Example of an effective case of reusing Ren Ren Ren Tang with Ephedra Hossein and Radix Eryngium
Li, female, born in 84.
First consultation: 2012.9.27
Complaint: 1 spontaneous miscarriage, back pain for 5 months.
History: Menstruation is usually regular, with a 30-day cycle and 6-7 days of menstruation, with medium volume. Her last menstrual period was on 9.23. She had menstrual cramps 1 day before and 1 or 2 days during her menstrual period.
She reported that after the spontaneous abortion in April of that year, she had the following symptoms: fear of wind and cold, sweating in the back; heel pain, cold pain in the lumbosacral and right knee, cold into the bone marrow (the patient’s original words are “cold into the bone”), lumbar acidity and weakness, with a feeling of “heaviness”; night sleep and dreaminess, weakness after waking up, swelling of the hands, and difficulty in clenching the fist; her mouth was full. After the miscarriage in April, she consulted several doctors and was diagnosed with “pelvic inflammatory sequelae”, and the prescriptions used were mostly based on tonifying the kidneys and nourishing the blood, activating blood circulation and relieving pain, with no improvement.
Physical examination: Tongue light dark red with thin coating, pulse slippery and right slightly sunken.
Analysis: cold pain and heaviness of the waist is due to cold dampness staying outside the kidney; the spleen is the main limb, cold dampness offends the spleen, so it is difficult to hold the hand swollen and sticky in the mouth; coldness of the waist and knees into the bone marrow, heel pain, indicating that the disease is beyond Taiyin, involving Shaoyin, cold dampness penetrates deep into the bones; fear of wind and cold, sweating on the waist and back is due to Yang deficiency; dreaming is due to Yang deficiency and lack of potential, and loss of harmony between Yin and Yang. The right pulse is the main yang, the right pulse is sunken, the right knee is cold and painful, in line with “the right and left are the paths of yin and yang”.
Disposition: 6 doses of Chinese herbal medicine.
The herbal formula was based on Ren Ren Ren Tang with the addition of Ephedra Hossein and Radix Pseudostellariae, as follows.
Dried ginger 20G Poria 30G Atractylodes macrocephala 30G Roasted licorice 15G
Dragon Bone 20G Raw Oyster 30G Roasted Ephedra 6G Hosin 6G
Radix et Rhizoma Pseudostellariae 15G Radix et Rhizoma Mulberry 20G
Second Diagnosis: 2012.10.11
Self-report: cold pain in lumbosacral and right knee worsened. After waking up, the hand grip was not tight and the heel pain improved.
Analysis: The amount of medicine prescribed in the first consultation was already quite heavy, including 20g of dry ginger, 15g of Radix et Rhizoma Atractylodis Macrocephalae and 30 of Atractylodis Macrocephalae, but after the patient took them, the cold pain in the lumbosacral and knee did not decrease but increased! A careful review of the previous diagnosis is correct, the use of medicine fits the rationale, so ineffective, because the medicine does not match the disease. Therefore, we reapplied Gan Jiang Ling Zhu Tang, in which the dry ginger was increased to 40g, and the Radix et Rhizoma was also increased to 20g, and the heart was increased to 9g.
Disposition: 7 doses of Chinese medicine.
Dried ginger 40G Poria 40G Atractylodes 40G Roasted licorice 20G
Dragon Bone 20G Raw Oyster 30G Roasted Ephedra 6G Hosanna 9G
Radix et Rhizoma Pseudostellariae 20G Radix et Rhizoma Mulberry 20G
2012.10.27, because my number was not available, I transferred 7 doses of the prescription to other doctors (continued ahead).
Third consultation: 2012.11.8
Self-report: all the symptoms (especially lumbosacral cold) were reduced by half after the previous consultation. Last menstruation: 10.24, dysmenorrhea reduced.
This time, she added: “After the miscarriage in April, I found that the leucorrhea after menstruation was heavy and blood-stained”. Because of the severe back pain and coldness before, I did not have time to care about this symptom, but now that the lumbosacral coldness and other symptoms have greatly decreased, I remembered to tell the doctor that I had this unspeakable problem of having a lot of blood in my belt. Now I have reached ovulation and have not yet experienced this symptom.
Analysis: The front is effective, remove the pungent spice to prevent its pungent warmth from dispersing too much and injuring the yin fluid; increase the amount of Radix Aconiti and decoct it first to prevent its toxicity; add Deer horn slices with blood and flesh to nourish the kidney and warm the governor.
Disposition: 7 doses of Chinese herbal medicine.
Dried ginger 40G Poria 40G Atractylodes macrocephala 40G Roasted licorice 20G
Dragon Bone 20G Raw Oyster 30G Roasted Ephedra 6G Radix Aconiti 30G (first decoction for 1 hour)
Mulberry 20G Deer horn slices 10G
Fourth Diagnosis: 2012.12.13
Self-report: Last menstruation 11.29, 5 days clean. The symptom of leucorrhea with blood after menstruation has been removed. Sacral cold stiffness, aggravated by cold weather, shortness of breath. Stool is no longer rotten.
Physical examination: light red tongue with white fur.
Analysis: The sacral coldness and stiffness recurred after the removal of Hesperidin in the front, considering that the front was not strong enough, so this formula was used again to search for wind and cold with Hesperidin; another concern was that the long-term application of large amount of dry ginger would hurt the stomach yin, so Kidney Dressing was slightly reduced by about one-fourth.
Disposition: 7 doses of Chinese medicine.
Dried ginger 30G Poria 20G Atractylodes macrocephala 30G Roasted licorice 18G
Dragon bone 20G raw oyster 30G roasted ephedra 6G hosin 9G
Radix et Rhizoma Pseudostellariae 30G Radix mulberry 20G Deer horn slices 10G
2012.12.26 Although the lumbar back was still cold, the patient took the front effective, because the number could not be registered, the patient transferred the prescription to another doctor for 7 patches.
Fifth consultation: 2013.1.31
Last menstrual period 1.25, the volume is acceptable.
The patient felt that the efficacy was still not good in the past two weeks, and the lumbosacral chill was slightly aggravated, such as cold wind blowing, and the stool was rotten, but the above symptoms were greatly relieved compared with the initial consultation.
Physical examination: tongue is correct and tender.
Analysis: The efficacy of the front kidney-holding soup was not good after reducing the amount, so it was still changed back to the amount of three consultations, with ephedra and fine spices finely adjusted.
Disposition: 7 doses of Chinese medicine.
Dried ginger 40G Poria 40G Atractylodes macrocephala 40G Roasted licorice 20G
Dragon bones 20G raw oyster 30G ephedra 9G fine pungent 6G
Radix et Rhizoma Pseudostellariae 30G Mulberry 20G Deer horn slices 10G
2013.2.5 After seven doses of the previous consultation, the symptoms were greatly reduced. Due to lack of registration, the patient transferred 7 more prescriptions from other doctors.
Sixth Consultation: 2013.4.2 Today, blood HCG was measured at 60.1 IU/L, estradiol at 230.82 pg/ml and progesterone at 67.18 nmol/l. Pregnancy was confirmed. She reports coldness in the back, phlegm in the throat and discomfort in the pharynx.
Physical examination: light red tongue, smooth and slightly sunken pulse.
Disposition: 5 doses of traditional Chinese medicine.
Analysis: The patient is pregnant and should not take any more pungent and warm medicine, so she was given the formula “An Fetus Drink” with 30g of Radix Bacopa Monnieri. as follows.
Radix Codonopsis Pilosulae 20G Semen Cuscutae 20G Semen Morindae 20G Eucommiae 15G
Agaricus blazei 12G Atractylodes macrocephala 20G Deer horn slices 10G Cistanche blazei 12G
Sandy 6G Semen 9G Bacopa monniera 30G
In addition, the patient was given 1 dose of the self-prepared formula “Light Yang Tea”. This formula is formed according to the principle of “treating upper jiao like feathers”, choosing thin and light smelling, light and dispersing drugs to make tea to treat “upper respiratory tract infection”, especially for those who are pregnant. The earlier the application of this formula the better the effect, which is in line with the principle of Wu Shu “treatment of external sensations such as the general, the army is valuable,” to achieve the purpose of “light can go to the real”. The specific drugs used are as follows.
Radix Platycodon 6G Licorice 6G Chrysanthemum 5G Chen Pi 5G
Made of Semen 5G Thornbush 5G
”Light Yang Tea” was taken for 2 times, with 3 doses left, and the table evidence was removed for 8 or 9 times, so it was stopped. Take the fetus Chinese medicine, until the fetal heart can be seen, hormone ideal.
One year later, the patient’s patient friend referred to her when she visited the clinic, she had already delivered and the mother and child were safe.
Case statement.
This case is a serious case of cold and dampness invasion, and the evidence belongs to the same disease of Sun, Shao-Yin and Tai-Yin. The patient had cold pain and heaviness below the waist after miscarriage. It was considered that the patient had a deficiency of spleen and kidney yang, and after giving birth, she felt cold and dampness, which stayed outside the kidney, and became “kidney-attached”.
The pathogenesis of this lumbago is cold dampness trapped in the waist, not kidney deficiency. As the “Jin Kui essentials” cloud “kidney with the disease, his body weight, waist cold, such as sitting in water, the shape of the water, but not thirsty, urination, eating as before, the disease belongs to the lower jiao, body labor sweating, cold dampness in the clothes, a long time to get, cold pain below the waist, the abdomen heavy as with five thousand money, licorice dry ginger Fu Ling Bai Zhu Tang main”. Therefore, the use of kidney with the soup warming Taiyin, under the Yi Yi earth over water.
Cold pain in the waist, sacrum and knees, with the feeling of “cold into the bone marrow”, because the cold and damp invasion is too deep, involving a wide range of external and solar, internal into Shaoyin, involving Taiyin, stagnating between the bones, the kidney alone can not take up the heavy responsibility, so add ephedra, fine spices, and eucalyptus soup warming through the surface and the inside, two solve too little.
Dragon bones and oysters can calm the mind, the second can strengthen the guard, and the third can prevent the warming and dispersal of drugs such as eucalyptus, ginger, pseudostellaria, ephedra, etc. too much; mulberryberry tonic liver and kidney, strengthen tendons and bones, dispel wind-dampness. The whole formula is used together, the three meridians are regulated, the spleen and kidney are balanced, there is a collection and dispersal, the same application of the remedy and diarrhea, together with the effect of warming the spleen and kidney, expelling cold and dampness, regulating yin and yang, so that the cold goes away, dampness is dispelled, the pain disappears.
In this case, the daily dosage of dry ginger reached 40g, Radix et Rhizoma Polygonati 30g, and Radix et Rhizoma Polygonati 9g before the effect was obvious, and the disease recurred when the dosage was reduced. During the three months of treatment, a total of 1420 grams of Radix et Rhizoma, 1940 grams of dry ginger, nearly 400 grams of ephedra and pseudostellaria were used, with no adverse effects, and the disease was removed and the Qilin was nurtured.
This case suggests that there are four.
First, identification is the core.
Chinese medicine treatment, when the diagnosis and treatment, to have a holistic view, not a headache to treat the foot. The name “pelvic inflammatory disease” in Western medicine should not be used to influence the name of the disease. The “inflammation” is not necessarily fire toxicity, back pain is not necessarily kidney deficiency, pain is not necessarily blood stasis. As the ancients said, “If you see phlegm, don’t treat phlegm; if you see blood, don’t treat blood; if you see sweat, don’t sweat; if you have heat, don’t attack heat; if you have gas, don’t consume gas; if you have seminal emission, don’t astringent discharge; if you know what’s interesting, you are the best in medicine”. To achieve this purpose, this level, you must read more classics, especially to be familiar with Zhang Zhongjing’s “Treatise on Typhoid Miscellaneous Diseases”.
Second, the amount of medicine is the key.
Correct identification and correspondence of theory and prescriptions and medicines are the basis for clinical efficacy. But if the amount of medicine is not enough, medicine does not offset the disease, it is still ineffective. As the saying goes, “the secret of Chinese medicine is in the amount of medicine”. Zhongjing’s use of medicine is to be heavy when heavy, light when light. Wu Jutong in the “Wenzhi Zhidian Volume 4? Miscellaneous said that “treating the upper jiao like a feather (not light, not lifting); treating the middle jiao like a balance (not flat and restless); treating the lower jiao like a power (not heavy, not sinking)”.
Third, doctors and patients should trust each other.
”Sometimes it can cure, often it helps, always go to comfort.” Although modern medicine continues to progress, there are still many unknown areas and there are still many uncertainties. Imagine what would be the result if you don’t operate because of the risk of surgery; if you don’t apply drugs because they have toxic side effects.
Perhaps some people think that Chinese medicine is different and is risk-free. This is actually a misconception. Eating chili peppers can irritate and aggravate hemorrhoids and ulcers, eating milk may cause diarrhea, eating mangoes may be allergic …… food, let alone drugs. The process of Chinese medicine treatment is also risky, Chinese medicine treatment relies on the bias (toxicity) of the drug to correct the bias of the body, this process of correction, this process of breaking the old pathological balance, the reconstruction of a new benign balance is risky. The ideal state for doctors is to be able to “set things right” without “overcorrecting” them, but in order to “correct” them, they often have to go through “overcorrecting” them. “This is just like western medicine “heparinization”, “atropinization”, this “correction” process will certainly have certain The process of “correction” is bound to have certain medical risks and a certain chance of adverse reactions. If, for fear of complaints, they do not dare to make the necessary attempts in the process of diagnosis and treatment, and if every Chinese medicine practitioner goes to be a good doctor and a “slow doctor”, prescribing some painless medicine and not daring to apply the “Jing Fang Da Nong”, then surely too many patients will continue to suffer. This is the result that both doctors and patients do not want to see! The trust and understanding of patients is the driving force for doctors to keep moving forward!
Today’s medical environment is not good, doctors are blamed, complaints are commonplace, and even ……
This case, the measurement of ginger, Radix et Rhizoma, Hesperidin, etc. far exceeds the “Pharmacopoeia” limit, as a doctor, I personally bear a greater medical risk! The trust and understanding given by the patient is the basis for the success of this treatment, so it is the patient who has to be thanked.
Fourth, the postpartum period needs to be tempered.
The national importance of sitting on the moon is not a bad custom, and there are still many important meanings in it that modern people need to continue to observe. Princess Kate’s postpartum appearance, so-and-so prime minister after birth that work, etc., that is the Western celebrities in the show, can not be over-interpreted. It is not a good idea to avoid the wind and cold after giving birth.