| Research purpose Based on two books named Linzheng Zhinan Yi’an(Case Records as a Guide to Clinical Practice)and Wenre Lun(Treatise on Warm-heat Disease),this study deeply researches and reinterprets the theory on differentiation and treatment of warm disease from Ye Tianshi,respecting and revealing the real intention of author,for the purpose of exploring the essence of his theory and clarifying the development rule and treatment method of warm disease,which will make great process for the further cognition on this disease in clinical practice.Research method Combining the methods of theoretical discussion and data mining and based on the original meaning of Ye’s works,this paper reinterprets the theory related to warm disease of him.According to the definition of warm disease in the textbook of higher education,the related medical cases in Linzheng Zhinan Yi’an are selected,except cases of chickenpox,dysentery,malaria,impediment disease or other specific diseases,as well as diseases occurs in more than one aspects of defense,qi,nutrient and blood.Then with the definition of patterns of defense aspect,qi aspect,nutrient aspect and blood aspect in the textbook of warm diseases,the criteria for inclusion,exclusion and classification of medical cases are further formulated.In addition,this study standardizes the data of selected medical cases,classifies the case database into defense aspect pattern of dampness-heat diseases(32 cases),defense aspect pattern of warmheat diseases(9 cases),qi aspect pattern of dampness-heat diseases(102 cases),qi aspect pattern of warm-heat diseases(152 cases),nutrient aspect pattern of warm-heat diseases(73 cases)and blood aspect pattern of warm-heat diseases(10 cases).All of databases above are imported into the System of Medical Case Cloud Platform(SMCCP),then the connection of warm disease symptoms and of main medicinals and combination of formulas can be explored by the analysis of complex network,so the core organizational structure of the symptom information and prescription in warm disease cases will be found.Finally,through analysis of diagnosis and treatment thought of Ye reflected in the core organizational structure,corresponding points in theoretical part will be verified,and the thought about development and treatment of warm disease in medical cases can be further collected.Research results Through data mining totally 6 results have been found.Ⅰ.Among the cases of defense aspect pattern of warm-heat diseases,cough is the most common symptom,combined with the indication from radar chart of channel tropism that the main direction of medicinal treating this type disease is lung,and it points out that exogenous pathogen of warm-heat invades lung at first.Ⅱ.From the cases of defense aspect pattern of dampness-heat diseases in Linzheng Zhinan Yi’an,we can find that the main pathogenesis of this type disease is dampnessheat invading lung and the main treatment is treating the lung.However,dampnessheat can not only invade the lung,but extensively affect the qi movement of sanjiao.Ⅲ.The radar chart of channel tropism of qi aspect pattern of warm-heat diseases shows that the main direction of medicinal treating this type disease is lung,indicating that the disease location is mainly in the lung system.Combined with above analysis result of defense aspect,it is proved that the exogenous pathogen of warm-heat from defense aspect to qi aspect ascribes to the disease stage in lung system.According to the data analysis of symptom,fever and cough are the main symptoms of qi aspect pattern,and based on the data analysis of Chinese medicinal,clearing heat and dispersing lung are the main treatment goals of this pattern,both of which indicate that the heat manifestation in qi aspect is more serious and more harmful to lung than that in defense aspect.Defense aspect syndrome is the superficial stage of lung system disease,while qi aspect syndrome is the deep stage,so there are differences of disease location and state between the two aspects.Combined with the radar chart of four natures and five flavors and the frequency histogram of application of qi aspect pattern,it can be found that medicinals of nourishing yin and generating fluid appear frequently in qi aspect of warm-heat diseases,indicating that there is some degree of body fluid injury.With the radar chart of channel tropism and the frequency diagram of medicinal,it can be found that the body fluid was mainly injured in lung and stomach,which proved that the yin injury caused by warm disease could produce transmission from the lung of upper jiao to the stomach of middle jiao.The medicinal node diagram of qi aspect pattern of warmheat diseases shows that formulas of qi aspect emphasize the compatibility of dispersing lung qi,suggesting that qi stagnation in lung is the core pathogenesis of this pattern.There are no medicinals used to regulate qi in spleen and stomach of middle jiao in the frequency diagram of medicinal and function,core medicinal framework,radar chart of channel tropism,four natures and five flavors,except for dispersing qi stagnation in lung of upper jiao.It shows that the stuffiness and fullness of stomach is an expression for all kinds of qi stagnation ascribe to lung disease,instead of spleen or stomach.Thus,it is suggested that if there are qi stagnation symptoms in other parts of body caused by the lung qi stagnation in warm-heat diseases,the lung qi should be dispersed at first to relieve the stuffiness and fullness of stomach or other qi stagnation symptoms.Ⅳ.The symptom combination diagram of qi aspect pattern of dampness-heat diseases reflects the close relationship in pathogenesis of upper,middle and lower jiao,which reveals the core role of sanjiao as the waterway of qi movement in the development of this type diseases,and proves the transmission rule that dampness-heat spreads and internally attacks qi movement in sanjiao along this waterway.The frequency diagram of medicinal and radar chart of channel tropism reflect Ye’s thought about separation and elimination of pathogenic qi in sanjiao for the treatment in qi aspect pattern of dampness-heat diseases.Although the symptom frequency chart shows that symptoms in middle jiao are the most common in qi aspect pattern of dampness-heat diseases,according to the analysis chart of complex network and radar chart of channel tropism,Ye’s treatment of this type diseases is still focusing on promoting lung qi5 and paying more attention on treating lung based on separation and elimination of pathogenic qi in sanjiao.Ⅴ.Analysis chart of complex network and symptom frequency diagram of nutrient aspect pattern shows that pathogenic qi transmits from qi aspect of lung to nutrient aspect of heart.Besides,the frequency diagram of medicinal and function,analysis of complex network and radar chart of channel tropism all shows that the main combination method of formulas in nutrient aspect pattern is clearing heat of both qi and nutrient aspects,and the heat of nutrient aspect needs to be expelled to qi aspect.According to radar charts of the four natures and five flavors,medicinals of sweet and cold with function of nourishing yin and generating fluid are frequently applied in this pattern.Combined with analysis on qi aspect pattern of warm-heat disease,it can be found that with the pathogenic qi transmitting from qi aspect to nutrient aspect,the injury of body fluid becomes more serious.According to radar chart of channel tropism,obvious deficiency of stomach yin appears in nutrient aspect.Although the main disease location is still in nutrient aspect of heart,the pathogenesis of deficiency in stomach yin will gradually become more prominent if this disease further develops to the late stage,turning into a major trend of this pattern.In addition,the high frequency of medicinals in the direction of liver and kidney also suggests that yin injury of liver and kidney has been involved in this pattern,which may tend to a further transformation into yin deficiency of liver and kidney.Ⅵ.Based on the limited analysis on medical cases of blood aspect pattern in Linzheng Zhinan Yi’an,we can find that the main treatment methods of this pattern are clearing heat,cooling blood and activating blood to resolve stasis,suggested by the frequency diagram of medicinal and function and analysis of complex network.However,the appearance of medicinals for dispelling and dispersing wind-heat like Forsythiae Fructus(forsythia fruit)in formulas of blood aspect pattern suggests that Ye might not simply use methods of cooling blood or resolving stasis,but still expelling heat from nutrient aspect to qi.Then the radar chart of channel tropism points that there is a close relationship between liver and blood aspect pattern,indicating that after entering into blood aspect of heart in upper jiao,the heat is likely to further transmit into liver in lower jiao.But due to the shortage of cases,this study does not confirm the possibility of disease transmission from blood aspect of heart to liver.Even though heart and liver are closely related to blood aspect,Ye only emphasized the leading role of heart(pericardium)in nutrient and blood aspect patterns of warm disease,and rarely expounded the importance of liver.Ye’s discussion on the relationship between liver and warm disease is mainly manifested in the late stage with occurrence of yin deficiency causing wind stirring.Therefore,the specific relationship between liver and blood aspect pattern of warm disease remains to be further researched.Research conclusionsⅠ.There are different transmission rules between warm diseases of warm-heat and dampness-heat.The location of warm disease of warm-heat from defense to qi aspect is the lung system,and the main syndrome ascribes to qi aspect pattern in lung rather than in yangming meridian.However,in addition to qi aspect pattern in lung,warm disease of dampnessheat can also transmit to sanjiao via moyuan(interpleuro-diaphragmatic space),staying in the waterway or disturbing qi movement of different zang-fu viscera,which leads to various symptoms and pathogenesis characteristics,especially the most common symptoms in middle jiao.Besides,the pathogenic qi of dampness-heat can further transmit into intestines and stomach through the waterway and cause the pattern of yangming fu-viscera excess.The transmission of warm diseases of warm-heat from qi to blood is mainly manifested as from the qi aspect of lung into the blood and nutrient aspects of heart.As Ye said,warm pathogen invades human body from mouth and nose,invading lung at first and then passing into pericardium.This is the revelation about disease transmission sequence of defense aspect,qi aspect,nutrient aspect and blood aspect.However,in addition to the mentioned transmission sequence,warm disease of dampness-heat can also disturb the nutrient aspect of heart through the waterway or intestines and stomach after transformation into heat or fire.Ⅱ.Ye established the transmission theory of warm disease.Ye believed that warm disease belongs to hand-meridian diseases and cold damage belongs to foot-meridian diseases.The transmission of cold damage,such as transmission from bladder channel of foot-taiyang to stomach channel of footyangming is called sequential transmission,while that of warm disease is different from sequential transmission in cold damage,like from lung channel of hand-taiyin to pericardium channel of hand-jueyin,so this kind of transmission is called reverse transmission.Inhaled through the mouth and nose,the pathogenic qi invading the lung channel of hand-taiyin at first,and then spread to the pericardium channel of handjueyin,which is the expression of the transmission rule of defense,qi,nutrient and blood in the concept level of zang-fu viscera and meridians,without transmission in foot meridians.In this process,there is no transmission of the transmission law of foot meridian system.Ye believed that warm disease belongs to hand-meridian diseases,which emphasizes the transmission feature of defense,qi,nutrient and blood in lung and heart.And he also pointed out the different rules of warm disease compared with cold damage through concepts of hand-meridian disease,foot-meridian disease,sequential transmission and reverse transmission.Transmission refers to a great changes in the state of yin and yang and pattern of disease.The essence behind the phenomenon of transmission in warm disease is the change of disease location in qi aspect or blood aspect.The most typical transmission rule of warm disease is from the lung channel of hand-taiyin to the pericardium channel of handjueyin.In addition to the above transmission rule,exogenous warm disease of dampness-heat is more likely to occur the transmission from sanjiao channel of handshaoyang to stomach channel of foot-yangming,and even to pericardium channel of hand-jueyin as time goes by.Warm disease is easy to maintain in a fixed stage for a long time without changes in symptoms,which is relative to the rapid spread characteristics of cold damage,indicating the general pathological rule that warm disease is easy to stay in the qi or blood aspect for a long time.Changes of yin and yang in the transmission of warm disease from qi aspect to blood is slower than that of cold damage.Therefore,Ye compared the transmission of the two kinds of diseases and proposed the difference of the transmission speed between them.It mainly shows as follows:warm disease is easy to stay in the lung channel of hand-taiyin and the pericardium channel of hand-jueyin for a long time without transmitting,while dampness-heat disease is easy to stay in the sanjiao channel of hand-shaoyang or one of zang-fu viscera for a long time,which is the most typical situation without transmitting in warm diseases.Ⅲ.Ye has systematic thought on syndrome differentiation and medicinals use of warm diseases.Exogenous warm disease of warm-heat mainly transmits in the two systems of lung and pericardium(heart)in upper jiao,so the treatment should fully consider the location,keep the characteristics of using light medicinals to treat diseases in upper jiao,pungent-cool medicinals to cure the defense and qi aspects pattern in lung,and salty,bitter and light medicinals to cure the nutrient and blood aspects pattern in heart.Exogenous warm disease of dampness-heat transmits in upper,middle and lower jiao and disturbs different zang-fu viscera through the sanjiao as the path of qi movement,showing various characteristics of diseases and pathogenesis.Due to the different accumulation parts of dampness-heat and the different influence on qi movement,Ye proposed the methods of separation and elimination in sanjiao to treat this type of diseases,which include opening the qi stagnation in upper jiao,promoting the transportation and transformation of spleen and stomach in middle jiao,and dredging the intestinal obstruction.At the same time,Ye focused on opening the qi stagnation in lung,especially for dampness-heat accumulating in sanjiao and symptoms appearing in middle and lower jiao.The premise of this treatment is that the location of dampnessheat must have a direct connection with the qi movement of lung,so this treatment is mostly based on the physiological and pathological basis of dampness-heat transmitting through the waterway sanjiao.In the transmission process of defense,qi,nutrient and blood aspects,there is always a kind of potential pathogenesis of yin injury,which is gradually aggravated with the deepening of the warm pathogen.When the warm disease develops to the degree of serious yin injury,the disease will show the rule of transmission in zang-fu viscera of three jiao.The yin injury of warm disease can be gradually aggravated from the lung of upper jiao to the stomach of middle jiao and then to the liver and kidney of lower jiao,and the change of yin deficiency in stomach,liver and kidney also can be found in the late stage of nutrient aspect pattern.In short,the transmission of warm disease from the heart and lung in upper jiao to spleen and stomach in middle jiao and then liver and kidney in lower jiao takes yin injury as the main pathogenesis.Ye summarized a clear theory about the division of medicinals use.He believed that with the transmission of warm diseases from upper jiao to lower jiao,the used medicinals should gradually change from light and floating to heavy and sinking,and the nature and flavour should also from pungent-cool to bitter-pungent-cold or sweetcold and then salty-bitter-cold.According to the summary of Linzheng Zhinan Yi’an,it can be found that Ye often chose light flowers,leaves and hollow fructus to treat diseases in upper jiao,the roots,stems,or unripe fructus with bitter and pungent taste and great intervene in qi and blood movement of human body to treat diseases in middle jiao,roots and stems with obvious sweet taste and juice to nourish spleen yin,and other heavy roots,stems and processed medicinals with salty taste to treat diseases of lower jiao.This thought is not only embodied in Ye’s medical cases of treating warm diseases,but also widely used in treating other clinical diseases.Ⅳ.There are other relevant findings in this study.The pattern of Baihutang(baihu decoction)in warm disease is.not necessarily the heat pattern of stomach channel of foot-yangming,but of lung channel of hand-taiyin.The pattern of Baihutang can’t directly link warm disease with yangming pattern in Shanghanlun(Treatise on cold damage).The treatment of nutrient aspect pattern should be divided into two parts.One is expelling heat and the other is clearing the heat transferred to qi aspect.The so-called expelling heat from nutrient aspect to qi is actually the short term for these two methods.Expelling heat refers to the treatment makes heat in the deep nutrient aspect transmit into the superficial qi aspect,and the effect of changing from deep to superficial is the meaning of expelling.Therefore,expelling heat is actually the therapeutic effect of nutrient aspect pattern with medicinals of clearing nutrient aspect and cooling blood,then further heat clearing is necessary.Most nutrient aspect pattern of warm diseases are transmitted from qi aspect in lung to nutrient aspect in heart,and expelling heat of this simple pattern mostly means out of qi aspect in lung. |
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