Edema syndrome is caused by water flooding the skin and causing swelling. The "Nei Jing" refers to "water" and "water swelling". "Lingshu Water Swelling" describes the symptoms of edema, saying: "When water starts to rise, the eyes will be slightly swollen, like lying down, the neck will pulse, cough will occur, coldness between the genitals and thighs, and the feet and shins will be swollen. "The belly is big and the water has already formed. Press the belly with your hand and it will rise up like it is wrapped in water. This is how it is done." "Su Wen·Shuire Acupoints" says: "It overflows up and down on the skin, so it is swollen. Those who are swollen will get sick because of the accumulation of water." This syndrome is characterized by excessive water-dampness that infiltrates into the skin and is characterized by swelling of the head, face, eyelids, limbs, abdomen and back.
Cause and pathogenesis
Water is yin, and yin is caused by the fault of yang. Yang diseases are always responsible for the two ends of deficiency and excess, that is, the deficiency of yang and the failure of yang. Yang Qi stagnation can cause water and dampness not to change, resulting in edema. As for the causes of yang deficiency and yang stagnation in the human body, the "Nei Jing" believes that there are many. Wind, cold, and dampness evil invade the lungs, spleen, kidneys, triple burners and other internal organs, resulting in organ dysfunction and water-dampness stagnation. "Su Wen·Shuire Acupoints" says: "The origin is in the kidneys, and the end is in the lungs." Zhang Jiebin said: "All symptoms such as edema are related diseases of the lungs, spleen, and kidneys. Covering water is the ultimate yin, Therefore, its origin is in the kidneys; water transforms into qi, so it is located in the lungs; water only fears earth, so it is controlled by the spleen. If the lungs are deficient, the qi will not transform into essence but will transform into water; if the spleen is deficient, the earth will not control water but will instead suppress it. If the kidney is deficient, the water will have no control and act recklessly."
1. External causes
"Suwen·Pingren Meteorological Theory" says: "Face swelling is caused by wind." Edema can be caused by wind evil attacking the surface, living in wetlands for a long time, wading in rain, etc. Wind is the first of the six evils. It often attacks the lungs and guards, causing the lungs to become dysfunctional. Feng and water compete with each other and cause edema. "Su Wen·Liu Yuan Zheng Ji Da Lun" says: "Dampness will lead to dampness and bloating, and even water retention will cause swelling." "Su Wen·Zhi Zhen Yao Da Lun" also says: "All dampness and swelling belong to the spleen. "It is pointed out that if water-dampness is caused externally and invades internally, the spleen-yang will be suppressed, the spleen and stomach will lose their ability to raise clearness and lower turbidity, and the water will not be controlled, resulting in edema.
2. Internal causes
are mostly caused by improper diet, insufficient congenital endowment, chronic illness, fatigue, etc. "Su Wen·Shui-Heat Acupoint Theory" says: "If you are brave and work hard, the kidneys will sweat, and when exposed to the wind, it will not be allowed to enter the internal organs, and it will not be allowed to pass through the skin externally. "Swollen stomach"; "The kidney is the gate of the stomach, and it is difficult to close the door, so water accumulates and follows its category." If you eat too much fat, sweet and thick food, over time, dampness and heat will block the spleen and stomach, and the spleen and stomach will be damaged; or due to lack of nutrition, the spleen and spleen will not be nourished. , resulting in poor spleen movement, stagnant water and dampness, and edema. If the congenital endowment is weak, the kidney qi is deficient, the bladder is not opened and closed, and the qi is abnormal; or if you are tired and indulge in sex the day after tomorrow, the spleen and kidneys will be damaged, and the skin will be covered with water, causing edema.
Classification
The names of edema syndrome in the "Nei Jing" include "Feng Shui", "Stone Water", "Gushing Water", "Overflowing Drinking", etc. Based on the different symptoms and causes and pathogenesis of edema syndrome, a brief description is as follows.
1. Feng Shui Syndrome
"Lingshu·Disease Diagnostic Ruler" says: "Look at the slight carbuncle on the person's eyes, as if he was lying down, his neck pulse is pulsating, and he coughs at times. When it arises, it is caused by Feng Shui skin swelling. "Zhang Jiebin notes: "The eye nest is the place where silkworms lie under the eyes. Carbuncle is the new appearance of slight swelling. The jugular pulse is the human pulse. If it cannot rise, press it. There is a nest. This is an external symptom of Feng Shui. "Feng Shui means edema caused by external wind. It can be seen that Feng Shui has superficial symptoms. The disease is caused by the kidneys. Common symptoms include edema, difficulty in urination, cough, body pain, and wind." , pulse floating, etc.
2. Syndrome of overflowing drinking
"Suwen: Essence of Pulse and Essence" says: "The liver pulse... If it is loose and loose, and the color is bright and lustrous, it is a disease of overflowing drinking. If it is overflowing drinking, it means excessive thirst and excessive drinking, and it is easy to drink excessively." "It also enters the skin, skin and intestines." Zhang Zhicong noted: "If it is not enough and the skin is discolored, it should be overflowing due to illness." "Jingui Synopsis" says: If a person is sick with water, his face will be bright and shiny, and the water will overflow on the skin, so the color will appear. Moisturizing. If the liver is in charge of dispersing and dispersing, if the liver qi is deficient and people are thirsty, they will drink more, which will overflow the skin and the intestines. Water overflow is edema. The symptom of overflowing water is that the water overflows on the skin of the limbs, and the water accumulates under the skin, making the skin thin and shiny.
3. Stone-water Syndrome
"Lingshu·Patterns of Evil Qi and Internal Organ Diseases" says: "The kidney veins are slightly larger than stone-water, starting from the umbilicus and at least in the abdomen." "Suwen·Yin-Yang Differentiation" also says: "Yin and yang are oblique, with more yin and less yang, which is called stone water, and the lower abdomen is swollen." Zhang Jiebin noted: "The kidney pulse...if it is slightly large, the kidney yin is also deficient. If the yin is deficient, it will not be transformed, and if it is not transformed, the qi and water will stop. The accumulation becomes stone water.
"The evil of cold water condenses in the lower abdomen, and water is of the yin type, so the lower abdomen becomes full and feels heavy." The main symptom of Shi Shui is heavy swelling of the lower abdomen.
4． Syndrome of water gushing
"Suwen·Qi Jue Lun" says: "The lungs move cold to the kidneys, causing water gushing. For water gushing, the abdomen is not firm when pressed, and the water qi travels to the large intestine. If it moves quickly, there will be a buzzing sound, such as The sac is covered with slurry, which is a disease caused by water. "Zhang Zhicong notes: "The kidneys are where water is stored, and the lungs govern the origin of the disease. This is because the cold evil in the lungs moves down to the kidneys, and the water vapor in the kidneys rises up in the lungs. The large intestine is the home of the lungs, and the lungs are located above the diaphragm. Therefore, when the water qi travels quickly in the large intestine, it will make a sound, just like when a bag is wrapped in slurry, the water will not flow and travel between the intestines. Kidney, kidney disease means that qi cannot transform into water, water stops gathering, and then surges up into the lungs from bottom to top. The lungs and large intestine are externally and internally connected, and water and moisture seep into the large intestine, and water accumulation becomes gushing water. The symptoms of water gushing are usually abdominal distention, which is not firm when pressed, and looks like a skin bag filled with water.
5． Spleen disease edema
"Suwen·Pulse Essentials Essence Theory" says: "If the spleen pulse... is soft and scattered, and the color is dull, the patient will have a swollen and watery foot." Zhang Jiebin noted: " If the spleen meridian is loose and discolored, it is especially due to spleen deficiency. The pulse of the spleen meridian runs from the thumb to the front of the medial malleolus, along the back of the calluses, and in front of the Jueyin. Therefore, if the foot is swollen and watery, it cannot be controlled by spleen deficiency. "Water." The spleen governs transportation and transformation. If the spleen is damp and stagnant, the body fluids will become stagnant and become swollen. The main symptom is severe swelling of the feet.
6. Yang deficiency and edema
"Suwen·Qi Tongtian Lun" says: "Because the Qi is swollen and the four dimensions are replaced, the Yang Qi is exhausted." Zhang Jiebin notes: "Those who are due to the Qi are those who defend the Qi. Yingqi stores all the Qi, and if it is out of tune, it can cause disease in the four dimensions, the limbs. The Qi is swollen and the limbs are the root of all Yang. , where the stomach qi is, it can even lead to four-dimensional disease... It can be seen that it is the exhaustion of yang qi, and yang can transform into qi, and qi can transform into water. If Yang is deficient, Qi will be weak. If Qi is weak, water will not flow, and water will accumulate and cause swelling. This disease is more severe, and the swelling of the limbs often occurs alternately. The swelling sometimes disappears, and it is lingering and difficult to heal. In addition, "Suwen·Water-heat Acupoint Theory" says: "The earth-qi belongs to the kidneys and generates water and fluids"; "The kidneys are the gates of the stomach, and closing the doors is unfavorable, so water accumulates and follows its category." It is also the edema caused by kidney yang deficiency.
7. Yang stagnation and edema
"Suwen·Tang liquid glutinous rice theory" says: "It is not born from the hair, and the five internal organs are exhausted." Wang Bing notes that this sentence means "the five internal organs are exhausted." ” meaning. The "Lectures on the Internal Classic of Medicine" edited by Cheng Shide believes that "exhaustion means to block. The Yang Qi of the five internal organs is blocked, the suppression is not spread, and the body fluids are not transformed, so they gather and become edema." The symptoms are clinical, virtual symptoms are not apparent, and the swelling is urgent.
8. Triple burner occlusion edema
"Lingshu·Wulong Body Fluid Differentiation" says: "The yin and yang airways are blocked, the four seas are blocked, the triple burner does not diarrhea, the body fluid does not melt, and the water and grains flow parallel to the intestines and stomach, different from the ileum, and remain in the ileum. If the lower burner cannot penetrate the bladder, then the lower burner will swell, and water overflow will cause water swelling. Zhang Jiebin noted: "This body fluid is called water distention. The third burner is the organ that determines the stagnation, and the bladder is the house of body fluid. If the qi is not transformed, the water will not flow." , so the triple burner cannot have diarrhea and the bladder cannot penetrate, which is the cause of swelling. "With prolonged edema, the triple burner is blocked, water cannot flow, Qi cannot transform into water, and water cannot penetrate into the bladder, and the water and dampness will stagnate. The symptoms are mainly swelling of the abdomen and lower limbs.
Treatment
From the above, it can be seen that the general pathogenesis of edema lies in yang deficiency and yang stagnation, and the main organs are kidney, lung, and spleen. Therefore, the "Nei Jing" explains the treatment of edema. Although there are many specific discussions on treatment, the general principle is to reconcile yin and yang, warm yang, replenish yang, and unblock yang. Therefore, regulating the functions of the kidneys, lungs, spleen, and fu organs is used as a means. "Suwen·Tangye Lilu Lun" puts forward "Political rule lies in balance" emphasizes this point. Specifically, it also proposed treatment principles and methods such as "removing flowers and leaves", "opening the ghost gate", "cleaning the house", "gently moving the four poles", "warming clothes", and "thorning the place where it is". The method of opening the gate of ghosts is to induce sweating; to cleanse the house is to facilitate urination; the method of removing flowers, leaves, and leaves has two meanings, one is to remove the excess water accumulated in the body, and the other is to remove the old accumulation in the blood vessels, "Lingshu·Xiaozhenjie" " says: "If you remove Wan Chen, you can remove the blood vessels," which is the method of acupuncture and bloodletting. Regarding the micro-movement of the four poles, Wang Bing noted: "Moving the limbs slightly allows the yang energy to gradually circulate." Zhang Zhicong noted: "Warm clothes to warm the lung qi; Miao needling to regulate the blood qi." The overall treatment principle is to warm the yang and regulate it. Qi moves mainly with water.
In terms of acupuncture treatment, "Su Wen·Gu Kong Lun" and "Su Wen·Shuire Acupoints" put forward the theory of "Shuishu fifty-seven points", that is, five acupuncture points for treating water. Seventeen places.
Specifically divided into three groups, the first group is on the jiri, with twenty-five points. The Ji bone is upward, there are five lines in the spine, the spine is in the middle line, one line on each side of the Governor channel, one line on each side of the Waixia channel, each line has five points; the second group is on Futu, with twenty points; the third group On the ankle, there are one row on the left and right, with six points in each row and twelve points in the middle. Clinically, using this fifty-seven point to treat edema has a good therapeutic effect. At the same time, "Lingshu·Four Seasons of Qi" also proposed the method of draining ascites, which was inspiring for later generations to treat ascites.
In terms of prescription treatment, for Feng Shui syndrome, you can choose the method of dispelling wind and diluting water, and you can choose Yueji Decoction or Fangji Huangqi Decoction proposed in "The Synopsis of the Golden Chamber"; for overflow and drink syndrome, you can use the method of promoting sweating and diuresis, and conditioning. For liver and spleen treatment, you can choose Daqinglong Decoction and Xiaoqinglong Decoction from "The Synopsis of the Golden Chamber"; for stone water syndrome, you can use Zhenwu Decoction to warm the kidneys and dispel cold, and to transform qi and diuresis; for water gushing syndrome, you can use Zhenwu Decoction to warm the kidneys and relieve the lungs. For spleen edema, you can choose the method of warming yang, strengthening the spleen and diluting water, and you can choose the method of strengthening the spleen and diuresis. For edema due to yang deficiency, you can choose Ji. Shengshenqi Pills combined with Zhenwu Decoction can be used; for triple burner occlusion and edema, in order to relieve triple burner, remove blood stasis and promote water circulation, you can choose Xuefuzhuyu Decoction. The application of the method of activating blood circulation and removing blood stasis to treat edema reveals the intrinsic relationship between blood stasis and water stasis. That is, due to the physiological connection of the mutual exchange of fluid and blood, there is mutual cause and effect between water stasis and blood stasis. pathological connection. Therefore, the method of removing blood stasis can promote blood circulation, thereby further promoting the movement of body fluids and eliminating edema.