Case 1: A Case of Knee Joint Pain
Patient Qiu Mou, male, 40 years old. First diagnosis in 20091February 18.
Chief complaint: Knee joint pain for 3 days. The patient told by phone that there was no obvious cause of knee pain, 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 previous history of arthritis.
Traditional Chinese medicine diagnosis: arthralgia syndrome, cold and dampness stagnation in meridians.
Prescription: Danggui Sini Decoction. Prescription: angelica 60g, cassia twig 15g, white peony root 15g, asarum herb 10g, medulla tetrapanacis 10g, raw licorice root 10g and 5 Chinese dates. 5 times, decocted in water, one time a day. After taking 3 drugs, the pain of knee joint was relieved, and after taking 5 drugs, the pain disappeared.
Press "Danggui Sini Decoction is the main therapy for those with cold hands and feet and heartbroken pulse" and "Danggui Sini Decoction should be the main therapy for those with chronic cold", among which "cold hands and feet", "heartbroken pulse" and "chronic cold inside" are the keys to this recipe. It is not difficult to find out from the analysis of the drug syndromes that constitute this prescription 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 muscles and bones, and treat contracture, paralysis, dryness and astringency"; Asarum is mainly used for "headache, brain movement, spasm of joints, rheumatism, arthralgia and muscle death", which can relieve exterior symptoms and dispel cold, and can be used to drive away chronic diseases such as cold in meridians and viscera. The intention of Tongcao is not easy to understand, and the textbook says that it can dredge the meridians to smooth blood circulation. This explanation seems to be suspected of being simply piled up with fake drugs. The author thinks it may be related to local edema caused by poor blood circulation at the extremities, 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 Chinese doctors explored the characteristics of this prescription from the perspective of abdominal diagnosis, and thought that "the patients with abdominal skin contracture are similar to those with Guizhi plus Shaoyao Decoction and Xiaojianzhong Decoction, and those with left umbilical Tian Shu (one inch on the left and one inch on the right) are similar to those with Danggui Shaoyao Decoction and Danggui Jianzhong Decoction. There is aggregation in the right abdomen and waist, while cold hands and feet and weak pulse belong to Danggui Sini Decoction syndrome. 」
Case 2: Mistreatment of "chilblain" medical record
Patient Wang, male, 43 years old. Came to the clinic on February 17, 2008.
Chief complaint: frostbite of hands for 4 years. Four years ago, the patient's hands began to get 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 and depressed, with pale and slightly blue color, more frostbite on the back of his hand, cold hands, frostbite in his ears, reddish tongue and deep pulse. At the time of prescription, the patient complained that there was no obvious cause for weakness of both upper limbs three months ago, he could not lift weights for a long time, and he had no pain and discomfort in his shoulders and neck. He had checked the positive and lateral radiographs of cervical vertebrae in a local hospital and found nothing abnormal. He did not receive any treatment during the period, and then relieved himself. At present, the symptoms of upper limb weakness have basically disappeared. Re-check: the mobility of cervical spine is basically normal, and the bilateral brachial plexus traction test, intervertebral foramen compression test and neck rotation test are all (-). The muscle tension of both upper limbs is not obviously abnormal, and the muscle strength is not obviously reduced. The tendon reflex of the second and third biceps brachii and the radial membrane reflex are symmetrically derived, and Hoffman's sign is left (+-) and right (-). Without considering it, the author thinks that the poor peripheral circulation of chilblain leads to weakness of hands.
Prescription: the original prescription of Danggui Sini Decoction, 30g of Danggui, 5g of Guizhi 15g, 6g of Radix Paeoniae Alba 10g, 6g of Herba Asari, 6g of medulla tetrapanacis 10g, 6g of roasted licorice and 5 small red dates. Five times, decocted in water, one time a day.
In May, 2008, the family told the patient to take medicine intermittently, and the improvement was not obvious, and he didn't pay attention to it. In April, he went to the hospital with numbness in his left side, but no abnormality was found in CT scan of his head and cervical vertebra. In May, he was hospitalized again when his condition worsened. After MRI scan of cervical vertebra, he was diagnosed as a "tumor in cervical spinal cord" and underwent surgery.
Press: The author failed to make a detailed investigation at the time of admission. According to the previous experience in treating chilblain, it was concluded that it was Danggui Sini Decoction syndrome, and the swelling of the back of the hand was a grass-clearing syndrome, and the cold was insidious, the course of disease was long, and the pain was Asarum syndrome. I thought that the medicine was not weak and was consistent with the condition, but the improvement was not obvious after taking the medicine, indicating that the prescription and the syndrome did not correspond. It is more appropriate to say that the case was misdiagnosed than the prescription.
Intraspinal tumor of cervical spine is an intramedullary tumor of cervical spine, and its clinical manifestations are mostly atypical, which is likely to be confused with other diseases that can cause functional damage of spinal cord and nerve roots. In addition, due to the slow growth of tumor and the great tolerance of spinal cord, it is difficult to make a diagnosis at an early stage and the clinical misdiagnosis rate is extremely high. "Dyskinesia is usually the second most common symptom of intramedullary tumors. Cervical cancer often occurs before the symptoms of the lower limbs, and the upper motor neurons of the upper limbs are weak, which is consistent with the symptoms of the damage and compression of the anterior horn neurons caused by the tumor in the center of the spinal cord ... Most patients complain of poor mobility, fatigue and decreased mobility. In the auxiliary diagnosis, "most of intramedullary tumors are negative on plain films, and most of them can not be displayed on plain CT. MRI can clearly show the size of spinal cord and whether there is morphological abnormality, and can determine whether the tumor is cystic or solid. Most tumors show high signal on T2-weighted images. The symptoms, signs and imaging findings of cervical spinal cord tumors are the key to diagnose this disease.
Although the author considered the examination of nervous system at that time, he was still unfamiliar 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 it is necessary to make a diagnosis and treatment of pure Chinese medicine on the premise of making clear the name of western medicine.