The diagnosis of disease and syndrome differentiation method

LiYongQing Inner Mongolia medical university college of traditional Chinese medicine

China's traditional Chinese medicine to

        Disease diagnosis and the essencial etiopathogenesis, is the basic theory of TCM, basic knowledge, basic skills of comprehensive utilization, is the core of the traditional Chinese medicine clinical disciplines content. They are two different concepts, cannot confuse STH with STH else.

        The diagnosis of disease, is based on received and diagnose all kinds of relevant material, and the exclusion of other suspected disease and concluded the result, it is the premise of the pattern identification and treatment. The essencial etiopathogenesis, is in the diagnosis of disease of confirmed. The diagnosis of disease - differentiation of symptoms and signs parting - according to the certificate in accordance with the legislation - choose party use this a complete process, called points disease syndrome differentiation and treatment, namely disease diagnosis and pattern identification and treatment.

        The clinical disciplines each kind of disease, all include several major card type, and in every major card type, sometimes can be divided into several different specific card type. Therefore, only disease diagnosis is correct, accurate differentiation, choose the application of reasonable proper, can ensure that treatment effect.

        Ex 1

        The general information

        LiuMouMou, male, 62 years old, March 11, 2012 first visit.

        1. The pathogenesis and treatment after: suffer from chronic bronchitis, more than 20 years, 1999 diagnosed with obstructive pulmonary emphysema. In 2012 after the Spring Festival, illness, from clothing amoxicillin, the compound aminophylline, compound liquorice tablets, illness have no obvious improvement.

        2. Symptoms: cough asthma, much sputum and thin white, chest labored breathing short, not prostrate, complexion tarnish, oral blue, palpitation, limbs cold, urinate less, lower limb edema, tongue lilac have ecchymosis, moss white slippery, vein sink weakness.

        3. Signs: barrel chest, diaphragmatic muscle motion restricted; Percussion is a surd, cardiac dullness boundary narrow; Auscultate breath sounds is abate, a whistle singing sound, heart sound far away. Temperature 36.6 ℃, the prostate gland proliferation, thyroid nodules.

        Diagnosis and pattern identification and treatment

        1. The diagnosis: obstructive pulmonary emphysema (cough asthma).

        Basis: (1) the history: suffer from chronic bronchitis, more than 20 years, 1999 diagnosed with obstructive pulmonary emphysema. (2) the symptoms and signs: (1) the symptoms: cough asthma, much sputum, chest labored breathing short, not prostrate, complexion tarnish, oral blue, urinate less, palpitation, lower limb edema. (2) the signs: barrel chest, diaphragmatic muscle movement is limited, percussion is a surd, cardiac dullness boundary narrowed, auscultate breath sounds is abate, a whistle singing sound, heart sound far away.

        2. The essencial etiopathogenesis,

        (1) card type: cold drink make lung, Yang failure blood stasis.

        (2) syndrome: cough asthma, much sputum and thin white, chest labored breathing short, not prostrate, palpitation, complexion tarnish, oral blue, cold limbs, urinate less, lower limb edema, tongue lilac have ecchymosis, moss white slippery, vein sink weakness.

        According to cough asthma, much sputum, chest labored breathing is short, can't lie low, heart palpitations, urinate less, lower limb edema, determine the specific disease position in the lungs, and involves the heart, kidney, In a disease in, or only cough asthma, much sputum, chest labored breathing short, not prostrate, urinate less, lower limb edema, vein heavy, and no chills and fever and chills and fever intercourse or see, therefore, eliminate disease in table and a half exterior and half. This process called a diagnosis of disease, including specific disease patients (lung, heart and kidney) and the disease patients ().

        Determine a specific disease with the disease, who just finished part of dialectical content, but also can't guide treatment, must further distinguish lesions chills and fever attribute and the actual attributes.

        According to the sputum thin white, complexion tarnish, oral blue, brothers and sisters and cold, tongue lilac have ecchymosis, moss white slip, vein weakness, determine the disease resistance of cold (no sputum yellow sticky, belly hot and red tongue moss yellow dry and hot like, but phlegm thin white, cold limbs, moss white slide and a cold like), belong to the actual inclusion (both shortness of breath, tongue light, vein weakness and virtual image, and the complexion tarnish, oral blue, purple tongue has petechia and real image). This process called differentiation of disease resistance, including chills and fever attributes (cold) and the actual attributes (the actual inclusion).

        According to the clinic and syndrome differentiation for related complete material, determine the cause and pathogenesis is cold drink make lung, Yang failure blood stasis (cold drink make lung, lung lost xuan drop, disease long involving the heart kidney, heart failure, renal sun be the spirit virtual cannot run qi and blood, change gas line water, temperature keep meridians), illness lay particular stress on, patient's condition is nasty, for evil is virtual reality. This process is to analysis the main pathogenesis, judge patient's condition, disease stage and evil positive growth and change.

        Through the "cough asthma, much sputum and thin white, chest labored breathing short, not prostrate, complexion tarnish, oral bleeding, limbs cold urinate less, lower limb edema, tongue lilac have ecchymosis, moss white slippery, vein sink weakness" this group performance comprehensive analysis, to determine a specific disease in the lung, and the heart and kidneys, list a disease in; Disease resistance of cold, belong to the actual inclusion; Etiology and pathogenesis is cold drink make lung, Yang failure blood stasis; Illness lay particular stress on, patient's condition is nasty, for evil real are virtual stage. Summarized as cold drink make lung, deficiency of Yang and blood stasis (card), cure to exorcise and righting and, namely WenHua cold drink, and lifted Yang invigorate the circulation of blood.

        (3) therapy: WenHua cold drink, and lifted Yang invigorate the circulation of blood.

        (4) prescription: attached Chen half according to tonga minus.

        (5) prescription: system radix aconiti lateralis preparata (first Fried) 25 grams, dried tangerine or orange peel 10 grams, the ginger pinellia tuber 15 grams, full snakegourd fruit 15 grams, semen lepidii 20 grams, red 10 grams, salvia miltiorrhiza 15 grams, poria cocos 20 grams, dry ginger 10 grams, Perilla 6 grams, platycodon grandiflorum 10 grams, roasted liquorice 10 grams, Chinese yam 30 grams, main ephedra 6 grams. Among them, the reuse radix aconiti lateralis preparata, kidney and strong heart, Chinese yam, tonifying lung qi, nano kidney qi; Dry ginger, pinellia tuber, temperature lung-heat cold, change drink polyester turbidity; Dried tangerine or orange peel, trichosanthes kirilowii maxim, Perilla, platycodon grandiflorum, qi wide chest phlegm; Semen lepidii, poria cocos, purging lung water, polyester phlegm turbidity, the urine, fixed palpitation; Safflower, salvia miltiorrhiza, invigorate the circulation of blood and blood stasis elimination; Main ephedra, releasing lungs and water, spasmolysis relieving asthma; Licorice harmonic the medicine. The whole party common strike temperature lung change drink, and lifted Yang invigorate the circulation of blood effect.

        Ex 2

        The general information

        Yue mou, male, 49 years old, see a doctor time on April 9, 2010.

        1. The disease after: stomach and a half months. Patients with stomach trouble 6 ~ 7 years, in 2006 to do gastroscope inspection, diagnosis of atrophic gastritis, by the traditional Chinese and western medicine to heal, and their condition when light weight, and increase trend year by year. Not long ago on a business trip, what food does not rule, appear of epigastric pain, successively oral zantac, omeprazole, clarithromycin, stomach Thai, no obvious symptoms improved and see a doctor. Patients have an annual health check, I've never been to courage and exception report.

        2. Symptoms and signs: department of epigastric pain, loss of appetite, nausea, pantothenic acid water, sallow complexion, body tired weakness, dry mouth not to drink, after drinking the stomach discomfort or pain worse, urine normal, tongue dim, moss huangbai phase and, vein sink weak weak. Gastroscopy diagnosis of atrophic gastritis, Courage B to exceed not seen abnormal.

        Diagnosis and pattern identification and treatment

        1. The diagnosis: atrophic gastritis (stomach).

        Basis: (1) the department of epigastric pain, loss of appetite, nausea, pantothenic acid water; Gastroscope inspection results. (2) is sallow complexion, loss of appetite, nausea, but no eye yellow, body yellow, urine yellow, wan threat pain, but the department of epigastric pain, urine normal, and never have courage anomaly inspection report, can preliminary exclude hepatic disease.

        2. The essencial etiopathogenesis,

        (1) card type: mixed chills and fever.

        (2) syndrome: department of epigastric pain, loss of appetite, nausea, pantothenic acid water, sallow complexion, body tired weakness, dry mouth not to drink, after drinking the stomach discomfort or pain worse, urine normal, tongue dim, moss huangbai phase and, vein sink weak weak.

        According to the department of epigastric pain, loss of appetite, nausea, pantothenic acid water, determine the specific disease in a stomach, determine the exterior-interior disease in a (no chills and fever and see, chills and fever exchanges, but neither hot nor cold evil, vein sink). This process called a diagnosis of disease, including specific disease patients (stomach) and the disease patients ().

        In determining a specific disease with the disease a, is far from guiding treatment, must further distinguish chills and fever attribute and the actual attributes.

        According to sallow complexion, body tired weakness, dry mouth not to drink, drink epigastric discomfort after department or make pain worse, tongue dim, moss huangbai phase and, vein weak weakness, determine the disease resistance of chills and fever mixed (neither thirsty to drink, moss yellow dry and clear thermal image, also do not have the mouth not thirsty, moss white slip and obvious cold like, but dry mouth not to drink, moss huangbai phase and), belongs to the actual inclusion (both after drinking of epigastric discomfort or pain worse, tongue, and reality of the dark like a sallow complexion, tongue weak, vein weak weakness of the virtual image). This process called differentiation of disease resistance, including chills and fever attributes (chills and fever mixed) and the actual attributes (the actual inclusion).

        According to the clinic and syndrome differentiation for related complete material, determine the cause and pathogenesis is mixed chills and fever, with the spleen and stomach, qi operation impeded, gastric permissive, rotten, spleen (including small intestine) absorption, transport is changed, transfer, compresses function decline; Patient's condition is not urgent, belong to middle lesions, for evil is virtual reality. This process is to analysis the main pathogenesis, judge patient's condition, disease stage and evil positive growth and change.

        Through the "department of epigastric pain, loss of appetite, nausea, pantothenic acid water, sallow complexion, body tired weakness, dry mouth not to drink, after drinking the stomach discomfort or pain, increase urine normal, tongue dim, moss huangbai phase and, vein sink weak weak" this a group of performance (four diagnostic methods of complete material) comprehensive analysis, to determine a specific disease in spleen stomach, list a disease in; Disease resistance of inclusion and false or true, Etiology and pathogenesis is mixed chills and fever, with the spleen and stomach, qi operation impeded; Patient's condition is not urgent, belong to middle lesions, for evil real are virtual stage. Referred to as chills and fever mixed (card), or say chills and fever mixed together, supplement hysteresis (card), or say, mixed with chills and fever, spleen and stomach (card), or say the spleen and stomach nakedness and inclusion (card) and so on, because of the spleen and stomach in nakedness chills and fever of mixed card, according to the principle of the essencial etiopathogenesis, appropriate cold temperature and, for the attack, octyl open bitter drain, lifting simultaneously.

        (3) therapy: heat dispersing cold stomach and spleen.

        (4) prescription: rhizoma coptidis tonga minus.

        (5) prescription: rhizoma coptidis 6 grams, radix scutellariae 10 grams, dangshen 15 grams, cassia twig 10 grams, dry ginger 10 grams, evodia rutaecarpa 5 grams, the ginger pinellia 12 grams, sepium 15 grams, salvia miltiorrhiza 12 grams, rhizoma zedoariae 10 grams, big jujube 5 pieces, roasted liquorice 5 grams.

        Among them, cassia twig, dry ginger, evodia rutaecarpa, rhizoma coptidis, radix scutellariae, cold temperature and, octyl open bitter drain; Dangshen, date, roasted liquorice and pinellia tuber suitable, lifting simultaneously, and the spleen in; Sepium, radix salviae miltiorrhizae, rhizoma zedoariae, acid and elimination stasis, line hysteresis. The whole party played a total of heat, cold, and scattered the spleen effect.

        In short, disease diagnosis and the essencial etiopathogenesis, is the basic theory of TCM, basic knowledge, basic skills of comprehensive utilization, is the core of the traditional Chinese medicine clinical subject content, is a traditional Chinese medicine inspection personnel the touchstone of basic skills, clinical curative effect is the reliable guarantee.

        Diagnosis and differentiation of symptoms and signs, are two different concepts, cannot confuse STH with STH else. The former is based on received and diagnose all kinds of relevant material, and then the exclusion of other suspected disease, to make sure it is the disease rather than he disease; The latter is the premise of the disease diagnosis, according to the received and differentiation of symptoms and signs all kinds of relevant material, and brushing away any other card type, in order to judge its credit card is rather than he.