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DIFFERENTIATlON OF SYNDROMES——THE PRECONDITION FOR TREATMENT | |
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辨證—治療的前提 | |
| Differentiation of syndromes (bian zheng) in TCM is a method to analyse and recognize the syndrome of disease. In otherwords, it is also a process in which the location, nature, occurrence and development of a disease as well as the condition of vital qi and pathogenic factors are identified according to the clinical data obtained from the four diagnostic methods. From the above it becomes obvious that differentiation of syndromes is the premise and foundation of treatment. Correct differentiation and appropriate treatment are the prerequisite for achieving the hoped-for results. There are a number of methods to differentiate syndromes in TCM, such as differentiation of syndromes according to the eight principles; differentiation of syndromes according to the theory of qi, blood and body fluid; differentiation of syndromes according to tbe zang-fu theory; differentiation of syndromes according to the theory of six meridians; differentiation of syndromes according to the theory of wei, qi, ying and xue, and differentiation of syndromes according to the theory of triple energizer. Each method, while having its own features and laying stress They should be applied flexibly and accurately so as to understand a disease comprehensively, thereby providing the basis for treatment. | 中醫(yī)的辨證是一種分析和認(rèn)識疾病證候的方法。換言之，它也是根據(jù)四診收集的臨床資料確定疾病的位置、性質(zhì)、發(fā)生和發(fā)展以及邪正狀況的一個過程。從以上可以明顯的知道辨證是治療的前提和基礎(chǔ)。正確的辨證和適當(dāng)?shù)闹委熓侨〉煤玫闹委熜Ч南葲Q條件。中醫(yī)有許多辨證的方法，如根據(jù)八綱辨證；氣血津液辨證；臟腑辨證；六經(jīng)辨證；衛(wèi)氣營血辨證和三焦辨證。每種方法都有自己的特點(diǎn)和側(cè)重點(diǎn)，必須準(zhǔn)確靈活的應(yīng)用才能綜合的了解疾病，從而為治療提供基礎(chǔ)。 |
| The eight principal syndromes, also known as "eight principles" (ba gang), refer to yin, yang, exterior, interior, cold, heat, deficiency and excess. The differentiation of syndromes according to the eight principles is the general guideline of TDS and important components of TCM diagnostics. Complicated as the clinical manifestations of diseases may be, they are classified under the eight principles. For example, the classification of syndromes-yin or yang; the location of disease-exterior or interior; the nature of disease-cold or heat; and the preponderance or discomfiture of vital qi and pathogens-deficiency of vital qi or excess of pathogen. Differentiation of syndromes according to the eight principles generalizes the intricate and volatile syndromes into four pairs: exterior and interior, cold and heat, deficiency and excess, and yin and yang. Therefore, in the diagnostic process, the eight principles can play a role in bring out the essentials. | 八個證候總綱也稱“八綱”指的是陰、陽、表、里、寒、熱、虛和實(shí)。八綱辨證是中醫(yī)的總的指導(dǎo)，是中醫(yī)診斷的重要組成部分。雖然疾病的臨床表現(xiàn)很復(fù)雜，但都可以根據(jù)八綱歸類。例如，陰證和陽證的歸類；表病和里病的定位；疾病的寒熱性質(zhì)；正邪的盛衰和虛實(shí)。八綱辨證將復(fù)雜易變的證候歸為四對：表里、寒熱、虛實(shí)和陰陽。因此，在診斷過程中，八綱辨證是必須的。 |
| Although this differentiating method classifies various syndromes into eight categories, they are interrelated and inseparable from each other. For instance, the exterior syndrome and interior syndrome are related to the cold, heat, deficiency and excess syndromes; the cold syndrome and heat syndrome are related to the exterior, interior deficiency and excess syndromes; the deficiency syndrome and excess syndrome are related to cold, heat, exterior and interior syndromes. These pathologic changes do not occur singly, the exterior and interior, cold and heat, deficiency and excess syndromes are usually found simultaneously. For instance, the disease with both the exterior and interior syndromes; the deficiency syndrome mingling with excess syndromes; intertwinement of the cold and heat syndromes. Under certain conditions these syndromes are often transformed into one another. For example, the exogenous pathogens may invade the interior and vice versa the cold syndrome may be transformed into heat syndrome and vice versa; the deficiency syndrome may be transformed into the excess syndrome and vice versa. With the progress of disease, some false appearances contrary to its nature may appear. e. g. ,cold syndrome with pseudo-heat symptoms and vice versa, deficiency syndrome with pseudo-excess symptoms and vice versa. Thus, when applying differentiation of syndrome according to the eight principles, physicians are required not only to have a masterly command of the characteristics of each syndrome, but also to pay attention to their coexisting, interlacing, transforming, and true or false conditions, so and so only can the disease be understood in an all-round way. Thereby, providing reliable basis for treatment. | 雖然這種辨證方法將不同的證候分成八類，但是它們之間是相互聯(lián)系、不可分離的。例如，表里證和寒熱、虛實(shí)證相關(guān)；寒熱證和表里、虛實(shí)證相關(guān)；虛實(shí)證和寒熱表里證相關(guān)。這些病理并不是單獨(dú)發(fā)生，而是表里、寒熱、虛實(shí)證通常同時出現(xiàn)。例如，表里證混雜的疾�。惶搶�(shí)夾雜的疾�。缓疅釆A雜的疾病。在一定條件下，這些證候常相互轉(zhuǎn)化。例如，表邪可以入里，反之亦然；寒證可以化熱，反之亦然；虛證可以轉(zhuǎn)實(shí)，反之亦然。疾病過程中，一些與疾病性質(zhì)相反的假象會出現(xiàn)。因此，醫(yī)生根據(jù)八綱辨證時，不僅必須精確的掌握每一種證候的特點(diǎn)，也要注意它們之間的共存、交錯、轉(zhuǎn)化和真假狀況，因此才能對疾病有全面的了解，從而為治療提供可靠的依據(jù)。 |
| Yin and yang are a pair of principles used to summarize the other three pairs of principles and are also the key principles in the eight principles. So the other three pairs of principles are classified under either yin or yang. Exterior, heat and excess syndromes are classified into the category of yang, while interior, cold and deficiency syndromes fall into the category of yin. Yin syndrome is characterized by deficiency of yang-qi and excess of yin in the body. Yang syndrome in characterized by the hyperactivity of yang-qi and hyperfunctions of the zang fu-organs, resulting from excess of yang-heat in the body. Yin and yang are also used to explain the pathological changes of the zang-fu organ, eg. yin depletion, yang depletion, yin deficiency and yang deficiency, etc. | 陰陽是一對可以總結(jié)其它三對原則的原則，也是八綱中最重要的原則。所以其它三對原則可被歸納為陰或陽。表、熱和實(shí)證歸為陽，而里、寒、虛證則歸為陰。陰證以體內(nèi)陽虛陰盛為特點(diǎn)。陽證以由體內(nèi)陽熱過盛引起陽亢和臟腑功能亢進(jìn)為特點(diǎn)。陰陽也通常用于解釋臟腑器官的病理變化，例如，陰陽俱虛、陰虛和陽虛等。 |
| Differentiation of syndromes according to the theory of qi, blood and body fluid is a differentiating method to analyse and identify the pathological changes of qi, blood and body fluid according to the theory of qi, blood and body fluid. Qi, blood, and body fluid, are the material basis for the functional activities of the zang-fu organs, their formation and circulation depend upon the normal functions of the zang fu organs. Therefore the pathological changes of qi, blood and body fluid may bring about the dysfunction of the zang-fu organs, and the dysfunction of the zang-fu organs will be bound to cause the pathological changes of qi, blood and body fluid. Hence, both of them should closely coordinate and complement each other. Qi has many syndromes, which are usually classified into four classes: qi deficiency, qi sinking, qi stagnation and reversed flow of qi. As concerns blood syndromes, TCM tends to group them under four heads: blood deficiency, blood stasis, heat in blood and cold in blood. " Physiologically, they complement each other and, pathologically, affect each other. Thereby, forming differentiation of syndromes of the same disease of qi and blood. Clinically, there is qi stagnation and blood stasis, qi deficiency and blood loss, deficiency of both qi and blood, qi deficiency and blood stasis, and qi prostration resulting from hemorrhage. Syndromes of body fluid may be classified into two categories: insufficiency of body fluid and water retention. Insufficiency of body fluid may cause the clinical manifestations: dryness of the mouth and throat, dry lips and tongue, subsidence of eyes, dry skin, scanty urine, constipation, a red tongue with scanty saliva and thready, rapid pulse. Whereas, retention of water may form such pathological substances as water, dampness and phlegm retention. Usually seen in edema, tympanites and phlegm-retention. | 氣血津液辨證是一種根據(jù)氣血津液理論分析和確定氣血津液病理變化的辨證方法。氣血津液是臟腑功能活動的物質(zhì)基礎(chǔ)，它們的形成和循行依賴于臟腑功能的正常。因此，氣血津液的病理改變可以引起臟腑功能的異常，同時，臟腑功能的異常也必然會導(dǎo)致氣血津液的病理改變。因此，它們兩者應(yīng)緊密協(xié)調(diào)相互補(bǔ)充。氣有許多證候，通常被分為四種類型：氣虛、氣陷、氣滯和氣逆。就血證而言，中醫(yī)試圖將其歸為四類：血虛、血瘀、血熱和血寒。在生理上，它們相互補(bǔ)充；在病理上，它們相互影響。因此形成了同一疾病的氣血辨證。臨床上，有氣滯血瘀、氣不攝血、氣血虧虛、氣虛血瘀和氣隨血脫。津液的證候可以歸為兩類：津液虧虛和水液儲留。津液虧虛可以導(dǎo)致以下的臨床表現(xiàn)：口干、咽干、唇舌干燥、眼眶凹陷，皮膚干燥、尿少、便秘、舌紅少苔和脈細(xì)數(shù)。而水液儲留可以由如停滯的水濕痰飲的病理物質(zhì)引起。通常見于水腫、鼓脹和痰凝。 |
| Differentiation of syndromes according to the theory of wei (defensive), qi (vital-qi), ying (nutrient) and xue (blood) is a differentiating method applied to analysing and differentiating exogenous febrile diseases. It was developed and created by YeTianshi in the Qing Dynasty. It supplements the differentiation of syndromes by the theory of the six meridians and enriches the differentiation of syndromes and treatment for exogenous febrile diseases in TCM. This theory is the basis used to classify syndromes, to identify transformation and determine treatment. The theory of wei, qi, ying and xue is of great practical value because, for one thing, it generalizes the pathological changes of febrile dis-eases as the four kinds of syndromes: weifen, qifen, yingfen and xuefen, for another, it represents the four different stages: superficial or deep and mild or serious in the development of exogenous febrile diseases. It is also believed as a law of the development and changes of exogenous febrile diseases. Diseases of the wei and qi stages are mild and superficial, whereas those of the ying and xue stages are deep and serious. | 衛(wèi)氣營血辨證是適用于分析和辨證外感熱病的一種辨證方法。它是清代葉天士創(chuàng)建和發(fā)展起來的。它補(bǔ)充了六經(jīng)辨證理論，豐富了中醫(yī)對外感熱病的辨證論治。這個理論是區(qū)分證候、確定變化和決定治療的基礎(chǔ)。衛(wèi)氣營血理論有極高的實(shí)踐價值，因?yàn)�，一方面，它將外感病的病理變化歸為四種證候：衛(wèi)分、氣分、營分和血分。另一方面，它代表了四個不同的階段：外感熱病發(fā)展中的淺深和輕重階段。它也被認(rèn)為是外感熱病發(fā)展變化的規(guī)則。衛(wèi)氣階段的疾病輕淺，而營血階段的疾病則深重。 |
| Differentiation of syndromes according to the zang-fu theories a differential method by which symptoms and signs are analysed to clarity the cause, the location and nature of disease as well as the conditions between vital qi and pathogens in light of the theories viscera figure (manifestation) , yin yang and five elements. It is the basis of various hinds of differentiation of syndromes and the basic diagnostic method of all clinical branches of TCM, and an important component part of all differential system in TCM. Differentiation of syndromes according to the theory of the zang-fu organs includes differentiating syndromes of zang-organs diseases, fu-organ diseases and complicated diseases of both zang-organs with fu-organs. | 臟腑辨證是一種根據(jù)臟象、陰陽和五行理論通過癥狀和征象對疾病的根源、位置和性質(zhì)以及正邪狀態(tài)進(jìn)行分析和歸類的辨證方法。它是其它辨證的基礎(chǔ)，也是所有中醫(yī)臨床分支學(xué)科的疾病診斷方法，是中醫(yī)辨證系統(tǒng)的重要組成部分。臟腑辨證包括臟病辨證，腑病辨證和臟腑辨證。 |
| Differentiation of syndromes acording to the theory of six meridians is a method of differentiating exogenous diseases in TCM. It was put forward in Treatise on Febrile Diseases by Zhang Zhonjing-a distinguished physician in the Eastern Han Dynasty. In Light of the yin-yang theory, the syndromes of the six meridians may be divided into three yang syndromes-taiyang, yangming and shaoyang and three yin syndromes-taiyin, shaoyin and Jueyin. Thereby providing a basis for differential diagnosis and treatment. Six meridians syndromes are the reflections of pathological changes in the zang-fu organs and meridians, among which three yang syndromes take the pathological changes of the six fu organs as their basis, while three yin syndromes take the pathological changes of the five zang organs as the their basis. | 六經(jīng)辨證是中醫(yī)辨證外感病的一種辨證方法。它是東漢時期一位杰出的醫(yī)生—張仲景在《傷寒雜病論》中提出的。根據(jù)陰陽理論，六經(jīng)證候可以分為三陽證—太陽、陽明和少陽以及三陰證—太陰，少陰和厥陰，從而為辨證論治提供基礎(chǔ)。六經(jīng)證是臟腑經(jīng)絡(luò)病理變化的反應(yīng)，三陽證以六腑的病理變化為基礎(chǔ)，而三陰證以五臟的病理變化為基礎(chǔ)。
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| Besides differentiating syndrome in light of the theory of triple energizer is one of methods of differential diagnosis for febrile diseases, put forward by Wu Jutong, a distinguished physician of the Qing Dynasty. Wu Shi takes triple energizer as the guiding principle of differentiation of syndromes of seasonal febrile disease in conjunction with differentiation of syndromes according to the theory of wei, qi, ying and xue, to emphasizes the pathological changes of the zang-fu organs related to triple energizer during the course of seasonal febrile diseases，the characteristics of syndromes and the law of transmission and transformation. Seasonal febrile disease is a general term for all acute febrile diseases resulting from various warm-heat pathogens in the four seasons. Differentiation of syndromes by the theory of triple energizer is also the premise and foundation of treatment. | 三焦辨證是辨證熱病的一種方法，由清代的一位杰出的醫(yī)生—吳鞠通提出的。吳氏以三焦結(jié)合衛(wèi)氣營血辨證為辨證溫病的指導(dǎo)原則，強(qiáng)調(diào)溫病中與三焦相關(guān)臟腑的病理變化、證候特點(diǎn)和轉(zhuǎn)化規(guī)律。溫病是由四季中不同的溫?zé)嶂耙鸬乃屑毙詿岵〉目偡Q。三焦辨證也是治療的前提和基礎(chǔ)。 |
| As a whole, conditions of differentiating syndromes are complex, what has been discussed in this unit is only those common, typical differentiating syndromes, they should be applied flexibly so as to decide the therapeutic principle on the basis of correct differentiating syndromes. | 總的來說，辨證是復(fù)雜的，該單元討論的只是一些普通、典型的辨證，它們應(yīng)被靈活的運(yùn)用，從而在正確的辨證基礎(chǔ)上確定治療原則。 |
