肋痛（Rib pain）

肋痛（Rib pain） 肋痛(Rib pain) The 08 question is dry: First station: medical record writing (60 minutes) Lee x *, male, 45 years old, staff, 2002 - 02 - 12, first visit. In the past three years with a history of hepatitis B, six months before the loss of a spouse has been depressed, nearly five months, repeated liver pain, pain because of changes in the emotional changes, and parts of the disorder, but because of busy work, no diagnosis and treatment. Nearly two weeks to aggravate liver distending pain, with weakness, eating less, belching frequently, then come to see a doctor. See: T:36 / C, P:80, R:18 / Bp:120 / 75mmHg. Lucid, body slim, pale red tongue, thin tongue fur, pulse string. Under the liver rib 2Cm, the quality is smooth, the light tenderness, the liver area knocks the pain (+), has not seen other positive signs. Laboratory examination: HBsAg (+). Liver function: alanine aminotransferase (ALT): 75IU / L (0 - 60 IU / L), aspartate aminotransferase (AST) 62 IU / L (0 - 50 IU / L), total bilirubin (SB) normal. Repeated liver pain for 5 months, aggravated by two weeks. Differentiation of symptoms and signs is based on the fact that recently, due to emotional stimulation, the liver Qi fails to reach the end of the bar, and it is blocked by the collateral and becomes hypochondriac pain. The gas is invisible, when poly loose, everything is uncertain, so the pain go up uncertain. Emotional changes and gas stagnation are closely related, so the pain with the emotional changes and adjustments. Liver tribulations, easy to make the spleen and stomach, so eat less belching. The pulse string is the image of liver depression. The basis of Western medicine diagnosis is: 1. There were three years history of hepatitis B in the past. 2, there are liver swelling pain, fatigue, diet symptoms. 3, liver function: alanine aminotransferase (ALT): 75IU / L, aspartate aminotransferase (AST) 62 IU / L, Total bilirubin (SB) is normal. HBsAg (+) Admission diagnosis: TCM diagnosis: liver qi stagnation, hypochondriac pain Diagnosis of Western medicine: viral hepatitis B Rule: Soothing the liver and regulating qi Prescription: Chaihu Shugan powder, add and subtract: 6G 9g 9g of Fructus aurantii, bupleurum Cyperi Rhizoma Chuanxiong 12g tangerine peel 6g 15g 15g of Radix Paeoniae Alba sarmentosum turmeric 12g 9g peel licorice 3G The 09 question is dry: First station: medical record writing (60 minutes) Cao x *, female, 38, cadre, 2002 - 03 - 19, first visit. The usual hobby fatty foods, today at noon in the hotel eating three hours after abdominal pain, pain at the beginning mainly in the upper abdomen, after gradually shifted to the right upper abdominal pain, radiating to the back of the right shoulder, at right upper abdominal pain 2 hours, accompanied by fever, anorexia, nausea and vomiting, mouth pain, yellow urine, then. See: T:39 C / P:96, R:20 / Bp:130 / 80mmHg. Lucid, overweight body, red tongue, yellow greasy moss, pulse string slide number. The right upper quadrant of the gallbladder area was markedly tender and muscular, and the Murphy sign (+) did not show any other positive signs. Laboratory examination: blood: WBC:12.3 * 109 / L, N:90%. The blood amylase is normal, the urine amylase is normal. Complaints: 2 hours, right upper abdominal pain and anorexia, pain, nausea and vomiting. On the basis of disease: the patient usually hobby sorghum Atsumi, spleen and stomach caused by dereliction of duty, endogenous heat, stagnation of liver and gallbladder, liver meridian and gallbladder Qi, causing hypochondriac pain. The damp heat, abnormal movements, so bitter anorexia, nausea and vomiting. Steaming hot and humid to pay, bile and unusual overflow, so yellow urine. Red tongue, yellow greasy fur, slippery pulse string is the syndrome of damp heat in liver and gall. The basis of Western medicine diagnosis is: 1. There is a history of overeating before the onset of disease. 2, right upper abdominal pain, pain to the back of the right shoulder fired, fever, anorexia, nausea and vomiting, mouth pain, yellow urine. 3, physical examination: the right upper quadrant of the gallbladder area is obviously tender and muscular, Murphy's sign (+). 4, laboratory tests: blood: WBC:12.3 * 109 / L, N:90%. The blood amylase is normal, the urine amylase is normal. Admission diagnosis: Chinese medicine diagnosis: hypochondriac pain - liver and gallbladder damp heat Western medicine diagnosis: cholecystitis Cure: qingrelishi Recipe: Longdan Xiegan decoction: Gentian 3G Gardenia 12g 12g Scutellaria Akebia 3G Plantago 30g 15g 12g 9g Alisma turmeric peel Artemisia 30g Phellodendron 15g 15g 9g 6 Jinqiancao Decoct Decoction The 11 question is dry: First station: medical record writing (60 minutes) Huang x *, male, 52 years old, staff, 2002 - 03 - 22, first visit. HBsAg positive history was found for ten years, so no further examination was performed because of no symptoms. Liver area pain, a month ago quarrel with the neighbors after long work in endlessly, aggravated, not treatment. Over the past week, these symptoms have increased, and conscious fatigue, fatigue, dry mouth, pharynx and dry, In the heart is hot, dizzy, then come to examine. See: T:36.5 C / P:72, R:18 / Bp:120 / 70mmHg. Lucid, medium in shape, red in tongue, less moss and wiry in pulse. There were no other positive signs in the liver area with knocking pain (+). Laboratory examination: liver function: alanine aminotransferase (ALT): 152IU / L (0 - 60 IU / L), aspartate aminotransferase (AST) 128 IU / L (0 - 50 IU / L), total bilirubin (SB) 16umoI / L (3.4 - 22 umoI / L.). HBVM (hepatitis B etiology): HBsAg (+), HBeAg (+), anti HBc (+), B ultrasound: chronic liver damage. Complained of side pain for one month and aggravated for two weeks. On the basis of differentiation of diseases: the elderly body empty, blood loss, deficiency of liver yin, and liver heat, Haoshang liver yin, can moisten the liver meridian, therefore flank pain. Flank pain, leisurely endlessly, encounter pains aggravating, hypochondriac pain characterized Yin deficiency, yin deficiency prone to heat, so dry mouth and throat, Fanre hearts. Blood deficiency, can not be on the wing, so dizzy. The liver wood by soil, splenism, limb bones loss in Ruyang, so fatigue. The tongue is red and has few moss and the pulse is thin. All of them are the picture of internal heat due to Yin deficiency, The basis of Western medicine diagnosis: 1. HBsAg positive history was found in ten years. 2, hypochondriac pain, fatigue, dizziness, upset, dry mouth, pharynx and dry. 3, liver function: alanine aminotransferase (ALT): 152IU / L (0 - 60 IU / L), aspartate aminotransferase (AST) 128 IU / L (0 - 50 IU / L), total bilirubin (SB) 16umoI / L (3.4 - 22 umoI / L.). 4, HBVM (hepatitis B etiology): HBsAg (+), HBeAg (+), anti HBc (+). 5 、 B ultrasound: liver damage. Admission diagnosis: Chinese medicine diagnosis: flank pain - liver yin deficiency Diagnosis of Western medicine: viral hepatitis B Rule: Nourishing Yin and softening liver Prescription: always fried as the main side Student 15g 15g 15g 9g from medlar Radix Glehniae Angelica 9g Kawa Ko 12g 9g 15g shanzhiside Ligustrum Polygonatum 15g 15g malt Wild jujube seed 15g Decoct Decoction