? The patient, female, 36 years old, came to the doctor because of bilateral axillary masses accompanied by pain for more than 10 years. An outpatient breast B-ultrasound showed: bilateral accessory breasts, about 2.7*3.4cm on the right side and 1.0*2.6cm on the left side. Symptoms: The patient is anxious, nervous, pale complexion, obvious tenderness in both accessory breasts, dry mouth, bitter mouth, occasional palpitation and chest tightness, occasional dizziness and discomfort, poor appetite and sleep, constipation, normal urination, and pale tongue. Red, thin and yellowish fur, stringy and weak pulse, blood pressure measured at 96/60mmHg, self-reported low blood pressure, past history of depression, long-term oral anti-anxiety medication, right accessory mastectomy after admission.

? Combined with the tongue and pulse conditions and symptoms and signs, give "Xiao Bupleurum Decoction", including 24g of Bupleurum, 9g of Scutellaria baicalensis, 10g of Codonopsis pilosula, 20g of white peony root, 12g of pinellia, 10g of jujube, 6g of ginger, and zhizi. Licorice 6g, 3 doses, one dose per day, taken warmly in three divided doses. During the ward rounds on the second day, the patient complained that his stool had been relieved and he had some diarrhea twice a day. I knew they didn't believe me at this moment, so I asked in detail. I used to have constipation, even once a week, but now I have stools twice a day, which are large in quantity, thin in quality, and smelly. I still considered the dizziness reaction of the medicine, and blindly took the medicine without using it, but the stool was heavy and smelly, which was a sign that the turbid evil came out of the stool. After communicating with the family, I continued to take the medicine.

After three doses, the patient actively asked to continue taking the medicine. She complained that the dry mouth and bitter taste had completely disappeared. Although she had bowel movements twice a day in the past few days, she did not feel any discomfort. The more she defecated, the more comfortable she became. Well, she insisted that she had diarrhea. Her tongue was light red, the coating was thin and yellow, and her pulse was stringy. , the effect is not improved, continue to give the above three doses, and three more doses are used up.

? ***After the sixth dose, the patient complained that he had bowel movements once a day, felt comfortable in his chest, and had mostly recovered from the dizziness and pain in his head. He only had occasional headaches in hot weather and tenderness in the left accessory breast. Disappear, consciously touch the mass and disappear. His diet has greatly improved compared to before, and he was asked to leave the hospital with medicine. On the basis of the above, 18g of Atractylodes macrocephala was added for five doses, and he was discharged with medicine.

I came for a follow-up visit on July 16th and reported that the symptoms had improved significantly and the symptoms had not recurred. I only felt that in the past few days, I woke up easily after sleeping, had many dreams, was easily awakened, sweated at night, had a light red tongue, and had a thin and white coating. , pulse string. I hesitated between "Bupleurum plus Dragon Bone Oyster Decoction" and "Xiao Bupleurum Decoction". Finally, I subtracted 6g of Atractylodes macrocephala, added 10g of white peony root, 6g of bergamot and 6g of polygala root, five doses, divided into three times. Warm service.

? I came for a follow-up visit today and reported that after taking the medicine, my sleep improved and I stopped sweating. I woke up easily after sleeping only two nights in a week. My complexion was bright and moist, my tongue was light red, the coating was thin and white, and the tip of my tongue was slightly swollen. Red, press the appropriate finger for pulse, measure blood pressure 110/85mmHg, combine the patient's previous symptoms, still take the meaning of Xiao Bupleurum and add Suanzaoren Decoction, give Bupleurum 24g, White Peony 10g, Jujube 10g, Ginger 3g, Pinellia 12g, Suanzaoren decoction. Ren 10g, Codonopsis pilosula 10g, Poria 10g, Bergamot 12g, Atractylodes 18g, Polygala 12g, five doses, taken warmly in three times. (The fly in the ointment is that the pharmacy lacks Scutellaria baicalensis, and should use Coptis chinensis instead, but it doesn’t work)

Conclusion: Xiaobupleurum is widely used in clinical practice as the first prescription for relieving Shaoyang. Considering the patient’s admission symptoms, I originally wanted to use it. Da Bupleurum was used, but the patient's tongue and pulse also showed signs of deficiency. According to Article 101 of "Treatise on Febrile Diseases", "Shanghan and stroke have Bupleurum syndrome, but it is sufficient to see just one syndrome, and there is no need to fully identify it. Any syndrome caused by Bupleurum Decoction "If the syndrome persists, give Bupleurum decoction again, and it will be rejuvenated, but fever and sweating will return." So I changed my mind to Xiao Bupleurum and found that one dose was effective, but I didn't see any fever. For sweating, combined with the tongue and pulse conditions and the patient's overall condition, I still added and subtracted the meaning of Xiao Bupleurum, and it was indeed effective. However, I hesitated when it came to the patient's sleep. In the end, I violated my prescription principles and chose a prescription that was more suitable for her. reduce. Although it was effective, I still felt that the effect was too slow. Until now, I also thought about it, would it have been better if I had directly invested in "Builus Bupleurum plus Dragon Bone and Oyster Soup"?