The content of the eight classes, Neijing laid the foundation for the differentiation of the eight classes. Zhang Zhongjing is more specialized in the diagnosis and treatment of typhoid miscellaneous diseases. Jingyue Quanshu contains Yin and Yang, six changes and so on. , further clarified the eight cardinals.
The clinical manifestations of the disease are ever-changing and complicated. According to the differentiation of eight syndromes, any disease can be classified by yin and yang, characterized by cold and heat, reflected by exterior and interior, and explained by excess and deficiency. Eight categories is a dialectical method to analyze the essence of diseases, and it is the general outline of various syndromes. In the process of disease diagnosis, it has the function of grasping simplicity, controlling complexity and outlining, which is suitable for syndrome differentiation of clinical disciplines. Specifically, it is to deepen the syndrome differentiation of all subjects on the basis of the eight programs.
In the eight categories of syndrome differentiation, the relationships among the eight syndromes of yin and yang, cold and heat, exterior and interior, and deficiency and excess are not parallel. Generally speaking, exterior syndrome, heat syndrome and excess syndrome all belong to the category of yang syndrome. Internal syndrome, cold syndrome and deficiency syndrome all belong to the category of yin syndrome. Therefore, in the eight-program syndrome differentiation, Yin-Yang syndrome is the general program that summarizes the other six syndromes. In addition, the eight syndromes are not independent of each other, but mixed and crossed with each other, reflecting complex clinical manifestations.
Under certain conditions, the exterior and interior disease sites and the cold and heat properties of deficiency and excess can often be transformed to different degrees, such as exterior pathogenic factors entering the interior, interior pathogenic factors exiting the exterior, cold syndrome turning into heat, heat syndrome turning into cold, from excess into deficiency, and deficiency into excess. When the disease develops to a certain stage, there may be some illusions that are contrary to the nature of the disease. Such as true winter vacation hot, true hot and false cold, true and false, true and false and so on. Therefore, when differentiating the eight syndromes, we should not only be familiar with the characteristics of the eight syndromes, but also pay attention to the relationship between them.
yin and yang
Yin He not only summarized the whole illness, but also used it to analyze a symptom. In the "Su Wen Yin and Yang should be like a big theory", it is put forward: "Look at the color and pulse, don't talk about Yin and Yang first." It is also said that "Yang disease cures Yin, and Yin disease cures Yang". Zhang Zhongjing divided typhoid fever into yin syndrome and yang syndrome, taking three Yin San yang as the general program. Zhang Jingyue, a physician in the Ming Dynasty, also emphasized that "Yin and Yang must be examined first for pulse diagnosis, which is the key to treating diseases". This yin and yang is the general program of syndrome differentiation of the eight programs, which can guide the three pairs of programs of exterior and interior, cold and heat, and excess and deficiency, so some people call the eight programs "two programs and six essentials." Therefore, syndrome differentiation of yin and yang plays an important role in disease syndrome differentiation.
Yin syndrome and yin syndrome
All diseases in the blood, including cold, lack of healthy qi, and the body's reaction is mostly falling, which belongs to the category of yin syndrome. Its symptoms are listlessness, pallor, chills, shortness of breath, low voice, no thirst, loose stool, long urine, pale tongue with white fur, and slow pulse. Its etiology and pathogenesis are old age and infirmity, or long-term internal injury, or exogenous pathogens spread to viscera, resulting in weak vital qi, yang deficiency and yin excess.
All symptoms of exterior syndrome, qi syndrome, true syndrome, heat syndrome, vital qi syndrome and physical hyperresponsiveness belong to the category of yang syndrome. Its symptoms are irritability, red face, strong breath, liking cold drinks, thick breath, abdominal pain and constipation, short and red urine, red tongue with yellow fur, floating or slippery pulse. Its etiology and pathogenesis are the invasion of evil spirits, the strong evil spirits, and the dispute between positive and negative.
Yin deficiency and yang deficiency
Yin deficiency and Yang deficiency are syndromes caused by yin and yang deficiency of human viscera. Under normal physiological conditions, the human body should maintain a relative balance between Yin and Yang, that is, "Yin is the secret and God is the right" (Su Wentong's Theory of Wondering Heaven). Once yin and yang lose this relative balance, there will be ups and downs of yin and yang, resulting in diseases.
The symptoms of Yin deficiency syndrome are hot flashes, night sweats, fever in hands and feet, emaciation, dry mouth and throat, short and red urine, red tongue with little fur and weak pulse. Its etiology and pathogenesis is chronic illness or atrioventricular strain, which leads to insufficient essence, blood and body fluid, and yin does not control yang.
The symptoms of yang deficiency syndrome include fatigue, pale face, shortness of breath, laziness in speaking, chills and cold limbs, spontaneous sweating, pale mouth and thirst, thin stool, long urine, pale tongue with white and wet fur and weak pulse. Its etiology and pathogenesis are chronic diseases, or strain, or sweating, vomiting, diarrhea and so on. , leading to yang deficiency, yang can not make yin.
Death of Yin and Death of Yang
Yin death and Yang death are mostly critical syndromes in the development of diseases. The death of yin mostly occurs in the case of rapid loss of vaginal fluid such as high fever and sweating, severe vomiting and diarrhea, and excessive blood loss. Common symptoms are excessive sweating, sticky, shortness of breath, warm hands and feet, restlessness, cold drinks, flushed face, red and dry tongue, weak pulse, etc. The death of yang is often caused by excessive pathogenic toxin, or visceral diseases that seriously consume yang in the body, and can also be caused by sweating, vomiting, diarrhea, bleeding, etc. Common cold sweat is like beads, pale face, weak breathing, chills in limbs, listlessness, pale tongue with moist fur and thready pulse.
internally and externally
Exterior and interior are two categories that distinguish the depth of lesions and the severity of diseases. Inside and outside is the concept of body structure. In Neijing, table is called table, including fur and muscle. The term "internal" refers to internal organs. "On Su Wen and Cough" said: "The moss is combined with the lung, and the moss is first affected by evil spirits, and the evil spirits are combined with it." This kind of fur is affected by evil spirits and belongs to exterior syndrome. Su Wenzhi's Theory of Truth also puts forward the law that "although it is on the skin, it is sweating". This is the origin of syndrome differentiation and treatment of exterior syndrome. Except exterior syndrome, all other diseases belong to interior syndrome. Generally speaking, diseases of fur, muscle carbuncle and meridians belong to exterior syndrome, and the condition is mild; The disease belongs to the internal syndrome of viscera, blood vessels and bone marrow, and its condition is serious.
Surface syndrome
Exterior syndrome refers to a syndrome caused by the invasion of six evils into human body from fur, mouth and nose, which is caused by diseases of skin and meridians. It has the characteristics of acute onset, short course of disease and shallow disease location.
Clinical symptoms: fever, aversion to cold, body pain, headache, thin and white fur, floating lungs, cough, cold nose and other symptoms.
Etiology and pathogenesis: the evil of six evils is on the surface of fur and muscle, which hinders the declaration of Wei qi and causes depression and fever; And Yang Can doesn't warm the skin, so it hates the cold; The lung governs fur and the nose enlightens. Fur, nose and mouth are affected by evil, and lung qi is not conducive to nasal congestion and cough. Pathogenic qi is depressed in meridians, and qi and blood are not strong, so headache and body pain; The conflict between good and evil leads to floating pulse and thin and white tongue coating.
The exterior syndrome can be divided into the following categories:
Exterior cold: wind and cold attack, and good and evil compete for muscle surface. Symptoms include severe aversion to cold, headache and obvious body pain, thin white and wet tongue coating and tight pulse.
Wind-heat pathogen invades lung-defense. Symptoms include mild aversion to cold, fever, sore throat, thin white and yellow tongue coating, thirst, red tongue and rapid pulse.
Exterior deficiency: wind pathogen invades the muscle surface, and the function of exterior defense is unstable, with symptoms of heavy wind, sweating and slow pulse.
External reality: the wind and cold attack from outside, the struggle between good and evil, and the principle of not tightening up. Symptoms include aversion to cold, no sweat, headache, body pain and tight pulse.
Internal syndrome
Interior syndrome refers to a kind of syndrome in which exogenous pathogenic factors enter the interior from the exterior or directly, as well as internal injuries caused by seven emotions, diet and fatigue. And diseases are caused by viscera, qi and blood, bone marrow, etc. The clinical manifestations are diverse, with the characteristics of long course and deep disease location.
Clinical symptoms: no aversion to wind-cold, no floating pulse, mostly changes in tongue quality and tongue coating.
Etiology and pathogenesis: generally affected by three factors, one is the development of exterior syndrome, that is, exterior syndrome entering the interior; Second, exterior evil is caused by viscera; Third, emotional internal injuries, diet, fatigue and so on lead to visceral dysfunction.
Interior syndrome can be classified as follows:
Internal cold: external cold spreads to the inside, or yang deficiency. Symptoms include aversion to cold and preference for warmth, tepid limbs, thirst, nausea and vomiting, abdominal pain and diarrhea, long urine, white and slippery fur and delayed pulse.
Internal heat: Exogenous evil turns into heat, or heat evil goes straight into viscera, or five influences turn into fire. Symptoms include aversion to cold, aversion to heat, high fever, thirst, irritability, hyperhidrosis, constipation, short and red urine, Huang Gan coating, rapid or heavy pulse.
Deficiency in the interior: deficiency of yin and yang, qi and blood in viscera, and decreased function. Symptoms: listlessness, timidity in a low voice, loss of appetite, abdominal pain, dizziness, palpitation, loose stool, pale tongue, white fur and weak pulse.
Interior excess: Exogenous pathogen enters the interior, which is associated with gastrointestinal tract, or caused by dysfunction of viscera. Symptoms: Abdominal distension and pain, refusal to press, constipation, Huang Chi in urine, sweaty hands and feet, thick and dark tongue coating, and heavy and firm pulse.
Relationship between exterior syndrome and interior syndrome
Inside-out syndrome: due to the enhancement of the body's disease resistance or proper treatment and nursing, the pathogenic factors reach the muscle surface from the inside out, that is, from the inside out. If the interior syndrome is agitated due to internal heat, cough and chest tightness, and then fever and sweating, irritability is relieved, or macula appears, this is the phenomenon that pathogenic factors are from the outside to the inside.
Exterior syndrome entering the interior: Exterior syndrome entering the interior may be caused by low disease resistance or excessive pathogenic factors, or improper treatment and nursing. If fever and aversion to cold occur instead of aversion to cold, symptoms such as polydipsia and polydipsia, red tongue with yellow fur and red urine will appear, indicating that the disease has changed from exterior to interior heat syndrome.
Exterior-interior disease: refers to the simultaneous appearance of exterior syndrome and interior syndrome in a certain period of time. In the early stage of the disease, in addition to both exterior and interior syndrome, it is mostly due to both exterior and interior syndrome; Or the superficial disease is not solved, complicated with other diseases, such as exogenous diseases, food damage, etc. Internal injuries come first, and exogenous diseases come last.
Syndrome of semi-exterior and semi-interior refers to the fact that in the process of disease development, pathogenic factors compete with each other, so that pathogenic factors can neither enter the interior, healthy qi can not drive away pathogenic factors from the exterior, and pathogenic factors are between the exterior and the interior. The clinical manifestations are cold and fever, bitter taste, dry throat, dizziness, fullness in chest and hypochondrium, upset and vomiting, eating and drinking, and thready pulse.
Chills and fever
Cold and heat are two categories that distinguish the nature of diseases. Generally speaking, cold syndrome means that the body yang is insufficient or cold pathogen is felt, while heat syndrome means that the body yang is excessive or heat pathogen is felt. There are many expositions about cold and heat in Neijing. For example, Su Wen's Yin and Yang should be alike, clearly pointing out that "Yang wins the heat, while Yin wins the cold", and Su Wen's Theory of Truth puts forward the therapeutic principle of "cold is hot, and heat is cold".
Cold syndrome
Cold syndrome is a syndrome characterized by feeling cold evil, or yang deficiency and yin excess, and weakening of body functional activities. Its clinical symptoms are: aversion to cold and preference for warm, pale mouth but not thirst, pale complexion, long urine, thin stool, pale tongue, light and slippery, and delayed pulse. Its etiology and pathogenesis are as follows: (1) Feeling cold pathogen or Yang Qi deficiency can cause insufficient warmth in human body, so it is now aversion to cold, white face and preference for warmth; Yin is abundant, and body fluid does not hurt, so the mouth is pale and not thirsty; Yang deficiency cannot warm small fluid, so urine is long and stool is thin; Insufficient yang, endogenous cold and dampness, you will see a pale tongue and white fur; Yang deficiency and weak qi, weak blood vessels, and delayed pulse.
Heat syndrome
Heat syndrome refers to the feeling of heat evil, or the excess of yang and the decline of yin, which is manifested as hyperfunction. Its clinical symptoms are: fever and aversion to cold, thirst and aversion to cold, red face and red eyes, dry stool, yellow and dry tongue coating and rapid pulse. Its etiology and pathogenesis are as follows: the etiology can be exogenous pathogenic fire, stagnation of seven emotions, or food accumulation, or atrioventricular strain, damage to yin essence, leading to yin deficiency and hyperactivity of yang. If the sun is too hot, the body is cold and hot; Fire hurts yin, and body fluid is consumed, so thirst and cold drinks, short and red urine; Insufficient body fluid in large intestine leads to dry stool; Excessive yang heat forces blood flow to accelerate, so the pulse rate is high.
Relationship between Cold Syndrome and Heat Syndrome
Hot and cold mixing
Cold and heat are mixed, that is, both cold and heat are seen. Clinically, there are generally upper heat and lower cold, upper cold and lower heat, exterior cold and interior heat, exterior heat and interior cold.
Upper heat and lower cold: Yang prevails, while Yin prevails. Symptoms include chest discomfort and frequent vomiting (upper fever); Abdominal pain, such as oppression, loose stool (lower cold).
Upper cold and lower heat: Yin is abundant in upper and Yang is abundant in lower. Symptoms include cold pain in the upper abdomen, vomiting and emaciation (upper cold); Short and red urine and dry stool (low fever).
Exterior cold and interior heat: exterior is attacked by cold evil, exterior is incomprehensible, and evil turns into heat; Or there is heat in it and you feel cold evil. Symptoms: aversion to cold, fever, anhidrosis and body pain (exterior cold); Asthma, irritability, thirst, cold drink, red urine, constipation (internal heat).
Exterior heat and internal cold: exogenous wind-heat causes internal injury and cold, or exogenous wind-heat causes spleen-stomach deficiency and cold. Symptoms: fever, headache and sore throat (exterior heat); Long urination, thin stool and cold limbs (cold inside).
Hot-cold conversion
The clinical transformation of cold and heat is first cold syndrome, then heat syndrome, and the cold syndrome gradually recedes; First, the heat syndrome first turns into cold syndrome, and the heat syndrome gradually recedes. This transformation mainly depends on the rise and fall of both good and evil. Anyone who turns from cold to heat has healthy qi and pathogenic factors, and yang is vigorous, but from yang to heat. If you feel cold pathogen, you begin to feel aversion to cold, fever, body pain, no sweat, white fur and tight pulse, which is the syndrome of exterior cold. With the further development of the disease, the symptoms such as cold pathogen entering the interior turning into heat and aversion to cold subsided, and symptoms such as upset and thirst, yellow fur and rapid pulse appeared, indicating that the syndrome changed from exterior cold to internal heat. Those who turn from heat to cold are mostly caused by evil heat hurting righteousness, healthy qi conquering evil and yang failing. For example, patients with high fever, due to excessive sweating, sweating in the yang or frequent vomiting and diarrhea, fluid in the yang, cold limbs, pale face and delayed pulse, indicate that heat syndrome is transformed into cold syndrome.
True and false cold and heat
Whether cold and heat are true or false indicates that the disease is in a critical stage, and the clinical symptoms are often different from the nature of the disease, that is, heat syndrome sees cold symptoms and cold syndrome sees heat symptoms.
Deficiency and excess, cold and heat: yang heat is depressed inside, but it cannot be reached outside, and yin is outside. Symptoms are dull and astringent, but the eyes are bright, the lips are red and dry, the mind is faint but sometimes agitated, the hands and feet are thrown up, the blood is hot, the voice is loud, the breath is foul, the stool is foul, the body is thirsty and cold, and I don't want to wear clothes, the urine is short and red, the constipation is heavy, the pulse is heavy and firm, the hands and feet are cold and the chest and abdomen are burning, the tongue is red and purple, the coating is brown and black, and it is dry and prickly.
The real winter vacation fever: Yin is abundant inside, and Yang is abundant outside. Symptoms are similar to those of heat syndrome, such as body heat, red face, thirst and pulse, but when it is hot, you want to add clothes and quilt, red face and cold limbs, thirst like hot drinks, less alcohol consumption, strong pulse, long urine, loose stool, pale tongue with white fur, etc.
Truth and falsehood-the actual situation
The distinction between reality and excess is the two basic principles to distinguish the rise and fall of evil. Any syndrome caused by the decline, low function, deficiency or material defect of maintaining physiological activities is called deficiency syndrome; Any disease with excessive pathogenic factors and insufficient positive energy can be called empirical evidence. The origin of the definition of virtual reality is that "the evil is real, and the original deficiency is virtual" in Su Wen's General Theory of Virtual Reality.
asthenia syndrome
Deficiency syndrome is more common after long-term illness or serious illness, or physical weakness and acquired disorder, which leads to insufficient vital qi, disharmony between viscera and qi, imbalance between yin and yang and other syndromes. Its symptoms are: listlessness, pallor, listlessness, cold limbs, shortness of breath or five senses upset, spontaneous sweating, night sweats, loose stool, frequent urination, pale tongue with little fur, and rapid pulse. The pathogenesis of the disease is: deficiency syndrome or congenital endowment deficiency, or acquired malnutrition. Such as eating disorders, spleen and stomach damage; Or seven emotions fatigue, internal injury to viscera; Or excessive atrioventricular, wasting true elements, and damaging healthy qi after a long illness. Through clinical practice, deficiency caused by nature is more common. Yang deficiency is not warm and firm, showing pale face, cold body and limbs, mental fatigue, shortness of breath and spontaneous sweating, and dysdefecation; If yin blood is not enough to control yang, yin deficiency will lead to internal heat, that is to say, five qi are upset and hot, night sweats; Deficiency of both qi and blood, qi is not enough to drum the pulse, and blood is not enough to fill the pulse, so the pulse is thin and weak; The lack of pale tongue coating is due to insufficient qi, blood and body fluid, so it cannot be nourished on the tongue.
Deficiency syndrome can be divided into exterior deficiency and interior deficiency, as well as cold syndrome and heat syndrome.
The pathogenesis of deficiency-cold syndrome is: yang deficiency and weakness, and warming and tonifying have no right. Symptoms include chills, cold limbs, abdominal pain, mental fatigue, long urination, loose stools, shortness of breath, shortness of breath, pale tongue, white and wet fur and slight pulse. The pathogenesis of deficiency-heat syndrome is that yin and body fluid are deficient and deficiency-heat is endogenous. Symptoms include hot flashes, night sweats, emaciation, fever in the five senses, dry throat due to blood, red tongue with little coating, and rapid pulse.
Real syndrome
Most of the empirical evidence is a symptom of excessive pathogenic factors. Although the real evil is sufficient and the healthy qi can resist the evil, it has not yet reached the level of loss. Therefore, it is often the intense stage of the struggle between evil and righteousness, which is mostly caused by the invasion of external evil into the human body, or the dysfunction of zang-fu organs and metabolic disorder, resulting in the retention of pathological products such as phlegm, dampness and blood stasis in the body. Its symptoms are: common fever, abdominal distension and pain, refusal to press, chest tightness, irritability, even delirium, shortness of breath, excessive phlegm and saliva, constipation, dysuria, strong pulse, thick and greasy tongue coating, etc. Its etiology and pathogenesis are as follows: whether it is the invasion of external evil or the result of phlegm-dampness and blood stasis, it belongs to evil reality. Fight evil, even fever; Heat disturbs the gods, or confuses the mind, which can make people dizzy, restless and confused. If pathogenic factors are blocked in the lungs, it will be abnormal and cause chest tightness and shortness of breath; Those with severe phlegm and dampness will have excessive phlegm and saliva, and the pathogen will accumulate in the gastrointestinal tract, which will lead to abdominal distension and pain leading to refusal to press and constipation. If the water stops when it is wet, it will be difficult to urinate without gasification. Good and evil contend, and when fighting for pulse, the pulse is strong; Wet turbidity accumulates on the tongue, so the coating is thick and greasy.
In clinical practice, there are two types of evidence: exterior evidence and interior evidence, as well as excess heat and excess cold.
Excess heat means excess heat and excess evil. Symptoms include intense heat, polydipsia, delirium, abdominal distension, pain, refusal to press, red urine, dry stool, thick and dry fur, and smooth and firm pulse. Excess cold means excess cold pathogen and suppression of yang qi. Symptoms include aversion to cold, cold limbs, abdominal pain, constipation, excessive phlegm, asthma and cough, thick and greasy fur, heavy pulse or strong string.
Relationship between deficiency syndrome and excess syndrome
There are three relationships between deficiency syndrome and excess syndrome: the mixture of deficiency and excess, the transformation of deficiency and excess, and the truth and falsehood of deficiency and excess.
There are six clinical manifestations of deficiency and excess:
1. Deficiency in exterior and excess in interior: the body is deficient in defending yang, and eating disorders are caused by exogenous pathogens. Symptoms include hyperhidrosis and aversion to wind (exterior deficiency); Abdominal distension, pain, refusal to press, constipation, yellow and thick coating (internal solid).
2. Insufficiency in exterior and interior: the exterior pathogen remains unsolved, and the internal qi is insufficient; Or spleen and stomach weakness caused by exogenous factors. Symptoms: fever, aversion to cold and anhidrosis (exterior and interior); Mental fatigue, limb weakness, anorexia, abdominal distension and pain after eating, and preference for pressing (internal deficiency).
3. Excess in the upper body and deficiency in the lower body: turbid lung and kidney deficiency. Symptoms include cough and asthma, excessive phlegm and saliva, chest tightness and abdominal distension, and inability to lie flat (upper solid); The waist and knees are sore, the limbs are cold, the spirit is weak, and the head is dizzy (lower deficiency).
4. False and true: guilty, hot and humid. Symptoms include palpitation, palpitation and insomnia (upper deficiency); Abdominal pain, diarrhea, purulent blood, acute interior and heavy interior (lower solid).
5. Excess and deficiency: Yang deficiency of spleen and kidney, flooding with water and dampness. Symptoms include cold pain in the knee, loss of appetite, loose stool, dysuria, swollen face and abdomen.
6. Deficiency in reality: stagnation of qi and blood, lack of healthy qi. Symptoms include abdominal distension and pain, hepatosplenomegaly, unfavorable stool, abdominal blue veins, pale face, purple tongue, emaciation, loss of appetite, shortness of breath, fatigue and rapid pulse.
Virtual-real conversion
Clinically, most patients who change from excess syndrome to deficiency syndrome are often caused by failure of empirical treatment, mistreatment or sweating, vomiting, gas consumption, blood consumption and body fluid consumption after diarrhea. For example, patients with high fever, thirst, irritability, and heavy pulse. Due to improper treatment, they will suffer from qi deficiency and fluid deficiency, such as emaciation, sallow complexion, lack of diet, fatigue and weak pulse. Few people turn from deficiency syndrome to positive syndrome, most of which are due to the lack of vital qi and yang, which leads to phlegm-dampness and blood stasis.
Right or wrong
In the process of disease development, when the empirical evidence reaches its peak, symptoms similar to deficiency syndrome may appear; When the deficiency syndrome develops to a certain stage, there will also be symptoms similar to the positive syndrome. Comprehensive analysis is needed in clinic to make a correct diagnosis.
True or false: deficiency of vital qi, deficiency of qi and blood, weakness of transport and transformation, yin failing to converge yang. Symptoms include abdominal pain, distending pain and pulse string; Or high fever, heavy pulse and the like (false reality). However, the pain of abdominal distension is sometimes relieved, and the pulse string is weak when it is pressed again. Or see the tongue is light or tender (true deficiency).
True and false deficiency: excess evil, yang depression. Symptoms include abdominal distension and pain, refusal to press, and inability to defecate for several days (true); But the spirit is weak and the pulse is weak (deficiency).