Why does TCM pay attention to dialectics?

Why should Chinese medicine pay attention to syndrome differentiation first? The reason is very simple, because it is impossible for ancient doctors to directly observe the pathological changes of human internal tissues with various instruments and experiments, and obtain data that can essentially explain the physiological functions of human internal organs. Moreover, the perceptual materials obtained through the four diagnoses are also true and false. If we don't make a careful analysis and summary of the phenomenon, it will be difficult to make an accurate judgment on the nature, cause and pathological position of the disease, and it will be impossible to choose the treatment method. This is also the reason why Chinese medicine emphasizes "syndrome differentiation and treatment".

Syndrome differentiation of traditional Chinese medicine refers to syndrome differentiation and treatment, which is an important part of TCM therapeutics and a major feature that distinguishes TCM from modern medicine and other traditional sciences. It grasps the main contradiction in the disease stage-"syndrome" to formulate treatment principles, treatment methods and drug selection process. "Syndrome" is the basis of TCM syndrome differentiation and the essence of TCM.

Syndrome is a pathological summary of the development of a disease to a certain stage. Because it includes the location, etiology, nature and the relationship between pathogenic factors and positive factors, it reflects the nature of lesions in a certain stage of disease development, so it reveals the essence of disease more comprehensively, profoundly and correctly than symptoms.

The so-called syndrome differentiation is to summarize and judge the data, symptoms and signs collected by the four diagnostic methods (looking, smelling, asking and pulse) as a syndrome of a certain nature through the analysis, synthesis and differentiation of the etiology, nature, location and the relationship between evil and positive. Treatment, also known as treatment, is to determine the corresponding treatment methods according to the results of syndrome differentiation. Syndrome differentiation is the premise and basis of determining treatment, and treatment is the means and method to treat diseases. Through the effect of syndrome differentiation and treatment, the correctness of syndrome differentiation and treatment can be tested The process of syndrome differentiation and treatment is the process of understanding and solving diseases. Syndrome differentiation and treatment are two interrelated and inseparable aspects in the process of disease diagnosis and treatment. They are the embodiment of the combination of theory and practice, the concrete application of reasonable methods and prescriptions in clinical practice, and the basic principles guiding the clinical work of traditional Chinese medicine.

Understanding and treating diseases in TCM means differentiating diseases and syndromes. Differentiation of symptoms and signs should be emphasized before it can be treated correctly. For example, colds, common symptoms such as fever, fear of cold, head and body pain and so on. It belongs to exterior syndrome, but due to the difference of pathogenic factors and body reactivity, it often manifests as wind-cold cold and wind-heat cold. Only by clearly distinguishing whether the "syndrome" of a cold belongs to wind-cold or wind-heat, can we determine whether to use pungent warming to relieve exterior symptoms or pungent cooling to relieve exterior symptoms, and give corresponding treatment. Therefore, the daily cold medicine VC Yinqiao tablets can't be eaten with any cold. It can be seen that the treatment based on syndrome differentiation is different from the local symptomatic treatment of phlegm, blood, fever, headache and foot pain, and it is also different from the treatment method of treating one disease with one prescription and one medicine, regardless of primary or secondary, and regardless of stages.

Treatment based on syndrome differentiation, as the basic principle guiding clinical diagnosis and treatment of diseases, can dialectically treat the relationship between diseases and syndromes. It can be seen that a disease can include several different syndromes, and different diseases can have the same syndrome in the development process. Therefore, under the guidance of the principle of syndrome differentiation and treatment, clinical treatment can adopt the method of "treating different diseases with the same disease" or "treating different diseases with the same treatment". The so-called "different treatment for the same disease" refers to the same disease, because the onset time, region and patient's body responsiveness are different, or at different stages of development, so the symptoms are different, so the treatment methods are different. Let's take a cold as an example. Because of the different seasons, the treatment is different. A cold in midsummer, because of the feeling of summer dampness, often need to use some aromatic drugs in the treatment to get rid of summer dampness. For example, in summer, we can use Pogostemon, Eupatorium odoratum and other drugs to treat colds, which is different from other seasons. And "treating different diseases at the same time" refers to different diseases. During their development, they can be treated in the same way because of the same pathogenesis. Such as chronic diarrhea, proctoptosis, uterine prolapse, etc. They are different diseases, but if they all show stagnation of middle qi, they can be treated by ascending middle qi.

It can be seen that the main purpose of TCM treatment is not to focus on the similarities and differences of "diseases", but to focus on the differences of pathogenesis. The same pathogenesis can be treated in basically the same way; Different pathogenesis requires different treatment methods. This is "the same treatment with the same syndrome, and the same treatment with different syndromes". Essentially, this is because the concept of "syndrome" includes pathogenesis. This principle of solving different contradictions in the process of disease development in different ways is the spiritual essence of syndrome differentiation and treatment.

The dialectical process of TCM should not only follow the general law of logical thinking, but also follow the basic theory of TCM, which is often said by TCM. The so-called eight categories refer to eight different syndromes of yin and yang, exterior and interior, cold and heat, and excess and deficiency. In fact, they can be further divided into four groups of contradictory concepts, namely, yin and yang, exterior and interior, cold and heat, and excess and deficiency. No matter how complicated the disease is, it can also be analyzed as a whole according to these four opposing concepts.

Yin and Yang are the classification of the basic nature of diseases. No matter what kind of disease, it can be divided into yin and yang.

All syndromes that belong to acute, dynamic, strong, excited, hyperfunction, enhanced metabolism and outward (extroversion) upward belong to yang syndrome. From the symptoms, such as flushing, body heat and cold, mania, chapped lips, thirst, loud voice, irritability, heavy breath, constipation or foul smell, abdominal pain, short and red urine, red tongue, Huang Gan tongue coating and strong pulse. , can be regarded as a positive disease.

All syndromes of chronic, weak, static, depression, hypofunction, low metabolism and introversion belong to Yin syndrome. From the symptoms, such as pale or dull face, heavy squat, cold and weak limbs, low voice, quiet and quiet, weak breathing, unwilling to open eyes, reduced diet, tasteless mouth, no annoyance or thirst, or like hot drinks, foul stool, long urination and abdominal pain. Pale and tender tongue, moist tongue coating and weak pulse can all be regarded as negative diseases.

Externally, it is a procedure to distinguish the location, depth and severity of the lesion.

Combined with specific diseases, exogenous pathogens invade the human body, starting from the skin, meridians, nose and mouth, presenting symptoms such as aversion to cold, fever, headache, body pain, limb pain, stuffy nose or cough. Precursors of colds, influenza and various acute infectious diseases. Wang Kentang generally belongs to the scope of prima facie evidence. If exogenous pathogens directly act on human viscera, blood vessels, bone marrow, etc. , causing high fever, dizziness, irritability, thirst, constipation, short and red urine, or visceral lesions, all belong to the category of internal syndrome.

Cold and Heat is a program to distinguish disease symptoms from two different attributes.

Cold syndrome is caused by cold pathogen, or by the decline of physical function and metabolic activity and the weakening of resistance caused by weak yang and excessive yin. Such as hypothermia, pallor, listlessness, lethargy, abdominal pain, thirst, loose stool and long urine, all belong to cold syndrome.

Heat syndrome is a series of syndromes of excess heat caused by pathogenic heat or hyperactivity of yang. Such as fever, irritability, redness, aversion to cold and heat, dry mouth and throat, thirst for cold drinks and so on. , all belong to heat syndrome.

Virtual reality is a procedure to distinguish the strength of human resistance from the rise and fall of disease pathogens.

Deficiency syndrome refers to the deficiency of vital qi, decreased anti-evil ability and decreased physiological function. The general symptoms are: pale face, listlessness, physical weakness, palpitation and shortness of breath, spontaneous sweating and night sweats. People who are weak and have been ill for a long time are mostly deficiency syndrome.

The excess refers to the excess of pathogenic factors, the fierce reaction between healthy qi and pathogenic factors, or the internal dysfunction of human body, which leads to stagnation of qi and blood, drinking water, resolving phlegm and accumulating food. Common symptoms are: acute fever, high fever, thirst, irritability, delirium, abdominal pain, constipation, short and red urine and so on. Most patients with somatic initial diseases have real syndrome.

Through the above introduction, we realize that the theory of syndrome differentiation of the eight cardinal principles of TCM is actually a principle that we must follow in synthesizing, generalizing, analyzing and summarizing disease phenomena and their occurrence and development. Correctly applying the theory of the Eight Cardinal Programmes, doctors will have a clear thinking when analyzing diseases, and can quickly understand the essence through phenomena, thus further grasping the main contradictions of diseases. This discrimination method has the advantages similar to the modern "optimization method".

"Su Wenyin Yang Ying Xiang Da Lun" pointed out: "Those who are good at diagnosing diseases, look at color and pulse, don't talk about yin and yang first." It shows that yin and yang are the general outline of eight syndromes. As long as it is determined that the disease belongs to yin syndrome or yang syndrome, the treatment scope of the disease can be quickly reduced by half. In this way, half can be eliminated layer by layer from the angles of exterior, interior, cold and heat, and excess and deficiency, and finally the scope to be considered can be reduced to one sixteenth of the original. If we consider other characteristics of symptoms, we can quickly and accurately find out the essence of the disease.

There are many methods of syndrome differentiation, which have been continuously created by doctors in past dynasties through long-term clinical practice. In addition to the above eight types of syndrome differentiation, there are mainly: etiology syndrome differentiation, qi-blood syndrome differentiation, viscera syndrome differentiation, meridian syndrome differentiation, six meridians syndrome differentiation, Wei-qi-nourishing blood syndrome differentiation, triple energizer syndrome differentiation and so on. Etiology differentiation focuses on finding out the cause from syndrome analysis; Syndrome differentiation of zang-fu organs is mainly applied to various internal injuries and miscellaneous diseases, which is a comprehensive application of other syndrome differentiation methods and directly creates conditions for the formulation of treatment principles; Syndrome differentiation of qi, blood, body fluid and meridians is closely related to syndrome differentiation of zang-fu organs and complements each other; Syndrome differentiation of six meridians and syndrome differentiation of defending qi and nourishing blood are suitable for typhoid and febrile diseases respectively. In addition, triple energizer syndrome differentiation is also one of the syndrome differentiation methods for febrile diseases. All kinds of syndrome differentiation have their own merits, and some contents overlap with each other. When using them, we must carefully experience the relationship between them in order to master them well.