Knowledge points of internal medicine of traditional Chinese medicine: abdominal distension

1. Concept: It refers to a kind of disease with abdominal distension like drum, characterized by abdominal distension, tension like drum, pale skin and exposed veins.

Second, the historical evolution:

1, the name of this disease was first seen in Neijing.

2. synopsis of the golden chamber? The liver water, spleen water and kidney water in the chapter of "Water-gas Disease" are mainly manifested as abdominal distension, which is similar to abdominal distension.

3. How to treat the pathogenic factors of the disease and the onset and feelings in the staging theory? Water poison? Related.

4. Danxi Heart Method puts forward the main etiology and pathogenesis of abdominal distension.

5. What is the name of "Zheng Yaozhijue"? Swelling? 、? Spider disease? .

6. Is "Jingyue Quanshu" also called this disease? Single abdominal distension? .

7. Medical law holds that long-term accumulation of symptoms will lead to abdominal distension.

8, "Blood Syndrome Theory" thinks? Blood? Incidence and contact with epidemic water and infection in the river? Water poison? Related.

3. Discussion scope: According to the clinical manifestations of this disease, it is similar to the ascites due to cirrhosis referred to by western medicine, including schistosomiasis, bile and malnutrition. As for other diseases with ascites, such as tuberculous peritonitis ascites, filariasis chylous ascites, advanced malignant tumor in abdominal cavity, heart and kidney diseases, etc. Those who show abdominal distension should also be treated according to the content of this article.

Etiology and pathogenesis

1, the disease is mainly in the liver and spleen, and the kidney for a long time:

2. Pathological changes are the interaction of qi, blood and water: qi stagnation, blood stasis and water-dampness stagnation, leading to abdominal distension.

3. The pathological nature always belongs to deficiency and excess, with excess at the initial stage and deficiency at the later stage; Deficiency refers to liver, spleen and kidney damage; Pathogenic excess refers to stagnation of qi and blood. Generally, at the beginning, it is mostly liver and spleen dysfunction. At this time, healthy qi cannot be damaged, and the disease is mild, which is the most. In the later stage, liver and spleen injury became more and more obvious, and then kidney qi was also insufficient. When kidney yang declines, it will be weak in qi steaming, unfavorable in opening and closing, insufficient in kidney yin, and yang qi can not be transformed, so water and body fluid will be lost, so it is mainly due to insufficient essence. However, virtual reality is often mixed and chaotic.

How to understand balloon flight? Yang deficiency is easy to treat, but yin deficiency is difficult to adjust?

Water is yin evil, yang will turn into body fluid. Therefore, patients with yang deficiency use drugs to warm yang and promote diuresis, and ascites is easy to subside. If it is because of yin deficiency, warming yang is easy to hurt yin, nourishing yin and helping dampness, and the treatment is quite difficult. Clinically sweet and cold products (such as Radix Adenophorae, Radix Ophiopogonis, Radix Rehmanniae, Rhizoma Phragmitis, Poria, etc. ) can be selected to achieve the effect of nourishing yin and promoting fluid production without sticking and helping dampness. In addition, adding a small amount of warming and nourishing products (such as a small amount of Ramulus Cinnamomi or Radix Aconiti Lateralis Preparata) to the medicine for nourishing yin not only helps to activate yang, but also prevents excessive nourishment.

The prognosis of this disease is generally poor, and the treatment is quite difficult. Early disease? Appropriate treatment can still achieve results. Extend to the later stage? Pathogenic excess is deficiency. If you feel exogenous evil again, your condition may get worse? See delirium, spasm, syncope and other serious signs.

5. Four difficult diseases in TCM: wind, tuberculosis, abdominal cavity and diaphragm.

Diagnostic points

I. Diagnostic basis

1, abdominal distension at first, especially after eating. Then the abdomen bulges like a drum, and in severe cases, the blue veins of the abdominal wall are exposed and the umbilicus is prominent.

2, often accompanied by fatigue, anorexia, oliguria, gnashing teeth, nosebleeds and other bleeding, as well as purple spots on the skin, manifested as sallow complexion, jaundice, dark red palms, red face, neck and chest, blood moles, crab claw lines.

3, this disease often has a history of diet, emotional internal injuries, insect poison infection or jaundice, hypochondriac pain, and accumulated diseases.

Second, disease and syndrome differentiation

1, differentiation between swelling and edema

The main cause of abdominal distension is liver, spleen and kidney damage, and qi and blood are hydrated in the abdomen. Abdominal distension is the main reason, and the swelling of limbs is not obvious. In the later stage, the prescription was accompanied by edema of limbs. Every time we met, there was blood on the face and neck, and the hypochondriac disease was hard and the veins stood out in the abdomen.

Edema is mainly due to the imbalance of lung, spleen and kidney function, and the skin is submerged by water. Its edema mostly starts from the eyelids and then spreads to the head, face and limbs. Or the lower limbs swell first, and then the whole body swells. Every time I see it, I feel pale, backache and exhaustion. If you have edema, you may also see ascites.

2. Differentiation of abdominal distension, abdominal distension and bloody abdominal distension.

Abdominal distension, belching or holding your breath is comfortable, and your abdomen is empty. Why? Panting? Most of them are liver depression and qi stagnation;

The abdomen is full and swollen, or looks like a frog's abdomen. It is like a bag wrapped in water, often accompanied by edema of lower limbs. Why? Minamata? Most of them are yang deficiency, and the water is wet and stops; The abdomen is full, the veins are exposed, the abdominal lump is as painful as acupuncture, and the face and neck are red and swollen with blood. Why? Blood? , mostly liver and spleen blood stasis and water stop.

treatment according to syndrome differentiation

First, the key points of syndrome differentiation: distinguish between excess and deficiency, and distinguish between primary and secondary specimens. Qi stagnation, blood stasis and dampness should be distinguished from positivism.

Start? Liver and spleen disorders? Pathogen is dominant, lack of healthy qi is not obvious, and the course of disease is relatively short.

Long illness? Liver, spleen and kidney injury? Positive deficiency is dominant.

Second, the main points of treatment: for journalists with standards, the methods of promoting qi circulation, promoting blood circulation, inducing diuresis or purging are adopted respectively; Those with insufficient essence should use the method of warming spleen and kidney or nourishing liver and kidney; If the essence is empty but the essence is real, those who are mixed and confused should attack and make up at the same time.

Third, the classification of syndrome differentiation and treatment

1, qi stagnation and dampness resistance syndrome? Main symptoms: abdominal distension, hypochondriac fullness or pain. Symptoms: reduced diet, abdominal distension after eating, belching, shortness of breath, short urination, thin, white and greasy tongue coating and thready pulse.

Pathogenesis: stagnation of liver-qi, spleen losing health, dampness blocking collaterals. Treatment: soothing the liver, regulating qi and promoting diuresis.

Representative: Chaihu Shugan Powder+Ling Wei Decoction.

2. Syndrome of water-dampness trapping spleen? Main symptoms: abdominal distension, pressing it like a bag filled with water, and concurrent symptoms: slight floating face, edema of lower limbs, bloating, heat relaxation, mental lethargy, chills and laziness, short and red urine, loose stool, white and greasy tongue coating and slow pulse.

Pathogenesis: dampness stagnation, weakness of spleen and yang, stagnation of cold water. Treatment: warming the middle energizer and strengthening the spleen, promoting qi circulation and promoting diuresis.

Representative: Shipi drink is added and subtracted.

3. Syndrome of accumulation of water and heat? Main symptoms: large and firm abdomen, acute abdominal distension, and concurrent symptoms: upset, bitter taste, thirst, yellowish skin, red and astringent urine, loose stool or unclean urine, tongue pulse: sharp red tongue edge, yellow greasy or gray-black fur, and rapid pulse.

Pathogenesis: damp-heat accumulation, middle-jiao accumulation and blood stasis. Treatment: clearing away heat and promoting diuresis, and promoting diuresis.

Representative: Zhongmanmanxiao Pill+Yinchenhao Decoction.

4. stagnant water retention syndrome? Main symptoms: abdominal distension, blue veins exposed, hypochondriac pain like acupuncture, and concurrent symptoms: dull complexion, or red blood, blood moles on face, neck, chest and arms, dry mouth, no drinking water, dark stool, dark tongue pulse, or purple spots, and thready pulse.

Pathogenesis: stagnation of liver and spleen, blood stasis of collaterals and water retention. Treatment: promoting blood circulation and removing blood stasis, promoting qi circulation and promoting diuresis.

Representative: add and subtract audio and video.

5. Yang deficiency and water excess syndrome? Main symptoms: abdominal distension, resembling a frog's abdomen, with a wide face. Symptoms: sallow complexion, or cystic white, dull and dull, listless, cold and swollen limbs, adverse urination, fat tongue pulse, purple color, pale white fur, and weak pulse.

Pathogenesis: yang deficiency of spleen and kidney, inability to warm and transport, and stagnation of water and dampness. Treatment: Warming spleen and kidney, transforming qi and promoting diuresis.

Representative: Attached Liling Decoction or Jisheng Shenqi Pill.

6, Yin deficiency water stop card? Main symptoms: abdominal distension, or exposure of veins stood out. Concurrent symptoms: dull complexion, purple lips, dry mouth, upset and insomnia, occasional epistaxis, bleeding gums, short and red urine, red tongue pulse, little or no body fluid, thin or no coating, and rapid pulse.

Pathogenesis: yin deficiency of liver and kidney, loss of body fluid distribution, and internal stagnation of water and dampness. Treatment: nourishing kidney and liver, nourishing yin and promoting diuresis.

Prescription: Liuwei Dihuang Pill+Yiguanjian.