Diagnosis of traditional Chinese medicine: an overview of syndrome differentiation of six meridians

Differentiation of six meridians is the program of syndrome differentiation and treatment in Treatise on Febrile Diseases. By the Eastern Han Dynasty. Zhang Zhongjing in Su Wen. On the basis of Treatise on Febrile Diseases, according to the syndrome characteristics and spreading law of typhoid fever, a set of syndrome differentiation methods is summarized.

Six meridians refer to Sun, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin. Based on the physiology and pathology of the meridians and zang-fu organs to which the six meridians belong, syndrome differentiation of six meridians comprehensively classifies various syndromes in the process of exogenous diseases into six types, namely, sun syndrome, Yangming syndrome, shaoyang syndrome, Taiyin syndrome, Shaoyin syndrome and Jueyin syndrome, so as to explain the pathological characteristics of exogenous diseases at different stages and guide clinical treatment.

In the differentiation of six meridians, the spirit of differentiation of eight cardinal principles runs through. According to the attribute of syndrome, it divides the evolution of exogenous diseases into two categories, namely, taiyang disease, Yangming disease and shaoyang disease, which are collectively called Sanyang disease. Taiyin Syndrome, Shaoyin Syndrome and Jueyin Syndrome are collectively referred to as Yin Three Syndrome. Those with excess pathogen have strong disease resistance and hyperactivity, showing heat and excess, and most of them belong to the syndrome of three yang diseases; Any deficiency of vital qi, exhaustion of pathogenic factors, attenuation of disease resistance and deficiency of disease potential are manifested as cold and deficiency, and most of them belong to three yin diseases.

The occurrence of typhoid fever is that the human body feels exogenous pathogens such as wind and cold, starting from the fur and muscles, gradually following the meridians, from the outside to the inside, and then spreading to the viscera. Therefore, when the pathogenic factors are on the surface of skin and meridians, they are manifested as exterior syndrome; When cold pathogen is internalized into heat, it is internalized into heat syndrome; Under the condition of qi deficiency and yang decline, cold pathogens often invade Yin San meridians, leading to a series of pathological changes in yang deficiency and cold.

The clinical manifestations of six meridian diseases are all based on the pathological changes of meridians and viscera, among which Sanyang disease is based on the pathological changes of six viscera and Sanyin disease is based on the pathological changes of five viscera. Therefore, the application of six meridians syndrome differentiation is not limited to exogenous diseases, but also can be used for internal injuries and miscellaneous diseases. However, due to its emphasis on the analysis of pathological changes caused by exogenous wind-cold and its transmission law, its syndrome differentiation of internal injuries and miscellaneous diseases is not extensive, which can not be equated with syndrome differentiation of viscera.

First of all, distinguish the diseases and syndromes of the six meridians.

(-) Sun syndrome

The main surface of the sun is the barrier of meridians, and the meridians of the sun run along the back of the neck, controlling the qi of ying and Wei. The viscera of the sun is the bladder, which stores water and liquid. When it is excreted by gasification, it is urine. When the wind-cold invades the human body, it usually damages the body surface first. The syndrome of the skin surface layer resisting good and evil is the syndrome of the sun meridian, which can be divided into stroke and typhoid fever, which is the initial stage of diseases caused by exogenous wind-cold. If the syndrome of Taiyang meridian is not cured, pathogenic factors can enter the fu-organs along the meridians, resulting in the syndrome of Taiyang fu-organs, which can be divided into water storage and blood storage.

1. Sun syndrome

It refers to the syndrome that wind-cold pathogen invades the muscle surface of human body, and the struggle between righteousness and evil, and the disharmony between ying and Wei, with aversion to cold, floating pulse and headache as the main manifestations.

The clinical manifestations are aversion to wind-cold, splitting headache and floating pulse.

Syndrome analysis This syndrome is caused by the invasion of the sun meridians by exogenous pathogenic factors, which is the initial stage of typhoid fever.

Wind-cold is bound to the exterior, Wei-yang is restrained, and muscle carbuncle is lost to temperature, so wind-cold is hated; The foot sun descends from the head to the back, and the sun suffers from evil, and the qi is unfavorable, and the head is far-fetched and painful; Good and evil fight on the surface of the sun's skin, and the pulse gas is stimulated outside, so the pulse floats.

Due to the differences in patients' feelings about pathogenic factors and constitutions, the syndromes of Taiyang Meridian are different from those of Taiyang Stroke and Taiyang Typhoid.

(1) solar apoplexy syndrome

Refers to the invasion of pathogenic wind-cold into the meridians of the sun, characterized by fever, aversion to wind, excessive sweating and slow pulse.

The clinical manifestations are fever, aversion to wind, hyperhidrosis, slow pulse or runny nose and retching.

Syndrome analysis: Wei is yang, ying is yin, and exogenous pathogenic factors due to wind-cold mainly invade the meridians of the sun, Wei qi is affected by evil, Yang floats outside, and fighting with evil causes fever; Air leakage, so that the outside of the guard is not solid, the camp rules do not sweat; Because of sweating, muscle relaxation, fat is not conducive to the wind; If exogenous pathogens invade the lung and stomach, lung qi will be lost, leading to nasal sounds and stomach qi loss, leading to retching.

This syndrome is based on pathogenic wind, sweating and slow pulse.

(2) solar typhoid fever

It refers to the syndrome that wind-cold evil mainly invades the meridians of the sun, and Wei Yang is restrained and ignorant, with aversion to cold, fever, no sweat, head and body pain and tight pulse as the main manifestations.

Clinical manifestations include aversion to cold, fever, severe headache, body pain, anhidrosis, tight pulse or asthma.

Syndrome analysis: cold pathogen mainly invades the surface of the sun, and the defensive yang is suppressed, so the skin loses temperature, so it hates cold; Cold-evil is depressed, rising against evil in the middle of the day, and good and evil struggle, so there is fever; Cold stagnation, stagnation of weiyang, impassability of meridians, and loss of warm nourishment of bones and muscles, so head and body ache; Cold stagnation, dense skin, mystery house does not open, so there is no sweat; The cold pathogen attacks the exterior, and the pulse gas is also excited externally, so the pulse is tight, so the pulse is tight; Cold pathogen binds to the exterior, lung qi loses its propaganda, and breathing is accelerated.

This syndrome is based on aversion to cold, anhidrosis, head and body pain and tight pulse.

2. Syndrome of Taiyang Fu-organs

The syndrome of sun syndrome is incomprehensible, and the pathogenic factor is conduction from the outside of the sun to the bladder viscera. According to the different pathogenesis, it can be divided into two types: solar water storage syndrome and solar blood storage syndrome.

(1) solar water storage certificate

It refers to the syndrome that the syndrome of the sun is insoluble, the pathogenic factors combine with water, the bladder is unfavorable for gasification, and the water does not exist, with fever, aversion to cold and unfavorable urination as the main manifestations.

The clinical manifestations are fever, aversion to cold, dysuria, small abdominal distension, thirst, or vomiting in water, pulse floating or several floating.

Syndrome analysis shows that the syndrome of Taiyang meridian is difficult to understand, and there are exterior syndromes such as fever, aversion to cold and floating pulse. Pathogenic heat spreads to the bladder, gasification fails, pathogenic factors combine with water, water stops storing, urination is unfavorable, and the lower abdomen is full; When the water is stopped, the body fluid is insoluble in gas, and the body fluid cannot be transported out, so people drink water when they are thirsty; If you drink too much water, it will stop in your stomach. If your stomach loses its balance, it will fall down, and you will vomit immediately after drinking it.

This syndrome is characterized by sun meridian, unfavorable urination and full abdomen.

(2) Syndrome of blood accumulation in the sun

It refers to the syndrome that the sun is insoluble, the evil heat is abundant inside, the blood is bound to the abdomen, and the abdomen is urgent or hard, and the stool is black.

The clinical manifestations are sudden or hard fullness of the lower abdomen, unfavorable urination, such as madness or madness, forgetfulness, dark stools like paint, and heavy and astringent pulse.

Syndrome analysis: Sun meridian syndrome is incurable, pathogenic heat binds blood with the spread of meridians, blood stasis and heat bind lower jiao and less abdomen, and the abdomen is even hard and full when it is urgent; Blood stasis and heat stagnation can disturb the mind, so it can be seen that mental disorder, even madness, forgetfulness and other symptoms; The disease is in the blood and does not affect the gasification function of the bladder, so urination is self-serving; Blood stasis goes down with stool, and the stool is black as paint; Pulse stagnation or stagnation is caused by blood stasis and heat stagnation, and pulse qi is unfavorable.

This syndrome is based on acute abdomen, self-interest in urination and black stool.

(2) Yangming disease syndrome

Refers to the syndrome of excessive yang heat and gastrointestinal dryness and heat in the development of typhoid fever. The main pathogenesis of Yangming disease is "stomach excess". Stomach, including stomach and large intestine; Actually refers to too many pathogenic factors. Therefore, the essence of Yangming disease belongs to interior excess heat syndrome, which is the extreme stage of the struggle between evil and righteousness. Yangming disease syndrome can be divided into Yangming meridian syndrome and Yangming fu-organs syndrome.

1. Yangming meridian syndrome

Refers to excessive pathogenic heat, which fills Yangming meridians, permeates the whole body, and there is no dry stool in the intestine, characterized by high fever, sweating, thirst and broad pulse.

Clinical manifestations include body heat, aversion to cold, aversion to heat, excessive sweating, thirst, restless mood, blushing, shortness of breath, Huang Gan fur and heavy pulse.

Syndrome analysis: most of the syndromes of Yangming disease are caused by the syndrome of sun, or the treatment of shaoyang disease is ineffective and pathogenic heat enters. Or the factor of excessive body yang, the first feeling of exogenous pathogenic factors is interior excess heat syndrome.

Yangming is a meridian with excessive qi and blood, and the yang is strong. When evil spirits enter Yangming, it is most easy to turn dryness into heat. The heat in the body is blazing, permeates the whole body, and transpires outside, so seeing body heat is not aversion to cold, but aversion to heat; Pathogenic heat is flourishing, forcing body fluid to leak out, so sweating is excessive; Heat hurts body fluids, sweat hurts body fluids, and thirst leads to drinking; Evil heat disturbs people, and anxiety leads to irritability; Qi and blood surge in the face, so the face is red; Heat is forced by the lungs, and breathing is unfavorable, so the gas is thick; Strong pulse and yellow and dry fur are the signs of Yangming fever.

This syndrome is characterized by fever, sweating, thirst and heavy pulse.

2. Yangming fu-organ syndrome

Pathogenic heat is abundant in the interior, fighting with intestinal dregs, and dry stool is accumulated in the interior, with hot flashes, sweating, abdominal pain, constipation and heavy pulse as the main symptoms.

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Clinical manifestations: hot flashes, hands and feet? However, sweating, abdominal distension, pain, refusal to press, constipation, even delirium, mania, insomnia, yellow and dry tongue coating, or tingling, even dark and dry tongue coating, heavy and slippery pulse.

Syndrome analysis: Yangming meridian is full of qi in the sun, Yangming meridian in the limbs is full of qi, and the intestine is actually hot, so the sun is hot, and the hands and feet are hot. Sweating; Pathogenic heat dregs are bound in the intestine, the internal organs are blocked, the navel is full of pain, and constipation is bound; When evil heat disturbs the mind, you will see that God is delirious and even manic. The yellow, dry, prickly, or scorched fur is the result of internal stagnation of heat and body fluid being robbed; Excessive pathogenic heat, visible pathogenic resistance, stagnation of pulse channels, so the pulse is heavy and powerful, and the pulse is slippery when the pathogenic heat is urgent.

This syndrome is characterized by hot flashes, sweating, abdominal pain, constipation and heavy pulse.

(3) shaoyang syndrome

It refers to the syndrome that pathogenic factors attack the yang gallbladder meridian, the cardinal is unlucky, and the meridian qi is unfavorable, with cold and heat intersecting and chest and hypochondriac pain as the main manifestations.

The clinical manifestations are bitter mouth, dry throat, dizziness, alternating cold and heat, fullness in chest and hypochondrium, no appetite, upset and nausea, and thready pulse.

Syndrome analysis: Most of this syndrome is an indissoluble syndrome of Taiyang Meridian, which is caused by pathogenic factors spreading to gallbladder meridian and gallbladder fu-organs, or by Jue Yin disease spreading to at least Yang.

Evil is due to the exterior competing with yang, while positive victory leads to fever; Evil enters the interior and fights with yin, evil prevails over cold, and evil is a dispute between the outside and the inside, so it is seen that cold and heat meet; If gallbladder heat disturbs the heart, it will upset you; It will have a bitter taste when it is inflamed; When it burns, it will make your throat dry; When it is disturbed, it will make you dizzy. Pathogenic depression and yang deficiency, adverse menstrual qi, so the chest and hypochondrium are full of bitterness; Pathogenic heat disturbs the stomach, and the stomach loses harmony, so you don't want to eat when you see it, and you vomit silently; Pulse string is a sign of hepatobiliary diseases.

This syndrome is based on the combination of cold and heat and fullness in the chest and hypochondrium.

(4) Taiyin syndrome

Refers to deficiency-cold syndrome characterized by weakness of spleen yang, endogenous cold and dampness, abdominal distension and pain, and diarrhea due to anorexia.

Clinical manifestations include vomiting, inability to eat, diarrhea, thirst, abdominal pain, hypothermia in limbs, and slow or weak pulse.

Syndrome analysis Taiyin disease can be caused by direct invasion of spleen and stomach by cold and dampness, or by improper treatment of Sanyang disease and damage to spleen and yang. Taiyin disease is a mild stage of three diseases of yin, which belongs to the syndrome of deficiency in the interior and cold.

Spleen yang is weak, cold and dampness are endogenous, and qi is blocked, so the abdomen is full and painful; Loss of spleen health will reduce food intake; Cold and wet betting is profitable; Cold and dampness attack the stomach, and the stomach loses harmony, so vomiting is seen; Yang deficiency loses its warmth, so the limbs are not warm; Spleen yang is weak and agitation is weak, so the pulse is slow or weak.

The main points of this syndrome are deficiency-cold symptoms such as pain and diarrhea when the abdomen is full.

(5) shaoyin syndrome

Refers to the syndrome of yin and yang failure in the late stage of typhoid fever, characterized by thin pulse and lethargy. The incidence of shaoyin syndrome is mainly in the heart and kidney. If the disease turns from yin to cold, it is a syndrome of less yin and cold; Yang-to-heat is a syndrome of deficiency of yin-heat.

1. Yin-cold deficiency syndrome

Refers to deficiency-cold syndrome characterized by deficiency of heart and kidney-yang, excessive yin and cold, and transformation from yin to cold, mainly manifested as aversion to cold, cold limbs and clearing the valley.

The clinical manifestations are not heat aversion to cold, but drowsiness, cold limbs, diarrhea, vomiting, inability to eat, or vomiting immediately after eating, or body heat aversion to cold, even red face and thready pulse.

Syndrome analysis shows that the disease is at least yin, and the heart, kidney, yang and qi are all deficient, so it is a whole deficiency-cold syndrome. Yang-qi declines, Yin-cold prevails, and it loses its warmth and nourishment, so it is seen that there is no heat and aversion to cold (that is, aversion to cold), but it is drowsy and the limbs are paralyzed; Kidney-yang deficiency, fire does not warm the soil, spleen and stomach accept transportation, lifting dereliction of duty, so it is beneficial to clear the valley, vomiting can not eat; If yin wins yang, you will see that your body is hot but not cold, and your face is red; Yang deficiency of heart and kidney, agitation and weakness, and thready pulse.

This syndrome is based on aversion to cold, limb syncope, diarrhea and thready pulse.

2. Yin deficiency and heat excess syndrome

Refers to deficiency-heat syndrome characterized by yin deficiency of heart and kidney and hyperactivity of yang, which changes from yang to heat, and is characterized by restlessness, red tongue tip and rapid pulse.

Clinical manifestations include restless sleep, dry mouth and throat, red tongue tip and rapid pulse.

Syndrome analysis: evil enters less yin, yang becomes hot, heat burns true yin, water does not help fire, heart fire is strong, it disturbs the mind, and it is too hot to sleep; Loss of yin leads to dry mouth and throat; Yin deficiency and yang heat, redness on the tip of the tongue, and rapid pulse.

This syndrome is mainly dysphoria and yin deficiency.

(6) Syndrome of Jue Yin

Refers to the late stage of the development and spread of typhoid fever, which is characterized by the confrontation of yin and yang, alternating cold and heat, and the resumption of faint and heat.

The clinical manifestations are quenching thirst, attacking the heart with qi, heartburn, hunger without eating, and vomiting with eating.

Syndrome analysis Jueyin disease is the end of six meridians disease, which is mostly caused by other meridians. Its basic pathological change is upper heat and lower cold.

Pathogens enter Jueyin, and pericardial fire is hot when it gets angry; Hot body fluid can quench thirst and drink water. The pulse of Jue yin is sandwiched between the stomach and diaphragm, and the fire is inflamed, and the liver qi can't be controlled, and the qi hits the heart directly, causing heartache and heat. Because of the cold, the spleen loses its health, and because of the liver wood, you can't eat it. If you eat too much, you will vomit. If there is ascaris in it, you can often vomit ascaris.

Second, the transmission and change of diseases and syndromes of six meridians.

The diseases and syndromes of six meridians reflect the pathological changes of zang-fu organs and meridians, and they are an interrelated and inseparable whole. Therefore, the diseases and syndromes of the six meridians can be transmitted to each other, which are manifested as dredging collaterals, straightening middle meridians and collateral diseases.

Pathogens invade from the outside, gradually develop inward, and change from one disease to another, which is called "transmitting menstruation". Among them, if it is handed down in the order of six channels of typhoid fever, that is, sun syndrome → Yangming syndrome → Shaoyang syndrome → Taiyin syndrome → Shaoyin syndrome → Jueyin syndrome, it is called "passing along the channels"; If it is passed down from generation to generation once or twice, it is called "Jing Yue Biography"; If the two meridians are from the exterior to the interior, it is called "exterior-interior transmission", such as sun disease spreading Shaoyin disease.

At first, typhoid fever was not introduced from Sanyang Meridian, but pathogenic factors directly entered Yin San, which was called "Zhi Zhong".

When two or three meridians appear at the same time without transmission, fever is called "comorbidity". For example, the sun is Yangming and the sun is Taiyin.

A fever is called "concurrent disease" if it is not stopped and is seen again. For example, the sun loses yin, and the sun loses yin.