6.29 Bleeding Syndrome

6. 29. 1 What is bleeding syndrome? And how many common types clinically are there?

Bleeding syndrome refers to the diseases caused by failure of blood to circulate in the vessels, or bleeding through nine orifices or ihmugh the skin. In internal medicine, the cornnion types of bleedng are nosebld, gingival ma, hemoptysis, haematernesis, hena tochezi a, urohematin and purpura.
6.29.2 What are the treatment principles for bleeding syndrome?
The treatment principics for bleeding syndrome can be summan 7cd as reati rig pathogenic fire, syndrome of Qi and bleeding.
6. 29. 3 How do you distinguish hemoptysis from herntemesis? What are their respective common types? And what are the main points of differentiation, respeclive treatments and recipes for them?
Bleeding with cough is coughing of blood in which blood comes Irom the lung; hemoptysis refers to blcxd brought up immediately ar ter coughing; while bleeding with vomiting is haematemesis in which blood comes from the stomach. Coughing of blood is scarlet mixed with phlegm in frothy form, small hlood mass or mouthful of blood are often in hemoptysis which are brought up by coughing, while haemarimesis is dark purpte or deep-red bkxid mixed with food-resi - due or blood mass and is often associated with hematochegia.
Hernop t ysis
(1) Ernpairment of the Lung by dryness-heat.
[Main points of differentiation) Itching throat, cough, phlegm with blood streads.
Removing heat, nourishing the iung and relieving vessels to stop bleeding.
[Recipe] Sang Xing Tang
(2)The liver-fire invading the lung
[Main points of differentiation] Cough, phlegm with bkxxi streaks, disiending pain in the chest and hypochondriuni.
[??Freatirient] Purging the pathogenic fire in liver and lung, and removing heat from the blood to stop bleeding.
[Recipe] Xie Bai Sin with T*Zi Ge San
(3 )The lung-heat syndrome due to Yin deficiency
[Main points of di fferentiat ion] Cough, dry throat, phlegm
with blood streaks, hectic fever and night sweating.
Noiirkhing Yin, rnosturizing the lung and relieving pulmonary collatrals to stop bleeding.
1
Recipe] RaiHeGu fin Wat
Hematemesis
(1 )Exceive heat in stomach
[Main points of differentiation] Red blood when vomiting, fullness in the stomach, o.zostornia, constipation, and slippery and rapid pulse.
[Treatment] Clearing away heat in the stomach and removing the blood stasis for hemosta-is.
[Recipe] Xie Xin Yang with SM Hui San
(2)The liver-fire invading the stomach
[Main points of differentiationl Vomiting with red b1oc, bitter taste and painful hypochondriurn.
[Treatment] Purging the liver-fire and stomach heat and removing heat from the blood to stop bl.eeding.
:Recipe] Long Dan Xie Gun Thng
(3)Bleeding due to deficiency of Qi
[Main 1X)irltS of differentiation] Continual vomiting with
blood, pa1piriitiori shortness of breath, listlessness, weak pulse. [Freatmerit I Strengthening the spleen, nourishing the hear
a rid rep len ishi rig qi for con unand in g blood +
ERccipei Gui P1 Tang
6.30 Edema

6.30.1 Try to deseirhe the etio?ˉogy arid pathogenesis of edema.
Edema is a clinical riiani[estati n of the dvsfcnct ion ci svsterni c?ˉ Yang-FM organs and ahncnnal Qi Eras/anna/ion Though the /ung p/een, kidney and bad ot San-iran 01 transfc,rrnat ion is responsible for cderna, but it?ˉs i-cxg in the kidney.
(1) Wind?acold pathogen leading to failure of the lung in maintaming normal water metabolism The lung is the upper resource of water, and :t function is to ascend vital Qi and descend turbid Qi + When the lung is affected by pathogens its functional activities will be disturbed, which wi[l cause retenUon of water, and counteraction between wind and water pathogeris, resulting in the swelling of die skin.
(2) Disturbance of ihe p1een-Qi ??by toxin and dampness Toxin of carbuncLe, furuncle and pyogenic infections or pathogenic dampness gathering in the spleen causes dysfunction of the spieen in transfx)r r. kading to disorder of water metabolism and resulting in swelling of ti-ic skin.
(3) Ac:cumulat:on of darnpnessheai obstructing the San-Jiao flampness-heai. accumulating for a long tinie in the San-jiao causes disorder of Qi arid impaired water metabol isni resulting in edema.
(4) Edema due io insufficiency of yang and the kidney-Qi Insufficiency of Yang-Qi, the kidney-Qi and the kidney-essence leads to dysfinci ion of the spleen and lung ind that of the urinary bladder, giving rise to edema.

6. 30 2 How is edema ]isnnguished from tympanites?

4
Abnormal warcr metabolism due to
dysfunction of the lung, spleen
vid lddney
Hiving h.sior-y o1 nephroses, Having case history of hepatopathy, pale complexion, swelling of the dimtrdsh and bluish cvrnplexlorit face and linibs hydrnthorax or aSCtLs WI r hoot nia-na of Limbs ascitas appcar!ng oniy in serioUs slighi swelling of the lower limbs cases without outstanding vcris seen in se. etc case outstanding on the ahdcwnnaL surface ?a -?a -. veins ott the abdominal surface
Give an outline of the symptoms,rnain points of diffcrentiation, treatnients and recipes of various types of Yangsh iii.
(1) FengSh u i overflow
Svrnptoms] Palpehrai edema followed rapidly by that of the limbs and the whoie body, in combination with fever, aversion to coW, soreness in hrnb joints, difficulty in urination, or cough with dyspnea and painful throat, reddish or whitish tongue floating and skppcry pulse, or deep and tight pulse.
[Main points of different[ation I Palpebral edema rapidly
derria
Etiology and pail ingenisis
spreading to the whole body, combined with exterior syndrome of
ETreatment I 1*xpelling wnd removing heat and pmmoting water metabolism by activating dispersing function of the lung.
[Recipe] The hi Jia ZIiu Tang
(2)Pathogenic dampness invading the body
ESyrnptoms] Palpebral edema spreading to the whole body, difficulty in urination, carbuncle and re, even ulcer combined with lever, aversion to cold, red tongue with thin and yellowish fur, floating, siippery and rapid PUl
Main points of diffcrentiationl Palpebral edema spreading to ihe whole body exterior syndronie jf wind?aheat, jrc and carbuncle, floating, slippery and rapid pulse.
[T?ˉreatinent 1 Ventilating the Jung, removing pathogen and promoting water metabolism to alleviate edema.
f Recipe] Ma Hun ng Lia Qian Ch I Xiao Dots Tang
(3)Reterjtion of wetness within the body
[Symptoms] General edema, sunken surface when pressed wLth finger, lassitude, oliguria, chest tighiness and nausea, poor appetite 1 whitish and greasy fur, deep and moderate pulse, slow onset with long penod Mai
points of differentiation] Genera!. edema, sunken sur?a face when presst d with finger k ng a rnrse of illness, lassitude, chest tightness and nausea.
[Treatment] Strengthening the spleen to eliminate wetness, activating Yang to promote diuresis.
[Recipe] Wei Ling Tang with Wa P1 Yin
(4) Excessive dampness-heat
[Symptorns] General edema, bound and glosy skin, feeling stuffy iii epigastriurn, excessive thirst, dark urine, constipation, yellowish nd greasy fur, slippery and rapid J)UIsc, or deep and rapid pulse.
Main points of diffcrcntiation] General edema, bound and glossy skin, feeling stuffy in epigasriiim, excessive thirst, dark urine, constip6on, yellowish and greasy fur.
[Treatment] Removing dami mess- heai by prornotizig water nietabolisrn
[Recipe] Shu.Zao YinZi
6 30.4 Acupuncture Treatment
[Treatment]
Select points from back S/ni points and Ren meridian. The reducing method of needling is used mredsma of Yang type and reinforcing method for edema of Yin type together with moxibustion.
[Prescription]
Shuifen, Qihai, Sanjiaoshu. and Zusanli
[Modification with various syndromes]
Edema of Yang type: Feishu., Hegu, and Lieque;
Edema of Yin type: Pishu, Shenshu, and Yinlingquan.
6.31 Stranguria

6. 31. 1 How is bood-stranguria distinguished from urohematin?
Blood-stranguria and hematutia have in common the symptoms of bleeding with urination, dark urine ,and even pure blood excreted ii netimes. Discrimnation should incus on whether there is painf ut sensatioii during urination. If there is it belongs to the former; if not , the latter.

6.31 .2 How are tile SIX types of stranguria distinguished?

(I) Heat-stranguria Main points of differentiation is frequent urination, oliguria, hot and painful discharge of reddish urine,constipation, yellowish and greasy fur.
(2)Stone-stranguria Main poinTs of differentiation is iraterruptim of urination, urethralgia, crainping sensation of the lower abdomen, orine with blood.
(3)Qi-stranguria Main points of differentiatioti is excess syndruine: diflicuk in urination, fullness and pain of the lower abdomm, wiry pulse; deficiency syndrome: disiending sensation in ihe lower abdomen. dribbing urination, feeble pulse.