Li Shimao Master of Traditional Chinese Medicine (1936-2015)
Li Shimao, a master of traditional Chinese medicine, made good use of the classic formula in the clinic, saying that the classic recipes and test prescriptions of the medical masters of the past generations are like stars and dots, full of the light of the wisdom of doctors. If you can understand the spiritual essence of these classic recipes and apply them flexibly, you can be confident in the face of complex clinical evidence. Li Shimao's clinical practice often chooses the ancient classic formula addition and subtraction according to the results of the dialectic, and sometimes even directly uses the original formula without adding or subtracting a drug. It is also like this that Li Shimao has only created two prescriptions in his lifetime, one is a new addition to lifting and dispersing, and the other is a cold spasm soup. Let's talk about the soup of cold spasms.
The origin of the cold spasm soup
The cold spasm soup is a combination of guizhi peony medicine and ephedra appendage soup and antispasmodic dispersion.
Guizhi to peony medicine plus ephedra appendage fine spice soup from the "Golden Kuai Yao Luo Shui Qi Disease Pulse Evidence and Cure" Article 29: "Qi is divided, the heart is firm, as big as a plate, the side is like a spinning cup, the water is made, the guizhi goes to peony medicine and ephedra appendages the fine spice soup master". The so-called water gas disease is the evil of water drinking, and the spleen and kidney yang deficiency stay in the stomach, resulting in the stomach full of blockage and swelling and even the formation of a tangible fistula, but it has not yet affected the blood.
This party is composed of raw ephedra, guizhi, cannon appendage, fine spices, ginger, hot licorice, jujube seven flavor medicines, the whole party together to warm the Yang Qi, disperse cold drink, adjust the qi machine, the treatment of water drink caused by the heart firmness, large as a plate, the side like a cup of qi division evidence. This party is also known as Guigan ginger jujube Ma Xin soup, Li Shimao explained this side when he said: "This side is actually a combination of Guizhi peony soup and ephedra fine spice soup. Guizhi goes to peony soup, which is found in article 21 of the "Treatise on Typhoid Fever", where the sun disease mistakenly hurts the sun and the pulse is full of chest.
Ephedra fine spice soup is found in article 301 of the Treatise on Typhoid Fever, which is too rare for the sick. One is less yin and yang in the hand, and the other is less yin and yang in the foot. Yang is weak and cold, the water cannot be drunk, and it is accumulated under the heart and is hard and full. The so-called qi point, that is, the water drinks by the yang of the void, and the knot is in the qi part. Fang dissolves his drink with xin hot yang, yang drinks loose and vaporizes lingxing, yang applies yin cloth and sweats out, Xuanfu opens, yin and yang are healed. This party takes the previous one, and the cloud atmosphere turns, and its gas is dispersed. The atmosphere is the yang of the human body, the atmosphere turns, the red sun hangs high, the light is empty, and the haze dissipates by itself. I clinically see that the yang is weak and the yin is strong, and the pulse strings are weak, and this party uses it many times."
Antispasmodic dispersion is from the "Secret Treasures", which is composed of centipede and whole scorpion two-flavored medicine. Centipede and whole scorpion taste are spicy, the main into the liver meridian, with the ability to dispel wind and disperse wind, extinguish wind and stop spasm, detoxify and loosen knots, activate blood circulation and relieve pain. The two drugs can be used to evacuate the external cold and can also be used to calm the internal wind.
Composition and efficacy of the soup
The cold spasm soup consists of 6 to 9 grams of ephedra, 9 to 12 grams of guizhi, 6 to 9 grams of fine spices, 10 to 30 grams of cannon appendages, 5 to 15 centipedes, 6 to 10 grams of whole scorpions, 9 to 15 grams of ginger, 6 to 9 grams of hot licorice, and 6 to 10 jujubes.
The three medicines of cannon appendage, guizhi and fine xin have the function of warming yang qi, warming yang qi, and warming water drinking. The combination of raw ephedra, guizhi and fine spices can not only dissolve the external cold and wet evil, but also open up the inner cold and moisture that spread out in Xuanfu. Centipede, quan scorpion with the three drugs of gun appendage, guizhi and fine xin to calm the internal wind, the internal treatment of yang deficiency water drinking yin cold caused by the tendon and vein cramping pain; with the three drugs of ephedra, guizhi, fine xin to dissolve the external cold and dampness, the treatment of external wind and dampness caused by the cold and dampness of the wind and dampness such as cold, muscle soreness, joint cold and stiffness and so on.
Ginger, hot licorice, jujube three-flavor medicine warm tonic spleen and stomach, reconcile camp guards, not only can be used internally to assist the cannon appendage, guizhi, fine spices, centipede, whole scorpion five medicines warm yang drink, calm the internal wind, but also can help ephedra, guizhi, fine spices, centipede, whole scorpion five medicines to relieve the cold and dehumidify and relieve pain. The whole party makes a total of warm and yang to disperse cold drinks, dissolve the cold and dehumidify the table, and extinguish the wind and relieve pain.
Indications for spasmodic soup
According to the drug composition and efficacy of cold spasm soup, it can be seen that cold spasm soup is adapted to three kinds of disease evidence: one is yang deficiency water stop, internal cold condensation, liver wind internal movement evidence; second, yang deficiency water stop, internal cold condensation, external wind cold certificate; third, yang deficiency water stop, internal cold condensation, liver wind internal movement, external wind cold certificate. The above three certificates all have the common yang deficiency water stop and internal cold condensation certificate, the difference is that it is accompanied by liver wind internal movement evidence, or accompanied by external wind cold manifestation. Therefore, the above three evidences are discussed separately to list their clinical manifestations.
Yang deficiency water stop, internal cold condensation stagnation certificate
Congestion in the stomach or hard pain in the stomach, do not like to drink water or like hot drinks, intestinal ringing, palpitations and coughing, cold fear, cold hands and feet, long urine, loose stool, enuresis or urinary incontinence, thinning of the lower part, puffiness of the face, puffiness of the lower limbs, fat mossy tongue, slippery veins.
Hepatic wind internal movement evidence
The limbs twitch or become numb, the hands and feet squirm, the limbs tremble, the head is dizzy.
External wind chill evidence
Cold and cold, headache, body pain, bone joint pain, numbness in pain in the extremities.
Indications for the application of spasmodic soups
There are many clinical manifestations of yang deficiency and water stoppage, yin cold condensation, and liver wind internal dynamics. Therefore, it is very important to grasp the indications for its clinical application.
Li Shimao said: "There are three main points for applying this side: spasm, cold and pain. Spasm: refers to the pulse spasm, the pulse sees the deep string tight, yu is called spasm. This vein is caused by the cold evil condensation, see this vein, the diagnosis of cold condensation can be determined by 80%. Cold: Cold refers to the cold or cold of the whole body, and can also be a local cold, such as limb cold, back cold, waist cold, belly cold, head cold, arm cold and so on. This is all caused by the cold condensation of the yang, and the yang qi cannot be warm.
In the diagnosis of cold condensation, its weight can account for 10%. Pain: or general pain, headache, low back pain, bone joint pain, or local pain, such as headache, chest pain, low back pain, abdominal pain, etc., which are cold and coagulated, and the blood is not clear and painful. The weight of this certificate in the diagnosis of cold condensation accounts for 5%. The remaining tongue evidence, signs, and symptoms can account for 5%. This is just a rough meaning. Such as hypertension, coronary heart disease, kidney disease, gastrointestinal disease, rheumatic immune disease, etc., all those who meet the above characteristics, can be cold spasms soup warm yang sweating, cold and spasm relief. After the sweat is dissipated, it is not a sweat that heals, but when you look at its pulse evidence, follow the evidence."
Li Shimao proposed a new pulse on the above ideas, the spasmodic pulse, which is manifested under the fingers as a tight string. The author experiences that the veins are mainly tight. Because there must be a chord in the tight vein, but the chord vein does not necessarily have a tight vein at the same time. Therefore, the deep string tightens the vein, that is, the tight vein. During the pulse examination, the doctor feels that the lower pulse is highly tense and pulsates from side to side, such as turning rope. This is caused by the inability of qi and blood to reach smoothly and the confinement of the vasculature.
Clinical virtual, real, cold and thermal evidence can all see this vein. Hypocrisy sees that the spasm pulse is caused by the inability of qi and blood to be nourished; empirical evidence shows that the spasm pulse is caused by the obstruction of evil qi and the inability of qi and blood to be nourished; the spasm pulse is caused by the stagnation of cold evil and the inability of qi and blood to nourish the meridians; and the hot evidence sees that the spasm pulse is caused by fiery depression and the inability of qi and blood to nourish the meridians. Therefore, the clinical spasm pulse should be judged according to the strength and weakness of the pulse, and combined with the tongue and other symptoms to judge the false cold and heat of the disease. It cannot be judged as a cold sign at the sight of a spasm pulse, which is prone to misdiagnosis.
In addition to the above three diagnostic points, the author also attaches great importance to the following two points in the clinic: (1) dynamic wind: it can be local convulsive numbness, or it can be numb with general tremor, such as limb tremor convulsions, general tremor convulsions, abdominal spasm, eye hanging, facial spasm numbness, etc.; (2) Tongue image: the tongue should be seen as light and fat, and the moss is white and slippery. On the basis of tongue image and pulse image, and one of the pain, cold and wind movement, it can be diagnosed as a cold spasm soup.
Modern medicine of acute and chronic gastritis, gastric ulcers, vascular headaches, neuropathic headaches, trigeminal neuralgia, brain tumor pain, osteosarcoma pain, sciatica, pain in herpes zoster, dysmenorrhea in women, gout, sequelae of concussion, sequelae of stroke, facial nerve paralysis, lumbar disc herniation, convulsions, epilepsy, tetanus, rheumatoid arthritis, rheumatoid arthritis, thromboangiitis obliterans, multiple neuritis, Raynaud's disease, Parkinson's syndrome, hypertension and other diseases, if the above diagnostic indications are met, Treatment with spasmodic soup may be considered.
The decoction method of the cold spasm soup and its return
Regarding the decoction method of cold spasm soup, Li Shimao: "The cannon is fried for 1 hour first, and then fried for 30 minutes with the remaining medicine, fried twice, and divided." Take 1 fry in about 2 to 3 hours, add three methods of auxiliary sweating, and make it sweat. Sweating, that is, sweating, stop taking; not thoroughly followed. After Khan, look at his pulse evidence and follow the evidence. If it does not make it sweat, it is fried twice in 1 dose, and divided after breakfast and dinner, without adding the three methods of auxiliary sweating."
The cannon is fried for 1 hour to reduce its toxicity. Li Shimao believes that the cannon attachment can be fried without first frying below 10 grams, which is safer. More than 10 grams are generally recommended for patients to fry first to ensure safe consumption.
The three methods of perspiration are: (1) sip hot porridge, or drink more warm water; (2) continuous medication, not once in the morning and evening, but every two or three hours, until the whole body sweats slightly, if you do not see this sweat, continue to take until you take two or three doses; (3) the cover is given warm. The ultimate purpose of the above three methods of auxiliary khan is to obtain the right khan.
Clinical features of positive sweating: (1) sweating all over the body, the head, trunk, and limbs; (2) continuous, sweating can last for half the night or all night; (3) slight sweating; (4) with sweating fever and decay. If there is a positive sweat in the cold spasm soup certificate, it is the indication that the yang qi is restored, the water is dissipated, the cold is relieved, and the Xuanfu is unobstructed, marking the healing of the disease. Li Shimao called it the "sweat measurement method". In the case of severe and critical illness, orthodontic sweat is an important indicator of disease outcome. If the condition is mild, Li Shimao will use the general decoction method, do not force the sweat, and wait for the disease to gradually recover.
Li Shimao's method of using cold spasm soup to seek correct sweat is similar to Zhang Zhongjing Guizhi's method of decoction with ephedra and fine spice soup. The decoction method of Guizhi to peony medicine and ephedra with fine spice soup is: "Seven flavors, seven liters of water, boil ephedra, go to foam, internal medicine, boil two liters, warm three servings." When sweating comes out, such as in the skin of an insect, it heals." There are similarities between fangzhong 'wenfu' and Li Shimao's three methods of auxiliary khan. After taking guizhi de-peony medicine and ephedra appendage fine spice soup, "when sweating, such as insects in the skin, that is, healing", is similar to Li Shimao's interpretation of the perspiration method. After taking the medicine, sweating or itching like a phenomenon in the skin of a worm is a sign of yang qi recovery, yang qi, water gas dissipation, cold relief, and Xuanfu opening, marking the healing of the disease.
From a clinical point of view, there are not many phenomena in sweating or itching like insects after taking guizhi de-peony medicine and ephedra appendage soup, so there is no need to be too rigid. Guizhi to peony medicine plus ephedra appendage fine spice soup recipe first boiled ephedra, remove ephedra foam, the main reason is that ephedra foam can be upsetting, and some people say that ephedra foam divergence is too strong to damage the right qi. Li Shimao believes that when applying a small amount of raw ephedra (generally less than 10 grams), its side effects are small, and it can not be fried first, if the amount is too much, consider frying first to foam. The amount of raw ephedra in the cold spasm soup is 6 to 9 grams, so there is no first frying ephedra to foam.
Medical record
Wang Mou, male, 50 years old, was first diagnosed on January 20, 2016. The patient complained of shoulder and back pain for 5 years and presented for treatment. Now the patient has shoulder and back pain, compression pain is even worse, shoulder and back cold, occasionally there will be numbness of fingers, headache and dizziness, chest tightness, insomnia is not easy to fall asleep, stomach discomfort has a sense of blockage, tongue is light and fat, moss white root is yellow and thick, and the pulse is tight and weak. There is a history of hypertension. Western medicine has diagnosed mild cervical spine hyperplasia. Chinese medicine diagnoses yang deficiency, cold drinking internal stop, damp heat inhibition under the scorch, wind and cold invasion meridian evidence.
Li Shimao was treated with cold spasm soup plus or minus. Prescription: Raw ephedra 5 g, guizhi 5 g, cannon appendage 5 g, fine spices 3 g, ginger 2 slices, jujube 2 pieces, licorice root 5 g, poria 5 g, Ze Yi 5 g, kudzu root 15 g, Yuanzhi 5 g, stone calamus 10 g, centipede 1 piece, whole scorpion 3 g, zombie silkworm 5 g, ground dragon 5 g, tuyuan 5 g, raw leeches 5 g, makechuan wu 3 g, make grass wu 3 g, yellow cypress 5 g, gentian 10 g, papaya 10 g, barley 10 g, late silkworm sand 5 g. 7 doses, decoction, 1 dose a day.
Second diagnosis: after taking the drug, the shoulder and back pain and chills have improved significantly, and the headache, dizziness and stomach discomfort and blockage have also decreased. According to the increase or decrease of the condition, after taking the drug for 1 and a half months, there was no attack of chest tightness, shoulder and back pain, headache and dizziness, stomach discomfort and other symptoms disappeared. Blood pressure also gradually returned to normal.
Press: shoulder and back pain, cold, tight pulse, for the yang deficiency, external feeling of wind and cold invasion of the foot sun bladder evidence, with ephedra, guizhi, kudzu root, chuan wu, making grass wu to dispel the wind and cold to relieve pain. Stomach discomfort has a sense of blockage, tongue pale white moss moisturizing, pulse tightness and weakness, for the evidence of water drinking internal stop, with cannon appendages, guizhi, poria, ze diarrhea, ginger, jujube, hot licorice spleen warm and yang qi li water; tongue root moss yellow thick, pulse number, for the yang deficiency, water drinking long-term heat long-term heat caused by the evidence of the next scorching damp heat, with yellow cedar, gentian, papaya, raw barley, late silkworm sand to clear the scorched damp heat; shoulder and back compression pain is even worse, occasionally there will be finger numbness, chest tightness, insomnia is not easy to fall asleep, tongue dark, pulse slippery, for the evidence of phlegm obstruction It uses Yuanzhi, stone calamus, centipede, whole scorpion, zombie silkworm, earth dragon, earth yuan, raw leech to transform phlegm into blood circulation. The whole party has a good effect on the spleen warm and yang drink, clear the damp heat, dissolve phlegm and activate the blood circulation, dispel the wind and disperse the cold and relieve pain.
The causes of hypertension in this case are manifold, including the reasons for the internal suspension of yang deficiency water drinking, the reasons for the steaming of the lower scorched damp heat, the reasons for the stasis of phlegm stasis, and the reasons for the external wind and cold invading the meridians and causing the meridians to be confined. It is the combined effect of the above various reasons that forms the hypertension in this case. Therefore, for the treatment of hypertension in this case, do not only focus on a certain factor or a certain pathogenesis, but also comprehensively analyze and take into account the overall situation in order to completely cure the stubborn disease of hypertension.
【Zheng Reiterated】
Since each person's constitution and condition are different, the prescription drugs and dosages in this case are only applicable to the patient's condition at that time. The prescriptions and dosages in this case may not be copied without the dialectical diagnosis and treatment of Chinese medicine practitioners. If necessary, the majority of readers should go to a regular hospital for diagnosis and treatment to avoid delaying the disease. ■
[Content compiled from: China Traditional Chinese Medicine News, February 1, 2018, fourth edition, author: Zhang Zaikang, Hebei College of Traditional Chinese Medicine]