| Objective: To summarize the diagnosis and treatment experience of researcher Hu Jingqing in treating senile dementia from heat,so as to provide support for the future construction of diagnosis and treatment scheme of senile dementia pathogenesis of "heat".Methods: The study was divided into three stages: literature study,practical analysis and integration of new knowledge.In the first stage,we will systematically study the literature on the treatment of senile dementia's by famous old Chinese doctors and discover its medication rules.In the second stage,by collecting the medical records of senile dementia patients diagnosed and treated by researcher Hu jingqing from July 2016 to September 2019 in the outpatient department of geriatrics,the case data of those who met the inclusion criteria were selected for data extraction and collation,and the "ancient and modern medical record cloud platform" was used to carry out frequency statistics and correlation analysis on drugs,drug pairs and four gases and five flavors used for treatment,thus analyzing the practical experience of researcher Hu jingqing in treating senile dementia based on the pathogenesis of "heat".In the third stage,through comparative analysis and theoretical research,researcher Hu Jingqing's diagnosis and treatment rule of senile dementia from heat is refined.Results: Literature study stage: 71 old Chinese doctors,146 senile dementia cases,273 prescriptions involving 274 drugs were included.In terms of TCM diagnosis,the top four are: phlegm-dampness syndrome 168 times(61.54%),kidney deficiency syndrome 160 times(58.61%),blood stasis syndrome 151 times(55.31%)and heat syndrome 43 times(15.75%).In terms of drug use,the first three frequencies were Acorus gramineus(69.60%),Polygala tenuifolia(58.24%)and Salvia miltiorrhiza(48.72%).According to the diagnosis of traditional Chinese medicine,the results show that the drugs commonly used to tonify kidney essence in famous old Chinese medicine are radix rehmanniae preparata(58.13%),cornus officinalis(44.37%),fructus lycii(33.75%),fructus alpiniae oxyphyllae(31.25%)and semen cuscutae(27.50%).Common expectorant drugs are Rhizoma Acori graminei(76.79%),cortex et radix Polygalae(58.33%),Rhizoma Pinelliae(37.50%),Rhizoma arisaematis cum bile(26.19%),pericarpium citri tangerinae(25%);Commonly used drugs for promoting blood circulation and removing blood stasis are Saviae Miltiorrhizae Radix(62.91%),Rhizoma Ligustici Chuanxiong(41.72%),Radix Angelicae Sinensis(33.77%),Radix Paeoniae Rubra(25.83%),and Semen Persicae(25.17%).Common heat-clearing drugs are Salvia miltiorrhiza(51.16%),Coptis chinensis(48.84%),Rehmannia glutinosa(44.19%),Curcuma aromatica(34.88%)and Gardenia jasminoides(27.91%).Practice analysis stage:(1)A total of 31 senile dementia patients treated by researcher Hu Jingqing were included(a total of 150 visits).Among them,there are 10 males and 21 females,with an average age of 74.77 10.30 years,an average of 5 visits,an average course of 3.2 years,a maximum of 19 years and a minimum of 6 months.(2)106 cases(70.67%)of senile dementia with "kidney deficiency and marrow reduction".The pathogenesis of "heat transformation" is mainly 73 cases(48.67%),69 cases(46%)of "stasis and heat accumulation" and 22 cases(14.67%)of "excessive heat".Among them,66 visits(44%)of patients had two pathogenesis at the same time,and the most common one was "phlegm heat covering orifices and blood stasis and heat stroke",accounting for 18.67%;26 visits(17.3%)of the patients had 3 pathogenesis at the same time,with "phlegm and heat covering orifices,stasis and heat stroke,kidney deficiency and marrow reduction" being the most common,accounting for 14%.(3)150 prescriptions of Hu Jingqing researcher for treating senile dementia contain 132 drugs,of which the first three are Poria cocos(82.67%),Coptis chinensis(72.00%)and Rehmannia glutinosa(63.33%).The top three drug combinations with the same frequency were "Coptis chinensis-Poria","Acorus gramineus-Poria" and "Rehmannia glutinosa-Poria".The top three confidence levels of related drugs were "Coptis chinensis ? Poria","Poria ? Coptis chinensis","Acorus gramineus ? Poria".The top three drug effects were loosening bowel to relieve constipation(219 times),clearing heat and cooling blood(162 times)and inducing diuresis and dampness(162 times).(4)106 visits were made to patients with "kidney deficiency and marrow reduction".The top five drug frequencies were Cornus officinalis(65.09%),Radix Rehmanniae(60.38%),Radix Rehmanniae Preparata(42.45%),Rhizoma Dioscoreae(34.91%)and Cistanche deserticola(26.42%).(5)The results of medication based on the pathogenesis of "heat transformation" showed that 73 visits were made to patients with "phlegm-heat-cloaking".The top five drug frequencies were Coptis chinensis(83.56%),Acorus gramineus(82.19%),Pinellia ternata(79.45%),Pericarpium Citri Reticulatae(68.49%)and Polygala tenuifolia(50.68%).69 visits were made to patients with "stasis,heat and blood stasis",and the top five drug frequencies were peach kernel(82.61%),safflower(72.46%),angelica(56.62%),Ligusticum wallichii(47.83%)and radix paeoniae rubra(26.09%).22 visits were made to patients with "excessive heat",and the top five drug frequencies were forsythia(90.91%),honeysuckle(86.36%),licorice(63.64%),coptis(63.64%)and figwort(59.09%).(5)Comparative analysis results show that,for patients with senile dementia and kidney deficiency syndrome,famous old Chinese medicine and researcher Hu Jingqing commonly use kidney-tonifying and essence-replenishing drugs such as Radix Rehmanniae Preparata,Corni Fructus,Rhizoma Dioscoreae,and Herba Epimedii.In addition,famous old Chinese medicine also commonly use pungent and kidney-warming drugs such as Alpinia Oxyphylla,Semen Cuscutae,and Radix Polygoni Multiflori Preparata,while researcher Hu Jingqing prefers yin-nourishing and heat-clearing drugs such as Radix Rehmanniae,Fructus Ligustri Lucidi,Rhizoma Anemarrhenae,and Cortex Phellodendri For patients with phlegm-dampness syndrome,two old TCM doctors and Hu Jingqing researchers commonly use Rhizoma Acori Graminei,Cortex et Radix Polygalae,Rhizoma Pinelliae and Pericarpium Citri Tangerinae.For patients with phlegm-dampness heat,the famous old Chinese medicine uses Dannanxing,while researcher Hu Jingqing usually uses Pinellia ternate or dried orange peel combined with Coptis chinensis to clear heat and dry dampness.For patients with mania caused by persistent phlegm,lapis chloris is used to remove persistent phlegm.For patients with blood stasis syndrome,famous old Chinese medicine and Hu jingqing researchers commonly use Rhizoma ligustici chuanxiong,radix paeoniae rubra and semen persicae.In addition,famous old TCM doctors prefer to use salvia miltiorrhiza.researcher Hu jingqing usually uses peach kernel,safflower,red peony root and tree peony bark to promote blood circulation and cool blood.for patients with severe blood stasis and heat,Xuefu zhuyu decoction is often combined with bezoar or buffalo horn to clear heat,cool blood and dissipate blood stasis,or another one pill of angong niuhuang pill is taken daily.For patients with heat syndrome,besides bitter and cold Coptis chinensis,famous old Chinese medicine practitioners also commonly use Salvia miltiorrhiza,Rehmannia glutinosa,Curcuma aromatica,Gardenia jasminoides Ellis and Cortex Moutan,while researcher Hu Jingqing prefers honeysuckle,forsythia,Scrophularia ningpoensis,artificial bezoar and giant knotweed to clear away heat and toxic materials.Conclusion: Famous old TCM doctors inherit and integrate the previous understanding of the etiology and pathogenesis of "forgetfulness" and "dementia".The treatment of senile dementia mainly takes "deficiency","phlegm" and "blood stasis" as breakthrough points,of which "kidney deficiency" is the basis and "phlegm" and "blood stasis" are the criteria.The fundamental treatment focuses on warming and tonifying,while the palliative treatment focuses on eliminating phlegm and inducing resuscitation,removing blood stasis and dredging channels.It treats both the symptoms and root causes,and supplements deficiency and purges excess.Researcher Hu Jingqing paid attention to the change of pathogenesis of "heat" caused by yin deficiency and heat of phlegm and blood stasis,and expanded and perfected the key points of pathogenesis identification of senile dementia as "deficiency,phlegm,blood stasis and heat".It is believed that "deficiency","phlegm" and "blood stasis" are not only the basis of senile dementia,but also the source of heat.In treatment,yin nourishing and heat clearing should be carried out for heat caused by kidney yin deficiency,instead of pure supplement and no diarrhea.Phlegm-dampness is easy to stagnate and heat up.Clearing heat and resolving phlegm should be paid equal attention to drying dampness and resolving phlegm.Blood stasis is often associated with heat evil,and attention should be paid to clearing heat,cooling blood and dissipating blood stasis.The heat evil is very severe and then accumulates in the fire,which is urgently attacked by the method of clearing heat and purging fire. |
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