I can hear the voice of Chinese medicine

Chapter 46 Discussion and treatment of bile reflux gastritis after gastrectomy

The tongue is dark and white with white fur. There are generally three reasons for this tongue symptom, food accumulation, liver depression and blood stasis, and internal dampness.

The so-called food accumulation, improper diet or abnormal digestion and transportation of the spleen and stomach, leads to food stagnation in the gastrointestinal tract after eating, and symptoms such as fullness and pain, belching and acid regurgitation, and vomiting of sour and rotten food may occur, resulting in purple tongue and dark white fur. greasy.

For those caused by food accumulation, you can take Baohe Pills, Zhishi Daozhi Pills and other drugs to digest food accumulation and relieve symptoms.

Liver stagnation and blood stasis are caused by obstruction of liver qi and qi and blood, which can be manifested as a dark purple tongue with white and greasy coating.

As for internal stagnation of water dampness, it means that the body has insufficient righteousness, resulting in blockage of muscles, joints, meridians, and numbness.

Li Yuquan's situation is more serious, because of the above three reasons.

"Look at it."

Lu Xuan gave up his position to Su Kenan.

Li Yuquan was not surprised by this, but Li Jueying frowned, but opened her mouth and said nothing.

This kind of training method, where the old leads the new, exists everywhere. After all, it is essential for new doctors to accumulate clinical experience, but this was the first time she saw it in the health center.

Su Kenan nodded obediently, changed places with Lu Xuan, felt his pulse, looked at Li Yuquan's tongue sign, and thought deeply.

Lu Xuan, on the other hand, was listening to his heart and comparing whether his judgment was accurate.

After a while, Lu Xuan came back to his senses and asked, "How is it?"

Su Kenan blinked: "His pulse seems to be a bit complicated."

Lu Xuan laughed, his pulse was thin and astringent, can it be uncomplicated?
"This old man has three pulse conditions." Lu Xuan reminded.

"Three..."

Su Kenan thought for a while and said, "Thin pulse..."

After pondering, Su Kenan looked at Lu Xuan as if asking for help.

Lu Xuan also knew that it was really difficult for Su Kenan to judge Li Yuquan's pulse, so he said directly: "The pulse is heavy and thin, and it is relatively easy to judge thin pulses. There is no certain experience in heavy pulses and astringent pulses, so it is relatively difficult to judge." .”

Su Kenan looked disappointed.

"Actually, if it's a single pulse, whether it's a thin pulse, a heavy pulse or a rough pulse, it's not too difficult to judge. It's just that Mr. Li's pulse is combined into three, and you can't judge whether it's normal."

Lu Xuan said comfortingly, if anyone can easily judge such a complicated pulse condition, then Chinese medicine does not need any clinical experience, and one can become a generation of famous doctors by self-study.

The reason why Chinese medicine is more difficult to learn than Western medicine is because of these difficulties.

Without a certain amount of experience, it is impossible to prepare for judgment.

The reason why Lu Xuan was able to judge it was mainly because he had been exposed to these three pulse conditions during this period of time, otherwise he would not be much better than Su Kenan half a month ago.

Hearing this, Su Kenan nodded slightly.

Lu Xuan continued: "If you know the pulse, you can judge a lot of things. I believe you should understand this, but before talking about Mr. Li's situation, let me first talk about the treatment of bile reflux gastritis after gastrectomy. How to differentiate and treat."

As he said that, Lu Xuan looked at Li Yuquan: "Old man, I may need to delay you for a while."

If you want to say it, you have to ask for the opinion of the patient.

If the patient is in a hurry, then he won't talk about it, and will mention it to Su Kenan when he is free.

Fortunately, Mr. Li Yuquan didn't care about these things. Not only did he not object, but he also showed a strong interest in it: "It's okay, I just want to listen too."

"Thank you, old man."

Lu Xuan thanked him, then straightened up his words, and continued: "Generally speaking, after gastrectomy and gastrointestinal anastomosis, patients have a high probability of developing acid bile reflux gastritis. Among them, Billroth II type gastrectomy The postoperative morbidity rate is two to three times that of Billroth I surgery.

The reason why bile reflux occurs is mainly due to the loss of pyloric function or pyloric insufficiency after the above-mentioned surgery. "

Speaking of this, Li Yuquan thought for a while and asked: "Dr. Lu, when I was in the hospital, I heard something. Some people who have not undergone these operations will also have bile reflux. Why is this?"

Lu Xuan did not expect that Li Yuquan would ask about this matter, but the other party was curious, and he knew everything he knew. "Actually, the reason is also very simple. Some patients have no history of surgery, but if the pylorus is insufficient, the twelve fingers Intestinal contents can still flow back into the stomach, causing reflux gastritis.

If the gallbladder is removed, the function of storing bile is lost, and bile will continue to flow into the duodenum.After gastrectomy, bile reflux into the stomach is the most common postoperative complication. "

"I see."

Li Yuquan suddenly realized, and then looked at Lu Xuan: "I have been taught."

Other doctors would not have told him so much.

At most, they just tell him what will happen if he doesn't do the surgery. He rarely tells the patient what kind of postoperative complications will occur if he does the surgery.

Lu Xuan nodded slightly, and continued: "Generally speaking, patients with bile reflux gastritis will have symptoms such as abdominal distension, burning, pain, etc., and the pain will worsen after eating. It cannot be relieved, or it will increase sharply, and a small number of beneficiaries may experience chest pain, anorexia, bloating and burning discomfort."

"For example, after eating greasy food, you will feel nausea and vomit bile, and after you vomit, your stomach will be slightly comfortable. Due to gastric emptying disorder, vomiting often occurs after eating or in the middle of the night, and the vomit may be accompanied by undigested food, or Occasionally a small amount of bloodshot eyes.

Fearing that the symptoms will aggravate after eating, many patients will reduce their diet, resulting in weight loss, diarrhea and malnutrition, and even anemia, headache, fatigue and weakness of the whole body and limbs, and sweating. "

"But..."

"But what?"

Lu Xuan changed the subject, glanced at the people in the clinic and said: "There is no such thing as reflux gastritis in the concept of traditional Chinese medicine, but this type of disease is included in the traditional Chinese medicine of "epigastric pain", "acid vomiting", "noisy" "And so on.

Its pathogenesis is mostly related to the liver qi's inability to regulate laxatives and regulate urination, which can lead to excessive gallbladder qi, which can lead to severe hiccups and dry mouth.

However, post-gastrectomy patients with intragastric burning and regurgitation of bitter acid water are only formed after the operation due to the loss of pyloric function or pyloric insufficiency.Of course, there are also bloating and stomach pain due to inflammatory changes in the local anastomosis, and regurgitation of bile. "

Speaking of this, Lu Xuan thought for a while, and then said: "There is an ancient medical book, "Su Wen Pingren Qi Lun" said: "The normal qi of ordinary people comes from the stomach qi, and the stomach is the normal qi of ordinary people." , People who have no stomach qi are said to be inverse, and those who are inverse will die.

The so-called people without stomach qi can get the real Zangmai without stomach qi.

Another example is also stated in "Lingshu Zhanglun", which believes that there are five entrances and exits connected with stomach qi: pharynx door, cardia door, pylorus door, air door, and soul door.

The ancients believed that food enters from the mouth and passes through the pharynx, esophagus, cardia, stomach, pylorus, small intestine, large intestine, and finally the anus. Any problem in any link will affect digestion and excretion.

It has been recorded in some ancient books that when the ancients dealt with these diseases, they first used the five techniques of surgical incision, muscle resection, arteries and veins, tendon knotting, marrow and brain removal, waste removal, claw curtain, decoction of the intestines and stomach, and rinsing. There is no record of whether there are any post-selective diseases, but these medical skills have been lost long ago, and no one knows them now. "

Speaking of this, Lu Xuan couldn't help but sigh.

The reason why Chinese medicine has declined in modern times is that on the one hand, Western medicine has risen too fast. On the other hand, the loss of many of its own medical skills is also the key, especially the content related to traditional Chinese medicine surgery. It cannot be compared with Western medicine.

Li Yuquan was stunned for a moment, then sighed: "It's a pity, otherwise, if it survives, it should be good news for many patients."

Speaking of this, Li Yuquan couldn't help looking at Lu Xuan again: "However, I didn't expect Dr. Lu to know so much. No wonder his medical skills are so good."

"The old man is absurd."

Lu Xuan unconsciously clasped his fists in thanks.

Li Yuquan thought for a while and asked, "Doctor Lu, what does my illness look like to you?"

Hearing this, Su Kenan also pricked up her delicate little ears with a serious look on her face.

Lu Xuan pondered, and said: "From the perspective of Chinese medicine, bile reflux gastritis after gastrectomy can be divided into four types.

The first is a weak spleen and stomach. People with weak spleen and stomach often have a weak spleen that cannot rise and a turbid stomach that cannot fall. The turbid juice from the bile refluxes into the stomach, causing distension, burning, pain, nausea and vomiting in the upper abdomen.

For those with weak spleen and stomach, they should first consider strengthening the spleen and replenishing qi. The spleen governs transportation and transformation, and the stomach governs reception. If the spleen is weak, transportation and transformation will be weak, so the ability of the stomach contents to be discharged is weakened or stagnated, causing rot and turbidity.

If the gallbladder turbidity is reduced, it will be normal. If the stomach turbidity is blocked, the bile turbidity will not go down and will inevitably go up against the stomach. The combination of turbidity and rot will cause burning and pain.

Therefore, such patients need to invigorate Qi and strengthen the spleen, so that the mechanism of ascending and descending can be restored, and the rotten and turbid things in the stomach will naturally descend smoothly, so that the root cause and symptoms can be cured. "

After hearing this, Li Yuquan frowned slightly, obviously not quite understanding.

After all, he is not a medical student, and he doesn't know much about Chinese medicine. He can probably understand what Lu Xuan said, but it is impossible to fully understand it.

On the other hand, Su Kenan frowned slightly, but at the same time, a trace of joy appeared on his delicate face.

She has learned a lot of what Lu Xuan said, but no one has explained it in such a systematic and detailed way.

All in all.

Su Kenan quickly understood the meaning.

"What about the second type?" Although Li Yuquan couldn't fully understand it, he knew that the first type Lu Xuan mentioned should have nothing to do with him, so he continued to ask.

"Phlegm and dampness block the stomach."

Lu Xuan recalled something and continued: ""Suwen Linglan Secret Code" says: The stomach is the organ of the storehouse, where the five flavors come out.

Today's gastrectomy is subtotal, so Cangcha missed the appointment and cannot normally absorb grains. Due to the failure of the pyloric closure function, the pyloric opening is loose, and bile naturally tends to flow back into the stomach. In addition, the stomach capacity is too small, and there is local traumatic inflammation. Therefore, the function of the spleen and stomach is greatly reduced and it is prone to dampness in Zhongzhou.

Long-term dampness tends to concentrate and resolve phlegm, while dampness and turbidity for prolonged periods cause heat-transformation. Therefore, such patients often experience burning nausea and vomiting, and food residues in the bile have an unpleasant smell.

The reason is very simple. The gallbladder stores the soul. If the gallbladder energy is weak and weak, it cannot store the soul, so it will lead to restlessness, insomnia, frequent dreams, and a feeling of boredom and unhappiness.

Damp resistance in Zhongzhou, dysfunction of the liver and spleen in ascending and descending, and negligence in receiving and transporting, so the upper abdomen is distended and uncomfortable.

Although the stool is formed, it is naturally fishy and unpleasant due to excessive dampness, heat and turbidity.

Control to invigorate the spleen, dehumidify and clear away heat, so that the spleen will be strengthened and then turbidity will be reduced.

The gallbladder is the fire of Shaoyang. When the gallbladder qi drops, the heat will be eliminated by itself, and the heat will be eliminated by humidification and phlegm, while clear and turbidity will be divided.

For the treatment of patients with bile reflux gastritis of phlegm-damp blocking stomach type, Huanglian Wendan Decoction is the first choice.

Coptis chinensis and Zhuru clear away heat and gallbladder, harmonize the stomach, Atractylodes macrocephala, Poria cocos, pinellia chinensis, coix seed, accumulate solid to strengthen the spleen and nourish qi, remove dampness from itself, and can also regulate intestinal activities, increase intestinal tension and affect the flow of bile , and can promote gastrointestinal motility and enhance gastric emptying ability.

The combination of angelica, white peony root, bletilla striata, and licorice can not only protect the wound mucosa, but also reduce the excitability of the vagus nerve, increase the tension of the pyloric sphincter, and control bile reflux. Don’t forget to circulate Qi.This prescription has miraculous effects on phlegm-dampness blocking the stomach and postoperative symptoms of gastric cancer. "

Li Yuquan became more interesting the more he listened, and sighed: "I didn't expect our Chinese medicine to be so broad and profound. I used to hear that Chinese medicine looks at sick people and treats people as a whole. I still don't believe it. Looking at it now Come on, I have underestimated the treasure of my country."

After hearing this, Li Yuquan probably just thought that Lu Xuan was very knowledgeable. After all, he was actually shocked by too many contents, but most of them were not very understandable.

But Su Kenan is different, she is a medical student, and she is also a student of the University of Chinese Medicine, so she naturally knows how important what Lu Xuan said is to a Chinese medicine doctor.

This kind of opportunity is simply impossible to have in school.

The instructor would not explain it in such detail, or in other words, the instructor may not be as knowledgeable as Lu Xuan, and he probably doesn’t know as much as Lu Xuan, and he can’t say what he wants to say.

She quickly typed these contents into a file on her computer, and remembered them in her mind when she had no time. She even turned on the recording on her phone long ago, planning to go back and digest it.

These experiences are so precious.

To put it bluntly, today's class alone is enough for any Chinese medicine practitioner to benefit from it for a lifetime.

How many people are suffering from gastric cancer today?
Too many to count.

As for patients who suffer from gastric cancer, not to mention all, most of them end up undergoing gastrectomy, and there are definitely many who will suffer from bile reflux after surgery.

If one can master the contents of what Lu Xuan said, this ability alone will be enough to establish a territory of his own in the field of Chinese medicine.

These things cannot be learned in school.

Even if you go to a large traditional Chinese medicine hospital, you won’t be able to tell if anyone understands it. Even if someone does understand, they may not be able to give you some advice.

There are too many things like learning apprentices and starving masters to death in the field of Chinese medicine.

Of course, not only in the field of Chinese medicine, but also in other fields, and the same is true in Western medicine.

There will always be some people who are unwilling to pass on what they have learned to others, resulting in the loss of many technologies.

But this is something that can't be helped, after all, people are egoists.

To some extent, Lu Xuan is really generous.

Not only did he say it, but he also said it very clearly, without a trace of reservation.

There are Chinese medicine practitioners like Lu Xuan who are willing to teach them all, but they are definitely not many.

At this moment, Su Kenan looked at Lu Xuan's pupils, and a gleam of light became brighter and brighter.

Him, what else?
(End of this chapter)