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甫寸-dr.libo的博客

甫寸之《胃靠养肠靠清》

 
 
 

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李博 男,中国中医科学院西苑医院 中医消化内科副主任医师,2006年毕业于北京中医药大学。 2005-2012曾担任丁香园循证医学版版主7年, 2014年获得NSFC国家自然科学基金青年项目资助 2015年入选北京市科技新星计划, 2015年入选中国中医科学院西苑医院育才计划。 2016年入选北京中医药传承“双百工程”唐旭东主任医师学术继承人 2016年1月出版小说体中西医消化内科科普书《胃靠养肠靠清》。

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腰背痛的莫西比利医院急诊科主任TCM in Muhimbili for lumbodorsal pain  

2009-09-09 03:40:30|  分类: 充实工作 |  标签: |举报 |字号 订阅

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腰背痛的莫西比利医院急诊科主任TCM in Muhimbili for lumbodorsal pain

 

这天,我的第一个病人走进来了,是个很有气质的中年男子,很客气的和我握手,门诊的Dr Naomi告诉我,这是我们莫西比利医院急诊科的主任。

 

我很高兴能和他们本院的医生做个交流和沟通,通过我的诊疗。作为坦桑尼亚最大的国立中央医院,在这里,每一个医生都举足轻重,他们会对本国医学的交流和学术,起着重要的影响作用,也是非洲高素质的人群。通过给他们的诊疗,找到中非医学交流,文化交流的切入点。

 

SurnameO*

Other nameDr.Ch*

Date of Birth1950  Sex:F

JobDirector of Emergency Department

Hospital Reg. Number:  A***

 

初诊:200994

主诉:腰背痛反复发作1年余,昨日加重。

病史:患者从1年前开始出现腰背痛反复发作,晨起大小关节活动均不利,僵硬疼痛,手指难以握紧,反复发作,昨日再次加重。在急诊肌肉注射止痛药:Inj. Dichlofeual ? 1pm 75mg一次后好转。平时还有上肢麻木,肩颈部不适,近一年来记忆力下降,容易忘事,反应迟钝。腰痛和天气变化关系不大,最主要是早晨明显,平素喜欢常温食物,纳食可,有胃溃疡病史,时有泛酸烧心,进食豆类可加重,曾服用PPI-Omeprazole caps 20mg OD)治疗缓解,二便正常,睡眠一般。

查体:肾区叩击痛阴性,腰L3L4L5有压痛,颈椎附近有硬结压痛。

实验室检查:2008X-ray示腰椎骨质增生,L3L4之间腰椎间盘突出,颈椎病

舌脉:舌体瘦长,舌淡红,苔薄白,脉位中,脉长滑尺弱。

建议:检查类风湿相关指标,以明确诊断。

诊断:腰椎间盘突出症;骨质增生;颈椎病;类风湿?

中医诊断:腰痛

辨证:肾虚督寒,经脉失濡,痹阻脉络(不荣,不通兼有之)

治疗:补肾强督,通经活络,益气养血

处方:补肾强督汤加减(加入香苏饮以护胃)

补骨脂10  骨碎补10  金狗脊10  伸筋草10

忍冬藤10  仙灵脾10  鸡血藤10  制香附10

紫苏叶10  鸡内金10  青陈皮10  炙甘草6

六剂颗粒剂 冲服

 

另:关节止痛贴2/外用腰部  1  Qd

 

医嘱:避风寒,加强运动。

 

告知医疗博客:http:libo.haodf.com

 

 

 

 

TCM in Muhimbili for lumbodorsal pain

 

 

 

SurnameO**

Other nameDr.C**

Date of Birth1950   Sex:F

JobDirector of Emergency Department

Hospital Reg. Number:  A***

Chief complaint: There is the lumbodorsal pain recurrent attacks for 1 year.

He complained that he had a the lumbodorsal pain recurrent attacks 1 year ago.He have an anchylosis in the every morning. It was worse yesterday. After he was taken acesodyne injection (Dichlofeual ? 1pm 75mg), he was feeling better. He have an acroanesthesia of extremitas superior and unwell shoulder and neck also. And he told me he have a bad memory. He likes the room temperature drink and food. His appetite was normal. But he have the illness of gastric ulcer. Sometimes he feels the burning sensation in his stomach. It get worse after had had the bean. After had get the PPI treatmentOmeprazole caps 20mg OD, the symptoms have went away. To empty the bowels was normal, once a day, not hard and not soft. The sleep was normal.

Physical examination: The percussion tenderness over kidney region was negative; There were tenderness on the lumbar vertebra L4 L5.

Laboratory examination: 2008year,X-ray showed there were the hyperosteogeny on the lumbar vertebra. And there was lumbar disc protrusion between L3 and L4.

TCM examination: Tongue: The body of tongue was lanky.. Red with white coating tongue.

Pulse: Huan and CHI RuoSlide and CHI-pulse being weak

Diagnosis: The lubar intervertebral disc protrusion; hyperosteogeny; Cervical syndrome; Rheumatoid?

TCM diagnosis: Low Back Pain (asthenia of both yin and yang; stagnation of QI and blood may bring about pain;)

Therapy: Invigorate the kidney Yin and Yang;

Prescription:  Bushen Qiangdu Tang  

Name of herb in Chinese Name of herb in English Name of herb in Latin Pronounce in TCM Weight(g)
补骨脂 Malaytea Scurfpea Fruit Fructus Psoraleae Buguzhi 10
骨碎补 Fortune's Drynaria Rhizome Rhizoma Drynariae Gusuobu 10
金狗脊 East Asian Tree Fern Rhizome Rhizoma Cibotii Gouji 10
伸筋草 Common Clubmoss Herb Herba Lycopodii Shenjincao 10
忍冬藤 Japanese Honeysuckle Stem Caulis Lonicerae Rendongteng 10
仙灵脾 Epimedium Herb Herba Epimedii Yinyanghuo 10
鸡血藤 Suberect Spatholobus Stem Caulis Spatholobi Jixueteng 10
制香附 Nutgrass Galingale Rhizome Rhizoma Cyperi Xiangfu 10
紫苏叶 Perilla Leaf Folium Perillae Zisuye 10
鸡内金 Chicken's Gizzard-membrane Endothelium Corneum Gigeriae Galli Jiniejin 10
青陈皮 Tangerine Peel Pericarpium Citri Reticulatae Chenpi 10
炙甘草 Liquoric Root Radix Glycyrrhizae Gancao 6

6 doses given. 1 dose per day taken orally twice a day.

Advice for the patient: Diet .Pay much attention to the food you take each time.

1 Take a king’s breakfast, having as many different kinds of food as you can; rich man’s lunch, having as much as you can; bagger’s dinner; that is taking as little as you can. The right time to have breakfast: 8:00a.m.; right time to have lunch: before  1:00p.m.; right time to have dinner: 7:00p.m.;

2It is better for you to take a light exercises..

3Take a test for Rheumatoid. There was nothing to see serious, but we need take the test, just to be certain.

4、To Visit my blog for patient : http://libo.haodf.com

 

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