|
Chronic suppurative otitismedia 慢性化脓性中耳炎 ? Differentiating syndrometo decide treatment 【辨证论治】 The commonly-seen syndromes of chronic supppurative otitis media includedampness intermingled with asthenia of the spleen, deficiency of the kidney aswell as hyperactivity of the liver due to asthenia of the kidney. The syndromeof dampness intermingled with asthenia is characterized by the perforation ofthe tympanic membrane in the centre of the tense part and pyorrhea inside theear without foul odour. Treatment should include strengthening the spleen toremove dampness. The syndrome of deficiency of the kidney is marked by theperforation of the tympanic membrane in the margin and pyorrhea inside the earwith foul odour. Treatment should be strengthening the kidney and eliminatingpathogenic factors. The syndrome of hyperactivity of the liver due to astheniaof the kidney is marked by the perforation of tympanic membrane in the flaccidportion and pyorrhea inside the ear with strange foul odour and the substancelike bean dregs. Treatment should lie in strengthening the kidney and clearingaway beat from the liver. 慢性化脓性中耳炎的常见证型有脾虚挟湿、肾元亏虚和肾虚肝旺等证。脾虚挟湿证的特点是鼓膜穿孔在紧张部中央，耳中流脓无臭，治疗应健脾除湿；肾元亏虚证的特点是鼓膜穿孔在边缘，耳中流脓有臭味，治疗应补肾祛邪肾虚肝旺证的特点是鼓膜穿孔在松弛部，耳中流脓异臭，有豆渣样物，治疗应补肾清肝。
方药 The prescription used is the modified Shenling Baizhu Powder (Powder ofGinseng, Poria and Bighead Atractylodes) in combination with Ermiao Pill (TwoWonderful Drugs Pill) composed of 10 g of Dangshen (Radix CodonopsisPilosulae), 10 g of Fuling (Poria), 15 g of Huangqi (Radix Astragali seuHedysari), 6 g of Cangzhu (Rhizoma Atractylodis), 6 g of Baizhu (RhizomaAtractylodis Maccrocephalae), 10 g of Shanyao (Rhizoma Dioscorreae), 10 g ofHuangbai (Cortex Phellodendri) and 3 g of Gancao (Radix Glycyrrhizae). 参苓白术数合二妙丸加减：党参10g，茯苓10g，黄芪15g，苍术6g，白术6g，山药1Og，黄柏10g，甘草3g.
Modification: 加 减 In the case of loose stool, add 10 g of Shengma (Rhizoma Cimicifugae) and10 g of Chaihu (Radix Bupleuri); in the case of profuse pus, 15 g of Yiyiren(Semen Coicis) and 6 g of Jiegeng (Radix Platycodi). 大便溏薄者，加升麻10 g，柴胡10g; 流脓量多者，加薏苡仁15 g，桔梗6g。
2.Syndrome of deficiency of thekidney 肾元亏虚证 Main symptoms and signs: 主要证候 The pus discharge inside the ear is prolonged, sticky and thick, withodour, and is often intermingled with blood. There exists granulation or polypinside the tympanic cavity. Tympanic membrane perforates in the marginal part.There exists severer conduction deafness. X-ray film of the mastoid processsees the vague transparent area. The patient suffers from dizziness, fatigueand aching pain in loins and knees. The tongue is red with a bit of fur and thepulse is thready and rapid. 耳内流脓，日久不愈，脓液粘稠，有臭味，鼓室内有肉芽或息肉，常有脓中夹血。鼓膜在边缘部穿孔。有较重的传导性聋。乳突X线片，可见模糊不清的透光区。头晕，乏力，腰膝酸软。舌红，苔少，脉细数。
Therapeutic methods: 治 法 Strengthening the kidney, eliminating pathogenic factors and removing the obstructionof orifices. 补肾培元，祛邪通窍。
Chinese medicine : 方药 The prescription used is the modified Zhibai Dihuang Pill (Pill ofAnemarrhena,Phellodendron and Rehmannia) composed of 10 g of Zhimu (RhizomaAnemarrhenae), 10 g of Huangbai (Cortex Phellodendri), 15 g of Shengdihuang(Radex Rehmanniae), 10 g of Shanzhuyu (Fructus Corni), 10 g of Shanyao (RhizomaDioscoreae), 6 g of Mudanpi (Cortex Moutan Radicis), 10 g of Zexie (RhizomaAlismatis), 10 g of Xiakucao (Spica Prunellae) and 6 g of Jiegeng (RadixPlatycode). 知柏地黄丸加减：知母10g，黄柏10g，生地黄15 g，山茱萸10g，山药10g，牡丹皮6g，泽泻10g，夏枯草10 g，桔梗6g。
3.Syndrome of hyperactivity ofthe liver due to asthenia of the kidney 肾虚肝旺证
Main symptoms and signs: 主要证候 Pyorrhea inside the ear is sometimes profuse and sometimes scanty. Thereexists the substance like bean dregs with special foul odour in the pus. Thepatient has severer conduction deafness or mixed deafness. The perforation ofthe tympanic membrane lies in the flaccid portion, or posterosuperior part ofthe tense portion. Through the perforation, the examiner can see the squamous substancewith greyish white colour and foul odour, or the indefinite-shaped substancelike bean dregs. X-ray film of the mastoid process or CT scan of temporal bonecan see the cholesteatomatous cavities of the upper tympanic cavity, antrumtympanicum or mastoid process. 耳内流脓，时多时少，脓液中有豆渣样物，有特殊恶臭。较严重的传导性聋或混合性聋。鼓膜穿孔位于松弛部，或在紧张部的后上方。从鼓膜穿孔处可见鼓室内有灰白色有恶臭味的鳞屑状或豆渣样无定形的物质。乳突X线片或颞骨CT扫描可见上鼓室、鼓窦或乳突有胆脂瘤性空洞。
Therapeutic methods: 治 法 Strengthening the kidney, clearing away heat and purging fire from theliver. 补肾培元，清肝泻火。
Chinese medicine : 方 药 The prescription used is the modified Zhibai Dihuang Pill (Pill ofAnemarrhena, Phellodendron and Rehmannia) in combination with Longdan XieganDecoction (Decoction of Gentiana for Purging the Liver Fire) composed of 10 gof Zhimu (Rhizoma Anemarrhenae), 10 g of Huangbai (Cortex Phellodendri), 15 gof Shengdihuang (Radix Rehmanniae), 10 g of Shanzhuyu (Fructus Corni), 6 g ofMudanpi (Cortex Moutan Radices), 10 g of Chaihu (Radix Bupleuri) and 15 g ofXiakucao (Spica Prunellae). 知柏地黄丸合龙胆泻肝汤加减：知母10g，黄柏10g，生地黄15g，山茱萸10g，牡丹皮6g，泽泻10g，龙胆草3g，山栀子10g，柴胡10g，夏枯草15g。 TO BE CONTINUED。。。  |
|
|
