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[经方之路]近期给老丈人治糖尿病的医案分享,纯长文无图.


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写在前面。
中医黑请绕道,右上角打X,不是写给你们看的。请自重。自觉关闭。谢谢~
有中医学识的可以进来一起交流。后面附有治疗记录。可以当成比较啰嗦的医案来看。
我初学经方,用方不够简洁老道,中医大佬们轻拍~

事情的开始是这样。

大概是2018年3月份吧,丈母娘来电说,老丈人最近身体忽然像吹气一样,全肿起来了。每天要喝大量的水,越凉越好,喜欢喝冰的。而且喝了不解渴,过了一会又特别渴又想喝。她觉得这很不正常,怕出什么事。就联系我,说我学中医的,问我这大概是什么回事。我想了下,烦渴欲饮,喝水不解渴,这个应该是消渴症吧。然后巴拉巴拉的聊起来了。丈母娘听了,一边就跟边上老丈人说。
但是老丈人呢,是有点抵触的,说自己没病,身体一切正常,吃得下睡得香的。这天没法聊了,更没办法问诊。
嗯。我是很无奈。但我做晚辈的,也不好说啥。就静观其变吧。
这个只是引子。

慢慢,过了个把月,时间到了4月中旬。
老丈人在SM的街边那种免费测量血糖血压的卖保健品的点,看到一堆老人排队在检测,他一想,不要钱,就去测测咯。然后一测不得了。血糖18.5,吓死了!他当场说,我不信你们,你们就是想搞我的钱。人家摊上的人员,就说,您不信再换个手测呗。再测,17.9.他反正是不信这些路边小摊的检测就是了,起身就走。
但是他也长个心眼,打电话问了有糖尿病的亲人,亲人都说这个数值已经很严重了,建议他去医院查查,如果真的是那么高,赶紧及时治疗哦,不是开玩笑的。说糖尿病不及时治疗,会引起一系列严重的并发症。于是他连忙又去了医院去测血糖,出来结果还是17.8这样。检测结果一出来他就不淡定了,没有原先的那种觉得别人骗他钱的感觉了。然后开始想,该怎么办。

听我丈母娘说,他当时是在衡量一个事。到底是去医院,常规治疗,还是找中医治疗。因为他询问过了有糖尿病十多年的直系亲人,询问治疗经验,取取经。
亲人告诉他,西药手段一旦上了,基本就停不上来了,要一直吃药,他这十几年,药不停的。中医是有效果,但是就是见效比较慢,可以尝试。他在纠结,到底是像别人一样,选择认命一直服药到老死。还是去尝试一下那仅有的一丝可能。

在他做艰难取舍的时候。
我丈母娘这时候呢,发挥了巨大的作用。
他说,你不是说你自己没病么,不是说吃得好睡得香么,现在怎么跟要死要死的人一样了。
女婿这边就会中医啊,我上次问了他也说会治啊,你去给医院乱搞,还不如给自己家人试试呢。我上次肾结石疼得要死也是女婿给我治好的啊。小宝(我老婆她弟女儿)前面咽喉肿大到只有一个小孔了,医生都说要做手术切掉了,也治好了吖。
即使是这样,老丈人还是想了一周左右。才决定找我看。
我老婆说,反正我们小孩子没人带,有点影响工作,干脆把老爸叫来帮带小孩吧。而且这边中草药便宜,质量又好。于是,老丈人在交待了一系列的事情以后,在4.23号从高铁动车到了GX。

到这边是晚上,我让我爸去动车站接人。为了避免给他增加心理压力,我告诉我爸,别跟他提治病的事。
然后24-25两天,由我爸和我老婆带他在小镇上逛逛。看看环境 ,散散心。
在26号的时候,因为我姐在医院上班,就带去做了全身检测。

以下是我手机用便签做的记录,中医学科的朋友可以看。
吃瓜群众就不用看了,你们也看不太懂,记录也不重要,看最后面结果就行了。

老丈人详细服药记录:
药前医院检查数据:
男,61周岁.168cm.160斤。
血压:140/90.血糖16.09.血粘高.
脂肪肝,肾积液,疑似肾囊肿,右肾结石。

主诉:血糖帮我降下来,其他一切不重要。

我收集的问诊信息:
一,腹满,抵抗感强烈,腹胀,食量少。
二,口渴厉害,喝水不解渴,自述感觉能喝掉一条河。
三,晨起脸油,口粘腻。“面垢口不仁”。眼睛有血丝。面色泛潮红,浮肿严重,眼袋和苹果肌像微瘪的水袋一样耷拉着。
四,手脚烦热,夜晚睡觉有时身体会忽然一阵很热。平常微微心烦。打呼噜几十年。睡觉近几年会流口水了。
五,脉浮有力,重按跳更力。
六,几十年来大便历来稀软不成型。大便次数多。
七,睡眠,会睡前半夜和后半夜两觉,后半夜觉有时五点才睡下。睡眠易受情绪影响,焦虑就容易彻夜难眠。
八,舌头胖大,水滑,齿痕,苔白。
九,小便黄,曾经有过喝水多的时候,憋不住尿的情况。全身浮肿明显,皮肤有很多暗斑点。(水斑)
开方:大柴胡汤(柴胡30)+五苓散+白虎汤+黄连5。桂枝茯苓丸子单独吃,早晚各一颗。七剂开路。
26号早上全身检查。血糖数据为16.09.
27号晚十一点半,喝第一餐药睡下。
28号询问口渴情况,说不觉得怎么渴了。
夜晚发现,他三十多年的震天呼噜声神奇的就没有了。有视频为证,详情看6班425学号,4月28日晚的朋友圈。
29号早上吃了油腻的肉包,三小时后测血糖,15.9。降的不明显,老人可能有点心急。说咽喉有点疼,异物感明显,咽不红,于是抓了甘草桔梗泡水。这里怀疑有半夏症。问诊得出有半夏泻心汤症。脸已经没有泛红,但油依旧,热未消。口不渴,喝不喝水都可以。打算暂时不变方,因为大柴胡和白虎汤见效了,大方向是没毛病的。等白虎汤症全消,再换方先调理肠胃。中午和晚上把脉,已经不浮。关脉,中,偏数。寸尺脉微不可感,重按依旧。(脉象偏主观,仅供参考)
30号,自述大便情况转好,不怎么稀了。我目测,腰一圈肥膘,开始缩水,没有那么圆润了,开始瘪了。聊到以前做胃镜,医生说他胃里面都是水,什么都看不清楚。今天吃饭完直接测血糖是15.1.有信心继续。晚上九点半把脉,关脉浮紧,重按也力,寸尺脉依旧摸不到。
5.1号,脉依旧,里热依旧。
5.2号,晚上有中医课,我听课。没有关注情况。就记得白天丈母娘视频通话里有提,老丈人咳嗽清嗓的频率很少了。以前十分钟清一次嗓。现在视频一小时清一次这样。
5.3号早上七点测血糖,第一次9.6,老丈人不信降那么快,马上测了第二次10.4。大便还是很稀软。给做医生的姐姐报喜,姐姐泼我冷水,“他最近也吃的少啊”,当然,不争论。姐姐说的也是实情。血糖明显降了就可以了。
到这,第一周的调理,首战告捷!

5.4号。早上和晚上分段重新收集信息。
体重,156斤。
舌质淡,舌苔中后段,黄厚。瘀血舌,腿干。晨起脸油腻。睡觉会盗汗,少许口水。
口基本不渴了。小便黄,大便稀。眼睛有明显血丝。
声音洪亮,爱说话。手脚常温,中脉,缓。
腹诊抵抗感还有些明显。
他说左膝盖,后腰,走路久了会酸。(就是他觉得是走路久酸的。)此处应理解为,左膝盖不舒服,后腰酸。

综合看,白虎汤症已经不明确,剔除掉。大柴胡体质,五苓散症,热症仍在。因为“舌黄未下者,下之黄自去”。
二次开方调整为:大柴胡汤(柴胡30)+五苓散+黄连党参甘草,七剂。守主方,试调肠胃。(有十二指肠溃疡史)。而桂枝茯苓丸换成了加味怀牛膝的丸子。
5.5日早上喝第一餐。
5.6日,血糖9.1。说腰疼厉害。加了30克葛根。
5.6-5.7两天私自停服桂枝茯苓丸。交代说是调理气血的,一定要吃的,对病情恢复有重要作用,立马又吃了。
5.7号反应,视力模糊不清。暂时不清楚原因,存疑。说腰疼依旧,无明显改善。腰一圈冰冷,加上有肾结石,积液或囊肿,我怀疑是肾着汤症。但是老丈人坚持说自己小便正常,所以不确定,再观察。
5.8号。大便好像没有那么烂了。腰还疼,比较厉害。问具体哪里疼,手指在后腰画了一横。哦,懂了,“腰一圈冷痛”,又记得说过曾经有过憋不住尿的情况,水肿明显,合肾着汤试试。我是不太信肾有问题小便还能保持正常的,不太合逻辑。
5.9号早上餐前血糖7.1.餐后8.4。开心。但是,老丈人说视力模糊很厉害。眼球有黄渍块。想不到原因。存疑。然后反馈说晚上睡觉不盗汗了。睡觉流口水基本没见有了。
5.10号。老丈人腰疼依旧,还是指在肾的位置。视力模糊依旧。淡定。继续先喝完这波药先。先让他疼两天,因为原因不清楚。
5.12号。血糖7.4-7.8。基本就稳定在8以内了。但是腰疼依旧。眼睛血丝明显。眼球中间长有黄色浊物。舌苔黄厚,舌体胖大,舌质淡红。
5.13号,第二周的药喝完了,停药一天。老丈人反应视力模糊的厉害。眼睛上好像开始在长东西。
5.14血糖8.4。略有回升。正常。停药了嘛。
5.15恢复服药。因症状变化,多了项背强几几,眼睛红血丝,长东西(疑似似翼状胬肉)导致视力模糊。便溏。药方变为大柴胡合五苓散+党参15炙甘草10葛...
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If we look at the TIOBE index, a measure of usage and influence among programming languages, Inform’s best result was 49th, in 2015: just above Mathematica, and just behind FORTRAN. (For comparison, the 49th most spoken natural language is Romanian.)
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Inform: Past, Present, Future
nform is available for Linux, Mac OS X, Windows and Android. Apple’s rules exclude it from iOS, but it has otherwise been on more or less every platform. The Mac App Store version gets about 2000 downloads a month, to give some idea of scale. <span>If we look at the TIOBE index, a measure of usage and influence among programming languages, Inform’s best result was 49th, in 2015: just above Mathematica, and just behind FORTRAN. (For comparison, the 49th most spoken natural language is Romanian.) Being in front of a large number of users means that your software has a large number of bugs, in the sense that a bug is a defect you actually know about. The more people participa




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If we look at the [...] a measure of usage and influence among programming languages, Inform’s best result was 49th, in 2015: just above Mathematica, and just behind FORTRAN. (For comparison, the 49th most spoken natural language is Romanian.)
Answer
TIOBE index,

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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If we look at the TIOBE index, a measure of usage and influence among programming languages, Inform’s best result was 49th, in 2015: just above Mathematica, and just behind FORTRAN. (For comparison, the 49th most spo

Original toplevel document

Inform: Past, Present, Future
nform is available for Linux, Mac OS X, Windows and Android. Apple’s rules exclude it from iOS, but it has otherwise been on more or less every platform. The Mac App Store version gets about 2000 downloads a month, to give some idea of scale. <span>If we look at the TIOBE index, a measure of usage and influence among programming languages, Inform’s best result was 49th, in 2015: just above Mathematica, and just behind FORTRAN. (For comparison, the 49th most spoken natural language is Romanian.) Being in front of a large number of users means that your software has a large number of bugs, in the sense that a bug is a defect you actually know about. The more people participa







Don’t Repeat Yourself’, or DRY, is taught by many make-yourself-a-better-programmer books — a genre of publishing which always reminds me of relationship self-help books. DRY says that the same concept shouldn’t be given more than one expression in the code. But taken to extremes, DRY means that any comment saying what a program is trying to do is redundant, because a program is by definition already a statement of what it does. Don’t repeat yourself, in other words, can be taken to mean: never explain yourself.
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Inform: Past, Present, Future
working programmers. All programming languages provide for comments, but coders often want to purge this marginalia, disliking any verbose comment as a form of ‘cruft’. It violates, they would say, the ‘Don’t Repeat Yourself’ maxim. ‘<span>Don’t Repeat Yourself’, or DRY, is taught by many make-yourself-a-better-programmer books — a genre of publishing which always reminds me of relationship self-help books. DRY says that the same concept shouldn’t be given more than one expression in the code. But taken to extremes, DRY means that any comment saying what a program is trying to do is redundant, because a program is by definition already a statement of what it does. Don’t repeat yourself, in other words, can be taken to mean: never explain yourself. I am a contrarian on this. My own programs are written using the doctrine of ‘literate programming’ — an unhelpful name today, implying a bit aggressively that everybody else is ill




Flashcard 3002615860492

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[...] or DRY, is taught by many make-yourself-a-better-programmer books — a genre of publishing which always reminds me of relationship self-help books. DRY says that the same concept shouldn’t be given more than one expression in the code. But taken to extremes, DRY means that any comment saying what a program is trying to do is redundant, because a program is by definition already a statement of what it does. Don’t repeat yourself, in other words, can be taken to mean: never explain yourself.
Answer
Don’t Repeat Yourself’,

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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Don’t Repeat Yourself’, or DRY, is taught by many make-yourself-a-better-programmer books — a genre of publishing which always reminds me of relationship self-help books. DRY says that the same concept shouldn

Original toplevel document

Inform: Past, Present, Future
working programmers. All programming languages provide for comments, but coders often want to purge this marginalia, disliking any verbose comment as a form of ‘cruft’. It violates, they would say, the ‘Don’t Repeat Yourself’ maxim. ‘<span>Don’t Repeat Yourself’, or DRY, is taught by many make-yourself-a-better-programmer books — a genre of publishing which always reminds me of relationship self-help books. DRY says that the same concept shouldn’t be given more than one expression in the code. But taken to extremes, DRY means that any comment saying what a program is trying to do is redundant, because a program is by definition already a statement of what it does. Don’t repeat yourself, in other words, can be taken to mean: never explain yourself. I am a contrarian on this. My own programs are written using the doctrine of ‘literate programming’ — an unhelpful name today, implying a bit aggressively that everybody else is ill