经方发越水湿法治疗疑难水肿案
增强出版Treatment of Intractable Edema by Classical Prescriptions
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1.重庆市中医院中医经典科,重庆 400021
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杜磊, 涂雅丹, 任毅. 经方发越水湿法治疗疑难水肿案[DB/OL].(2023-03-01)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34917062&Fpath=home&index=0
DU Lei, TU Yadan, REN Yi. Treatment of Intractable Edema by Classical Prescriptions[DB/OL].(2023-03-01)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34917062&Fpath=home&index=0
杜磊, 涂雅丹, 任毅. 经方发越水湿法治疗疑难水肿案[DB/OL].(2023-03-01)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34917062&Fpath=home&index=0 DOI:
DU Lei, TU Yadan, REN Yi. Treatment of Intractable Edema by Classical Prescriptions[DB/OL].(2023-03-01)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34917062&Fpath=home&index=0 DOI:
病史摘要,2,患者因“确诊肺恶性肿瘤9月,双下肢水肿4月”入院。入院前9月患者于外院诊断为“小细胞肺癌(T2N3M0)Ⅲ期”,予化疗(具体药物不详),免疫治疗(特瑞普利单抗)后病情相对稳定,无咳嗽咯痰及喘累等。入院前4月,患者行第5个周期免疫治疗后出现双下肢水肿,伴全身酸胀不适,未特殊处理,之后双下肢水肿进行性加重,时有上肢水肿,全身肌肉酸胀,乏力不适,在外院查甲状腺功能提示“甲状腺功能减退”,服用左甲状腺素钠片后,甲功恢复正常,但水肿未见消退。患者在外院经静脉滴注人血白蛋白及利尿等治疗后水肿可稍缓解,但水肿及全身酸胀仍反复发作,总体无明显改善。中医诊断 1、水肿病 太阳证类;2、肺癌 表闭水停证。西医诊断 1、甲状腺功能减退性水肿 2、肺恶性肿瘤(T2N3M0 Ⅲ期小细胞肺癌)3、恶性肿瘤免疫治疗 4、双肺肺气肿。干预措施 先后予中药汤剂防己黄芪汤、桂枝芍药知母汤、四妙散、《金匮》续命汤、越婢加术汤、大青龙汤口服,普通针刺、中药熏蒸等中医特色治疗,西医予利尿(消肿效果不佳,后停用)、补充甲状腺素处理(患者入院时甲状腺功能指标即在正常范围)。疗效转归 患者排出大量小便,出院时四肢浮肿较入院明显消退,四肢酸胀乏力改善,稍口干,喜饮温,不多饮水,纳寐可,大便调。患者带大青龙汤7剂出院续服,半月后微信随访,双上肢浮肿基本消失,双下肢浮肿进一步缓解,病情稳定。
Medical history summary, The patient was admitted to the hospital for "confirmed lung cancer for 9 months and edema of both lower limbs for 4 months".9 months before admission, the patient was diagnosed as "small cell lung cancer (T2N3M0) stage III",After chemotherapy (the specific drug is unknown) and Immunotherapy (Triprilimab), the condition is relatively stable.No cough, expectoration and dyspnea.4 months before admission,The patient developed edema of both lower limbs after the 5th cycle of immunotherapy. Accompanied by general acid swelling and discomfort,no special treatment.Then the edema of both lower limbs was aggravated, sometimes there was edema of upper limbs, and muscle soreness, fatigue and discomfort.Thyroid function examination in the external hospital indicates "hypothyroidism", after taking levothyroxine sodium tablets, thyroid function returned to normal.But the edema did not subside, The edema of the patient can be slightly relieved after intravenous infusion of human albumin and diuresis in the external hospital.However, edema and systemic acid swelling still occurred repeatedly, and there was no significant improvement overall.,TCM diagnosis, 1.Edema disease Solar syndrome; 2. Lung cancer Body surface closed and water stop syndrome.,Western medicine diagnosis, 1. Hypothyroid edema;2.Lung cancer (T2N3M0)stage IIIsmall cell lung cancer); 3.Immunotherapy of malignant tumor;4.Bilateral emphysema.,Interventions, The intervention measures were given Traditional Chinese Medicine decoction(Tetrandra and Astragalus Decoction,Guizhi Shaoyao Zhimu Decoction,Simiao powder, a decoction to stimulate a dying person,Yuemaiden Jiashu Decoction,major green dragon decoction) Orally,Characteristic treatment of traditional Chinese Medicine,Western medicine was treated with diuresis (detumescence effect was poor, and then stopped), and thyroxine supplementation(thyroid function index was in the normal range at admission).,Efficacy outcome, The patient excretes a lot of urine and the edema of the limbs obviously subsided compared with that at the time of admission.Improvement of limb soreness and fatigue,slightly dry mouth,like drinking warm,but didn't drink much water. The patient got normal diet,sleep and stool.The patient took 7 doses of daqinglong decoction after discharge and continued to take it,Wechat follow-up half a month later,edema of both upper limbs basically disappeared,edema of both lower limbs was further relieved with table condition.
水肿小细胞肺癌经方大青龙汤
edemasmall cell lung cancerclassical prescription majormajor green dragon decoctionOncologyGerontology
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