1、手三阴手三阴Differentiation of syndromes(4)Differentiation of syndromes according to the pathological changes of zang-fu organsvTCM was not founded on the basis of precise anatomy.Internal organs,more accurately called zang-fu organs,actually refer to the major functional systems of the human body.vIn the
2、 progress of TCM,no patho-anatomy was studied.vTherefore,the pathological changes of the internal organs should not be misunderstood as the patho-anatomical changes of organs and tissues on which the western diagnosis of diseases is based.vThey are the pathophysiological changes of the functional sy
3、stems recognized in the light of tradition Chinese medical theories.vDiagnosing pathological changes of the internal(zang-fu)organs is the most important component of differentiation of syndromes,for it is often a comprehensive analysis of the pathogenesis in a given cases,vincluding its location,na
4、ture,and the condition of confrontation between the anti-pathogenic and pathogenic factors.vIn combination with the eight general parameters,determination of the pathogenic factors and the state of qi,blood and body fluids,determining the pathological changes of the internal organs usually makes a c
5、omplete syndrome diagnosis,not only for non-febrile diseases in internal medicine,but also for most diseases in other branches of clinical medicine.1.stagnation and obstruction of heart blood（1）vSummarize:this often results from insufficiency of heart qi and heart yang,causes retardation of blood fl
6、ow in the heart，occurs in angina pectoris and myocardial infarction in western medicine.1.stagnation and obstruction of heart blood（2）vClinical manifestations:precordial or substernal pain,stabbing or dull in character,often reaching the shoulder and arm,accompanied by palpitations,dark-purplish ton
7、gue or purple spots on the tongue,deep,hesitant or irregular pulse,cyanosis of the face,lips and nails,cold limbs and spontaneous sweating.1.stagnation and obstruction of heart blood（3）vSyndrome analysis:stagnation of blood in the heart produces cardiac pain and palpitations.As the heart meridian of
8、 hand-shaoyang traverses the shoulder and the medial aspect of the arm,the above pain occurs.Dark-purplish tongue or purple spots on the tongue,and a deep,hesitant or irregular pulse are signs of blood stagnation.In severe cases,the overall blood circulation is also retarded,leading to cyanosis.Seri
9、ous deficiency of qi and yang causes spontaneous sweating and cold limbs.1.stagnation and obstruction of heart blood（4）vHerbal formula:vXuefu zhuyu tang(p285)v(decoction for removing blood stasis in chest)2.clouding of the heart by phlegm（1）v Summarize:characterized by mental derangement or loss of
10、consciousness,is not infrequently encountered in depressive episode,epilepsy,stoke and the critical stage of a chronic disease.2.clouding of the heart by phlegm:（2）vClinical manifestations:impaired consciousness with inconerent speech and rattling of phlegm in the throat,as observed in strokes;low s
11、piritedness with a feeling of hopelessness,apathy,muttering to oneself,2.clouding of the heart by phlegm:（2）other abnormal behavior as observed in depression;sudden loss of consciousness with convulsions and rattling in the throat as observed in epilepsy.a pale tongue with a white greasy coating a s
12、lippery pulse are also the symptoms2.clouding of the heart by phlegm:（3）vSyndrome analysis:the heart is clouded by phlegm consciousness will be impaired or lost.The formation of phlegm may be related to stagnation of liver qi due to emotional influences in depression,with apathy,muttering to oneself
13、,and other abnormal behavior.the phlegm is usually derived from dysfunction of zang-fu organs and hidden in the heart meridian in epilepsy2.clouding of the heart by phlegm:（3）liver wind is stirred up the phlegm will go upward and cloud the heart the syndrome occurs in paroxysms.clouding of the heart
14、 by an upsurge of phlegm together with endogenous wind loss of consciousness are consistent with the presence of turbid phlegm A pale tongue with a white greasy coating and a slippery pulse 2.clouding of the heart by phlegm:（4）vHerbal formula:vDitan Tang 3.invasion of the lungs by wind-cold（1）v Summ
15、arize:this is an exogenous affection of the lungs by wind-coldusually seen in colds and acute bronchitis.3.invasion of the lungs by wind-cold（2）vClinical manifestations:Coughing with expectoration of thin and whitish sputum,chills and mild fever,no sweating,headache,stuffy and runny nose,white coati
16、ng of the tongue a floating,tense pulse 3.invasion of the lungs by wind-cold（3）vSyndrome analysis:Coughing the lungs are invaded by wind-cold.Disturbance of the normal flow of lung qi leads to coughing,and the sputum is thin and whitish because the pathogenic cold impeding the normal distribution of
17、 fluid in the lungs produces phlegm,but does not condense it.The nose is the“specific opening”of the lungs.Disturbance of the dispersing function of the lungs results in a stuffed-up nose with watery discharge.The lungs are also in charge of defensive qi,which resists the invading pathogens on the s
18、uperficial part of the body.3.invasion of the lungs by wind-cold（3）When defensive qi is restrained by exogenous pathogens,chills occur;and when defensive qi resists the pathogens,heat is generated.In addition,the pathogenic cold closes the pores.Therefore,there are chills with fever but no sweating.
19、In comparison with pathogenic heat,pathogenic cold only induces mild fever while pathogenic heat may give rise to high fever.Since the pathogenic factor has not been transmitted into the interior,the tongue coating is still normal.A floating,tense pulse indicates superficial affection by cold3.invas
20、ion of the lungs by wind-cold（3）vThis syndrome is very similar to exterior cold syndrome(an exterior syndrome caused by wind-cold).The difference lies in the fact coughing is the chief symptom in this syndrome,while chills and fever are the main symptoms and coughing is mild or even absent.3.invasio
21、n of the lungs by wind-cold（4）vHerbal formula:vMahuang tang(Decoction of Ephedra):v (p260)EphedraCinnamon twigBitter apricot seedLicorice root4.invasion of the lungs by wind-heat（1）vSummarize:this is an exogenous affection of the lungs caused by wind-heat and usually seen in influenza,upper respirat
22、ory infections,acute bronchitis the early stages of general infectious diseases.4.invasion of the lungs by wind-heat（2）vClinical manifestations:Coughing with expectoration of yellow,thick sputum,fever with mild aversion to wind,dryness of the mouth and sore throat,reddened tip and yellow coating of
23、the tongue a rapid,floating pulse.4.invasion of the lungs by wind-heat（3）vSyndrome analysis:This syndrome is characterized by coughing and exterior syndrome of wind-heat.Invasion of the lungs by exogenous wind-heat impairs the cleansing and descending function of the lungs,thus causing coughing.By t
24、he action of heat,fluids in the lungs are condensed to phlegm which is thick and yellow.4.invasion of the lungs by wind-heat（3）Resistance of defensive qi against the invading wind-heat produces fever,and restraint of defensive qi by wind at the superficial portion of the body leads to mild aversion
25、to wind.Upward invasion of wind-heat causes sore throat,and impairment of body fluids by heat gives rise to thirst.Reddened tip and yellow coating of the tongue,and rapid,floating pulse indicate the presence of wind-heat.4.invasion of the lungs by wind-heat（3）vThe difference between this syndrome an
26、d exterior heat syndrome(an exterior syndrome caused by wind-heat)lies in the fact that the former is marked by coughing with expectoration of thick,yellow sputum,while in the latter coughing and expectoration is mild or even absent.Fever may be obvious in both syndromes.4.invasion of the lungs by w
27、ind-heat（4）vHerbal formula:5.Invasion of the lungs by heat(heat in the lungs)(1)vSummarize:vThis is often caused by direct invasion of the lungs by exogenous pathogenic heat or heat transformed from wind-cold or wind-heat when the latter enters the interior.It can be encountered in acute and chronic
28、 bronchitis,pneumonia and other respiratory infections in west medicine.5.Invasion of the lungs by heat(heat in the lungs)(2)vClinical manifestations:Coughing with expectoration of thick,yellow sputum,dyspnea with coarse breathing or flaring of the nares,high fever with thirst,restlessness,5.Invasio
29、n of the lungs by heat(heat in the lungs)(2)epistaxis,hemoptysis,constipation,scanty concentrated urine,reddened tongue with yellow coating,a rapid pulse.5.Invasion of the lungs by heat(heat in the lungs)(3)vSyndrome analysis:The syndrome is characterized by common symptoms of lung diseases in combi
30、nation with manifestations of interior heat.Accumulation of pathogenic heat in the lungs induces upward perversion of lung qi,resulting in coughing.The phlegm is formed due to condensation of fluids by heat,and so is thick and yellow.The pathogenic heat and phlegm impede the descending function of t
31、he lungs,giving rise to dyspnea with coarse breathing.5.Invasion of the lungs by heat(heat in the lungs)(3)The heat causes fever and impairs the body fluids,resulting in thirst,constipation and scanty,concentraded urine.The heat may also disturb the mind,causing restlessness.If blood vessels are inj
32、ured by heat,there is epistaxis or hemoptysis.A reddened tongue with a yellow coating and rapid pulse indicates heat in the interior.5.Invasion of the lungs by heat(heat in the lungs)(4)vHerbal formula:vMa xing shi gan tang(p264)v(decoction of ephedra,apricot seed,gypsum and licorice root)6.Invasion
33、 of the lungs by dryness(dryness of the lungs)(1)vSummarize:vThis syndrome can be encountered in patients with colds or bronchitis in dry seasons.6.Invasion of the lungs by dryness(dryness of the lungs)(2)vClinical manifestations:Dry cough or cough accompanied by scanty,sticky sputum difficult to ex
34、pectorate,dry nose,lips,tongue and throat;chills and fever,or chest pain with hemoptysis.Reddened tongue(or tip of the tongue)with thin white or yellow coating,a rapid pulse.6.Invasion of the lungs by dryness(dryness of the lungs)(3)vSyndrome analysis:vThis syndrome is an exogenous affection charact
35、erized by dryness of the respiratory system,and at the early stage it may be accompanied by an exterior syndrome manifested by chills and fever.Dryness is apt to be transformed into heat or fire,which goes deep into the lungs or injures the blood vessels,thus causing chest pain and hemoptysis.In the
36、 early stage,when the pathogenic dryness stays chiefly in the upper portion of the lungs,only the tip of the tongue is reddened6.Invasion of the lungs by dryness(dryness of the lungs)(3)but when it goes deep into the lungs,the whole tongue is reddened.The white and yellow colors of the tongue coatin
37、g depend upon the intensity of the heat into which the pathogenic dryness has been transformed.The rapidity of the pulse also corresponds to the intensity of the heat6.Invasion of the lungs by dryness(dryness of the lungs)(3)vBoth invasion of the lungs by dryness and deficiency of lung yin are chara
38、cterized by dryness symptoms,but the former is acute while the latter is chronic.If there is any fever in the exogenous affection of the lungs by dryness,it only persists for a short period and is often accompanied by chills,but in deficiency of lung yin there is usually long-standing afternoon feve
39、r accompanied by malar flush and heat sensation in the chest,palms and soles.6.Invasion of the lungs by dryness(dryness of the lungs)(4)vHerbal formula:vSangxing Tang 7.Deficiency of fluid in the large intestine(1)vSummarize:vThis is a syndrome of yin deficiency,either constitutional,or occurring du
40、ring a chronic disease with impairment of yin fluid or after a febrile disease when the consumed fluid has not yet been restored.It may also take place after excessive postpartum hemorrhage.As a constitutional disorder,it is most frequently manifested as habitual constipation.7.Deficiency of fluid i
41、n the large intestine(2)vClinical manifestations:Hard fecal mass with difficult infrequent elimination dryness of the mouth and throat,Accompanied by foul breath and dizzinessDry reddened tongue Thready,hesitant pulse.7.Deficiency of fluid in the large intestine(3)vSyndrome analysis:Deficiency of fl
42、uid in the large intestine makes the fecal mass hard and difficult to eliminate.The defecation is often infrequent-once every three or five days or even more than ten days.Yin deficiency causes dryness of the mouth and throat.Retention of the fecal mass in the large intestine may lead to upward flow
43、 of turbid qi,resulting in foul breath and dizziness.Deficiency of yin is accompanied by relative exuberance of yang,and hence the tongue is dry and reddened.Thready and hesitant pulse is due to insufficient fluid in the arteries.7.Deficiency of fluid in the large intestine(4)vHerbal formula:vZengye
44、 Chengqi Tang8.Sinking of spleen qi(1)vSummarize:vThis is also called“sinking of the qi of the middle energizer”or simply“sinking of middle qi.”it is often a further development of deficiency of spleen qi and may occur in some cases of chronic colitis,functional disorders of the intestines,prelapse
45、of the rectum or uterus,and probably also in gastroptosis and other visceroptosis in west medicine.8.Sinking of spleen qi(2)vClinical manifestations:Deficiency of spleen qi(or yang)plus bearing-down sensation in the abdomen,Incessant diarrhea,Dripping of urine after urinationProlapse of the rectum o
46、r uterus.8.Sinking of spleen qi(3)vSyndrome analysis:vAll the manifestations listed above in addition to deficiency of spleen qi are due to failure of the spleen in its lifting function.8.Sinking of spleen qi(4)vHerbal formula:vSijunzi Tang(p288)9.Failure of the spleen to control blood(1)vSummarize:
47、vThis is characterized by chronic bleeding,particularly in the lower part of the body,and is often seen in functional uterine bleeding,hematochezia,hematuria and hemorrhagic diseases.9.Failure of the spleen to control blood(2)vClinical manifestations:MenorrhagiaHematocheziaHematuria Subcutaneous hem
48、orrhageOther chronic hemorrhagesPale tongueThready,weak pulse.9.Failure of the spleen to control blood(3)vSyndrome analysis:The spleen has the function of keeping the blood flowing within the blood vessels.If deficiency of spleen qi affects this function,blood will escape from the blood vessels.Sinc
49、e the bleeding is due to chronic deficiency of spleen qi,which is often accompanied by loss of its ascending power or lifting function,the bleeding is often chronic and chief occurring in the lower part of the body.9.Failure of the spleen to control blood(4)vHerbal formula:vGuipi Tang(p295)10.Stagna
50、tion of food in the stomach(1)vSummarize:vThis is a syndrome caused by impaired digestive function of the stomach with stagnation of undigested food.In most cases,it occurs in indigestion due to improper diet,particularly due to taking too much food and drink at one meal.It may also be attributed to
