Stubborn headache is cured by 2 classics.

First, the diagnosis site 2, syndrome differentiation and treatment 3, speculative explanation: headache is a common clinical syndrome, or Qingyang does not rise. There are both internal and external causes. The patient had migraine for many days, but repeated medication was ineffective. The pain occurs every 2 p.m. And 12:00 midnight. Sometimes you can stop holding your breath when you are in pain. The head acupoints are closed, and traditional Chinese medicine is used to dispel wind and relieve spasm and relieve pain. First fry ephedra to foam, the left head is not always regular sharp pain, syndrome differentiation treatment student A: although headache is a common disease, this is because the cause of headache is very complicated. The symptoms of this case should fall within the scope of partial pain in the above example, and the former doctor has used an empirical prescription for migraine, which has the power to open meridian qi and cut through the pass. Is it not evil qi? While the deficiency headache does not seem to be so severe, the right belongs to wind deficiency and the left belongs to phlegm-heat. "only the sun meridian is the longest, so headache is the manifestation, so how to identify Sanyang headache? this case is exactly in line with the pain of the head horn before and after the ear, so it belongs to Shaoyang headache.

1. Diagnosis scene

II. Treatment based on syndrome differentiation

Third, speculate and solve doubts.

Introduction:Headache is a common clinical syndrome, which can be caused by a variety of reasons, or by wind and cold, or by hyperactivity of liver yang, or not by clear yang. There are both internal and external causes. Today we are going to learn a medical case in which patients have migraine for many days and attack at a fixed time every day, but repeated medication is not effective. What on earth is going on? In the end, what prescription was cured? Let's start today's reading.

Diagnosis site

Ren, male, 50 years old. The date of first visit was May 31, 1993. The left head has been throbbing for half a month.

I caught a cold in early May and was treated with proprietary Chinese medicine. I began to have a headache on the left side on the 12th. The pain broke out at 2 pm and 12:00 at midnight. During the attack, the pain is as painful as a peck, which is unbearable and lasts for 20 to 40 minutes. Sometimes you can stop holding your breath when you are in pain. Spontaneous sweating, bad wind, bitter mouth. Brain atrophy was detected by CT. There has been a similar attack, the head acupoints are closed, but this closure is not effective. Oral administration of chlorpromazine, aspirin and analgin were also ineffective. Traditional Chinese medicine can dispel wind, relieve spasm and relieve pain.

A few days ago, a doctor saw that all kinds of drugs were ineffective, and Yun had an empirical prescription, which was 30g of ephedra, 30g of cassia twig, 30g of poppy shell, 10g of licorice and 10g of gentian. First fry ephedra to remove foam, and then add various medicines to fry and take. However, the pain did not relieve at all after taking it.

Engraving diagnosis: the left side of the head is not always regular sharp pain, bitter mouth, spontaneous sweating, evil wind. Tenderness in the left eye, yellow and black tongue coating, thick and greasy, thin pulse.

Treatment based on syndrome differentiation

Student A:Although headache is a common disease, it is not easy to treat because the causes of headache are very complicated. The symptoms of this case should fall within the scope of migraine in the above example, and the former doctor has used an empirical prescription for migraine, which is violent and has the power to open meridian qi and cut through the pass, but it is ineffective. Is it not evil? The virtual headache does not seem to be so severe, and will not have regular attacks, I really do not know how to treat it.

Teacher:For migraine, Li Shizhen believes that "the right belongs to wind deficiency and the left belongs to phlegm-heat", but the clinical experience does not seem to be the case. However, Cheng Guopeng's theory has a certain reference significance. He said: "as for the head in the Sanyang Meridian, there are headaches, but the Sun Meridian is the longest, and its pain is the most common, so headache is a symptom."

So how to identify Sanyang headache?He said: "the pulse of Shaoyang starts from the sharp canthus of the eye, reaching the corner of the head and behind the lower ear, so where Shaoyang has a headache, the pain around the ear and even the horn of the head." This case is in line with the pain of the head horn before and after the ear, and has bitterness in the mouth, so it belongs to Shaoyang headache, and sweating evil wind accords with the provisions of Sun Zhongfeng syndrome, so the syndrome differentiation is Sun Shaoyang disease, disharmony between Ying and Wei, and headache of dampness and turbidity.

Diagnosed as migraine, give Xiao Chaihu decoction and Guizhi decoction.

Bupleurum 12g, Scutellaria baicalensis Georgi 10g, Pinellia ternata 12g, Cinnamomum cassia twig 10g, Radix Paeoniae Alba 30g, Codonopsis pilosula 20g, licorice 10g, Chuanxiong 40g, ginger 10g, jujube 20g. 1 dose.Fried in water, take 1 service a day.

Second visit on June 1st. After taking the medicine, it was very comfortable, but it had a sharp pain in the afternoon and turned to persistent slight pain after relief. The pain is no longer limited to the left side, is diffuse, the left eye is still tenderness. The pulse is slippery and the tongue is coated as before.

Add Evodia rutaecarpa 20g, cassia seed 24g above. 1 dose.

Three visits on June 2nd. After the medicine, the pain was relieved, the stool was unobstructed, and the tenderness of the left eye was greatly reduced. I feel more comfortable than I have ever had in more than 20 days. The smooth pulse has eased, and the black moss has receded but is still yellow and thick. Add 3 doses to the top.

After 3 consecutive revisits, the symptoms disappeared from decreasing.

He came to see him on July 15 because of his illness, but Yun did not relapse.

Eleven years later, in the summer of 2004, the patient who had retired and returned to his home country had never issued Yunqian syndrome again because of his illness.

Speculate and solve doubts

Student A:The ancients used wind medicine for every headache, saying that "above the top, only the wind can reach; the thin taste, the yang in yin, those who ascend to heaven from the earth." Therefore, the use of thin "wind medicine" to treat headache seems to be a principle, or valuable experience. In this case, the use of "wind medicine" is unexpectedly less, this is why?

Teacher:The "principles" and experience you mentioned are applicable to a certain extent. In traditional Chinese medicine, the most basic (and highest) principle is syndrome differentiation and treatment. therefore, in general, other principles and experiences should be under the guidance of syndrome differentiation, or when combined with syndrome differentiation and treatment, can play a role effectively.

What is "certificate"?"Syndrome" is the indication, which is the reflection of the nature of the disease. The provisions of each side of Zhong Jing represent such a kind of "certificate", so it is effective to use it. This case has a headache in the part of Shaoyang meridians, and there is "bitter mouth" in one of the main syndromes of Shaoyang disease, while Zhong Jing specifically pointed out that "typhoid stroke has Chaihu syndrome, but it is not necessary to see one syndrome."

Therefore, its syndrome belongs to Xiao Chaihu Tang syndrome, and its spontaneous sweating evil wind is Guizhi Tang syndrome, so it is used for treatment. And the so-called "wind medicine", that is, divergent medicine, in this case there is no sign of divergence, so we do not use the prescription of wind medicine. The effect of the medicine is good, which also proves the correctness of adhering to this principle.

Student B:The most important feature of the pain in this case is that the child does not have a regular attack at 02:00. It should be a characteristic symptom. Has it been considered when using the upper part?

Teacher:Of course I thought about it. All diseases made at regular times are mostly related to the growth and decline of yin and yang and the circulation of qi. The disease occurs before 02:00, when yin flourishes and yang declines, when yang declines and yin flourishes. It can be seen that before 02:00, the son is in the "transition" stage of the growth and decline of yin and yang qi, when the yang qi is declining, and the passage of meridian qi is easy to be blocked, resulting in "cold qi entering the menstruation late, sobbing but not going."... Therefore, it suddenly hurts.

Obviously, for this kind of pain, it should be able to regulate yin and yang, reconcile Ying Wei, in order to treat the disease fundamentally. And Xiao Chaihu decoction is a special prescription for regulating yin and yang, and Guizhi decoction is also a reconciling agent for Yin and Yang, which is obtained from external evidence to relieve muscle and Ying Wei, and internal syndrome to regulate yin and yang, so the two parties invest together.

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