Licorice Gakuen | Purpura, hematuria

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Author: Liu Jianfeng

Wang, female, 9 years old.

Main complaint: Purpura for 2 years, aggravated with cold for more than 1 week.

Overview of medical history: The patient suffered from allergic purpura without obvious inducement in 2014 and went to a certain hospital Diagnosed as: ① allergic purpura (skin type, abdominal type); ② purpura nephritis (proteinuria type); ③ left renal vein nutcracker borderline positive; ④ superficial gastritis; ⑤ duodenitis erosion. Purpura and purpura kidney improved after treatment. Now do a urine occult blood test every week, check urine occult blood last week (±). I am weak and afraid to go to school. I am very afraid of the wind and catch a cold when encountering wind and cold. I had a cold almost every month, and this time I had another cold for more than a week, and the purpura also increased again. Many treatments failed to heal, so I came to the National Medical Hall for treatment.

Acute diagnosis: headache, stuffy nose, dry cough, dry throat, sore throat, throat congestion, mild pain in the knee joints and ankle joints of both lower limbs, multiple mung bean-sized dark purple petechiae and ecchymosis on the lower legs, which do not fade when pressed.

No fever, fear of wind and cold, profuse sweating, neither bitter nor thirsty mouth, no appetite, indigestion, no stomach bloating at ordinary times, feeling bloated and uncomfortable after meals, stool once a day, first hard and then loose, white and rosy face , lower eyelid margin redness, dry lips.

The tongue is tender and slightly fat, the tip of the tongue is red, the tongue coating is thin and white and watery, the middle part is greasy and the coating is slightly yellow, and the rest is peeling off. The pulse is thready.

Syndrome differentiation of the six meridians: Shaoyang, Taiyin, Shaoyin, Yangming combined disease, which belongs to Jueyin. This is a combination of cold and heat, and a mixture of reality and reality.

Pathogenesis: Deficiency of the surface, disharmony between the camp and the guard, stagnant fire in the upper burner impairs body fluid, deficiency of blood in the camp and blood stasis, deficiency of the stomach in the middle burner and stopping drinking, drinking water in the lower burner and upside down.

Core pathogenesis: disharmony between camp and guard, fluid damage to camp and blood, inverse drinking.

Governing method: relieve muscle and disperse cold, clear heat and nourish body fluid, harmonize camp and health, reduce adverse effects and drink.

Recipe: Prescription 1: Zhuyeqianhu Decoction.

Prescription 2: “Sketch” Astragalus Soup.

[Prescription] Prescription 1: Zhuyeqianhu Decoction.

Zhuyeqianhu Decoction: Peucedanum 15g, Scutellaria baicalensis 6g, Sun-dried Ginseng Slices 6g, Pinellia Ginger 10g, Licorice 6g, Guizhi 10g, Paeoniae Alba 10g, Bamboo Leaf 12g, Angelica 10g, Jujube 15g (cut), Ginger 10g (sliced, bring your own).

7 doses, 1 dose per day, decocted in water and taken warmly twice.

Prescription 2: The other side of the book is handed over to the patient’s mother.

“Small piece” Astragalus soup: 12g astragalus, 12g cinnamon sticks, 12g red peony root, 12g roasted licorice, 6g skullcap, 12g rehmannia glutinosa, 12g Ophiopogon japonicus, 10g angelica, 20g jujube (cut), 12g ginger (sliced).

Advice: Avoid drinking cold, cold food, sweet food, too greasy food. After the cold is cured, take “Xiaopin” Astragalus Decoction intermittently to treat purpura and prevent colds, taking 3 doses a week.

With ear pressure therapy.

【Treatment scenarios】

Sterilize both ears with 75% alcohol, wipe them clean with cotton swabs, and then implement ear pressure therapy (Wangbuliuxing seed patch, 2 tablets per patch, press ear points), select points: lung, trachea, allergic area, spleen , kidney, endocrine, sympathetic.

[Discrimination of ideas and answering questions]

[Student A] Teacher, what is the left renal vein nutcracker critical positive ?

[Teacher] This is a disease name in western medicine, also known as left renal vein compression syndrome, which is called the “nutcracker phenomenon” in western medicine, and it is one of the common causes of non-renal hematuria in children.

This is because in some children, when the left renal vein flows into the inferior vena cava, the angle formed between the abdominal aorta and the superior mesenteric artery is squeezed, causing symptoms such as occult blood in the urine.

At present, Western medicine has no good treatment for this disease, and the prognosis of patients is generally good.

In adulthood, due to the establishment of collateral circulation and the increase of fatty connective tissue around the origin of the superior mesenteric artery, the degree of compression of the left renal vein can be relieved, so most hematuria will gradually improve.

These are just for understanding. No matter how Western medicine treats this disease, we will treat this disease according to TCM syndrome differentiation.

[Student B] Teacher, how should we differentiate the symptoms of this little patient?

[Teacher] Let’s distinguish from all the symptoms of the patients collected just now.

Afraid of cold, stuffy nose, profuse sweating, arthralgia, thin white tongue coating, floating and weak left pulse, insufficient chi, this is Shaoyin apoplexy syndrome.

Runny nose, cough, tender tongue slightly fat, stringy pulse due to Taiyin stomach deficiency and stop drinking, water drinking is reversed.

Dry cough, dry throat and congestion, red lower eyelid margins, dry lips, thin tongue coating, slightly yellow in the middle, peeling coating, stringy and thready pulse.

Indigestion is not good, and I feel bloating and discomfort after meals, and there are western medicine examination conclusions: superficial gastritis, duodenitis erosion, and it is identified as stomach deficiency in Taiyin middle burner.

Dark purple petechiae and ecchymosis on the calf are Shaoyin wounds.

The lower eyelid margin is red, the lips are dry, the throat is congested, the tip of the tongue is red, with red spots, and the yellow fur is Yangming heat injury body fluid.

Hard stool at the beginning, this is Yangming lijie.

The syndrome of the six meridians is Shaoyang Taiyin combined with Shaoyin and Yangming, which belongs to Jueyin.

This is a mixture of cold and heat, and a mixture of reality and reality. The pathogenesis is deficiency of the exterior, disharmony between the camp and the guard, stagnant fire in the upper burner impairs body fluid, deficiency of blood in the camp and blood stasis, deficiency of the stomach in the middle burner and stopping drinking, and water in the lower burner drinking upside down.

The core pathogenesis is the disharmony between the camp and the guard, fluid damage to the blood in the camp, and inverse drinking.

The treatment method is to relieve muscle and dissipate cold, clear heat and nourish body fluid, harmonize camp and health, and detoxify drink.

Prescribe two prescriptions, one is Zhuyeqianhu Decoction, and the other is “Xiaopin” Astragalus Soup.

[Student C] Teacher, why did you write two prescriptions?

[Teacher] One is to solve the current symptoms, use Zhuyeqianhu Decoction; the other is to prevent it in daily life, prevention is very important, use “Xiaopin” Huangqi Decoction.

The patient has been suffering from purpura for a long time, and has long-term urinary occult blood. There are also many mung bean-sized dark purple petechiae and ecchymosis on the calf of both lower limbs, and he is very prone to colds. Combined pulse syndrome, mixed cold and heat, mixed deficiency and excess, belongs to Jueyin disease, that is, half-outer and half-interior yin syndrome, which damages the blood.

Mr. Hu Xishu believes that half-outer and half-inner yin syndrome is Jueyin disease, which is a very wise concept and can solve many clinical problems.

If you have read Professor Feng Shilun’s article about Hu XishuAfter interpreting a series of lectures on “Treatise on Febrile Diseases”, Mr. Hu Xishu knew that there is a famous prescription for half-outside and half-inside yin syndrome, which is Chaihu Guizhi Ganjiang Decoction. Mr. Hu Xishu is also very good at using this prescription to treat many chronic intractable diseases.

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