Last time, Xi Jianzhong and Zhong Xiaoyi were listening attentively, when they were suddenly interrupted by a coughing sound, and when they looked at it, an old woman and a five or six-year-old girl came into the consultation room. The old woman was in her sixties, with a fair complexion and a chubby build, and from time to time she coughed in bursts of voice, which was heavy and muddy, accompanied by obvious wheezing;The little girl was well-proportioned, ruddy-complexion, and occasionally coughed a few times, but she was in good spirits. As the old woman spoke, she kept beating her hand on her chest. It turned out that due to the heavy snow in the previous days, the temperature plummeted, and the old woman was careless, and the old slow bronchia (chronic bronchitis) for many years was committed. When she got up this morning, the old woman noticed that her granddaughter, who was sleeping with her, also began to cough, so she hurried to the hospital to see a doctor.
Old man, you go to check the blood routine first, and take a chest X-ray by the way. The little girl will check the blood routine, and there will be no need to take a chest X-ray. Xi Jianzhong skillfully completed the physical examination and quickly opened the test sheet.
After a while, the old woman and the little girl returned. The old woman's blood routine showed a total of 10 109 l white blood cells and a neutrophil ratio of 81%.Chest x-ray showed widening of the intercostal space and thickening of the markings in both lungs.
The elderly woman has an acute attack of chronic bronchitis, which seems to belong to the category of 'asthma syndrome' according to the theory of traditional Chinese medicine. Xi Jianzhong is now learning to use the theory of traditional Chinese medicine to consider clinical problems, "As for syndrome differentiation and prescription medication, let Zhong Xiaoyi carry it out." ”
While asking about the old woman's medical history, Zhong Xiaoyi recorded in the medical record: cough, accompanied by wheezing, vomiting a small amount of white sticky sputum, accompanied by chills, cold limbs, sweating when moving or coughing and wheezing, sleeping comfort, urine adjustment, constipation. The tongue is not red, the body is fat, the moss is white and slightly greasy, and the right inch of the pulse is strong.
The patient is suffering from chronic illness caused by feeling the wind and cold, and the "Treatise on Typhoid Fever" says, "Wheezing home, making cinnamon branch soup, and adding thick apricot seeds." (18) 'This patient should be added or subtracted with Guizhi decoction, while taking into account his chronic illness in the lungs. Zhong Xiaoyi said with certainty.
Professor Guo nodded approvingly to the students, and the prescription was as follows: 6g of cinnamon branch tip, 15g of red and white peony, 15g of Chuanpu, 9g of bitter almond, 15g of melon kernel, 15g of Kaijin lock, and 6g of boiled licorice. 7 doses.
Professor Guo, I have a question. Zhong Xiaoyi read the prescription and said, "You use Guizhi soup to dispel wind and cold, magnolia bark and almonds to relieve cough and asthma, melon seeds to dissolve phlegm and laxative, and open gold locks to clear the lungs and dissolve phlegm, I understand all of these." But why do you still use red peony?”
For a variety of chronic pulmonary diseases, clinicopathological studies have found that due to the chronic inflammatory changes of the bronchi or alveoli, it can often cause spasm of the bronchioles or excessive expansion of the alveoli, and the above reasons can lead to microcirculation disorders in the lungs, which will aggravate the ventilation and ventilation dysfunction of the lungs and aggravate the disease, which is also one of the important reasons for the prolongation of chronic pulmonary diseases. Red peony has a blood-invigorating effect and can improve microcirculation disorders in the lungs. Moreover, modern pharmacological studies have confirmed that both white peony and red peony have good anti-inflammatory and antispasmodic effects, which can promote the absorption of inflammation and relieve bronchial spasm. "Even from the perspective of our traditional Chinese medicine, these patients do have different degrees of blood stasis, such as the tongue image will most likely have a faint purple color, which is the evidence of blood stasis syndrome and the indication for the use of blood-activating and stasis drugs." By the time the patient develops hypoxemia, the tongue will appear visibly bruised, and even cyanosis of the lips may occur. ”
Xi Jianzhong listened to Professor Guo's words, and couldn't help but be impressed by his profound knowledge of modern medicine, and secretly made up his mind: Such old experts in traditional Chinese medicine can understand Western medicine, and I should learn more about the medicine of the motherland while learning Western medicine while I am young.
Zhong Xiaoyi asked the old woman to stick out her tongue again, and sure enough, she found that the edge of her tongue was a faint purple.
Come and show my granddaughter, who has caught a cold from me. "She started coughing when she got up this morning, there was no phlegm, she said that her throat was itchy, and she was afraid of cold, and I was sweating profusely when I touched her." No, the underwear I just changed in the morning is already wet. ”
The little girl has an acute upper respiratory tract infection, which should belong to the 'cold' or 'cough' of traditional Chinese medicine. Xi Jianzhong took the little girl's blood test sheet and spoke, which showed that the proportion of neutrophils was 78%.
Zhong Xiaoyi felt that the little girl's right inch pulse was slightly larger, "This patient should also meet the Guizhi Tang syndrome, but it is accompanied by a more obvious cough." ”
Professor Guo was very satisfied with the performance of the two students, and the prescription was as follows: Gui Zhijian 45g, fried white peony 9g, Chuanpu 3g, bitter almond 6g, bellflower 6g, nepeta 3g, raw licorice 3g. 3 doses.
Or cinnamon sticks and magnolia apricot soup. Zhong Xiaoyi was a little surprised.
Article 43 of the "Treatise on Typhoid Fever" 'Sun disease, the lower slight asthma, the table is not solved, and the cinnamon branch and the apricot soup are the main ones. This and 18 are both indications for cinnamon and apricot soup. The difference is that 18 patients have always had asthma, which was caused by external evil after being exposed to wind and cold;Article 43 is about the patient's new feeling of wind and cold, and wheezing and coughing due to mistreatment. In fact, in Zhongjing's view, the wheezing cough that appears after the new feeling is the most suitable for using cinnamon sticks and magnolia apricot soup, so it is said: Guizhi plus magnolia apricot soup is the main one;The chronic disease is the wheezing cough caused by wind and cold, and sometimes it can also be used to **, so Zhongjing called it: make cinnamon branch soup, add magnolia apricot good. Professor Guo said, "In the Treatise on Typhoid Fever, Zhong Jing often uses words such as 'Lord's' and 'Yi' and 'Ke and 'Ke He' in his prescriptions. The difference in tone also implies the difference in the correspondence between the square and the evidence. 'Lord' means that the previous formula is most suitable for the use of this prescription**, and 'appropriate' means that the previous prescription is more suitable for this prescription**, and can be used with ' implies that the previous prescription can be used either the original prescription ** or other similar prescriptions**.
Professor Guo, I have a question. Xi Jianzhong began to ask again, "These two patients, obviously one is 'asthma' and the other is 'cold', why can Chinese medicine use the same prescription for two completely different diseases?"”
Haha!Professor Guo smiled, "This involves a basic problem of traditional Chinese medicine, which is 'treating different diseases at the same time'. Traditional Chinese medicine attaches great importance to syndrome differentiation and treatment, that is to say, syndrome is the basic focus of TCM clinical practice, and syndrome is the specific embodiment of pathogenesis. Different stages of the same disease often lead to different clinical syndromes due to differences in their pathogenesis, so we are all familiar with the need for 'different treatments for the same disease'. In fact, for different clinical diseases, if the pathogenesis of the pathogenesis is the same, then the diagnosis of clinical 'syndrome' should also be the same. Its theoretical basis is that the certificate is the same and the same treatment, and the certificate is the key to the decision. The old woman suffered from a chronic illness caused by the external cold, and her lungs were lost and she became wheezingThis little girl is the wind and cold, the evil qi is forced inside, and the lungs are lost and the upward is coughing. The basic pathogenesis of the two pathogenesis is the same, so the method is the same.
It turns out that the core of what we usually talk about syndrome differentiation and treatment is to identify the pathogenesis of diseases. Zhong Xiaoyi feels that she has a new understanding of the book knowledge of Chinese medicine, "I feel that the understanding of the concept of 'disease' in Chinese medicine is often vague, and it seems that it is not as rigorous as disease in modern medicine, and there is a clear difference." For example, this little girl can roughly meet the diagnosis of different 'diseases' such as 'cold', 'cough' and 'sun disease' in traditional Chinese medicine. ”
You have some truth to that, but it's not entirely true. Professor Guo gushed about his professional knowledge: "Due to the limitations of social and historical conditions, Chinese medicine has taken a completely different path from the development of modern medicine in terms of understanding diseases. Unlike modern medicine, which is good at understanding diseases from the perspective of microscopic pathology, Chinese medicine pays more attention to grasping diseases from a macroscopic and holistic perspective to summarize the laws of diseases. Therefore, as you have discovered, the vast majority of TCM 'diseases' in TCM are actually only clinical symptoms or signs, which is completely incomprehensible from the perspective of modern medicine.
It is also because of this that TCM symptoms such as cough, wheezing, and asthma are all related to the dysfunction of the lungs, and it is sometimes difficult to strictly distinguish them in clinical practice. However, these TCM diseases, named after symptoms, have been endowed with a unique connotation of disease - regularity in the evolution of pathogenesis. For example, cough causes lung qi loss and lung qi reversal, wheezing phlegm strains the lungs and obstructs the airway, asthma syndrome causes lung qi to be sluggish, and the kidneys lose intake. Therefore, although TCM emphasizes syndrome differentiation and treatment, you should realize that syndrome differentiation is actually carried out on the basis of distinguishing 'disease' (the disease of TCM). The core of TCM disease differentiation lies in grasping the main symptoms. For example, although cough, wheezing, and asthma have clinical similarities, there is a sound in the throat of wheezing, and the nose of wheezing snorts and shoulders are fundamentally different from coughing. ”
After listening to Professor Guo's words, Xi Jianzhong had a feeling of surprise: "It turns out that I always think that Chinese medicine only understands syndrome differentiation and does not know how to diagnose diseases, but it turns out that Chinese medicine also pays attention to disease differentiation, but the diseases of Chinese medicine are completely different from those of modern medicine." ”
How a person eats "Doctor!".Can I see a doctor?Xi Jianzhong's thoughts were suddenly interrupted.