Guan Ge

　　Diseases such as edema, oliguria, stranguria, and others, under the influence of repeated attacks by pathogens, dietary and physical exhaustion, or improper treatment, may repeatedly occur and fail to heal, leading to the exhaustion of the Yin and Yang of the spleen and kidneys, malfunction of Qi transformation, internal accumulation of dampness, turbidity, and toxic pathogens, failure of Qi to transform into water, closure of the kidney gate, and the inability to urinate; the upward invasion of dampness, turbidity, and toxic pathogens attacking the stomach results in vomiting, and thus Guan Ge develops. The exhaustion of the Yin and Yang of the spleen and kidneys is the root cause, and the internal accumulation of dampness, turbidity, and toxic pathogens is the manifestation. Therefore, the pathological manifestation of this disease is characterized by deficiency in the interior and excess in the exterior. During the course of the disease, the internal obstruction of dampness in the middle-jiao can lead to diarrhea or constipation; the external overflow of dampness, turbidity, and toxic pathogens can cause skin itching, or the precipitation of frost-like substances; the upward熏 of dampness, turbidity, and toxic pathogens can cause foul breath in the mouth, or a urinary smell, thick and greasy tongue coating; the upward obstruction of clear orifices by dampness can lead to drowsiness or confusion of consciousness. Depending on the individual's constitution and physical quality, dampness, turbidity, and toxic pathogens in the body can undergo different transformations of cold and heat. Cold transformation manifests as the syndrome of cold turbidity attacking upwards, while heat transformation manifests as the syndrome of internal accumulation of damp-heat. With the progression of the disease, the deficiency of the body fails to recover, and damage can occur from deficiency. Due to the interdependence of Yin and Yang, damage to Yang can lead to Yin deficiency. Moreover, due to the correlation between the five internal organs, kidney disease can affect other organs. Kidney disease affecting the liver can lead to Yin deficiency in the liver and kidney, internal movement of wind due to deficiency, and symptoms such as spasms or convulsions of the hands and feet; kidney disease affecting the heart can lead to oppression and palpitations in the chest, or pain in the anterior chest area, and even loss of consciousness; kidney disease affecting the lung can lead to cough and asthma, oppression in the chest, shortness of breath, and inability to lie flat.

　　In summary, the pathogenesis of Guan Ge is often manifested as deficiency in the interior and excess in the exterior, with alternating cold and heat, primarily affecting the kidneys, with the kidneys, spleen, stomach, heart, liver, and lung all suffering. The basic pathogenesis is the exhaustion of the Yin and Yang of the spleen and kidneys, malfunction of Qi transformation, and the upward invasion of dampness, turbidity, and toxic pathogens attacking the stomach. Due to the mutual influence between the excess in the exterior and the deficiency in the interior, the condition can continuously worsen, leading to a critical situation of internal closure and external exudation, and the collapse of Yin and Yang.

　　1, Early stage:Based on the history of kidney disease such as edema, stranguria, and urinary retention, and the symptoms of the original disease, the appearance of pale or dark complexion, fatigue, cold limbs, soreness and tenderness in the lumbar spine, or accompanied by edema, significant reduction in urine output, headache, insomnia, loss of appetite, nausea in the morning, occasional vomiting, pale and swollen tongue with tooth marks, thin white or thin greasy fur, deep and fine pulse or weak pulse. This stage is mainly due to Yang deficiency of the spleen and kidney, but there are also some patients with symptoms such as dizziness, blurred vision, red tongue quality, and thin and rapid pulse, indicating Yin deficiency.

　　2, Late stage:In the early stage, symptoms continue to worsen, and there are also some GuanGe patients whose symptoms in the early stage are not obvious. Under the influence of factors such as heavy colds and surgery, the symptoms of the late stage of GuanGe can suddenly occur. Symptoms include frequent nausea and vomiting, foul breath or urine smell in the mouth, or diarrhea, several to more than ten times a day, constipation, dry skin, even scaly skin, itchy, or frost-like precipitation on the skin, slow and deep breathing, cough, shortness of breath, chest tightness and palpitations, or pain in the anterior chest, significant edema, further reduction in urine output, even obstruction, toothache, epistaxis, ecchymosis, hematemesis, hematochezia, tetany, irritability, delirium, drowsiness, and even coma, thick and greasy or yellowish and dry tongue fur, or peeled, deep and fine pulse, or thin and rapid pulse, or knotting or missing.

　　The condition of urinary obstruction is called Guan, and the condition of continuous vomiting is called Ge. The clinical manifestations of GuanGe are mainly characterized by the coexistence of urinary obstruction and vomiting. Urinary obstruction occurs first, followed by vomiting, and after vomiting occurs, it presents with the syndrome of coexistence of urinary obstruction and vomiting. However, in the course of the disease, the accompanying symptoms are very complex. If it develops from edema, the symptoms include pale or dark complexion, fatigue, aversion to cold, cold limbs, clear urine, pale and swollen tongue with tooth marks, which is often due to Yang deficiency of the spleen and kidney; if it develops from stranguria, the symptoms include dizziness, blurred vision, dry skin or cramps, toothache, epistaxis, ecchymosis, irritability, restless, red and dry tongue quality, or peeled, thin and rapid pulse, which is often due to Yin deficiency of the liver and kidney. Yang deficiency is prone to dampness and turbidity, so dampness and turbidity accompanied by Yang deficiency syndrome are often cold and damp; Yin deficiency is prone to dampness and turbidity transforming into heat, so dampness and turbidity accompanied by Yin deficiency syndrome are often damp and hot.

　　Actively treating diseases such as edema, stranguria, and urinary retention, and preventing the occurrence of common cold and warm disease are the key to preventing the occurrence of GuanGe.

　　In terms of adjustment and regulation, it is necessary to strictly control the intake of protein, and try to choose high-quality proteins that can be fully absorbed and utilized by the human body, such as milk and egg white; appropriately provide high-calorie, vitamin-rich, and easily digestible diet, pay attention to oral and skin cleanliness, and those with edema should avoid salt.

　　At the time of diagnosis, in addition to relying on clinical manifestations, it is also necessary to make use of auxiliary examinations. This disease, combined with renal function, ultrasound, CT and other examinations, is helpful to clarify the diagnosis. This disease seriously affects the patient's daily life, so it should be actively prevented.

　　Therapeutic diet for Guan ge

　　1, Willow leaf 1 liang, decoct a bowl of soup and take it all at once, twice a day, and it can unblock urination in 2-3 days.

　　2, Add 120g of corn ear and 3g of fennel to the pot with an appropriate amount of water, cook and strain the dregs, add an appropriate amount of sugar for seasoning, and it can be drunk.

　　3, Grind 15g of peach and plum seeds into paste, decoct 15g of Job's tears, remove the dregs, mix with sugar, and take it all at once.

　　4, Sugar cane porridge, prepare about 100-150 grams of sugar cane juice for later use; cook 100 grams of rice porridge, and add the sugar cane juice when it is half cooked, and cook until done for eating.

　　5, Banyan fruit porridge: Dry banyan fruit 10-20 grams, decoct and take the juice, add 100 grams of glutinous rice and cook porridge, season with rock sugar and scallions as needed, and eat.

　　6, Honey preserved radish: Wash the fresh radish clean, cut into dices. Boil in boiling water and remove the water, dry in the sun for half a day, then add 150 grams of honey in the pot and simmer with low heat, mix well, and eat after meals.

　　What foods are good for Guan ge patients

　　Diet should be light and cool, and more foods with a cooling effect should be eaten, such as fresh vegetables (vegetable food), fresh pears, etc., among which vegetables like rapeseed, celery, water spinach, and shepherd's purse are the best for purging the liver and gallbladder fire.

　　What foods are bad for Guan ge patients

　　Avoid eating indigestible and greasy rough foods, including fish, meat, spicy, and fried foods; avoid smoking and drinking.

　　Type: Spleen and kidney failure, internal dampness and turbidity

　　Clinical manifestations include a dark and dull complexion, oliguria or anuria, edema of the limbs, nausea and vomiting, shortness of breath and fatigue, poor appetite and aversion to food, aversion to cold and cold limbs, loose stools, headache and irritability or drowsiness, and even convulsions and coma. The tongue coating is white and greasy, and the pulse is deep and thin.

　　Treatment method: Warm and tonify the spleen and kidney, transform dampness and reduce turbidity.

　　Medicines

　　1. Main Formula:Aconite and middle-jing decoction (from 'Taiping Huimin Heji Fang' by Chen Shiwén et al.) combined with evodia (from 'Jin Gui Yao Lue' by Zhang Zhongjing) with modifications

　　Prescription: Prepared aconite 12 grams, cinnamon 6 grams, codonopsis 30 grams, white atractylodes, poria, morinda officinalis, epimedium, and evodia 15 grams each, pinellia 18 grams, tangerine peel and ginger 9 grams each. Decoct for oral administration.

　　For severe edema, especially those with pleural effusion and ascites, add 0.5 grams of dried rhubarb powder (in empty capsules) for oral administration.

　　2. Traditional Chinese Medicine Prepared Medicines:附桂理中丸, 6 grams each time, 3 times a day.

　　3. Single Formula and Recipe

　　(1) Kidney-nourishing rhubarb decoction (from 'Comprehensive Collection of Secret Chinese Medicine Recipes' by Hu Ximing et al.)

　　Prescription: Prepared aconite 15-30 grams, raw rhubarb 15-30 grams, motherwort 15-30 grams, astragalus 30-60 grams, niter 10-20 grams. Decoct for oral administration, or retain for enema.

　　(2) Oyster shell enema formula (from 'Shanghai Journal of Traditional Chinese Medicine' by Tu Sen, 1983.7)

　　Prescription: Oyster shell 30 grams, raw rhubarb 10 grams, and prepared aconite 10 grams. Decoct and remove the dregs, retain for enema, 1-2 doses per day.

　　Type: Spleen and kidney failure, damp-heat intermingling

　　The patient's complexion is sallow or pale, with lumbago, fatigue, lack of appetite, dizziness, headache, irritability, nausea, vomiting, a foul smell in the mouth, or fever, dark urine, and constipation. The tongue coating is yellow, greasy, and turbid, and the pulse is wiry and rapid.

　　Therapeutic method: Invigorate the spleen and kidney, clear heat and reduce turbidity.

　　Medicines

　　1. Main Formula:Wensuitang (from Xu Shuwei's 'Benshi Fang') combined with Huanglian Wendan decoction (from Sun Simiao's 'Beiji Qianjin Yaofang') modified

　　Prescription: 15 grams of chuanxiong, 12 grams of renshen, 15 grams of dahuang, 12 grams of fahemia, 9 grams of chenpi, 10 grams of zhuru, zhi shi, shengjiang, huanglian, each 10 grams, 6 grams of gancao. Decocted for oral administration.

　　2. Traditional Chinese Medicine Prepared Medicines:Qingkailing Oral Liquid, 4 milliliters each time, three times a day.

　　3. Single Formula and Recipe

　　Dahuang mugong decoction (from Li Rongheng's 'Traditional Chinese Medicine Journal' 1988.3)

　　Prescription: 30 grams each of rhubarb, tanshen, and mugwort, decocted in water to obtain 200 milliliters of medicine fluid, used for retention enema, once a day.

　　3. Syndrome of pathogen invading the heart and liver. Type of blood-heat and wind

　　Symptoms: Vomiting, urinary retention, delirium, searching clothes and bed, convulsions, spasms, vomiting and hemoptysis, defecation and hemorrhage. Tongue is curled, tongue red with thick and turbid coating, pulse wiry and thready.

　　Therapeutic method: Open orifices, cool blood, and stop wind.

　　Medicines

　　1. Main Formula:Qingying decoction (from Wu Jutong's 'Wenbingiaobian') combined with Ganyanggouteng decoction (from Yu Genchu's 'Tongshu Shanghanlun') modified

　　Prescription: 30 grams of water buffalo horn (decocted first), 20 grams of raw rehmannia, 15 grams of huangqin, 15 grams of jinhuahua, 10 grams of huanglian, 3 grams of antelope horn slices (decocted separately), 18 grams of gouteng, 18 grams of baishao, 12 grams of juhua, mudanpi, zhuru, shigepi, yujin, each 12 grams, 6 grams of gancao. Decocted for oral administration.

　　2. Traditional Chinese Medicine Prepared Medicines

　　(1) Qingkailing Injection, 40 to 60 milliliters each time, added to 500 milliliters of glucose solution for intravenous drip, once or twice a day.

　　(2) Xingnaojing Injection, 10 to 20 milliliters each time, diluted in 500 milliliters of isotonic glucose injection for intravenous drip.

　　Four. Other Therapies for Guige Treatment

　　1. External Treatment:Use 125 grams of garlic, pounded into a paste, applied to both lumbar regions, once a day. The area to be applied should be coated with vaseline first to prevent blisters after application. It can also be applied to the abdomen with vinegar and mirabilite (the amount is not specified), just a thin layer, covered with oil paper, applied 4 to 6 times a day.

　　2. Acupuncture Therapy:In cases of Guige (obstruction of the meridians) with vomiting, urination, and slight benefit, it is advisable to first moxibustion at the acupoints of Shenshu, Qihai, Tianshu, etc., and needle the acupoints of Yongquan, Shuifen, etc.

　　3. Traditional Chinese Medicine Retention Enema:Take 30 grams of rhubarb and huaihua, 30 grams of pu gong ying, and 300 milliliters of water to decoct into a liquid. Use it for retention enema, once or twice a day.