Damp-heat of spleen and stomach. Also known as damp heat in middle coke. Mostly due to damp evil or improper diet, overeating fat and sweet, resulting in damp-heat injury to the spleen and stomach. Symptoms include abdominal distension, fatigue, weight, loose stool, body heat, bitter taste, thirst, scanty and yellow urine, and even yellow skin like orange, yellow and greasy tongue coating and rapid pulse. The treatment is mainly to clear away heat and promote diuresis. Damp-heat syndrome of spleen and stomach can be seen almost every day in outpatient department. It involves many diseases of digestive system, tumor and urinary system, among which digestive system diseases are common, such as chronic gastritis, reflux esophagitis, gastric or duodenal ulcer, gastritis, chronic hepatitis B, liver cirrhosis, fatty liver, gallstones and gallbladder polyps. After liver cancer surgery, esophageal cancer or gastric cancer or intestinal cancer surgery, there may be different stages of development, and chronic gastritis takes the first place. The main cause of damp-heat syndrome of spleen and stomach is that the above diseases have not been effectively treated, and the lesions have moved and developed repeatedly. Secondly, it is related to unhealthy lifestyle, such as eating greasy food, spicy food, smoking and drinking, which leads to spleen and stomach injury, dampness and heat. It can be seen that to prevent the occurrence of damp-heat in spleen and stomach, we must first actively treat the above-mentioned basic diseases. At the same time, we should change the unhealthy lifestyle, eat moderately, don't smoke, don't drink and so on. The physiological characteristics of the spleen and stomach are that the rise and fall of the spleen and stomach is the acquired foundation and the source of qi and blood biochemistry. Its functional characteristics mainly focus on rising and falling. Spleen governs transport and transformation, and its distribution is subtle and clear; Stomach governs reception, decays Shui Gu, and governs turbidity. Spleen ascending is healthy, while stomach descending is harmonious. Spleen is not healthy, and qi does not rise; Stomach disharmony, turbid qi does not fall, but rises. The spleen is yin, the stomach is yang, and the fu-organs are fu-organs, which are in harmony with the exterior and the interior, rising and falling. It not only presides over the decomposition and fine distribution of Shui Gu, but also relates to the ups and downs of Yin and Yang, Qi and blood, fire and water of the whole human body, so it is the hub of the ups and downs of the human body. The rise and fall of the spleen and stomach are mutually causal. The stomach loses harmony and falls, but the temper does not rise. The spleen rises abnormally, but the stomach does not fall, as Yu said: "The qi in the middle epigastrium is abundant, and the clear qi in the water valley rises and fills a hundred pulses, and the turbid qi is discharged to the large intestine, and it disappears." When the spleen is clear and the yang rises, and the stomach is turbid and the yin falls, the qi and blood will be biochemically active and orderly. If it's not lucky, it will be biochemical for no reason. If it doesn't drop, it will turn into a disease. 2. Spleen and stomach diseases are characterized by damp stagnation. Although there are many syndromes, dampness and qi stagnation are interlinked in pathogenesis. The spleen and stomach are the officials of the granary, the sea of water valley, where everything is at ease and evil spirits are easy to attack. Because of this, the spleen and stomach rise and fall abnormally, so the water turns wet and the valley turns stagnant, leading to stagnation of dampness, food, phlegm, qi, blood and fire. The true depression is that the pathogenic factors are mixed, the airway is blocked, and the depression is in the middle energizer. If the spleen and stomach are deficient in cold, the transport and transformation are out of balance, the ascending and descending are out of balance, and turbidity and turbidity intersect, dampness and depression can also arise from this. The so-called deficiency leads to prosperity, while deficiency leads to stagnation. As Su Wen-tiao said, "There is fatigue, lack of body qi, deficiency of grain qi, weakness of upper energizer and difficulty of lower energizer ..." Because dampness and depression are the main pathogenesis, when treating spleen and stomach diseases, the general purpose is to warm, clear, tonify, or diarrhea, so as to promote depression, promote diuresis and restore elevation. Third, the spleen and stomach diseases focus on conditioning, and the spleen and stomach diseases are wet and stagnant, among which the spleen diseases are wet and easily trapped by dampness; Stomach diseases with excessive heat are often caused by improper lifting of qi. Therefore, the key to spleen and stomach diseases is to recuperate, explore its source, clarify the causes of qi disorder, treat the symptoms, restore the normal rise and fall of spleen and stomach, and eliminate dampness stagnation and rise and fall. When regulating the spleen and stomach, it should also be combined with dispersing lung qi. Because the spleen governs the transportation of Shui Gu, and the valley melts like water, and the lung governs the distribution of subtle substances, such as fog, the spleen needs the help of the lung to complete the distribution of subtle substances in Shui Gu, as Su Wen's meridian differentiation theory says: "The spleen governs the dispersion of subtle substances, from the lungs to the bladder meridian." The lung dominates the declaration and descending, the spleen and stomach dominate the ascending, clearing away turbidity, and the qi moves up and down together. Therefore, we must not forget to regulate the lungs when treating the spleen, and we must investigate the spleen when treating the lungs. Drugs for strengthening spleen and regulating stomach, such as almond, Fructus Trichosanthis and Herba Ephedrae, should be added in clinical medication. In Clinical Guide to Medical Records, Ye used almonds to disperse lung qi and relieve depression, so that dampness was blocked, which was the first time to disperse lung qi, promote diuresis and strengthen spleen. Damp-heat of the spleen and stomach: There are many symptoms of damp-heat of the spleen and stomach. Stomach pain, noisy burning, dry mouth and hunger, Huang Chi urine and poor stool are the key points of syndrome differentiation of damp-heat of the spleen and stomach. The treatment of this disease should be based on the principle that clearing heat does not hinder diuresis, and diuresis does not help heat. It is necessary to add and subtract Sanren decoction, and often add winter melon skin and wormwood to make the dampness clear and the spleen and stomach calm. Damp-heat diarrhea is often treated with Gegen Qinlian Decoction. If jaundice occurs, you can add or subtract Chen Yin Wuling Powder. -Wang Huilan's experience in treating damp-heat syndrome of spleen and stomach is rare in the north, but it has increased in recent years due to the change of diet structure. In the study with teacher Wang Huilan, I found that Wendan decoction is often used to treat damp-heat syndrome of spleen and stomach, and achieved good results. Now the teacher's understanding of spleen and stomach damp-heat syndrome and common treatment methods are summarized as follows. 1 etiology and pathogenesis, spleen and stomach weakness is the basic theory of traditional Chinese medicine, and deficiency of vital qi is the internal root of the disease. "Lingshu, the beginning of all diseases" says, "Wind and rain are cold and hot, and you can't be empty, and evil can't harm people alone." Although there are many causes and pathogenesis of damp-heat syndrome of spleen and stomach, the functional state of spleen and stomach is the decisive factor. Clinically, whenever a patient "eats one more bite" due to exogenous factors or a meal, it will cause fullness in the upper abdomen, nausea, loss of appetite, or abnormal stool, and yellow and greasy tongue coating. Tracing back to the source, whether it is congenital endowment deficiency or acquired disorder, we can always find the disease of spleen and stomach weakness. The spleen and stomach are weak, and the grain water cannot be transported normally. Hydration becomes wet, and valley becomes stagnation. Wet stagnation for a long time will turn into heat, which can form damp heat. At the same time, various disease factors can easily lead to spleen and stomach weakness, dysfunction and damp heat. 1. 1 Feel exogenous pathogens Because of the physiological characteristics of the spleen and stomach, dampness and dryness easily invade the spleen and stomach. Spleen is wet soil, which is a "wet area", and wet is the most likely to hurt spleen; The stomach is dry and prone to dryness. Dryness is the evil of yang heat, and dryness is very hot. The combination of stomach heat and spleen dampness is damp heat. Other evils besides six evils, such as exogenous wind-heat and spleen deficiency, combine exogenous wind-heat with endogenous dampness to form damp heat. As Xue said: "The sun is injured internally, and the wet drink does not gather, and the external evil causes it again, so it is damp and hot." At the same time, exogenous pathogenic factors invade the lungs, chest tightness and cough, and abnormal qi movement can also hurt spleen and stomach weakness, making dampness endogenous, depressed and hot, forming damp heat. 1.2 Irregular diet is the most common cause of spleen and stomach injury. "Double your diet and hurt your spleen and stomach." Alcoholism, overeating, overeating, fatty diet, too sweet and unclean diet, etc. are all easy to hurt the spleen and stomach, causing food accumulation, dampness resistance and qi stagnation. And food accumulation, dampness resistance and qi stagnation can be turned into heat for a long time. Alcohol itself is "qi stagnation and dampness heat", and qi stagnation is also an important factor of water-dampness stagnation. Fat, sweet and delicious, it has the characteristics of dampness and heat. It can be seen that many factors of improper diet can be the cause of damp-heat syndrome of spleen and stomach. Although the stomach likes to moisten dryness, the formation of damp-heat syndrome of spleen and stomach is also directly related to the stomach. Food is first ingested by the stomach, and symptoms such as fullness, anorexia and nausea are often seen first in clinic. Spleen and stomach belong to middle earth, which cooperate with each other physiologically and affect each other pathologically, so the relationship between damp-heat syndrome and stomach is inseparable, so it is called spleen-stomach damp-heat syndrome. 1.3 Emotional factors: "spleen decides thinking" and "thinking leads to qi stagnation". Zhang Jingyue once said: "But thinking hard hurts the spleen." . If you think too much, your mood will be blocked, which will affect the antidiarrheal function of the liver. The normal function of the liver is an important condition for the spleen to promote the health of the stomach and coordinate the healthy movement of the spleen, that is, "get what you want from the soil." Stagnation of liver-qi can not regulate qi-flowing, spleen ascending stomach descending disorder, spleen losing health and transporting dampness, dampness stagnation transforming into heat and damp heat are the results. Of course, the diseases of spleen and stomach caused by the above causes are different in different individuals, which is determined by different physical qualities, different functional characteristics of spleen and stomach and different forms of response to the causes. The clinical manifestations of chronic spleen and stomach diseases are mostly mixed with excess and deficiency, and damp heat is one of the manifestations of mixed with excess and deficiency. "Urgent is to treat the symptoms". When damp-heat rising is the main contradiction, it is necessary to clear damp-heat mainly and strengthen the spleen to help transport. Wendan Decoction is derived from "Three Causes and Four Stagnation Syndrome Prescriptions" and consists of Pericarpium Citri Tangerinae, Rhizoma Pinelliae, Poria, Fructus Aurantii Immaturus, Caulis Bambusae, Radix Glycyrrhizae Preparata, Rhizoma Zingiberis Recens and Fructus Jujubae. The original text "after treating a serious illness, I can't sleep because of virtual annoyance, and I feel cold, which also cures fright." The coolness of its medicinal properties depends entirely on the number of ingredients. This prescription is simple and mild in nature. Through flexible addition and subtraction, the exterior-interior syndrome of deficiency and excess cold and heat can be applied, and its clinical application far exceeds the scope of syndrome treatment recorded in the original records. Teachers often use their prescriptions to treat damp-heat syndrome of spleen and stomach. Zhong Fang Erchen Decoction can dispel dampness, eliminate phlegm, regulate qi and regulate middle energizer. Pinellia ternata has the functions of eliminating dampness and resolving phlegm, harmonizing stomach and dispersing stagnation, tangerine peel regulating qi and regulating stomach, moistening dryness and benefiting qi, Poria strengthening spleen and eliminating dampness, licorice mixing medicine, benefiting qi and harmonizing middle warmer, ginger and jujube strengthening spleen and regulating stomach, consolidating soil and eliminating dampness, immature bitter orange inducing stagnation, reducing swelling and promoting diuresis, bamboo shavings are sweet and cool in nature, harmonizing stomach, and clearing heat and resolving phlegm. * * * play the role of eliminating pathogenic factors, strengthening the body resistance, eliminating dampness and clearing heat, regulating qi and guiding stagnation. Although it means strengthening the spleen without stagnation, it eliminates dampness without helping heat. Treating damp-heat syndrome of spleen and stomach, clearing heat but not helping dampness, is quite symptomatic. Because the damp-heat syndrome is lingering, it is necessary to investigate the causes, distinguish damp-heat and add and subtract flexibly. Damp-heat syndrome of spleen and stomach is characterized by abdominal distension, fullness, nausea, drowsiness, dry mouth without drinking or less drinking, sticky mouth, sticky stool or dark knot, pale or red tongue, yellow and greasy tongue coating, and smooth or slow pulse. When the wet weight is greater than the hot weight, Rhizoma Atractylodis, Herba Agastaches, Coicis Semen, Fructus Amomi Rotundus and Rhizoma Acori Graminei are added; Removing damp heat from Rhizoma Zingiberis Recens and Fructus Jujubae, and adding Scutellariae Radix or Coptidis Rhizoma and Herba Artemisiae Scopariae; It is rare that heat is heavier than moisture, and cold should not be used too much. Adding reed rhizome can damp heat, clear away heat and promote fluid production, facilitate urination, and add radish seeds and burnt areca nut to dissipate heat in stool. Eat with Jiao Sanxian and radish; Radix Bupleuri, Caulis Perillae, and Cortex Magnolia Officinalis are added for stagnation of liver qi; Atractylodes rhizome and Atractylodes macrocephala are obviously added to spleen deficiency. Exogenous damp-heat of spleen and stomach is combined with warming gallbladder and benefiting intestines in the syndrome differentiation and treatment, and both exterior and interior are treated. In patients with damp-heat syndrome of spleen and stomach, gastroscopy often finds a large amount of retention fluid in the stomach, which is viscous. At this time, Atractylodes lancea is reused, so as to eliminate dampness by fragrance and strengthen the spleen to help transport. It should be noted that heat belongs to Yang, while dampness belongs to Yin. If you clear away heat, use cold medicine; Cold helps dampness; To treat dampness, warm drugs should be used; If you are warm, you should help to heat it. In addition, the herbs for treating dampness are fragrant and dry, and are easy to consume body fluids. Therefore, it is necessary to distinguish carefully in clinic and master the discretion of medication. Deficiency and cold of spleen and stomach is the source of dampness, which often occurs first and then turns into heat. Clinically, dampness is heavier than heat, that is, both damp and heat are equally important. The treatment is mainly to eliminate dampness and regulate qi, because dampness is the easiest to block qi-flowing, and regulating qi is helpful to eliminate dampness. The most common fragrant and mild products for eliminating dampness, such as Pogostemon cablin, Eupatorium odoratum, Amomum villosum, Acorus gramineus, Poria cocos, Coicis Semen, etc., are added with heat-clearing drugs when eliminating dampness and clearing heat. 3 patients, female, 68 years old. After the cold recovered, the patient was full of abdominal distension, feeling stuffy and uncomfortable, bored and sick, depressed, with bad stool, dry mouth and no desire to drink water, and felt sleepy and weak for more than a month. The complexion is sallow, the tongue is reddish, the fur is yellow and thick, the pulse is thin and smooth, and the lower limbs are slightly swollen. He also said that for many years, whenever he caught a cold or had a careless diet, he would get sick. Syndrome Differentiation: Spleen and stomach are weak, damp heat is accumulated in the middle, and dampness is heavier than heat. Treatment: regulating qi and strengthening spleen, eliminating dampness and clearing heat. Wendan decoction is modified. Prescription: Pericarpium Citri Tangerinae 10g, Rhizoma Pinelliae Preparata 15g, Poria 30g, Caulis Bambusae 10g, Herba Agastaches 10g, Rhizoma Atractylodis 15g, Cortex Magnolia Officinalis 12g, and Rhizoma Acori Graminei 10g. After taking 4 doses of medicine, the upper abdominal distension was relieved and the thick greasy fur became thinner.