Obviously, patients with repeated dizziness are not simply physically weak, and it is difficult to get rid of dizziness from the root cause simply by tonifying deficiency.
This is the case with Mr. Li, 72, who came to see a doctor some time ago. He has been dizzy for five years and his head is as heavy as a thick quilt. Moreover, dizziness is related to the change of posture, which generally appears when getting up and walking, and is relieved when sitting down and resting. When walking, I feel top-heavy, like stepping on cotton, and my work is aggravated, accompanied by tinnitus, such as cicadas, fatigue, indigestion, loss of appetite, and feeling full after meals. Observing the tongue, we can see that the tongue is light, fat and black, and the coating is white and thick.
According to Mr. Li's situation, TCM syndrome differentiation holds that qi deficiency and clearing yang do not rise, and phlegm and blood stasis hinder collaterals.
In fact, dizziness caused by phlegm and blood stasis is more common in clinic, especially for people with long-term dizziness. A large number of clinical practices also show that phlegm and blood stasis are important pathogenic factors of many difficult and complicated diseases in clinic.
Traditional Chinese medicine believes that "wind, fire, phlegm, blood stasis and deficiency" are common factors leading to dizziness, and "wind" mainly refers to the internal movement of liver wind. The main symptoms of patients are dizziness, tinnitus, headache and swelling, numbness of limbs, red tongue with yellow coating and rapid pulse. "Fire" generally refers to hyperactivity of liver fire, dizziness, headache, red face and red eyes, vexation and irritability, bitter taste, red tongue, yellow fur and rapid pulse. "Phlegm" refers to the obstruction of turbid phlegm, which is mainly manifested as dizziness, nausea and vomiting, greasy fur and slippery pulse. "Blood stasis" is mostly qi stagnation and blood stasis, and its symptoms are dizziness, headache, local pain, dark lips and tongue, petechiae and ecchymosis, or swelling of the tongue root and unsmooth pulse.
However, "deficiency" is common in three situations, and the common characteristics are repeated attacks, mental fatigue and aggravated work. First, qi deficiency and clear yang do not rise, with dizziness, top-heavy, pale tongue and thready pulse as the main symptoms; Second, qi and blood deficiency, with dizziness, pallor, palpitation and insomnia, pale tongue and weak pulse as the main symptoms; Third, liver and kidney deficiency, with dizziness, red eyes, tinnitus, deafness, hypochondriac pain, weak waist and knees, red tongue with little fur and rapid pulse as the main symptoms.
However, because the above syndromes are not static, clinical practice is more about witnessing the dynamic changes of symptoms and the combination of syndromes. It's like a battle, and the strength of both sides will change with time. Just like Mr. Li in the above case, the root cause of his dizziness is "Qi deficiency clearing yang, phlegm and blood stasis blocking collaterals".
The appearance of phlegm is usually caused by the dysfunction of the spleen. Traditional Chinese medicine believes that spleen governs the transport of water and body fluids, while spleen deficiency cannot transport body fluids, so it converges to phlegm. Therefore, Zhu Danxi, one of the four masters in Jin and Yuan Dynasties, put forward the theory that "treating phlegm, consolidating spleen and soil, and drying spleen and dampness are the basis of treatment".
In addition, phlegm blocks blood vessels and blood circulation is blocked, that is, blood stasis, blood stasis blocks blood vessels, body fluid is not good, and phlegm and blood stasis can be mutually causal, so we should pay attention to the treatment of phlegm and blood stasis.
For example, human blood vessels are equivalent to highways, and phlegm is like a damaged car. The more phlegm, that is, the more damaged cars, will lead to the more blocked roads, the more blocked blood vessels and the more blocked blood flow, and blood stasis will also aggravate the accumulation of phlegm, so phlegm and blood stasis often interact in the process of pathological changes.
Moreover, the clinical practice of Le Qisheng's TCM team found that blood stasis and phlegm are mutually cemented and can spread all over the viscera and meridians, so the syndrome of "phlegm and blood stasis" often involves multiple systems. Dizziness and headache in the brain, cough and asthma in the lungs, palpitation, chest pain, numbness in the limbs.
Therefore, patients with such diseases often show dizziness, or headache, numbness of limbs, local tingling, insomnia and palpitation, and the tongue coating is generally greasy (white greasy, yellow greasy, sticky greasy, thick greasy, etc.). ), and the tongue is often purple or dark red, or there are petechiae and ecchymosis, and the sublingual veins are thickened and varicose.
Based on the above syndrome differentiation, it can be seen that only the treatment of promoting blood circulation and removing blood stasis is inexhaustible, and the treatment of eliminating dampness and resolving phlegm alone will inevitably lead to the recurrence of vertigo, so both should be taken into account.
For example, Mr. Li, the patient in the above case, was diagnosed as qi deficiency and yang clearing, and phlegm and blood stasis blocked collaterals, so he was given the treatment of invigorating qi and clearing heat, resolving phlegm and dredging collaterals. Prescriptions include Yiqi Congming Decoction, Siwu Decoction and Alisma Decoction.
Radix Astragali, Radix Codonopsis, Fructus Viticis, Rhizoma Cimicifugae, Radix Puerariae, Cortex Phellodendri, Radix Angelicae Sinensis, Radix Rehmanniae Preparata, Rhizoma Ligustici Chuanxiong, Radix Paeoniae Alba, Rhizoma Alismatis, Rhizoma Atractylodis, Radix Salviae Miltiorrhizae, Folium Nelumbinis, and Periostracum Cicadae, with a dosage of 14 per day, and taken in the morning and evening.
After taking the above dose 14, Mr. Li returned to the clinic, and he reported that dizziness, dizziness and tinnitus were all relieved. But after a walk, I still feel dizzy and weak, top-heavy, sticky in my mouth and greasy with white hair. According to the prescription of the first visit, adjust the medication and instruct to continue taking 14 dose.
At the third visit, Mr. Li achieved remarkable results after taking the medicine. Blood pressure is stable at 100/70mmHg, conscious, head-heavy and light-footed, standing and walking smoothly, mental improvement, appetite increase, tinnitus and sticky feeling in the mouth are obviously relieved, stool is formed, and white greasy coating has subsided. Xiaobugeng recipe continued to take more than 20 doses, dizziness did not recur, and symptoms improved.
In this case, Radix Astragali and Radix Codonopsis were used for the first diagnosis. Radix Angelicae Sinensis, Radix Rehmanniae Preparata, Rhizoma Chuanxiong, Radix Paeoniae Alba, Radix Salviae Miltiorrhizae, nourishing blood, promoting blood circulation, removing blood stasis, dredging collaterals, promoting diuresis and removing turbidity; Pueraria lobata, Cimicifuga foetida, Vitex negundo, and Lotus Leaf are lifted lightly, and the qi of clearing yang is lifted; Paeonia lactiflora astringent yin blood; Cortex Phellodendri tonifies kidney and produces water to prevent hair from rising too much; Alisma orientalis promotes diuresis, permeates dampness and reduces turbidity, and guides turbidity and reduces yin; Atractylodes lancea is the source of dampness, spleen and phlegm. The cicada dispersed the wind and stopped singing. The second diagnosis and the third diagnosis are based on the above prescriptions, and the compatibility of drugs makes the spleen and qi, qi and blood circulation, phlegm and turbidity, and treat both the symptoms and root causes, which conforms to the pathogenesis and has obvious curative effect.
It should be noted that the etiology and pathogenesis of dizziness are complex and the clinical symptoms are different. With the acceleration of the pace of modern society and the increasing pressure of life and work, many people are accompanied by mental and emotional problems such as insomnia, anxiety, irritability and depression, which leads to mental malnutrition, mental disuse, recurrent diseases and chronic illness. In the process of clinical diagnosis and treatment, a variety of pathogenic factors can appear alone, or coexist and transform with each other, and should be treated in combination with their own symptoms, course of disease and syndromes. Only when medication conforms to the pathogenesis can we get rid of dizziness and other symptoms from the root and reduce recurrence.
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