In my clinical practice, I have an important experience, that is, there is a process of accumulation in reading and seeing a doctor, from less to more, from simple to complex, from easy to difficult. Little by little, day by day, trickle down into a river. Let's take the theory of the spleen and stomach as an example
1) Use ancient recipes, and the magic lies in the teacher's heart
Spleen and stomach disease syndrome is a common clinical injury fever for spleen and stomach weakness and depression of central qi. At the beginning, I also applied this prescription, and the main treatment of this syndrome is effective. Later, it was found that many patients were in the process of ** fever, and other symptoms were also cured, which attracted their own attention. Then he paid attention to it, recorded it, and compiled it into a book. If there is a fellow Taoist, Wang, who suffers from internal hemorrhoids and blood in the stool, and the self-use of Buzhong Yiqi decoction is ineffective, and the rest of the diagnosis is that the middle qi is subsided, the spleen is not unified with blood, and the drug certificate is consistent, why is the Dongyuan prescription out of order?There is still a layer of blood fever in the large intestine in the hemorrhoidal blood, and the locust flower has been used to disperse the cool serum heat since ancient times, so it is effective to participate in the two parties. And try to use other hemorrhoids patients are also effective, the prescription is: astragalus five money, codonopsis four money, atractylodes, angelica three money, cimicifuga one and a half money, locust rice three money, elm, arborvitae leaves each four money, tangerine peel money, bupleurum one money, licorice one and a half money. Every five doses are used to stop bleeding, followed by ten doses to be consolidated. Since then, Yu Xi has used the tonic qi soup to treat various diseases of the middle qi. If you have a habitual miscarriage, use the original prescription to add Ejiao, Artemisia leaves, Continuation, Eucommia, and Mulberry parasitism to tonify the kidney and strengthen the fetus;prolapse, with the original formula plus parsnip, citrus aurantium, that is, the combination of three odd scatter, can raise the qi;The use of the original recipe plus Chuanxiong (eight points), wind prevention and treatment of spleen deficiency and diarrhea for a long time originated from You Yi's "Golden Kui Wing", but there is always no Dongyuan to supplement the qi and promote yang. It can be seen that the key to using ancient recipes is to learn from their hearts, use their methods, and be flexible in order to accumulate their own experience.
2) Learning theories is more expensive than tracing back to the source
Starting from the application of Dongyuan Buzhong Yiqi Soup, I repeatedly read Dongyuan's "Treatise on the Identification of Internal and External Injuries", "Treatise on the Spleen and Stomach", and "The Secret Collection of the Orchid Chamber", from which I got a lot of inspiration. In particular, the "Treatise on the Spleen and Stomach" cites a large number of "Su Wen" and "Lingshu" to explain the theory of the spleen and stomach, solve difficulties and puzzles, advocate the theory of lifting and falling, and make up for the ascending yang in all directions. Therefore, I focus on the physiology, pathology, symptoms, treatments, prescriptions and drugs of the spleen and stomach, trace the origin of the theory of the spleen and stomach, and comprehensively compare the similar and opposite aspects. For example, "Neijing" "people are based on stomach qi" and Li Zhongzi's "spleen is the foundation of the day after tomorrow";"Neijing" "Yang Dao is real ** void" and "Treatise on Typhoid Fever" Yang Ming "stomach is real", Taiyin and spleen are insufficient;Dongyuan promotes spleen yang, and Tianshi nourishes stomach yin;Dongyuan "regulates the spleen and stomach to regulate the five organs" and Jingyue "regulates the five organs to regulate the spleen and stomach". All of these are accumulated and summarized by classification with famous sentences, famous prescriptions, main methods, and main drugs, and classified cards. Among them, I especially appreciate Zhang Zhongjing's "Jin Kui Yaolu" "The spleen is prosperous in all seasons and is not subject to evil" and Zhou Shenzhai's words "There are many people who are cured by finding the spleen and stomach without healing diseases", and they are used in clinical practice in connection with reality. If there are patients with recurrent disorders, a six-year medical history, the use of Western medicine and Chinese medicine to nourish the kidney and blood is ineffective, although there is a deficiency of the five organs, but the deficiency is not supplemented;Seeing that its abdomen is full, sluggish, loose stools, and greasy, it is cold and damp and sleeps the spleen, and the Huoxiang Zhengqi is combined to calm the stomach and disperse, and the bitter and warm and dry dampness awakens the spleen and appetizes. Following the methods of replenishing qi and nourishing blood, ** difficult diseases such as chyle ascites, hemoviolet, and coronary heart disease have also achieved good results.
3) Think diligently and sum up lessons and lessons
Not only do I have a habit of accumulating successful experiences, but I also pay attention to learning from failures from failed cases. I remember that in Yongxiu County, Jiangxi Province, there was a group of children with summer fever, who saw fever, polydipsia, frequent urination, sluggishness, loose stools, red tongue, and pulse deficiency. The initial syndrome is yin deficiency and summer heat, which is effective in nourishing yin and clearing heat. After thinking for a long time, the upper thirst and lower urine were focused on the syndrome differentiation, and the compress of Naijin liquid was abnormal. "The spleen is the stomach and its fluid". The disease of jin fluid should be regulated by the cardinal organs of the spleen and stomach. Fever, sluggishness, loose stools, red tongue, and pulse deficiency are also seen, which are obviously caused by insufficient spleen yin and floating yang. Therefore, Chen Wuxue Liushensan, "Bureau" Shenling Baizhu San, etc., use a large number of yams, lentils, seeds, and lotus meat to moisten the spleen and yin, and combine Lingcao to strengthen the spleen and invigorate qi, and the spleen and soil are healthy and the liquid is infused, and the spleen and yin are restored and the summer heat is self-eliminated, and finally the whole work is done.
At the same time, I often learn lessons from the failure cases of others and accumulate experience. There was a baby surnamed Liu, six months old, suffering from pneumonia, with green, strepto, red, gentamicin ineffective, in addition to fever without sweating, cough and phlegm, holding breath and lifting shoulders, vomiting, anorexia, and diarrhea five to twenty times a day, the stool was green mucus. When asked about the mother, the child usually has poor digestion and is prone to diarrhea and vomiting. After taking erythromycin, vomiting and diarrhea appeared. It can be seen that the spleen and stomach have been injured, which is caused by the lack of spleen qi and the loss of stomach qi. Therefore, it is recommended to stop using Western medicine, control the amount of breastfeeding, in order to protect the stomach qi, up and down diarrhea and fever, commonly known as "leaky bottom typhoid fever", such as the treatment of asthma to promote the lungs is easy to hurt the spleen and stomach, the treatment of diarrhea must be adjusted and hinder the lungs. I thought that the condition is complicated, the spleen deficiency is the foundation, and the lungs are the symptoms, so we should treat the symptoms first, and then the root cause. Use Xiaoqinglong and skullcap soup (the original recipe is gypsum because the spleen gypsum is not suitable, easy to use skullcap) two doses, after sweating, change to spleen and stomach ginseng qin self-surgery to cultivate native gold.
4) Selected medicines, repeated scrutiny
For the application of drugs, I have also continued to accumulate experience in clinical evidence, repeatedly scrutinized, and compared the differences between similar drugs and the same drugs of different types.
For example, the clinical use of qi drugs to treat spleen and stomach qi stagnation disease, there are incense, black medicine, wood incense, sand kernel, tangerine peel, citrus aurantium, magnolia, betel nut, pot-bellied skin, koren, etc., its spicy fragrance is warm and dry, with pain, fullness, depression, phlegm, dampness, and stomach, spleen transport effects, some drugs also have asthma, blood activation, liver soothing, and the effect of passing. However, because it is dry and easy to consume gas, it should not be used for a long time. Later, it was found in the clinical syndrome that the "Jiyin Compendium" with flavored black medicine soup can not only treat women's qi stagnation and dysmenorrhea, but also be effective for spleen and stomach qi stagnation syndrome. The four flavors of black medicine, incense, sand kernel and wood fragrance in the square are peaceful, and there are differences in the same, and there are similarities in the differences. Such as incense attached to the qi and soothe the liver and relieve depression, long in pain relief;The black medicine is full of qi, and it is suitable for the chest and abdomenWood incense is wide and stops diarrhea, and it is more suitable for diarrhea and diarrhea;Sand kernels are breathing and awakening the spleen and appetizing, and can aromatize and dissolve dampness. In clinical practice, two or three flavors are often selected in small quantities (one or two coins) to be used, and each one has a good effect.
Another example is the disharmony of the spleen and stomach, the stomach qi is reversed, and vomiting, belching, hiccups, acid swallowing, etc., and the rest of the two drugs are selected to reduce the inversion and stomach method. At first, I applied Zhongjingxuan to replace the ochre soup, but the time limit was not effective. If there is constipation, dry mouth, and greasy stomach heat, then go to ginseng, grass, jujube and melon wilt, weathered nitrate, rhubarb, and citrus aurantium.
For Yueju Pills, Wuji Pills, Banxia Xingxin Decoction, Citrus Pills and other prescriptions, the compatibility ratio of residual medicine also depends on the patient's constitution and symptoms. Such as citrus pills, false weight atractylodes, real weight accumulation. Wuji pills, Hanjun Wu Yu, Rejun Coptis chinensis. Yueju pills, incense, Chuanxiong, atractylodes, Divine Comedy, and mountain gardenia to treat the "six depressions", but also distinguish the difference between qi, blood, dampness, phlegm, and fire food, and enter and exit the cut.
When I take medication, I always pay close attention. For example, there is mint to relieve depression and clear air with aroma, the dosage is small, and the compatibility is wonderful. It is also effective when added to the spleen and stomach prescription medicine. And imitate its meaning to use lotus leaves, herb leaves, also play the same effect. Then add Su leaves and loquat leaves in the adversity side, and take the work of stopping vomiting and soothing the lungs. Both of them are leaf medicines, lotus leaves and mint are cleared, and loquat leaves and Su leaves are turbid. This kind of continuous accumulation of experience may seem ordinary, but there is a lot to be gained from it.