1、脏腑辨证脏腑辨证 脏腑辨证脏腑辨证，是在认识脏腑生理功能、病变，是在认识脏腑生理功能、病变 特点的基础上，将四诊所收集的症状、体特点的基础上，将四诊所收集的症状、体 征及有关病情资料，进行综合分析，从而征及有关病情资料，进行综合分析，从而 判断疾病所在的脏腑部位判断疾病所在的脏腑部位 、病因、病性等，、病因、病性等， 是为临床治疗提供依据的辨证归类方法。是为临床治疗提供依据的辨证归类方法。 简言之，即以简言之，即以脏腑脏腑为纲，对疾病进行辨证。为纲，对疾病进行辨证。 Syndrome differentiation of Syndrome differentiation of viscerav
2、iscera Syndrome differentiation of viscera means Syndrome differentiation of viscera means to differentiate syndromes according to the to differentiate syndromes according to the physiological functions and pathological physiological functions and pathological changes of the viscerachanges of the vi
3、scera 脏腑辨证脏腑辨证是中医辨证体系中的重要内容之是中医辨证体系中的重要内容之 一，也是中医临床各科辨证的必备基础。一，也是中医临床各科辨证的必备基础。 中医用于临床的辨证方法较多，但中医用于临床的辨证方法较多，但脏腑辨脏腑辨 证证的内容比较系统、完整，生理、病理概的内容比较系统、完整，生理、病理概 念均较确切，纲目清楚，内容具体，因此，念均较确切，纲目清楚，内容具体，因此， 脏腑辨证脏腑辨证是临床辨证的基本方法，是整个是临床辨证的基本方法，是整个 辨证体系中的重要组成部分。辨证体系中的重要组成部分。 Syndrome differentiation of viscera is the
4、base for syndrome differentiation in the clinical specialties of TCM and is an important part in the syndrome differentiation system in TCM .Among many syndrome differentiation methods, Syndrome differentiation of viscera is systematic and complete, with exact physiological and pathological concept,
5、 clear outline and specific content. 脏腑生理功能及其病理变化是脏腑辨证的脏腑生理功能及其病理变化是脏腑辨证的 理论依据。脏腑病证是脏腑功能失调反映理论依据。脏腑病证是脏腑功能失调反映 于外的客观征象。由于各脏腑的生理功能于外的客观征象。由于各脏腑的生理功能 不同，所以它反映出来的症状、体征也不不同，所以它反映出来的症状、体征也不 相同。根据脏腑不同的生理功能及其病理相同。根据脏腑不同的生理功能及其病理 变化来分辨病证，这是脏腑辨证的理论依变化来分辨病证，这是脏腑辨证的理论依 据。所以熟悉各据。所以熟悉各脏腑的生理功能及其病变脏腑的生理功能及其病变 特点特点
6、，则是脏腑辨证的基本方法。，则是脏腑辨证的基本方法。 Physiological and pathological change of viscera is the theoretical basis of the syndrome differentiation of viscera . Visceral Disease Syndrome is the outside reflection of dysfunctional viscera. Different symptoms and signs are reflected due to the physiological function
7、 differences. The theoretical basis of the syndrome differentiation of viscera is to distinguish syndrome according to the differences of physiological functions and pathological changes of viscera. Therefore, the basic method of syndrome differentiation of viscera is to know the physiological funct
8、ions and pathological features of viscera well. 人体是人体是以五脏为中心的有机整体以五脏为中心的有机整体，脏腑之，脏腑之 间、脏腑与各组织器官之间，间、脏腑与各组织器官之间， 他们在生理他们在生理 上相互联系，在病理上则相互影响。因此，上相互联系，在病理上则相互影响。因此， 在进行脏腑辨证时，一定要从整体观念出在进行脏腑辨证时，一定要从整体观念出 发，分析脏腑病变所属证候，仔细审辨其发，分析脏腑病变所属证候，仔细审辨其 内在联系。内在联系。 human body is an organic whole, with the five interna
9、l organs as the center . Various visceras, organs and tissues are interacted physically and interconnected pathologically with each other . Therefore, overall concept is important in the Syndrome differentiation of viscera 注意注意八纲、病因、气血津液各种辨证方法八纲、病因、气血津液各种辨证方法 与与脏腑辨证方法脏腑辨证方法的相互关系。的相互关系。脏腑辨证不脏腑辨证不 单是以
10、辨明病证所在脏腑的病位为满足，单是以辨明病证所在脏腑的病位为满足， 还应分辨出脏腑病位上的病因和病性。如还应分辨出脏腑病位上的病因和病性。如 在在脏腑实证脏腑实证中，有寒、热、痰、瘀、水、中，有寒、热、痰、瘀、水、 湿等不同；在湿等不同；在脏腑虚证脏腑虚证中，又有阴、阳、中，又有阴、阳、 气、血虚之别，只有探明病因病性病机，气、血虚之别，只有探明病因病性病机， 才能为立法、处方、用药提供确切依据。才能为立法、处方、用药提供确切依据。 Visceral Syndrome is not only to identify the location of disease syndromes in th
11、e viscera, but also to distinguish the cause and nature of disease, such as the difference of cold, heat, phlegm, blood stasis, bluid and dampness in visceral sthenia syndrome, and the yin, yang, qi, blood deficiency in visceral visceral asthenia syndrome. Understanding the pathogenesis, cause and n
12、ature of disease clearly is the basis of method determination prescription and medication. 脏腑的证候类型繁多，各证候的临床表现脏腑的证候类型繁多，各证候的临床表现 异常复杂。要想准确地掌握各证的临床特异常复杂。要想准确地掌握各证的临床特 点（审证要点），必须抓准各证的点（审证要点），必须抓准各证的主要脉主要脉 症症，反复地进行鉴别。尤其对类同的证候，反复地进行鉴别。尤其对类同的证候， 要重点审察其同中之异的症状和体征。要重点审察其同中之异的症状和体征。 There are various syndrom
13、es of viscera many organs, with complex clinical manifestations. In order to accurately master the clinical features of different syndromes, its critical to grasp the main symptom and pulse condition of the syndrome with repeated identification. Especially for the similar syndromes, its essential to
14、 distinguish the differences of similar symptoms and signs. 一、心与小肠病辨证 居胸中，心包络护卫于外，为心主之宫城。居胸中，心包络护卫于外，为心主之宫城。 手少阴心经循臂内侧后缘，下络小肠，与手少阴心经循臂内侧后缘，下络小肠，与 小肠互为表里。心开窍于舌，在体合脉，小肠互为表里。心开窍于舌，在体合脉， 其华在面。心的主要生理功能：一是其华在面。心的主要生理功能：一是主血主血 脉脉，具有推动血液在脉道中运行不息的作，具有推动血液在脉道中运行不息的作 用；另则是用；另则是主神明主神明，为人体精神和意识思，为人体精神和意识思 维活动的中枢
15、。维活动的中枢。 一、syndrome differentiation of heart and small intestinal disease The heart is situated in the chest, with pericardium guarding outside. the Heart Meridian of Hand- Shaoyin is along the trailing edge of medial arm and connected to small intestine with a exterior-interior relationship.The hea
16、rt opens into the tongue, connects to vein in the body and has its outward manifestations in the face. The main physiological functions of the heart: one is to dominate blood and vessels since it is the motive force for blood circulation; the other is to house the mind as the centre of human spirit
17、and consciousness. 心的病变主要反映在心的病变主要反映在主血脉主血脉功能的失常，功能的失常， 主心神主心神的意识思维等精神活动的异常。的意识思维等精神活动的异常。 Pathological changes of the heart refer to the dysfunction of the heart and its functions to govern the mind and blood vessels。 心病的证候有心病的证候有虚实虚实之分。之分。虚证虚证多由思虑劳多由思虑劳 神太过，或先天不足，脏气虚弱，久病伤神太过，或先天不足，脏气虚弱，久病伤 心，导致心，导
18、致心气虚心气虚、心阳虚心阳虚、心阴虚心阴虚、心血心血 虚虚、心阳暴脱心阳暴脱；实证实证多由痰阻、火扰、寒多由痰阻、火扰、寒 凝、气郁、瘀血等原因，导致凝、气郁、瘀血等原因，导致心火亢盛心火亢盛、 心脉痹阻心脉痹阻、痰迷心窍痰迷心窍及及痰火扰神证痰火扰神证。 The heart disease is either asthenic or sthenic. Asthenic heart disease is usually due to excessive anxiety, congenital defects, asthenia of visceral qi in senility or imp
19、airment of the heart by prolonged illness which leads to asthenia of heart qi, asthenia of heart blood, asthenia of heart yin and sudden loss of heart yang. Sthenic heart disease is due to phlegm retention, fire disturbance, cold coagulation, qi stagnation and blood stasis which lead to obstruction
20、of heart vessels hyperactivity of heart fire, confusion of heart by phlegmatic fired disturbing the heart. 心：心： 虚证虚证气、血、阴、阳气、血、阴、阳 实证实证火、热、痰、瘀、寒、气火、热、痰、瘀、寒、气 小肠：小肠： 小肠实热小肠实热 heart： astheniaqiqi、bloodblood、yinyin、yangyang stheniastheniafirefire、heatheat、phlegmphlegm、stasisstasis、 coldcold、qiqi small
21、intestinesmall intestine： sthenic heat syndrome of small intestinesthenic heat syndrome of small intestine 心病的常见症状：心病的常见症状：惊悸、怔忡、心痛、心烦、失惊悸、怔忡、心痛、心烦、失 眠、多梦眠、多梦、健忘、神昏、神识错乱健忘、神昏、神识错乱，脉结代或促、脉结代或促、 舌痛、舌疮舌痛、舌疮等。（舌体病变，归属于心）等。（舌体病变，归属于心） 心火下移小肠：小便赤涩灼痛。心火下移小肠：小便赤涩灼痛。 Clinical manifestations of heart diseaseC
22、linical manifestations of heart disease： palpitationpalpitation, , chest painchest pain, , dysphoriadysphoria, , insomnia,insomnia, dreaminessdreaminess, amnesia, coma, , amnesia, coma, confusion of confusion of consciousnessconsciousness , knotted and slow regular , knotted and slow regular intermi
23、ttent pulse or fast pulse, intermittent pulse or fast pulse, ulceration and ulceration and pain of tongue,etcpain of tongue,etc. . Heart fire transmit to the small intestineHeart fire transmit to the small intestine： Urinary Urinary difficulty with burning paindifficulty with burning pain。 （一）心气虚、心阳
24、虚：（一）心气虚、心阳虚： 心气虚：心气虚：心之常见症状心之常见症状+ +气虚证气虚证 心阳虚：心之常见症状心阳虚：心之常见症状+ +阳虚证阳虚证 （二）心血虚、心阴虚：（二）心血虚、心阴虚： 心血虚：心之常见症状心血虚：心之常见症状+ +血虚证血虚证 心阴虚：心之常见症状心阴虚：心之常见症状+ +阴虚证阴虚证 （一）（一）heart heart qiqi asthenia asthenia 、heart yang astheniaheart yang asthenia： heart heart qiqi asthenia asthenia ：common symptoms of common
25、 symptoms of heart disease + heart disease + qiqi astheniaasthenia heart yang asthenia heart yang asthenia ：common symptoms of common symptoms of heart disease + yang astheniaheart disease + yang asthenia （二）（二）heart blood astheniaheart blood asthenia、heart yin heart yin astheniaasthenia： heart bloo
26、d asthenia heart blood asthenia ： common symptoms common symptoms of heart disease +blood astheniaof heart disease +blood asthenia heart yin asthenia heart yin asthenia ： common symptoms of common symptoms of heart disease + yin astheniaheart disease + yin asthenia 心血虚：心血虚： 【临床表现临床表现】心悸，头晕，失眠多梦，健心悸，
27、头晕，失眠多梦，健 忘，面色淡白或萎黄，唇、舌色淡，脉细忘，面色淡白或萎黄，唇、舌色淡，脉细 弱。弱。 心血亏虚，不能濡养心脏心血亏虚，不能濡养心脏 本证以心悸、失眠及血虚证为审证要点。本证以心悸、失眠及血虚证为审证要点。 Heart blood astheniaHeart blood asthenia： 【clinical manifestationsclinical manifestations】 palpitation, dizziness, insomnia, palpitation, dizziness, insomnia, dreaminess, amnesia, pale com
28、plexion or sallow dreaminess, amnesia, pale complexion or sallow complexion, pale lips and tongue as well as thin and weak complexion, pale lips and tongue as well as thin and weak pulse.pulse. Insufficiency of heart blood failure to nourish the heart.Insufficiency of heart blood failure to nourish
29、the heart. Key points for syndrome differentiaton: Key points for syndrome differentiaton: palpitation, insomnia, dreaminess and blood palpitation, insomnia, dreaminess and blood astheniaasthenia 【证候分析证候分析】心血不足，心失所养，心动心血不足，心失所养，心动 不安，故心悸怔忡；血不养心，心神不宁，不安，故心悸怔忡；血不养心，心神不宁， 则失眠多梦；血虚不能上荣头面，故见头则失眠多梦；血虚不能上荣
30、头面，故见头 晕、健忘、面色淡白或萎黄、唇舌色淡，晕、健忘、面色淡白或萎黄、唇舌色淡， 不能充盈脉道则脉象细弱。不能充盈脉道则脉象细弱。 【syndrome analysis 】 palpitation is due to insufficiency of heart blood ,lack of proper nourishment of the heart, and irregular heart beating, insomnia and dreaminess are due to failure of blood to nourish the heart and anxiety; di
31、zziness, amnesia, pale or sallow complexion as well as light whitish lips and tongue are due to failure of asthenic blood to nourish the head and face; thin and weak pulse is due to insufficiency of blood in the vessels. 心阴虚心阴虚 【临床表现临床表现】心烦心悸，失眠，多梦，或心烦心悸，失眠，多梦，或 见五心烦热，午后潮热，盗汗，两颧发红，见五心烦热，午后潮热，盗汗，两颧发红
32、， 舌红少津，脉细数。舌红少津，脉细数。 心阴亏损，虚热内扰心阴亏损，虚热内扰 本证以悸烦不宁、失眠多梦及阴虚证为审本证以悸烦不宁、失眠多梦及阴虚证为审 证要点。证要点。 Heart yin asthenia 【 clinical manifestations 】dysphoria, palpitation, insomnia, dreaminess, afternoon tidal fever, feverish sensation over five centers, flushed cheeks, night sweeting, reddish tongue with scanty sa
33、liva, thin and fast pulse. Insufficiency of heart yin, asthenic heat disturbing the heart Key points for syndrome differentiation: palpitation, dysphoria, insomnia, dreaminess and yin asthenia syndrome. 【证候分析证候分析】心阴不足，心失所养，心动心阴不足，心失所养，心动 不安，故心悸怔忡；阴虚心神失养，且虚不安，故心悸怔忡；阴虚心神失养，且虚 热扰心，心神不安，故心烦、失眠多梦；热扰心，心神不
34、安，故心烦、失眠多梦； 阴不制阳，虚热内生，则五心烦热，潮热，阴不制阳，虚热内生，则五心烦热，潮热， 盗汗，颧红；舌红少苔脉细数为阴虚内热盗汗，颧红；舌红少苔脉细数为阴虚内热 之象。之象。 【symptoms analysis 】palpitation is due to insufficiency of heart yin, lack of proper nutrition of the heart and irregular heart beating: dysphoria insomnia an dreaminess are due to lack of proper nutrition
35、 of the heart, asthenic heat disturbing the heart and anxiety; feverish sensation over the five centers ,afternoon tidal fever flushed cheeks and night sweating are due to failure of yin to control yang and internal generation of asthenic heat; reddish tongue with scanty saliva and thin and fast pul
36、se are signs of yin asthenia an internal heat. 心血虚心血虚与与心阴虚心阴虚二证均属心之阴血不足，二证均属心之阴血不足， 故均以故均以心悸失眠心悸失眠为主症。不同之处是为主症。不同之处是心血心血 虚虚尚有血虚不荣而致的面唇、爪甲及舌质尚有血虚不荣而致的面唇、爪甲及舌质 的淡白。而的淡白。而心阴虚心阴虚常有阴虚而生内热的烦常有阴虚而生内热的烦 热，颧红盗汗，舌红少津，脉数等症状。热，颧红盗汗，舌红少津，脉数等症状。 Heart blood asthenia and heart yin asthenia are both deficiency of h
37、eart yin and blood, so palpitations and insomnia are the same main symptoms of them. The differences are the pale complexion, lips, nails and tongue due to deficiency of heart blood in heart blood asthenia and the feverish sensation, flushed cheeks, night sweating, reddish tongue with scanty saliva
38、and fast pulse due to deficiency of heart yin in heart yin 心气虚心气虚 【临床表现临床表现】心悸，气短，精神疲惫，动心悸，气短，精神疲惫，动 后加重，面色淡白，或有自汗，舌质淡，后加重，面色淡白，或有自汗，舌质淡， 脉虚。脉虚。 心气不足，鼓动无力心气不足，鼓动无力 本证以心悸及气虚证为审证要点。本证以心悸及气虚证为审证要点。 Heart qi asthenia 【clinical manifestations 】palpitation, shortness of breath, spiritual lassitude, aggrav
39、ation after movement,pale complexion, or spontaneous sweating, pale tongue and weak pulse. Insufficiency of heart qi, failure of heart qi to propel Key points for syndrome differentiation: palpitation and qi asthenia syndrome 【证候分析证候分析】心气不足，鼓动乏力，则心心气不足，鼓动乏力，则心 悸、怔忡；心居胸中，心气亏虚，胸中宗悸、怔忡；心居胸中，心气亏虚，胸中宗 气运
40、转无力，故胸闷气短；心神失养则神气运转无力，故胸闷气短；心神失养则神 疲乏力；动则气耗，故活动劳累之后诸症疲乏力；动则气耗，故活动劳累之后诸症 加剧；汗为心液，心气虚则肌表不固，故加剧；汗为心液，心气虚则肌表不固，故 自汗；气虚运血无力，气血不充，则面色自汗；气虚运血无力，气血不充，则面色 淡白、舌淡苔白、脉弱。淡白、舌淡苔白、脉弱。 【symptoms analysis 】insufficiency of heart qi, lack of proper moisture an nourishment of the heart and irregular beating of the hea
41、rt lead to palpitation; shortness of breath and spiritual lassitude are due to functional decline resulting from qi asthenia; spontaneous sweating is due to qi asthenia and weakness of weiqi to protect the superficies; aggravation after movement is due to consumption of qi after movement; pale compl
42、exion, pale tongue and weak pulse are due to failure of asthenic qi to propel and insufficiency of qi and blood. 心阳虚心阳虚 【临床表现临床表现】心悸怔忡，心胸憋闷或痛，心悸怔忡，心胸憋闷或痛， 气短，自汗，形寒畏冷，面色气短，自汗，形寒畏冷，面色晄晄白，或面白，或面 唇青紫，舌质淡胖或紫暗，苔白滑，脉弱唇青紫，舌质淡胖或紫暗，苔白滑，脉弱 或结代。或结代。 心阳虚衰，鼓动无力，虚寒内生心阳虚衰，鼓动无力，虚寒内生 本证以心悸怔忡、胸闷和阳虚证为审证要本证以心悸怔忡、胸闷和阳虚证为
43、审证要 点点 Heart yang asthenia 【clinical manifestations 】palpitation, chest oppression or pain, shortness of breath, spontaneous sweating, aversion to cold and cold limbs, pale complexion or cyanotic complexion and lips, pale and bulgy tongue or purplish tongue, whitish slippery tongue fur, weak pulse,
44、or knotted pulse, or slow regular intermittent pulse. Asthenia of heart yang, weakness to propel, endogenous asthenia cold generated Key points for syndrome differentiation: palpitation, chest oppression or pain and yang asthenia. 【证候分析证候分析】心阳不振，鼓动无力，心动心阳不振，鼓动无力，心动 失常，故心悸怔忡；胸阳不振，阳虚则寒失常，故心悸怔忡；胸阳不振，阳虚
45、则寒 凝，寒凝则经脉不通，轻则胸闷气短，重凝，寒凝则经脉不通，轻则胸闷气短，重 则心痛；心阳虚衰，卫外不固，则自汗；则心痛；心阳虚衰，卫外不固，则自汗； 阳气亏虚，形体失于温煦，则畏寒肢冷；阳气亏虚，形体失于温煦，则畏寒肢冷； 胖，苔白滑，脉沉迟无力，或微细均为阳胖，苔白滑，脉沉迟无力，或微细均为阳 虚寒盛之象，脉气不相接续则脉结、代。虚寒盛之象，脉气不相接续则脉结、代。 【symptoms analysis 】palpitation is due to asthenia of heart yang, weakness to propel and irregular heart beating
46、; chest oppression or pain and shortness of breath are due to inactivation of thoracic yang; aversion to cold and cold limbs are due to yang asthenia and lack of proper warming; spontaneous sweating is due to weakness or weiqi to protect the superficies; pale complexion or cyanotic complexion and li
47、ps as well as knotted pulse ,slow regular intermittent pulse or weak pulse are due to asthenia of heart yang to warm and propel and inhibited circulation of blood; pale and bulgy tongue or purplish tongue as well as white and slippery fur are signs of asthenia and exuberant cold. 心阳虚脱心阳虚脱 【临床表现临床表现】
48、在心阳虚证表现的基础上，在心阳虚证表现的基础上， 更见突然冷汗淋漓，四肢厥冷，呼吸微弱，更见突然冷汗淋漓，四肢厥冷，呼吸微弱， 面色苍白，或心痛剧烈，口唇青紫，脉微面色苍白，或心痛剧烈，口唇青紫，脉微 欲绝，甚或神智模糊，昏迷不醒欲绝，甚或神智模糊，昏迷不醒 心阳衰极，阳气暴脱心阳衰极，阳气暴脱 本证以心阳虚和亡阳的临床表现为审证要本证以心阳虚和亡阳的临床表现为审证要 点点 Sudden loss of heart yang 【clinical manifestations 】Apart from the symptoms of heart yan asthenia, there appear
49、 some other symptoms, such as sudden profuse cold sweating, cold limbs,weak breath, pale complexion, or sharp heart pain, cyanotic lips, indistinct pulse, even or unconsciousness and coma. Extreme asthenia of heart yang, sudden loss of yangqi. Key points for syndrome differentiation: asthenia of heart yang and sudden loss of yangqi. 【证候分析证候分析】阳气衰亡，津随气泄，故冷阳气衰亡，津随气泄，故冷 汗淋漓，不能温煦肢体，则四肢厥冷；
