Yang Muxiang Discribing phlegm and blood stasis from the treatment of hyperlipidemia
He has been in medicine for more than 40 years, has been rigorous in his studies, has superb medical skills, and is good at treating many difficult and complicated diseases. The author is fortunate to follow his teacher in clinical practice and has benefited a lot. It has achieved good results in the diagnosis and treatment of hyperlipidemia through phlegm and blood stasis. Here is a case to illustrate it for readers.
1. Typical medical records
Zhang, female, 56 years old. First diagnosis on June 25, 2004: Dizziness, headache, heavy head, and more than three years of pregnancy, which has worsened recently. It is often accompanied by chest tightness and abdominal distension, loose stools, pale red and dark tongue, white and greasy coating, and stringy and astringent pulse.
lipids : Total cholesterol 5.73mmol/L, triglyceride 2.39 mmol/L, high-density lipoprotein cholesterol 0.86 mmol/L, LDL3.57 mmol/L.
Western medicine diagnosis: hyperlipidemia.
Traditional Chinese medicine diagnosis : vertigo, phlegm and stasis syndrome.
Professor Yang Muxiang believes that the patient is dizzy because phlegm and turbidity conceals the clear yang, so he is dizzy and has a heavy head like a cloud; phlegm and turbidity blocks the blood flow, so he suffers headaches; phlegm and turbidity block the middle, turbidity does not descend, and qi is not smooth, and chest tightness occurs; phlegm and turbidity trap the spleen, and the spleen loses its health, so the abdominal distension and loose stools are loose; the tongue is pale and red and dark, the tongue is white and greasy, and the pulse is stringy and astringent, which is a sign of phlegm and blood stasis and qi stasis.
treatment is to strengthen the spleen and remove dampness , eliminate phlegm and reduce turbidity, and promote blood circulation and remove blood stasis .
Prescription: 6g of orange lucidum, 15g of roasted Astragalus, 10g of fried Atractylodes macrocephala, 10g of Qing Pinellia halberd 10g, Alisma 10g, Salvia miltiorrhiza 15g, Turmeric 10g, Porkus kale hamster 15g, one dose a day, decocted in water, a total of 14 doses.
Instruct patients to eat less fatty, sweet, rich, and spicy foods, and avoid alcohol.
follow-up visit: dizziness and headache have been reduced, chest tightness and abdominal distension, loose stools, pale red and dark tongue, white and greasy coating gradually fades, and astringent pulse. Add savory white 10g, sausage 10g, sausage 10g, coix seed 10g, poria 15g, amomum keratin 6g, and take 14 doses. Three diagnosis: dizziness and headache, heavy head as if it is covered has basically disappeared, chest tightness and abdominal distension are significantly reduced, tongue light red and slightly dark, white and greasy coating, pulse string .
front-front reduction of bean curd, safflower, and amomum villossus, and 14 doses were taken. Four diagnosis: All symptoms are flat, the tongue is pale red, the tongue is thin and white, and the pulse is slightly stringy.
review of all indicators: total cholesterol 4.96mmol/L, triglyceride 1.63mmol/L, high-density lipoprotein cholesterol 1.52mmol/L, low-density lipoprotein cholesterol 2.91mmol/L. There was no recurrence in the follow-up and the clinical control standards were met.
2. Find out the pathogenesis
Hyperlipidemia is a disease that causes the lipid levels in the plasma to exceed the normal range due to abnormal lipid metabolism. There is no such disease name in traditional Chinese medicine. According to clinical manifestations, traditional Chinese medicine classifies it as the category of qi, blood, body fluid lesions, similar to phlegm and turbidity and blood stasis. Professor Yang Muxiang believes that blood lipids are transformed by the essence of water and grain, which is a component of the blood. Under normal circumstances, the content remains within a certain range and has the effect of nourishing the body; if blood lipids exceed the normal range, it becomes a pathogenic factor. Although its pathogenesis is complex, it is not just about the five aspects of deficiency, depression, phlegm, dampness and blood stasis. From the perspective of the internal organs, the spleen is responsible for transportation and dispensing essence. The spleen's transportation and transformation function is normal. It not only makes the essence of water and grain subtle and produces active, but also spreads the whole body through the effect of dispensing essence, providing nutrition to the body. Once the spleen loses its health and transportation and the body fluid is dispensed with abnormal distribution, dampness will be caused into phlegm; the kidney is responsible for storing essence and is the place where vital energy is lived. The vital energy flows through , the triple burner , which plays a dominant role in the body body fluid. Once the kidney's transpiration and qi transformation function is abnormal, water and dampness will stop gathering, phlegm and turbidity will be produced; the liver is responsible for dispensing and dispensing, and regulating the qi mechanism, which is related to the distribution and operation of the human body's qi and blood body fluids in the body. Once the liver fails to dispensing and dispensing, the qi mechanism will be unfavorable, which will inevitably lead to the accumulation of body fluids, poor blood circulation, and phlegm and stasis. To sum up, the formation of hyperlipidemia is closely related to the dysfunction of the liver, spleen and kidneys. The dysfunction of the liver, spleen and kidneys is the basis of the disease, and the blockage of phlegm and blood stasis is the symptom of the disease. After the disease occurs, the causal effect of the specimen forms a vicious cycle, the phlegm becomes more stagnant, the blood stasis becomes worse, and the veins become damaged over time, which will become an important factor in causing cardiovascular and cerebrovascular disease .
3. Be proficient in formulating prescriptions
Professor Yang Muxiang has screened the clinical effect of drugs that have the effects of resolving phlegm and reducing turbidity, promoting blood circulation and removing blood stasis, strengthening the spleen and replenishing qi and treating this disease through years of clinical verification.
This recipe consists of 6g of orange lucidum, 15g of roasted Astragalus, 10g of fried Atractylodes macrocephala, 10g of Qing Pinellia ternata, 10g of Alisma, 10g of Salvia miltiorrhiza, 15g of Salvia miltiorrhiza, 10g of Turmeric, 15g of Knotweed, etc.
Among them, the main medicines for orange meridians to resolve phlegm and unblock the meridians, promote qi and promote blood circulation. The literature has confirmed that this medicine is the first time to be used for the treatment of hyperlipidemia; Pinellia halberd is good at drying dampness and eliminating phlegm, and diarrhea and diarrhea to reduce dampness, which is a source of deficiency of phlegm;
Salvia miltiorrhiza promotes blood circulation and removes blood circulation, turmeric qi and promotes blood circulation, koji stimulating blood circulation, guanosita activates blood circulation and dispersing blood circulation, and can clear heat and relieve dampness. The three medicines are used to help orange meridians to smooth qi and promote blood circulation; roasted Astragalus and fried Atractylodes strengthen the spleen and replenish qi and eliminate dampness, so as to help resolve phlegm, lower turbidity, promote qi and remove blood circulation.
All medicines combine to help eliminate phlegm and reduce turbidity, promote blood circulation and remove blood stasis, strengthen the spleen and replenish qi. They treat both the symptoms and the root causes and directly cut off the pathogenesis. Modern pharmacology studies have shown that Pinellia ternata, Alisma, Salvia miltiorrhiza, turmeric, and knotweed all have the effects of reducing total cholesterol, triglycerides, and proβ-lipoprotein.
4. Detailed and refined
When Professor Yang Muxiang was diagnosed, he would follow the symptoms based on this prescription:
If the waist and knees are sore and weak, kidney deficiency and weak body, add mulberry parasitic 15g and 10g Eucommia ulmoide to nourish the kidneys and strengthen the waist; if the headache does not heal for a long time, the pain is like a thorn in the cone, especially at night. If the blood stasis of the brain, add Chuanxiong 15g and 3g leech (grain the powder and put it in the capsule to take) to enhance the ability to remove blood stasis and unblock the meridians; if the ribs are swelling and painful, irritable and irritable, the liver will be For those with depression and stagnation, add Bupleurum 10g, Tulip 10g, Xiangfu 10g, Chuanyizi 10g, Chuanyizi 10g to relieve the liver and regulate qi;
If you are dizzy and swelling, red face, red eyes, burning and painful ribs, and liver depression and transforming fire, add 10g Gardenia, Gentian grass 6g, and scutellaria baicalensis to clear the liver and relieve fire; if you are dizzy, tinnitus , head and head and head, heavy feet, and liver yang are too hyperactive, add Uncaria (later Next) 15g, trunca terrestrial 15g, 15g of Radix Cassia (decoct first) to calm the liver and suppress yang;
If chest tightness and tingling process occurs, chest yang is not clear, heart pulse is blocked, add 10g of leucorrhea, 15g of leucorrhea, 110g of red peony 10g, and Chuanxiong is 15g to promote heart yang, promote blood circulation and unblock blood circulation; if limbs are numb, phlegm and stasis are blocked, add gallbladder 10g, earth dragon 10g, chicken blood vine 30g to eliminate phlegm and remove blood circulation and unblock blood circulation;
If the stool is dry and difficult to get rid of, and if the heat and depression are depressed, add rhubarb (afterwards) 10g, Raw Rehmannia 15g, Scrophularia 15g, and Ophiopogon japonicus 15g to relieve heat and increase fluid and relieve bowel movements;
If the stool is late in menstruation or dysmenorrhea , and the menstrual color is purple and dark, add zelan 10g, motherwort 15g, peach kernel 10g, and safflower 10g, to remove blood stasis and regulate menstruation.
In the diagnosis, Professor Yang Muxiang focused on exploring the importance of phlegm and blood stasis from the changes in the tongue and pulse. For example, if the tongue is white, thick and greasy, and the pulse is slow, the phlegm is excessive; if the tongue is light red and dark, or there are ecchymosis or pectoris, and the pulse is stiff, the blood stasis is severe; if the tongue is light, dark, white, greasy, and the pulse is thin and astringent, it is a sign of phlegm blockage. The pulse syndrome is combined with ginseng, and the symptoms are added and decreased according to the symptoms, and good results are obtained.
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