中医学英文课件Differentiationofsyndromes4

1、手三阴手三阴Differentiation of syndromes(4)Basic Theory of Traditional Chinese MedicineDifferentiation of syndromes according to the pathological changes of zang-fu organsTCM was not founded on the basis of precise anatomy. Internal organs, more accurately called zang-fu organs, actually refer to the majo

2、r functional systems of the human body. In the progress of TCM , no patho-anatomy was studied. Therefore, 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. They are th

3、e pathophysiological changes of the functional systems recognized in the light of tradition Chinese medical theories.Diagnosing 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 patho

4、genesis in a given cases, including its location, nature, and the condition of confrontation between the anti-pathogenic and pathogenic factors. In combination with the eight general parameters, determination of the pathogenic factors and the state of qi, blood and body fluids, determining the patho

5、logical changes of the internal organs usually makes a complete 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）Summarize:this often results from insufficiency

6、of heart qi and heart yang, causes retardation of blood flow in the heart，occurs in angina pectoris and myocardial infarction in western medicine. 1.stagnation and obstruction of heart blood（2）Clinical manifestations:precordial or substernal pain, stabbing or dull in character, often reaching the sh

7、oulder and arm,accompanied by palpitations, dark-purplish tongue 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）Syndrome analysis: stagnation of blood in the hea

8、rt produces cardiac pain and palpitations. As the heart meridian of 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

9、, the overall blood circulation is also retarded, leading to cyanosis. Serious deficiency of qi and yang causes spontaneous sweating and cold limbs.1.stagnation and obstruction of heart blood（4）Herbal formula :Xuefu zhuyu tang (p285) (decoction for removing blood stasis in chest)2.clouding of the he

10、art by phlegm（1） Summarize:characterized by mental derangement or loss of 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）Clinical manifestations:impaired consciousness with inconer

11、ent speech and rattling of phlegm in the throat, as observed in strokes; low spiritedness 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 i

12、n the throat as observed in epilepsy. a pale tongue with a white greasy coating a slippery pulse are also the symptoms2.clouding of the heart by phlegm:（3）Syndrome analysis:the heart is clouded by phlegm consciousness will be impaired or lost. The formation of phlegm may be related to stagnation of

13、liver qi due to emotional influences in depression, with apathy, muttering to oneself, 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 wi

14、ll go upward and cloud the heart the syndrome occurs in paroxysms. clouding of the heart 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 hear

15、t by phlegm:（4）Herbal formula :Ditan Tang 3.invasion of the lungs by wind-cold（1） Summarize: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）Clinical manifestations:Coughing with expectoration of thin and whitis

16、h sputum,chills and mild fever,no sweating, headache, stuffy and runny nose, white coating of the tongue a floating, tense pulse 3.invasion of the lungs by wind-cold（3）Syndrome analysis:Coughing the lungs are invaded by wind-cold. Disturbance of the normal flow of lung qi leads to coughing, and the

17、sputum is thin and whitish because the pathogenic cold impeding the normal distribution of 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 disc

18、harge. The lungs are also in charge of defensive qi, which resists the invading pathogens on the superficial 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.

19、In addition, the pathogenic cold closes the pores. Therefore, there are chills with fever but no sweating. 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 inte

20、rior, the tongue coating is still normal. A floating, tense pulse indicates superficial affection by cold3.invasion of the lungs by wind-cold（3）This 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 sy

21、mptom in this syndrome, while chills and fever are the main symptoms and coughing is mild or even absent.3.invasion of the lungs by wind-cold（4）Herbal formula :Mahuang tang (Decoction of Ephedra): (p260)EphedraCinnamon twigBitter apricot seedLicorice root4.invasion of the lungs by wind-heat（1）Summar

22、ize: this is an exogenous affection of the lungs caused by wind-heat and usually seen in influenza, upper respiratory infections, acute bronchitis the early stages of general infectious diseases. 4.invasion of the lungs by wind-heat（2）Clinical manifestations:Coughing with expectoration of yellow, th

23、ick sputum,fever with mild aversion to wind, dryness of the mouth and sore throat, reddened tip and yellow coating of the tongue a rapid, floating pulse.4.invasion of the lungs by wind-heat（3）Syndrome analysis:This syndrome is characterized by coughing and exterior syndrome of wind-heat. Invasion of

24、 the lungs by exogenous wind-heat impairs the cleansing and descending function of the lungs, thus causing coughing. By the 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 wi

25、nd-heat produces fever, and restraint of defensive qi by wind at the superficial portion of the body leads to mild aversion 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,

26、floating pulse indicate the presence of wind-heat.4.invasion of the lungs by wind-heat（3）The difference between this syndrome and 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

27、 in the latter coughing and expectoration is mild or even absent. Fever may be obvious in both syndromes.4.invasion of the lungs by wind-heat（4）Herbal formula :Sang Ju Yin ( p263)(Decoction of Mulberry Leaf and Chrysanthemum)5.Invasion of the lungs by heat (heat in the lungs)(1)Summarize:This is oft

28、en 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 bronchitis, pneumonia and other respiratory infections in west medicine.5.Invasion of the lungs by he

29、at (heat in the lungs)(2)Clinical manifestations:Coughing with expectoration of thick, yellow sputum,dyspnea with coarse breathing or flaring of the nares, high fever with thirst, restlessness, 5.Invasion of the lungs by heat (heat in the lungs)(2)epistaxis, hemoptysis, constipation,scanty concentra

30、ted urine,reddened tongue with yellow coating,a rapid pulse.5.Invasion of the lungs by heat (heat in the lungs)(3)Syndrome analysis:The syndrome is characterized by common symptoms of lung diseases in combination with manifestations of interior heat. Accumulation of pathogenic heat in the lungs indu

31、ces 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 the lungs, giving rise to dyspnea with coarse breathing. 5.Invasion of the lungs by heat (

32、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 injured by heat, there is epistaxis or hemoptysis. A reddened tongue with a yellow

33、coating and rapid pulse indicates heat in the interior. 5.Invasion of the lungs by heat (heat in the lungs)(4)Herbal formula :Ma xing shi gan tang (p264)(decoction of ephedra, apricot seed, gypsum and licorice root)6.Invasion of the lungs by dryness (dryness of the lungs)(1)Summarize:This syndrome c

34、an be encountered in patients with colds or bronchitis in dry seasons.6.Invasion of the lungs by dryness (dryness of the lungs)(2)Clinical manifestations:Dry cough or cough accompanied by scanty, sticky sputum difficult to expectorate, dry nose, lips, tongue and throat;chills and fever, or chest pai

35、n 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)Syndrome analysis:This syndrome is an exogenous affection characterized by dryness of the respiratory system, and at the early stage

36、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 early stage, when the pathogenic dryness stays chiefly in the

37、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 coating depend upon the intensity of the heat into which the pat

38、hogenic 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)Both invasion of the lungs by dryness and deficiency of lung yin are characterized by dryness symptoms, but the former is acute whi

39、le 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 fever accompanied by malar flush and heat sensation in th

40、e chest, palms and soles.6.Invasion of the lungs by dryness (dryness of the lungs)(4)Herbal formula :Sangxing Tang 7.Deficiency of fluid in the large intestine (1)Summarize:This is a syndrome of yin deficiency, either constitutional, or occurring during a chronic disease with impairment of yin fluid

41、 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 in the large intestine (2)Clinical manifestations

42、: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)Syndrome analysis:Deficiency of fluid in the large intestine makes the fecal mass

43、 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 of turbid qi, resulting in foul breath and d

44、izziness. 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)Herbal formula :Zengye Chengqi Tang8.Sinking of spleen qi (1)Su

45、mmarize:This 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 of the rectum or uterus, and probabl

46、y also in gastroptosis and other visceroptosis in west medicine.8.Sinking of spleen qi (2)Clinical manifestations:Deficiency of spleen qi (or yang) plus bearing-down sensation in the abdomen,Incessant diarrhea, Dripping of urine after urinationProlapse of the rectum or uterus.8.Sinking of spleen qi

47、(3)Syndrome analysis:All 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)Herbal formula :Sijunzi Tang (p288)9.Failure of the spleen to control blood (1)Summarize:This is characterized by chronic

48、 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)Clinical manifestations:MenorrhagiaHematocheziaHematuria Subcutaneous hemorrhageOther chronic hemorrha

49、gesPale tongueThready, weak pulse.9.Failure of the spleen to control blood (3)Syndrome 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.Since the bleeding is due to ch

50、ronic 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)Herbal formula :Guipi Tang (p295)10.Stagnation of food in the sto

51、mach (1)Summarize:This 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 weakness of the sto

52、mach. 10.Stagnation of food in the stomach (2)Clinical manifestations:Epigastric fullness, distension or painBelching with fetid odor Acid eructation or vomiting of sour fetid gastric contents (with alleviation of epigastric distension or pain after vomiting), or flatus and loose bowels with sour fe

53、tid stools; thick greasy tongue coating and slippery pulse.10.Stagnation of food in the stomach (3)Syndrome analysis:Stagnation of undigested food in the stomach causes epigastric fullness, distension or pain. Disturbance in the descending function of the stomach leads to upward perversion, and so t

54、here is belching with fetid odor, acid eructation or vomiting of sour fetid undigested food. 10.Stagnation of food in the stomach (3)After vomiting the pathogenic factor (undigested food) is removed, and so the distension and pain are alleviated. Stagnation of undigested food leads to formation of e

55、ndogenous damp and impairment of the intestine function, and thus frequent flatus and loose stools with sour fetid odor. Stagnation of undigested food in the stomach forces the turbid qi to ascend, thus forming the thick greasy tongue coating. Slippery pulse in food stagnation suggests excess of the

56、 pathogenic factor (undigested food) confronted by powerful qi and surging blood.10.Stagnation of food in the stomach (4)Herbal formula :Baohe Wan (p301)11.Fire in the stomach ( stomach fire) (1)Summarize:This is usually due to partiality for spicy hot food which produces heat and fire, emotional de

57、pression which leads to transformation of stagnated qi into fire, or invasion of the stomach by exogenous pathogenic heat. Clinically, the syndrome may be seen in gastritis, ulcerative stomatitis, periondontal diseases and diabetes mellitus.11.Fire in the stomach ( stomach fire) (2)Clinical manifest

58、ations:Burning pain in the epigastrium accompanied by acid regurgitation or vomiting right after eating; thirst with desire for cold drinks.polyphagia with frequent hunger; foul breath, ulceration in the mouth, swollen, painful and bleeding gums. Constipation and scanty concentraded urine, reddened

59、tongue with a yellow coating, slippery, rapid pulse.11.Fire in the stomach ( stomach fire) (3)Syndrome analysis:Fire in the stomach causes burning pain. It also leads stomach qi adversely upwards, and so there is vomiting right after eating. However, stomach fire also means hyperactivity of the stom

60、ach, and so in some cases the patient complains of excessive desire for food. The stomach meridian sends its branches to the gums. Fire of the stomach leads to ulceration in the mouth, and swollen, painful, bleeding gums, and forces turbid qi in the stomach to flow upwards, causing foul breath. 11.F