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Tympanites

Diagnosis and Treatment

A .Key Points for Differentiating symptoms

Tympanites is a complicated syndrome with deficiency in origin and excess in superficiality. Excess in superficiality has its stress on qi stagnation, blood stasis or water retention. Deficiency in orign has its stress on deficiency of the spleen-qi, deficiency of qi and yin, deficiency of the spleen-yang, deficiency of the spleen and kidney or yin deficiency of the liver and kidney. Therefore, although the main symptom is abdominal distention, there are differences in clinical manifestations. Qi stagnation is often accompanied with hypochondriac distention, sigh, eructation, bitter taste in the mouth, and taut pulse. Abdominal distention can be slightly alleviated after passing flatus. Blood stasis is often accompanied with thin limbs, vessels seen in the abdomen, mass in the hypochondria or abdomen, darkish complexion, vascular nevus in checks, chest and arms, squamous and dry skin, liver palm, darkish lips and nails, and ecchymosis on tongue edge. Water retention is often accompanied with abdominal distension, water-vibrating sound in the abdomen, lassitude all over the body, scanty urine and loose stool. Deficiency of the spleen-qi is often accompanied with sallow complexion, lassitude, anorexia, pale tongue and slow pulse. Deficiency of qi and yin is often accompanied  with deficiency of the spleen-qi, thirst with no desire to drink, hunger with no desire to eat, thinness, dysphoria with feverish sensation in chest, palms and soles, dry and hot skin, and  red thin tongue with scanty saliva. Deficiency of the spleen-yang is often accompanied with sallow complexion, aversion to cold, cold limbs, loose stool, pale enlarged tongue, and deep, thready and powerless pulse. Yang deficiency of the spleen and kidney is often accompanied with cold pain in the waist and knees, damp-cold scrotum impotence, premature ejaculation, and delayed and scanty menstruation, Yin deficiency of the liver and kidney is often accompanied with dizziness, tinnitus, lassitude in loin and knees, insomnia due to vexation, red checks ,epistaxis, red tongus with scanty fur, and taut and thready pulse.

B.Distinguishing Tympanites from Edema

It is very difficult to distinguish tympanites from edema at their late stage. However, tympanites and edema at their early stage can be clearly distinguished as follows:

C .Key points for Therapeutic Principle

Tympanites dus to qi stagnation should be treated with drugs of rgeulating the flow of qi to eliminate distension. Tympanites due to blood stasis should be treated with drugs of promoting blood circulation to remove blood stasis.Tym panites due to water retention should be treated with drugs of promoting diuresis to dispel retained water. Tympanites due to weakened body resistance should be treated with drugs of strengthening the body resistance and restoring normal function of the body to consolidate the constitution. It is appropriate to eliminate pathogen at the early stage, and to purge and nourish simul- taneously at middle and late stages. The key point is to induce diuresis and eliminate distension at middle stage and to prevent and treat serious accompanying symptoms at late stage.

D. Diagnosis and Treatment at Different Stages

 According to course of illness and relation between vital energy and pathogenic factor,tympanites is divided into early,middle and late stages.Symptoms at early stage mainly are incoordination between the livet and spleen,qi stagnation,blood stasis and dampness odstruction in the abdomen.No treatment or mistreatment at early stage will make vital qi to be gradually impaired and the disease enter middle stage with symptoms of weakened body resistance and excessive pathogen.At late stage,vital qi gradually depletes,serious accompanying symptoms appear one after another,and pathological changes are in terwoven and complicated.

Schematic Diagram for Etiology and Pathogenesis of Tympanites

(A) Diagnosis and Treatment at Early stage

Main Symptom:distended abdomen is beaten like a drum. the main symptom is not alleviated for a long time .

Accompanying Symptoms: hypochondriac distending pain,anorexia, lassitude and scanty urine. Abdominal distension is aggravated after meal and alleviated after eructation and passing flatus.

Tongue and Pulse:darkish tongue or with ecchymosis,white and greasy fur,and taut and slippery pulse.

Analysis: Jaundice, hypochondriac pain and abdominal mass, if untreated or mistreated, will cause incoordination between the liver and spleen, stagnation of the live-qi ,failure of the spleen to transport nutrients, qi stagnation, blood stasis and water retenion, hence  abdominal distention. Serious qi stagnation and blood stasis and slight water retention make the distended abdomen beaten like a drum. Deep-rooted and serious disease lasts a long time without alleviation. Dysfunction of the liver and stagnation of qi cause hypochondriac distention or pain. Indigestion due to unhealthy spleen and stomach causes anorexia Abdominal distension is aggravated after meal and alleviated after eructation and passing flatus. Qi stagnation and water retention cause lassitude and scanty urine. Darkish tongue or with ecchymosis, white and greasy fur, and taut and slippery pulse are also symptoms of qi stagnation, blood stasis and water retention.

Treatment: regulating the flow of qi, promoting the circulation of blood,inducing diuresis and eliminating distension.

(B) Diagnosis and Treatment at Middle stage

Main Symptom: serious distension, stiffness and fullnese of abdomen; water-vibrating sound in motion; sunken area appearing after pressing .

Accompanying Symptoms: sallow and dim complexion, lassitude, abdominal distension, no desire to eat ,thirst with no desire to drink, vascular nevus and spider nevus scatted on neck, checks, chest and back, vessels seen in abdomen, liver palms, constipation or loose stool, and scanty urine.

Tongue and Pulse: pale enlarged tongue with teeth-print, or dark purple tougue  with ecchymosis, thick and greasy fur, and thready and slippery pulse.

Analysis: Lingering tympanites makes more and more Qi, blood and water accumulated in the abdomen, so the abdomen becomes seriously enlarged, stiff and full, bringing unbearable sufferings to the patient. The abdomen with water retained in it produces water-vibrating sound in motion, or has a sunken area on it after pressed. Impairment of the liver, spleen and kidney by pathogen causes sallow and dim complexion and lassitude. Dysfunction of the spleen and stomach and disorder of qi cause distension of the stomach and abdomen. The patient does not dare to eat because the distension will become aggravated after eating. Water retention and indigestion cause thirst no desire to drink, constipation or loose stool, and scanty urine .Blood stasis causes vasular nevus and spider nevus scatted on neck ,checks, chest and back, vessels seen in abdomen, and liver palms.Pale enlarged tongue with teeth-prints, or dark purple tongue with ecchymosis, thick and greasy fur, and thready and slippery pulse are signs of dysfunction of the liver, spleen and kidney, weakened boby resistance,and excessive qi,blood and water.

Treatment: strengthening the boby resistance, promoting the flow of qi, removing blood stasis, inducing diuresis, and treating symptoms and causes simultaneously.

(C) Diagnosis and Treatment at Late Stage: Pathogen has not eliminated completely ,weakened body resistance is the main cause of illness, and accompanying symptoms are coma ,hematemesis and hemafecia.

1. Weakened Body Resistance and Excessive Pathogenic Factors

Main Symptoms: abdominal distension with more uncomfortable feeling in the evening than in the morning ,lassitude, inclination to move ,short breath, low voice ,and a mere skeleton.

Accompanying Symptoms: sallow or pale complexion, cold pain in the waist and knees, aversion to cold, cold limbs, impotence, menolipsis, dysphoria with feverish sensation in chest, palms and soles, squamous and dry skin dizziness, tinnitus, insomnia and night sweat .

Tongue and Pulse: pale  tongue, white fur ,deep and thready or feeble or taut pulse.

Analysis: Lingering retention or qi, blood and water impairs the spleen and kidney. Dysfunction of qi further aggravates retention of water .Uncomfortable feeling caused by abdominal distension is severer in the evening than in the morning with the vital qi weakened and strengthened .Deficiency of vital qi leads to lassitude, inclination to move ,short breath and low voice .Difficulty in generation of essence and blood gives rise to a mere skeleton and sallow or pale complexion .Yin excess due to yang deficiency of the spleen and kidney causes cold pain in the waist and knees ,aversion to cold,cold limbs, impotence, menolipsis, pale enlarged tongue ,and  deep, thready and feeble pulse ,Hyperactivity of fire due to yin deficiency of the liver and  kidney causes dysphoria with feverish sensation in chest, palms and soles, squamous, and dry skin ,dizziness, tinnitus ,insomnia ,night sweat ,pink enlarged tongue ,and deep ,thready and taut pulse

Treatment: mainly warming and recuperating the spleen and kidney ,or nourishing the liver and kidney.

2.Hematemesis an Hemafecia

Main Symptom: in mild  case ,vomit with fresh blood or blood clot ,or darkish feces; in  severe case ,serious hematemesis or dark  red loose stool .

Accompanying Symptoms: bitter taste in dry mouth ,burning heat in the stomach, bowel sound,abdominal distension, palpitation, short breath, perspiration ,and cold limbs .

Tongue and Pulse :reddish yellow or pale tongue ,taut ,slippery and rapid or deep ,thready and rapid pulse ,

Analysis: incoordination between the liver and spleen ,heat due to lingering stagnation of qi in the middle-jiao,and oppression or blood vessels by heat cause hematemesis ,hemafecia, bitter taste in dry mouth ,burning heat in the stomach ,bowel sound and abdominal distention

Deficiency of qi and blood causes palpitation ,short breath ,perspiration and cold limbs. Red tongue ,yellow fur ,and taut and slippery pulse are signs of excessive heat in the middle-jiao. Pale tongue and deep ,thready and rapid pulse are signs of depletion of qi and blood .

Treatment: patients with depletion of qi blood should be treated with drugs of supplementing qi and inducing astringency to purge heat,calm vessels,remove heat from blood and stop bleeding.

3. Coma

Main Symptomsd: dysphoria ,gradual lethargy and coma ;or divagation ,gradual lethargy and coma .

Accompanying Symptoms: oppressed feeling in the stomach, anorexia, nausea ,vomiting ,and disorder of visceral function .

Tongue and Pulse :red tongue with yellow and greasy fur, or normal tongue with greasy fur, and slippery pulse.

Analysis:Invasion of the pericardium by accumulated damp-heat causes dysphoria ,gradual lethargy and coma .Red tongue ,yellow and greasy fur and slippery pulse are signs of damp-heat .Invasion of the pericardium by accumulated phlegm-dampness causes divagation ,gradual lethargy and coma .Normal tongue with greasy fur is a sign of phlegm .Disorder of qi in the middle-jiao ,and failure of the stomach-qi to descend cause oppressed feeling in the stomach ,anorexia ,nausea ,vomiting and disorder of visceral function .

Treatment :refreshing the mind and inducing resuscitation .

Preventive and Nursing Measures:

1.    Attention should be paid to recuperation. Serious patients should

mainly stay in bed.

2.The patient should take proper low-salt diet, should not eat seafood, uncooked cold, fatty, pungent, oil-fried, rough and solid food, should not drink wine, and should reduce smoking cigarettes.

3.The patient should keep emotion stable, eliminate fearful psychology and strengthen confidence in treatment of abdominal mass, jaundice and hypochondriac pain.

4.The patient should pay attention to climatic changes to prevent body resistance from weakened.

Lingering tympanites with its focus at the liver and spleen will impair the kidney. Its main pathological mechanism is stagnation of qi, blood and water, and impairment of the liver, spleen and kidney. At early stage, no treatment or mistreatment of jaundice, hypochondriac pain and abdominal mass causes incoordination between the liver and spleen, stagnation of qi, obstruction of dampness, and stagnation of cold-dampness or damp-heat in the spleen. At middle stage, impairment of the liver and spleen affects the kidney, causing syndrome of deficiency in origin and excess in superficiality with qi stagnation, blood stasis, water retention, yin deficiency of the liver and kidney, or yang deficiency of the spleen and kidney. At late stage, lingering retention of qi, blood and water aggravates deficiency of the liver, spleen and kidney, with accompanying symptoms of coma, hematemesis and hemafecia.

Tympanites should be treated according to its superficiality, origin, deficiency and excess. At early  stage, excessive pathogen is the main factor, but the vital qi has not declined. Stress should be put on expelling pathogen, or promoting the flow of qi to remove dampness, or warming the middle-jiao to disperse dampness, or removing heat to induce diuresis, in order to coordinate the liver and spleen, eliminate water retention and relieve distension. At middle stage ,pathogen impairs the vital qi. Elimination of qi stagnation, blood stasis and water retention should be accompanied with protecting the vital qi, and warming and nourishing the spleen and kidney or nourishing the liver and kidney. At late stage, weakened body resistance is the main factor, and pathogen is still lingering with accompanying symptoms. It is rather difficult for tympanites at late stage to be treated with unfavorable prognosis. At that time, weakened body resistance should mainly be treated, but only with slow-acting drugs. Excess in superficiality should also be treated simultaneously. Emergency treatment should be actively given to accompanying symptoms of coma, hematemesis and hemafecia with drugs to refresh the mind, induce resuscitation, remove heat from the blood and stop bleeding.

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