▲Luo Yongjia was born in 1938 in Nanhai County, Guangdong Province (now Nanhai, Foshan), a famous Chinese medicine practitioner in Guangdong Province, and the chief Chinese medicine physician 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 Data]
Zheng, male, 52 years old. Date of visit: November 3, 2020.
[ Pathogenesis]
Complaints: Repeated coughing, runny nose and sneezing for more than 10 years.
Past History:Have “chronic superficial history of gastritis.
[First Diagnosis Syndrome]
< span>History of present illness:Coughing, runny nose, and sneezing recurred, dry mouth, tearing, stomach bloating, chest pain, exacerbated by anger. Limbs are cold and sweaty. Insomnia and dreams. Constipation, easy diarrhea after eating raw cold.
PE:Red tongue, yellow fur, Pulse sinking.
[ Syndrome differentiation and treatment]
Traditional Chinese medicine diagnosis: 1. Cough;
Western medicine diagnosis: 1. Chronic bronchitis; 2. Allergic rhinitis; 3. Stomach Intestinal disorders.
Treatment based on syndrome differentiation: The patient’s chest pain, aggravated by anger, is actually related to liver stagnation and qi stagnation. Emotional insufficiency, liver dysfunction, poor Qi movement, prolonged stagnation and turning into fire, insomnia, dreaminess, intrusion of the lungs along the meridians, non-lowering of lung qi, cough, dry mouth, red tongue, etc. Yellow moss; cold sweating of the limbs is the manifestation of deficiency of kidney yang, dereliction of duty and endogenous cold pathogens. Deficiency of spleen yang can show stomach distention, diarrhea after eating raw cold, nasal congestion and runny nose. Combined with the symptoms of tongue and pulse, it is a combination of cold and heat, upper heat and lower cold, liver stagnation transforming into fire, spleen and kidney deficiency and cold. It is suitable for warming kidney yang, dispelling cold pathogens, soothing liver qi, and reassuring spirit.
Treatment method: warming yang and dispelling cold, soothing liver and promoting qi, nourishing yin and soothing the mind.
Recipe: Cooked Aconite 10g, Cinnamon 10g, Angelica Radix 15g, Xinyi 15g, Schisandra 10g, Ophiopogon japonicus 20g, Suanzaoren 20g, Corydalis 10g, Turmeric 10g, Atractylodes 15g, Fangfeng 15g, Licorice 6g. 6 doses.
【Follow-up process】
Revisit: 2020.11.10 span>
She complained that her sleep was improved compared with the previous one, more dreams, tears and salivation during sleep, chills and headaches, one bowel movement for 2-3 days, and frequent urination.
PE: Red tongue, slightly yellow fur, and deep pulse.
Syndromic diagnosis: yang deficiency, damp heat.
Treatment based on syndrome differentiation: The patient’s sleep improves, but the kidney yang is insufficient, the fire does not generate soil, and the spleen is deficient Healthy movement, lack of biochemical sources of qi and blood, lack of nourishment of mind and insomnia, spleen deficiency and dampness, lack of clear yang, chills and headaches, dampness and heat, and more dreams and frequent urination. Combined with the tongue and pulse, it is suitable for warming the yang and strengthening the spleen, promoting qi and eliminating dampness, and assisting with clearing heat and eliminating dampness.
Treatment method: Warming the yang and strengthening the spleen, invigorating the qi and eliminating dampness, and clearing away heat.
Recipe: Codonopsis 20g, Atractylodes 10g, Pinellia 10g, Amomum 15g, 15g mother, 30g coix seed, 20g yam, 30g tuckahoe, 6g licorice, 10g cassia twig, 15g cooked aconite, 10g bergamot. 6 doses.
Mental fatigue, still coughing, sneezing, dry mouth, dizziness, tinnitus, numbness in right hand. Insomnia, more dreams. She complained of weightlessness and palpitations when driving downhill. V. Nocturnal emission, premature ejaculation history.
PE: Dry tongue, white coating, slow pulse.
Syndromic diagnosis: heart and kidney discord.
Treatment based on syndrome differentiation: The kidney controls qi, and the deficiency of the qi in the kidney invades the lung, causing cough, and the deficiency of the kidney is not solid. Nocturnal emission, premature ejaculation, dizziness and tinnitus due to deficiency of kidney yin, spread to the heart, the function of yin fluid restricting yang heat decreases, so insomnia, palpitations, and weightlessness are aggravated; Treating the heart and kidney, nourishing yin and reducing fire.
Treatment method: communicate with heart and kidney, nourish yin and reduce fire.
Recipe: Codonopsis 15g, Ophiopogon 20g, Schisandra 10g, Cinnamon 10g, Astragalus 15g, Epimedium 20g, Corydalis 15g, Morinda officinalis 15g, Turmeric 15g, Paeonia lactiflora 15g, Acorus calamus 10g, Albizia Julibrissin 15g, Coptis chinensis 5g. 9 doses.
Revisit: 2020.12.01
Complained that the cough was lighter than before, and now there is no runny nose or sneezing. Eye pain, itching, and tears. Dry mouth, bitter taste, distending pain in right flank. Sweat on inner thighs and soles of feet. Stool 2 a line.
PE: Red tongue, cracked tongue, white coating, slow pulse.
Syndromic diagnosis: deficiency of liver and kidney, internal dampness and heat.
Treatment based on syndrome differentiation: Liver qi loses its balance for a long time and turns into fire, and penetrates the meridian to invade the lung , The hair is cough, and also see dry mouth, bitter mouth, deficiency of liver yin, loss of nourishment of liver collaterals, then eyes, chest and flank pain. Deficiency of kidney yin, yin does not control yang, and the deficiency of fire is endogenous, and sweating is seen. Combined with tongue and pulse, it is a syndrome of liver and kidney yin deficiency. It is suitable for nourishing liver and kidney, supplemented by nourishing yin and reducing fire.
Treatment method: nourishing liver and kidney, nourishing yin, removing dampness and clearing heat.
Recipe: Wolfberry 15g, chrysanthemum 10g, dogwood meat 10g, Chinese yam 10g, Rehmannia glutinosa 15g, Poria 10g, Cortex Moutan 15g, Alisma 15g, Lily 20g, Licorice 3g, Schisandra chinensis 10g, Taizishen 15g. 6 doses.
[note] span>
“The five viscera and six viscera are all coughing, not just one lung”. The patient has a slow onset and a long history of cough, which is an internal injury cough. Cough caused by internal injury is caused by dysfunction of the viscera, internal pathogens drying the lungs, the lungs are not clear and subdued, and the lung qi goes up. Allergic rhinitis is a traditional Chinese medicine rhinitis, and ancient books record: “fire attack lung deficiency, rhinitis.” In addition, the patient also suffers from insomnia, which is closely related to the heart, liver, spleen and kidney.
The patient’s initial diagnosis and syndrome differentiation is a mixture of cold and heat. Coughing the lungs. Long-term illness damages the kidneys, and the kidneys do not accept qi, and cough is also seen. If the kidney yang is insufficient, the warmth and dereliction of duty are seen. The symptoms are cold sweating of the limbs, insomnia and more dreams. The overall cold of the patient is greater than the heat, so it is suitable to warm the kidney yang, soothe the liver stagnation, and reassure the spirit. Among them, aconite and cinnamon warm and invigorate the kidney yang, and soothe the nerves.
Sleep improved in the second diagnosis, but the yang of the spleen and kidney has been weakened for a long time. To invigorate qi and dispel dampness, the prescription is Shenling Baizhu San, which warms yang and promotes qi, and helps the spleen and stomach to transport water and dampness. The third-diagnosis patients still have discomforts such as cough, insomnia and palpitations. Combined with the medical history and symptoms and signs, the syndrome is differentiated as heart-kidney incompatibility. In the fourth-diagnosis patients, the symptoms of cough are reduced, the mouth is dry and bitter, the eyes are full of pain, the pain in the chest and flank, and sweating is due to deficiency. Considering that the patient is physically weak for a long time, and the function of the viscera is damaged, it is not necessary to use the product of great suffering and cold, but to nourish yin and reduce fire. The prescription uses Qiju Dihuang Pill to nourish the kidney and nourish the liver, and it is compatible with Lily, Taizishen, Schisandra, etc. to nourish qi and nourish yin.
In general, the treatment of cough, rhinorrhea, and insomnia should follow the syndrome. Combining the patient’s medical history, symptoms, and signs, taking into account the various internal organs, such as warming the yang, nourishing the yin, strengthening the spleen, nourishing the liver and kidney, etc., correcting and tonifying deficiency, taking into account the primary and secondary factors, and not committing the commandment of deficiency and excess. In addition, attention should be paid to the four o’clock adjustment, active exercise, dietary conditioning, improving the body’s immunity, so that the righteousness can be stored, and the evil cannot be done. ■
(writing for this case: Guan Xixuan and Zhou Yiping)
[Source: Department of Vasculitis, Affiliated Hospital of Traditional Chinese Medicine, Guangzhou Medical University]