Zhang Yingdong used Xiaoqinglong soup to add and subtract diabetes to test a case.
*: China Journal of Traditional Chinese Medicine 5th Edition 2023-07-24
Zhang Yingdong, deputy chief physician of Shanxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, is good at using classic prescriptions for diabetes, and the effect is better. The author has learned from the teacher Xi benefited a lot, and now he uses Xiaoqinglong Tang to add and subtract ** diabetes case as follows.
Jiang Moumou, male, 59 years old, was first diagnosed on March 7, 2023. Chief complaint: elevated blood sugar for more than 30 years. He had a history of hypertension for 15 years, a history of coronary heart disease for more than 1 month, and a BMI (body mass index) of 26 years after kidney stone surgery5. Waist circumference 100cm, currently injecting insulin gludec aspart 20U in the morning and 16U in the evening, 50mg when taking acarbose tablets at lunch, blood sugar control can be, preprandial blood sugar 6mmol L, postprandial blood sugar 8mmol L. Inscription: The patient has good spirit, sleep, general appetite, loose stools, 3 4 times a day, normal urination, cold in the whole body, cold in the back, not afraid of heat, warm hands, sweating more in the upper body, self-reported occasional chest tightness and pain, cough, runny nose after recovery from new coronavirus infection, tooth marks on the tongue, white and greasy, and light under the tongue. The left side is thin, and the right side is tight and powerful.
Add melon and shallot to Xiaoqinglong soup, and "send its yang" to warm water and drink, and cleanse phlegm and clear yang and lower qi. The prescription is as follows: ephedra, asaroxin, banxia, dried ginger, cinnamon branch, peony, licorice, schisandra, melon, shallot, non-decoction granules, take after meals, 3 times a day, 1 sachet each time. At the same time, the amount of insulin was reduced, from the original 36U to 28U, that is, insulin aspart was 16U early and 12U late, and liraglutide was given 06 mg once daily.
The second diagnosis on March 15: the patient was in good spirits, sleeping, had a normal appetite, the stool was not dry or loose, the frequency was reduced to 2 or 3 times a day, the urine was normal, the whole body was afraid of cold, the back was cold, the hands were warm, the sweating of the upper body was reduced, and there was no chest tightness and pain, no cough and runny nose in recent days. Teeth marks on the tongue, pale and greasy, pale under the tongue. The left side is thin, and the right side is tight and powerful. Weight loss of 2kg, BMI258. Waist circumference 94cm. Blood sugar was stable, preprandial blood sugar was 6mmol L, postprandial blood sugar was 8mmol L, and the traditional Chinese medicine continued to give Xiaoqinglong decoction with melon and shallot, and the dosage was the same as before. The insulin dosage was reduced from 28 to 20 u, insulin degludec aspart was 12 u in the morning and 8 u in the evening, and liraglutide was 18 mg once a day.
The third diagnosis on March 21: the patient was mentally sleeping, had a general appetite, the stool was not dry or loose, the number of times was reduced to 1 2 times a day, the urine was normal, the whole body was afraid of cold, the back was cold, the hands were warm, the sweating of the upper body was reduced, there was no chest tightness and pain, no cough and runny nose. Teeth marks on the tongue, pale and greasy, pale under the tongue. The left side is thin, and the right side is tight and powerful. Weight loss of 3kg, BMI 255. Waist circumference 93cm. Blood sugar remained stable, blood sugar before meals was 6mmol L, postprandial blood sugar was 8mmol L, and the traditional Chinese medicine continued to give Xiaoqinglong decoction with melon and shallot, and the dosage method was the same as before, plus Erxian decoction, and it was taken after meals, 3 times a day, 1 bag 1 time. The insulin dosage was reduced from 20 U to 12 U, and insulin degludec aspart was only used for 12 U in the morning, and acarbose tablets were stopped, and liraglutide was given 18 mg once a day.
Fourth diagnosis on March 28: the patient was mentally sleeping, had a normal appetite, had normal stools, 1 time a day, urinated normally, was not afraid of cold, had a cold back, and had little sweating on the upper body. Weight loss 4kg, BMI2515, waist circumference 92cm. Recently, the blood sugar has been normal, and the Chinese medicine continues to give Xiaoqinglong soup and Erxian decoction, and the dosage is the same as before. The insulin dosage was reduced from 12 U to 8 U, and insulin degludec aspart was only used 8 U in the morning and liraglutide 18 mg once a day. After his condition improved, the patient returned to the Northeast.
Follow-up on April 11: the patient lost 55kg，bmi24.6. Waist circumference 90cm. Recently, the blood sugar has been well controlled, stable as before, insulin gludec aspart has been stopped, and liraglutide 18 mg once a day.
Follow-up on June 30: blood glucose control was acceptable, stable as before: preprandial blood glucose 6 mmol L, postprandial blood glucose 8 mmol L. Liraglutide is reduced to 12 mg once daily.
According to the complex condition of the patient in this case, long-term use of insulin caused discomfort such as large stomach, obvious cold intolerance, loose stools and frequent stools, post-COVID cough, chest tightness and palpitations. The sandwich model was used to analyze the symptoms of the patient, and the whole body was cold and the back was cold, and the right side was superficialCough, runny nose, loose stool, tooth marks on the tongue, white greasy, and light under the tongue are all manifestations of the symptoms of water drinking, which belongs to the middle layer;In addition, the patient is obese and suffers from a variety of metabolic diseases, which is the innermost layer of the core transportation deficiency, which is the disease of wind and cold on the outside, water storage and drinking on the inside, and yang deficiency.
In this case, Xiaoqinglong Tang was first treated with the same flavor as the inside and the outside, referring to Article 40 of the "Treatise on Typhoid Fever": "Those who are incomprehensible about typhoid fever, have moisture under their hearts, retching and fever, or are thirsty, or beneficial, or choking, or unfavorable to urination, have a full stomach, or wheezing, are the main ones of Xiaoqinglong Soup." "At the second diagnosis, the patient's symptoms were quickly relieved, the sweating of the upper body was reduced, the loose stool improved, the symptoms of cough, runny nose and chest tightness and pain disappeared, and the symptoms of quick effect were obtained, and further improved in the follow-up process. During this process, insulin and hypoglycemic drugs are gradually reduced, and the patient's blood sugar remains stable. Follow-up to Erxian Tang Wenyang cure, the overall ** method is a sandwich treatment method that takes into account the three layers. At follow-up, the patient lost 55kg, waist circumference decreased by 10cm, and the spirit and sleep were good, and the blood sugar control was better. After 2 months of follow-up, only one western medicine was used and the dosage was gradually reduced, blood sugar was stable, and the overall physical condition improved.
For complex diseases, Zhang Yingdong believes that it is necessary to focus on the overall situation and "treat people and treat diseases". This case is people-oriented, implements the treatment of obesity diabetes mellitus under the Guanghan method, and achieves quick relief in a short period of time under the premise of ensuring safety, and stops insulin and acarbose tablets. While scientifically reducing and stopping drugs, blood sugar has been kept stable, which is a successful case of "seeking quick results based on long-term effect". (Yang Wan, Shanxi University of Traditional Chinese Medicine, Hao Juanjuan, Shanxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine).