Wind and water contending with each other

A disease pattern chiefly characterized by sudden puffy swelling of the head and face; wind-cold or wind-heat exterior signs.

Description: Sudden swelling of the head and face, spreading gradually down the body, but remaining more pronounced in the upper body; thin shiny skin; short voidings of scant urine; mild heat effusion and aversion to cold; absence of sweating.

• When attributable to wind-cold, there is aversion to cold with mild heat effusion, absence of sweating, a thin white tongue fur, and a pulse that is floating and tight.
• When attributable to wind-heat, there is pronounced heat effusion and mild aversion to cold, painful swollen throat, red tongue, and a pulse that is floating and rapid.

Diseases: Water swelling; common cold.

Pathogenesis: External contraction of wind-cold or wind-heat causing non-diffusion of lung qì and defense qì and obstructing the normal movement of water through the body so that it spills out into the skin.

Analysis of signs

• Water qì spilling outward: Sudden swelling of the head and face, with thin and shiny skin.
• Wind: Since wind by nature is swift and changeable and tends to affect the yáng regions, the swelling begins swiftly in the upper body and spreads rapidly but remains more pronounced in the upper body. For this reason, this is a yáng water pattern, in contradistinction to yīn water patterns caused mainly by spleen-kidney vacuity, which tends to affect the lower body.
• Obstruction of the upper source of water: Short voidings of scant urine attributable to water being unable to flow down to the bladder.
• Wind-cold: Cold causes pronounced aversion to cold and tempers the heat effusion caused by defense qì’s struggle against the evil. Because cold causes contraction and tension, the pulse is tight. The floating quality of the pulse reflects the fight against the evil in the exterior.
• Wind-heat: Heat evil affecting the exterior and the struggle to fight the evil makes for a pronounced heat effusion with mild aversion to cold. Heat is directly responsible for the painful swollen pharynx and the red tongue with thin fur (possibly turning yellow) as well as the rapidity of the pulse.

Treatment

Medicinal therapy: Wind-heat patterns are treated by dispersing wind and clearing heat, as well as diffusing the lung and moving water, using variants of Spleen-Effusing Decoction Plus White Atractylodes (越婢加朮汤 yuè bì jiā zhú tāng). If there is painful swelling of the throat, add isatis root (Isatidis Radix, 板蓝根 bǎn lán gēn), Platycodon (Platycodonis Radix, 桔梗 jié gěng), and forsythia (Forsythiae Fructus, 连翘 lián qiào) to clear the throat, disperse binds, and resolve toxin. Wind-cold patterns can be treated by the same formula, Spleen-Effusing Decoction Plus White Atractylodes (越婢加朮汤 yuè bì jiā zhú tāng), minus gypsum (Gypsum Fibrosum, 石膏 shí gāo) plus perilla leaf (Perillae Folium, 紫苏叶 zǐ sū yè), saposhnikovia (Saposhnikoviae Radix, 防风 fáng fēng), and cinnamon twig (Cinnamomi Ramulus, 桂枝 guì zhī).