|
DIFFERENTIATlON OF SYNDROMES——THE PRECONDITION FOR TREATMENT | |
|
辨证—治疗的前提 | |
| 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. | 中医的辨证是一种分析和认识疾病证候的方法。换言之，它也是根据四诊收集的临床资料确定疾病的位置、性质、发生和发展以及邪正状况的一个过程。从以上可以明显的知道辨证是治疗的前提和基础。正确的辨证和适当的治疗是取得好的治疗效果的先决条件。中医有许多辨证的方法，如根据八纲辨证；气血津液辨证；脏腑辨证；六经辨证；卫气营血辨证和三焦辨证。每种方法都有自己的特点和侧重点，必须准确灵活的应用才能综合的了解疾病，从而为治疗提供基础。 |
| 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. | 八个证候总纲也称“八纲”指的是阴、阳、表、里、寒、热、虚和实。八纲辨证是中医的总的指导，是中医诊断的重要组成部分。虽然疾病的临床表现很复杂，但都可以根据八纲归类。例如，阴证和阳证的归类；表病和里病的定位；疾病的寒热性质；正邪的盛衰和虚实。八纲辨证将复杂易变的证候归为四对：表里、寒热、虚实和阴阳。因此，在诊断过程中，八纲辨证是必须的。 |
| 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. | 虽然这种辨证方法将不同的证候分成八类，但是它们之间是相互联系、不可分离的。例如，表里证和寒热、虚实证相关；寒热证和表里、虚实证相关；虚实证和寒热表里证相关。这些病理并不是单独发生，而是表里、寒热、虚实证通常同时出现。例如，表里证混杂的疾病；虚实夹杂的疾病；寒热夹杂的疾病。在一定条件下，这些证候常相互转化。例如，表邪可以入里，反之亦然；寒证可以化热，反之亦然；虚证可以转实，反之亦然。疾病过程中，一些与疾病性质相反的假象会出现。因此，医生根据八纲辨证时，不仅必须精确的掌握每一种证候的特点，也要注意它们之间的共存、交错、转化和真假状况，因此才能对疾病有全面的了解，从而为治疗提供可靠的依据。 |
| 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. | 阴阳是一对可以总结其它三对原则的原则，也是八纲中最重要的原则。所以其它三对原则可被归纳为阴或阳。表、热和实证归为阳，而里、寒、虚证则归为阴。阴证以体内阳虚阴盛为特点。阳证以由体内阳热过盛引起阳亢和脏腑功能亢进为特点。阴阳也通常用于解释脏腑器官的病理变化，例如，阴阳俱虚、阴虚和阳虚等。 |
| 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. | 气血津液辨证是一种根据气血津液理论分析和确定气血津液病理变化的辨证方法。气血津液是脏腑功能活动的物质基础，它们的形成和循行依赖于脏腑功能的正常。因此，气血津液的病理改变可以引起脏腑功能的异常，同时，脏腑功能的异常也必然会导致气血津液的病理改变。因此，它们两者应紧密协调相互补充。气有许多证候，通常被分为四种类型：气虚、气陷、气滞和气逆。就血证而言，中医试图将其归为四类：血虚、血瘀、血热和血寒。在生理上，它们相互补充；在病理上，它们相互影响。因此形成了同一疾病的气血辨证。临床上，有气滞血瘀、气不摄血、气血亏虚、气虚血瘀和气随血脱。津液的证候可以归为两类：津液亏虚和水液储留。津液亏虚可以导致以下的临床表现：口干、咽干、唇舌干燥、眼眶凹陷，皮肤干燥、尿少、便秘、舌红少苔和脉细数。而水液储留可以由如停滞的水湿痰饮的病理物质引起。通常见于水肿、鼓胀和痰凝。 |
| 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. | 卫气营血辨证是适用于分析和辨证外感热病的一种辨证方法。它是清代叶天士创建和发展起来的。它补充了六经辨证理论，丰富了中医对外感热病的辨证论治。这个理论是区分证候、确定变化和决定治疗的基础。卫气营血理论有极高的实践价值，因为，一方面，它将外感病的病理变化归为四种证候：卫分、气分、营分和血分。另一方面，它代表了四个不同的阶段：外感热病发展中的浅深和轻重阶段。它也被认为是外感热病发展变化的规则。卫气阶段的疾病轻浅，而营血阶段的疾病则深重。 |
| 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. | 脏腑辨证是一种根据脏象、阴阳和五行理论通过症状和征象对疾病的根源、位置和性质以及正邪状态进行分析和归类的辨证方法。它是其它辨证的基础，也是所有中医临床分支学科的疾病诊断方法，是中医辨证系统的重要组成部分。脏腑辨证包括脏病辨证，腑病辨证和脏腑辨证。 |
| 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. | 六经辨证是中医辨证外感病的一种辨证方法。它是东汉时期一位杰出的医生—张仲景在《伤寒杂病论》中提出的。根据阴阳理论，六经证候可以分为三阳证—太阳、阳明和少阳以及三阴证—太阴，少阴和厥阴，从而为辨证论治提供基础。六经证是脏腑经络病理变化的反应，三阳证以六腑的病理变化为基础，而三阴证以五脏的病理变化为基础。
|
| 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. | 三焦辨证是辨证热病的一种方法，由清代的一位杰出的医生—吴鞠通提出的。吴氏以三焦结合卫气营血辨证为辨证温病的指导原则，强调温病中与三焦相关脏腑的病理变化、证候特点和转化规律。温病是由四季中不同的温热之邪引起的所有急性热病的总称。三焦辨证也是治疗的前提和基础。 |
| 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. | 总的来说，辨证是复杂的，该单元讨论的只是一些普通、典型的辨证，它们应被灵活的运用，从而在正确的辨证基础上确定治疗原则。 |
