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(skin-edem

a), Zheng Shui (Zheng-edema), Shi Shui (Stone-edema), Huang Han (Yellow-sweat) 【 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 interi

or. 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 transfor

ming 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 isolate

d in lower jiao

– Huang Han (Yellow-sweat)• Zang fu: SP LU• Edema in four extremities and face, yellow sweatin

g, 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 passag

e 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 Praeparat

a)

– 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 Yan

g 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 . regu

late 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 Rec

ens)» 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)