Great doctor starts with adding points

Wu Xie cleaned up the medicine changing cart and washed his hands before returning to the doctor's office. After seeing Xiong Yao, he apologized and said, "Old Doctor Xiong, I'm sorry, I just went to change the medicine. waited."

Only then did Xiong Yao lift his eyelids: "This is all your work, so why not be embarrassed."

"Xiao Wu, I came to you because of Lin Hua's illness. What do you think of his current situation?" Xiong Yao's words went straight to the point.

Wu Xie took Xiong Yao a cup of boiled water in a paper cup first, and after placing it carefully, Xiong Yao found a chair and sat down: "Doctor Xiong, Lin Hua's current situation is in the recovery period after a stroke. Severe loss of limb muscle strength, movement coordination impairment, and sensory disturbances in the right lower and upper limbs..."

"This is a typical symptom of hemiplegia. In the stable recovery period, there are so many symptoms, which is very difficult. It is basically difficult to improve." Wu Xie's tone was formal and his expression was complicated.

Although Lin Hua can provide a lot of knowledge gain in the bed he is in charge of, such a hospitalization is actually meaningless except to waste the patient's own money.

With all the medicines and technical level in the Shazhen Health Center, it is a waste of Lin Hua's time, and there will be certain risks. Wu Xie not only can't cure him, but also has a sense of experience and gain, and he has to worry about Lin Hua's treatment at any time. Recurrence of cerebral vascular embolism and other conditions and death...

"So I still need Dr. Xiong to think of a way." Wu Xie then looked at Xiong Yao expectantly.

Xiong Yao said before that it can get better? This means he has a way!

What Lin Hua suffered was cerebral infarct stroke, not hemorrhagic stroke, this is the prerequisite.

Regardless of the type of stroke, it can actually be divided into the fatal acute phase, stable phase, and sequelae phase.

Among them, the fatal acute stage is for life, the stable stage is for function, and for the sequela stage, it can only be prevented.

The window period Lin Hua is in now is the aftereffect period after the stable period. The current sequelae have basically been finalized, and the best time has been lost if he wants to use drugs or surgery to regain his function.

This is the current understanding of modern medicine on the disease of stroke. From the perspective of modern medicine, as well as the guidelines for post-stroke treatment, what can be done to Lin Hua now is to do functional rehabilitation and avoid recurrence of embolism. anticoagulation regimen.

But Xiong Yao also said that he has a way. If he can get such a way, or have some experience, then Wu Xie can treat such patients by himself in the future. One such patient is a huge point of knowledge. Gain, five or six more, Wu Xie felt that he could definitely learn some freedom.

The reason why Wu Xie chose to believe this is also because he found such a key statistical data from the literature——

Degree of recovery: The degree of recovery of hemiplegic patients after a stroke is related to many factors, including the age of the patient, the location and severity of the lesion, and early treatment. Statistics show that about 50% of patients with hemiplegia after stroke can achieve a certain degree of recovery within 6 months, but the degree of recovery varies from person to person.

Recurrence rate: The recurrence rate of post-stroke hemiplegic patients is related to many factors, including the patient's age, sex, past medical history, type and location of the lesion, etc. Statistics show that the recurrence rate of hemiplegic patients after stroke is between 5% and 15%. If it is under regular control, the recurrence rate will be reduced to less than 5%.

The lower recurrence rate after 6 months and under control is another secondary reason why Wu Xie did not directly suggest that Lu Junyin push the patient away.

Being a doctor cannot be done casually. Every decision must be carefully considered, especially for diseases in unfamiliar fields.

This is also an important reference in the medical malpractice risk scoring scale——

Xiong Yao may have seen what Wu Xie meant, or maybe he had such a meaning in the first place, so he touched his chin and said: "It is mentioned in "Su Wen·On the Innocence of Ancient Times" that 'the one who has a stroke does not speak, and the one who speaks does not." Apoplexy is also caused by pain; those who are not benevolent have apoplexy; those who are benevolent but do not speak are also paralyzed.'”

"Now Lin Hua's symptoms, in our field of Chinese medicine, are called apoplexy."

Wu Xie followed suit and nodded. Xiong Yao was a Chinese medicine practitioner, and Wu Xie didn't understand, but Xiong Yao added an explanation. He began to analyze the arthralgia after hemiplegia from the classics of traditional Chinese medicine.

"In Chinese medicine, there is no such description as hemiplegia, but the arthralgia associated with apoplexy has been recorded in classics since ancient times."

"Apoplexy arthralgia, in the four-in-one consultation, there are the following records."

"Wang Zhe, "Synopsis of the Golden Chamber · Atrophy Theory" and "Clinical Guide to Medical Cases · Stroke" discuss separately:

"So when a stroke occurs, facial spasms, eye swelling, mouth corners are crooked, tongue is forced to stop speaking, upper limbs cannot be lifted, and lower limbs cannot be flexed or stretched."

"The patient is thin and weak, his muscles are atrophied, his limbs are weak, and he can't control himself. His shape is like a hanging chime."

"Facial spasm, muscle atrophy, weakness of limbs, emaciated body, inability to lift upper limbs, inability to bend and extend lower limbs and other symptoms."

"In your modern medicine, this should be called disuse atrophy, right? I see someone wrote a medical record like this."

Wu Xie heard the words, thought for a while, and answered cautiously: "There is also called neurotrophic atrophy. Although the final manifestation is the same, the meaning is similar, and it also has a disability."

"Re-discussing the pulse condition - "Treatise on Febrile and Miscellaneous Diseases The Beginning of All Diseases" says: When the Cunkou pulse is deep and thin, it is Yin Qi; if it is deep and late, it is cold; "Floating but weak, it is Qi; slippery and counting, it is hot."

"The pulse condition is slow or slippery and late, which means that Qi and blood are not smooth or Yin deficiency and coldness..."

"Apoplexy is a disease, hemiplegia, unable to speak, this is hemiplegia....Paralyzed, the qi is not functioning, and yang qi is blocked. If the mouth is silent, the pulse is weak, yin and yang are both weak, so it is impossible to speak. Or Unkind hands and feet, this is the disease of cold arthralgia,... according to the pulse, it is like a number, this is also cold."

"These are the records of the classics. Have you read my summary description in the notes I gave you?" Xiong Yao asked after citing the scriptures for a while.

Wu Xie shook her head honestly: "Doctor Xiong, after getting the book you gave me, I waited and watched the part about joint dislocation. I didn't read and understand the arthralgia."

Let’s do one honestly first, even if you are very proficient in one disease, it’s better than you dabble in a hundred more, just like this surgical infectious disease, specialization level, that’s not the same as being proficient in getting started. kind of thing.

Xiong Yao also nodded, and said: "Patients with arthralgia due to apoplexy generally have dull complexions, which is due to poor blood flow and imbalance of yin and yang. The tongue coating is thick and off-white. It is still the cause of poor blood flow."

"These are all about diagnosis, which is about diagnosis." Xiong Yao imitated how Wu Xie gave him popular science and modern medical knowledge before, explaining and explaining some things about apoplexy and arthralgia one by one in categories and levels.

"The next thing is about treatment. When we treat stroke arthralgia, there is no source of medicine and no fundamental prescription, but there is a direction to follow—"

"The "Huangdi Neijing" states: 'Bi, cold also. Cold makes the water coagulate and cannot move, so it is called numb. The meridians are blocked and the muscles lose their place, so they can't move.'"

"The imbalance of qi and blood leads to the blockage of meridians and the loss of muscle movement ability. Therefore, the key to treating hemiplegia after stroke is to regulate qi and blood, clear the meridians and activate collaterals, and restore muscle movement ability."

"Maybe you can understand this?" After Xiong Yao recounted the classics like feeding a child, he fed Wu Xie again in vernacular.

Wu Xie nodded: "Qi and blood are not separated, they can be transformed into each other, and the luck of Qi and blood are different."

Wu Xie could only use his little knowledge of Chinese medicine to answer the vulgar layman.

Xiong Yao also didn't comment on Wu Xie's faults: ""Synopsis of the Golden Chamber" also said: "Paralyzed people, their qi is not good, and their yang qi is blocked. If the mouth is silent, the pulse is weak and both yin and yang are weak, so it is impossible to speak. Or inhumaneness of hands and feet, this is a disease of cold arthralgia,... According to the pulse, it is like a number, this is also cold. "

"This shows that in our traditional Chinese medicine's cognition, stroke arthralgia belongs to cold arthralgia, so."

"The treatment of post-stroke hemiplegia focuses on warming the meridians, dispelling cold and blood stasis, and activating the body's self-healing ability. This is the principle of treatment, and the principle of treatment is one direction. Am I right?" When Xiong Yao said this, he still He narrowed his eyes deliberately.

Hearing this, Wu Xie was a little moved. He could see that Xiong Yao was trying to get closer to him, and told himself in a way and form that he could understand, what exactly is this cold arthralgia, and what should he do? rule.

After sorting it out in a more friendly way, he then told himself what kind of system and system Chinese medicine would look like according to the understanding of modern medicine. He really wanted to teach himself.

But Wu Xie still didn't understand. While feeling guilty in his heart, he didn't know how to persuade such a stubborn little old man.

Wu Xie really wants to say, it's too late for me to change careers now, Old Doctor Xiong, Grandpa Xiong, Doctor Xiong...