▲Luo Yongjia was born in 1938 in Nanhai County, Guangdong Province (now Nanhai, Foshan), a famous traditional Chinese medicine practitioner in Guangdong Province, the chief TCM physician of Guangzhou Traditional Chinese Medicine Hospital, and a former doctor of Guangzhou Traditional Chinese Medicine Hospital Dean, full-time deputy director of Guangzhou Institute of Traditional Chinese Medicine, professor of Guangzhou University of Traditional Chinese Medicine, postgraduate tutor, deputy director of the National Professional Committee of Integrated Traditional Chinese and Western Medicine Peripheral Vascular Disease, deputy director of the Surgery Branch of the Guangdong Association of Traditional Chinese Medicine, Guangdong Province Member of the Chinese Medicine Science and Technology Expert Committee, expert of the Guangdong Provincial Drug Evaluation Expert Database, consultant of the Guangzhou Society of Traditional Chinese Medicine, a representative of the 7th, 8th and 9th People’s Congress of Guangdong Province, a standing member of the Guangdong Provincial Committee of the China Peasants and Workers Democratic Party, and the Guangzhou Municipal Committee Vice President.
[ Basic information]
Xu, female, 63 years old. Date of visit: March 29, 2019.
01 【Onset Process】
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The right calf was red, swollen and painful for more than 1 month.
Prior history: Five years ago, she underwent surgery for varicose veins in our hospital. Denied hypertension, diabetes, coronary heart disease history. He denied any history of drug or food allergies.
Marriage history: Menopausal.
02 【First diagnosis
Main description: After a long walk, the right calf was red, swollen and painful, without aversion to cold and fever, slightly aversion to wind, no sweating, dry mouth There is no bitterness in the mouth, and sleep can be satisfied, and the two will be adjusted.
Physical examination: The superficial veins of both lower extremities were exposed scattered, without tortuous mass, cyanosis, and induration of the medial malleolus of the right foot. Red skin, low skin temperature, tenderness (+), dark red tongue, fat tongue, white coating, slippery pulse.
03 [Treatment based on syndrome differentiation]< /span>
Western medicine diagnosis: Lower extremity varicose veins with phlebitis.
Traditional Chinese medicine diagnosis: green snake venom.
Syndromic diagnosis: Qi deficiency and cold coagulation, phlegm and blood stasis.
The patient is old and frail, with deficient qi and blood, aversion to wind and slippery pulse, which are signs of qi deficiency and phlegm dampness. Phlegm-damp internal resistance, visible tongue body fat and white coating, dark red tongue, local induration, which is the sign of phlegm and blood stasis intertwined. Phlegm and blood stasis.
Treatment method: nourishing qi and resolving phlegm, dispelling cold and removing dampness, promoting blood circulation and dispelling knots.
Prescription: French pinellia 15g, Codonopsis 15g, oyster (fried first) 30g, cinnamon Branch 10g, Poria 30g, Astragalus 30g, Baked Ephedra 10g, Angelica 10g, Dried Ginger 10g, White Peony 15g, Fritillaria 15g, Atractylodes 15g, Licorice 6g.
Dosage: Decoction, one dose per day, 7 doses.
04 【Follow-up process ]
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Review: April 12, 2019
The redness, swelling and pain of the right calf improved significantly, the affected area was still induration, the tongue was dull, the coating was thin and white, and the pulse was slippery. The formation of induration is caused by the condensation of phlegm and core, and the cold and dampness does not dissolve. Looking at the tongue and pulse, there is still cold and dampness inside, guarding the upper part, warming the body and dispelling cold, strengthening the righteousness and eliminating pathogenic factors.
Prescription: French pinellia 15g, Codonopsis 15g, oyster (fried first) 30g, cassia twig 10g, tuckahoe 30g, Astragalus 30g, Ephedra 10g, Angelica 10g, Ginger 10g, Paeonia lactiflora 15g, Fritillaria 15g, Atractylodes Rhizoma 15g, Licorice 6g.
Dosage: Decoction, one dose per day. 7 doses.
05 【Notes】< /span>
this In traditional Chinese medicine, it belongs to the green snake venom. The green snake venom is an inflammatory thrombotic disease that occurs in the superficial veins. It is manifested as swelling, burning, redness, and tenderness of the superficial veins. The cord-like objects can be touched. In acute cases, fever and general discomfort can occur. The symptoms, equivalent to Western medicine superficial thrombophlebitis, is a common complication of varicose veins.
“The Golden Mirror of Medicine, The Essentials of Surgical Heart Method” is called loach carbuncle, saying: “This syndrome is born on the inner side of the calf, and the pain is hard. Swollen, several inches long, shaped like a loach, its color is reddish, and it is formed by the condensation of dampness and heat in the liver and spleen meridians. “The patient with this disease is old, with insufficient qi and blood, and the circulation of qi and blood is not smooth. In addition, phlegm dampness blocks the meridians. , Cold pathogen stagnation, the occurrence of this disease. Luo Lao believes that the swelling and pain are not hot, the pain is deep inside, the evil is deep inside, and the outside is cold and stagnant.
Ephedra and cinnamon sticks in the recipe can warm the meridians and dispel cold, dispel cold and dampness, and warm the meridians. Can regulate yin and yang, harmonize nutrition and health; Pinellia, Poria, Dried Ginger dissolve collaterals, warm and cold-dampness, Codonopsis, Astragalus, Atractylodes, invigorate spleen and replenish qi, oyster, Fritillaria, reduce phlegm and disperse knots, Angelica nourishes blood and activates blood, licorice Anzhong protects the stomach, when the evil qi goes away, the meridians are freed, and the phlegm can be dissipated. ■
(This case was written by Lu Nan and Zhou Yiping)
[Source: Department of Vasculitis, Affiliated Hospital of Traditional Chinese Medicine, Guangzhou Medical University]