Combined Chinese and Western medicine treatment plan for traumatic intracranial hematoma

  Traumatic intracranial hematoma is called medullary sea stasis in Chinese medicine. The “Ling Shu Hai Lun” “the brain is the sea of marrow, its transmission lies on its cover, the lower in the Feng Fu”. “Sea of marrow is not enough, then the brain turns tinnitus, shin acid vertigo, eyes do not see, slack and rest.” The evidence of the treatment of the standard of care “cloud” “cover the medulla sea of the true qi gathered, the pawn does not suffer evil, suffer evil death not cure.” In the “Medical Lin Correction of the Brain Marrow”, it is pointed out that “the one who is in the brain marrow is called the Sea of Marrow.” The Ling Shu evil qi visceral disease form: “If there is a fall, the evil blood stays inside and does not go.” The current textbook of orthopedics and traumatology also has the evidence of “cranial blood stasis” among the internal evidence of injury. This is the name of the disease, which is equivalent to “intracranial hematoma” in Western medicine.  1, signs and symptoms: patients have headache and dizziness, tinnitus, memory and comprehension loss, mental indifference, impaired consciousness and the corresponding localization of the injury site signs typical patients have intermediate waking period and other stasis blocking clear orifices witness, generally are actual evidence. In the later stage, when dizziness and tinnitus, memory and comprehension loss and other symptoms of empty medulla oblongata occur, they are mostly deficient. Trauma to the head causes stagnation of qi and blood stasis, blocking the clear orifices, so that the clear yang does not rise, the cloudy yin does not descend, the qi reverses, the gods are misled, and the brain function becomes impaired and produces a series of manifestations.  2.Treatment principle: large hematoma must be removed by early craniotomy. Conservative treatment and postoperative treatment mainly focus on removing blood stasis and stopping bleeding, moving qi, relieving pain and opening the orifice.  (1) Conservative treatment For consciousness or mild drowsiness, no pupil changes, hematoma volume <30ml above the curtain, <10ml below the curtain, layer thickness <10mm, midline structure displacement <10mm, and stable condition, conservative treatment can be given under the premise of close clinical observation, the main measures are dehydration, hormone, hemostasis, anti-infection and blood stasis treatment, the application of dehydrating agents should not be in large doses in the early stage. The main measures are dehydration, hormone, hemostasis, anti-infection and blood circulation. During the conservative treatment, the changes of consciousness, pupil and vital signs should be closely observed, and CT should be used for dynamic observation, and once the indication for surgery appears, emergency surgery should be performed to remove the hematoma to relieve intracranial hypertension.  (2) Surgical treatment Usually bone window craniotomy or bone flap craniotomy is used to facilitate complete removal of hematoma, adequate hemostasis and subdural exploration if necessary. In recent years, with the widespread use of CT scan, the number of reports of successful treatment of epidural hematoma by minimally invasive methods (including drilling and drainage, small bone window craniotomy, etc.) has gradually increased. The authors believe that we should pay attention to the indications and surgical techniques of various procedures in order to achieve satisfactory results.  (3) Chinese medicine treatment Conservative treatment and postoperative treatment mainly focus on resolving blood stasis and stopping bleeding, moving Qi, relieving pain and opening orifices. Internal medicine: Chinese medicine: Tian Qi powder 3g, 3 times per item. Chinese herbal medicine: Peach and red four-item soup with reduction. Commonly used medicines: peach kernel, safflower, Chuanxiong, red peony, angelica, hedgehog, salvia, yanhu, rehmannia, codonopsis.