General:sheetsXX, female, 81, from Zhengzhou City, retired worker. No history of drug allergy was found. 2019year07month First visit on 16day.
Complaint:Both lower extremities edema1more than a month.
History of present illness:1 More than a month ago, there was no obvious cause for edema of both lower extremities and edema of the eyelids. Now he is taking Naoxintong capsules and health care medicines. tune. The tongue is dark red, the coating is thin and greasy, and the pulse is deep and thin.
Specialist examination and auxiliary examination: (2019-07-16) span>Five Classification of Blood Routine:EO# 0.02 10^9/L↓、EO% 0.40 %↓, RBC 3.26 10^12/L↓, span>HGB 99.00 g/L↓, HCT 31.00 % ↓, MPV 12.00 fL↑;(2019-07-16)< /span>Auto urine analysis:EC 14.40 ↑, BACT 1369.40 ul↑; no obvious abnormality in renal function.
Traditional Chinese Medicine Diagnosis:edema disease p>
Syndromes:Damp-heat syndrome
Treatment:clearing heat and water
Preliminary Medicines:
July 26, 2019Reply< /span>Diagnosis:After taking the medicine, the edema and fatigue of the lower extremities are relieved, the swelling of the hands is relieved, and the vision is blurred , Poor appetite and insomnia, difficulty falling asleep, second stools, dark red tongue, thin white greasy coating, deep and thin pulse.
Process:7.16Japanese mulberry sticks30g, self-defense10g, Chrysanthemum20g, Chrysanthemum24g, Jiao Sanxian20g. Traditional Chinese medicine9paid, one dose per day, taken with water.
Notes:Treatment of edema, “Vegetarian Question: The Treatise on Liquor and Liquor in Decoction and Liquor puts forward three basic principles: “go to Wan Chen’s house”, “open the gate of hell” and “clean the house”. The meaning of Zhong Jingzong’s “Neijing” is found in “Internal Classics”Synopsis of the Golden Chamber: Combining Treatment of Water, Qi, Pulse and Syndrome” states: “Those with water, swollen below the waist, should facilitate urination; swollen above the waist should be cured when sweating.” Law. The patient in this case has the syndrome of dampness and heat accumulation, so the treatment is to clear away heat and divert water, and then use Wuling San to add or subtract. In the recipe, Poria spleen nourishes qi and strengthens the spleen to infiltrate dampness; Polyporus clears heat and invigorates water to infiltrate dampness; when water is abundant in the interior, Alisma clears heat and infiltrates dampness; The branches are warm and yang qi is dissolved to dissolve water; damp heat is abundant, soil Poria, Imperata Root, plantain, Qumai, and talc can all clear heat and benefit water. In the second diagnosis, the edema is relieved, the joints are still painful, and the vision is blurred. Add mulberry twig and Chixueteng to relieve pain.