1. Types of tuberculosis:
Type I: Primary pulmonary tuberculosis.
Type Ⅱ: hematogenous disseminated pulmonary tuberculosis.
Type ⅲ: infiltrative pulmonary tuberculosis.
Type Ⅳ: chronic fibrocavitary pulmonary tuberculosis.
Type V: tuberculous pleurisy.
2. Lesion range and cavity position: Lesion range is described by upper, middle and lower lung fields.
Upper lung field: the inner end of the lower edge of the second anterior rib is above the horizontal plane.
Middle lung field: below the upper lung field and above the level of the inner end of the lower edge of the fourth anterior rib.
Lower lung field: below the middle lung field.
If there is a cavity, add an "O" to the corresponding lung field. The right lesion was recorded above the horizontal line, and the left lesion was recorded below the horizontal line. No lesions on one side are indicated by (-).
3. Examination of sputum tuberculosis
Sputum tuberculosis examination is the main index to diagnose and judge the curative effect. Positive sputum examination is indicated by (+), and negative sputum examination is indicated by (-). The sputum examination method should be indicated, which is indicated by smear, collection (collection) or culture (cultivation). Picturesque (+); Settings (-); Pei (-). Sputum bacteria have been negative for 3 consecutive months, and at least 65438 0 times of smear or bacterial collection and inspection (culture if conditions permit) are negative as the standard. When the patient has no sputum or has not checked sputum, it should be marked as "no sputum" or "not checked".
4. Activity and prognosis:
When judging the activity and prognosis of patients, we can consider the clinical manifestations, lung lesions, cavities, sputum bacteria and so on.
Progressive period: any of the following circumstances is a progressive period.
Newly discovered active lesions; Lesions are more and more serious than before; New cavity or cavity enlargement; Phlegm bacteria turn positive.
Improvement period: any of the following circumstances is the improvement period.
The lesion was better than before absorption; Cavity contraction or closure; Sputum bacteria decreased or turned negative.
Stable phase: the lesion is inactive, the cavity is closed, and the sputum bacteria continue to turn negative (at least/kloc-0 times per month), all of which last for more than 6 months. If the cavity still exists, the sputum bacteria must be negative 1 year or more.
Differential diagnosis:
1. Differentiation between primary syndrome and non-tuberculous pneumonia: the former is more common in children, tuberculin test is positive, and leukocytosis is mainly lymphocytes. The latter is found in all ages, acute onset, severe infection, tuberculin test (-), leukocytosis, mainly neutrophils.
2. Differentiation between tuberculosis of bronchial lymph nodes and central lung cancer:
The former is more common in children and adolescents. Chest X-ray showed that hilar lymph nodes were enlarged, and axillary lymph nodes in neck were also enlarged during physical examination. Central lung cancer is more common in adults or the elderly. Although mediastinal widening can also be seen, OT (-), accompanied by dyspnea and no fever, is often positive for cancer cells by sputum examination, which can be diagnosed by fiberoptic bronchoscopy.
3. Miliary tuberculosis should be differentiated from typhoid fever:
Both of them have hepatosplenomegaly, but the former has high fever, and chest X-ray shows miliary shadow changes in the lungs, while the latter has persistent high fever, abdominal distension and lethargy, and the body temperature and pulse (heart rate) are separated. It is characterized by high body temperature and low pulse rate. 4. Differentiation between infiltrative pulmonary tuberculosis and bronchopneumonia:
The former is more common in adults, with slow onset and mild symptoms. Chest X-ray shows the shadow of infiltrative lesions at the apex of lung, and OT examination can make a diagnosis. The latter mostly occurs in young children or the elderly, with acute onset and severe symptoms. The pronunciation of the lesion is distorted, and the lesion is mainly in the middle zone of the lower part of both lungs.
5. Differentiate infiltrative pulmonary tuberculosis from mycoplasma pneumoniae pneumonia and allergic pneumonia:
Infiltrating pulmonary tuberculosis, in addition to the above characteristics, the focus is fixed and absorbed slowly; However, mycoplasma pneumonia and allergic pneumonia are absorbed quickly, and eosinophils in peripheral blood increase. 6. Differentiation between pulmonary tuberculosis and lung cancer:
The former has neat and sharp edges, uneven density, calcification points and satellite foci. The latter has irregular edges, lobulated or umbilical changes, tumor cells can be seen in sputum, and tumor tissue cells can be seen in lung biopsy or fiberoptic bronchoscopy.
7. The difference between caseous pneumonia and pneumococcal lobar pneumonia:
Both of them may have sudden high fever and lung consolidation shadow, but the density of the former is uneven, and there are many large and small cavities along the trachea, and tuberculosis can be seen on sputum smear, while lobar pneumonia has an acute onset, a short course of disease, an increase in polymorphonuclear leukocytes, a neat chest film shadow boundary and uniform density, and the general antibiotic treatment effect is better.
8. Differentiate chronic fibrocavitary pulmonary tuberculosis from chronic bronchitis and bronchiectasis:
According to the medical history and sputum smear examination. The former has a history of tuberculosis, positive sputum tubercle bacillus, OT (+), chest X-ray shows that tuberculosis focus is mostly in the upper fields of both lungs. The latter has a history of smoking, vomiting a lot of pus and phlegm, leukocytosis, mainly neutrophils, and the lesions are mostly in the lower fields of both lungs.
Modern medical therapy:
Patients with symptoms should be treated first, and comprehensive treatment methods such as medicine, nutrition, rest, proper exercise and psychotherapy should be adopted. Patients should actively cooperate. Regular life, complete treatment plan, and strict observation to avoid delaying treatment and complications.
Ordinary care:
Patients with obvious symptoms of pulmonary tuberculosis poisoning, hemoptysis or acute active lesions should stay in bed. Symptoms are relieved and activities are gradually increased. Properly strengthen nutrition, such as adding animal and plant protein and vegetables and fruits containing vitamins. Proper sunbathing is also conducive to recovery.
Selection of anti-tuberculosis drugs;
1. Remifentanil (isoniazid, INH, h): It has the function of inhibiting and killing tuberculosis, and is the first choice for anti-tuberculosis. Adult 0.3 g,/kloc-0 or 3 times orally, or intravenously or intratracheal. For acute miliary pulmonary tuberculosis, the dosage can be increased to 0.6 g/day, and vitamin B6 can be added to prevent peripheral neuritis. The course of treatment is 6 ~ 12 months. The side effects of this medicine are small, but there are occasional side effects such as mental excitement, peripheral neuritis, male mammary gland hyperplasia and liver injury. Therefore, attention should be paid to observation during medication, and if there are side effects, the drug should be stopped and another drug should be selected.
2. Streptomycin SM: It can inhibit the reproduction of tuberculosis and is suitable for active tuberculosis. It is also a first-line anti-tuberculosis drug. Adult intramuscular injection 1.0g/ day, and the elderly, children and thin people should reduce it as appropriate. It can also be inhaled by tracheal drip or atomization, and the course of intramuscular injection is 2 ~ 6 months. After short-term treatment 1 ~ 3 months, intermittent therapy can also be used, with intramuscular injection 1 g twice a week for 2 ~ 6 months. The side effects of this medicine are tinnitus, deafness and vestibular dysfunction caused by the eighth cranial nerve injury, which leads to dizziness and imbalance. Irreversible deafness and dizziness often occur if the dose is not reduced or the drug is stopped in time.
3. Sodium p-aminosalicylate (NaPAS): It has weak bacteriostatic effect on tuberculosis, but its drug resistance is small. Adults take 8 ~ 12g orally twice a day, or add 500 ml of 5% glucose solution intravenously, so the medicine is easy to decompose and deteriorate when exposed to light, so it must be wrapped around the infusion set with black paper or cloth to avoid light. Side effects include anorexia, nausea and diarrhea. If you take it after meals or add soda, you can reduce the adverse reactions of the gastrointestinal tract.
4. Rifampicin RMP Rifampicin RFD is a broad-spectrum antibiotic, but it has a strong effect on tuberculosis, so it has recently been used as the first choice for anti-tuberculosis drugs. The dose of RMP is 450 ~ 600 mg per day, and it is taken orally on an empty stomach in the morning. Side effects are gastrointestinal reaction and liver function damage, so liver function should be measured before taking medicine, and patients with liver disease should use it with caution.
The effect of RFD is the same as that of RMP, but the dose is 1/3 of RMP, that is, 150 mg per day, taken on an empty stomach. Because of the small dose, the side effects are also reduced, and it is also one of the first choice combination drugs for anti-tuberculosis.
5. Ethambutol EMB: It has a strong killing effect on tuberculosis. Adults take 600 mg orally, 2-3 times a day, and its side effect is retrobulbar optic neuritis, which is characterized by decreased visual sensitivity, central blind spot and decreased green vision.
6. Kanamycin: It has the same effect as SM, and can be used by people who are allergic to SM. The adult dose is intramuscular injection every day 1g, but local injection often leads to incomplete absorption or severe pain. The side effects are damage to the eighth cranial nerve and kidney.
7. Pyrazine amide PZA: It can inhibit the excretion of uric acid by kidney, promote the deposition of uric acid to joint tissues, and cause joint pain, while RMP can promote the clearance of uric acid, so it is often used with RMP to alleviate the above side effects. The adult dose is 1.5 ~ 2g per day, which is taken orally for three times, and the side effect is liver injury.
8. Thiourea (TB 1): The dosage is 75 ~ 100 mg per day for adults, and the side effects are gastrointestinal reaction, leukopenia and liver damage.
Matters needing attention in the use of anti-tuberculosis drugs:
The above anti-tuberculosis drugs are accurate, reliable and easy to use, and should be the first choice for treatment. In order to increase the curative effect and reduce the formation of drug resistance, triple therapy is often used, that is, SM plus H plus RMP or ethambutol. If the illness is mild, you can also use the two-way method, that is, H plus SM. H single drug can also be used for preventive medication or prevention of recurrence.
Take the medicine early, and the dose should be enough. Early lesions were mainly exudation. When the metabolism of mycobacterium tuberculosis is vigorous, the bactericidal power of drugs is strong. At the same time, early pathological changes have less damage to lung tissue, and early medication can make the tissue absorb better and repair faster. When the disease turns to cheese necrosis and cavity is formed, the damaged lung tissue can not be repaired well, so we should take enough drugs as soon as possible.
Anti-tuberculosis drugs have many side effects on liver, kidney and brain nerve, so before taking drugs, ask whether there are diseases in liver, kidney and vision, pay attention to observation after taking drugs, and check liver and kidney regularly to avoid complications.
The International Tuberculosis Association advocates that remifentanil (H), rifampicin (R), pyrazinase (Z), streptomycin (S), thiosemicarbazone (TB 1) and ethambutol (E) should be listed as the main anti-tuberculosis drugs, among which H, E, R and S are listed as the first-line anti-tuberculosis drugs in China.
1. Application scheme for new treatment of active pulmonary tuberculosis patients:
①2SHRZ/4RH (negative SZ); 4 months later); ②6RHE； ③2 Shanghai /IOHP.
2. Initial treatment plan for patients with bacterial negative active pulmonary tuberculosis:
(1) sputum bacteria were negative, but there were cavities or extensive lesions. It can be used as a reference for the treatment of patients with positive bacteria. ②6RH； ③RHP .
In this scheme, Arabic numerals represent the number of months of medication: P stands for PAS, that is, aminosalicylic acid. According to the local drug supply and economic situation. Change R to D (rifampicin) and P to E in the scheme.
Dosage: s:0.7g/ day; H:0.3g/ day; P: 10g/ day; Z: 1.5g/ day; E: weight; 55 kg, 1g/ day; R: 0.45g/ day for those weighing less than 55kg and 0.6g/ day for those weighing more than 50kg; D: weight < 55kg, 0.2g/ day, weight ≥ 55kg, 0.3g/ day.
3. Reprocessing plan:
Retreatment refers to: ① initial treatment failure (sputum bacteria are still positive after 6 months of routine chemotherapy, or the lesion is aggravated). ② Irregular chemotherapy lasted for more than 3 months. ③ Recurrence after initial treatment. The retreatment plan is: ① Reh; ②K (kanamycin) zh; ③T(TBI)ECP (capreomycin); ④I3，I4THECP .
4. Secondary pulmonary tuberculosis:
Sputum bacteria positive or cavity: ① 2 SHP); /4S2H2P2 (SHP twice a week after 4 months); ②3SHP (or T)/9I5HP (or t); ③2SH or 2SH/7HR；; ; ④2 Hz /4 hours.
Sputum bacteria were negative without cavity: ① 2Sh/IOH2P2; ②2SH/IOHP (or t); ③I2HP (or t); ④2SHR？ /FONT & gt； Three hours.
Note: During the application of anti-tuberculosis drugs, liver function and white blood cell count should be checked regularly to observe its toxic and side effects.
TCM treatment based on syndrome differentiation;
1. lung yin deficiency type:
Symptoms: dry cough, hoarseness, bloodshot sputum, dull pain in chest, hot flashes due to bone steaming, fever in hands and feet, redness in cheeks, especially in the afternoon, night sweats, emaciation, preference for cold drinks, red tongue and rapid pulse. (ESR is often high and hemoglobin is low. )
Syndrome analysis: lung is fine and dirty, likes dryness, and lung yin is insufficient, so Su Qing is lost, and qi goes against and coughs, but yin is deficient in lung dryness, so there is no phlegm. Dry heat and collateral damage lead to hemoptysis, and internal heat due to yin deficiency leads to low-grade fever in the afternoon, which requires dry mouth and cold drinks to clear the fire. Night sweats are manifestations of yin deficiency, because night sweats do not move during sleep. Yang hyperactivity due to yin deficiency, night sweats, red tongue and thready pulse are also symptoms of yin deficiency, which are more common in the early stage of onset.
Treatment: nourishing yin and moistening lung, clearing away heat and killing insects.
Prescription: Yuehua Pill.
Radix Adenophorae 12g, Radix Ophiopogonis 12g, Radix Asparagi 10g, Radix Rehmanniae 18g, Radix Stemonae 15g, Rhizoma Bletillae 20g, Rhizoma Dioscoreae 30g, Poria 15g and Bulbus Fritillariae Cirrhosae/kloc.
Decoct with water, daily 1 dose, and take orally twice in the morning and evening.
Add madder, Cirsium japonicum and Notoginseng Radix to hemoptysis. Night sweats and glutinous rice roots. Scutellariae Radix and Rhizoma Anemarrhenae are added to asthenic fire, and calcined oyster is added to spermatorrhea.
2. Yin deficiency and excessive fire type:
Symptoms: cough, shortness of breath, sticky phlegm, red cheekbones, hot flashes, night sweats, insomnia, chest pain, hemoptysis, nocturnal emission, irregular menstruation, emaciation and fatigue, red tongue with thin coating and heavy pulse. (Hemoglobin and red blood cells are low. )
Syndrome analysis: phlegm is small and sticky, it is not easy to cough up, and even hemoptysis is caused by collateral injury. Light can be blood in the sputum, bright red in color, and massive hemoptysis with blood clots, which is regarded as dangerous. If there is spleen deficiency, the water is wet and the cloth is lost, and the dampness is stored in the lungs, while the symptoms of cough and excessive phlegm are more common in those with deficiency of both lung and spleen. Hot flashes are periodic chronic fever, mostly internal injuries, yin injuries and excessive fire. Water does not control fire, Yang rises. Symptoms are flushed cheeks and heavy internal heat, you are upset and sleepy, forcing body fluids to leak out and night sweats are heavy. Vein disharmony, stagnation of qi and blood, chest pain, nocturnal emission due to excessive fire, failure to nourish the chong and ren, and disorder of the moon. The child stole the mother's qi, lung disease and spleen, and biochemical malnutrition, but he was emaciated, muscular fatigue, and little movement. The tongue is crimson, the fur falls off, and the pulse is deep and thin, which is the manifestation of yin injury and insufficient dirty qi after a long illness. It is more common in patients with long-term tuberculosis. Treatment: nourishing yin to reduce fire, resisting tuberculosis and killing insects.
Prescription: Baihe Gujin Decoction combined with Artemisia annua Biejia Powder.
Carapax et Plastrum Testudinis 10g, Colla Corii Asini 12g (dissolved), Cordyceps sinensis 12g, Picrorhiza picrorhiza 10g, Bupleurum chinense 10g, Lilium 30g, Radix Rehmanniae 20g, Radix Ophiopogonis 12g, and Radix Platycodi.
Decoct with water, daily 1 dose, and take orally twice in the morning and evening.
3. Deficiency of both qi and yin:
Symptoms: pale face, fatigue, slight cough, poor appetite in loose stool, excessive phlegm, spontaneous sweating due to fear of wind, night sweats, red cheekbones, pale tongue with white fur, teeth marks, heavy and thin pulse and weak strength. (Hemoglobin and red blood cells decreased significantly. )
Syndrome analysis: For the body suffering from chronic diseases, yin disease damages Yang, resulting in both qi and yin injuries, mainly involving lung and spleen. The lung does not control qi and the spleen loses transport, so you can see a weak voice, pale face, thin stool, spleen deficiency and dehydration, and phlegm and blood stasis. Deficiency of lung and insecurity of exterior and interior lead to sweating and fear of cold, and weakness of yang leads to mental fatigue, fatigue and lack of moss, which is easy to cause colds. Combined with the inherent symptoms of tuberculosis, such as yin injury, red cheekbones and night sweats, the syndrome of both qi and yin injury is formed, with pale tongue with white fur, teeth marks and weak pulse, all of which are symptoms of consuming yin and hurting qi. This is more common in patients with pulmonary tuberculosis who have been ill for a long time. Treatment: benefit lung and spleen, kill insects and tonify deficiency.
Prescription: Shen Ling Baizhu Powder.
Pseudostellaria heterophylla 15g, Poria cocos 15g, Atractylodes macrocephala 15g, Dioscorea opposita 30g, Platycodon grandiflorum 12g, Lily 30g, Jujube 10, Astragalus 20g, Lotus Seed 15g, and Angelica sinensis/kloc-.
Decoct with water, daily 1 dose, and take orally twice in the morning and evening.
4. Yin and Yang deficiency type:
Symptoms: listlessness, emaciation, yellow complexion, hoarseness, hot flashes and night sweats, bone steaming, loose stool, frothy or bloody sputum, palpitation, shortness of breath, reticence, loss of appetite, spontaneous sweating, nocturnal emission, amenorrhea, yellow and dry fur, and thin or weak pulse.
Syndrome analysis: Zang-fu organs are interrelated, so under pathological conditions, local lung lesions will inevitably affect other organs and the whole. Therefore, there is a saying that "its evil hair benefits the five internal organs." Tuberculosis is most closely related to spleen and kidney. Spleen is the mother of lung, and lung deficiency consumes spleen to maintain health, so spleen is also deficient. Spleen deficiency can't make water enter the valley and nourish the lungs. Kidney is the son of lung, lung deficiency leads to kidney loss of nutrition, or kidney deficiency leads to fire burning gold, and the son steals the mother's qi, which makes lung qi more exhausted and fails to nourish the kidney, which eventually leads to deficiency of both lung and kidney, deficiency of kidney yin, excessive fire and disorder of seminal vesicle, as shown in wet dream, while women have symptoms of kidney deficiency such as irregular menstruation.
If lung deficiency can't govern the liver, kidney deficiency can't nourish the liver, liver fire is on the high side, and upper resistance can bully the lung, showing symptoms such as impatience, irritability and hypochondriac pain. Such as lung deficiency fire, kidney deficiency water is not conducive to fire, but also accompanied by insomnia, night sweats, bone steaming, fever and other symptoms. If the patient is seriously ill for a long time, it can evolve into lung, spleen and kidney diseases. Or because of lung disease and kidney, kidney deficiency can't absorb qi, or because of spleen deficiency and kidney, spleen can't refine essence and nourish kidney, and it changes from acquired to congenital, and even lung deficiency can't help the heart to control blood, resulting in qi deficiency and blood stasis, shortness of breath, shortness of breath, palpitation, lip spasm and limb cold edema. This is the occurrence of pulmonary heart disease.
This syndrome is seen in patients with deficiency of lung, spleen and kidney, developed from deficiency of both qi and yin, and is seen in the late stage of severe pulmonary tuberculosis.
To sum up, pulmonary tuberculosis is mainly due to yin deficiency, followed by deficiency of both qi and yin, and deficiency of both yin and yang. According to the syndrome differentiation of zang-fu organs, the initial stage of the disease is lung yin deficiency, followed by lung and spleen diseases, both qi and yin injuries, and the later stage is lung, spleen and kidney deficiency, resulting in deficiency of both yin and yang, which shows the serious syndrome of liver, heart and zang-fu organs function damage. Treatment: nourishing yin and yang, consolidating the roots and killing insects.
Prescription: Modified Butian Jujube Pill.
Pseudostellaria heterophylla 15g, Atractylodes macrocephala 15g, Rhizoma Dioscoreae 30g, Poria 20g, Radix Astragali 30g, Placenta Hominis 15g, Radix Angelicae Sinensis 15g, Cornu Cervi 10g, Carapax et Plastrum Testudinis 12g, Radix Paeoniae Alba/.
Decoct with water, daily 1 dose, and take orally twice in the morning and evening.
Symptomatic treatment:
1 hemoptysis: A small amount of hemoptysis can be treated with drugs such as Shi Hui Pill, Artemisia argyi powder, Notoginseng Radix, Agrimonia Agrimonia, Anluoxue and 6 aminocaproic acid. For massive hemoptysis, pituitrin 10 unit and 20ml 10% glucose solution can be injected intravenously or intravenously, but it is contraindicated for patients with hypertension and coronary heart disease. When hemoptysis occurs, the patient should lie on his side to prevent hemoptysis from overflowing the lungs, or perform tracheotomy to suck blood to prevent suffocation. Blood transfusion is possible when necessary; If there is only a small amount of blood in sputum, no special treatment is needed. 2 Fever: Physically cool the high fever patients, give antipyretics and corticosteroids as appropriate, and use antibacterial drugs for secondary infection.
Night sweats: take antiperspirant tablets or belladonna tincture 0.3 ~ 0.6 ml when sleeping. Traditional Chinese medicine uses floating wheat, glutinous rice root 30g, dried peach 15g, and 5-7 red dates, which are decocted in water.
4 Cough and expectoration: cough with Kebiqing and codeine for dry cough; If the sputum is too thick, use ammonium chloride, steam or α chymotrypsin, or compound platycodon grandiflorum tablets for atomization inhalation, 0.3g each time, 3 times a day, and add chlorpheniramine if necessary.
Application of hormones:
Hormones are generally not used, but they can be used in severe cases to reduce toxic reactions. The adult dose of prednisone is 30mg/ day, min 1 ~ 3 times. Those who use the hormone for a long time should gradually reduce the amount every week after the symptoms are relieved, and stop using it after 4 ~ 6 weeks. If it is serious, ACTH can be used to maintain adrenal cortex function, with a dose of 25 ~ 50 units, intramuscular injection or intravenous drip.
Surgical treatment:
Surgical treatment, such as lobectomy, pneumothorax, pneumoperitoneum, etc. For those who are still too big to heal after systemic anti-tuberculosis treatment, or the cavity is not closed after treatment, the sputum bacteria are still positive, or tuberculosis balls are formed, or a large number of hemoptysis are life-threatening, they can be considered.
Psychotherapy:
Psychotherapy is an important part of comprehensive anti-tuberculosis treatment, and it is also a positive measure to mobilize patients' anti-tuberculosis ability and promote the improvement of their condition. It is necessary for patients to master the basic knowledge of treating and preventing diseases, achieve self-regulation and actively cooperate with treatment. Methods Persuasion, suggestion and biofeedback were used. Nutritional therapy:
This is an important way to cultivate healthy qi. Reasonable deployment of diet, enhance physical fitness, in order to promote the improvement of the disease. Traditional Chinese medicine believes that "medicine is not as good as food supplement" is reasonable.
Physical exercise:
Proper physical exercise and breathing exercise are beneficial to improve systemic symptoms and promote the recovery of lung function. But don't overdo it, so as not to damage your health. Such as simple qigong, breathing exercises, walking and so on.
Unilateral prescription:
1. Garlic Bletilla striata: 20g of purple garlic, peeled and mashed, 3g of Bletilla striata, taken with rice juice, 2 doses per day.
2. Qinbudan: 9 g of Scutellaria baicalensis Georgi, 9 g of Stemona Stemona 18 g, 9 g of Salvia miltiorrhiza Bge. * * * is fine powder, daily 1 dose.
3. Huangbai Siwei Powder ("Qianqifang"): It is suitable for patients with pulmonary tuberculosis and hemoptysis. Bletilla striata 12g, rhubarb 9g, catechu 6g, alum 3g, * * * as fine powder, divided into 30 packets, three times a day, each time 1 packet. It often has a good effect on pulmonary tuberculosis patients with a small amount of hemoptysis.
4. Bao Tiejin 30-60g, Rhizoma Dioscoreae Septemlobae 30g, Colla Corii Asini, Rhizoma Bletillae, Fructus Trichosanthis, Semen Armeniacae Amarum, Folium Eriobotryae, Radix Asteris, Radix Stemonae, Bulbus Fritillariae Cirrhosae 10g, decocted in water, daily 1 dose, divided into 2 parts. It is suitable for all types of tuberculosis.
5. 9 grams of Cordyceps sinensis, 9 grams of Ophiopogon japonicus, 9 grams of Adenophora adenophora, lean pork 1 00g,1time per day, 10 to 15 days. It is suitable for patients with pulmonary tuberculosis consuming lung yin.
6. Radix Rehmanniae, Semen Persicae, Radix Ophiopogonis, Rhizoma Dioscoreae and Stemonae each 9g, Herba Hedyotidis Diffusae and Herba et Gemma Agrimoniae each 30g, Radix Camptothecae acuminata and Radix Salviae Miltiorrhizae each 65438 02g, decocted in water, with 65438 0 doses per day. Suitable for lung yin deficiency type.
7. 9 grams of Gentiana macrophylla, 30 grams of Bupleurum, Radix Glehniae, Radix Ophiopogonis, Fructus Toosendan, Radix Rehmanniae, Cortex Lycii, Cynanchum atratum, Artemisia annua, Herba Dendrobii, Rhizoma Bletillae, Aristolochia, Scutellariae Radix and Stemona Radix, 30 grams of Hedyotis diffusa and Herba et Gemma Agrimoniae, and 65,438 02 grams of Camptotheca acuminata and Salvia miltiorrhiza respectively. It is suitable for pulmonary tuberculosis with yin deficiency and excessive fire.
8. 250 grams of anchovy, Stemona Stemona 1 5g, Cortex Lycii15g, and 20g of Radix Rehmanniae, decocted in water, daily1dose for 7- 10 days. Suitable for pulmonary tuberculosis with deficiency of both qi and yin.
9. Radix Astragali Preparata, Radix Codonopsis, Rhizoma Dioscoreae, Poria, Radix Ophiopogonis (stir-fried with rice), Semen Ziziphi Spinosae, Steamed Coicis Semen, Rhizoma Polygonati Odorati, Lily, Colla Corii Asini (stir-fried with clam powder), Radix Angelicae Sinensis and Folium Eriobotryae each 70g, Radix Rehmanniae Preparata100g, Fructus Corni, Bulbus Fritillariae Cirrhosae, Radix Dipsaci, Radix Asteris and Folium Eriobotryae
10. Bovine placenta 1, sweet almond 15g, bitter almond 12g, 3 slices of ginger, 3 pieces of red dates and a proper amount of wine. Wash the bovine placenta with clear water, soak it for several hours, then blanch it with boiling water, cut into pieces, heat it in a wok, add a little oil, heat it again and put it down. Suitable for patients with persistent cough caused by pulmonary tuberculosis.
1 1. 50g of floating wheat, 50g of black beans (or bean skin) and 2 slices of ebony, decocted in water and taken at night. 1 week. Suitable for people with tuberculosis and night sweats.
12. Concha Haliotidis 12g, Cortex Lycii 10g, Radix Bupleuri 6g, crushed concha Haliotidis, decocted with the other two ingredients. Suitable for pulmonary tuberculosis with low fever.
13. Stir-fry clam powder and donkey-hide gelatin, grind them into fine powder, 9 grams a day, and take them twice. Suitable for tuberculosis and hemoptysis.
External treatment:
1. Usage: 30g of Oletum Trogopterori, 30g of white mustard seed, 30g of pigeon dung, 30g of garlic (peeled), 60g of licorice 12g, 60g of L-plant of Bletilla striata, 60g of pig spinal cord, musk 1g and proper amount of vinegar. First pour the vinegar into the pot, and then dissolve the musk. Apply it to Shufei, Pishu, Shenshu and Gaozhuyu, change the dressing 1 time for 2 days, and treat for 6 days +05 days 1 time, with an interval of 3 times, and continue to use it. It is suitable for pulmonary tuberculosis with yin deficiency and lung heat.
2. Umbilical application method: 2 grams of Galla Chinensis and 2 grams of cinnabar, * * * ground into fine powder, mixed with water to make paste, coated on plastic film, applied to umbilical fossa, and fixed in rubber market for 24 hours 1 time. Suitable for tuberculosis night sweats.
3. Friction method: Impatiens balsamina root, ginger, cinnamon and camphor. Ginger and cinnamon are pounded together, mixed with camphor, and impatiens root is dipped in medicine to wipe the chest and back, 2 ~ 3 times a day, 30 minutes each time. Suitable for tuberculosis, asthma, night sweats and hemoptysis.
4. Inhalation method: Mash 50g of purple garlic, smear garlic paste in a glass bottle, stick the bottle mouth to the nose and mouth, and inhale its volatile gas 1 ~ 2h,1,twice a day. It is suitable for the syndrome of tuberculosis forming cavity.
Acupuncture therapy:
Acupuncture therapy:
1. lung yin deficiency type:
Acupoints: Shu Fei BL 13, Chize Road 5, Zhongfu Road 1, Gaoyishu LB43.
The most suitable acupoints for hemoptysis are LU6 and thenar LU 10.
The plaster is supplemented, and the rest points are supplemented and diarrhea.
2. Yin deficiency and excessive fire type:
Acupoints: GV 14 of Dazhui, Taixi, Kongzui Road 6 and Sanyinjiao SP6.
Amenorrhea with blood sea SP 10, spermatorrhea with Guanyuan CV4, irritability with Shenmen HT7, and Fu Liu KI7.
Dazhui was treated by purgation, while other acupoints were treated by Pingbu Xie Ping.
3. Deficiency of both qi and yin:
Acupoints: Shu Fei, Pishu, Zusanli and Taixi.
Hot flashes are equipped with Dazhui GV 14 and ambulance PC5, night sweats are equipped with Yinbi HT6 and Houxi SI3, and loose stool is equipped with Shu Tian ST25 and Qihai CV6.
Taixi point uses the method of calming and purging, and the rest points use the method of reinforcing.
Auricular point therapy:
Acupoints: lung, kidney, Shenmen and Ping Jian.
Diarrhea of large intestine.
Needle acupuncture was used to stop diarrhea, with moderate intensity stimulation. The needle was kept for 20min minutes, 65438 0 times every other day.
Acupoint injection:
Acupoints: Shu Fei, Dazhui, Tuberculosis, Zhongfu, Gaoyishu, Zusanli and Quchi.
Use 100 mg of vitamin B 1 injection or 0.2g of streptomycin, select two acupoints at a time, and puncture after routine disinfection. When there is a feeling of numbness in the local area and there is no blood return, slowly inject the liquid medicine. Every day or every other day, 1 time, 1 time is1course of treatment. After resting for 5 ~ 7 days, proceed to the next course of treatment.
Moxibustion therapy:
Acupoints: Shu Fei BL 13, Gaoyishu BL43, Taixi, Zusanli ST36 and Sanyinjiao SP6.
Hot flashes, night sweats, Yin Qi HT6, Zhao Hai KI6, hemoptysis LU6, nocturnal emission BL52, amenorrhea SP 10, loose stool ST25, Shu Tian.
Moxibustion with moxa sticks is 5~ 10 per point, once a day.
Cupping therapy:
Acupoints: Shu Fei, Miscanthus altissima, tuberculosis, flash fire cupping, every time 15 ~ 20 minutes, every day 1 time.
Massage therapy:
Prescriptions: Shu Fei, Gaoyishu, Pishu, Zusanli, Sanyinjiao, Taixi, etc.
Press, knead, push, etc.
Addition and subtraction: If the lung qi is insufficient, the symptoms are dyspnea, shortness of breath, fatigue and hyperhidrosis, then add Zen massage to Dingchuan point, massage points in the brain, zhongwan point, etc., to replenish the lung and replenish qi, cultivate the soil and generate gold; If you see your breathing is shallow and short, your voice is low, your breath is timid, and you even open your mouth and lift your shoulders. You can't lie flat because your lungs and kidneys are deficient and you can't control your qi. In Guanyuan, Qihai, Baihui, Tang Yin, Taiyang and other acupoints, the methods of pressing and kneading are added to replenish lung and kidney. If fire due to yin deficiency is strong and hot flashes appear, massage with your thumb and apply it to acupoints such as Chise, Sudden, Quchi, Dazhui, Shenshu, Taixi and Sanyinjiao to nourish yin and reduce fire, moisten lung and clear heat. Prevention:
The root of tuberculosis prevention and treatment is to treat patients and cut off the spread of tuberculosis. In order to reduce the incidence of tuberculosis, we should do a good job in vaccination and strengthen social propaganda and management.
BCG vaccination: BCG is an inactivated bovine tuberculosis vaccine, and BCG vaccination is an effective way to prevent the spread of tuberculosis. Treatment of primary disease: diabetes, pneumoconiosis, liver cirrhosis, viral diseases (measles, flu, etc.) have been confirmed. ) can promote the onset of tuberculosis. When the pulmonary artery is narrow, the pulmonary artery at the tip of the lung is depressed, and the local resistance is weak, which is also the prone part of tuberculosis. Therefore, treating the primary disease is one of the important measures to prevent and treat tuberculosis.
Some drugs, such as adrenocortical hormones and anticancer drugs, can promote the onset of tuberculosis, so attention should be paid to their use, especially for patients who use hormones for a long time (such as asthma patients), and anti-tuberculosis drugs should be added to avoid the tendency of static tuberculosis infection to active tuberculosis.
Strengthen the propaganda of tuberculosis prevention: In addition to the knowledge of preventing infection for healthy people, patients should also learn not to spread germs, and family members should learn to isolate and treat patients' sputum. Regular physical examination of susceptible people: it has always been believed that tuberculosis is easy to occur in young people. However, investigations in recent decades have proved that the incidence rate of young people has decreased rapidly, while the incidence rate of the elderly has increased relatively, which may be related to the decline of immune function, easy reinfection or recurrence of static lesions in the elderly. Smoking, alcoholism and malnutrition will promote the onset of tuberculosis. After the onset of the elderly, the symptoms are often atypical, OT skin test is often negative, chest X-ray can be negative, which is easy to be confused with aging, especially when there are other lesions (such as tumors and anemia), which is more difficult to find. Pretending to have a regular physical examination is more important. In case of dry cough, hot flashes and night sweats, diagnostic treatment can be given, that is, anti-tuberculosis treatment should be given. If the symptoms improve, the whole course of treatment should be treated to