Study On The Law Of TCM Syndrome And TCM Syndrome Differentiation Of Deficiency Syndrome

Deficiency-heat pattern was a commonly seen pattern in clinic, and it also can be derived from other diseases. Despite the similarities, there were lots of differences in the mechanism and treatment on deficiency-heat pattern in the documents throughout the history. However, there was no systematic study on the rules of herbal properties and combination for this pattern. Therefore, this study embarked on collecting literatures and analyzing the rules of herbal application, focusing on ancient literatures supplemented by modern ones, to summarize the rules of herbal properties and combination, meanwhile to explore ancient and modern physicians’ various interpretations of deficiency-heat patterns and the evolution of treatment methods, aiming at providing useful references for further research and clinical prescription.This study includes three parts:1. Literature study of ancient literatures on deficiency-heat patterns:the theoretical interpretation of the concepts, classification, etiology, pathogenesis and treatment on deficiency-heat patterns in different historical periods were collected and sorted.2. The study of the rules of herbs and patterns:(1) The ancient part:Study methods and details:taking Encyclopedia of Traditional Chinese Medicine (Zhong Hua Yi Dian) as the main retrieval literatures, relevant literatures and documents, from Eastern Han dynasty to Qing dynasty and during the period of Republic of China, were reviewed and screened. Then a database was established to analyze and summarize the rules of the herbal properties and combination.Results:①Tonifying herbs were used most frequently, followed by heat-clearing herbs (exterior-releasing herbs were used as frequently as heat-clearing herbs in Jin and Yuan dynasties), and the herbs above were often combined with exterior-releasing, dampness-draining, phlegm-resolving, astringing, qi-regulating, blood-activating or interior-warming herbs. Before and during Song dynasty, physicians preferred to use herbs cool and cold in property, while herbs warm in property were used frequently in other dynasties. As for flavors, herbs with sweet flavor were listed on the top, followed by herbs with bitter and acrid flavors.②For tonifying herbs, qi-tonifying ones, especially herbs warm in property and sweet in flavor were used most frequently. Among qi-tonifying herbs, in terms of frequency, gan cao was used the most, followed by ren shin and huang qi. In terms of dosage proportion, hudng qi was often of the highest proportion and in Qing dynasty and the period of Republic of China, ren shen was of the highest proportion. Among blood-tonifying herbs, in terms of frequency, dang gui, bdi shao and shu di hudng were used the most. In terms of dosage proportion, shu di huang was of the highest proportion. Among yin-tonifying herbs, mai dong and gan di huang were used most frequently and the dosage proportion was varied in different periods. Among yang-tonifying herbs, rou gui and fu zi were used most frequently and of the highest dosage proportion.③For heat-clearing herbs, herbs bitter and cold in properties were used most frequently. Huang qin, zhi mu, di gu pi and shi gdo were used frequently before Song dynasty, while on dosage proportion, shi gao and lu gen were of higher proportion. Heat-clearing herbs were used much less in Jin and Yuan dynasties, but di gu pi, zhi mu and huang qin were used frequently. Zhi mu, huang qin, huang bdi and di gu pi were used most frequently in Ming dynasty, while in terms of dosage proportion, huang bai, huang lian and zhi mu were of the highest proportion. However, zhi mu, mu dan pi, di gu pi and huang qin were used most frequently in Qing dynasty, while in terms of dosage proportion, shi gdo, zhi mu, qing hao and xudn shen were of the highest proportion.④For other herbs in combination, chai hu, shengjiang and sheng ma were selected most frequently to release the exterior;fu ling was selected most frequently to promote urination to drain dampness; chuan xiong was selected most frequently, followed by niu xi into activate blood; wu wei zi, wu mei, shan zhu yu and mu li were selected most frequently for astringing effects; chen pi and zhi qiao were selected most frequently to regulate qi; ban xia and jie geng were used most in herbs that resolve phlegm; qin jiao was selected most frequently to dispel wind-damp.(2)The modern part:Study methods and details:taking the deficiency-heat pattern in cancer cases as an example, relevant electronic literature and document literature research were conducted. And statistical analysis based on the data was conducted, then the rules of properties and combination of the selected herbs were summarized.Results:①For fever complicated with qi deficiency, qi-tonifying herbs were used most frequently. The herbs warm in property and sweet in flavor were used most frequently. Among tonifying herbs, herbs with sweet flavor and neutral property were used most frequently. Among qi-tonifying herbs, huang qi, bai zhu, gan cao and dang shen are used frequently. Among other tonifying herbs, dang gui and bai shao were used most frequently. Heat-clearing herbs cold in property and sweet in flavor, such as di gu pi, huang qin and zhi mu were used frequently. Other herbs for modification were chai hu, sheng ma, chen pi, fu ling, sheng jiang and ban xia.②For fever complicated with yin deficiency, heat-clearing herbs were used most frequently, particularly herbs cold in property and sweet in flavor. Among tonifying herbs, herbs sweet and bitter in flavors and cold in property were used frequently. Among yin-tonifying herbs, sheng di huang, bie jia, and mdi dong were used frequently. Among other tonifying herbs, gan cdo, huang qi and dang gui were used most frequently. Heat-clearing herbs cold in property and bitter and sweet in flavor, such as qing hao, di gu pi and huang qin were used frequently. Other herbs for combination were qin jido, wu wei zi, shan zhu yu, fu ling and mu li.③For fever complicated with yang deficiency, tonifying herbs were used most frequently, especially herbs warm in property and sweet in flavor. Among tonifying herbs, herbs sweet in flavor and neutral in property were used most frequently such as gan cao, bai zhu, huang qi, bai shao, dang gui, dang shen and sheng di hudng. Among herbs that warm yang, fu zi, and gan jidng were used most frequently. Other herbs for combination were gui zhi, chen pi, hudng bai and long gu.④For fever complicated with both qi and yin deficiency, tonifying herbs were most commonly applied, especially the herbs cold in property and sweet in flavor. Among tonifying herbs, herbs sweet in flavor and neutral in property were in the most frequency. Among qi-tonifying herbs, gan cdo, huang qi and tai zi shen were more commonly used, while among yin-tonifying herbs, mai dong and sheng di hudng were in most frequency. Herbs that clear heat applied for the pattern were most in bitter flavor and in cold property, zhi mu, shi gao, mu dan pi and huang qin as representatives. Other herbs for combination were ban xia, chai hu, chen pi, fu ling, wu wei zi and shan zhu yu.3. ConclusionFor deficiency-heat patterns, ancient physicians used the strategies of tonifying qi, blood, yin or yang, and relieving heat, resolving heat, purging heat and nourishing yin according to various pathogenesis. For better efficacies, they combined the herbs in ascending and descending properties, as well as accompanied the herbs in astringing and dispersing properties. They also attached great importance to protect healthy qi combining herbs in astringing property.For fever complicated with qi deficiency, modern physicians mainly focus on tonifying qi, accompanied by tonifying blood at the same time, together with small amount of herbs that elevate lucid yang and herbs that regulate qi and invigorate the spleen. For fever complicated with yin deficiency, herbs that nourish yin and clear heat are often applied, together with herbs in astringing and descending property with solid quality. For fever complicated with yang deficiency, tonifying herbs and warming-yang herbs are usually prescribed, together with herbs in astringing property and herbs that nourish yin and calm the mind. For fever complicated with deficiency of both qi and yin, the strategies of both tonifying qi and nourishing yin can be applied, accompanied by herbs in descending property with solid quality, and small amount of heat-clearing or heat-relieving herbs.Although ancient and modern physicians have common treatment methods, they also have their own prescription features. And they select various herbs not confined to herbs that clear deficiency-heat. The key to the treatment is the way of herbal combination, and the ascending and descending of qi movement and the protection of qi, blood, yin and liquid.