2 English reference hydrocephalus
waterhead
hydrocephalus
Summary Hydrocephalus refers to a disease caused by excessive accumulation of cerebrospinal fluid in ventricles and subarachnoid space. The main manifestations are ventricular enlargement, cranial suture separation and abnormal head circumference. -Generally, there are two kinds: traffic hydrocephalus and obstructive hydrocephalus. Congenital malformation, intracranial infection or hemorrhage, intracranial tumor or other space-occupying lesions can lead to this disease, and its pathogenesis includes ventricular system obstruction, cerebrospinal fluid absorption disorder or excessive cerebrospinal fluid secretion. Modern western medicine has no reliable drug treatment so far, and the prognosis of surgical treatment is difficult to determine.
In Chinese medicine, this disease is equivalent to "removing bone" and "filling bone". Its record was first seen in Etiology: "When you open the skull, the child will be old, and the beginning will be stitched." In the Northern Song Dynasty, the symptoms of this disease were described in more detail. "Prescription of Pediatric Medical Certificate" says: "Old people are not harmonious, and kidney qi is laughing less. There are many white eyes, and white and thin ones are more sad and less happy. "
For the etiology, pathogenesis and treatment of this disease, doctors from Sui, Tang and Song dynasties tend to be caused by kidney deficiency. For example, the theory of various sources of diseases is called "kidney qi does not lead to failure", and tonifying kidney is often used for treatment. In the Jin and Yuan Dynasties, different opinions began to appear. For example, Zhu Zhenheng pointed out that the disease was caused by qi deficiency and excess heat (treating Cui Hui by uncovering the skull), and advocated the use of Sijunzi decoction and Siwu decoction for treatment. Doctors in the Ming Dynasty made great efforts. For example, Wanquan mentioned in the Secret of Infant Health Care in the Ming Dynasty that the disease can be "kidney deficiency after illness, the water is too abundant to fire, and the internal heat is steaming up, and its marrow is hot, and the head boundary is subdivided." To prepare Jiawei Xieqing pills for syndrome differentiation and treatment. "Compendium of Materia Medica" records the external treatment of this disease: "In addition to the skull of children, blood drops on the crown of Dan cock, and peony powder is better." On the basis of summarizing the previous experience, Jin Jian, a medical scholar in Qing Dynasty, emphasized the combination of syndrome differentiation and treatment with oral and external application: "Bushen Dihuang Pill is acceptable, Buyang Fuyuan Powder is the first, sealing powder is more effective, and temporary application is safe." A great deal of experience accumulated by the ancients is still used for reference by modern doctors.
The report on the treatment of this disease by modern Chinese medicine was first seen in 1959, which is a proven case of acupuncture treatment. Since the early 1960s, there have been reports that the disease was cured by Chinese medicine, but most of them were cases, including congenital hydrocephalus and hydrocephalus after purulent meningitis. Hydrocephalus can be treated by massage. In 1970s, great progress was made in the diagnosis and treatment of this disease. Through clinical practice, it is recognized that stasis heat, stagnant water and blood stasis can all cause diseases. In the aspect of syndrome differentiation, the syndrome of heat toxin and blood stasis has been added, and the methods of clearing away heat and purging fire, detoxifying and relieving convulsion, dredging orifices and activating blood circulation, and inducing diuresis have been developed. Its treatment scope has also been extended to acute hydrocephalus after meningocele operation. During this period, there have been many large-scale clinical observations. Since 1980s, the understanding of the clinical law of this disease has been deepened. For example, a new viewpoint of brain water stasis is put forward, and the method of dredging orifices, promoting blood circulation, removing blood stasis and benefiting water is valued by many doctors. It is particularly worth mentioning that in recent years, acupuncture therapy has made a great breakthrough in the application of treating this disease, and many explorations have been made in acupoint methods, such as acupuncture combined with mild moxibustion with moxa sticks, burning moxibustion with medicated thread, acupuncture combined with external application of traditional Chinese medicine, etc., and it has been observed that from the perspective of TCM syndrome differentiation, the curative effect of patients with yang deficiency is better than that of patients with yin deficiency. According to the classification of western medicine, the effective rate and prognosis of communicating hydrocephalus are better than those of obstructive hydrocephalus.
4 Etiology and pathogenesis Comprehensive ancient and modern literature, the etiology of this disease is quite complicated. It can be caused by congenital endowment deficiency, fetal weakness, kidney deficiency, or yin consumption of spleen and kidney after a serious illness; It can also be caused by exogenous cold, heat toxin, internal injury, acquired disorder, spleen and stomach weakness, etc. In recent years, it has been found that some craniospinal operations are improper and the brain orifice is blocked, which leads to this disease. Its pathogenesis can be summarized as follows:
Kidney deficiency is mostly due to congenital deficiency and deficiency of kidney qi. The kidney governs the bone, produces marrow, and the brain is the marrow sea. Kidney deficiency can't produce marrow and nourish bones, which leads to overdue skull fracture and enlarged skull. If the kidney yin fails, the water is too hot, the internal heat rushes up, the brain marrow is steamed, the brain marrow is hot and the fontanel is wide, which leads to this disease.
Spleen deficiency is often caused by acquired disorder, weakness of spleen and stomach, and abnormal transport, so that it is impossible to clear yang, turbid yin does not fall, drinking evil, and the skull is blocked, leading to the opening of cranial suture.
Exogenous heat toxin invades and accumulates in it, blocking the orifices or turbid phlegm, which will turn into heat for a long time and rush to the brain, so that the qi in the fu-organs will not fall, and the water will be stagnant, resulting in bone removal.
Deficiency of kidney qi can lead to blood stasis, leading to deficiency of qi and blood and weak operation; Blood stasis in the brain collateral, or spleen deficiency and turbid water, blood stasis in the brain collateral, or improper operation, blood stasis can oppress the brain pulp, block the brain orifices, and the water will extravasate for a long time.
5 Syndrome Differentiation The syndrome differentiation of this disease can be roughly divided into the following four types:
1. Head abnormality, skull suture separation, enlarged anterior fontanel, flat fontanel, drooping eyes, white eyes, sallow complexion, night sweats and aversion to heat, restlessness, dry mouth, fever in hands and feet, constipation caused by kidney yin deficiency. The tongue is dark red, the coating is slightly yellow and less fluid, the pulse is heavy and thin, and the fingerprint is slightly dark.
2. Abnormal head, skull suture separation, enlarged anterior fontanel, flat or sunken fontanel, drooping eyes, dull expression, spontaneous sweating and night sweats, cold limbs, loose diarrhea, pale lips and soft mouth, and light and fat tongue caused by deficiency of spleen and kidney yang. The white fur pulse is late or slightly late and weak, and the fingerprint is light and dark.
3. Abnormal head due to heat toxicity, high fontanel, no sweat and fever, persistent convulsions, or convulsions due to high fever, dizziness, red face and red lips, or purple, constipation or defecation, or discharge of evil things. Red tongue with yellow coating, rapid pulse or disease, purple or slightly dark fingerprints.
4. The head is abnormal due to congestion, the skull seam is separated, and the blue veins on the head are exposed. You are agitated and crying, and your face is pale or dull. In severe cases, you are paralyzed or numb, and you are thirsty and don't want to drink water. Lip, purple tongue or tongue edge have ecchymosis, pulse string or deficiency, and fingerprints are purple or dark blue. ?
6. 1 therapeutic effect standard, which is not uniform at present, is formulated as follows according to the current data and literature.
Basic recovery: the clinical symptoms disappeared, the skull returned to normal range and stopped developing. Cranial suture is closed, fontanel is closed or tension is not high, there is no scalp vein swelling, sunset sign (-), mental development is good, limb movement is normal, and X-ray or CT examination shows normal. Symptoms have been consolidated for more than 1 year.
The effect is remarkable: the clinical symptoms are basically disappeared or obviously alleviated, the skull is reduced, the anterior fontanel is flat, the scalp vein is looming, the sunset sign (+/-), the cranial suture is narrowed, the intelligence is acceptable, and the limb function is restored. X-ray or CT examination showed obvious improvement. The symptoms were consolidated for more than 3 ~ 6 months.
Effective: clinical symptoms were relieved, skull enlargement was slowed down, fontanel was slightly longer, cranial suture was not closed, scalp vein was full, mental development was poor, sunset sign was not significantly improved, and limb function was slightly restored. X-ray film or CT examination showed some improvement or no improvement.
Ineffective: 1 ~ 3 months after medication, symptoms and signs did not improve or continue to deteriorate, and even aggravated death.
6.2( 1) Classified Treatment of Kidney Yin Deficiency
Treatment: tonify kidney and promote marrow, nourish yin and promote yang.
Prescription: Radix Rehmanniae Preparata, Semen Plantaginis, Radix Dipsaci, Radix Astragali, Herba Taxilli, Herba Cistanches and Polygoni Multiflori each 3g, and Fructus Corni, Cortex Moutan, Poria and Rhizoma Alismatis each 6g.
Addition and subtraction: Yin deficiency and internal heat plus Anemarrhena asphodeloides and Cortex Phellodendri; Constipation plus angelica; Tortoise shell or tortoise shell ointment is added to tortoise shell.
Usage: daily 1 dose, decocted in water twice, and taken evenly in three times.
Commonly used prescriptions: Bushen Dihuang Pill, etc.
(2) Yang deficiency of spleen and kidney
Treatment: invigorating spleen and kidney, activating yang and promoting diuresis.
Prescription: Poria cocos, Polyporus, Plantago asiatica and Radix Rehmanniae each 6g, Atractylodis Rhizoma, Pericarpium Citri Tangerinae and Jiang Banxia each 5g, Angelica sinensis and Colla cornus Cervi each 9g, Cinnamomum cassia twig, Glycyrrhiza uralensis, Cornus officinalis, Rhizoma Dioscoreae and Radix Cyathulae each 3g.
Addition and subtraction: add burnt hawthorn, burnt malt, burnt medicated leaven, and reduce rehmannia glutinosa; Dilute stool, increase the amount of poria cocos and yam; Add Pinellia ternate and Pericarpium Citri Tangerinae for vomiting.
Usage: daily 1 dose, decocted in water twice, and taken evenly in three times.
Commonly used prescriptions: Gui Ling Shugan Decoction, Fuyuan Powder, etc.
(3) Toxic heat
Treatment: clearing heat and purging fire, opening knot and dredging collaterals.
Prescription: 9 grams of dandelion, 9 grams of radix rhapontici, 9 grams of honeysuckle, 9 grams of calamus, 9 grams of fructus lipuidambaris, 6 grams of scutellaria baicalensis, 6 grams of lalang grass rhizome, 6 grams of cortex moutan and 6 grams of akebiae.
Addition and subtraction: add cinnabar and amber powder to scare; Vomiting plus Pinellia ternata, bamboo shavings and fresh wife; High fever convulsion plus angong Niuhuang pill.
Usage: daily 1 dose, decocted in water twice; Take it evenly in three times.
Commonly used prescriptions: Xieqing pills, etc.
(4) Blood stasis
Treatment: promoting blood circulation and removing blood stasis, breaking arthralgia and dredging collaterals.
Prescription: 50 grams of Salvia Miltiorrhiza, 25 grams of peach kernel, 0/5g of Ligusticum chuanxiong, 0/5g of safflower, 25g of earthworm and 0/5g of poria cocos.
Addition and subtraction: add musk 0.0 1g, leech 0.5g, bezoar 0. 1 g, borneol 0.5g and rhubarb 7.5g for severe constipation, make into powder and take orally.
Usage: Each dose is 2 days, decocted in water twice, and taken evenly in 6-8 times.
Commonly used prescriptions: Tongqiao Huoxue decoction, etc.
Curative effect: According to the above four types of diagnosis and treatment, 275 cases were treated with * * * *, among which according to the statistics of 224 cases with exact curative effect, 1 13 cases were basically cured, 58 cases were markedly effective, 28 cases were effective and 25 cases were ineffective. The total effective rate was 88.8%.
6.3 Prescription Treatment (1) Tongqiao Huoxue Lishui Decoction
① Oral prescription:
Ingredients: Radix Angelicae Sinensis, Radix Paeoniae Rubra, Rhizoma Chuanxiong, Carthami Flos, Semen Persicae, Radix Salviae Miltiorrhizae, Radix Astragali, Lumbricus, Scorpio, Semen Plantaginis, Rhizoma Acori Graminei, 1 onion, and 3 Chinese dates.
Addition and subtraction: nystagmus plus Gastrodia elata, Uncaria rhynchophylla and Bombyx Batryticatus; Reuse Astragalus membranaceus without turning the eyeball; Codonopsis pilosula and Atractylodes macrocephala are added in small amount.
Usage: daily 1 dose, decocted in water twice, and taken evenly in 3-4 times.
② External use:
Ingredients: Carthamus tinctorius and Folium Artemisiae Argyi 1 0g, Gleditsia sinensis150g, Moschus10g.
Usage: add 2500ml of water to the first three herbs, decoct for 2 hours, then remove the residue to get juice, concentrate it into liquid medicine until it can be hung into thread, then add human musk and mix well, and put it in a bottle for refrigeration. When in use, the child's hair is shaved first, and the medicine is evenly applied to the head, and the cranial suture and fontanel are properly coated with a certain thickness. Then wrap it with a bandage, and keep it moist with warm water 1 time in the morning and evening, and change the dressing 1 time every week.
Treat both internal and external diseases, with 30 days as a course of treatment and 3-7 days rest in the middle.
Efficacy: 7 cases were treated with internal and external therapy, 4 cases were basically cured, 2 cases were markedly effective, and the effective rate was 1 case, with a total effective rate of 100%.
(2) Hydrocephalus pills
Composition: Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Colla Cornu Cervi, Radix Achyranthis Bidentatae, Poria, Rhizoma Polygonati, Fructus Leonuri, Polyporus, Cortex Moutan, Semen Plantaginis, Herba Cistanches, each 65438+/-00g, and Radix Angelicae Sinensis, 6g. The medicine is made into honeyed pills, each pill weighs 65438 0.5g. ..
Usage: Take 1 time in the morning and evening. Children within 3 months, half a pill at a time; Children over 3 months old, each time 1 capsule.
Efficacy: * * treatment 1 case, 4 cases were markedly effective, 5 cases were effective, and1case was ineffective, with a total effective rate of 90%.
(3) Double-glue and double-angle mixture
Comprises 6 grams of colla cornus Cervi, colla Corii Asini, Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Corni Fructus, Cortex Moutan, Radix Angelicae Sinensis, Poria, Polyporus, Alismatis Rhizoma, Fructus Leonuri and Cornu Saigae Tataricae.
Usage: This prescription is mainly used for hydrocephalus after meningocele. The maximum dose for children under 0 years old is 1. Decoct 1 dose every day before and after operation.
Efficacy: 85 cases were treated with this prescription and western medicine, and all of them achieved remarkable results.
(4) Jiawei Wuling Powder
Composition: Poria, Pericarpium Arecae 65438 05g, Polyporus, Alisma orientalis, Achyranthes bidentata, Plantaginis 65438 00g, Atractylodis Macrocephalae 5g, Cinnamomum cassia 2g.
Add or subtract: add 20g gypsum for fidgety, amber noodles 1g (taken by flushing); Vomiting with bamboo shavings10g; Dry stool 7.5g, Anemarrhena asphodeloides10g.
Usage: daily 1 dose, decocted in water twice, taken regularly.
Curative effect: 4 cases of hydrocephalus were treated with * * * *, and all of them received certain curative effect.
6.4 He Shiying's Medical Records of Old Chinese Medicine
Zhang X, male, 34 days after birth. 1975 February 1 1 First time to see a doctor. Two days after the baby was born, the head began to get bigger, and the tongue was more obvious before the full moon. The front fontanel is wide and full, and the cranial suture is separated. Scalp vein dilatation, poor spirit, lethargy, anorexia, spitting milk, defecation. Eyes down, normal heart and lungs. The tongue is reddish, the fingerprints are dull and the pulse is weak. Impression: Congenital hydrocephalus (craniectomy).
Prescription: 6g of Radix Rehmanniae Preparata, 3g of yam, 9g of cornu Cervi degelatinatum, 3g of Achyranthes bidentata, 9g of Poria, 3g of Cornus officinalis, 3g of Angelica sinensis, 9g of Polyporus, 3g of Fructus Leonuri, 3g of Cortex Moutan and 9g of Plantaginis. Daily 1 dose, decocted in water.
After taking the medicine, I urinated more in one day, and my spirit and nursing gradually improved, so I stopped vomiting. After two weeks of continuous service, the circumference began to shrink gradually, and the eyes stopped looking down. After the third week, the head circumference is basically normal, the front fontanel is flat and the cranial suture is small.
Press: He Lao thinks that this situation is caused by deficiency of kidney qi and brain marrow. Dihuang Pill is used to treat the symptoms by tonifying kidney, promoting marrow production, hydrating and drying dampness, and has achieved remarkable results. He Lao pointed out that this disease is difficult to treat, such as simply tonifying the kidney, which has a very slow effect. Therefore, it is emphasized to treat both the symptoms and the root causes, and the earlier the treatment, the better the effect. Generally, after taking 1 ~ 2 weeks, the head circumference begins to shrink, and it can return to normal after more than 3 ~ 6 weeks. But this method is only applicable to children with congenital hydrocephalus.
6.5 Drug Use Regularity By summarizing the drug use of more than 4 specific prescriptions reported in various places, there are *** 10 articles, and the drug use is ***7 1 flavor. The list of people who have reported the literature for more than 2 times (including 2 times) and used it for more than 10 times is as follows:
Frequency of application (example)
Report (article)
Medicine? thing
>200
eight
Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Poria, Cornus officinalis.
10 1~200
5~6
Colla cornus Cervi, Radix Angelicae Sinensis, Radix Achyranthis Bidentatae, Rhizoma Alismatis, Cortex Moutan, Fructus Leonuri, Polyporus and Semen Plantaginis.
15~ 100
2~4
Radix Astragali, Herba Cistanches, Moschus, Radix Paeoniae Rubra, Semen Persicae, Rhizoma Chuanxiong, Carthami Flos, Radix Salviae Miltiorrhizae, Lumbricus, Rhizoma Acori Graminei, Scutellariae Radix, Rhinoceros horn, Radix Gentianae, Caulis Akebiae, Coptidis Rhizoma, Bombyx Batryticatus, and Atractylodis Rhizoma. As can be seen from the above table, at present, tonifying kidney and promoting marrow is still the most widely used medicine in treating hydrocephalus in children in traditional Chinese medicine; Followed by invigorating spleen and promoting diuresis. Drugs that promote blood circulation and remove blood stasis, and clear away heat and toxic materials have also attracted much attention. This kind of medication not only conforms to the law of clinical syndrome differentiation and treatment, but also reflects the future development trend to some extent.
6.6 Other therapies (1) Acupuncture
① Body acupuncture therapy
Acupoint selection: Main acupoints: Baihui Tousi Shen Cong, Pig's Foot Shutou Shenshu, Sanyinjiao Fu Tou. Matching points: Dazhui, Zusanli, Fengchi, Fengfu, and permeable zhongji.
Operation: take the main points at a time and add points as appropriate. Acupuncture adopts the method of short-term moderate * * *, light twisting and slow lifting, twisting each point for 3 times, slow lifting 1 time, and then pulling out the needle after 3 times. After each needle, add chiropractic for 3 times, or tap along the posterior Du meridian and bladder meridian for 3 times with a leather needle. 65438+ 0 times a day, 30 days as a course of treatment, stop acupuncture for 3 ~ 5 days to continue treatment.
Efficacy: 78 cases were treated with * * * *, and 2 cases were effective. Among 76 cases, 44 cases were basically cured, 3 cases were effective/kloc-0, and 9 cases were ineffective/kloc-0, with a total effective rate of 75%.
② Comprehensive method
Acupoint selection: Key points: Divide into 2 groups. Group A: Shuigou, Zhigou, Sishencong, Hegu, Shuiwu, Yinjiao, Zhongji, Shuidao, Yinlingquan, Zusanli, Yinjiao and Fuliu; Group B: Fengfu, Fengchi, Dazhui, Mingmen, Shu Yao, Yinmen, Weizhong, Chengshan and Juegu.
Operation: Use 1 group every time, and add and subtract acupoints according to children's conditions. In the early stage, acupuncture or short-term acupuncture is the main method. After getting used to it, you can leave a needle in your limbs for 20 ~ 30 minutes. Tap Jiaji point with a leather needle before each needle, tapping from top to bottom, with skin flushing as the degree. If the urine is short and red, the fontanel is not closed, and the limbs are cold, use moxa sticks to rotate moxibustion on the water surface, vaginal intercourse and Guanyuan for 5 ~ 10 minutes each time. In order to strengthen the effect, Chinese medicine can be applied externally to the child's head. Acupuncture every day 1 time, 30 ~ 50 times as a course of treatment, with an interval of 10 day. Apply every other day 1 time.
The external traditional Chinese medicine is prepared as follows: Radix Euphorbiae, Flos Daphne genkwa, Radix Kansui and Radix Phytolaccae each 65,438+00g, Borneolum Syntheticum 65,438+0g and Moschus 65,438+00mg, which are ground into fine powder and blended into paste with vinegar or vaseline for later use.
Efficacy: 69 cases were treated with * * * *, with an effective rate of 5 1 case and an ineffective rate of 0/kloc-8 cases, with a total effective rate of 73.9%. Communicative hydrocephalus has excellent curative effect.
(2) Single prescription
① Gleditsia sinensis paste
Ingredients: Gleditsia sinensis. 1500g, 60g of mugwort.
Usage: Grind the seedless Gleditsia sinensis, mix it with Folium Artemisiae Argyi and 7500g of water, fry it with strong fire for 2 hours, and then filter it. Concentrate until a stick with a length of 9 ~ 15cm is pulled out by dipping the chopsticks in the liquid medicine, remove the fire, let it cool slightly, put 0.9 ~ 1.5g musk into the pot, stir it evenly, and put it into a porcelain container for later use. When in use, the ointment is evenly applied to the whole head, cranial suture and anterior fontanel, and the medicine is thick. Change the plaster 1 every two months and use it for 3 ~ 5 times.
Efficacy: 2 cases were cured.
② Kaijisan
Composition: Rhizoma Atractylodis, Natrii Sulfas each 12g, Squama Manis 9g, Fried Pollen Typhae 24g, Calculus Bovis, Zhuge 1.5g, Amber and Cinnabaris 6g, and raw sheep liver 1.
Usage: First grind the medicinal materials separately. Then cut open the liver of the raw ram, steam the first four herbs and bake them into powder, then add the last four herbs and mix well. Take about 0.3 grams each time, twice a day, and take 0.3 grams of ferrous sulfate in the morning and evening. Don't eat cold food. At the same time, prick the pimple in the child's mouth with a triangular needle and bleed at four o'clock, every 10 day 1 time.
(3) Massage
Operation: tonify the liver and gallbladder for 65,438+00 minutes, tonify the three customs for 5 minutes, tonify the spleen and stomach for 65,438+00 minutes, clear the six fu organs for 5 minutes, and massage the Erma point for 65,438+00 minutes. Knead the weakness of the lower limbs for 5 minutes; Shake your head and cry for 5 minutes, knead Tianxin for 5 minutes, and knead four pieces 1 minute; Urine yellow and kidney clear for 5 minutes; Clear six fu-organs for 5 minutes, and clear large intestine for 5 minutes. Every day 1 time,1time is a course of treatment.
Efficacy: 6 cases were treated with * * *, all of which achieved good results.
(4) dietotherapy
Composition: walnut kernel 200g, antler powder 120g.
Usage: grind the medicine * * * into fine powder, one course of treatment, 1 time, each time16g, and take it 20 times. Drink bone marrow soup during taking medicine, and the amount is not limited, such as pig, sheep and ox bone soup.
6.7 Other measures