中醫(yī)學英文Differentiationofsyndromes

1、Differentiation of syndromes according to the pathological changes of zang-fu organs vTCM 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 progress of TCM , no patho- ana

2、tomy 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 systems recognized in the li

3、ght 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, nature, and the condit

4、ion 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 complete syndrom

5、e 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 flow in the

6、 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 tong

7、ue 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 mer

8、idian 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, the overall blood circulation is also retarded, leading t

9、o cyanosis. Serious 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 menta

10、l 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） vClinical manifestations: impaired consciousness with inconerent speech and rattling of phlegm in the thr

11、oat, 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 in the throat as observed in epilepsy. a pa

12、le tongue with a white greasy coating a slippery pulse are also the symptoms 2.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

13、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 epilepsy 2.clouding of the heart by phlegm: （3） liver wind is stirred up the phlegm will go upward and cloud the heart t

14、he 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 heart by phlegm: （4） vHerbal formula :

15、 vDitan Tang 3.invasion of the lungs by wind- cold（1） v Summarize: this is an exogenous affection of the lungs by wind-cold usually 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 an

16、d 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） 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 thi

17、n 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 discharge. The lu

18、ngs 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. In addition

19、, 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 interior, the t

20、ongue coating is still normal. A floating, tense pulse indicates superficial affection by cold 3.invasion 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 i

21、n 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） vHerbal formula : vMahuang tang (Decoction of Ephedra): v (p260) Ephedra Cinnamon twig Bitter apricot seed Licorice root 4.invasion of the lungs by wind- heat（1

22、） vSummarize: 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） vClinical manifestations: Coughing with expectoration

23、of yellow, thick 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） vSyndrome analysis: This syndrome is characterized by coughing and exterior syndrome of win

24、d-heat. Invasion of 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 ag

25、ainst the invading wind-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 th

26、e 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 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 th

27、ick, 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 wind- 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

28、 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 heat (heat in the lungs)(2) vCli

29、nical 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 concentrated urine, reddened tong

30、ue 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 combination with manifestations of interior heat. Accumulation of pathogenic heat in the lungs induces upward pervers

31、ion 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 (heat in the lungs)

32、(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 coating and rapid

33、 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 of the lungs by dryness (dryness of the lungs)(1) vSummarize: vThis syndrome can be

34、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 expectorate, dry nose, lips, tongue and throat; chills and fever, or chest pain

35、 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 characterized by dryness of the respiratory system, and at the early st

36、age 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

37、the upper portion of the lungs, only the tip of the tongue is reddened 6.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 t

38、he pathogenic dryness has been transformed. The rapidity of the pulse also corresponds to the intensity of the heat 6.Invasion of the lungs by dryness (dryness of the lungs)(3) vBoth invasion of the lungs by dryness and deficiency of lung yin are characterized by dryness symptoms, but the former is

39、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 fever accompanied by malar flush and heat sensat

40、ion 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 during a chronic disease with impai

41、rment 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 in the large intestine (2) vCl

42、inical manifestations: Hard fecal mass with difficult infrequent elimination dryness of the mouth and throat, Accompanied by foul breath and dizziness Dry reddened tongue Thready, hesitant pulse. 7.Deficiency of fluid in the large intestine (3) vSyndrome analysis: Deficiency of fluid in the large in

43、testine 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 of turbid qi, r

44、esulting 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 Chengq

45、i Tang 8.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, prelap

46、se 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 urination Prolapse of

47、 the rectum or 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 con

48、trol blood (1) vSummarize: 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: Menorrhagia He

49、matochezia Hematuria Subcutaneous hemorrhage Other chronic hemorrhages Pale tongue Thready, 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

50、, blood will escape from the blood vessels. Since 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

51、 blood (4) vHerbal formula : vGuipi Tang (p295) 10.Stagnation 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 t

52、oo much food and drink at one meal. It may also be attributed to weakness of the stomach. 10.Stagnation of food in the stomach (2) vClinical manifestations: Epigastric fullness, distension or pain Belching with fetid odor Acid eructation or vomiting of sour fetid gastric contents (with alleviation o

53、f epigastric distension or pain after vomiting), or flatus and loose bowels with sour fetid stools; thick greasy tongue coating and slippery pulse. 10.Stagnation of food in the stomach (3) vSyndrome analysis: Stagnation of undigested food in the stomach causes epigastric fullness, distension or pain

54、. Disturbance in the descending function of the stomach leads to upward perversion, and so there 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

55、the distension and pain are alleviated. Stagnation of undigested food leads to formation of endogenous 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 form

56、ing the thick greasy tongue coating. Slippery pulse in food stagnation suggests excess of the pathogenic factor (undigested food) confronted by powerful qi and surging blood. 10.Stagnation of food in the stomach (4) vHerbal formula : vBaohe Wan (p301) 11.Fire in the stomach ( stomach fire) (1) vSumm

57、arize: vThis is usually due to partiality for spicy hot food which produces heat and fire, emotional depression 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,

58、periondontal diseases and diabetes mellitus. 11.Fire in the stomach ( stomach fire) (2) vClinical manifestations: 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, ulcera

59、tion in the mouth, swollen, painful and bleeding gums. Constipation and scanty concentraded urine, reddened tongue with a yellow coating, slippery, rapid pulse. 11.Fire in the stomach ( stomach fire) (3) vSyndrome analysis: vFire in the stomach causes burning pain. It also leads stomach qi adversely

60、 upwards, and so there is vomiting right after eating. However, stomach fire also means hyperactivity of the stomach, 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, an