The discussion of protecting qi and nourishing blood in Neijing refers to the shallow and deep levels of physiological functions and their distribution in human body. Zhang Zhongjing's Treatise on Febrile Diseases has the pathogenesis and dialectical theory of defending qi and nourishing blood. On the basis of Neijing, Ye, a famous doctor in Qing Dynasty, applied Zhongjing's exterior-interior syndrome differentiation theory and summarized the syndrome differentiation method of defending qi and nourishing blood through clinical practice, which not only summarized four different syndromes of epidemic febrile diseases, but also pointed out four stages of the development of epidemic febrile diseases with different severity. Syndrome differentiation of Wei-qi and Ying-blood is of great significance to the diagnosis and treatment of febrile diseases.
Determine the lesion site: Wei-fen syndrome is mainly on the body surface, and the lesion sites are mostly in fur, muscles, limbs, head and face, nose, throat and lungs; Syndrome of dividing qi mainly exists in lung, chest diaphragm, spleen, stomach, intestine, gallbladder and bladder. Syndrome differentiation of camp is that evil heat goes deep into the heart camp, and it is sick in the heart and sick in the heart pocket; Blood syndrome mainly invades the heart, liver and kidney.
Distinguish the stages of the disease course: pathogenic factors enter from Wei to Qi, from Qi to Camp, and from Camp to Blood, indicating that pathogenic factors are deepening step by step and the condition is getting worse.
Explain the law of pathogen transmission: generally, epidemic febrile diseases spread from exterior to interior, starting from Wei Fen, and gradually spreading to qi, nutrient and blood, and from exterior to interior, from light to heavy, which is called anterograde transmission; If the pathogen of Wei-fen is directly introduced into pericardium or blood without qi-fen, it is called reverse transmission; If the etiology is caused by qi, ying and blood, it is caused by latent evil; In the process of transmission and transformation, the evil of Wei-fen did not stop, and the syndrome of Qi-fen or Ying-fen was also seen, that is, Wei-qi was in the same disease or Ying-fen was in the same disease; If the evil of qi is not solved, but there is a syndrome of qi and blood, it is the same disease of qi and blood or the burning of both qi and blood. Whether it spreads depends on the type of pathogenic factors, the severity of pathogenic factors, the strength of physique and the appropriateness of treatment and nursing.
Determine the principle of treatment: the evil lies in the Wei-fen, and it is advisable to sweat out and drive it out; Pathogens are in qi, so it is advisable to clear away heat and promote fluid production, not to sweat, and to avoid using nourishing blood to divide medicines, so as not to lead pathogens into yin; Heat enters the camp, using the method of clearing the camp and soaking the heat; Evil lies in blood, so it is advisable to cool blood and disperse blood.
First, who counts cards?
Wei-fen syndrome is the initial stage of epidemic febrile disease, which is characterized by fever, slight aversion to cold, headache and body pain, thin and white tongue coating and floating pulse. Due to the different onset season, pathogenic nature and human reaction, different manifestations may occur. Common ones are:
(1) wind temperature exterior syndrome
It is more common in the early stage of influenza and epidemic cerebrospinal meningitis.
Clinical manifestations: it has the characteristics of Wei-fen disease, but the fever is heavier, and the aversion to cold is lighter, with nasal congestion, runny nose, cough, slightly thirsty mouth, red tongue edge and floating pulse.
Syndrome analysis: it mostly occurs in spring and winter, which is caused by exogenous pathogens such as wind and temperature invading lung and Wei. Warm pathogen belongs to heat, so the fever is heavy, the tongue edge is sharp and red, and the pulse is rapid. Heat damages body fluids, which makes you thirsty. It is equivalent to the "exterior heat syndrome" in the syndrome differentiation of the eight cardinal principles.
(2) exterior syndrome of wet temperature
More common in gastrointestinal cold, intestinal typhoid, infectious hepatitis, urinary tract infection.
Clinical manifestations: it has the characteristics of Wei-fen disease, with heavy head swelling, heavy limbs, joint pain, white and greasy tongue coating and slow pulse.
Syndrome analysis: This syndrome mostly occurs in rainy season. This disease is caused by damp-heat invading the surface. Wet and heavy, so the head is swollen, the body is heavy, and the fur is white and greasy.
(3) exterior syndrome of autumn dryness
Found in some influenza, cold, diphtheria and so on.
Clinical manifestations: headache, body heat, slight aversion to wind and cold, no sweat or less sweat, dry cough without phlegm or less phlegm, dry nose, dry throat, cleft lip, thin, white and dry tongue coating, and thready pulse.
Syndrome analysis: the qi of autumn dryness is on the exterior, "dryness is better than dryness", so the mouth, nose and throat are dry due to insufficient body fluid. The lungs are dry, so there is less dry cough or expectoration.
Second, syndrome differentiation of qi
Qi syndrome is the second stage of epidemic febrile disease, which is characterized by high fever without aversion to cold, thirst, yellow fur and rapid pulse. When pathogenic factors invade qi, strong evil is strong healthy qi, and strong qi is strong fire, so the syndrome of qi-heat appears. Except dehumidification and temperature, all kinds of health diseases are converted into heat and fire after air intake. There are many types of syndromes due to the different zang-fu organs and parts of qi and the different nature and severity of pathogenic factors. Common ones are:
(a) Gas is rich in heat.
More common in influenza, Japanese encephalitis and so on.
Clinical manifestations: It has the characteristics of qi-divided diseases, such as fever, thirst, excessive sweating, heavy pulse, Huang Gan's tongue coating, blushing, upset, delirium, convulsion, etc.
Syndrome analysis: this syndrome is characterized by qi deficiency and excessive heat, so the face is hot and red. When body heat burns body fluids, it perspires. When you are hot and sweat, you will be thirsty if you hurt your body fluid.
Heat disturbs the mind, but it disturbs gossip. Extreme heat causes wind and convulsions.
(2) Accumulation of heat in lung and stomach
It is found in some acute tonsillitis, pharyngolaryngitis, mumps, diphtheria and so on.
Clinical manifestations: it has the characteristics of qi-fen disease, such as dry throat, burning pain, hoarseness, rotten white spots on the throat and swelling of the neck.
Syndrome analysis: lung and stomach heat steam up the throat, so the throat is hot and dry, burning and hoarse; It leads to the attack of fire in the liver and gallbladder, phlegm coagulation, swelling of the neck and rotten white spots in the throat.
(3) Pathogenic heat blocks the lung.
It is found in some acute bronchitis, lobar pneumonia, bronchiectasis complicated with infection, lung abscess and so on.
Clinical manifestations: it is characterized by qi deficiency, cough, dyspnea, chest pain, yellow and thick phlegm, sweating and fever.
Syndrome analysis: Wind-heat pathogen injures the lung, decoction burns body fluid into phlegm, phlegm heats the lung, and the lung loses consciousness, resulting in cough, asthma, chest pain and yellow and thick phlegm. There is no exterior syndrome of internal heat, so sweating is difficult to understand.
(4) Stagnation of heat in chest and diaphragm
It is found in some influenza, typhus, scarlet fever, pneumonia and so on.
Clinical manifestations: chest tightness, hot flashes, facial fever, red lips, thirst and constipation.
Syndrome analysis: Yangming meridian is divided into dryness and heat, and pathogenic heat accumulates in chest and diaphragm, so it shows chest tightness and irritability. Heat turns fire into inflammation, and the face is hot and the lips are red. Calories consume body fluids and make you thirsty and constipated.
(5) Gastrointestinal excess heat is found in some influenza, Japanese encephalitis, acute suppurative appendicitis, intestinal obstruction, etc.
Clinical manifestations: high fever or hot flashes in the afternoon, constipation or diarrhea, watery yellow odor, abdominal distension and abdominal pain, dysphoria, red tongue, Huang Gan or gray-black prickles with fur, and heavy pulse.
Syndrome analysis: heat pathogen entering the interior leads to stagnation, moderate anxiety and heat, and obstruction of stomach and intestines qi, so fever, abdominal distension and pain, refusal to press, constipation. Heat disturbs the mind, leading to irritability, heat disturbs the pericardium and leads to delirium. Heat hurts body fluid, so the tongue is red and the coating is yellow and dry.
(6) Humidity and temperature of gas
It is found in intestinal typhoid fever, leptospirosis, infectious hepatitis and salmonella infection.
Clinical manifestations: hypothermia, chest tightness, abdominal distension and pain, thirst, dysuria, unpleasant stool, or diarrhea, yellow and white tongue coating, thick and greasy, and slow pulse.
Syndrome analysis: Damp-heat blocks qi, so body heat is not strong. Damp-heat in upper energizer, chest tightness and thirst; Medium coke, full abdomen; Lower energizer, uncomfortable stool or diarrhea, and poor urination.
Third, the business license
Syndrome differentiation is a serious stage of pathogenic invagination of epidemic febrile diseases. Most of them were confused by Qi and introduced into the camp. It is also possible for Wei Fen to enter the camp directly without dividing qi, that is, "reverse pericardium"; Or warm evil and go straight to the camp. Camp is the original energy in blood and the predecessor of blood, which communicates with the heart from the inside. Therefore, Ying-fen disease is characterized by damage of Ying-yin and restlessness, and its clinical manifestations are night fever, restlessness, macula, dull tongue without coating, and rapid pulse. The camp is between qi and blood. If the camp turns to qi, it means that the condition is getting better. If you get blood from the camp, you are seriously ill.
(A) heat into the camp
It exists in Japanese encephalitis, epidemic cerebrospinal meningitis and other serious infections.
Clinical manifestations: fever at night, dry mouth, upset and insomnia, occasional delirium, mild rash, red tongue without coating, and rapid pulse.
Syndrome analysis: pathogenic heat invades the camp and the camp yin fails, so it is very hot in the middle of the night, with red tongue without coating and rapid pulse. Pathogenic heat diverges and nourishing yin rises, so the mouth is not thirsty. The spirit in the camp is connected with the heart, and the camp is hot and uneasy, so I am upset and sometimes talk nonsense. Heat dredging blood collaterals, pale spots.
(2) Heat enters pericardium
More common in all kinds of encephalitis, meningitis, septicemia, toxic dysentery, heatstroke and so on.
Clinical manifestations: In addition to the characteristics of nutritional diseases, there are also different degrees of consciousness disorders, such as apathy, speech difficulties, slow response, auditory hallucinations, grasping empty beds, delirium, incontinence, red tongue and slippery pulse.
Syndrome analysis: heat evil enters pericardium and blocks the heart.
(3) Heat moving liver wind
It is more common in encephalitis, meningitis, various infectious diseases and toxic encephalopathy.
Clinical manifestations: fever, thirst, dizziness, pain, red eyes, fidgety hands and feet, and even carbuncle, convulsion, convulsion, tongue trembling, angulation, red and dry tongue, and rapid pulse.
Syndrome analysis: excessive pathogenic heat leads to liver wind, so it is excess heat, carbuncle, spasm, angle arch inversion, dizziness and upper disturbance pain. Pathogenic heat consumes body fluid and injures the camp, but the eyes are red, upset and thirsty.
(d) Camp and health of the same disease
It is found in the early stage of influenza, toxic pneumonia, Japanese encephalitis and other diseases.
Clinical manifestations: slight aversion to wind and cold, headache and body pain, chest tightness and cough, insomnia due to night heat, or macula, red tongue and rapid pulse.
Syndrome analysis: the evil of lung Wei is not solved, so it has a slight aversion to cold, headache and body pain. Pathogenic heat binds the lungs, and the lungs are not obvious, chest tightness and cough. The evil of Wei-fen spreads to Ying-fen, resulting in macula, red tongue without coating, insomnia due to night heat, etc.
(5) Qi-camp coexists with diseases.
It is found in acute gastroenteritis, Japanese encephalitis, acute hepatitis and acute bacillary dysentery.
Clinical manifestations: Qi-deficiency syndrome in nutritional diseases, or aggravation of Qi-deficiency syndrome in nutritional diseases, can all be the same disease of qi and nutrition, with red tongue and yellow and white fur.
Syndrome analysis: Acute injury of Yin Ying caused by excess heat of qi, or extravasation of campfire and gradual development of stomach qi.
Fourthly, blood syndrome is the deepest stage of the development of epidemic febrile diseases. Heart, liver and kidney are the main pathological changes of blood syndrome. The clinical manifestations are not only serious syndromes, but also the characteristics of promoting blood circulation and damaging yin. The main manifestations are fever at night, accompanied by conscious manifestations, bleeding, macula, red tongue and rapid pulse.
There are two sources of heat entering the blood: one is from gas to blood; The second one is from the camp.
(1) both qi and blood injuries
It is found in some cases of intestinal typhoid fever, miliary tuberculosis and leptospirosis with bleeding.
Clinical manifestations: heat and thirst, irritability, red tongue with yellow coating, or spots on the skin, and even vomiting blood and bleeding.
Syndrome analysis: Qi-heat toxin coexists with blood-heat toxin, and excessive heat, thirst and yellow fur are the signs of Qi-heat. Red tongue and irritability are signs of heat disturbing blood. When heat enters the blood and the blood is forced to run, you will see spots, vomiting blood, bleeding and so on.
(2) Excessive blood heat
It is found in some meningitis, typhus, leptospirosis and allergic purpura.
Clinical manifestations: on the basis of camp syndrome, mania, rash, bleeding (including hematemesis, nosebleed, bloody stool, hematuria, irregular menstruation) and purple tongue are common.
Syndrome analysis: the heart governs blood, blood heat disturbs the heart and anxiety disturbs the mind. If there is something wrong with blood heat, you can see macula and various bleeding syndromes.
The blood is very hot, so the tongue turns purple.
(III) Syndrome of Deficiency of Injury Yin
It is seen in patients with severe mixed dehydration.
Clinical manifestations: low fever, early cooling at dusk, feverish sensation in five senses, dry throat and mouth, deafness and drowsiness, bright red tongue with bright fur, and rapid pulse. Or see lip atrophy, tongue contraction, dry teeth, hand and foot convulsions, palpitations, weak or numbered pulse.
Syndrome analysis: pathogenic heat enters the interior and burns vaginal fluid, and yin deficiency leads to hyperactivity of yang and internal disturbance, so five spirits are upset and hot flashes occur. Yin essence deficiency, can not moisten dry orifices, so dry mouth and deafness. Because of yin deficiency, god loses his vitality, so he is tired and sleepy. Deficiency of true yin, deficiency of liver and kidney essence and blood, inability to nourish tendons and spasm of tendons and veins, so hands and feet creep and even twitch. Yin deficiency can't nourish viscera and organs, so the lips are wilting, the tongue coating is shrinking, the teeth are dry, and palpitations appear. Yin deficiency can not converge yang, and yin and yang are out of harmony, so the pulse is large and numerous, or small and numerous.