2021年1月29日星期五

what does a hemorrhoids look like,Comprehension of the use of prescriptions

    Guang'anmen Hospital, China Academy of Chinese Medical Sciences (Beijing 100053)

    Jingfang, the original meaning is the prescription of experience, the classic prescription, and later refers to the prescription in Zhang Zhongjing's Treatise on Febrile and Miscellaneous Diseases. Because of its outstanding efficacy and a long history and repeated clinical verification, it is revered as the "master of the group". Classical prescriptions are characterized by fewer and refined drugs, strict drug compatibility and drug dosage ratios, and proper use, which often cures illnesses and causes symptoms. Mr. Yue Meizhong, a famous doctor in modern times, once expressed the feeling that "no prescriptions can cure serious diseases". The author discovered during clinical trials that the clinical manifestations of many diseases are very similar to those described in the Treatise on Febrile Diseases. According to the principle of prescription and syndrome correspondence, it is not limited to the diagnosis of the disease name in modern medicine. If there is a syndrome, the prescription is used, and all are as effective as a drum. Here are four cases of the prescription of the classics, and analyze the understanding of the prescriptions, and share them with colleagues.

    1. Sini Powder in Treating Chronic Atrophic Gastritis

    Gao, female, 64 years old. Visited on January 18, 2008.

    Main complaint: stomach pain for more than 10 years. The patient developed gastric distending pain more than 10 years ago, and was diagnosed as "chronic atrophic gastritis" by gastroscopy in a hospital on October 16, 2006. After taking the Chinese patent medicine for regulating qi and swelling, periridone and acid-suppressing western medicine, it was slightly relieved . In July 2007, the author gave more than 10 doses of Buzhong Yiqi Decoction to be invalid. The immediate symptoms: continuous fullness of the gastric cavity, needle-like pain, less appetite, only a small mouthful of rice at noon, with burning sensation, belching, no pantothenic acid, no nausea; insomnia since childbirth for nearly 40 years, usually every night Only able to fall asleep for 1 hour, sometimes sleepless throughout the night; dizziness, fatigue and fatigue; body pain, backache after long standing for a long time; easy cold hands and feet, frequent calf cramps; non-yellow urine, stool for 4 to 5 days, dry and crunchy ; The tongue is pale red, the coating is thin and yellow, and the pulse is heavy and weak. Check: The body is thin, the complexion is yellow and dull; the hands below the wrist stripes are cold, the color of the hands is dark purple, and the palms are thin. Western medicine diagnosis: chronic atrophic gastritis; Chinese medicine diagnosis: stomach pain, stagnation of gastric qi and fire syndrome. For treating Qi, clearing away heat and stomach, Sini San is supplemented, prescription: Bupleurum 12 g, Citrus aurantium 12 g, Peony 15 g, Raw licorice 10 g, Dandelion 30 g, 5 doses. Decoction in water, one dose a day. And give Liuwei Dihuang Wan an empty stomach in the morning, 20 capsules each time. Order to stop taking other drugs.

    Second visit (February 4): After the medicine, the stomach distension and burning pain are the third of the ten, and the appetite is slightly increased; I can sleep for about 2 hours a night, the backache is significantly reduced, and the hands and feet are more likely to become warmer than before. Stool is one line for 2 to 3 days. Stool quality is still dry; tongue and pulse are the same as before. Cha: The complexion turns yellow and dark. The original prescription took 5 more doses and continued to take Liuwei Dihuang Pills.

    Third visit (February 14): Stomach pain aggravated after stopping the drug during the Spring Festival, and then relieved after taking the upper part again. After 5 doses of medicine, gastric discomfort is less than eight. I can eat half a bowl of rice each time, but sleep does not continue to improve. Stool is still dry for one line on the 2nd, but it is better than before; the tongue is pale red and the coating is thin and white. , The pulse is stronger than before. Check: The complexion turns ruddy, the luster reappears, and the hands and feet are warm. The original prescription of Suanzaoren Decoction, prescription: Suanzaoren 30g, Poria 12g, Anemarrhena 10g, Chuanxiong 6g, Raw Licorice 6g, 5 doses. Decoction in water, 1 dose a day, and continue taking pills.

    Note: Sini San in "Treatise on Febrile Diseases" mainly treats the limbs not warm from heat to yang stagnation in Shaoyin disease, namely: "Shaoyin disease, Sini, the person may cough, or palpitations...Sini San is the main cause." The author uses this prescription to treat chronic gastritis, chronic gastric ulcer, chronic cholecystitis, chronic allergic rhinitis, cold hands and feet of young people, etc. and have achieved good results.

    Judging from the article records, "cough", "palpitations", "difficult urination", etc. are all probable, while "four inverses" are characteristic and inevitable. In terms of location, the four inverses are obvious from below the wrist; in terms of pathogenesis, the four inverses are caused by the stagnation of the Yang Qi and the inability to be warm at the end. The improvement of the four inverse symptoms is an important criterion for judging the effectiveness of the prescription. In addition, the author also experienced other applicable symptoms of this side. For example, the complexion is dull and dull, or the color of the palm fingers is dark; the pulse condition seems to be absent at first, but it becomes stronger after pressing it for a long time; usually sweating is less or difficult; others have cold nose and ear tips, which is easy Nasal congestion and runny nose, mental impotence, etc. From the analysis of the drug syndromes, according to the medication habits of "Treatise on Febrile Diseases", if you use Bupleurum, you will have discomfort in the thoracic and diaphragmatic flank area; if you use Citrus aurantium, you will have stomach distension, abdominal distension, dry stool, and fullness in the abdominal examination; Stomach pain, abdominal pain, calf cramps and pain symptoms; licorice treatment has irritability and urgency.

    This case is a typical four inverse evidence. The author first saw that he had dizziness, lack of appetite, fatigue, pale complexion, and weak pulse, etc., so he took a soup for nourishing the middle qi and tonifying qi, but he didn’t see any success, indicating that he had no other symptoms. Because the patient is not simply Qi-deficiency syndrome, but also has Qi-stagnation syndrome (Sini San syndrome) and stagnation-heat syndrome (gastric cavity has fullness, burning, pain, and thin yellow tongue coating). Therefore, in the prescription, Sini powder is used to regulate qi and stomach, and dandelion is reused to clear stomach fire. Because the patient has obvious backache, thin body, thin thenar area of ​​palms, and is a type of congenital liver and kidney insufficiency, Liuwei Dihuang Wan was used to improve physical fitness. After the stomach discomfort is improved, Suanzaoren Decoction is used to nourish the heart and calm the nerves to treat insomnia, and then use Buzhong Yiqi Pill to treat the aftermath.

    2. Banxia Xiexin Decoction in Treating Chronic Gastric Ulcer

    Ding, male, 46 years old. Visited on February 11, 2008.

    Main complaint: Stomach fullness and dull pain recurring for 4 years. The patient suffered from fullness of the gastric cavity and dull pain and discomfort 4 years ago. In March 2005, he was diagnosed as "gastric ulcer" by gastroscopy at the local hospital. He was concurrently eradicated with Hp triple therapy and acid suppression therapy, but the symptoms were recurring. Now take omeprazole. Engrave: Stomach fullness and discomfort, sometimes dull pain, aggravated after eating spicy and cold food; nausea in the morning, brushing teeth, good sleep, loose stool; red tongue, thin and greasy coating, yellow and white, and heavy pulse. Cha: The expression is silent, and the stomach does not hurt. Western medicine diagnosis: chronic gastric ulcer; Chinese medicine diagnosis: scum syndrome, epigastric pain. The original prescription of Banxia Xiexin Decoction, prescription: prepared Pinellia 10 g, Coptis 6 g, dried ginger 6 g, skullcap 10 g, Codonopsis 10 g, roasted licorice 10 g, 5 jujube, 3 doses. Decoction in water, 1 dose a day, 3 warm doses. And instruct the patient to stop taking western medicine.

    Second visit (February 15): After the medication, the symptoms were significantly reduced, and the swelling pain did not occur; but the new stool has a heavy sensation, the texture becomes thinner, and the smell is not heavy; the tongue becomes pale and the coating becomes thin and white. Deep pulse. Prescription: The original prescription of Coptis chinensis was reduced to 3 g, and dried ginger was increased to 9 g, 3 doses.

    The third visit (February 17): After taking two doses of the medicine, the heartburn became severe. After stopping the medicine, it eased slightly. I had to take omeprazole by myself to suppress acid, the tongue turned red, the tongue coating became thin and yellow and greasy, and the pulse was sinking. Prescription: The original prescription of Coptidis was changed to 8 g, and the dry ginger was changed to 4 g, 3 doses. After the medication, the symptoms disappeared again, and the patient was then instructed to take 3 doses of this prescription when the patient relapsed. After half a year of follow-up, the patient was in stable condition without subjective discomfort.

    Press: "Typhoid fever on the 5th or 6th day... but if it is full but not painful, this is a lump, but Bupleurum is not compatible with it, it is suitable for Banxia Xiexin Decoction." "Tang Zhuzhi", in which "pimple under the heart", "but full without pain", "vomiting" and "bowel" are the dialectical points of this prescription. It is generally believed that the weakness of the spleen and stomach, and the combination of cold and heat in the heart are the pathogenesis of this syndrome. However, the syndrome cannot be fully grasped based on the pathogenesis, and the identification of specific symptoms must be refined. According to the author’s clinical experience, the pathogenesis of “cold” is mainly manifested in the patient’s inability to drink cold and cold food, and swelling or relief after eating; the pathogenesis of “hot” is mainly manifested in the patient’s inability to eat spicy food, and the stomach after eating. There is a feeling of burning and noisy, red tongue, yellow greasy tongue coating, etc. The pathogenesis of "deficiency" is mainly manifested as loss of appetite, fatigue, and weak pulse due to long-term stomach discomfort and lack of source of spleen and stomach movement. According to the analysis of drug symptoms, brushing teeth, nausea, or nausea and hiccups after eating (ie, "vomiting"), greasy tongue coating is a Pinellia syndrome; can not drink cold, or vomit after eating, or fullness in the stomach, loose stools are cold (ie "Bowel") is the dry ginger syndrome; "heart scum", red tongue is the coptis syndrome; scutellaria syndrome and mouth pain are the scutellaria syndrome; body fluid loss after vomiting and diarrhea is the ginseng syndrome; contracture pain is the jujube syndrome; Irritability and urgency caused by stomach discomfort is licorice syndrome.

    Therefore, this case is a typical case of Banxia Xiexin Decoction. The first diagnosis is combined with the prescription and the effect is like a drum. However, the second diagnosis showed that the tongue turned pale, loose stools recurred, and later heavier feelings. Ginger syndrome, so reduce the dry ginger, re-use dry ginger to stop the benefit, after the medicine, the condition will aggravate, the heat phenomenon will reappear, and the ratio of dry ginger and coptis will be adjusted again and it will be effective. Therefore, the author realizes that dosage is an important factor in clinical prescriptions. A dosage corresponds to a medicine syndrome (prescription syndrome), that is, "quantity syndrome", which is similar to the dose-effect relationship in modern pharmacology. The compatibility ratio of dried ginger and coptis is the key to the effectiveness of this prescription.

    3. Treatment of Lumbar Intervertebral Disc Protrusion with Guizhi Plus Baizhu Fuzi Decoction

    Ding, male, 42 years old. First visit on January 29, 2008.

    Sore back and legs for 3 years. The patient developed low back pain 3 years ago and radiated to his right leg. CT scan of the lumbar spine at the local hospital showed: lumbar 4/5, lumbar 5/sacral 1 disc herniation. Two years ago, it was discovered that the left leg was painful, and the therapeutic effects of traction and drugs were not obvious. Engraved: lumbosacral pain and discomfort, traction radiates to the posterior outer sides of the lower limbs, cold, prolonged lying on the side, aggravated after standing, heat can not be relieved; pharyngeal swelling, thirst, dry stool; usually easy to catch a cold, often swollen throat Pain; the tongue is light and tender and purple and dark, the tongue coating is thin and white, the pulse is not floating, it is weak when taking it, and there is nothing when taking it down. Check: The skin is fair, the tonsils are slightly red and not swollen; the lumbar spine 4/5 tenderness is positive, and the straight leg elevation test is positive. Western medicine diagnosis: lumbar disc herniation; Chinese medicine diagnosis: low back pain; cold and damp stagnation syndrome. To treat coldness and dehumidification, Guizhi Jiashufu Decoction, prescription: Guizhi 15 g, red peony 6 g, white peony 6 g, roasted licorice 10 g, 3 slices of ginger, 5 jujube, 30 g of fried Atractylodes, Cooked Fupian 15 g, 5 doses, decocted in water.

    Second visit (February 2): After taking the medicine, I realized that my waist symptoms almost disappeared, my left leg symptoms were relieved by 70%, and my right leg symptoms were relieved by 30%. Walking was no longer as sore and swelling as before; the throat discomfort disappeared, the stool became easier and the texture was not dry ; The tongue is light and the coating is thin and white, and the pulse turns strong. The defender takes another 5 doses.

    Third visit (February 10): After the medicine, the left leg has no discomfort, and the pain of the right leg is relieved by about 70%; stool is normal, one line per day. Self-reported that he did not catch a cold again during the medication, and his energy improved. Then the original prescription and Guizhi Fuling Pills were treated with 10 g of peach kernels, 10 g of poria, and 6 g of paeonol on the top. The symptoms did not further relieve after the medicine. Instruct the patient to take a break. The follow-up has been up to half a year and the condition is stable.

    Note: Guizhi plus Baizhu Fuzi Decoction is not the original prescription of "Treatise on Febrile Diseases", but its changes did not include Guizhi Jiafuzi Decoction, Guizhi Fuzi Decoction, Quguijia Baizhu Decoction, Gancao Fuzi Decoction and other categories. The author used this prescription to treat many cases of lumbar disc herniation, and found that the pain relief effect is obvious, and the shorter the course of the disease, the better the effect. Here is the author's understanding of Guizhi plus Baizhu Fuzi Decoction prescription as follows.

    From the "Treatise on Febrile Diseases" Guizhi plus Aconite Decoction, Guizhi plus Baizhu Decoction, and Licorice Aconite Decoction, it is known that sweating, pain, irritation, and bowel movements are the main points of the syndrome differentiation. It is worth noting that "the body is painful and cannot rotate side" and "the joint is painful, pinching, and cannot be flexed" very vividly describe patients with lumbar disc herniation due to nucleus pulposus and compression of the sciatic nerve. , Irritability, and insomnia symptoms. From the analysis of drug syndromes, in addition to Guizhi Decoction syndrome, there should also be aconite syndrome and Baizhu syndrome. Spasm and pain of limbs and joints, severe sweating and bad wind, body swelling, weak or heavy pulse are the syndrome of aconite; stagnation of moisture, low back pain, self-interest or disadvantage in urination, and dry stool are syndromes of Baizhu.

    Recalling the case, although the patient did not sweat, the pulse was slow, but the patient was of medium size, pale complexion, easy to feel externally, pain in the waist, legs and feet along the Sun Meridian, pale and tender tongue, dark purple, weak pulse, physical fitness Weak, can also be regarded as Guizhi Tang physique. The patient is not a typical Guizhi Decoction syndrome with floating and slow pulse, but may be related to the compound Shen pulse with aconite syndrome. Waist and leg pain is caused by cold dampness condensing meridian joints, which is a monkshood syndrome. Atractylodes macrocephala has a lot of experience in the treatment of low back pain in ancient times. For example, Chen Shiduo believed that "low back pain is the intrusion of moisture into the kidney uterus." How can the moisture in the middle stay for a long time, and it will naturally get wet and lose pain." The heavy sorrow of the waist and legs is caused by internal dampness, so Baizhu is used to dispel water and gas to relieve pain. In addition, dry stool is also an indication of Atractylodes macrocephala. The author has observed that many patients with lumbar disc herniation have dry stool. After repeated use of white stool, low back pain and constipation can be improved. In the third visit, considering that the patient's lower limbs were sore and numb and painful, and that it was aggravated by lying still at night, it was a stagnant blood syndrome. Therefore, Guizhi Fuling Pill was added to improve the blood circulation of the waist, but the symptoms did not improve. Whether there is a good way to treat with decoction is worth exploring.

    The Kampo community in Japan has also made in-depth discussions on this testimony. For example, Jiyidongdong’s "Fangji" said, “People with painful joints in the wet family, or hemiplegia, slanted mouth and eyes, or severe headache, or body paralysis, or For those with severe head pain, the master of Guizhi Jiashu Futang", the representative of the eclectic faction Asada Zongbo also used Guizhi Jialingshu Fu Tang to successfully treat the intractable low back pain of the French minister and became famous. Reference for treating lumbar disc herniation.

    4. Taohe Chengqi Decoction and Guizhi Fuling Pills for Mixed Hemorrhoids

    Xiong, male, 58 years old. First visit on January 25, 2008.

    Anal pain and discomfort for 2 days. The patient has a history of mixed hemorrhoids for more than 20 years. He had undergone surgical treatment 18 years ago, and has been repeated since then. Two days ago, after overwork, anal pain and discomfort occurred, and there was a small amount of dark red blood after going to the toilet; sometimes dizziness and headache, coughing and wheezing at night, good sleep, yellow urine, dry stool; dark red lips, red tongue, The fur is thin and white, and the pulse string is strong. He had a history of hypertension for 5 years, and he took captopril tablets. Check: blood pressure 134/96mmHg; the patient has a strong physique, dark red complexion, firm muscles, and loud voice; abdominal examination and lower abdomen are firm and strong; protruding vegetations can be seen in the perianal appearance at 7 and 11 points, without finger examination. Western medicine diagnosis: mixed hemorrhoids; Chinese medicine diagnosis: internal and external hemorrhoids, stasis and heat mutual syndrome. Treating Dang Huayu, clearing heat and clearing the fu organs, imitating Taohe Chengqi Decoction to remove Glauber's salt and Guizhi Fuling pills, prescription: peach kernel 10 g, raw rhubarb 10 g, cinnamon stick 10 g, poria 15 g, red peony root 10 g, paeonol 10 g, raw licorice 6 g, 3 doses, decocted in water.

    After the patient took the upper 2 doses, the stool became soft, the hemorrhoid pain was greatly reduced, the appearance of vegetation was reduced by half, the anus was basically no pain after 3 doses, the dizziness and headache disappeared, the night cough and asthma were reduced by half, and the vegetation disappeared after 1 week. No recurrence was found during follow-up for more than 8 months.

    Note: In this case, the patient’s perianal pain and swelling, vegetation, and dark red lips are symptoms of blood stasis; large abdomen and stool, strong abdominal examination, usually prone to dizziness and headache, elevated blood pressure, dry stool, red tongue and strong pulse strings. Yang confirmation is a classic indication of using rhubarb, so consider choosing a prescription for promoting blood circulation containing rhubarb.

    The original Taohe Chengqi Decoction mainly treats typhoid fever and lower scorch blood accumulation syndrome, "The sun disease is incomprehensible, and the bladder heats up. The person is like crazy, the blood flows down, and the lower one is healed...externally relieved, but those who suffer from a low abdomen can attack. Therefore, it is suitable for Taohe Chengqi Decoction.In the prescription syndrome, the key to syndrome differentiation is the acute knot of the abdomen. In this case, the perianal pain and swelling were particularly painful during defecation, which can be seen as an extension of the "abdominal dysfunction". The prescription relieves heat and eliminates blood stasis, and is most suitable for the syndrome of dry stool and lower abdominal pain. Glauber's salt is considered to reduce the power of diarrhea. In addition, Guizhi Fuling Pill originally used to treat pregnancy stasis to block the uterus, and the bleeding does not stop. The author often takes this prescription to improve the blood circulation below the lumbosacral area, and the two prescriptions are used to promote the absorption of blood stasis. After the medicine, the symptoms are greatly reduced, and the effect is like a drum, indicating that the prescription corresponds to the syndrome.

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