A case study of Wuling powder in the treatment of edema

Edema is a type of disease syndrome characterized by edema of the eyelids, head, face, limbs, abdomen and even the whole body as the main clinical features due to various reasons leading to water retention in the body and flooding the skin [1]. Due to the differences in pathogenic factors and physical constitution, the pathological properties of edema are divided into Yin water and Yang water. Yang water is true, and it is mostly caused by exogenous wind pathogens, sores, and dampness; yin water is deficiency or a mixture of deficiency and excess, mostly caused by diet fatigue, lack of endowment, chronic illness and physical deficiency [2]. Zhang Jingyue's "Jingyue Quanshu · Miscellaneous Diseases" records: "Any symptoms such as edema are diseases related to the spleen, lung and kidney. Covering water is the ultimate yin, so its origin is in the kidney; water is transformed into qi, so its standard In the lungs; water only fears the earth, so it controls the spleen." And "there is no yang in the yin, and the qi cannot be transformed, so the water channels are blocked, overflowing and swollen." An important rule for the treatment of yin water edema [3]. Elderly people with visceral qi deficiency and lack of righteous qi are a frequent group of yin water edema. The author used Wuling Powder to restore the body's qi transformation, taking into account the regulation of the functions of the lungs, spleen and kidneys, and treating a case of yin water edema, and a satisfactory effect was obtained. The report is as follows.

The patient Qin, female, 67 years old, visited the doctor on September 19, 2014. The chief complaint was "frequent urination, oliguria and pain for more than 1 week, fever and vomiting for 1 day". Medical history: The patient developed frequent urination, oliguria, pain in urination, dripping urination, decreased urine output, dry mouth and polydipsia, poor appetite, and sometimes nausea and vomiting 1 week ago without obvious incentives. The outpatient doctor checked the urine routine. : Urobilinogen (+), bilirubin (+), occult blood (+++), protein (+), white blood cells (+++), considering urinary tract infection, take levofloxacin for oral anti-infection, and Chinese medicine for clearing away heat and dampness After treatment, the symptoms of frequent urination and urgency were relieved after taking the medicine, but urination was still difficult, and the mouth was dry and thirsty, and the drinking water increased. On the morning of September 19, he came to see a doctor when he had aversion to cold and fever. Symptoms: frequent urination, oliguria, dysuria, aversion to cold and fever, maximum body temperature of 38°C, repeated vomiting, moderate swelling of both lower extremities, mild swelling of face and upper extremities, heavy pulse, red tongue with little coating. Check the blood vessels of the lower extremities, heart and kidney color Doppler ultrasound, no obvious abnormality in blood biochemistry. Diagnosis: Western medicine diagnosis: idiopathic edema. Chinese medicine diagnosis: edema, the syndrome is Yin water. Recipe: Wuling Powder. Prescription: Guizhi 15g, Poria 20g, Polyporus 20g, Alisma 20g, Atractylodes 15g. A total of 3 doses, decocted in 250ml of water, taken in two warm doses, and drink plenty of warm water. After taking one dose of the medicine, the amount of urination increased significantly, the vomiting stopped, the edema gradually disappeared, the skin of the face and upper extremities was wrinkled, the edema of the lower extremities was relieved, the fever was only in the afternoon, and the thirst was relieved. After the second dose, the amount of urination was still high, the swelling of the lower extremities was reduced by half, there was no fever, and the patient was still thirsty. After three doses, the amount of urination was still high, the edema of the lower extremities had been eliminated, and the thirst was significantly improved, but the thirst was still there. The original prescription was given 2 more doses, and all symptoms disappeared after taking the medicine, and there was no recurrence after follow-up for half a year.

The patient in this case has typical yin water edema, which is due to his old age and yang deficiency, unfavorable qi transformation and urinary tract infection, resulting in frequent urination, oliguria, dysuria and dry mouth and polydipsia. The former doctor used anti-infection, heat-clearing and damp-damp treatment to relieve the frequent urination and urgency, but the bitter-cold medicine hurts the deficient yang, and the qi does not turn into water, so the inconvenience of urination is aggravated and the dry mouth is very beneficial. Lung health deficiency, intolerance to wind and cold, aversion to cold and fever, inability to drink water, unfavorable urination, excessive drinking of water in the body, upside-down, vomiting, generalized swelling of the skin, and a deep pulse is a sign of yang deficiency. However, there was no obvious abnormality in the related examinations of Western medicine, and the diagnosis was idiopathic edema. Idiopathic edema[4] is a common clinical disease and frequently-occurring disease. , caused by the abnormal increase of extracellular fluid under the skin, and its symptoms belong to the category of "edema" in traditional Chinese medicine. Regarding edema, "Plain Questions: Decoction and Liquor Liquor" proposes: "Peace control is a balance, go to the scorpion... Open the gate of hell, clean the house." Syndrome and Treatment" proposed: "Swelling below the waist should facilitate urination, and swelling above the waist should be cured by sweating". Wuling powder also has the dual functions of sweating and urination, which is exactly in line with it. In this case, the key to the patient's edema was poor urination and no way out for drinking water. The pathogenesis is that the bladder gasification of the lower coke is unfavorable, and the water is stored in the lower coke. The treatment is based on the transformation of Qi and water, and the regulation of the functions of the three internal organs of the lung, spleen and kidney. In the prescription, Alisma diuresis is used for the monarch. The ministers use Poria and Polyporus to help the monarch to relieve water and dampness. The kidney controls water, and the removal of dampness is conducive to the recovery of kidney-yang. Moreover, cinnamon twig warms yang and transforms qi to help kidney yang transform qi and promote water. Wetness is removed, qi is transformed into beneficial, so that the exhausted kidney yang has the opportunity to recover. Combined with Atractylodes to tonify qi to transport and transform water and dampness, the combination of Poria can not only show the effect of strengthening the spleen and making water, but also play the role of transporting the four cloths of the body. , the water wet biochemical passive. "Su Wen · Linglan Secret Canon" says: "The bladder is the official of the capital of the continent. The body fluid is stored in the body, and the qi can be released." Therefore, it is accompanied by cinnamon sticks to warm the yang and transform the qi to help the water and the kidney yang. Warm, and can be pungent and warm to disperse to dispel external pathogens, and the external pathogens can be dispelled without being bound, so that the lung qi can restore the function of regulating water channels. The whole formula transforms qi and water, and can take into account the functions of kidney yang warming, spleen spleen transporting and dispersing essence, lung dredging and waterway regulation, recovery of qi transformation, urination, self-removal of edema, and self-healing of various diseases.