Case 1 headache
The patient, Sun, female, 39 years old, from Gao Shan Township, Sanmen County, was admitted to the hospital on December 26, 2012 for “abnormal urinalysis with elevated blood creatinine for six months”, hospitalization number: 376219.
Six months ago, the patient had a positive urine test and an elevated blood creatinine of 107umol/L. There was no obvious dizziness or headache, no facial or bilateral lower limb swelling, and the blood pressure was sometimes high.
He had a history of “hepatitis B minor tri-positive” for more than 10 years without antiviral treatment.
She has a history of recurrent headache, with headache mainly in the forehead, pain mainly in the forehead, pain can last for a whole day, aggravated during menstruation, accompanied by nausea, sometimes mainly dry vomiting, long-term irregular oral “headache powder” pain relief treatment for several years, and later oral “Fenbid The treatment is mainly oral “Fenbid”.
Examination: urine routine: protein +-, microscopic red blood cells ++; 24-hour protein quantification 0,14g, blood creatinine 94,0umol/L, serum albumin 38,2g/L, glomerular filtration rate (GFR) 63,9ml/min; hepatitis B surface antigen positive, hepatitis B core antibody positive, hepatitis B e antibody positive, hepatitis B virus DNA 7,34×10^3 copies/ml .
Renal puncture results: 1, IgA nephropathy (thylakoid hyperplasia with segmental crescent formation); 2, chronic tubulointerstitial nephritis
The headache has been relieved recently, with dizziness and vomiting, but not vomiting, without rotation of vision and tinnitus, good night sleep, no dry mouth, normal stool, dark red tongue, thin moss, obvious sublingual vein stasis, stringent and astringent pulse, reduced by heavy pressure.
Pathogenesis: Stomach cold and liver rebellion, blood stagnation, and rebellion of turbid yin.
Treatment: Warming the liver and stomach, draining turbidity, promoting Yang and activating blood circulation to resolve blood stasis
Wu Juju 15g, Radix Codonopsis 15g, Ginger 30g, Jujube 10g, Angelica dahurica 10g, Chuanxiong 45g, Radix Angelicae Sinensis 10g, Tao Ren 10g, Safflower 6g, Radix Paeoniae 10g, Radix Bupleurum 10g, Radix Platycodon grandiflorum 5g. 3 doses
After taking the medicine, he had one attack of headache with reduced severity and pain duration of about 1 hour, without nausea as well as vomiting, and still felt dizzy.
Wu Zhuyu 15g, Dang Shen 15g, Ginger 30g, Jujube 10g, Angelica dahurica 10g, Chuanxiong 45g, Angelica sinensis 10g, Tao Ren 10g, Safflower 6g, Radix Paeonia lactiflora 10g, Chai Hu 10g, Radix Platycodon 5g, Zedoary 30g, Rhizoma Atractylodis Macrocephalae 10g. 3 doses
The patient’s headache was relieved at the time of discharge.
Case 2 Headache
Lv, 28 years old, a kindergarten teacher. She came to the hospital for treatment of “thyroid nodule and uterine fibroid”. During the course of medical history, she was told that she has had headache for more than 3 years, with headache mainly in the top and left temporal region, with vague pain every day, which is obviously aggravated during menstruation, usually afraid of cold, constipation, poor appetite, little food, frequent belching, erratic, dry vomiting, no nausea, vomiting, low menstrual volume, black color, obvious dysmenorrhea, and short duration of menstruation (3-4 days). The tongue is pale red, with thin coating, inconspicuous sublingual stasis and thin pulse strings.
Pathogenesis: Stomach cold, liver rebellion, turbid yin upward rebellion and Shaoyang pivot adverse stasis.
Treatment: Warming the liver and stomach, draining turbid yin and promoting Yang, and harmonizing Shaoyang, activating blood circulation and resolving blood stasis.
Wu Juju 15g, Radix Codonopsis 10g, Ginger 30g, Jujube 10g, Chuanxiong 20g, Chai Hu 10g, Radix Codonopsis 10g, Scutellaria 10g, Semen 10g, Radix et Rhizoma Glycyrrhizae 10g, Gui Zhi 10g, Poria 10g, Taoren 10g
Second consultation: On the second day of taking the medicine, the headache attacked, the degree was more severe than usual, the pain was obvious at the top at first, then shifted to the left temporal lobe, insisted on taking the medicine, on the third day it shifted to the right temporal lobe, then the degree gradually reduced compared with before. On the fifth day, there was basically no pain, and the belching was significantly reduced and the bowel movements were clear. The tongue and pulse are the same as before.
The above prescription was continued with 7 doses. The headache was relieved without recurrence.
Case 3: Polycystic kidney hemorrhage
The patient, Huang, female, 49 years old, from Hangzhou, was admitted to the hospital on October 26, 2012, with the hospitalization numbers 371747 and 375593 (billed once on December 17, 2012) because “polycystic kidney was found 19 years ago, recurrent hematuria for 13 years and recurrence for 1 day.
Diagnosis.
1, polycystic kidney infection with hemorrhage
2, chronic renal insufficiency CKD stage 5
Maintenance hemodialysis
Renal hypertension
renal anemia
3.Multiple stones in both kidneys
4, liver cysts
After admission, levofloxacin and moxifloxacin were used for anti-infective treatment, and symptomatic treatment was given with bactrim injection, hemostatic aromatic acid, vitamin K1 injection, and anorectal blood tablets to stop bleeding. Nearly one month after the above treatment, recurrent dark red hematuria, frequent abdominal pain, and obvious when the position changes.
11, 26 moments of diagnosis: the patient solves dark red urine, the amount is not much, the spirit is soft, the face is atrophic, the fear of cold is obvious, especially the back is obvious, the appetite is average, the night sleep is still possible, there is no obvious dry mouth, the stool is not smooth, the tongue is reddish, the moss is thin and yellow, the pulse is sunken and string.
Pathogenesis: Spleen-Yang deficiency, spleen does not control blood.
Treatment: Warming the middle and strengthening the spleen, stopping bleeding.
Herbs: Astragalus membranaceus 20g, Radix Angelicae Sinensis 10g, Radix Codonopsis pilosulae 15g, Rhizoma Atractylodis Macrocephalae 10g, Radix Platycodon grandiflorus 5g, Radix Ginseng 10g, Radix Ginger 50g, Radix Glycyrrhiza Uralensis 10g, Cornu Cervi Pantotrichum 30g, Radix Oyster 30g first decoction, Rhizoma Rootstalk Char 10g, Radix Blood Yu Char 3g 3 doses 11,26-11,28
After taking the medicine, the color of urine was slightly lighter than before, but it still showed hematuria, and the fear of cold and chills was improved.
For the second consultation, the above was added with Panax notoginseng powder 3g for dosing.
Later, due to unsatisfactory blood pressure control, the patient contacted the hemodialysis unit to increase ultrafiltration and adjust the antihypertensive drugs and stopped using Chinese medicine. After treatment, blood pressure was well controlled. However, hematuria was still present and requested herbal treatment.
2012.12.19 Third Consultation: The patient has dark red urine, not much volume, soft spirit, yellowish complexion, fear of cold still exists, especially in the back, general appetite, sleep at night is still possible, dry mouth, likes to drink cold water, constipated stool, solved stool is a kind of pellets, red tongue, yellowish brown moss, sunken string pulse, heavy pressure is strong.
Pathogenesis: internal stagnation of heat, heat enters the blood and moves the blood
Treatment: Cool the Blood to stop bleeding, and clear the heat
Radix Bupleurum 50g decoction, Radix Rehmanniae 30g, Radix Paeoniae Alba 15g, Radix Paeoniae Lactiflora 30g, Radix Salviae Miltiorrhizae 15g, Radix Ginseng 10g, Radix Forsythiae 15g, Citrus Aurantium 10g, Radix Glycyrrhiza Uralensis 10g, Radix Oyster 30g decoction, Radix Longbone 30g decoction, Radix Lotus Root Char 10g, Radix Artichoke Char 10g, Radix Artichoke Char 10g 3 doses of strong decoction
2012, 12, 25 Fourth Consultation: The patient had smooth stool, urine color improved significantly, dry mouth symptom improved, chilliness and fear of cold improved again, red tongue, yellowish brown coating, sunken string pulse, still strong on heavy pressure.
Decoction of 50g of water hyacinth, 30g of raw earth, 15g of red peony, 30g of white peony, 15g of dandan bark, 10g of basilica, 15g of forsythia, 10g of hedgehog, 10g of roasted licorice, 30g of raw oyster, 30g of dragon bones, 10g of lotus root charcoal, 10g of small thistle charcoal, 10g of large thistle charcoal, 5g of cicada, 10g of ginger yellow, 10g of stiff silkworm, 10g of jiao jasmine. 3 doses of strong decoction
The urine color turned yellow and the symptoms improved, and the patient was discharged.
Case 4: Erythema multiforme
Patient Zhang, female, 33 years old, Hangzhou resident, hospitalization number 309013, was admitted with “abnormal urinalysis for 7 years, creatinine elevation for 6 months, and generalized skin rash for 1 month”.
Diagnosis: 1, erythema multiforme; 2, IgA nephropathy, chronic renal insufficiency, uremia
The patient’s medical history is more than 7 years, clinical urinalysis is abnormal with high blood pressure, renal puncture suggests: IgA nephropathy (proliferative sclerosing nephritis) sclerosis proportion is about 40%, hormone + primaquine + ARB and so on 2 years after the discontinuation of hormone treatment. Six months ago, he was found to have elevated creatinine of 200+umol/L and protein ++++ in urine test. 1 month ago, he had a high fever of 39,0℃ with a red rash of needle dots all over the body, which fused into patches and faded under pressure with itching after he got cold, ate shrimp and took cephalosporin anti-inflammatory drugs. Later, the rash worsened and all of them melted into flakes, and no normal skin could be seen. The dermatology department considered “polymorphic erythema” and gave intravenous gammaglobulin and methylprednisolone injection (80-150mg/day), which relieved the high fever, but the rash did not improve, and the blood creatinine increased progressively, so he was transferred to our department. He was given hemodialysis (hemofiltration, HDF) and symptomatic treatment with methylprednisolone, immunoglobulin and anti-allergy. Intravenous hormone was continuously applied for more than 4 months (maximum 120mg/day, new rash appeared when the dose was reduced to 80mg/day at the beginning, later it was gradually reduced to 40mg/day.) During this period, she also took oral Chinese medicine, but the effect was not good and she stopped using it.
Erythema all over the body, red in color, all fused into patches, due to long-term hormone therapy, Coxsackie’s disease is obvious, with dry mouth, fear of heat, preferring to drink cold water, red tongue, little coating, string and smooth pulse.
Pathogenesis: Heat enters the blood and moves the blood
Treatment: cooling the Blood and clearing heat to eliminate blemishes
Chinese herbal medicine: 100g of water hyacinth, 30g of raw earth, 15g of red peony, 15g of white peony, 10g of dandruff, 50g of comfrey, 15g of raw cyperus, 30g of dry lotus grass, 10g of wu mei, 10g of fang feng, 10g of snake shedding, 10g of angelica, 10g of bitter ginseng, 10g of roasted licorice, 1 centipede. 7 doses.
After taking the medicine, the symptoms of dry mouth and fear of heat improved significantly, and water hyacinth was increased to 200g first decoction, and the rest of the medicine was continued as before.
Rash improved, symptoms improved, gradually withdraw hormone. After the above cumulative consumption of more than 1 month, the patient’s whole body erythema reduced light, visible normal rash.
Case 5: mixed cold and heat
The patient, Shi, female, 63 years old, Yuhang, “elevated blood sugar for more than 10 years, intermittent swelling for 10 years” was admitted to the hospital on November 15, 2012, hospitalization number: 373207.
Diagnosis
1. Chronic kidney disease
Chronic renal insufficiency CKD stage 5 maintenance hemodialysis
Renal anemia
Renal hypertension
2.Type 2 diabetes mellitus
Diabetic nephropathy
Diabetic retinopathy
3.Post-operative right lower extremity malignant tumor
The patient had diabetes mellitus for 10 years with poor glycemic control. He had a history of “retinal detachment” and was diagnosed as “diabetic retinopathy” by a foreign hospital.
She was hospitalized 10 years ago for “fish bile poisoning and acute renal failure”, and the recovery of renal function was unknown at that time.
He had a history of surgery for “malignant tumor of the right lower extremity” more than a year ago, and was treated with chemotherapy after surgery.
He was given symptomatic treatment: maintenance hemodialysis 3 times/week; insulin combined with Bystolic tablets for glucose-lowering treatment, and Ligustron, folic acid, and Nimhangxin injection to correct anemia.
12, 27 check-up: pain in the lower limbs is obvious, poor appetite, depression, fear of cold during the day is obvious and cannot be relieved by wearing thick clothes, fear of heat at night, bare feet, cannot cover the blanket, poor night sleep, light red tongue, thin yellow moss, thin string pulse.
Pathogenesis: syncope, mixed cold and heat
Treatment: Warming liver yang, regulating cold and heat
Herbs: Wu Mei 15g, Hsiang Xin 6g, Gan Jiang 20g, Radix Angelicae Sinensis 20g, Radix et Rhizoma Polygonati 20g, Hua Jiao 10g, Gui Zhi 12g, Huang Lian 10g, Huang Bai 10g, Radix Codonopsis Pilosulae 30g, Dao Zao 15g 3 doses.
Second Diagnosis: The symptoms of fear of cold during the day and fear of heat at night improved significantly. Continued with 3 doses.
Case 6: Mixed cold and heat
Zhang, female, 56 years old, a patient of Deqing Clinic. Abnormal urinalysis, urine protein +-++, red blood cells +-+++, occasional swelling of both lower extremities, no hypertension, refused kidney puncture, diagnosis “chronic nephritis-IgA nephropathy?” .
The patient was given Radix Polygoni Multi-Glucoside Tablets 10mg tid and Mecasin 40mg qd for proteinuria and hematuria.
Patient’s prominent symptoms: fear of cold, general appetite, lumbago, frequent urination during the day, need to go to the toilet immediately after drinking water, sleep at night, basically do not get up at night, normal stool, light tongue, thin white fur, sunken and thin pulse.
Pathogenesis: deficiency of kidney yang, internal stagnation of water and drinks
Treatment: warming kidney yang and dispelling drinks
Chinese medicine: Zhen Wu Tang + Wu Ling San plus reduction. (Dose of Radix et Rhizoma Polygonati 10g)
Second consultation: fear of cold slightly improved, but other symptoms did not improve significantly, and the frequency of urination increased, especially 2-3 times at night, tongue and pulse basically the same as before.
The dosage of the previous prescription was adjusted: the dosage of Radix Aconiti was increased by 20g.
Third consultation: urine routine: protein negative, red blood cells +. But other symptoms still did not improve. Re-interrogation of symptoms: patient’s fear of cold is obvious, but with a little work, fear of heat appears, necessitating the blowing of electric fans (in winter).
Pathogenesis: syncopal yin disease, mixed cold and heat
Treatment: Warming liver yang, regulating cold and heat
Chinese medicine: Wu Mei 15g, Hsiang Xin 6g, Gan Jiang 20g, Angelica Sinensis 20g, Radix et Rhizoma Polygonati 20g, Hua Yao 10g, Gui Zhi 12g, Huang Lian 10g, Huang Bai 10g, Dang Shen 30g, Dao Zao 15g 5 doses.
Fourth diagnosis: After taking the above, the patient’s symptoms improved significantly, the frequency of urination was basically normal, especially fear of cold and fear of heat improved significantly. Urine routine was negative for protein and negative for red blood cells.
The above prescription was continued for 7 doses. The patient is still being followed up.
Case 7: Pneumonia infection in uremic patient
Patient Liu, male, 43 years old, was admitted to the hospital with “chronic renal insufficiency, maintenance abdominal dialysis; upper respiratory tract infection” because of “abdominal dialysis for more than 1 year, fever and cough for 3 days”. The patient was admitted to the hospital with “chronic nephritis, chronic renal insufficiency CKD stage 5” more than one year ago, and started maintenance abdominal dialysis treatment. The highest temperature of 39 degrees Celsius, with fever, cough, cough sputum white, local antibiotics, antipyretic drugs applied for 3 days, ineffective admission. The blood was checked for high-sensitivity C-reactive protein 21,68 mg/L; blood routine: white blood cell count 6,0*10E9/L, neutrophil (%) 66,8%, hemoglobin 96 g/L, platelet count 229*10E9/L; emergency biochemical routine: urea (Urea) 16,3 mmol/L, creatinine (Cr) 1165 μmol/L, potassium (K) 3,2 mmol/L; pulmonary 2mmol/L; pulmonary CT examination: inflammation of the upper lobe of the right lung and the lower lobe of the left lung.
Diagnosis: 1, lung infection
2, chronic nephritis
Chronic renal insufficiency CKD stage 5
Maintenance abdominal dialysis
Renal hypertension
Renal anemia
3.Hypertensive heart disease
Heart enlargement Heart function grade 3
After admission, he was treated with Rohypnol and Mucosolvan to reduce sputum.
Diagnosis: fever, chills, no sweating, cough and sputum, yellow and white sticky sputum, slight shortness of breath, general discomfort, dry mouth, drinking warm water, red tongue, yellow fur, sunken, dry and counted pulse, strong heavy pressure.
Pathogenesis: Wind-cold contains heat in the lung
Treatment: Promoting heat in the lung and clearing heat
Raw ephedra 9g, cinnamon stick 9g, light almond 9g, roasted licorice 10g, raw gypsum 50g, raw ginger 15g, sliced turmeric 10g, cicada 6g, stiff silkworm 10g, made jun 3g, forsythia 15g, peppermint 5g 3 doses
After taking the medicine, slight sweating, chilliness and dry mouth were significantly relieved, body temperature was normalized, and cough as well as coughing sputum improved. He was discharged from the hospital after 5 days of hospitalization.