升清降濁失常與正午頭痛夜間踝痛之關係

18歳の女性で、体格はがっしりしています。訴えは両足のくるぶしの痛みで、特に夜中や座っているときに痛みや酸っぱさを感じるとのことで、外傷の経歴はありません。脈は軟らかく力がなく、特に寸部の脈はしっとりしており力がなく、沈んだ感じがします。問診の際、患者はめまいや頭痛の症状を訴え、毎日正午に頭痛があり、後頭部の太陽経の横三寸の位置に痛みがあると述べました。尺部の脈は沈んで弱く、舌は瘀斑がありつるっとしています。腰痛があり、特に生理期後の2日目に血塊が伴います。

述べられた症状から次のように考えられます：

夜中の足首の痛み： 陰気が最も盛り、陽気が最も弱いとき、または座っている姿勢が太陽経の流れを妨げているため、外くるぶしの申脈のツリや痛みが生じる可能性があります。
正午の頭痛： 陽気が最も盛りの正午に、気虚と湿気が清陽の上昇を妨げ、頭痛を引き起こす可能性があります。患者の頭がぼんやりしているとの記述や、頭痛時のめまいもこれに合致します。
脈の気虚と湿気の滞留： 脈が弱く、舌に瘀斑がありつるっとしていることから、気虚と湿気の滞留が考えられます。
背部の症状： 肩や首が緊張しており、腰は柔らかく空虚な感じがあり、太陽経が冷たく緊縮した感じがすることが示唆されます。

以上の症状から、清陽が上昇せず、濁陰が下降せず、特に太陽陽明経路に影響を及ぼしている可能性があります。以下の治療を検討することをお勧めします：

左神門、太衝を補う： これらは陽気を補うための重要な経穴です。
右合谷、公孫を平衡させる： 経絡の流れを調整し、気血循環を促進します。

鍼治療を行う際には、針を約10分間留め、改善の効果が見られるでしょう。しかし、治療の効果を確実にするために、専門の中医師に相談することをお勧めします。

An 18-year-old female with a robust physique complains of bilateral ankle pain, particularly during the night and when sitting, accompanied by a tingling sensation. She has no history of external injury. Her pulse is soft and weak, notably the pulse at the cun position which is slippery and weak, sinking on deep palpation. When inquired, the patient mentions experiencing dizziness and daily noon headaches located on both sides, three cun lateral to the posterior hairline. The radial pulse is weak and deep, and her tongue appears with dark spots and a slippery coating. She also experiences lower back pain with blood clots, especially on the second day after her menstrual period.

Based on the provided information, it can be inferred that:

Nighttime Ankle Pain: This could be related to the peak of yin and the weakest point of yang during the night, or it could be due to obstruction of the taiyang meridian caused by her sitting posture, resulting in a tingling pain at the external ankle shenmai point.
Noon Headaches: The headaches at noon might result from the impact of deficiency in qi and the lingering presence of dampness obstructing the ascending of clear yang during the time when yang is at its peak. The described sensation of a heavy and congested head along with the dizziness during headaches corresponds to this situation.
Weak Pulse with Lingering Dampness: The soft and weak pulse, along with a tongue displaying dark spots and a slippery coating, indicates a combination of deficiency in qi and lingering dampness.
Back Symptoms: The tense shoulders and neck, as well as the soft and weak sensation in the lower back, indicate cold and contraction in the taiyang meridian.

Considering these factors, it is possible that the issue stems from a failure of the clear yang to ascend and the turbid yin to descend, mainly affecting the taiyang and yangming meridians. It is advisable to consider the following treatment:

Tonify Left Shenmen and Taichong: These are important acupoints for reinforcing yang qi.
Harmonize Right Hegu and Gongsun: This will help balance the flow of meridians and promote the circulation of qi and blood.

During acupuncture treatment, it is recommended to leave the needles in place for approximately 10 minutes to observe the potential improvement. However, for ensuring the efficacy of treatment, consultation with a professional Traditional Chinese Medicine practitioner is advised.