【TCM diary】面瘫复诊

2025年5月1日

自述有好转，嘴角没那么外斜，说话较轻松、眼睑能闭得更全。

面部较紧实、嘴角稍正、示齿较轻松，能露齿更多、额纹较深，有往右额长的趋势、能鼓气不漏气。

右翳风不痛。

无味觉改变、听力下降、喝水时水丛嘴角流出。

无肢体无力、语言障碍、意识障碍。

纳寐可。

左膝盖痛。

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【Pharmacology】Antidepressants

Antidepressants Depression: experience unusually long periods of sadness guilt and decreased interest in activities can occur alone or a part of a larger disorder such as bipolar disorder people with bipolar disorder experience periods of depression alternating with periods of mania in which person feels abnormally optimistic euphoric and energetic Treatment: Antidepressant drugs which work by elevating levels of certain neurotransmitters in the brain led to development of monoamine hypothesis Content: 1. Monoamine hypothesis 2. Five different classes 3. Serotonergic neuron & Noradrenergic neuron 4. Drug a. Selective serotonin reuptake inhibitors (SSRIs) b. Serotonin norepinephrine reuptake inhibitors (SNRIs) c. Tricyclic antidepressants (TCAs) d. Monoamine oxidase inhibitors (MAOIs) e. Atypical antidepressants 5. Lithium 6. Reference 1. Monoamine hypothesis states th...

【TCM diary】跟诊日记：德教会义诊-罗达盛医师（一）

25/4/2025 居銮德教会义诊 - 罗达盛医师（一）腰痛跟湿的关系一位 Uncle 前来义诊，主诉腰酸背痛，食用生冷瓜果后症状加重。见舌色紫而偏干，脉弦。老师为其开立：柴胡疏肝散以疏解肝气，小柴胡汤以调理胃肠敏感，六味地黄丸以滋阴补肾（考虑其年高，顾护先天之本），藿香正气水以祛湿解暑、理气和中，并加用五苓散以利水渗湿。对于前方药的配伍，我基本理解，但对加用五苓散的思路尚有疑惑，遂向老师请教。老师解释道：腰为肾之外府，肾之精气所灌注之处。肾主水液，主持调节全身水液代谢。若体内水湿过重（如脾虚运化失常、肾阳不足或外感湿邪），湿气困阻经络，气血运行不畅，腰部筋脉肌肉失养，遂致沉重、酸胀、隐痛之感。湿气之于经络，犹如泥浆阻塞水道，气血难达，腰脊因‘粮食’（气血）不足而生酸痛沉重。尤其马来西亚地处热带，气候常年湿热多雨，湿邪更易郁滞于体内，损伤脾阳，助生内湿。生冷瓜果之性寒凉，进一步伤及脾阳，加重水湿困滞，经脉瘀阻，故见腰背酸痛加剧。故治疗此证，除疏肝理气、健脾和中、滋阴补肾外，尤应重视祛湿通络。此次加用五苓散，旨在利水渗湿、温阳化气，以助气血流通，祛除湿邪，从而缓解腰背酸痛之症。” 后续：老师过目之后，进一步分享患者原本有胃胀、呃气等症状，曾投香砂六君子汤无效，后改用柴胡疏肝散、小柴胡汤合藿香正气水，始见效。三周前因食凉物致腰酸复发，胃中微不适。实为肝气不疏，脾虚湿聚，加之患者素体肾湿邪乘虚内扰腰脊所致。老师提醒此例辨证要点为：舌面润滑，乃水湿内蕴之象，因此在前方基础上加用五苓散以加强利水，配合六味地黄丸以滋肾固本。之前是有胃胀呃气等症候，医用香砂六君子无效后，老师调治，投以柴胡舒肝散、小柴胡汤合藿香正气才有起效。3星期前因食凉物致腰酸，胃微不舒。这实乃木不疏脾虚湿聚，丌生致腰酸。老师也提醒我此例临床辨症要点为舌面润滑为水湿之候，故照原方加五苓散增强利水化湿，六味地黄丸补肾。经此一例，我深感此前对中医的理解尚浅，多停留在表面，未能真正做到“四诊合参”。中医治疗疾病，必须立足于中医基础理论，包括阴阳五行、脏腑经络学说及四诊八纲辨证。唯有通过精准辨证，方能确立治法，继而选择方药，从而环环相扣、切中病机，达到疗病之效。这正是中医“辨证论治”的核心价值所在。在临床中，我常易受西医检验数据及其病名诊断...

【TCM diary】跟诊日记：德教会义诊-罗达盛医师（三）

28/4/2025 居銮德教会义诊 - 罗达盛医师 ( 一）脚部糜烂今天接诊了几位脚部溃烂的病人，老师分别处方了二妙散和当归拈痛丸，并建议患者自行购买赛霉安散用于外敷。老师特别向我介绍了赛霉安散的成分与功效：该方由石膏、冰片、朱砂（水飞）组成，具有清热止血、收敛祛湿、化腐生肌的作用，广泛应用于多种皮肤和黏膜类疾病，包括口腔、鼻腔、咽喉溃疡，牙周炎性溃疡，以及皮肤碰伤、刀伤和慢性溃疡等。对于今天遇到的两位老人家，脚部伤口长时间无法结痂收口，老师观察其脉象偏无力，判断可能属于正气亏虚、气血不足，生肌乏力的情况，因此建议加用补中益气汤。此方具有补中益气、升阳举陷之功，方中黄芪尤擅生肌收口，对于久不收口的慢性伤口有一定帮助。老师还指出，许多伤口长期无法愈合，其中一个常见原因是包扎过于严密，导致伤口缺乏通风与氧气供应。虽然 “ 伤口不能碰水 ” 是防止感染的基本原则，但如果因此导致伤口长时间处于潮湿、封闭环境，也可能不利于组织修复。适当暴露在空气中，有助于干燥、结痂和加速愈合。此外，一些患者因糖尿病影响血液循环及免疫功能，也会出现伤口愈合迟缓的现象，临床上应加以辨识与调理。车祸后伤口糜烂不收口糖尿病伤口无法收口（二）手指肿痛今日接诊一例手指浮肿疼痛患者。初诊观察无明显红肿、灼热、剧痛等典型炎性表现，初步排除痛风性关节炎的可能。患者诉手指浮肿疼痛，屈伸乏力。追问病史，既往无高尿酸血症、高血压及糖尿病，仅胆固醇偏高。舌淡红，苔黄润，脉象濡。老师原拟予舒筋活血汤，以活血通络、缓解筋脉拘急。然问诊中发现患者频频擤鼻，进一步追问得知近期伴有伤风表现。故调整处方如下：荆防败毒汤 180g 、小柴胡汤 90g 、半夏天麻白术汤 90g （药水）。荆防败毒汤主治外感风寒湿邪，常用于发热、头痛、肢体酸楚等表证。该方除疏风解表、祛痰止咳外，...

【Neuro】23 rare behavioral and mental disorders

A simple sort-out syndrome of 23 rare behavioral and mental disorders. All information obtain from the internet. 1. Capgras syndrome Syndrome : An irrational belief that someone they know or recognize has been replaced by an imposter. Associated: Alzheimer’s disease, Schizophrenia, Brain injury 2. Fregoli delusion Syndrome: A mistaken belief that some person currently present in the deluded person's environment (typically a stranger) is a familiar person in disguise. Associated: Alzheimer’s disease, Schizophrenia, Brain injury 3. Cotard syndrome Syndrome : A series of delusions that range from a belief that one has lost organs, blood, or body parts to insisting that one has lost one's soul or is dead. Associated: Dementia, Encephalopathy, Multiple sclerosis, Parkinson's disease, Stroke, Subdural bleeding, Epilepsy, and Migraine. 4. Reduplicative paramnesia Syndrome: Delusional belief that a place or location has been duplicated, existing in two o...

【Pharmacology】General and local anesthetics

Anesthesia A reversible condition induced by anesthetic drugs that cause reduction or complete loss of response to pain or another sensation such as consciousness and muscle movements during surgery or other invasive procedures that can be painful. Two main types of anesthesia: General anesthesia: makes the whole body lose feeling movement and consciousness drugs Local anesthesia: numbs only a specific targeted area of the body drugs Content: 1. Anesthesia stage 2. Mechanism of action 3. General anesthetics i. 1st group (Intravenous agents) ii. 2nd agent (Intravenous & Inhalation agent) iii. 3rd agent (halogenated volatile anesthetics) 4. Dexmedetomidine 5. Local anesthetics 6. Reference 1. Anesthesia stage Anesthesia performed with general anesthetics occurs in four stages: Stage 1: Induction a period during which the patient goes from state of consciousness to a state of unconsciousness Stage 2: Exc...

【方剂学】涩肠固脱剂--真人养脏汤（原名纯阳真人养脏汤）

涩肠固脱剂适用于泻痢日久不止，脾肾虚寒，以致大便滑脱不禁的病证代表方如真人养脏汤、四神丸等。 1. 真人养脏汤（原名纯阳真人养脏汤）《太平惠民和剂局方》 ---- 涩肠固脱，温补脾肾【用法】上锉为粗末。每服二大钱（ 6g ），水一盏半，煎至八分，去滓，食前温服。忌酒、面、生、冷、鱼腥、油腻（现代用法：水煎服）。【运用】本方为治泻痢日久，脾肾虚寒之常用方。以大便滑脱不禁，腹痛喜温喜按，食少神疲，舌淡苔白，脉迟细为辨证要点。原书注曰： “ 如脏腑滑泄夜起久不瘥者，可加炮附子三四片煎服。 ” 可资临证参佐。组成：罂粟壳、诃子、肉豆蔻、肉桂、人参、白术、当归、白芍、木香、炙甘草 a. 组成君：罂粟壳 ---------------- 去蒂萼，蜜炙，三两六钱（ 9g ） · 涩肠固脱止泻臣： a. 诃子 ---------------- 去核，一两二钱（ 9g ） · 苦酸温涩，功专涩肠止泻 b. 肉豆蔻 ---------------- 面裹，煨，半两（ 8g ） · 温中散寒，涩肠止泻 · & 诃子：助君药以增强涩肠固脱止泻之功 · 君臣相配，体现 “ 急则治标 ” 之法佐： a. 肉桂 ---------------- 去粗皮，各八钱（各 6g ） · 温肾暖脾，兼散阴寒泻痢日久，气血亏虚 👇 b. 人参 ---...

【方剂学练习题】各论：第四章　清热剂

一、填空题 1 ．白虎汤主治 _______ 证。 ANS ：气分热盛证 2 ．竹叶石膏汤的组成是由白虎汤去 ______ 加 ______ 而成。 ANS: 知母 ; 竹叶麦冬半夏人参 3 ．竹叶石膏汤中麦冬与半夏用量比例为 ______ 。 ANS: 2:1 Note: 麦冬 ---------- 去心，一升（ 20g ）半夏 ---------- 洗，半升（ 9g ） 4 ．清营汤主治 ______ 证，其舌象为 ______ 。 ANS: 热入营分 ; 绛而干 5 ．黄连解毒汤组成中除黄连外，还有 ______ ，该方体现了 ______ 之法。 ANS: 黄芩、黄柏、栀子 ; 苦寒直折 6 ．普济消毒饮是治疗 ______ 的常用方剂，其功用是 ______ 。 ANS: 大头瘟清热解毒，疏风散邪 7 ．凉膈散中用量最大的药物是 ______ 。 ANS: 连翘 8 ．凉膈散组成中包含有 ______ 承气汤的全部药物，其体现了 ______ 之法。 ANS: 调胃；以泻代清 9 ．被前人称之为“疮疡之圣药，外科之首方”的方剂是 ______ 。 ANS: 仙方活命饮 ...

【Pharmacology & 方剂学】Traditional Chinese Medicine (TCM) – Does its contemporary business booming and globalization really reconfirm its medical efficacy & safety?

Traditional Chinese Medicine (TCM) – Does its contemporary business booming and globalization really reconfirm its medical efficacy & safety? 笔记 1. Introduction 有几个国家同意中医 Promoting the globalization of TCM, Traditional Chinese medicine has been spread to 183 countries and regions around the world. According to the World Health Organization, 103 member states have given approvalto the practice of acupuncture and moxibustion 29 have enacted special statutes on traditional medicine 18 have included acupuncture and moxibustion treatment in their medical insurance provisions 2. What's in the TCM bottle? The philosophy behind Chinese medicine is a melding of tenets from Buddhism, Confucianism, and the combined religious and philosophical ideas of Taoism. TCM is based on the concept that illness occurs when a person's “internal Qi” falls out of balance. Qi: the word the Chinese use to describe the un-measurable energies that theoretically permeate ev...

【TCM & Western Medicine】阿片类药物（Opioids）& 中药

阿片类药物（Opioids）是治疗中重度疼痛的首选药物。其不良反应主要包括：便秘恶心呕吐瘙痒头晕尿潴留嗜睡谵妄认知障碍呼吸抑制 Related link: 【Pharmacology】OPIOIDS 内容： 1. 癌性疼痛 2. 便秘 3. 阿片类成瘾慢性稽延症状 4. 参考文献 1. 癌性疼痛是晚期恶性肿瘤最常见症状之一被列为“第五生命体征” 生命四大体征：呼吸、体温、脉搏、血压癌痛治疗的药物：非甾体类抗炎药物 (Non-Steroidal Anti-Inflammatory Drug) 阿片类药物 (Opioids) 中医癌性疼痛属“痛证”范畴病因：正气亏虚、邪毒内侵病机：“毒、瘀”壅塞经络治疗：行气活血、化瘀解毒功效的中药组方外敷联合西药治疗好处：增强止痛效果缩短止痛起效时间延长镇痛时间从而减少爆发痛次数提高患者的生活质量一定的抗肿瘤作用中药方： “双黄散结散” 全方具有清热解毒、散结止痛的作用。君： a. 大黄 (Rhubarb) 苦寒泻热：荡涤胸腹之邪热 b. 黄柏 (Phellodendron amurense Rupr) 苦寒泻热：清下焦热 & 大黄：清热解毒散结臣： a. 苦参 (Sophora flavescens) b. 蒲公英 (Dandelion Herb) 加强清热解毒之功 c. 三棱 (rhizoma sparganii) d. 莪术 (Curcuma) 破血逐瘀佐使： a. 乳香 (frankincense) 行气舒筋 b. 没药 (Myrrh) 行气化瘀 & 乳香：活血定痛 c. 冰片 (Borneol) 通窍散火、消肿止痛 **现代研究亦表明，大黄、黄柏、冰片、乳香、没药、三棱、莪术、蒲公英等药物均有有很好的抑制肿瘤、止痛等作用。另外一方：川芎、白芷、姜黄、乳香、没药、肿节风、山慈姑、蚤休、麻黄、白芥子、王不留行 11味中药精细加工成粉并与凡士林调和而成膏状功能：扶正气、消肿痛、活血化瘀，调畅经脉，透皮达里，引诸药直达病所。好处：避免了异体蛋白过敏现象因其主要成分为植物避免药物通过肝脏时的首过效应其中药有效成分透过皮肤屏障，直接进入人体循环，无胃肠降解和胃肠刺激作用治疗疼痛效果明显、持续时间长无不良反...

【LAW】Complementary Medicine (T&CM) Act 2016 and the Responsibilities of Registered Practitioners

Complementary Medicine (T&CM) Act 2016 and the Responsibilities of Registered Practitioners Content: Traditional & Complementary (T&CM) Act T&CM Act T&CM Council What are the types of registration as specified under the Act? T&CM practices Prohibitions Obligations of practitioners Other existing Act which must be adhered PREVENTION AND CONTROL INFECTIOUS DISEASES ACT 1988 SALE OF DRUGS ACT 1952 MEDICINES (ADVERTISEMENT & SALES) ACT 1956 ENVIRONMENTAL QUALITY ACT 1976 1. Traditional & Complementary (T&CM) Act 1.1 T&CM Act Act 775 T&CM Council to: Regulate the T&CM services Provide for matters connected therewith Date of Enforcement: 1 August 2016 Enforcement phase: Phase 1: 1 August 2016 Enforcement of section 1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,20,42,43,44,45,46,47,60,61 & subsection 63 (1) & (3) Phase 2: 1 March 2021 Enforcement of section 2,18,19, subsection 22 (1), (2), (3), (4), (6), (10), and (11), section 23,24,25,26,27,...

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