Transcript Golden Chamber 2

Golden Chamber 2
• Chapter 14 On Pulse Syndrome
Complex and Treatment of Edema
• Concept: edema caused by qi failing to
transform.
• Classification:
– Feng Shui (Wind-edema), Pi Shui(skinedema), Zheng Shui (Zheng-edema), Shi
Shui (Stone-edema), Huang Han (Yellowsweat) 【1】
– Five Zang Shui ( five Zang edema) 【13】
【14】 【15】 【16】 【17】
Five Zang Edema
– 【13】 Heart edema
– 【14】 Liver edema
– 【15】 Lu edema
– 【16】 SP edema
– 【17】 K edema
– Feng Shui (Wind-edema)
•
•
•
•
•
Location: LU
Exterior syndrome: aversion to wind, joints pain
Edema: face swollen first or severer
Degree: acute onset, fast development
Pathogenesis: Wind from exterior, water from
interior.  Wind water conflict and flood in skin
• “The exterior of the exterior”
– Pi Shui(skin-edema)
•
•
•
•
•
Zangfu: LU, SP
Not related to an exterior syndrome
Swelling all over body, especially extremities
Degree: slow onset
Pathogenesis: SP LU qi deficency, fail to transport
and regulate water passage, water flood in
superficial body
• “Interior of the exterior” type water retention.
– Zheng Shui (Zheng-edema)
• Ki, SP, LU
• Fullness in abdomen with wheezing
• Pathogenesis: SP K yang deficiency qi
transforming dysfunction  flow upward to disturb
LU
– Shi Shui (Stone-edema)
• Zangfu: Liv, K
• Fullness in abdomen without wheezing
• K yand deficiency, Liv qi stagnation  water
isolated in lower jiao
– Huang Han (Yellow-sweat)
• Zang fu: SP LU
• Edema in four extremities and face, yellow
sweating, deep slow pulse, no aversion to wind
• Pathogenesis: water dampness obstructed in Ying
and Wei (from Golden Chamber description).
• Causes and pathogenesis
– 【2】 Wind and Water Co-attack
• Wind attack Lu
– Acute stage with excess wind urticaria
– Chronic stage rotten blood and flesh impetigo
– Excess water  edema in exterior
– 【12】 SP deficiency fail to “Trans”
• After disease with diarrhea or dysentery
• Thirst SP ST qi and fluid damaged
• Difficult urination SP qi deficiency fail to transport
fluid
– 【9】 LU fail to regulate water passage, K
deficiency leads to flooding
• Cun Kou pulse wiry and tight
– LU qi deficiency with cold  fail to regulate water
passage  the fluid from diet can not be transported by
qi movement and stay in intestines  edema
• Shaoyin pulse tight  cold, pain, and deep
interior, water
– K yang deficiency with interior cold Bladder Qi
transform disability difficult urine edema
– 【20】 Blood level syndrome and Water level
syndrome interaction
• Edema after menstruation absence Blood
level blood stasis blocks in water passage
• Edema before menstruation absence Water
level water pathogen obstructed blood flow
– 【30】Qi Level syndrome
• Upper Middle Jiao yang qi deficiency, qi and blood
deficiency, with cold
–
–
–
–
–
Cun Kou pulse: slow and chopy
Fu Yang pulse: feeble and slow
Cold limbs, chills yang qi obstruction
Fullness in abdomen
Bone pain  blood bostruction
• Treatment principles
– Promote urination 【18】
For edema/water retention below waist
– Promote diaphoresis 【18】
For edema/water retention above the waist
– Purge downward 【11】
For edema below the waist but only in
emergency situations (big belly, dysuria, deep
unpalpable pulse).
• Differentiation and Treatment
– Feng Shui
• Wind edema with heat
–
–
–
–
Edema all over body
Floating pulse
Thirst
Absent of high fever??
• Yue Bi Tang 越婢汤 【23】
–
–
–
–
–
麻黄ma huang (Herba Ephedrae)
石膏 shi gao （Gypsum Fibrosum）
甘草gan cao (Radix Glycyrrhizae Uralensis)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
大枣da zao (Fructus Zizyphi Jujubae)
• Differentiation and Treatment
– Feng Shui
• Wind edema with exterior deficiency
–
–
–
–
Floating pulse
Heavy sensation in body
Sweating
Aversion to wind
• Fang Ji Huang Qi Tang防己黄芪汤【22】
–
–
–
–
防己 fang ji (Radix Stephaniae Tetrandrae)
甘草gan cao (Radix Glycyrrhizae Uralensis)
白术bai zhu (Rhizoma Atractylodis Macrocephalae)
黄芪huang qi (Radix Astragali Membrnacei)
• Differentiation and Treatment
– Pi Shui
• Skin edema with heat
– Edema
– Deep pulse
– Difficult urination
• 越婢汤加术汤 Yue Bi Jia Zhu Tang 【5】
– 越婢汤 Yue Bi Tang 【23】
» 麻黄ma huang (Herba Ephedrae)
» 石膏 shi gao （Gypsum Fibrosum）
» 甘草gan cao (Radix Glycyrrhizae Uralensis)
» 生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
» 大枣da zao (Fructus Zizyphi Jujubae)
– 白术bai zhu (Rhizoma Atractylodis Macrocephalae)
• Differentiation and Treatment
– Pi Shui
• Skin edema with excessive exterior
– No sweating
• 甘草麻黄汤Gan Cao Ma Huang Tang 【25】
– 甘草gan cao (Radix Glycyrrhizae Uralensis) 2 Liang
– 麻黄ma huang (Herba Ephedrae) 4 Liang
• Differentiation and Treatment
– Pi Shui
• Skin edema with exterior deficiency
– Edema in extetrimities
– Trembling limbs
• 防己茯苓汤Fang Ji Fu Ling Tang 【24】
–
–
–
–
–
防己 fang ji (Radix Stephaniae Tetrandrae)
黄芪huang qi (Radix Astragali Membrnacei
桂枝gui zhi (Ramulus Cinnamomi Cassiae)
茯苓fu ling (Poria)
甘草gan cao (Radix Glycyrrhizae Uralensis)
– Zheng Shui (and Feng Shui) 【26】
• Deep pulse with heavy breath is Zheng Shui
– Deep pulse
– wheezing
• Ma Huang Fu Zi Tang麻黄附子汤
– 甘草gan cao (Radix Glycyrrhizae Uralensis)
– 麻黄ma huang (Herba Ephedrae)
– 附子fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
– Zheng Shui and Feng Shui 【26】
• Floating pulse with cough is Feng Shui
• Xing Zi Tang 杏子汤
– Yellow Sweating
• Wei obstruction with Ying heat, exterior deficiency with damp
obstruction
–
–
–
–
Yellow sweating
Similar to Feng Shui (Wind-edema)
Deep pulse
No aversion to wind
• Huang Qi Shao Gui Ku Jiu Tang 黄芪芍桂苦酒汤 【28】
–
–
–
–
黄芪huang qi (Radix Astragali Membrnacei)
白芍bai shao (Radix Paeoniae Lactiflorae)
桂枝gui zhi (Ramulus Cinnamomi Cassiae)
苦酒 ku jiu bitter liquor (vinegar)
– Yellow Sweating 【29】
• Qi Deficiency with excessive damp obstructing
Yang qi on upper part
– Fever with cold lower limbs
• Gui Zhi Jia Huang Qi Tang 桂枝加黄芪汤
– Gui Zhi Tang (Cinnamon Twig Decoction) 桂枝汤.
regulate Ying and Wei
» 桂枝gui zhi (Ramulus Cinnamomi Cassiae)
» 白芍bai shao (Radix Paeoniae Lactiflorae)
» 甘草gan cao (Radix Glycyrrhizae Uralensis)
» 生姜sheng jiang (Rhizoma Zingiberis Officinalis
Recens)
» 大枣da zao (Fructus Zizyphi Jujubae)
– 黄芪huang qi (Radix Astragali Membrnacei)
– Qi level disease
• Yang deficiency with yin coagulation
– Hardness in epigastria water retention
• Gui Zhi Qu Shao Yao Jia Ma Huang Xi Xin Fu Zi Tang
【31】
–
–
–
–
–
–
–
桂枝gui zhi (Ramulus Cinnamomi Cassiae)
甘草gan cao (Radix Glycyrrhizae Uralensis)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
大枣da zao (Fructus Zizyphi Jujubae)
麻黄ma huang (Herba Ephedrae)
细辛 xi xin (Herba Asari )
附子fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
– Qi level disease
• Spleen deficiency with qi obstruction
• Zhi Zhu Tang 枳术汤 【32】
– 枳实 zhi shi (Fructus Aurantii Immaturus )
– 白术bai zhu (Rhizoma Atractylodis Macrocephalae)