Met a patient yesterday, who has hiccup for 27 months, from stomach to chest, bleeding, and throw out what he ate and drank regularly... I actually don't really know how the western chiropractors work, from Chinese medicine point view, it looks not too complicated... Here is some thoughts:
In Chinese medicine, it called 呃逆 -- 患者自觉胸膈气逆,喉间呃呃连声,不能自主。可单独发生,症状轻微,多持续数分钟至数小时后自愈;也可以继发于其他急慢性病过程中,症状多较严重,可昼夜不停,或间歇发作,迁延数日至数月不愈。可能因为饮食不当,情志不遂,正气亏虚等使胃失和降,气逆动膈引起。西医学里面的单纯性膈肌痉挛及其他疾病如胃肠神经官能症,胃炎,胃扩张,胃癌,肝硬化晚期,脑血管病,尿毒症及胃食管手术后等引起的膈肌痉挛都可以是为中医学上的“呃逆”
《辩证》
临床表现区分:
- 胃中寒冷:呃声沉缓有力,胸膈及胃脘不舒,得热则减,遇寒更甚,口淡纳呆,苔薄白,脉迟缓。
- 胃火上逆:呃声洪亮有力,冲逆而出,口臭烦渴,喜冷饮,脘腹胀痛,便秘尿黄,舌红,苔黄燥,脉滑数。
- 肝气犯胃:呃逆连声,常因情志不畅而诱发加重,胸闷胁胀,脘腹痞满,嗳气纳呆,肠鸣矢气,苔薄白,脉弦。
- 脾胃阳虚:呃声低长无力,气不得续,腹中冷痛,泛吐清水,脘腹不舒,喜温喜按,手足不温,食少乏力,便溏,舌质淡,苔薄白,脉细弱。
- 胃阴不足:呃逆短促而不得续,口干舌燥,烦躁不安,不思饮食或食后饱胀,大便干结,舌质红,苔少而干,脉细数
《治疗》
1. 针灸 - 和胃降逆止呃。以任脉,足阳明和手厥阴经穴为主
==> 中脘和足三里按症选补泻法;内关和膈俞穴用平补平泻法。配穴按虚补实泻法,寒症配艾灸。
==> 配穴: 胃寒--梁门;胃热--陷谷;肝气犯胃--期门,太冲;阳虚--气海,关元;阴虚--太溪
==>方义:中脘为胃募穴,足三里为胃经合穴,下合穴,两穴同用,泻之清热解气,补之益气温中;膈俞利膈镇逆,内关和中解郁。
2.推拿 - 和胃降气平呃。以任脉及相应背俞穴为主
==>取仰卧位,阿是穴,缺盆和内关分别施指按法和指揉法(交替进行),以局部明显酸胀为度;膻中,上脘,中脘施一指禅推法;上腹顺时针摩法;
==>取俯卧位,脾俞,胃俞,膈俞,肝俞,胆俞施按揉法及擦法
==>胃寒--延长摩腹时间;胃热--加足三里按揉;肝气犯胃--加期门,章门按揉法和两肋擦法;阳虚--加背部督脉和膀胱经及八髎穴擦法;阴虚--加足三里,三阴交,血海按揉
西医认为呃逆主要是由于膈神经受某些因素刺激,致使膈肌产生不自主的,间歇的,强烈的收缩而引起。患者要保持良好情绪精神舒畅,避免外邪侵袭,饮食宜清爽,进易消化食物。。。
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