1, etiology and pathogenesis 1.1 The disease is located in the liver and spleen, long time and kidney, can involve the lungs, heart Dropsy is mostly due to evil poison long detention, or wine and food, drug poison, but from the transformation of dystrophy, jaundice, accumulation, etc., is a difficult disease in internal medicine. At the beginning of dropsy, the liver and spleen are injured first, the liver loses drainage, the spleen loses health, both are mutual causes, and even gas stagnation and moisture obstruction, clear and turbid mix, at this time the real is the main; and then moisture and turbidity contained in the middle jiao, blocking the qi, both can be depressed and heat, resulting in water-heat accumulation, but also because the wet from the cold, water and moisture trapped spleen; long time, the qi and blood stagnation, tunnel congestion, stagnation and water stay even more. If the liver and spleen are deficient, the disease extends to the kidney, and the kidney fire is weak, the kidney is unable to warm the spleen and help the spleen to evaporate the water and dampness, and the opening and closing of the spleen is not in order, the gasification is unfavorable, and the yang deficiency and water prevails. In addition, clinical dropsy combined with pleural fluid is not uncommon. There is a saying that “swelling and asthma are related to each other”, which means that dropsy is closely related to the lung. The lung is the master of gasification and is the source of water, regulating the water channels, propagating the three jiao and transporting fluid downward, playing an important role in the metabolism of water and fluid by gasification and propagation. Dropsy for a long time, the spleen does not function properly, the kidney loses gasification, and the turbid yin reverses, which inevitably affects the function of the lung as the main gasification and regulating the water channel, and can lead to chest fullness and stuffiness, asthma and cough. In the late stage of dropsy, the heart is often disturbed by dampness, damp-heat and stasis-heat, which obscures the heart and leads to mental fainting. 1.2 Gas stagnation, blood stasis and water-dampness are the main causes of dropsy, together with damp-heat, stasis-heat and liver wind Yu Jiayan said: “The disease of distension is not only water wrapping, gas knot and blood stasis”, while Tang Rongchuan said: “The blood knot is also sick with water, and the water knot is also sick with blood”, indicating that although there are differences between gas dropsy, blood dropsy and water dropsy, but It shows that although there are differences between dropsy of air, dropsy of blood, and dropsy of water, all three are mostly caused by junction, only that they are different in emphasis. As stated in the “Discourse on Dropsy Dropsy Theory” says: “The Yin of the spleen and earth is injured …… clear and turbid mix, the tunnel is congested, the gas becomes turbid, the blood stagnates and is hot; heat stays for a long time, the gas becomes wet, wet and hot, so the fullness is born.” Clinically, dropsy is often associated with damp-heat, stasis-heat, phlegm-drinking evil; in terms of the location of the evil stop, there are differences in the upper chest and the outer limbs. If damp-heat congests the liver and gallbladder in the middle jiao and stasis-heat in the lining, jaundice; if yin deficiency and blood heat, stasis of the ligaments may lead to epistaxis, vomiting blood, and blood in the stool; if liver and kidney yin deficiency, the evil is transformed from heat, steaming fluid and producing phlegm, internal clouding of the heart orifices and inducing liver wind, serious symptoms such as delirium and convulsions are seen. Therefore, the treatment of qi, blood and water should be combined with the methods of clearing dampness and heat, cooling the blood to resolve blood stasis, and resolving phlegm to quench wind. 1.3 Mixed deficiency and real, Yin deficiency should be especially cautious Dropsy is mostly seen in the decompensated stage of liver cirrhosis, often caused by chronic liver disease that is not cured for a long time. In addition to abdominal distension as large as a drum, many patients also see body heat, bleeding, urination, emaciation, dull or pale yellow face, or even sallow, like dust, dull purple lips, red tongue with purple or vivid, little or peeling moss, thin pulse or thin string. This is yin deficiency dropsy. As the evidence of yin deficiency in dropsy is mostly revealed in the remission of other symptoms or late in the course of the disease, it is often neglected by the physician. The dampness, heat, stasis and toxicity are detained for a long time, and the mishandling of treatment (such as improper attack and expulsion) not only consumes gas but also inevitably injures yin and blood. The spleen and kidney Yang deficiency for a long time, Yang loss and Yin. Generally speaking, dropsy is mostly a sympathetic condition if the spleen and kidney yang deficiency is seen, but clinical yin deficiency type dropsy is the most common, and it is mostly a rebellious condition. The ancients said “Yang deficiency is easy to treat, Yin deficiency is difficult to adjust”, because water is Yin evil, Yang will be transformed, so Yang deficiency with warm Yang water, ascites is easier to subside. If the dropsy is Yin deficiency, warming Yang is easy to hurt Yin, nourishing Yin and helping dampness; plus the clinical common liver and kidney Yin has dried up, and Qi stagnation, water stoppage, damp heat, stasis heat and other evil incandescence, easy to cause liver wind with phlegm heat, the upper closed clear orifices, loss of the master, or the change of moving blood, similar to the clinical excessive release of ascites, diuresis or diuretic too much, feeling evil fever and other injury to Yin and loss of fluid, very easy to induce liver encephalopathy, the clinical evidence must be treated with caution. 2. Treatment experience 2.1 Reviewing the situation, weighing the symptoms and priorities, and focusing on the root of the disease Although dropsy is mostly caused by the mutual knotting of qi, blood and water, and the symptoms are urgent, the deficiency of liver, spleen and kidney, and the lack of regulation of qi, blood, yin and yang are the root of the disease. However, it is necessary to identify the time to remove the evil, such as the duration of the disease, the strength and weakness of the body, the urgency of the disease, as well as the difference between partial gas, partial blood, and partial water, so that the treatment can be analyzed comprehensively and the main points can be better mastered. For those with short duration of illness and good constitution, the main purpose is to remove the evil, and the amount of water-relieving medicine is chosen with great force. However, it is emphasized that one is that water-relieving drugs tend to hurt Yin and should always take into account the nourishment of Yin; two is that we should take care of the spleen and stomach, regulate the spleen and stomach, reduce the side effects and enhance the therapeutic effect; three is that water-relieving agents should only be used temporarily; four is to clear damp-heat, warm cold-damp, clear stasis-heat, soften hardness and stasis, and regulate qi to open and promote depression, etc., all are the scope of the dropsy dispelling method. Support should be centered on strengthening the spleen, taking into account the liver and kidneys. Long-term illness, the disease is still slow, although the abdomen is as large as a drum, but the limbs of large flesh, thin bones such as firewood, is a deficiency of evil, the original deficiency of the symptoms, when the support of the righteous to eliminate evil, to supplement the main, taking into account the elimination of evil. If the ascites subsides, but the liver, spleen and kidney vital energy has not yet returned, and the blood circulation is not yet smooth, the ascites may still reappear, at this time, we must seize the opportunity to cultivate the vital energy to consolidate the therapeutic effect. Zhou used to use three methods: dredge the liver and strengthen the spleen method: for liver depression and spleen deficiency, qi stagnation and not working, dropsy, dropsy is the main set, the formula is Chai Hu dredge the liver with Stomach Ling Tang plus reduction, the use of Radix et Rhizoma Ginseng, Atractylodes Macrocephala, Poria, Astragalus, etc. Warming the spleen and kidney method: for the inability of the spleen and kidney to warm water and dampness, and the stagnation of water and dampness, mainly dropsy, the formula is based on the prescription of Radix Rehmanniae, Zhen Wu Tang, Ji Sheng Kidney Qi Wan, or combined with Wu Ling San plus or minus. Nourishing the liver and kidney method: For yin deficiency dropsy, we often use the formula of Consistent Decoction with addition and subtraction, mainly nourishing yin and taking into account the elimination of evil. However, nourishing Yin should not be too nourishing and greasy, and can be supplemented with warming products (such as small doses of Gui Zhi or Radix et Rhizoma Polygonati) in nourishing Yin medicine, which can not only help to pass Yang and transform Qi, but also prevent too much nourishment and greasiness. 2.2 To dispel evil, we must proceed step by step and stop at the half of its decline. Dropsy dispels evil, especially the method of expelling water, as stated in Su Wen – Yin Yang Ying Xiang Dazheng: “Those who are full in the middle, drain the inside”. The general principle is to “promote water without hurting yin, dispel evil without hurting righteousness, and to supplement but not converge evil”, and to “stop by decaying the greater part of it”. The lighter and slower ones use light percolation and dampness products, such as Yin Chen Wu Ling San, five skin drink type of cut, can add white foxglove, winter melon skin, Chen Huludao and so on, the dosage from light to heavy to 30-60g, with the evidence of choice; water drink and heat, the symptoms are seen in the abdomen as large as a drum, fullness is unbearable, dry mouth and tongue, urine, yellow stool dry, Zhang Zhongjing has pepper hebecarbamate Huang Wan of the formula, before and after the elimination of drainage, the choice of anti-heat, rhubarb, as appropriate. If appropriate, use fried Echinacea to laxate and expel water. Heavy and urgent cases can be selected to expel water prescriptions, such as the powdered nephrite, or boat car pill, or control saliva Dan, or ten jujube soup, etc., generally 2 to 3 days as a course of treatment, if necessary, stop 3 to 5 days and then use. In the process of use, the drug dose should not be too large, the attack time should not be too long, so as not to damage the spleen and stomach caused by coma, bleeding changes, pay attention to the disease that stop. When taking the medicine, we must closely observe the condition, pay attention to the reaction after the medicine, and strengthen the regulation of care. Clear contraindications: dropsy for a long time, is weak; or fever, jaundice deepening; or peptic ulcer, has been complicated by gastrointestinal bleeding, or see bleeding tendency, are not suitable for use.
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