I remember someone suffering from typhoid fever for five or six days, sweating on the head, no sweat below the neck, cold hands and feet, stuffy heart and constipation. Or see cold limbs, sweating and tightness, thinking that yin syndrome. The pulse condition was heavy and tight before diagnosis.
Let's take a look at this medical record and see his symptoms. For five or six days, typhoid fever, sweating in the head, no sweat below the neck, cold hands and feet, swollen heart, constipation, cold limbs, and tight pulse. Is this Taiyang disease or Yangming disease? Or shaoyang disease or yinsan disease? If the patient sits in front of us, the patient is very ill.
How should we treat it? Tight pulse, constipation, this is the internal syndrome. There is head sweat, and there is also head sweat in the syndrome of Chengqi decoction; Cold hands and feet, the syndrome of Chengqi decoction can also have cold hands and feet; The heart is stuffy, and the syndrome of Chengqi decoction can also be stuffy. Is this Chengqi Decoction or is it in a hurry to get Yin San to prove it? Is this a yin syndrome or a yang syndrome?
Sometimes, when we distinguish between yin syndrome and yang syndrome, we will be a little confused. Let's see how Xu Shuwei treats it:
Yu Yue: This disease is suspicious, but the stool is knotted, but it is not empty and cloudy. Although the pulse is heavy and tight, it is a syndrome of less yin, mostly for self-interest and no secret knot. It is said that this one is half inside and half outside, so it is better to throw small Bupleurum.
Xu used Xiaochaihu decoction to treat upper energizer, lower body fluid, and harmonize stomach and qi, and then recovered. Of course, sometimes the records of medical records are not necessarily complete. This is what the medical record shows, and what may happen in the reporter's mind is different from the author's situation at that time.
When we read this medical record, it touched us a lot. There is no such disease at all. At least I didn't see Xiaochaihu decoction or Shaoyang disease at first sight. But Xu is treated according to Xiaochaihu decoction and shaoyang syndrome, and Xiaochaihu decoction is good. The reason is that it is not suitable for any treatment, not suitable for sun treatment, not suitable for Yangming treatment, not suitable for treating acute syndrome of three yin, not suitable for any other treatment, then it can only be treated according to half exterior and half interior shaoyang.
Clinically, the syndrome differentiation of six meridians is often the same as the multiple-choice questions in our previous exams. Anyway, there are only a few answers, which shows that one of the six classics should be correct. When we can't choose the correct answer from the following, we often need to use the elimination method backwards to eliminate one by one, and the last one should be.
Second, I often think that someone has typhoid fever, upset and vomiting, and has a cold and fever. The doctor treated it with Bupleurum chinense. Yu Yue: The pulse is large and firm, and the heat is in the stomach. Can Xiaochaihu go? Zhong Jingyun: Typhoid fever has been going on for more than ten days, and the heat has accumulated in the stomach. If you return to cold and heat, you will have a big Bupleurum soup. Take it three times and you'll get well.
Obviously it is a syndrome of Xiaochaihu decoction. Why can't I use Xiaochaihu decoction? The pulse is big and solid, and the pulse is big. You should also think of plaster, that is, white tiger soup, small Bupleurum soup and white tiger soup are also very common. As mentioned earlier, when Shaoyang Yangming merged, Xiaochaihu decoction merged with Chengqi decoction. Then Xiaochaihu decoction can be combined with Chengqi decoction, and there is no doubt that Xiaochaihu decoction can also be combined with Baihu decoction. Xiaochaihu decoction can turn yellow and add mirabilite. Of course, Xiaochaihu decoction can also be added with gypsum, which is a series of prescriptions in clinic.
So, for this patient, how is Dachaihu Decoction used, that is, Xiaochaihu Decoction plus Don Juan? Instead of using Bupleurum plaster soup? Xu said: the pulse is large and solid, and the heat accumulates in the stomach. Can Xiaochaihu decoction go safely? ",he didn't focus on shit here.
The first medical record clearly pointed out that it was constipation, but Xiaochaihu decoction was used instead of Dachaihu decoction, and this medical record did not mention stool, but Dachaihu decoction was used instead of Xiaochaihu decoction.
Thirdly, I still remember that someone had typhoid fever, with sore eyes, dry nose, unable to lie down, blocked stool and a large pulse for several days. Sweating overnight, it is said that the speed is lower than that of Bupleurum chinense. The doctor said: Yangming is sweating, and the body fluid has been discharged. The method should be honey exchange, so why use rhubarb medicine? Yu said: I only know to hold steady. If I use Bupleurum, can the police know the secret of Zhongjing? Go for it, but with Bupleurum, just take it twice.
Body heat, eye pain, dry nose, not lying down, Yangming meridian disease; Obstruction of stool, Yangming interior syndrome; It's been many days since the pulse of large size, that is, the pulse of inch size. What do you mean by "sweating all night"? Did you sweat more the night you saw the doctor? Xu said that you should use Dachaihu decoction quickly.
This is obviously Yangming syndrome, whether it is meridian syndrome or viscera syndrome, why use Dachaihu decoction? Each of these three medical records seems to have problems, but we seem to think that all three medical records should be correct and there is no cross-linking. There is nothing wrong with the prescription.
The first one should be written as small Bupleurum with large Bupleurum, and the second one should be written as large Bupleurum with small Bupleurum. No, we can't say why, but we vaguely feel that this treatment is right. We vaguely feel that the real clinical experts, the real typhoid fever, how everyone uses the classics. So we feel that we need to work towards this goal, and we still have a long way to go.
So, what should we think? When we use classical prescriptions, prescriptions correspond to syndromes, that is, when we use prescriptions, prescriptions and drugs, and when we use a certain level, it is more rational and more feeling, that is, inspiration. When this disease tests you, you need to test your inspiration. It's similar to the multiple-choice questions in previous exams. That feeling is coming, and I don't know which answer is right. I just rely on it. Once obtained, the accuracy is very high. This is inspiration, depending on the feeling. However, that kind of inspiration comes from our usual repeated practice and usual study. Then our letter of credit correspondence is the same. But to some extent, this feeling can't be expressed in words.
Maybe the clinical skills between doctors are high or low. Sometimes, at this point, the same patient may be at least a little used by two doctors. Some may work, some may not. Everything expressed in our book is down-to-earth, and we really need to be down-to-earth on the basis of down-to-earth.
For example, in clinic, patients who often suffer from depression obviously have all the symptoms of qi depression, but your treatment of qi depression is ineffective, and no matter how you treat it. At this time, we use Xuefu Zhuyu Decoction, but on the other hand, we ask ourselves that this patient can't tell the symptoms of Xuefu Zhuyu Decoction, but as long as we use Xuefu Zhuyu Decoction and drink it that night, the patient will be relieved that night. This phenomenon is not common, but it does exist in clinic. I think it is right for me to distinguish and use the correct method, but it is ineffective. A small step forward in theory, we suddenly have a bright future.
The Xiaochaihu decoction we are talking about here, from Xiaochaihu decoction to reconciliation, treating exterior syndrome on the basis of reconciliation and treating interior syndrome on the basis of reconciliation, is also a half step forward in theory. Perhaps at some point, when we face a certain disease and feel that the syndrome we have identified is correct and invalid, we should think about it in turn, whether this patient needs to be treated on the basis of reconciliation. Looking back, maybe we will leave at once.
Reconciliation is a very important practice left by Treatise on Febrile Diseases.