- Disease, that is, disease, is a complete life process caused by the imbalance of yin and yang, visceral tissue damage or physiological dysfunction caused by the action of pathogenic evil qi on the human body, and the righteous qi of the human body fights against it.
- Syndrome, i.e., syndrome, is a pathological summary of a certain stage or type of disease process, which is generally composed of a set of relatively fixed, intrinsically related symptoms and signs that can reveal the essence of a certain stage of the disease or a certain type of lesion.
- Symptoms, that is, the general term for symptoms and signs, are individual, isolated phenomena in the course of the disease, including various abnormal sensations of the patient himself and various abnormal manifestations perceived by the doctor. Symptoms are the main basis for judging diseases and identifying syndromes, but because they are only individual phenomena of diseases, they may not fully reflect the essence of diseases and syndromes.
Teacher Xie said: "Xiao Wang, today we are going to learn about syndrome differentiation and treatment. ”
Xiao Wang nodded and took notes seriously. Mr. Xie said: "In fact, in traditional Chinese medicine, 'syndrome' refers to the comprehensive manifestation of various symptoms that occur in the body at a certain stage in the development of a disease, which can also be understood as a symptom. The syndrome is variable due to the different stages of disease development and the different symptoms that reflect this stage. Since the 'syndrome' is a generalization of the pathological response of the body at a certain stage in the development of the disease, the syndrome reveals the essence of the disease more comprehensively, profoundly and correctly than the symptoms. 'Dialectic' in Chinese medicine refers to the process of authentication and identification. The process of syndrome differentiation is based on the data collected by the four clinics of looking, smelling, asking, and cutting, and through analysis and synthesis, to identify the cause, nature, and location of the disease, as well as the relationship between evil and good, and generalize and judge it as a certain nature of syndrome. ”
Xiao Wang asked again: "What about governance?" ”
Teacher Xie said: "Treatment, also known as treatment, is to determine the corresponding treatment method according to the results of syndrome differentiation. Syndrome differentiation and treatment are two inseparable parts of the process of diagnosis and treatment of diseases. Syndrome differentiation is the premise and basis for deciding treatment, and treatment is the means and method of treatment. Through the effect of the treatment, the correctness of the dialectic can be tested. ”
Dialectics is to serve "argumentation", how to "argue"?
Identify the cause:
Teacher Xie took the notebook, nodded with a smile, and motioned for Xiao Wang to sit down. He is well aware of Xiao Wang's intentions and efforts, and has always been full of encouragement and expectation for this young student.
"Etiological differentiation is an important part of TCM diagnosis, which helps us understand the cause of the disease and then guide our treatment." Teacher Xie explained succinctly. Then, he pointed to the contents of Xiao Wang's notebook and continued: "There are many kinds of etiological syndromes, such as the invasion of the six prostitutions, the infection of the furious qi, the internal injury of the seven emotions, the eating disorder, the loss of work and rest, the fall of the golden blade, etc., which may lead to the occurrence of diseases. At the same time, the causes and effects of diseases are usually interrelated, and pathological products in one stage may become new causes in the next stage, such as phlegm turbidity, blood stasis, food accumulation, etc. Improper medical treatment is also a potential cause. ”
Xiao Wang nodded and continued to ask: "So, what is the process of dialectic?" ”
Mr. Xie thought for a while, and then replied: "Identifying the cause is mainly through the four diagnosis methods of looking, smelling, asking, and cutting, understanding the patient's living habits, diet, working environment, emotional state, etc., and analyzing the nature, location, timing and relationship of the cause. First, the patient's medical history should be carefully analyzed, including the cause of the disease, the course of its development, as well as the patient's lifestyle habits and diet. Secondly, observe the patient's symptoms, such as pulse and tongue coating, which are important clues to the cause. These clues are then linked to different causes to deduce the most likely cause. Finally, the syndrome is differentiated according to the etiology and the corresponding treatment plan is formulated. ”
Xiao Wang Shen continued to ask: "So, can you give another example?" ”
Teacher Xie smiled and said, "Taking a cold as an example, the cause of its occurrence may be related to the invasion of external evils such as cold evil, wind evil, and damp evil, or it may also be caused by internal factors such as physical weakness, low immunity, and irregular life. Through syndrome differentiation analysis, different types of syndromes such as wind-cold cold, wind-heat cold, damp evil cold, and qi deficiency cold can be obtained, which provides a basis for the treatment of the cause. ”
Identification of disease location:
Teacher Xie also said: "Xiao Wang, correctly identifying the location of the disease can more accurately determine the cause and nature of the disease, and then guide the formulation of the treatment plan. To master this technique, you need to have an in-depth understanding of the viscera, meridians, six meridians, health qi and blood, and three jiao. First of all, you must understand that the location of the syndrome is crucial for the diagnosis and treatment of the disease. It helps to understand the extent of the spread of the disease and helps you determine the medication to be used. ”
Xiao Wang carefully wrote down this important information. "Teacher Xie, I understand, but I still don't know how to accurately distinguish the disease location."
Teacher Xie smiled, took out an ancient book, and turned a page. "For example, when a cold first appears, it manifests as headache, nasal congestion, cough and other symptoms, which proves that the disease is on the surface, and the treatment should be based on Xinwen Jiebiao; If the condition is aggravated and symptoms such as fever, coughing up yellow phlegm, chest tightness, and shortness of breath appear, it is necessary to consider that the disease has entered the body to dissolve heat, and the treatment should be mainly to clear heat and dissolve phlegm. Therefore, identifying the location of the disease is also a very critical step in TCM diagnosis. ”
Xiao Wang followed Mr. Xie's guidance, and then, Mr. Xie said: "The commonly used methods for syndrome differentiation include viscera syndrome differentiation, six meridian syndrome differentiation, Weiqiying blood pattern differentiation, three-focal pattern differentiation, and meridian pattern differentiation. Among them, viscera syndrome differentiation is mainly used for internal injury and miscellaneous disease differentiation; The pattern differentiation of the six meridians, the pattern differentiation of Weiqiying blood, and the pattern differentiation of the three focal points are mainly used for the differentiation of external susceptible diseases; Meridian pattern differentiation is a supplement and auxiliary to viscera pattern differentiation, which has a wide range of applications, and is especially commonly used in the diagnosis and treatment of acupuncture, massage, bone injury and other specialties. ”
Distinguish between disease and disease
Mr. Xie began to explain: "Pathological syndrome differentiation is a syndrome differentiation method that analyzes, inducts and judges the various symptoms and signs exhibited by patients under the guidance of traditional Chinese medicine theory, so as to determine the current nature of the syndrome of the disease. Identifying the disease is to identify the development trend and outcome of the disease. ”
Xiao Wang nodded, signaling that he was listening carefully. Teacher Xie continued: "Disease discrimination refers to the determination of the virtual and real properties of the disease and the attributes of cold and heat. In the theory of traditional Chinese medicine, it is believed that there is a distinction between yin and yang in the evil qi that causes disease, and there is also a difference between yin and yang in the righteous qi of the human body. Diseases with different attributes invade the human body and compete with the body's righteous qi, resulting in the imbalance of yin and yang, and the appearance of different types of disease syndromes, which are manifested as different cold and heat. ”
Teacher Xie added: "In addition, diseases generally have a certain law of development and change. Grasping the law of disease transmission can gain insight into the overall situation of disease change and prognosis, predict the evolution of syndromes in the course of the disease, and improve the accuracy of syndrome differentiation. ”
Xiao Wang asked: "Mr. Xie, I have always wanted to understand the three dimensions of TCM treatment. ”
The first dimension of TCM treatment: evidence-based legislation
Teacher Xie smiled and nodded, and began to explain: "Xiao Wang, the first dimension of TCM treatment is 'syndrome legislation', which refers to the establishment of corresponding treatment plans according to the identified disease syndromes. Each syndrome has its own specific pathological mechanism and manifestations, so the treatment should also vary according to the syndrome. For example, for wind-cold syndrome, the treatment method of Xin-Wen Jieping should be used, and for the syndrome of wind-heat cold, the treatment method of Xinliangjie should be used. Therefore, on the basis of syndrome differentiation and according to the characteristics of the disease, the corresponding treatment methods are selected to achieve the best treatment effect. ”
The second dimension of TCM treatment: choosing a prescription according to the law
Xiao Wang listened carefully as he took out his notebook and began to record. "Teacher Xie, what does it mean to 'choose a prescription according to the law'?" He asked curiously.
Teacher Xie explained with a smile: "'Choosing a prescription according to the law' means that after the treatment method is determined, we need to choose a specific treatment plan according to the requirements of the treatment method. The treatment plan includes the specific medication plan, the specific implementation method of non-drug therapies such as acupuncture and massage, and the time and frequency of treatment. The formulation of the treatment plan should comprehensively consider the nature of the disease, the course of the disease, the age, the physique, the patient's lifestyle and other factors to achieve the best treatment effect. At the same time, it is also necessary to adjust and revise the treatment plan in time according to the changes in the condition during the treatment process to ensure the effectiveness and safety of the treatment. ”
The third dimension of TCM treatment: treatment according to prescriptions
Xiao Wang nodded, and recorded this explanation with a serious face. He felt as if he was in an ocean of knowledge, waiting with anticrative anticipation for more revelations.
"The last dimension is 'treatment according to the prescription,'" Mr. Xie continued, "which means that the corresponding treatment is carried out according to the doctor's prescription. Treatment may include medication, non-pharmacological treatments such as acupuncture and massage, and dietary conditioning. Treatment is usually carried out by a health care provider, but in some cases, patients may also be able to do the treatment on their own under the guidance of a doctor. ”
Xiao Wang listened while writing this passage into his notebook. "Teacher Xie, thank you for your explanation, I think these three dimensions are really meaningful."
Teacher Xie smiled and nodded: "Yes, Xiao Wang, syndrome differentiation and treatment are two inseparable aspects in the process of diagnosis and treatment of diseases in traditional Chinese medicine, among which treatment is based on the results of syndrome differentiation, formulating treatment plans and selecting drugs. If dialectics is the premise and basis of dialectic, then dialectics is the test and extension of the accuracy of dialectic. In addition, only with accurate syndrome differentiation can an accurate treatment plan be formulated and good results can be achieved. Therefore, syndrome differentiation and treatment are the embodiment of the combination of TCM theory and practice, and are the basic principles in the clinical practice of TCM. At the same time, syndrome differentiation and treatment are also the specific applications of theories, methods, prescriptions, drugs and other aspects of knowledge in clinical practice in the theoretical system of traditional Chinese medicine. ”
During the Ming and Qing dynasties, the dialectic of diagnosis, the theory of infectious diseases and the development of traditional Chinese medicine cases
Xiao Wang asked again: "Teacher Xie, the students are checking the ancient books of traditional Chinese medicine in the Ming and Qing dynasties, what are the main developments of traditional Chinese medicine in the Ming and Qing dynasties?" ”
Teacher Xie replied: "First of all, let me tell you that Zhang Jingyue's "Jingyue Quanshu Chuan Zhonglu" in the Ming Dynasty and Cheng Zhongling's "Medical Understanding" in the Qing Dynasty all regard yin and yang, appearance and interior, cold and heat, and void and reality as the Dafa of dialectic. These basic syndrome differentiation methods ran through TCM diagnosis during the Ming and Qing dynasties. ”
Xiao Wang listened attentively and took every word of Mr. Xie to heart. He couldn't help but think of the books he had seen before, and a clear idea of these theories began to form in his mind.
Mr. Xie continued: "Shen Jinao's "Miscellaneous Diseases Source and Rhino Candle" in the Qing Dynasty is a monograph that explains miscellaneous diseases, classifying various miscellaneous diseases according to the internal organs and meridians, wind, cold, summer, dampness, external and internal injuries, etc. He listed in detail the origin, pulse, symptoms and corresponding prescriptions of each disease, described its origins, learned its symptoms, examined its main treatments, and used prescriptions according to the disease, which provided important guidance for clinical practice. ”
Xiao Wang stared at Teacher Xie's eyes tightly, as if he wanted to learn more knowledge from it. He felt Mr. Xie's profound medical skills and understood the importance of these theories in practice.
"Wu Youke's "Treatise on Warm Epidemics" in the Ming Dynasty played an important role in promoting the development of the theory of warm disease." Mr. Xie continued, "He distinguished the difference between plague and typhoid fever, summarized the invasion route, infection mode and epidemic characteristics of plague, and put forward treatment rules and medication ideas. ”
Xiao Wang stared at Mr. Xie intently, feeling his love and awe for this medicine. He recalled the theory of warm illness he had learned in medical school, and now he couldn't help but feel enlightened when he heard Mr. Xie's explanation.
Ye Tianshi of the Qing Dynasty established the Weiqiying blood syndrome differentiation method in the "External Warmth Chapter", emphasizing the importance of tongue identification and dental examination in clinical practice. Wu Jutong created the three-focal syndrome differentiation method in "Differentiation of Warm Disease". Wang Mengying's "Warm Longitude and Latitude" has perfected the theoretical system of syndrome differentiation in warm disease. Teacher Xie's voice gradually softened, as if he was communicating with the long river of time.
Xiao Wang was quietly immersed in Mr. Xie's narration, and he began to understand the wisdom contained in these historical documents, as well as the care for human health contained in them.
Teacher Xie opened the notes and read them carefully, with a focused and gentle expression. He slowly explained: "In addition, TCM diagnostics in the Ming and Qing dynasties made a great contribution to the development of infectious diseases. During this period, many physicians began to write monographs on infectious diseases, such as Lu Zhiyi's "Treatise on Malaria" in the Ming Dynasty, which focused on the diagnosis and treatment of malaria's common and degenerative diseases. "Summary of Epidemic Diphtheria", "Diphtheria Whole Life Collection" and "Diphtheria Strip Identification" are all monographs on diphtheria, which introduce the manifestations, symptoms, diagnostic methods, treatment principles, prescription medication, and prognostic judgment of diphtheria. "The Complete Book of Hemp and the Living Person", "Yu Xie Ma Ke Collection", "The New Book of Measles", and "The Integration of Measles" are monographs on measles, which summarize the pathogenesis and symptoms of measles. ”
His voice was gentle and clear, like music ringing in his ears. Xiao Wang listened quietly, intently recording every important point.
Xiao Wang asked again: "Is there still a development of understanding of cholera and plague?" ”
Mr. Xie was very satisfied and said, "Yes, Wang Mengying's "Treatise on Cholera" and Luo Zhiyuan's "Plague Contract" discuss the diagnosis and syndrome differentiation of cholera and plague in more detail. ”
Mr. Xie continued: "At the same time, the development of medical cases in the Ming Dynasty has gradually matured. Jiang Qian's "Famous Doctor's Case" collected nearly 3,000 cases of medical cases of doctors and families in the past dynasties before the Ming Dynasty and the hundred medical cases contained in the history of the Ming Dynasty, mainly in internal medicine, and also in the departments of surgery, gynecology and facial features, creating a precedent for medical cases in the mainland, and also an important monograph on the study of ancient medical cases. ”
Xiao Wang's notebook quickly appeared more content, and he was very interested in Mr. Xie's explanation.
Mr. Xie went on to say: "At the same time, a large number of personal medical case monographs have emerged, such as "Shishan Medical Case", "Zhou Shenzhai Medical Case", "Wang Kentang Medical Case", "Li Zhongzi Medical Case" and so on. ”
"In the Qing Dynasty, the development of medical cases reached its peak," Mr. Xie continued, "such as "Ancient and Modern Medical Cases", "Clinical Guide Medical Cases", "Wu Jutong Medical Cases", etc., are all collections of medical cases by some famous artists. These medical cases not only cover clinical experience, but also have strict requirements for the format of medical record writing, which has had an impact on the later medical record writing standards of traditional Chinese medicine. Among them, Wei Zhixiu's "Continuation of Famous Medical Cases" is a supplement to "Famous Medical Cases", supplementing the clinical examination cases of famous doctors in previous dynasties before the early Qing Dynasty. ”
Xiao Wang's eyes kept staring at Teacher Xie tightly, as if he wanted to engrave every word he said in his heart.