| Purpose:The theory of spleen governing transformation and transportation and the theory of spleen dominating blood control are the hardcore of the theory of visceral picture of spleen.This article reorganized the origin and development of the theory of spleen governing transformation and transportation and the theory of spleen dominating blood control based on the origin and clinical application of the theory.This article enriched the connotation of the theory of visceral picture of spleen,and expounded the rule of treatment of diseases related to spleen,which is more effective in guiding clinical practice.Method and Content:We reorganized ancient literature thorough the 312 ancient document in part 1.We divided the time into four periods: the period of Pre-Qin and Han Dynasties,the period of the Three Kingdoms to Tang Dynasties,the period of Song Jin and Yuan Dynasties,the period of Ming and Qing Dynasties.This part reorganized the trajectory and discussed the theory of spleen governing transformation and transportation,and the theory of spleen dominating blood control.We discussed four diseases in Part 2 that closely related to spleen including diarrhea,fullness,blood syndrome and chest pain from the National Key Basic Research Program of China("973" Program).A study on the inheritance and Innovation of the theory of visceral picture of spleen such as spleen governing transformation and transportation,spleen dominating blood control.We divided the time into three stages in chronological order: Pre-Qin to Tang Dynasties,Song Jin Yuan Dynasties,Ming and Qing Dynasties.The etiology and pathogenesis,syndrome and treatment were discussed.We reorganized the ancient document and drawn two-wire diagram based on the ancient database to reflect the change of data more intuitive.We established the ontology network of the four diseases by Using gephi software to explore the rules of the treatment of the four diseases related to spleen.First we determined the keywords for the search based on the study of the name of diseases.Then we selected the indexing category of searching: etiology and pathogenesis of pathology,symptom and clinical presentation,prescription of treatment.We exported the searching results format for excel,then excluded irrelevant items according to exclusion criteria,then standardized the terminology of etiology,syndrome,symptom and prescription.We divided the time into three stages in chronological order: Pre-Qin to Tang Dynasties,Song Jin Yuan Dynasties,Ming and Qing Dynasties.The frequency of the terminology of etiology,syndrome,symptom and prescription of the three periods was statistically analyzed,then converted to scale and selected high frequency data.We brought the etiology and syndrome data into the software,then drawn two-wire diagram of etiology and syndrome and analyse the data.The factor after scaling will be ranked from high to the end by frequency without considering the time factor.Then we used the high frequency data to make node data table.We made relative edge data table between etiology,syndrome,symptom and prescription based on the database.We established ontology network of the four diseases to explore the rules of the treatment of the four diseases based related to spleen.The results of comprehensive literature research,two-wire diagram of etiology and syndrome,and the ontology network were visualized and concluded.Results:1Reorganizing the origin and development of the theory of spleen governing transformation and transportation.The theory of spleen governing transformation and transportation originated in Pre-Qin and Han Dynasties.The emergence of the theory of spleen transformation and transportation was closely related to the anatomical position of the spleen,the ancient practice and the attributes of the five elements of the spleen.The function of transportation and transformation was accomplished by the spleen and stomach,It emphasized the transportation of spleen and transformation of stomach.It was clearly recognized that the digestive function of the stomach and the delicate transport process of the spleen.The substances such as water,grain and liquid were transported.The etiology,syndromes and treatment of dys-splenism were clear in Nei Jing.The prescription for the treatment of dys-splenism began to appear in Shang Han Lun and Jin Gui Yao Lue.The diseases were treated by differentiation of symptoms and signs,and mainly by warming and supplementing spleen yang.The principle-method-recipe-medicines of spleen governing transformation and transportation were completed.The treatment of spleen governing transformation and transportation was abundant in three Kingdoms to Tang Dynasty.In this period,the treatment of spleen diseases was more diversified.Daoyin technique for the treatment of spleen diseases was appeared in Zhu Bing Yuan Hou Lun.food therapy for the treatment of spleen diseases was appeared in Zhou Hou Bei Ji Fang.Acupuncture of spleen diseases was appeared in Zhen Jiu Jia Yi Jing.The classification of dys-splenism was more detailed.The function of transformation attributed to the spleen.Spleen governing transformation and transportation were discussed separately.Spleen governing transformation was called xiao,mo,hua.Spleen governing transportation was called that running vital Qi for stomach,perfusing to four sides or received by other viscera.There was a hundred schools of thought of spleen governing transformation and transportation in Song,Jin and Yuan Dynasties.Spleen governing transformation and transportation were accounted in Song Dynasty at the first time.However,this theory was not unified in a large number of medical books at that time.The function of spleen governing transformation was still called mo,xiaogu,fuhua and kehua.The function of spleen governing transportation was called bu or bo and so on.Physicians in Jin and Yuan attached importance to the study of etiology and pathogenesis.Different schools of medicine analyzed the etiology and pathogenesis of dys-splenism from different angles.Li Dongyuan founded the theory of spleen and stomach,put forward the theory of internal injury of spleen and stomach and the depression of medium Qi,highlighted the important significance of lifting hinge,emphasized the influence of spleen Qi and spleen Yang to the function of transformation and transportation.The theory of spleen governing transportation and transformation reached the peak.During the Ming and Qing Dynasties,the theory of spleen governing transportation and transformation was further improved and applied.The function of spleen and stomach was divided clearly.The stomach accepted and the spleen transferred.It emphasized the nourishing and auxiliary role of spleen Yin on the basis of spleen Qi and spleen Yang.A large number of consilias were recorded for the treatment of dys-splenism.Li Zhongzi put forward the theory that spleen was the foundation of acquired constitution and established the status of spleen that regulated the other four viscera,which extended from the main function of digestion and absorption to the vital position for life supporting by metaplasia Qi and blood.2 Reorganizing the origin and development of the theory of Spleen dominating blood control.The formation of the theory of spleen dominating blood control was the process of Yang Qi dominating blood,Qi dominating blood,spleen Qi dominating blood.Pathogenesis of spleen dominating blood control appeared in the Pre-Qin and Han Dynasties.It was recorded that the bleeding syndrome could be caused by exhausted spleen Qi and leaking of spleen Qi.It reflected that the spleen Qi dominating blood control from the pathogenesis angle.Spleen wrapping blood was only an anatomical description without the meaning of dominating blood.The physicians of later generations put forward theory of spleen dominating blood control based on the this anatomical form.The prescriptions of tonifying Yang were used to treat the bleeding syndrome in Jing Gui Yao Lue,It was clarified that Yang Qi regulating blood.The prescriptions of spleen dominating blood control were appeared in the three Kingdoms to the Tang Dynasty,Some doctors put forward a series of methods and prescriptions for treating bleeding from spleen.The drugs of tonifying spleen were used to treat bleeding syndrome in Zhou Hou Bei Ji Fang.Prescriptions of tonifying spleen were used to treat bleeding syndrome in Xiao Pin Fang and Qian Jin Yi Fang.It put forward that blood and Qi went along with each other in Zhu Bing Yuan Hou Lun.The loss of viscera Qi caused various bleeding syndromes.It was clarified that Qi dominating blood.The theory of spleen dominating blood control was formed in Song,Jin and Yuan Dynasties.The spleen failure of controlling the heart blood could cause the blooding syndrome.It was clearly that the hemorrhagic disease was related to the spleen.Docters began to use Guipi decoction to treat the bleeding syndrome.It was clarified that spleen Qi dominating blood.The theory of spleen dominating blood control was perfected in Ming and Qing Dynasties.The word of spleen dominating blood appeared in Dian Nan Ben Cao,It clearly pointed out that spleen dominating blood was the dominating effect of spleen on blood in Nu Ke Bai Wen.The theory of spleen dominating blood control based on the theory of spleen governing transformation and transportation.Spleen dominating blood both meant generating blood and dominating blood at the beginning.Tang Zonghai emphasized that spleen dominating blood meant spleen Qi control blood flowing in the vein not over the vein.It didn't mean that the spleen was the organ for storing blood,so that the spleen dominating blood exclusively refers to the dominating blood in the vein.3Studying the treatment of the diseases related to the Spleen.The evolution rule of etiology and pathogenesis of Diarrhea: wind cold dampness,diet,emotion and deficiency of viscera could cause diarrhea.It mainly discussed the exogenous cold evil in the Pre-Qin to Tang Dynasties.Deficiency of viscera increased in Song Jin and Yuan Dynasties.Damp heat evil caused disease increased in late Ming and Qing Dynasties.The evolution rule of syndrome: Spleen Yang deficiency syndrome,cold stagnation gastrointestinal syndrome were the major syndrome before Pre-Qin to Tang Dynasties.Deficiency syndrome increased in Song Jin Yuan period.Syndrome of dampness stagnancy due to spleen deficiency increased after Ming and Qing Dynasties.Evolving law of treatment: Warming drugs were priority in Pre-Qin to Tang Dynasties.The method of tonifying middle-Jiao and Qi in the treatment of diarrhea increased in Song Jin Yuan period.During the Ming and Qing Dynasties,the treatment changed from warming and tonifying to cooling.The treatment of diarrhea from the spleen was reflected in the etiology and pathogenesis of that external evil,improper diet,emotional internal injury acted on the spleen,or stomach,large small intestine that related to spleen could cause diarrhea.In addition,the deficiency of spleen viscera could cause diarrhea.The main syndromes of diarrhea were mainly from spleen Yang deficiency to dampness stagnancy due to spleen deficiency.Focus of discussion transited from the simple deficiency of spleen to deficiency in origin and exogenous in superficiality.The treatment of diarrhea changed from initial warming spleen Yang to tonifying spleen Qi.The treatment of diarrhea had focused on Spleen deficiency throughout its development of treatment.The evolution rule of etiology and pathogenesis of fullness:Coldness and dampness was the main cause of fullness in Pre-Qin to Tang Dynasties.Coldness and dampness was also the main cause of fullness in Song Jin Yuan period.Damp-heat increased after Ming and Qing Dynasties.The evolution of the law of syndrome: Cold damp stagnation was the major syndrome in Pre-Qin to Tang Dynasties.Qi stagnation increased in Song Jin Yuan period.Sinking of spleen Qi increased after Ming and Qing Dynasties.Evolving law of treatment: Diaphoretic recipes were given the first place in Pre-Qin to Tang Dynasties.Aromatic agent increased in Song Jin Yuan period.The Ming and Qing Dynasties focus on treatment of deficiency of fullness.The treatment of fullness from spleen reflected that both spleen deficiency and sthenia could cause fullness.Spleen deficiency failure to transport and caused Qi stagnation in the Middle-Jiao,It caused fullness in the Middle-Jiao,and treated by the method of tonifying Middle-Jiao and Qi.The excess fullness caused by spleen and stomach blocked in the medium-Jiao,and treated with purgative method or dispersing method to dissolve the excess of spleen and stomach.In addition,Dys-splenism caused endogenetic phlegm and retained fluid that obstructed in the Middle-Jiao,and led to intermingled deficiency and excess of fullness treated with tonification and purgation.Evolution of the etiology and pathogenesis of Blood disease: Blood disease major caused by hot in Pre-Qin to Tang Dynasties.The proportion of blood disease caused by anxiety increased in Song Jin Yuan period.After Ming and Qing Dynasties doctors attached great attention to blood stasis and summer evil that caused Blood disease.The evolution law of syndromes: blood heat bleeding was the mainly syndrome in Pre-Qin to Tang Dynasties.Syndrome of Qi failing to control blood increased after Song Jin Yuan period.Syndrome of spleen failing to control blood and Qi deficiency bleeding increased in Ming and Qing Dynasties.The evolution of treatment: Cooling blood to stop bleeding and convergence hemostatic agent were the major treatment of blood disease in Pre-Qin to Tang Dynasties.Tonifying Qi to stop bleeding was the major treatment after Song Dynasty.Invigorating spleen and ascending Yang to stop bleeding was the priority treatment during Ming and Qing Dynasties.Blood stasis hemostatic drugs began to use to stop bleeding in the period.The treatment of blood disease from spleen and the theory of Spleen dominating blood control existed simultaneously.Fire-heat is the major etiology of blood disease.The bleeding caused by Spleen deficiency had been recorded by Nei Jing.The deficiency of blood disease increased with the emergence of Spleen dominating blood control after Ming and Qing Dynasties.The syndrome of Spleen failing to control blood was a manifestation of the theory of Spleen dominating blood control.The law of Etiology and pathogenesis of chest pain and heart disease: The Etiology and pathogenesis of chest pain and heart disease was asthenia in origin and asthenia in superficiality.Coldness tend to cause chest pain in Pre-Qin to Tang Dynasties.The discussion on blood stasis and phlegm was increased in Song Jin and Yuan Dynasties.Blood stasis and phlegm that could cause chest pain and heart pain inceased in Ming and Qing Dynasties.The evolution law of syndrome: Syndrome of Yang deficiency and cold coagulation and deficiency of heart Yang syndrome were the major syndrome in Pre-Qin to Tang Dynasties.The discussion on syndrome of Qi stagnation increased during the Song Jin and Yuan period.Resistance of phlegm was the major syndrome in Ming and Qing Dynasties.The evolution of treatment: Warming agent was the major drug in Pre-Qin to Tang Dynasties.Aromatic agent increased in Song Jin Yuan Dynasties.The drug treating Qi stagnation and blood stasis increased in Ming and Qing Dynasties.It expanded the disease spectrum treated from Spleen that treating chest pain based on treating Spleen.It was mentioned that improper diet could damage the Spleen and Stomach,gathered dampness to phlegm,and blocked middle-Jiao to cause chest pain from Song Dynasty,It was more emphasized that the main cause of blood stasis and phlegm was impairment of the Spleen-Qi and Stomach-Qi due to improper diet in Ming and Qing Dynasties.It embodied the theory that treated chest pain from the treating Spleen that the method of invigorating Qi,strengthening Spleen-Qi and expelling phlegm were applied in the treatment of chest pain.The treatment of the chest pain from the spleen indicated that other diseases could also be treated from the spleen,and had important clinical significance.Conclusions:1 The development of the theory of Spleen governing transformation and transportation had gone through four periods:Origin of the theory,the enrichment of treatment,the contention of hundreds schools of thought and the improving of application.The frame of the theory of Spleen governing transformation and transportation was famed in Pre-Qin and Han Dynasties.It emphasized the function of spleen governing transportation and the stomach governing transformation.The prescription for the treatment of dys-splenism appeared.The principle-method-recipe-medicines of spleen governing transformation and transportation was completed.The function of transformation attributed to the spleen.Spleen governing transformation and transportation were discussed separately.Daoyin technique,food therapy and acupuncture for the treatment of spleen diseases were appeared.The function of transformation and transportation was combined in the Song Dynasty.The Spleen governing transformation and transportation appeared explicitly.Doctors of various schools showed diversity in the treatment of spleen deficiency.Li Dongyuan founded the theory of spleen and stomach,put forward the theory of internal injury of spleen and stomach and the depression of medium Qi,emphasized the influence of spleen Qi and spleen Yang to the function of transformation and transportation.The theory of spleen governing transportation and transformation reached the peak.The functions of the Spleen and the stomach were divided clearly during the Ming and Qing Dynasties.Doctors proposed that Spleen Yin effected the function of Spleen governing transformation and transportation.A lot of consilias of dys-splenism were appeared during this period.The principle-method-recipe-medicines of spleen governing transformation and transportation was perfected.2 The development of the theory of Spleen dominating blood control had gone through four periods:The first appearance of the pathology,the emergence of prescription drugs,forming of theory,explicit present.The formation of the theory of spleen dominating blood control was the process of Yang Qi dominating blood,Qi dominating blood,spleen Qi dominating blood.The production of spleen dominating blood control was a process that pathology appeared before physiology.The pathology of spleen dominating blood appeared in Nei Jing.Prescription for tonifying Yang was used to treat hemorrhage in Jin Gui Yao Lve.It put forward that blood and Qi went along with each other in the three Kingdoms to the Tang Dynasty.It was clarified that Qi dominating blood.It was clearly that the hemorrhagic disease was related to the spleen in Song,Jin and Yuan Dynasties.Docters began to use Guipi decoction to treat the bleeding syndrome.It was clarified that spleen Qi dominating blood.The theory of Spleen dominating blood control explicit presented during the Ming and Qing Dynasties.It was clarified that spleen dominating blood meant spleen Qi control blood flowing in the vein.The theory of the Spleen dominating blood meant producing and controling blood in the beginning,then meant controlling blood only.3 The results showed that all the 4 diseases were closely related to the Spleen and could be treated clinically from the Spleen.Among them,chest pain was less contact with other diseases except from the Spleen.The role of cold evil,heat evil,damp evil and emotion was emphasized in the study of the causing of diarrhea,abdominal fullness,blood disease and chest pain and heart disease.We found that deficiency of spleen Qi syndrome and deficiency of spleen Yang syndrome were both appeared in four disease.The difference between chest pain and heart disease and other three diseases was the syndrome of phlegm coagulation and blood stasis on the basis of spleen Qi deficiency and spleen Yang deficiency.Lizhong Decoction and Sijunzi decoction were used when treating these two syndromes.The treatment of chest pain and heart pain was invigorating the spleen and eliminating phlegm and removing stasis. |
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