chinese medicine research talent in Shaanxi Province, he has successively studied in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine and the You'an Hospital Affiliated to Capital Medical University. He has published more than 10 papers, edited 1 book, and presided over and participated in 5 provincial and municipal scientific research projects.
Specialty in treatment: all kinds of fatty liver, alcoholic liver and related metabolic syndromes, various acute and chronic viral hepatitis, liver fibrosis, cirrhosis of the liver ascites and complications.
Clinic hours: Thursday morning Outpatient location: East 3 Liver Disease Clinic, Area A, 3rd Floor of the Clinic
Source: Xi'an Traditional Chinese Medicine Hospital