Understand the brain structure, physiology and pathology.
Wang Mianzhi believes that, structurally speaking, the brain is an ocean of bone marrow. "Lingshu Jing" points out: "Mr. Man, after essence, essence is born in the brain". The kidney dominates the bone and produces marrow, and the marrow meets the brain as the marrow sea. Su Wen Wu Zang Gen Pian says: "The marrow belongs to the brain." Therefore, the brain is composed of the bone marrow of the kidney. At the same time, the brain can only complete its physiological function by injecting and nourishing the essence of the five internal organs. For example, "On the Confusion of Ling Shu Da" said, "The essence of the five internal organs is focused on the purpose and essence." The generation and change of vision are closely related to the brain, and the essence of the brain comes from the five internal organs. Therefore, the brain is the mansion of Yuan God and needs the nourishment of qi and blood. Full of blood, clear and bright eyes; The brain is also inseparable from the nourishment of bone marrow. The theory of Lingshu Sea says: "If there is more marrow in the sea, it will be light and strong." Wang Mianzhi believes that although the Yellow Emperor's Internal Classic didn't explicitly put forward that the brain was the place of Yuan God, it was not until Li Shizhen in Ming Dynasty and Wang Qingren in Qing Dynasty that the brain was the place of spirituality and memory. However, in Su Wen's Theory of Meridian, it is recorded that "the head is a smart house", and the word smart points out the function of the Yuan God, so in Chinese medicine, the heart and brain are the same as the main god. Pathologically, due to the lack of marrow sea and qi and blood, Shen Yuan was malnourished, and various symptoms appeared. The book "On Shu Hai's Spirit" records that "the brain turns to tinnitus due to the lack of marrow, the shin hurts and dazzles, the eyes are blind, and the rest is relaxed", all of which explain various symptoms caused by the lack of nutrients in the brain.
The brain contains Shen Yuan, which is the place to clear away deficiency, while Shen Yuan relies on essence and blood for nourishment. The brain is afraid of cold and heat, cold injury to bone marrow is easy to have a headache, and heat disturbs the mind and makes you dizzy; Where does the cold come from? Su Wen's Theory of Ice Cream points out: "If you have a bad cold, it will reach the bone marrow." Heat is endogenous, or anger and blood stasis, heart and liver fire inflammation, or Yangming fu-organs, evil heat is dry in spirit; In the theory of epidemic febrile diseases in later generations, turbid pathogens harm the clear, and the clear orifices are covered, which are more common in phlegm-dampness, phlegm-heat and damp-heat; Blood stasis is blocked in the brain collaterals, and qi and blood are not nourished, which is easy to cause headache and dizziness. Soothing the liver, helping the spleen, refreshing the brain. However, if the phlegm is sparse, the liver yang will rise, and every sputum can be turned into wind, causing civil strife. Wang Mianzhi believes that the pathogenesis of encephalopathy is characterized by the mixture of deficiency and excess, with deficiency syndrome mostly consisting of deficiency of essence, qi and blood, and excess syndrome mostly manifested as phlegm, fire, blood stasis and hyperactivity of yang; From the relationship between viscera, deficiency is mostly related to kidney and spleen, but it is closely related to heart, liver and stomach.
Characteristics of therapeutic drugs
Commonly used treatment methods include tonifying kidney and benefiting qi, nourishing blood and promoting blood circulation, regulating qi and resolving phlegm.
Radix Rehmanniae, Radix Rehmanniae Preparata, Radix Achyranthis Bidentatae, Herba Cistanches, Cortex Eucommiae preparata, Herba Taxilli, Radix Asparagi, Radix Ophiopogonis, Fructus Lycii, cornu Cervi degelatinatum, cornu Cervi degelatinatum glue, etc. Both are commonly used to tonify the kidney, which is the dirty of fire and water. Two waters contain one fire. Although it is called the palace of fire and water, it is actually yin, so even the drugs for tonifying kidney and yin are warm, aiming at clarifying the relationship between yin and yang and fire.
Four kings are used for invigorating qi, and four kings are used for invigorating spleen and qi. Wang Mianzhi especially likes to use raw Astragalus membranaceus, which is used to tonify the qi of spleen and lung, and it is refreshing. It is often combined with Chuanxiong. Chuanxiong is a gas medicine in the blood, which "rises to the top and falls to the blood sea". Here, the characteristics of ascending hair are taken, and the two drugs are used together, which have the functions of benefiting qi, promoting qi circulation and promoting blood circulation, so that the deficiency of brain qi can be supplemented, the brain collaterals can stagnate, the qi and blood can run smoothly, and the brain can be nourished; However, excessive publicity for clearing heat should be avoided. Excessive promotion of clearing heat will help yang to generate wind, which is not suitable for people with high blood pressure and yang-heat constitution. If you want to use it, you can cooperate with Achyranthes bidentata to tonify liver and kidney, promote blood circulation and remove blood stasis, draw blood and reduce fire, so that the magnet can tonify kidney and replenish essence. The two drugs not only tonify the liver and kidney to treat cerebral spinal insufficiency, but also prevent raw Astragalus membranaceus and Ligusticum chuanxiong from rising too much by using their anti-adverse characteristics. The combination of the four drugs, which can tonify qi and blood, promote qi and blood circulation, and naturally restore the normal function of the brain, is Wang Mianzhi's profound thought on treating encephalopathy, and it is also a subtle pen of his prescription compatibility.
Taohong Siwu Decoction can promote blood circulation and nourish blood, which is both tonic and active, or it is compatible with Danshen, which contains the merits of four things and the sum of heart and brain. Of course, Radix Rehmanniae with Radix Rehmanniae Preparata, Radix Paeoniae Rubra with Radix Paeoniae Alba, and Semen Persicae with Flos Carthami are the compatible drug pairs that Wang Mianzhi likes to use clinically.
The products of important towns are designed for liver yang, such as raw concha Haliotidis, raw keel, raw oyster, raw dragon teeth, mother-of-pearl, magnet, ochre and roasted tortoise shell. Although they all have the function of inhibiting yang, they should be used with caution. Raw concha Haliotidis can clear liver, improve eyesight and relieve constipation, raw keel, raw oyster and mother-of-pearl can soothe the nerves, and magnets can tonify kidney and replenish essence. Ochre, tortoise shell and dragon teeth are also important medicinal materials. Wang Mianzhi pointed out: "Ochre is the medicine of Yangming meridian points, and it is the medicine of pulse-flushing. Chong is a sea of blood, so it is a good medicine to treat anyone's upwelling of qi and blood, which is better than a magnet, but it is a medicine for Yangming Meridian and Liver Meridian, and it is a medicine that is better than tonic. " In fact, clinically, "keel and oyster are too slow. If they are used to calm the liver and calm the wind, the head will swell badly and hurt badly. When there are signs of stroke, it is better to use dragon teeth and abalone shell. " This is the crystallization of decades of clinical experience in Wang Mianzhi.
Gastrodia elata, Uncaria rhynchophylla, etc. It is used to clear the liver and calm the wind. Wang Mianzhi's prescription dosage is relatively small, generally 3g gastrodia elata and 6g Uncaria. The teacher thinks that if used in large quantities, these drugs will spread out and help the wind. For pungent, fragrant and dry drugs such as Rhizoma Chuanxiong and Notopterygii Rhizoma, that is, drugs for removing external wind, the dosage must be small, and at the same time, it must be filled with cool and heavy products to control the rise and avoid rising and dispersing, supporting yang and damaging body fluids and moving wind.
Different encephalopathy drugs are different.
Treating brain tumor, while promoting blood circulation, paying attention to resolving phlegm and covering phlegm and blood stasis is the foundation of tumor. Erchen Decoction and Ditan Decoction are the first choice for resolving phlegm, and Acorus gramineus combined with Pollen Typhae is a classic drug pair for treating brain tumors in Wang Mianzhi. Acorus gramineus can clear phlegm and induce resuscitation, Pollen Typhae can promote blood circulation and remove blood stasis, and the combination of the two drugs can also treat phlegm and blood stasis. Phlegm and blood stasis are often combined with insects to dredge collaterals, such as scorpion, stiff silkworm and earthworm, which use insects to escape, dredge collaterals and penetrate evil.
For multiple sclerosis and inflammatory demyelinating diseases, we should pay attention to tonifying the kidney, covering the kidney, and controlling bone and marrow. Bone marrow poured into the spine is the spinal cord, and the upper part of the brain is the medullary sea. Tonifying the kidney should not be done recklessly, and it advocates less fire and less qi, seeking yang in yin and yin in yang. It is forbidden to do it by brute force. Such as Radix Rehmanniae Preparata, Cornus officinalis, Radix Polygoni Multiflori Preparata, Radix Ophiopogonis, Fructus Schisandrae Chinensis, etc. After the repeated attacks of multiple sclerosis, the myelin sheath is constantly damaged beyond repair, the motor function is limited, and it is impossible to walk. Wang Mianzhi classified it as "flaccidity syndrome", which not only tonifies the kidney, but also regulates Yangming qi and blood.
For elderly patients with Parkinson's disease and cerebellar ataxia, it is very important to tonify the yin of liver and kidney. Radix Rehmanniae, Radix Rehmanniae Preparata, Radix Asparagi, Radix Ophiopogonis, Radix Scrophulariae, Os Draconis, Concha Ostreae and Carapax et Plastrum Testudinis are commonly used for nourishing yin and calming wind.
Motor neuron disease, atrophy of limb muscles and tongue body, massive loss of seminal blood. On the basis of replenishing vitality, every kind of flesh-and-blood product, such as antler cream and antler glue, is used to supplement seminal blood. Invigorating qi is mainly based on strengthening the spleen, because spleen is the source of qi and blood biochemistry and the foundation of the day after tomorrow, which plays an important role in controlling limb muscles and myasthenia.
For epilepsy, the liver is responsible for phlegm. Epilepsy in children is mostly spleen deficiency and phlegm dampness, which is different from Banxia Baizhu Tianma Decoction. For patients with yin deficiency and blood deficiency, liver body malnutrition and liver yang turning to wind, Radix Rehmanniae, Radix Paeoniae Alba, Radix Angelicae Sinensis, Herba Dendrobii and Flos Chrysanthemi are used to nourish the liver, Concha Haliotidis, Magnetite and Prunella vulgaris are used to clear the liver and calm the liver, and Gastrodia elata and Lumbricus are used to dredge collaterals and calm the wind.
Cerebrovascular diseases include cerebral infarction, cerebral hemorrhage and blood stasis after acute phase. Their pathological features are the same. On the premise of syndrome differentiation and treatment, strengthen blood circulation and remove blood stasis, and even use drugs to break blood and remove blood stasis, such as Eupolyphaga Seu Steleophaga and leech. Wang Mianzhi thinks that the blood separated from the meridians is blood stasis, so the treatment of cerebral hemorrhage should also promote blood circulation and remove blood stasis, and it should be early, but the operation of blood must rely on the promotion of qi, which can promote blood circulation only when the qi is sufficient, so it is often used to invigorate qi and promote blood circulation. This treatment is also suitable for brain trauma. Wang Mianzhi pointed out: "The left side of hemiplegia is easier and better than the right side, and the symptoms of the lower side (lower body) recover faster than the upper side (upper body). If the hand is bent but not extended, it will be more difficult to treat. " Honesty is the talk of experience, and today's clinical experience is still applicable.
For common symptoms of nervous system diseases such as headache, dizziness, numbness, trembling and convulsions, such as headache and dizziness, it is obvious when you get up in the morning, and it will be relieved after a little exercise, but then it will get worse. Wang Mianzhi thinks that this is caused by qi deficiency, because when you wake up, your breathing doesn't rise, and your headache and dizziness are obvious. After exercise, the breath rises and the brain is radiant, so dizziness and headache are relieved, but fatigue consumes gas. Numbness is caused by abnormal camp and guard trips and skin malnutrition. In Wang Mianzhi, Guizhi decoction is often used to adjust the camp and health, but the dosage of Guizhi is small, or Huangqi Guizhi Wuwu decoction is used to replenish qi and promote blood circulation to relieve joint pain. Tremors and convulsions are often attributed to yin deficiency, deficiency of qi and blood, dystrophy of tendons and veins, and internal movement of liver wind. Wu Jutong Sanjia Fumai Decoction or Dading Zhu Feng has a better clinical effect.
Typical medical record
Patient, male, 35 years old. First visit:1September 30th, 994. Complaining about walking unsteadily and swearing for half a year. Six months ago, the patient walked unsteadily without cause, accompanied by delirium, and his symptoms gradually worsened. Magnetic resonance imaging (MRI) of the head in the outer hospital showed atrophy of olive-pons-cerebellum, but it did not improve significantly after symptomatic treatment. Recently 1 month, it is more and more difficult to walk, and the language is difficult to understand. Frequent urination and nocturnal urination are beneficial. Diagnosis: It is difficult to walk, I can barely stand, move slowly for 2-3 steps, shake unsteadily, my lower limbs are slightly swollen, my speech is astringent, I have urgent urination, nocturia, sometimes I have incontinence, my tongue is red, there are petechiae on the edge, the fur is thin and white, there is yellow greasy fur inside, and my pulse is thin.
Diagnosis: malnutrition syndrome (called olive-pontine-cerebellar atrophy in western medicine).
Treatment principle: invigorating kidney and qi, nourishing blood and activating blood, resolving phlegm and calming wind.
Prescription: Radix Astragali 30g, Radix Achyranthis Bidentatae 10g, Rhizoma Chuanxiong 3g, Magnetite 25g (fried first), Bombyx Batryticatus 6g, Radix Polygalae 6g, Poria 18g, Scorpio 3g, Rhizoma Acori Graminei 12g, Carthami Flos 9g, Semen Persicae 9g, Radix Angelicae Sinensis 18g, and Herba Cistanches. 10 dose.
19941June1kloc-0/Second visit: After taking the above dose, the strength of lower limbs was enhanced. Take 2-3 steps before taking the medicine and 20-30 steps after taking the medicine, your feet will swell, you will walk lightly, and your urine frequency will decrease. Take the effect from above, add salvia miltiorrhiza 12g, and then take 30 doses.
After 4 months of continuous treatment, the symptoms improved continuously, and I was able to walk for 50 meters continuously, walking slowly indoors was more stable than before, I was able to go to the toilet by myself, my feet were not swollen, my language was clearer than before, and my urination was improved urgently. I urinate from 5-6 times to 2-3 times every night.
Olive cerebellopontine atrophy is a hereditary ataxia disease, characterized by chronic ataxia, and there is no effective treatment in clinic at present. The disease of traditional Chinese medicine is called scabies, which is characterized by unfavorable language and unstable walking. Liver and kidney govern the lower energizer, and you can't walk if your muscles and bones are weak. "Su Wen Mai Jie" said: "The sun is so-called ... it is abolished when it enters the middle, so it is abolished. If you catch it from the inside and faint, it will be embarrassing, and it is also kidney deficiency. Those who are less yin will be shocked. " It shows that kidney deficiency is the root of this disease. If the water falls below, the wind will shake on it, so it is unstable to walk. The kidney opens to the second yin and controls the opening and closing of the bladder, while kidney deficiency leads to the loss of bladder gasification function, so urination at night is urgent and frequent. Of course, limb weakness and language disorder are also related to deficiency of qi and blood, which makes limbs and tongue useless. Qi deficiency and blood deficiency lead to blood stasis, qi deficiency and body fluid lead to stagnation of phlegm and water, and blood stasis on the tongue and yellow tongue coating lead to phlegm and blood stasis. The lower limbs are swollen and there is water stopping inside. Treatment should be tonifying kidney and qi, nourishing blood and activating blood, resolving phlegm and calming wind. Supplementing qi with a large amount of raw astragalus can increase; Chuanxiong, pungent and warm, is a medicine for qi and blood, and has strong ability to escape and ascend and descend everywhere. Astragalus can reach the brain, replenish qi and promote blood circulation, and Angelica can replenish brain qi and blood. Achyranthes bidentata nourishes liver and kidney, promotes blood circulation and removes blood stasis; Magnets can tonify kidney and replenish essence, which can not only cure the disease, but also prevent Radix Astragali and Rhizoma Ligustici Chuanxiong from lifting excessively due to their descending characteristics, thus contributing to fire and wind. Cistanche deserticola tonifies the kidney and moistens the intestines; Rhizoma Acori Graminei, Radix Polygalae preparata, Poria, resolving phlegm, inducing resuscitation, calming the heart and calming the nerves; Bombyx Batryticatus, Rhizoma Gastrodiae and Scorpio are good at entering collaterals, eliminating pathogenic factors, resolving phlegm and calming wind; Stir-fried Fructus Aurantii Immaturus promotes qi, reduces phlegm and swelling, and promotes blood circulation and phlegm. The combination of various drugs, the correspondence between drugs and syndromes, and the consideration of tonifying and reducing. It takes effect after taking 10 dose. After adjusting the medication for 4 months, the symptoms will continue to improve, and you can walk slowly indoors and take care of yourself.
In a word, Wang Mianzhi advocated the theory that the brain and the heart dominate the spirit. Encephalopathy is characterized by deficiency, excess, cold and heat. Deficiency is mainly spleen and kidney deficiency and qi and blood deficiency. In fact, phlegm, blood stasis and dampness are all symptoms. Treating both disease and syndrome, invigorating spleen and kidney, invigorating qi and blood, resolving phlegm and removing blood stasis have achieved satisfactory clinical effects, and the rest symptoms have been alleviated.