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Original link: https://www.igancao.com/aq
Author: Yang Tao
Wang Moumou, male, 72 years old
First visit on August 3, 2022
Chief complaint: Back pain for 2.5 years
History of present illness: Self-reported multiple color Doppler ultrasound, CT and routine blood biochemical examinations showed no obvious abnormalities, and there was no obvious improvement in many places with traditional Chinese medicine and Western medicine ( Traditional Chinese medicine, Chinese patent medicine, anti-inflammatory and analgesic western medicine, plaster for external use, etc.), after being introduced by someone, come to our office for treatment. Main symptoms: Sometimes full back pain, sometimes the back pain location is not fixed, can appear up and down, left and right, mainly fullness pain, sometimes stabbing pain, even pain on both sides of the chest and hypochondriac, local pain like pounding and pressing, no burning sense. Nameike, dry mouth, obvious at night, no bitterness in the mouth, white and sticky phlegm spit from time to time. Yellow urine, normal stool. Cracked tongue, reddish and dark, white and greasy fur, sublingual varicose veins, deep stringy and slippery pulse.
Past history: Self-reported heart disease history, usual palpitation
Auxiliary examination (Recently): 2022.7.13 Chest CT showed 1. slightly heavy markings on both lungs, 2. left costophrenic angle not smooth.
Diagnosis: Chest obstruction, yin deficiency and Qi stagnation, phlegm and blood stasis
Prescription:Bupleurum plus Longgu Muli Decoction combined with Zhishi Xiebai Guizhi Decoction and Danshen Drink
Medication: Bupleurum 15 grams, 10 grams of Pinellia, 10 grams of Scutellaria, 10 grams of Codonopsis, 10 grams of Poria, 10 grams of Guizhi, 10 grams of red peony and white peony, 6 grams of roasted licorice, 15 grams of Shenglong and Mu (fried first) , Stir-fried Citrus aurantium 10g, Scallop 10g, Trichosanthes peel 20g, Salvia miltiorrhiza 15g, Muxiang and Amomum 6g each (below), Angelica 10g, Chuanxiong 10g, Dendrobium 15 grams, 7 doses, decocted in water, one dose per day, divided into two doses. Advise to eat a light diet, avoid spicy, raw, cold, greasy, fishy hair and indigestible food; pay attention to cold protection, keep warm, exercise properly, and regulate emotions.
Second visit on September 1, 2022
Back pain on both sides was significantly relieved after taking the medicine , There was no recurrence after drug withdrawal. He complained of a history of mild jaundice (liver function on April 21, 2022: total bilirubin 26.04, indirect bilirubin 16.39), yellow eyes appeared in recent days, reexamination of liver function today: total bilirubin 27.78, Direct bilirubin 11.1, indirect bilirubin 16.68. Then he was treated with Chinese patent medicines Yinzhihuang Granules and Honghua Xiaoyao Tablets, and he was advised to continue to pay attention to diet and other daily care.
Note: In clinical practice, many patients have back pain or chest pain (especially on both sides), and CT examination is often normal (or with lung nodules, etc.), Western medicine often There is no way to treat it, or you can only prescribe some painkillers, and some plasters and acupuncture treatments have unsatisfactory effects. Because such patients are often not infection or simple wind-cold-damp blockage, but Shaoyang cardinal unfavorable, endogenous phlegm-dampness, blockage of meridian, obstruction leads to pain – phlegm stasis blockage (invisible phlegm circulates with qi, qi Stop phlegm and stop stasis), It is often accompanied by medical history and symptoms of liver, gallbladder, spleen and stomach, and it is often seen that the tongue (red) is dark, the coating (yellow/white) is thick and greasy, and the pulse is deep and stringy. When encountering such patients, choose Chaihu plus Longgu Muli Decoction, and add traditional Chinese medicines for reducing phlegm and promoting qi, promoting blood circulation and relieving pain, and the effect is often quite good.
Use of addition and subtraction (according to disease location and emphasis on phlegm, stasis, cold, heat, deficiency and excess):
- Cold phlegm/drinking lungs, those who are afraid of cold on the back, add dried ginger, asarum, schisandra, etc., or combined with Xiaoqinglong Decoction
- Targeted from phlegm-damp internal resistance or often Those who have chest pain and discomfort can take Zhishi Xiebai Guizhi Decoction, or Wendan Decoction, or Xiaoxianxiong Decoction
- Those with insomnia, dreaminess, fear and fear can calm the nerves Dingzhi Pills
- For those who prefer qi stagnation and blood stasis, combine Sini Powder, Guizhi Fuling Pills, or Danshen Drink
- Anxiety, abdominal distension and constipation, combined with Zhizi Houpu Zhishi Decoction
- Persons with stasis and heat in the body and abdominal pain and constipation, combined with Taoren Chengqi Decoction.
- Spleen deficiency with loose stools and diarrhea combined with Sijunzi Decoction and Lizhong Decoction
- Those with phlegm stagnation in the throat and obstruction are suitable for half Xiahoupu Decoction, Jugeng Gancao Decoction or Yinqiao Mabosan (those who prefer phlegm heat, dry throat and sore throat can use Chinese patent medicines such as Jubei Mixture, Lanqin Oral Liquid or Compound Guazijin Granules)
- For those with concurrent cough, take Xiaoqinglong Decoction or Maxingyigan Decoction (or Chinese patent medicine Lianhua Qingwen Granules, etc.), and treat the cough first if the cough is severe
- Those with gallbladder stones take Dachaihu Decoction, and after taking the medicine, they often discharge black and foul stools, which may also be accompanied by drug reactions such as chills, fever and sweating
Attachment: The difference between visible sputum and invisible sputum in terms of appearance, source and influence
1. Appearance
Visible sputum is sputum in a narrow sense, and is a pathological product visible to the naked eye. There are many changes in color and shape, among which the more common ones include Thin white phlegm, thick yellow-green phlegm, etc. The invisible phlegm is phlegm in a broad sense, usually referring to phlegm dampness, phlegm fire, and phlegm turbidity in the human body. We can’t see this phlegm, but it affects our body. For example, obesity caused by phlegm condensation and chest obstruction caused by phlegm stasis can be regarded as invisible phlegm.
2. Source
Chinese medicine believes that “the spleen is the source of phlegm, and the lung is the device for storing phlegm “Most of the phlegm in the body comes from the spleen. Most of the visible phlegm comes from the lungs. When patients suffer from wind-cold cold or wind-heat cold, tangible phlegm can be coughed up. However,invisible phlegm is caused by exogenous pathogenic factors or disharmony between viscera (mainly with the liver and gallbladder) related to the spleen and stomach), and can enter the meridians and circulate with the blood flow, and the internal organs are everywhere.
3. Influence
Visible sputum is concentrated in the lungs, the impact is relatively limited, and most patients have cough ,respite, shortness of breath, chest tightness and other symptoms. However, invisible phlegm has different effects when it stays in different organs. Among them, phlegm confounding the heart orifice can lead to the patient’s confusion, fatigue and fatigue, and phlegm staying in the stomach can cause the patient’s spleen and stomach to lose harmony, food accumulation, and phlegm entering the collaterals is scrofula Swelling, phlegm nucleus, patients may experience numbness and weakness in limbs, turbid phlegm condenses in the throat and becomes plum nucleus qi, and patients may feel a strong foreign body sensation in the throat and obstructed swallowing.
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