TCM in Muhimbili for Malaria坦桑尼亚疟疾病人的中医药诊治

TCM in Muhimbili for Malaria坦桑尼亚疟疾病人的中医药诊治

 

Surname：M中国中医科学院西苑医院消化科（脾胃病科）李博

Other name：D**

Date of Birth：1985

Job：Student  Sex  F

Hospital Reg. Number:  A3**

 

 

初诊：2009年10月15日

主诉：寒热往来10余日。

病史：从10天前开始出现寒热往来，感觉恶寒发热，疲劳无力，没有测过体温。近日症状加重，全身无力，精神倦怠，经查血中有疟原虫，具体数量不详，口服当地抗疟药（奎宁成分）没有缓解。刻下：精神倦怠，身着衣服较厚（目前为坦桑尼亚的夏天），倦怠乏力，胸闷气短，咳嗽，声重，有粘痰不易咯出。

查体：心率102次/分，律齐，未闻及心脏杂音及干湿?音，身体偏烫，体温38.2摄氏度。

实验室检查：Muhimbili血液报告：疟原虫3/200wmb。

舌脉：舌体正常，舌红，苔白，脉位中，脉象滑。

诊断：疟疾

辨证：少阳阳明同病，痰浊郁肺

治疗：清阳明热，疏解少阳，化痰健脾理气

处方：白虎柴胡汤加减

生石膏60  知母10  青蒿20  柴胡10

浙贝母10  草果10  槟榔10  鸡内金10

炒麦芽10  麦冬10

六剂颗粒剂 冲服 一日两次

清开灵颗粒2盒/3g Tid

 

Surname：M

Other name：D**

Date of Birth：1985

Job：Student  Sex  F

Hospital Reg. Number:  A35**

First visit: 15^th October, 2009

Chief complaint: The alternate attack of chill and fever for 10 days.

She complained that the alternate attack of chill and fever10 days ago. She feel that were nephrasthenia asthma and fiver and tiredness. She did not take a temperature. And she has not received any treatment before. Recent she feel bad and general weakness. She was lassitude. The result of test blood showed us there was haemoplasmodium in blood. After had had the chinine, she did not feel better. Now she wearing in thick clothes. Even though it is Summer in Tanzania, but she feel chill still. Lassitude and debilitation. Chest distress and short breath. Cough. And the phlegm difficult to hawk out.

His appetite was bad also, urine and stool were normal. The sleeping was normal. She likes the warm food and water. She was easy to get angry on her live.

Physical examination: HR 102/min. The cardiac rhythm was regularity. There are not cardiac murmur and Rattle in chest. The body was hot and the body temperature was 38.2 centi-degree.

Laboratory examination: Malaria parasite.

TCM examination: Tongue: The body of tongue was normal. Red with white coating

Pulse: Hua（Slide）

Diagnosis: Malaria

TCM diagnosis: Malaria

Differentiation of symptoms and signs：SHAO YANG and YANGMING meridians were unwell, turbid phlegm obstructing in the lung;obstruction of the lung by phlegm

Therapy: Clean the fire of  SHAO YANG and YANGMING meridians； dissipate phlegm； invigorate the spleen；regulating vital energy.

Prescription:  Baihu and Bupleuri Decoction.  

 

Name of herb in Chinese	Name of herb in English	Name of herb in Latin	Pronounce in TCM	Weight（g）
生石膏	Gypsum	Gypsum Fibrosum	Shigao	60
知母	Common Anemarrhena Rhizome	Rhizoma Anemarrhenae	Zhimu	10
青蒿	Sweet Wormwood Herb	Herba Artemisiae	Qinghao	20
柴胡	Chinese Thorowax Root / Red Thorowax Root	Radix Bupleuri	Chaihu	10
浙贝母	Thunberg Fritillary Bulb	Bulbus Fritillariae Thunbergii	Zhebeimu	10
草果	Tsaoko Amomum Fruit	Fructus Tsaoko	Caoguo	10
槟榔	Areca Seed	Semen Arecae	Binglang	10
鸡内金	Chicken"s Gizzard-membrane	Endothelium Corneum Gigeriae Galli	Jiniejin	10
炒麦芽	Malt	Fructus Hordei Germinatus	Maiya	10
麦冬	Dwarf Lilyturf Tuber	Radix Ophiopogonis	Maidong	10

6 doses given. 1 dose per day taken orally twice a day.

Second visit: 17^th October, 2009

After that medicine, the symptoms get less and the patient feels better. The tongue and pulse were same to before.

Continue that treatment therapy for three days.

 

青蒿味苦性寒，辛香透散为君，善使阴分伏热透达外散，清热除蒸，截疟。据现代研究表明，可以杀灭红细胞中的疟原虫，并且对氯喹耐药的患者仍然有效。从古代临床记录到现代药理研究都是世界公认的抗疟疾治疗有效的中草药。

 

生石膏甘辛大寒，为阳明发热首选的良药，可以清理阳明实热，和知母配合，共同为白虎汤的主要成分。

 

柴胡为少阳经专药，独能疏解少阳经气，为少阳开阖枢机之首选。

 

草果性温，燥湿健脾为臣，《本草纲目》曰:草果与知母同用，治瘴疟寒热，取其一阴一阳无偏胜之害，盖草果治太阴独胜之寒，知母治阳明独胜之火也。所以，草果可以配合青蒿，共同对疟疾进行杀灭。

 

槟榔，从古至今文献记载均有抗疟作用。据现代药理研究，具有抗疟的作用。中医认为，槟榔健脾理气消食，对于疟疾患者的食欲下降，中医认为是脾虚不运。只有脾胃消化好，身体的新陈代谢才会正常，才会恢复正常的免疫力，而有助于驱除疟原虫。槟榔可以促进患者的食欲，增加身体的抵抗力，恢复身体正常的代谢。

 

浙贝母，知母清热化痰为佐，无痰不做疟，并且中医把身体抗击外来感染的产生的病理产物看作是痰湿。在身体无痰的情况下，不容易发生疟疾，而得了疟疾能够更好的清除身体内的痰湿的情况下，有助于疟疾的治疗，疟原虫的清除。浙贝母，知母并不是直接针对疟原虫进行杀灭，但是它们化痰作用可以说是病理产物的清道夫。它们把疟原虫在人体产生的毒素??痰湿清除出身体。

 

鸡内金，炒麦芽，健运中州，资后天之本，为药物的吸收和散步提供原动力。

 

麦冬滋阴健胃，针对热病后期伤阴的情况，未雨绸缪，护阴健胃。

 

中医5000年的临床探索表明，方剂治疗是一个整体，让各种药配合起来可以发挥更大的作用，很多单独的中草药治疗疾病的时候，如果合理配伍，可以起到更好的协同作用。

 

感谢wuyu的精彩专业翻译

 

Sweet Wormwood Herb (Qinghao, Herba Artemisiae Annuae) has bitter flavor and cold nature. It is the sovereign (principal) medicinal, pungent, fragrant and dispersing. It is good at outthrusting the bending heat out of yin, clearing heat and dispelling steaming, interrupting malaria. According to modern researches, it can kill the malaria parasites in red blood cells, and still effective for those who are resistant to chloroquine. From the ancient clinical records to modern pharmacological researches, Sweet Wormwood Herb is world-widely received herb for malaria.

Tsaoko (Caoguo, Fructus Tsaoko) has warm nature, can dry dampness to fortify the spleen. It is the minister medicinal. Compendium of Materia Medica (Ben Cao Gang Mu) recorded: the combination of Tsaoko and Common Anemarrhena Rhizome (Zhimu, Rhizoma Anemarrhenae) can treat miasmic malaria, because one herb belongs to yin nature and the other belongs to yang nature, there is no abnormal exuberance of yin or yang. Since Tsaoko can treat single abnormal exuberant cold in greater yin, Common Anemarrhena Rhizome can treat single abnormal exuberant fire in yang brightness. Therefore, Tsaoko may cooperate Sweet Wormwood Herb to treat malaria.

Areca Seed (Binglang, Semen Arecae) is recorded to treat malaria both in ancient and modern literatures. According to modern pharmacological researches, it has the anti-malaria effect. Traditional Chinese medicine uses Areca Seed to fortify the spleen, regulate qi and promote digestion. As to lower appetite, TCM considers it due to spleen deficiency to fail in transportation. Only the spleen and stomach are good at digestion, the metabolism and immunity could be normal, and then helpful to dispel malaria parasite. Areca Seed can promote patient’s appetite, enhance body immunity, rehabilitate the normal metabolism.

Thunberg Fritillary Bulb (Zhebeimu, Bulbus Fritillariae Thunbergii) and Common Anemarrhena Rhizome (Zhimu, Rhizoma Anemarrhenae) can clear heat and resolve phlegm. They serve as assistant medicinal. Without phlegm, there is no malaria, and TCM considers the pathologic productions generated by fighting external pathogeny as phlegm and dampness. If there is no phlegm is human body, the human will not easily develop malaria. If malaria has already comes, clearing phlegm and dampness in body will help to treat malaria and clear malaria parasites. Thunberg Fritillary Bulb and Common Anemarrhena Rhizome do not kill malaria parasites directly, but they can be regarded as street sweepers for their phlegm resolving effect. They discharge the toxin---phlegm and dampness produced by malaria parasites out of body.

5000 years TCM clinical researches show that the formula is a whole body which combines all kinds of herbs to exert greater effect. With appropriate combination, many single herbs can cooperate better when treating diseases.