? On edema in Neijing

Edema syndrome is edema caused by water flooding the skin, which is called "water" and "water swelling" in Neijing. "Water swelling in the pivot" describes the symptoms of edema. It says, "When the water rises, my eyes are slightly swollen, like a new one. Its neck is throbbing, sometimes it coughs, its thighs are cold, its feet are swollen, its shin is swollen, and its abdomen is big, so its water has reached the end. Put your hand on his abdomen and get up at will, as if wrapped in water, waiting. " Su Wenshui's Theory of Hot Blood says: "The skin overflows from top to bottom, so it is swollen, and the swollen person gets sick because of stagnant water." This syndrome is characterized by excessive water infiltration into the skin, manifested as edema of the head, face, eyelids, limbs and abdomen.

Etiology and pathogenesis

Water is the fault of yin and yin is the fault of yang, and the disease of yang is always attributed to both ends of deficiency and excess, that is, both yang deficiency and yang stagnation can lead to water dampness and edema. As for the causes of yang deficiency and yang stagnation in human body, Neijing holds that there are many evils of wind, cold and dampness, which are committed in the lungs, spleen, kidney, triple energizer and other viscera, resulting in dysfunction of viscera and stagnation of water and dampness. "Su Wenshui's theory of blood" says: "This is in the kidney and ends in the lung. Zhang Jiebin said: "All syndromes such as edema are related to lung, spleen and kidney. Covering water is the most yin, so it is in the kidney; Water is soluble in qi, so it is marked in the lung; Water is only afraid of soil, so it is made in the spleen. Today, lung deficiency makes it turn into refined water instead of refined water, spleen deficiency makes the soil resist water, and kidney deficiency makes the water act rashly without owner. 」

1. External factors

Su Wenping's Theory of Meteorology said: "Facial edema is the wind. Edema can be caused by wind evil attacking the surface, staying in wetlands for a long time, wading in the rain, etc. Wind is the first of the six evils, often invading the lungs, lung disorders, and edema caused by feng shui fights. " "Su Wen Liu Zhengyuan's Collection of Great Works" says: "When it is wet, it will drain, and when it is closed, it will swell. Su Wen Zhi Zhen Da Lun also said: "All dampness and distension belong to the spleen. It is pointed out that if the water is wet from the outside, the water is wet and invades, the spleen yang sinks, and the spleen and stomach lose the ability to ascend and clear and descend turbidity, and the water is uncontrollable, resulting in edema.

2. Internal factors

Mostly due to improper diet or congenital endowment, long illness and fatigue. "Su Wen Shui Re Xue Lun" says: "A brave man who works hard will sweat in the kidneys, but when he meets the wind, he can't stay in the internal organs and can't go beyond the skin, but can stay in the point and walk in the skin, which is called bloating"; "The kidney closes the stomach, which is not conducive to closing the door, so it gathers water and follows its kind. Eating too much fat and sweetness will be blocked by damp heat for a long time and damage the spleen and stomach; Or due to insufficient nutrition, bad temper, unhealthy spleen and stagnant water and dampness, edema is caused. If congenital endowment is weak, kidney qi is insufficient, bladder opening and closing is unfavorable, and gasification is abnormal; Or acquired fatigue and indulgence, spleen and kidney injury, extensive skin, edema.

classify

The appellations of edema syndrome in Neijing are geomantic omen, Shi Shui, gushing water and overflowing drink. According to the different symptoms, etiology and pathogenesis of edema syndrome, it is briefly described as follows.

1. Fengshui syndrome

"Ling Shu Lun Disease Diagnosis Ruler" said: "If the eyes of people are slightly carbuncle, if they lie up as new, their necks will sometimes pulsate and cough, and if they press their hands and feet to gain weight, their skin will swell." Zhang Jiebin noted the cloud: "The net nest, now the silkworm lies. Carbuncle, that is, new swelling. The neck pulse is also gratifying. If you can't afford it, you have a nest. Yes, it is feng shui and skin swelling. " Geomantic omen is edema caused by exogenous wind, so it can be seen that geomantic omen should have exterior syndrome, and its root cause is kidney, such as edema, adverse urination, cough, body pain, aversion to wind and floating pulse.

2. Overflow syndrome

"Su Wen pulse condition subtle" says: "The liver pulse ... is loose and has too many colors. Excessive drinking, thirst and drinking, easy to enter the muscle skin outside the stomach. " Zhang Zhicong's Note: "People are not as good as color, but when they are ill." "synopsis of the golden chamber" says: the husband is moist when he is ill, his face is fresh and moist, and his skin is covered with water, so his color is moist. The liver governs the drainage, and the liver is qi-deficient and thirsty, so that it overflows the skin and stomach for drinking. "Liver governs the drainage, liver qi deficiency, drainage dereliction of duty, spleen dampness has no right to transport, overflow is edema. Symptoms of drinking overflow are more common in the skin of limbs, and the skin is thin and shiny under water storage.

3. Shi Shui Certificate

"Syndrome of Pathogenic Viscera Caused by Lingshu" says: "The kidney pulse is slightly larger than that of Shi Shui, at least there is abdominal swelling below the navel." Su Wen's Theory of Differentiating Yin and Yang also said: "Yin and Yang are inclined, with more yin and less yang, which is called Shi Shui, and less sputum. "Zhang Jiebin's Note:" The kidney pulse is slightly larger, and the kidney yin is also deficient, and the yin deficiency remains unchanged. If it remains unchanged, the qi will not gather, resulting in Shi Shui. The evil of cold water condenses in the abdomen, and the water is yin, so the abdomen is full and there is a feeling of falling weight. Shi Shui's syndrome is characterized by lower abdomen, falling and swelling.

4. Water inrush syndrome

Su Wen's Theory of Qi Determination says: "Lung is cold in kidney, and water surges in kidney. If the water surges, the abdomen is not firm, and the water vapor is trapped in the large intestine, the sound is like a bladder wrapped in pulp, and the disease of water is also. " Zhang Zhicong's note: "The kidney is full of water, and the lung governs the origin, so the cold evil of the lung moves down to the kidney, and the water vapor of the kidney rushes up to the lung. The large intestine is the house of the lungs, and the lungs live on the diaphragm. So the water vapor is trapped in the large intestine and rushing noisily. For example, if the pulp is wrapped in a capsule, the water does not contact the flow and walks between the intestines. " Lung evil is transmitted to the kidney. Kidney disease is characterized by qi failing to turn water into water, and water stops gathering, and then surges up from the bottom of the lung, lung and large intestine. When the water is wet, it seeps through the large intestine, and the water gathers into gushing water. The symptoms of water gushing are mostly abdominal fullness, which is not difficult to press, like a skin wrapped in water.

5. Spleen edema

Su Wen's pulse condition is subtle: "Spleen pulse ... is soft and scattered, and its color is dull, when the sick foot is swollen and watery." Zhang Jiebin pointed out: "If it is loose and the color is dull, it is especially spleen deficiency. The spleen meridian runs from the thumb to the front of the medial malleolus, along the hip bone and before crossing Jueyin. Therefore, if the sick foot swells with water, spleen deficiency cannot control water. Spleen governs transport and transformation, spleen deficiency and dampness, poor body fluid, stagnation as water, and water swelling. Its symptoms are mainly swollen feet.

6. Yang deficiency edema

"Su Wentong's Theory of Strange Heaven" says: "Because of qi swelling, four-dimensional generation, yang fatigue." Zhang Jiebin said: "Because of gas, all the gas in the ying gas reservoir is gas. If it is not adjusted, it will lead to diseases. Four-dimensional, limbs also. Generation after generation, change and disease. Because the air is swollen, the airway is not good. The limbs are the foundation of all yang, where the stomach qi is, and the disease even occurs in four dimensions ... As we all know, Yang Qi is exhausted. " Gas is yang, which turns into gas and gasifies to produce water. Yang deficiency leads to qi failure, qi failure leads to water failure, and water accumulation leads to swelling. This disease is more serious, more common in edema changes of limbs, sometimes swelling disappears, lingering is difficult to heal. In addition, in Su Wen's Theory of Hydrothermy, it is said that "the gas on the ground belongs to the kidney and is born of water"; "The kidneys and stomach are also closed, so it is not good to close the door, so it is the same to gather water." It is also edema caused by kidney-yang deficiency and failure.

7. Yang stagnation and edema

"Su Wen Tang Yi Lao Lun" says: "Out of nothing, the five internal organs are exhausted." Bing Wang's remark on the cloud means "the five internal organs have yang decline". Cheng Shide's "Neijing Lecture Notes" thinks that "exhausting one's mind means depression". The yang of the five internal organs is blocked, the body fluid is insoluble, and it is swollen. "The symptoms are positive, the virtual image is not obvious, and the swelling is urgent.

8. Edema due to triple energizer occlusion

"Ling Shu Wu Jiao Jin Bie Ye" says: "The Yin and Yang airways are blocked, the four seas are blocked, the triple energizer does not diarrhea, and the body fluid does not melt. Shui Gu stays in the stomach side by side, so it is different from the ileum. It stays in the lower coke and cannot penetrate into the bladder. Therefore, the lower coke swells and the overflow swells. " Zhang Jiebin pointed out: "This body fluid will also swell with water. Sanjiao is the official of blasphemy, and bladder is the house of body fluid. If qi does not change, water will not work, so triple energizer can't diarrhea and bladder can't seep, which is caused by swelling. If edema lasts for a long time, triple energizer is blocked, water and liquid are blocked, qi can't be converted into water, and bladder can't be infiltrated, then water dampness will stagnate. Its symptoms are mainly swelling of abdomen and lower limbs.

treat cordially

It can be seen from the above that the total pathogenesis of edema lies in yang deficiency and yang depression, and the viscera are mainly kidney, lung and spleen. Therefore, although there are many specific discussions on the treatment of edema in Neijing, it is always based on the general principle of harmonizing yin and yang, warming and tonifying yang, and dredging yang, so it is a means to regulate the functions of kidney, lung and spleen, which Su Wentang proposed. " Specifically, it also puts forward the treatment principles and methods such as "removing old stubble", "opening the door of hell", "cleaning the house", "fretting quadrupole", "warming clothes" and "stabbing". Open the door of hell to sweat; Cleaning the house is conducive to urination; In addition to the old and the old two meanings. One is to remove excess water and liquid accumulated in the body, and the other is to remove old stagnation in blood vessels. Lingshu Xiaozhen said that "removing the old, but also removing blood vessels", that is, acupuncture bloodletting. Micro-motion quadrupole, note the cloud: "Micro-motion of limbs makes Yang unfold gradually. Zhang Zhicong's note: "Warm clothes warm the lungs; The mistake of regulating blood gas. The general treatment principles are warming yang, regulating qi and promoting blood circulation.

In the aspect of acupuncture treatment, Su Wen's Theory of Bone Control and Su Wen's Theory of Water-heat Points put forward the theory of "fifty-seven points of water pivot", that is, fifty-seven points control water. It is divided into three groups. The first group is on the wall, * * * 25 points. The tarsal bones are upward, * * * five elements, the spine is the middle line, the du meridian is the two sides, the outer knight is the two sides, and each line has five acupoints; The second group on the rich road, * * * 20 points; The third group is on the ankle, with six points in each row and twelve points in each row. These 57 acupoints have a good therapeutic effect on edema in clinic. At the same time, Lingshu Sijiqi also put forward the method of draining ascites, which is of guiding significance to the treatment of ascites in later generations.

In the aspect of prescription treatment, the method of expelling wind and promoting diuresis can be used to treat Fengshui syndrome, and Bai Yue decoction or Ji Fang Huangqi decoction proposed in synopsis of golden chamber can be added or subtracted; For the syndrome of excessive drinking, Da and Xiao Qinglong Decoction in Synopsis of the Golden Chamber can be used to add and subtract sweating, promote diuresis and regulate liver and spleen. For Shi Shui's syndrome, Zhenwu decoction can be used to warm kidney and dispel cold, and turn qi into water. For the syndrome of water gushing, the methods of warming kidney, dispersing lung, activating yang and promoting diuresis can be modified by Wuling powder; Spleen edema, warming yang, strengthening spleen and promoting diuresis, can choose to add and subtract Jianpi decoction; For edema due to yang deficiency, Jisheng Shenqi Pill and Zhenwu Decoction can be used as methods to warm kidney, help yang and induce diuresis. The methods of dredging triple energizer, removing blood stasis and promoting blood circulation can be modified by Xuefu Zhuyu Decoction. Promoting blood circulation and removing blood stasis to treat edema reveals the internal relationship between blood stasis and body fluid, that is, there is a causal pathological relationship between body fluid and blood stasis due to the physiological relationship between body fluid and blood. Therefore, the method of removing blood stasis can promote blood circulation, thus further promoting the operation of body fluids and eliminating edema.