Case 1: A case of knee pain.
Patient Qiu, male, 40 years old. First diagnosis in June 5438+February 65438+August 2009.
Chief complaint: Knee joint pain for 3 days. The patient told by telephone that there was no obvious pain in the knee joint, difficulty in walking, no redness and swelling in appearance and no increase in skin temperature in the touch area three days ago. Good appetite, moderate sleep, normal defecation, no tongue pulse and no special discomfort. No history of arthritis.
Traditional Chinese medicine diagnosis: arthralgia syndrome, cold and dampness blocking collaterals.
Prescription: Danggui Sini Decoction. Prescription: 60g of angelica sinensis, 0g of cassia twig15g, 0g of radix paeoniae alba15g, 0g of Asari10g, 0g of medulla tetrapanacis10g, 0g of liquorice10g and 5g of Chinese dates. 5 times, decocted in water, daily 1 time. After taking 3 drugs, the pain of knee joint was relieved, and after taking 5 drugs, the pain disappeared.
According to Danggui Sini Decoction, cold hands and feet, heartbroken intestines and chronic cold are the main indications, among which cold hands and feet, heartbroken intestines and chronic internal cold are the key points of this recipe. It is not difficult to find that Guizhi decoction removes ginger and adds angelica, asarum and medulla tetrapanacis. Angelica sinensis in the prescription can nourish blood and relieve pain. "It can relieve pain, relax bowels, benefit bones and muscles, and treat spasm, paralysis and dryness"; Asarum is mainly used for "headache, brain movement, arthralgia due to rheumatism, and muscle death", which can relieve exterior syndrome and dispel cold, and can be used for expelling cold, meridians, viscera and other chronic diseases. Cao Tong's intention is not easy to understand. The textbook says it can dredge meridians and make blood circulation smooth. This explanation seems to be suspected of being simply piled up with fake drugs. The author thinks that it may be related to local edema caused by poor blood circulation in limbs, such as frostbite, which often leads to swelling of the back of the hand. To sum up, general pain (head, chest, abdomen, limbs), especially chronic cold pain in joints of limbs (such as joint pain for many years, aggravated by cold, etc.). ), swelling and thready pulse are the characteristics of this recipe. In addition, Japanese traditional Chinese medicine discussed the characteristics of this prescription from the perspective of abdominal diagnosis, and thought that "abdominal skin contracture is similar to Guizhi plus Shaoyao decoction and Xiaojianzhong decoction, and left umbilical Shu Tian (one inch left and one inch right) is similar to Danggui Shaoyao decoction and Danggui Jianzhong decoction. Aggregation in the right abdomen and waist, cold hands and feet and weak pulse belong to Danggui Sini Decoction syndrome. 」
Case 2: Mistreatment of "Frostbite" Medical Records
Patient Wang, male, 43 years old. I came to the clinic on February, 2008 17.
Chief complaint: hand frostbite for 4 years. Four years ago, the patient's hands began to suffer from frostbite, the back of his hand was swollen and painful, and he was able to sleep well without any discomfort. It was observed that the patient's hands were swollen, sunken, pale and slightly blue, with more frostbite on the back of his hand, cold hands, frostbite on the roots of his ears, red tongue and heavy pulse. When prescribing medicine, the patient complained that there was no obvious reason for weakness of both upper limbs three months ago, and he could not lift weights for a long time, and there was no pain and discomfort in his shoulders and neck. He had examined the anteroposterior radiograph of the cervical vertebra in a local hospital and found nothing unusual. During the period, she did not receive any treatment, and then she relieved herself. At present, the symptoms of upper limb weakness have basically disappeared. Re-examination: The range of motion of cervical spine is basically normal, and the bilateral brachial plexus traction test, intervertebral foramen compression test and neck rotation test are all (-). There is no obvious abnormality in muscle tension of both upper limbs and no obvious decrease in muscle strength. Second, the tendon reflex of triceps brachii and radial membrane reflex are derived symmetrically, and Hoffman sign is left (+-) and right (-). Regardless, the author thinks that poor peripheral circulation of chilblain leads to hand weakness.
Prescription: Danggui Sini Decoction, 30g of Danggui, 5g of Ramulus Cinnamomi10g, 6g of Radix Paeoniae Alba10g, 6g of Asari, 6g of medulla tetrapanacis10g, 6g of roasted licorice and 5 small red dates. Five times, decoction, once a day.
In May 2008, the family told the patient to take the medicine intermittently, and the improvement was not obvious, and he ignored it. In April, he went to the hospital because of numbness in his left limb, and there was no abnormality in CT scan of his head and cervical vertebra. In May, his condition deteriorated and he was hospitalized again. After cervical MRI scan, he was diagnosed as "cervical intramedullary tumor" and received surgical treatment.
Reporter: The author did not conduct a detailed investigation when he was admitted to the hospital. According to the previous experience in treating chilblain, it is summarized as Danggui Sini Decoction syndrome, swelling of the back of the hand as clearing grass syndrome, concealed cold, long course of disease and pain as Asarum syndrome. I thought that the medicine was not weak, which was consistent with the condition, but the improvement was not obvious after taking the medicine, indicating that the prescription and syndrome did not correspond. It is not so much a prescription as a case that was misdiagnosed.
Intraspinal tumor of cervical spine is an intramedullary tumor of cervical spine, with atypical clinical manifestations, which is easily confused with other diseases that can cause functional damage of spinal cord and nerve roots. In addition, due to slow tumor growth, high spinal cord tolerance, early diagnosis is difficult, and the clinical misdiagnosis rate is extremely high. "Dyskinesia is usually the second common symptom of intramedullary tumors. Cervical cancer often occurs before the symptoms of lower limbs, and the motor neurons in upper limbs are weak, which is consistent with the symptoms of damage and compression of anterior horn neurons caused by central spinal cord tumors ... Most patients complain of poor mobility, fatigue and decreased mobility. In the auxiliary diagnosis, "most of intramedullary tumors are negative on plain film, and most of them cannot be displayed on CT plain scan." MRI can clearly show the size and morphological abnormality of the spinal cord, and can determine whether the tumor is cystic or solid. Most tumors showed high signal intensity on T2-weighted images. The symptoms, signs and imaging findings of cervical spinal cord tumor are the key to diagnose this disease.
Although the author considered the examination of nervous system at that time, he was not familiar with the diagnosis and treatment of the disease, so he failed to be vigilant and mistakenly thought it was caused by chilblain. The author learned a lesson from this case, and we should make a diagnosis and treatment of pure Chinese medicine on the premise of knowing the name of western medicine.