May isang babae na nasa unang araw ng menstruation, at biglang nagkaroon ng sipon. Mayroon siyang headache, alternating chills and fever, abdominal pain sa lower abdomen, low appetite, at walang thirst, o kung may thirst, hindi masyado. Sa isang ospital, siya ay diagnosed bilang "sipon," at binigyan ng IV antibiotics nang ilang araw, ngunit ang sintomas ay hindi bumaba. Pagkatapos ay nag-preskrip siya ng herbal medicine, ngunit ang resulta ay hindi maganda, at kumuha siya ng tulong sa akin. Ang unang preskripsyon ay silver flower decoction plus some modifications. Ang kanyang kasalukuyang estado: headache, dizzy, alternating chills and fever, sweating then fever goes down, thirst but not much drinking, lower abdominal pain, nervous, irritable, poor sleep, confused dreams, chest and rib pain, palpitations, low menstrual flow, prolonged bleeding, short and dark urine, red tongue, wiry pulse. Diagnosis: exogenous infection during menstruation, residual pathogen, heat entering the blood chamber, heat and blood stasis combined. Treatment: harmonize shaoyang, clear heat, calm the spirit, activate blood, resolve stasis, cool blood, regulate menstruation. Prescription: baihu 10g, huangqin 10g, danpi 10g, zhi zi 10g, yin hua 10g, lian qiao 10g, pu gong ying 15g, yi mu cao 15g, ze lan 10g, hong hua 10g, dang gui 10g, chi shao 10g, sheng long chi 30g (pre-boiled). After 3 doses, symptoms improved, chills and fever gone, more blood clots passed, menstruation ended. Continue for another 3 doses, all symptoms resolved.
Ang kaso na ito ay exogenous infection sa panahon ng menstruation, sa larangan ng TCM na tinatawag na "heat entering the blood chamber." Tungkol sa "heat entering the blood chamber," mayroon itong parehong description sa "Shanghan Lun" at "Jin Gui Yao Lue," sa loob ng exogenous disease category. Ang "blood chamber" ay may iba't ibang interpretasyon sa mga historian. May mga nagsasabi na ito ay uterine artery, iba nagsasabi na liver, iba nagsasabi na uterus. Batay sa mga teorya at clinical practice, ang blood chamber para sa babae ay talagang tumutukoy sa uterine body, kasama ang connected channels tulad ng Chong and Ren meridians, at mga organ na nauugnay sa menstrual cycle. Dahil ang Chong meridian ay "sea of blood," ang Ren meridian ay "master of the uterus," at ito ang basehan ng pagbubuo at pagpapalaki ng babae. At ang liver meridian ay nag-uugnay sa genitalia, at ito ang organ na nagtatago ng dugo. Kaya ang konsepto ng blood chamber ay dapat ma-comprehend nang buo upang tugma sa clinical reality, at hindi dapat isiping ito ay isang konkretong organ.
Ang sanhi at mechanism ng "heat entering the blood chamber" ay dahil sa pasyente na may emotional stress, depression, at liver qi stagnation. Sa panahon ng menstruation, o pagkatapos ng childbirth, kapag ang blood sea ay walang sustansya, ang wind-cold or wind-heat pathogen ay sumakop sa katawan, ang heat at blood ay magkakasundo, ang righteous and evil qi ay magkakasundo, hindi maka-out, at ang blood ay stuck sa uterus. Clinical manifestations: fever, headache, no thirst or little thirst, eats normally, silent, confused mind, delirium like seeing ghosts, constipation. Ang diagnosis and treatment method ay gaya nito:
1. Heat initially enters: symptoms include alternating chills and fever like malaria, can be treated with Xiao Chai Hu Tang, and acupuncture at Qimen point.
2. For heat pathogen from warm disease that enters internally, use Tao's Xiao Chai Hu Tang or Gui Zhi Hong Hua Tang with modifications. ① If menstruation just started, exposed to wind-cold, cold turns into heat, heat enters blood chamber, first alternating chills and fever, then like malaria, menstrual flow blocked and stopped. For mild cases or weak constitution, use Yi Chai Hu Yin. ② If there are blood clots or lower abdominal pain, indicating blood stasis, add Yi Mu Cao, Dang Gui, Ze Lan, Hong Hua to activate blood and regulate menstruation. ③ Due to wind-heat exposure or severe heat, with imbalance in Chong and Ren meridians, liver unable to store blood, heat forces blood to flow, causing prolonged or heavy bleeding, treat by clearing heat and cooling blood. Add Sheng Di, Dan Pi, Qing Hao, Di Gu Pi, Pu Gong Ying, Yin Hua, etc., to cool blood, nourish yin, clear heat. ④ If Chong and Ren meridians are weak and bleeding is heavy, add Sheng Ma, Di Yu, Lian Fang Tan to strengthen Chong and Ren, and San Qi to stop bleeding. ⑤ If heat is severe, blood is blocked by heat, trapped in uterus, heat and stasis combine, rising through Chong and Ren, ascending to Yangming, symptoms include dry mouth and bitter taste, thirst, headache, flushed face, irritability. Mild cases add Huang Lian, Zhi Zi to clear heat; if constipation, add Da Huang or Da Chai Hu Tang with modifications. ⑥ If menstruation is ending or postpartum, blood sea empty, exposed to external pathogen, leading to internal heat and blood stasis, use Chai Hu Si Wu Tang, Xiao Yao San, or Dan Zhi Xiao Yao San with modifications.
3. Even if the disease is improving, but if the constitution is weak and heat remains or bleeding continues, treatment should use Bu Qi Yi Yin Jian or similar.
4. If spleen is weak, use Gui Pi Tang.
5. If both qi and blood are deficient, use Shi Quan Da Bu Tang.
6. If blood heat is stagnant, use Xiao Chai Hu Tang with Dan Pi, Hong Hua, Dang Gui, etc.
Summarizing, "Heat entering the blood chamber" in clinical practice will never present all the typical symptoms described in books. Therefore, one must start from clinical reality, grasp the etiology and mechanism, and apply flexible diagnosis and treatment to achieve good results.
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