<h1 class="pgc-h-arrow-right" data-track="1" > based on the experience of applying ephedra appendage soup based on pulse diagnosis</h1>
Original Cheng Shen Rong Qionghai Chinese Medicine Wu Can
Based on the pulse diagnosis of the prescription application of ephedra appendage fine spice soup experience
Qionghai City Hospital of Traditional Chinese Medicine Cheng Shenrong
Introduction: Since the "Jingfang Training Camp" was held in early June this year, a group of hardcore young Chinese medicine talents have emerged, and Comrade Cheng Shenrong is one of them. He works in the rehabilitation ward, and in the face of patients with communication difficulties, zhongjing yin and yang pulse method accurately distinguishes and improves clinical efficacy, which plays a vital role. The following two medical cases are its clinical examination cases, please criticize and correct them!
Case 1:
The patient, Xie Moumou, male, 75 years old, was admitted to the hospital with "shortness of breath for 1 day" on 2021-09-14 08:27.
Admission to the hospital: patients with shortness of breath, cough, occasional cough, sputum is white, sticky, difficult to cough out, no sweating, left limb weakness, unfavorable activity, can not stand and walk, left limb stiffness, left upper limb is flexed like an elbow, speech is still fluent, occasional drinking water cough, no nausea and vomiting, no headache, no shortness of breath, no bloating, abdominal pain, fatigue, naco, sleep in general, two stools. Physical examination: body temperature: 38.3 °C, pulse: 106 times / min, breathing: 20 times / min, blood pressure: 149 / 66 mmHg. Mental tiredness, both lungs can hear wet rales and phlegm sounds, no dry rales, bilateral pupils and other large iso-circles, about 3.0 mm in diameter, sensitive to light reflexes, bilateral eyeball activity to the left is slightly limited, bilateral frontal striations are basically symmetrical, the left nasolabial fold is slightly shallower, the corner of the mouth is slightly tilted to the right, the tongue is extended to the right, and the pharyngeal reflex is weakened. Left upper extremity proximal muscle strength level 1, distal muscle strength level 1, left lower extremity proximal muscle strength level 2, distal muscle strength 1, left limb muscle tone is high, left upper limb is flexed elbow, left lower limb can not flex the knee, left foot dorsal extension and dorsal flexion is limited, left biceps reflex and left knee reflex due to physical failure to cooperate, left triceps muscle, left Achilles tendon reflex and right tendon reflex are normal; right limb muscle strength and muscle tone are normal. Pathological signs are not elicited. Pain in the left limb is less tactile than on the right. Bilateral dorsal artery wave pulsation is slightly reduced. The right lower extremity can be seen in the heel of the right lower extremity with red, swollen and ruptured skin, a little exudation, and moderate edema of the right lower extremity. The tongue is dark red, the moss is thin white, the veins are stringy, and the right side is slippery.
Auxiliary tests: 2021-09-14 Blood count: Red blood cell count (RBC) 2.76↓10^12/L, hemoglobin (HGB) 87.00↓g/L, hematocrit (HCT) 27.40↓%. Type B-nanouricipide: N-terminal brain natriuretic peptide 2484.00↑pg/mL. 2-merid assay: D-dimer 2.47↑ mg/L. Coagulation function: fibrinogen (Fbg) 5.08↑g/L, antithromboplastin III (AT-III) 65.30↓%. Liver function: total protein (TP) 57.20↓g/L, albumin (ALB) 26.30↓g/L, globulin (GLB) 30.90 N g/L, albumin/globulin (A/G) 0.85. Renal function: urea nitrogen (BUN) 3.12 ↓ mmol / L, creatinine (CR) 46.00 ↓ umol / L. Hypersensitive C-reactive protein (Hs-CRP) 70.47↑mg/L. No significant abnormalities were found in blood gas analysis, procalcitonin, and myocardial enzymes. 2021-09-14 Chest CT flat scan: 1. Chronic bronchitis, emphysema; interstitial inflammation of both lungs; after treatment of lower lobe infection of both lungs. 2. A small amount of pleural effusion on the left side. Compared with the previous film (2021-9-5): the foci of infection in the lower lobes of both lungs and the left pleural effusion were slightly increased compared with before, and the mediastinal lymph nodes were slightly larger than before. Upper thigh CT: 1, the right inner thigh of the soft tissue diffuse swelling, with a long strip of mixed density foci, hematoma? Color ultrasound double lower extremity arterial and vein: both lower extremity arteriosclerosis and multiple plaque formation. No abnormalities were seen in the veins of both lower extremities.
Diagnosis of traditional Chinese medicine: 1. Asthma Sputum fever lung evidence
Western medical diagnosis: 1. Lung infection 2. Hemiplegia 3. Cerebral infarction 4. Dysphagia 5.Hypertension Grade 3 Extremely high risk 6.2 diabetes 7.Secondary epilepsy 8.Vascular dementia 9.Electrolyte metabolism disorder 10.Adrenal insufficiency 11.Pressure ulcers in the stressed area 12.Chronic bronchitis with emphysema
On the 14th, the patient had fever, the diagnosis of lung infection was clear, and cefotaxime sodium anti-infection treatment was given; the patient's right side was slippery, the ruler was not weak, considering the patient's repeated inhalation pneumonia in the past 3 months, fever, sputum, and had been using antibiotics for 3 months. Its 1 week ago the patient had a wet sound in the lungs, the pulse pun floated, after giving Xiao qinglong plus gypsum soup, the lung rales disappeared for 2 days, repeated again, and the fever appeared, considering the patient's right guan slippery (not enough sense of fullness), not floating, the ruler is not weak, combined with the pulse, so the treatment is still the right guan slippery large as the treatment object, with wuling scatter plus gypsum treatment, and add light attachment tablets 1 pack, at this time the light attachment tablets and five lings in the poria, white surgery, combined with the stalk technique, to strengthen its role in regulating water vapor. The prescription is five lings with plaster and light tablets. The prescription of traditional Chinese medicine is as follows: (granules) 1 pack of guizhi; 1 pack of Bai Shu; 1 pack of poria poria; 1 pack of ze diarrhea; 1 pack of pig lily; 1 pack of gypsum; 1 pack of light attached tablets with 5 doses, 1 dose per day, water.
On the 17th, the patient basically had no fever, and the sputum sounds and wet sounds in the lungs were still significant.
Identification of general bacterial and fungal cultures of sputum on the 17th: Klebsiella pneumoniae. Resistant to amoxicillin/clavulanate, moxifloxacin, levofloxacin, cefazoline, ceftazidime, cefpiramide, cefotaxime, and sensitivity to cefoxitin, meropenem, and amikacin. Patients with Klebsiella pneumoniae are multidrug-resistant bacteria, resistant to cefotaxime, with a resistance index greater than 32, reaching the highest value. The patient's body temperature decreased, the symptoms improved, but the lungs were still sputum, and the blood oxygen saturation fluctuated at 90-91%, and on the 17/9th, cefotaxime sodium was discontinued according to sputum culture + drug sensitivity, and anti-infective therapy with amikacin injection was discontinued;
On the 19th, the patient was considered to be significantly resistant to cefotaxime during the rounds, and the patient was still deferveent, considering that it was closely related to traditional Chinese medicine, because the lung sputum sound and wet sound were significant, and the prescription was kept again without taking the pulse.
Keep the top, with 5 doses, 1 dose a day, water.
On the 22nd round, the patient's mental health is poor, drowsiness, both lungs can hear obvious wet rales and sputum sounds, wet rales and sputum sounds have increased compared with before, and the blood oxygen saturation of fingertips fluctuates between 86-90% of the fingers. The condition worsened, the pulse was found that the patient's right pass slippage has tended to normal pulse force, the left pass, inch pulse force is significantly weakened than before, basically can not be put, the left ulnar is strong, the pulse force is comparable to the normal pulse force. It shows that the right pass has been solved by Wuling Sanjia plaster, but there is also a evidence of ephedra appendage fine spice soup vein. At this time, the patient 5 doses of Wuling powder plus gypsum, light attachment tablets, has taken 2 doses, there are still 3 doses, because there are appendages in front, so on the basis of the time, add ephedra (granules) 1 pack, fine spices (granules) 1 pack. Let the patient take another 3 doses, and the nurse must be sure to make sure that the patient can take the Chinese medicine today.
On the 23rd round, the patient's spirit can be answered, very surprised, listen to the lungs again, the breath sounds of the lungs are clear, no obvious dry and wet rales and sputum sounds are heard, and the blood oxygen saturation of the fingertips is 96%.
On the 24th, the blood oxygen saturation of the fingertips reached 99%. Good spirits, very happy, because the patient usually has no infection in the lungs when the blood oxygen is only 95-96%.
His condition was stable and he stopped taking Chinese medicine for 3 days.
On the 27th, the patient was again mentally poor, low potassium, potassium 2.6, low protein, again appeared pulmonary rales, significant sputum sounds, blood oxygen saturation fluctuated between 82-89%, potassium supplementation and protein supplementation, continued the current amikacin anti-infection, Chinese medicine decoction and then gave ephedra appendage fine spice soup and five lings powder plus gypsum soup 5 doses prescription as before.
On the 29th, the lungs improved significantly, the wet sound disappeared, and a little sputum sound could be heard, and he was discharged from the hospital.
On the 10.3rd, due to drinking water and coughing, he could not eat until he was hospitalized again in our department, and on the 10.4th, he checked the room and listened to the lungs, and did not hear obvious dry and wet rales. Blood oxygen saturation is normal.
Case 2:
The patient, Deng Moumou, male, 60 years old, was "crooked for 1 week at the corner of his mouth." "Admitted to the hospital on 2021-09-22 17:47.
Admission to the hospital see: clear, general spirit, dark face, crooked corners of the mouth to the right, left papillae pain, left eye closure weakness, white about 2mm, unable to complete the cheeks, whistle and other actions, left headache, swelling pain, no dizziness, no limb weakness, numbness, no drinking water cough, no cough, cough, no chest tightness, palpitations, no shortness of breath, no nausea, vomiting, slightly cold limbs, occasional bloating, abdominal pain, abdominal pain, sleep, two stools normal.
Physical examination: blood pressure: 130/80 mmHg. No obvious abnormalities were found on cardiopulmonary examination, abdominal weakness, mild tenderness under the sword process, no rebound pain, and no abnormalities were found in the remaining abdominal examination. The bulbs of both eyes are normally active, the bilateral pupils are large and equally round, about 3 mm in size, sensitive to light reflexes, there is no nystagmus in both eyes, the left eyelid is incompletely closed, the white is about 2 mm, the left frontal streaks disappear, the left nasolabial fold is slightly shallower, the corner of the mouth is skewed to the right, the tongue is extended to the left, and the pharyngeal reflex is normal. Limb muscle strength and muscle tone are normal, physiological reflexes are present, and pathological reflexes are not elicitated. The tongue is dull, mossy, the double veins are tight, the right side of the pulse is normal, the left side of the ruler is strong, and the inch is weak.
Auxiliary examination: 2021-09-22 Outpatient examination of our hospital: Cranial CT indication: 1, bilateral basal ganglia and bilateral radiation coronary area multiple lacunar ischemic degenerative foci, no acute cerebral infarction, it is recommended that the skull MRI flat scan + DWI + SWI further examination. 2. Leukoplasmic looseness, senile brain atrophy. 3. Calcification of the wall of the intracranial segment of the right internal carotid artery. There were four items of blood lipid checks: total cholesterol (CH) 7.92 mmol/L, triglycerides (TG) 9.95 mmol/L, HDL cholesterol HDLC0.72 mmol/L, LDL LDLC 4.53 mmol/L. Glycosylated hemoglobin (HbA1c) 11.50%.
Diagnosis of Traditional Chinese Medicine: Seclusion and less yin evidence.
Western medical diagnosis: 1. peripheral facial nerve palsy 2. multiple cerebral infarction 3, hyperlipidemia 4, type 2 diabetes.
Treatment is given to monitor blood pressure, anti-inflammatory, blood pressure control, insulin combined with drugs to control blood sugar, lipid reduction, nutrition nerves, stomach protection, improvement of circulation and other symptomatic treatment; traditional Chinese medicine characteristic therapy to give ordinary acupuncture (face) to soothe the meridians, patch therapy (to correct the external application of the left side of the face), thunder fire moxibustion (dicang, Shimonoseki, sun), TDP (left side of the face) warm menstrual blood circulation and other treatments.
Chinese medicine decoction considers less yin evidence, give ephedra appendage fine spice soup, the prescription is as follows: (granules)
1 sachet of ephedra; 1 sachet of fine spices; 1 sachet of light attached tablets with three doses, once a day, one dose at a time, rinse with boiled water.
On the 25th round, the patient's left frontal striae recovered, the left eyelid recumbent position closed normally, the vertical position was exposed to about 1 mm, the angle of the mouth was tilted to the right and improved earlier, the left nasolabial fold became shallow, and the left papillae pain disappeared. The pulse, the left inch of the ruler pulse force tends to be consistent, the effect is not more square, and then give ephedra appendage fine spice soup 3 doses.
On the 28th, the patient's condition further improved and he asked to be discharged from the hospital.
Experience:
Both patients were effective with ephedra appendage soup, especially in the past 3 months, the patient has been transferred to the pulmonology department twice for treatment due to poor control of lung infection. I am also very happy to be able to win this time.
Among them, Xie's fever has been solved by Wuling Scatter plus gypsum soup, but shortness of breath, cough, phlegm, both lungs sputum sound and wet sound are obvious, fingertip blood oxygen saturation fluctuates between 86-90% of the fingers, but it suggests that the prescription drug is not completely symptomatic. In the course of treatment, the patient appears "but wants to sleep", according to the typhoid fever theory 37: sun disease, ten days have gone, the pulse is thin and sleepy, the outside has been solved. Set chest full of rib pain, with small chai hu soup, pulse but floating, give ephedra soup. Typhoid fever theory 281: The less yin is a disease, the pulse is fine, but the desire is also sleepy. How to determine whether a patient has oligodo or oligodo? If it is a shaoyin disease, why has the appendage been added to the Wulingsan, but it still cannot effectively prevent the disease from passing into the shaoyin?
Patients are drowsy, demented, unable to communicate effectively. According to Director Chen Jianguo's "Illustration of Meridian Pulse Evidence", I found the direction, and the patient's pulse strength was manifested as "the left pass, the inch pulse force is significantly weakened compared with before, basically unable to put it, the left ulnar is strong, and the pulse force is equivalent to the normal pulse force" similar to the ephedra appendage fine spice soup. In the "Illustration of the Meridian Pulse Evidence", the pulse evidence characteristic of the ephedra appendage fine spice soup is that "the sinking position of the left hand ulnar is too veiny, and the remaining veins are sinking and weak". At this time, I encountered a problem, the patient's left inch is weak and weak, the left ulnar pulse force is normal, but it is not too pulse, is this in line with it? According to the pulse evidence diagram of ephedra appendages in Director Chen Jianguo's early "Zhongjing Yin and Yang Pulse Method", we can see that the left ulnar pulse force is normal, and it is not too much pulse. I think that the righteous qi of the lower focus is weak, unable to resist evil, and the pulse strength is naturally insufficient, and it is impossible to show too much pulse.
It is that the patient's ulnar pulse is not heavy, and it belongs to the middle of the too much vein, which is inconsistent with the sinking pulse of the left hand of the ephedra appendage fine spice soup as stated by Director Chen Jianguo. Should we use this party, and how should we choose it? We can see that the evil qi is transmitted within the road map, and the strongest pulse force is from the floating position of the ephedra soup inch vein to the middle position of the Xiao Chai Hu Guan vein, and then to the sinking position of the ephedra appendage fine spicy soup ulnar vein. In this patient, there is no left inch of the vein, and the strongest pulse force point is moved to the ulnar part, indicating that the evil qi is transmitted to the lower focus, and there is a tendency to transmit to the ulnar pulse sinking position immediately. Ephedra and fine spices in the square have the power to penetrate upward from the lower focus of the human body, plus the cannon appendage of the warm coke, and go out from the lower focus, which is just in line with the current pulse trend.
The third problem is that the patient's original right guan is slippery, after wuling scatter plus gypsum attached to the soup treatment, the pulse strength has tended to normal, but Director Chen believes that the pulse of the ephedra appendage fine spice soup is characterized by the sinking position of the left hand ulnar is too heavy, the remaining veins are sinking and weak, but the patient's right guan pulse force is close to normal, how to choose at this time? I found the answer from director Chen Jianguo's illustration of the pulse evidence of Chai Hu Gui Zhi Tang, which is the combination of the strongest floating position of Gui Zhi Tang and the strongest middle of The Guan Pulse of Xiao Chai Hu Tang. When explaining the conjunction, the pulse force should be the coincidence of the two. The patient's left vein scatters yin and evil, and the right vein of precipitation drinking can be carried out at the same time, complementing each other, and the patient's use of ephedra appendage fine spice soup and Wuling scatter plus gypsum combination, it is indeed effective, but also from the side to prove my argument.
Case 2 Patient has been facial paralysis for 1 week, there is severe hyperlipidemia and type 2 diabetes, poor blood glucose control, hyperglycemia often affects peripheral nerves, resulting in peripheral nerve paralysis, and the patient's limbs are cold, less yin, yang depression, this patient's facial paralysis is a more clinically tricky type. According to the patient's pulse evidence that "the double pulse string is tight, the right side pulse force is normal, the left side is strong, and the inch is weak", considering the ephedra appendage fine spice soup certificate, and achieving good curative effect.
Wu Can press: Because it is an inpatient, it is given integrated traditional Chinese and Western medicine treatment, but accurate and effective traditional Chinese medicine treatment can significantly improve symptoms and shorten the course of the disease. I hope that through the above two cases, you can be enlightened and gain something. At the same time, the excavator of the Zhongjing Yin-Yang Pulse Method, Teacher Chen Jianguo, made a concise and concise hint for this article (see the figure below), hoping that everyone will combine Teacher Chen's three books to further understand the pulse diagnosis of relevant evidence.
Hu Xishu Jingfang Medicine Qionghai Heritage Base
Zhongjing Yin Yang Pulse Fa Qionghai Inheritance Base
October 19, 2121