Liver and gallbladder damp-heat syndrome: The evil of dampness and heat is contained in the liver and gallbladder, causing the liver and gallbladder to fail to function, or the liver and gallbladder are ineffective, or the spleen and stomach are hindered in transportation and transformation, or the dampness and heat are suppressed, or the hypochondrium is distended due to unfavorable central qi. Pain, bitter taste in mouth, poor appetite, short and red urine and other symptoms.

Syndrome of gallbladder stagnation and phlegm disturbance: Symptoms such as palpitations, insomnia, dizziness and tinnitus caused by emotional failure, stagnation of gallbladder qi, inability to vent, heat generation and phlegm, and restless gallbladder qi.

Causes of the disease

Liver and gallbladder damp-heat syndrome: exogenous damp-heat evils fumigate the liver and gallbladder, causing inability to relieve diarrhea, or living in a humid place, wading in rain and water, causing internal trapping of dampness evils, brewing over time Turbid heat, or the body's yang is strong, and when dampness is felt, the dampness and heat will stick together, causing each other to suffer. Or damp-heat in the middle burner, infiltrating the spleen and stomach, fumigating the liver and gallbladder, or overeating and stopping after eating, or weak spleen and stomach, unable to digest food, food accumulation and stopping inside, depression and dampness-heat, damp and heat in the liver and gallbladder, or overeating spicy, fatty and sweet food Thick and greasy food, such as food, wine, cheese, etc., causes the stomach to be a sea of ??water and grains, so it damages the spleen and stomach. Dampness traps Taiyin, brews dampness and transforms into heat, and steams the liver and gallbladder, resulting in liver and gallbladder dampness-heat syndrome.

Syndrome of gallbladder stagnation and phlegm disturbance; mental depression and emotional insufficiency lead to stagnation of liver and gallbladder qi, failure to expel qi, qi stagnation producing phlegm and heat, and phlegm-heat internal disturbance. The liver and gallbladder are the exterior and interior of each other, the gallbladder is attached to the liver, and bile is metabolized by the remaining qi of the liver. The excretion and normal function of bile depend on the liver's excretion function. Therefore, stagnation of liver qi and insufficient drainage can often affect the excretion function of bile, leading to stagnation of bile qi, restless bile qi, and poor bile excretion.

Pathogenesis

Liver and gallbladder damp-heat syndrome: The main pathogenesis is that dampness and heat accumulate in the spleen and stomach, fumigating the liver and gallbladder, liver failure and diarrhea, poor cardinal function, bile overflow, liver crosses soil, spleen and stomach The function of transportation and transformation is neglected, or damp and heat may be trapped in the gastrointestinal tract, or damp and hot may be injected into the bladder and two yin, etc. If damp-heat soaks into the internal organs, it will not only cause dysfunction in the functions of the liver, gallbladder, spleen and stomach, but can also overflow the body and skin surface, causing yellow water sores, or local redness, swelling and erosion, skin eczema, carbuncles, etc.; if damp-heat evil If the flow flows into the meridians and joints, the meridians will be blocked, resulting in the sluggish flow of Qi and blood, which may lead to arthralgia syndrome: limb joints are red, swollen, hot and painful, with difficulty in flexion and extension, and the onset is urgent. "Dampness and heat flow, numbness and pain in the limbs" ("Clinical Guidelines for Medical Records"), and even heat pain in the lumbar spine. "Dampness and heat, low back pain, internal heat, irritability, spontaneous sweating and thirst, red and astringent stools, and heavy soreness" (" "Treatment of disease caused by pulse"). The spleen governs the muscles of the limbs, and the dampness and heat are inside and penetrate the muscles and veins, so the muscles lose nutrition and become useless, leading to impotence syndrome. If damp-heat blocks and stagnates the meridians, Qi and blood will not flow smoothly, and the tendons and veins will not be nourished, the muscles and veins will not be nourished, resulting in severe spasms. This damp heat invades the meridians and tunnels" ("Warm Heat Diseases"). If dampness and heat intersect in the body, causing the liver to lose its ability to disperse and drain, resulting in qi stagnation and dampness obstruction, or the spleen does not control water and the water qi becomes stagnant, or the bladder fails to vaporize, then edema may occur. If dampness and heat rise up and obscure the clearing of the orifices, it is easy to cause headaches. If external dampness and heat disturb the head and the orifices lose their normal function, dizziness may also occur. In short, dampness and heat can not only affect the liver and gallbladder, but also affect the tendons, qi and blood, clear orifices, etc., leading to pathological consequences such as qi stagnation and dampness, muscle spasm, flaccidity, headache, dizziness, etc.

Syndrome of gallbladder stagnation and phlegm disturbance: Its main pathogenesis is mostly due to poor mood or mental disorder, which leads to liver and gallbladder qi stagnation, qi stagnation producing phlegm, phlegm stagnation turning into heat, stomach disharmony and depression, and uneasiness. . Blockage due to turbid phlegm can also cause headaches as liver qi rises and offends the gods. Or due to the accumulation of phlegm in the body, which blocks the chest yang, it can also develop into chest arthralgia, causing chest tightness and pain, body pain that penetrates the back or back pain that pierces the heart. If phlegm blocks the meridians and veins, the phlegm will condense and qi will stagnate, causing paralysis. Blockage, sluggish circulation of Qi and blood, loss of moistening and nourishment of the meridians and tendons, leading to flaccidity or paralysis syndrome. If phlegm accumulates in the heart, or obscures the heart orifices, blocking the mind, or phlegm stagnation transforms into fire, phlegm fire It disturbs the mind, or the phlegm-fire is strong, causing liver wind, which can cause epilepsy, madness, heart attack, stroke and other syndromes. In short, although the syndrome of gallbladder stagnation and phlegm disturbance is caused by the stagnation of bile qi, the clinical syndrome is actually disturbed by phlegm heat. Therefore, phlegm evil is at work, and a variety of diseases can occur, such as headache, flaccidity, heartache and chest obstruction, madness, stroke, etc. Pathological consequences include phlegm blocking the clearing of the orifices, disturbing the meridians, phlegm condensing and qi stagnation, and transforming heat and fire.

Key points for identification

Liver and gallbladder damp-heat syndrome: burning, swelling and pain in the flanks, abdominal distension, anorexia, or lumps under the flanks, nausea and vomiting, bitter mouth, loose stools or dry stools , short red urine, red tongue, yellow and greasy coating, stringy and rapid pulse. It may be accompanied by yellow staining of the skin or white eyes, or alternation of cold and heat, or eczema, unbearable itching, or swollen and painful testicles, or vaginal discharge with yellow color and smell, etc.

Liver and gallbladder damp-heat syndrome is clinically characterized by burning and distending pain in the flanks, bitter mouth, anorexia, and red tongue with yellow and greasy coating.

Syndrome of gallbladder stagnation and phlegm disturbance: palpitation and insomnia, hypochondriac pain and distension, dizziness and tinnitus, irritability, excessive breathlessness, bitter mouth and nausea, upset and chest tightness, red tongue with yellow and greasy coating, stringy and slippery pulse. The clinical characteristics are palpitation, insomnia, bitter mouth and bloated body, dizziness, tinnitus, and yellow and greasy tongue coating.

Differential analysis

The syndrome of liver and gallbladder dampness-heat and the syndrome of gallbladder stagnation and phlegm disturbance both have the pathogenesis of liver and gallbladder qi stagnation, heat stagnation in the gallbladder and bowels, unfavorable cardinal organs, and gastric disharmony, so they have Symptoms include hypochondriac pain and swelling, bitter mouth, nausea and vomiting, red tongue, yellow and greasy coating, stringy pulse and other similar symptoms. However, the two have different clinical manifestations due to different pathogenic factors (the former is damp-heat and the latter is phlegm-heat).

Liver and gallbladder dampness-heat syndrome: Due to the evil of dampness and heat, the liver and gallbladder are internalized, the liver wood is lost in the strips, and the Qi movement is unfavorable. The flanks are the dividing line of the liver, so the symptoms are burning, swelling and stuffiness in the flanks and ribs. pain. The liver qi is inverse and invades the spleen earth, resulting in dysfunction of the spleen and stomach's reception, transportation and transformation, resulting in anorexia and abdominal distension. If there is stagnation of liver and gallbladder qi, qi disease and blood stasis, qi stagnation and blood stasis, lumps under the flanks will be seen. If the liver and gallbladder qi is unfavorable, it will invade the stomach, resulting in loss of balance in the stomach. Stomach qi will rise and rise, resulting in nausea and vomiting. If bile overflows, the mouth will be bitter. Dampness and heat are inherent, dysfunction of the digestive system, malfunction of the large and small intestines in their functions of decomposition, conduction, separation and secretion of turbidity. If the dampness is greater than the heat, loose stools will result. If the heat is greater than the humidity, the stool will be dry and hard, and the urine will be short and red. A red tongue, yellow and greasy coating, and stringy and rapid pulse are all signs of dampness and heat in the liver and gallbladder. If damp heat fumigates the spleen, stomach, liver and gallbladder, and bile does not follow the normal path, it will overflow on the skin and white eyes, forming jaundice. Damp-heat accumulates in the liver and gallbladder, and the gallbladder and cardinal organs are unfavorable. Good and evil are competing between half the outside and half the inside. When evil qi enters the inside, aversion to cold will occur, while righteous qi resists evil and causes fever. If dampness and heat flow along the liver pulse (the liver pulse passes through the vagina and reaches the lower abdomen) and soaks into the vagina, the disease will develop vaginal eczema, unbearable itching, or vaginal discharge that is yellow in color and smells bad. If dampness and heat are stagnant and Qi and blood are stagnated in the lower veins, the testicles will become swollen and painful.

Syndrome of gallbladder qi stagnation and phlegm disturbance: It is always caused by qi stagnation in the liver and gallbladder, qi stagnation transforms into fire, burning fluid turns into phlegm, or qi stagnation produces phlegm, phlegm stagnation transforms into heat, internal disturbance of phlegm-heat, and restless gallbladder qi cause the disease. Feeling frightened. Phlegm-heat disturbs the mind and spirit, causing insomnia and upset. Stagnation of bile qi, unfavorable menstrual qi, and blockage of qi movement can lead to chest tightness, hypochondriac pain, distension, and tightness. Phlegm-heat disturbs the clearing of the orifices, causing dizziness and tinnitus. The liver governs dispersion and regulates emotions, which is also derived from its function of regulating qi. If the Qi mechanism is stagnant and the liver loses its smoothness and softness, it will lead to excessive rest, irritability and irritability. Gallbladder heat invades the stomach, causing the stomach to lose its balance and descend. Stomach qi will go up and down, and liver qi will go up and down accordingly, resulting in bitter mouth and vomiting.

In terms of clinical symptoms of liver and gallbladder dampness-heat syndrome and gallbladder stagnation and phlegm disturbance syndrome, in addition to the symptoms of arthritis, the former is characterized by clinical symptoms caused by dysfunction of the spleen and stomach and internal accumulation of dampness and heat. , if the spleen and stomach are out of balance, there will be abdominal distension, anorexia, and irregular stools; dampness and heat are accumulated in the bladder, and the gasification is not good, so the urine will be short and red; dampness and heat will be injected into the genitals along the meridians, resulting in eczema and yellowish odor. . The latter is characterized by clinical symptoms caused by gallbladder failure, qi stagnation, and internal disturbance of phlegm-heat. For example, if gallbladder stagnation is not comfortable, there will be chest tightness, irritability, and poor breathing; phlegm-heat internal disturbance of the mind and Qingqiao, Then there will be panic, insomnia, dizziness, tinnitus, and upset. In addition, liver and gallbladder damp-heat syndrome often easily causes bile to not follow the normal path and form jaundice, or liver and gallbladder qi stagnation, qi stagnation and blood stasis, blood stasis in the hypochondriac, resulting in accumulation of symptoms, or evil stagnation of Shaoyang, unfavorable cardinal system, and alternation of cold and heat due to conflicting evils. , it can have both jaundice and lumps.

In terms of the pathogenesis of liver and gallbladder damp-heat syndrome and gallbladder stagnation and phlegm interference syndrome, the main pathogenesis of liver and gallbladder damp-heat syndrome is the accumulation of dampness and heat in the liver and gallbladder, stagnation of qi, unfavorable central organs, and bile. Overflow, loss of spleen health, loss of balance in the stomach, dampness and heat, infiltration of the genitals or unfavorable gasification of the bladder. The pathogenesis of the syndrome of gallbladder stagnation and phlegm disturbance is lack of gallbladder and qi stagnation, which turns into fire, or qi stagnation produces phlegm, phlegm and fire are disturbed, the bile is restless, and the mind is restless, and the phlegm is moved by fire and rushes up to clear the orifices. . The liver and gallbladder damp-heat syndrome and the gallbladder stagnation and phlegm disturbance syndrome are both syndromes of interior, syndrome, and heat, but the former is caused by damp-heat, and the latter is caused by phlegm-fire. Although both diseases are related to the liver and gallbladder, the former is still related to the spleen and stomach, and the latter is related to the spleen and stomach. The focus is on the courage, which is related to the heart. Liver and gallbladder damp-heat syndrome can cause secondary damp-heat symptoms such as skin eczema, limb flaccidity, joint spasm, headache, dizziness, etc. due to the stagnation, infiltration, and spread of damp-heat evil. The syndrome of gallbladder stagnation and phlegm disturbance can cause headache, heartache, chest numbness, madness, epilepsy, stroke, limb paralysis, etc. due to internal attack, upward inversion and horizontal movement of phlegm fire. As the "Medical Prescriptions" says: "The gallbladder is a pure internal organ, and it is a meridian with little qi and blood. If phlegm and fire disturb the gallbladder, it will lead to gallbladder heat and various diseases."

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In terms of the etiology and history of liver and gallbladder damp-heat syndrome and gallbladder stagnation and phlegm interference syndrome, liver and gallbladder damp-heat syndrome is mostly caused by the external attack of damp-heat evil, or the failure of the spleen and stomach to transport and transform, resulting in accumulation of dampness and heat generation. There is a history of feeling damp and hot, and the syndrome of gallbladder stagnation and phlegm disturbance is mostly caused by poor emotions and stagnation of liver qi, so there are factors of emotional disharmony.

For liver and gallbladder damp-heat syndrome, the treatment should be to soothe the liver and promote gallbladder, clear away dampness and heat, and use Longdan Xiegan Decoction ("Lanshi Secret Collection"); for the treatment of gallbladder depression and phlegm disturbance, it should be treated to clear away heat and resolve phlegm. To harmonize gallbladder and invigorate qi, use Wendan Decoction. "Wendan Decoction treats a weak heart and timidity, easily frightened by things, ominous dreams, and confusing visions, resulting in frightened and timid heart, qi stagnation and phlegm production, salivation and qi throbbing, and the recurrence of various symptoms, such as shortness of breath, palpitations, and spontaneous sweating. , swollen limbs, tasteless food, feeling depressed and restless"