(the text contained in the "diagnosis" of more than sentiment. Shanghai University of Traditional Chinese Medicine press. 2009 first edition
(the text contained in the "diagnosis" of more than sentiment. Shanghai University of Traditional Chinese Medicine press. 2009 first edition. Zhu America, chief editor Jiang Jian)
Warm and humid climate, fat and spicy diet, plus the tense pace of life, in recent years, Shanghai people have more and more stomach. A typical symptoms of stomach is nausea and vomiting in the hospital, I almost every day as a chief complaint of patients. The same symptoms, western medicine treatment in general, Chinese medicine treatment can be very different; sometimes western medicine has been powerless, and the traditional Chinese medicine can be a dose of more.
One day in May this year, I am on duty in the ward had encountered such a patient: a 60 year old woman, two, frequent vomiting, dizziness, micro cold. Emergency blood: white blood cells 8.6 * 109/L, neutrophils 76%. The diagnosis of acute gastritis, given oral levofloxacin anti infection, intravenous famotidine acid, vitamin B6, antiemetic, seems to be slightly eased. After wards, patients still feel nausea, vomiting slightly moving, one hour vomited three times, is very painful. The doctor followed the diagnosis and treatment of small Shen beds in emergency, continue to use the drug, but the effect is not obvious, combined with metoclopramide antiemetic, are still valid. Ask of history: three of the patients had fever before the day, the temperature is not high, self testing of about 37.8 degrees Celsius, then taking home a stuffy nose chills, by "cold tablets", relieve nasal chills, body temperature dropped to 37.3 degrees celsius. The symptoms of nausea and vomiting, no obvious congestion, slightly dizzy, ignoring the rotating micro, aversion to cold, pale tongue, yellow greasy moss, pulse moisten slip. From the analysis of history, the patient should be corrected for the diagnosis of gastrointestinal type of cold, emergency medication is obviously lack of targeted. Just as the antiemetic metoclopramide, vitamin B6, which may be effective, but the actual application was also demonstrated on this patient is invalid. Because near work, real Chinese medicine has stopped accepting ward prescription, Dr. Shen proposed using granisetron Qiongzhen spit, consider the drug is a potent selective peripheral and central nervous system 5-HT3 receptor antagonist, formerly used for nausea and vomiting caused by chemotherapy or radiotherapy, the effect of cold induced vomiting may not be better than metoclopramide, and drug it is too expensive, not used. Fortunately, we have owned the emergency ward cabinet, although the taste is not much, but it is still as pressing danger to rescue. A moment later, I wrote the following Zhang Ziou fang:
Coptis 3 grams 9 grams of sweet basil
On the two, with 300 ml boiling water soak for 5 minutes, go to the dregs, take 100 ml, 100 ml every 2 hours and then served as a service agent, before going to bed.
See a full cup of medicine, some patients seem to dislike, frowned, about to speak, but saying nothing. Half an hour later, the nurse came and the patient was still vomiting! I immediately rushed to the bedside, but found that the decoction did not move. Indeed, whenever anorexia vomiting patients are difficult to accept, not to mention the Chinese medicine decoction, give the impression of this is "conditioning conditioning" and "cure chronic disease", "emergency" in this moment, who has the mood to eat bitter juice "slow"? Insight into the patient's mind, problems will be smoothly done or easily solved through persuasion, patients, immediately drink a small cup. As expected, after taking the drug, the patient did not vomit. The second day rounds, according to the pathogenesis, the sage Coptis Decoction on the basis of add wind dispersing cold dampness medicine, another side, not on the two day after the rehabilitation of patients.
Sage "from Coptis Decoction" primary disease of dampness heat, dosage of Coptis is only 0.9 ~ 1.2 grams, sage is only 0.6 ~ 0.9 grams, this "warm Jingwei" explained: "the fraction of light, light to the agent what makes ear disease". With a small amount of the light, with boiling water is lesser, so in this case without boiling. Is small, but often can see miraculous harvest, but clinical vomiting is lung stomach and damp heat obstructing, cast rudd-u.
Another case is vomiting, western medicine diagnosis and treatment of the above is completely different, pofeizhouzhe, worth mentioning. It was a Friday afternoon in April, by the emergency room patients: a middle-aged men, a day before the food festival, sudden stomach pain and vomiting, second in the morning to the gastroenterology clinic, medical history and endoscopic report combined with clinic doctor, diagnosed as esophageal hiatal hernia repair, postoperative reflux esophagitis "to the emergency, inflammation, intravenous vitamin B6, omeprazole, 654-2, after the administration of stomach pain reduced, but still can not control the vomiting in the afternoon, then at two wards. At the time of admission in patients with vomiting frequency, there is an almost every ten minutes, although the spit and less, it is difficult to spit when carefree, violent action, expression of pain, unable to stop. Vomit censorship, occult blood (+ +). For inserting gastrotube, gastrointestinal decompression, drainage of gastric contents about 300ml, brown, with food residue, after decompression with 37 6 grams of powder injected into stomach bleeding control. To five points off work, vomiting slightly eased. The next morning rounds, thought the symptoms should be significantly reduced, but the actual situation is disappointing. The patients looked fatigue, vomiting endlessly, just rejection by gastric outflow only, and because of stomach discomfort in the throat stem, more. Patient feedback showed that all treatment measures were almost ineffective for vomiting. Careful analysis of disease: Patients with esophageal hiatal hernia and stomach pain and vomiting, frequent severe vomiting caused by gastrointestinal mucosal injury (cause, treatment of occult blood positive) so the primary objective is to reduce the incidence of vomiting. At the beginning of gastrointestinal decompression, due to the rapid discharge of the stomach contents, the vomiting is temporary relief, but the root cause of vomiting has not been released, so in the end can not stop vomiting. The conventional antiemetic metoclopramide may cause stomach stomach aggravating, may also exacerbate mucosal bleeding, it should not be used; vitamin B6 effect is weak, has no obvious effect in clinic, then there is no need to. The only thing left is Chinese medicine.
Patients with the disease for more than two days, signs of nausea frequently, appetite vomiting, gradually to eat also spit, Water Valley Club, mental fatigue, red tongue, thin and yellow moss, empty pulse string number. This certificate of origin Qi disorder, heat stagnation in two coke, after two days of vomiting, stomach big deficiency, that heat deficiency, cold and heat isolation to. To the pathogenesis of Zhongjing Coptis decoction, but three thinning agent.
9 6 6 ginseng ginger Coptidis Guizhi 9
Jiang Banxia 12 jujube 9 Zhigancao 6
The seven flavor, with water of 1 liters, cook take 600 ml. I go to the clothes, three times a day, and even served three days.
According to the stomach, patients feel hot from the stomach rises, is very refreshing. An agent and vomiting reduced, three agents actually received full power. A week after the examination, fecal occult blood (-) patients. Effect of quick, reason is beyond expectation is vomiting in patients with esophageal hiatal hernia, if stop vomiting, then hernia must have returned back to the body, it is difficult to imagine the medication alone can achieve this purpose, and doing so quickly. In fact, the prescription at the beginning, I was not thinking of using traditional Chinese medicine and the hernia, just according to the prescription and syndrome differentiation of the thoughts of Coptis decoction, did not want to check after effect if women, not only vomiting disappeared, disease also healed.
The above two cases, or for the pathogenesis of damp heat obstructing, or cold and heat, always in hot, spit contrarian play, once the effective treatment, the disease that is quickly. Here is a case, no heat pathogenesis, vomiting is not very intense, is not frequent, but Jiuzhibuyu, patients suffering. This is a female patient, 58 years old, in March this year in our out-patient treatment, nearly five years before the diet with repeated vomiting, epigastric pain, belching and acid regurgitation, vomiting after drinking soup to see more, drink after a while that of spit, spit out fast, no longer as. Out of hospital gastroscopy examination of "superficial gastritis, HP (+)", to the anti HP triple therapy for a course of treatment, the symptoms did not improve, and then in a hospital for Chinese medicine specialist outpatient treatment of traditional Chinese medicine for half a year, also invalid. At the end of last year, attracted calls in Department of Gastroenterology in our hospital treated by Professor Cai Gan, January, stomach acid reflux disease all except only vomiting is still, to take domperidone, vitamin B6 can slightly improve, because of job transfers, inconvenience in Puxi, then to the hospital of traditional Chinese medicine outpatient treatment to eastern. Patients with newly diagnosed, sallow complexion, cold warm, although the body is still a spring, winter, when the sound of belching, faint, discomfort in the throat, as a matter in which the stem, swallow it, spit out, do not want to drink water after the prosecution, will vomit, one day drink will not feel very thirsty, the food can be two satisfied, regulating. Slightly dark pale tongue, greasy moss thin water, fine pulse. The phlegm infestation, drink stop coke, throat phlegm depression, treatment should be five Lingya, banxiahoupu Decoction with the use of seven party agent.
30 15 20 Atractylodes Poria Polyporus Alisma 15
6 15 9 Magnolia ginger Banxia Guizhi 9
Nine taste, to 1 litres of water, boil 600 ml. I go to the clothes, three times a day.
A week after follow-up, the symptoms improved obviously, a little water can not spit, throat discomfort, the original take seven agent, in addition to various symptoms noted. Entanglement of five years of disease, and then disappear.
A review of three cases, the diagnosis of Western medicine were gastrointestinal cold, hiatal hernia, chronic gastritis, symptomatic treatment method is quite similar, no drug metoclopramide, domperidone and vitamin B6, but the effect is not satisfactory; due to treatment, western medicine has been the lack of effective treatment for colds, anti HP therapy drug treatment of esophageal hiatal hernia and chronic gastritis in the case of vomiting symptoms improved and no obvious help. In contrast, the treatment of Chinese medicine from the vomiting of different pathogenesis, the development of three significant differences in prescription. Careful comparison, can be found in the first two prescriptions have Coptis, after the two have the Pinellia and ginger, and the first end of the two Zhang Suye is the same. Coptis, pinellia, ginger, sage is the main drug ingredients for the rest of the symptomatic, different etiology (pathogenesis). The main medicine corresponding to the symptomatic Coptis heat syndrome, pinellia, ginger, sweet basil corresponding to the cold syndrome, if appropriate compatibility, and both cold and heat. Think deeply, and can be found in traditional Chinese medicine antiemetic ingenious both causes and symptoms, even symptomatic drugs also contains due to treatment means, and Western medicine in symptomatic with the result is completely separate. This is the unique value of traditional Chinese medicine.