| ObjectiveThrough the general survey of The Medical Book of Wang Mengying edited by Sheng Zengxiu,the author extracted the medical records of Wang Mengying’s prescriptions,used computer software to input the year,diseases,symptoms(tongue),syndrome,prescription,source and other factors,and analyzed the diagnostic thought of tongue syndrome differentiation in Wang Mengying’ s tongue diagnosis work Tongue Differentiation.The author tried to explore Wang Mengying’ s thought of the syndrome differentiation mode including disease--symptoms(tongue)--syndrome--prescription and the correspondence relationship including symptoms(tongue)--prescription(classical prescriptions),and Wang Mengying’s application characteristics of classical prescriptions,combing his clinical differentiation characteristics to make up for the original deficiency of classical prescriptions in tongue diagnosis.Methods(Ⅰ)Literature survey method:Taking Wang’s related discussion on tongue diagnosis and medical cases of classical prescriptions in Wang Mengying’s Tongue Discrimination as the object of study and extracting Wang’s medical cases of applying Zhong Jing’s law and theory flexibly,This topic used the traditional research method of literature review to make a statistical analysis of the tongue images,reveal the diagnostic thinking of the tongue syndrome differentiation in the book of Tongue Differentiation and probe into the clinical thoughts and diagnostic characteristics of Wang Mengying’s applying the classical prescriptions.(Ⅱ)Metric Method Based on Literature:After a comprehensive study of the literature,the inclusion criteria were that the medical cases containing drugs of classical prescriptions in Wang Mengying’s medical cases were summarized in advance and those containing the auxiliary drugs were screened out later,which were regarded as the research object of this topic.(Ⅲ)Theoretical Analysis of traditional Chinese medicine(TCM):Combining TCM diagnosis and syndrome differentiation theory,this paper expounds Wang Mengying’s thought of tongue syndrome differentiation.(Ⅳ)A Holistic Approach Combined with A Case Study:Combining case study of medical cases of classical prescriptions,the paper made a comprehensive analysis of Wang’s medical cases and the formation process of tongue diagnosis to probe into Wang Mengying’s syndrome differentiation thinking.(Ⅴ)Method of Comparative Study:By comparing Wang’s description of tongue image in Tongue Differentiation with the application of tongue syndrome differentiation in Wang Mengying’s medical cases,this paper confirmed Wang Mengying’s thought of tongue syndrome differentiation,and tried to reveal the consistency of Wang Mengying’s tongue syndrome differentiation in theory and practice.ContentsThis topic is the intersection research of TCM literature and TCM clinic.The classical prescriptions researched by the topic mainly referred to the prescriptions in Treatise on Febrile Diseases of Zhong Jing and Synopsis of Golden Chamber.Wang Mengying’s medical cases of classical prescriptions were seen in Huichun Lu,Renshu Zhi,Wangs hi Yi’an Sanbian,Guiyan Lu,and Chengfu Yiying(hereinafter referred to as Five Wang’s Medical Cases),which included 350 cases through adding and subtracting the classical prescriptions.The research content mainly included the five aspects as follows:(Ⅰ)The Writing Style and Characteristics of Wang Mengying’s Medical CasesThe paper expanded the discussion about Wang Mengying’s chronological writing features,read Wang Mengying’s wording and sentences analyzing the pathogenesis carefully,and observed the process describing the patients condition.This paper laid emphasis on the tongue description in Wang’ s medical cases,compared with the patient information and medical cases of the same patient and the same family were extracted in order to find the clinical value provided by the patients information in Wang Mengying’ s medical cases further.(Ⅱ)The syndrome differentiation mode including disease--symptoms(tongue)--syndrome--prescription and the correspondence relationship including symptoms(tongue)--prescription(classical prescriptions)Paying attention to tongue diagnosis was not only the characteristic of Wang Mengying’s diagnosis and treatment,but also the important embodiment of Wang’s medical theory and clinical skills.In view of the chronology of Wang’s medical cases,this paper intended to explore the dynamic changing law of Wang Mengying’s tongue diagnosis,and summarized Wang Mengying’s thought of tongue syndrome differentiation by means of charts and statistics of tongue diagnosis frequency.It was found that Wang Mengying gradually embodied more diagnostic characteristics of tongue syndrome differentiation in medical cases with time passing by.The key point was to selected the medical cases of using gypsum,gardenia,pinellia,qinlian,the root of Chinese pulsatilla decoction,weijing decoction and so on by Wang Mengying,in which tongue images were recorded.The paper combed the relationship among diseases,syndromes,tongue images and classical prescriptions and mainly researched on the thinking pattern of disease--symptoms(tongue)--syndrome--prescription of the malaria,dysentery,cough,stomach disease and cold.Then the correspondence relationship of symptoms(tongue)--prescription(classical prescriptions)was demonstrated through probing into the clinical value of tongue,includingPurple(red)tongue,yellow moss,black tongue(moss),white moss,thick moss and greasy moss,etc.(Ⅲ)Literary Study of Wang Mengying’s Tongue DifferentiationThis part mainly conducted a literary research on Wang Mengying’ s Tongue Differentiation.It was known that Jiang Guangxu found the manuscript in Wangjia Cun ancestral hall and Tongue Differentiation wasn’t included into BieXiaZhai Series of Books.The annotation in Sheng Zengxiu’s The Medical Book of Wang Aengying mentioned that the book was written by Wang Shixiong,annotated by modern man Wu Keqian,and published in 1926.Sheng Zengxiu thought that the contents of the book Tongue Differentiation were extracted from the contents of tongue diagnosis in previous dynasties and less new,so Tongue Differentiation was not included in The Medical Book of Wang Mengying.The object of this study is the edition of Tongue Differentiation that was published with Wu Keqian ’s annotation by Shanghai Dazhong Book Company in 1926.The historical data of the edition,background,publisher and the annotator were investigated,which reflected the philology value of Tongue Differentiation.(Ⅳ)The Diagnostic thought of Tongue Syndrome Differentiation in Tongue Di fferentiationTongue Differentiation was Wang Mengying’s monograph on tongue diagnosis,and it could be seen from the preface of the book that it contained many treatises on tongue diagnosis from different dynasties.The tongue images in this book were mainly divided into nine chapters,including white moss tongue,yellow moss tongue,black moss tongue,grey tongue,red tongue,purple red tongue,micro-caramel tongue coating,blue tongue coating,pregnancy typhoid tongue.Wang Mengying’s thought of tongue diagnosis was mainly embodied in the preface and the general discussion of each chapter.The preface of the book mainly highlighted Wang Mengying’s clinical diagnosis thought of using tongue diagnosis to make up for the former sages looking at tongue syndrome differentiation less and it was necessary to adopt tongue diagnosis by elaborating the physiological and pathological mechanism of foot yangming and the theory that yangming was tied to the tongue.Wang Mengying’s view on yangming disease was quoted and discussed and on this basis the author focused on the general parts of white mossy tongue,yellow mossy tongue,black mossy tongue,red tongue and slightly caramelized mossy tongue in Tongue Differentiation,so as to understand Wang Mengying’s syndrome differentiation mode of disease--symptoms(tongue)--syndrome--prescription gradually.(Ⅴ)The Clinical Characteristics of Wang Mengying’s Application of Classical PrescriptionsThe medical cases of Wang Mengying’s gypsum,gardenia,pinellia and rhizoma coptidis were selected to analyze the application characteristics of these four types and probe into the corresponding relationship of syndrome(tongue)--prescription(classical prescriptions).Results(Ⅰ)The year,patient,name of disease,syndrome type,tongue image,prescription and source list of Wang Mengying’s prescription were compiled(see appendix).The corresponding relationship sheets of syndrome(tongue)--prescription(classical prescriptions)of Huichun Lu,Renshu Zhi,Wangshi Yi’an Sanbian,Guiyan Lu,and Chengfu Yiying were made.(Ⅱ)A total of 350 cases of Wang Mengying’ s medical cases were compiled,including 49 cases of Huichun Lu,,150 cases of Renshu Zhi,81 cases of Wangshi Yi’an Sanbian,52 cases of Guiyan Lu,and 18 cases of Chengfu Yiying.(Ⅲ)154 cases containing tongue images in Wang Mengying’s medical cases were collected,which showed that the syndrome differentiation pattern of disease-symptom(tongue)-syndrome-prescription was being perfected day by day and its portion in each book was increasing gradually.There are 5 cases in Huichun Lu,accounting for 10.20%.There were 74 cases in Renshu Zhi,accounting for 49.33%.There were 44 cases in Wangshi Yi’an Sanbian,accounting for 54.32%.There were 20 cases in Guiyan Lu,accounting for 38.46%.There were 11 cases in Chengfu Yiying,accounting for 61.11%.(IV)The syndrome differentiation pattern of disease-symptom(tongue)-syndrome-prescription of the malaria:malaria-purple red tongue-syndrome of consumption of fluid due to intense heat-gypsum prescription;malaria--yellow moss tongue-summerheat syndrome--gypsum prescription;malaria--greasy moss tongue--spittoon gas alternating resistance syndrome--pinellia prescription;malaria-black moss tongue(stem)-yang ming-gypsum,gardenia and coptis prescription;malaria--black moss tongue(slippery)--deficiency syndrome of yuan yang--subclass prescription.The syndrome differentiation pattern of disease--symptom(tongue)--syndrome-prescription of the dysentery:dysentery disease--purple red tongue,yellow moss tongue--heat injury yin syndrome--the root of Chinese pulsatilla decoction;dysentery disease--greasy moss tongue--damp heat block syndrome--the root of Chinese pulsatilla decoction;dysentery disease--yellow moss tongue--dampness and heat block stomach syndrome--pinelliae decoction for purging stomach-fire,xiaoxianxiong decoction and jupi zhuru decoction;dysentery disease--white moss tongue--qi deficiency and dampness resistance syndrome,phlegm heat syndrome--jupi zhuru decoction.The syndrome differentiation pattern of disease-symptom(tongue)-syndrome-prescription of the cough:cough--yellow moss tongue-yang ming syndrome-gypsum prescription;cough-yellow moss tongue-phlegmy heat choking lung syndrome-jing wei decoction;cough--purple red tongue--heart and stomach stasis syndrome-baihu decoction;cough-purple red tongue(no moss)-yin deficiency and yang hyperactivity syndrome-ganmai dazao decoction;cough-greasy moss tongue-phlegm-dampness-lung-dampness syndrome-pinellia prescription,jupi zhuru decoction and jing wei decoction;cough-white moss tongue-heat and dampness syndrome-gypsum with bamboo shavings decoction.The syndrome differentiation pattern of disease-symptom(tongue)-syndrome-prescription of the stomach disease:stomach disease--purple red tongue--summerheat syndrome-baihu decoction;stomach disease--greasy moss tongue--spittoon gas act-resistance syndrome--the gua luo xie bai ban xia decoction;stomach disease--greasy moss tongue--spittoon gas act-resistance syndrome--banxia houpu decoction;stomach disease--greasy moss tongue--phlegm heat syndrome--xiaoxianxiong decoction;stomach disease--yellow moss tongue--phlegm heat syndrome-jupi zhuru decoction.The syndrome differentiation pattern of disease-symptom(tongue)-syndrome-prescription of the cold:cold disease--black moss tongue--heat injury yin syndrome--lily prescription,gardenia prescription,bamboo skin pills;cold disease-yellow moss tongue-yang ming syndrome-gypsum prescription;cold disease--purple red tongue--fire-toxicity syndrome--rhizoma coptidis prescription and gardenia prescription;cold disease--greasy moss tongue--phlegm and dampness accumulate lung syndrome--pinellia prescription;cold disease-greasy moss tongue-phlegm food mutual knot syndrome-orange fruit gardenia black bean decoction.(V)The corresponding relationship of syndrome(tongue)--prescription(classical prescriptions):purple red tongue,black moss tongue-lily prescription;greasy moss tongue-pinellia prescription;purple red tongue,black moss tongue-gardenia prescription;purple red tongue,yellow moss tongue--rhizoma coptidis prescription;purple red tongue,yellow moss tongue--gypsum prescription;yellow moss tongue,white moss tongue-jupi zhuru decoction.(Ⅵ)Wang Mengying was good at using gypsum prescription to clear heat and treat malaria,pinellia prescription to reduce and eliminate phlegm and let the heat get out of the body,gardenia prescription to smooth the mood and breath,rhizoma coptidis prescription to remove the dampness and heat and calm the mood.(Ⅶ)The thinking mode Disease--symptoms(tongue)--syndrome-prescription is the concentrated embodiment of Wang Mengying’s thought of tongue syndrome differentiation.This thinking mode is conducive to the precision and standardization of the use of,avoiding the clinical use of curing classical prescription and providing a new idea for the clinical use of classical prescription.(Ⅷ)By comparing the application of tongue diagnosis in Tongue Differentiation and Wang Mengying’s medical cases,it was found that the theoretical analysis of tongue diagnosis in Tongue Differentiation has a corresponding relationship with the practical application of tongue diagnosis medical cases.The corresponding relationship of syndrome(tongue)--prescription(classical prescriptions)could be concluded from the use of tongue analysis in Wang Mengying’ s medical cases.(Ⅸ)The paper paid attention to the patient information in Wang Mengying’ s medical cases,studied multiple medical records of the same patient and the medical records of the same family patients,and highlighted the importance of disease diagnosis concerned with constitution,family disease spectrum and family genetic tendency.(Ⅹ)Tongue Differentiation,annotated by Wu Keqian and published by Shanghai Dazhong Book Company in 1926,was of great literature value.It was edited and published based on Jiang Guangxu’s retained copy who was a famous book collector in Zhejiang,and supplemented and annotated by Wu Keqian who was a famous doctor in Hai Ning.Its publisher has also issued a number of publications in the Shanghai Dazhong Book Company.(Ⅺ)By probing into the corresponding syndromes of white moss tongue,yellow moss tongue,black moss tongue and red moss tongue in Tonguo Differentiation,it could be referred that Wang Mengying thought the coldness assembled on the skin and the heat couldn’t escape from the body and there was also dead syndromes for the white moss tongue.The yellow moss tongue was not discussed in taiyang channel and shaoyang channel and had a symptom of inner heat.Black mossy tongue was a crisis tongue with poor prognosis.The red moss tongue showed the heat in stomach and heart.If there was accumulated moss,it revealed the heat was exuberant.The micro-caramel moss tongue was lunar and showed that food was accumulated in stomach.ConclusionTongue Differentiation fully embodied the diagnostic thought of Wang Mengying’s tong syndrome Differentiation.Wang Mengying’s thought of tongue syndrome differentiation made up for the syndrome differentiation deficiency of doctors in previous dynasties and improved the accuracy of syndrome differentiation.By expounding the physiological and pathological mechanism of foot yang ming and the theory that yang ming was tied to the tongue,Wang Mengying demonstrated the importance of the tongue that was the most reliable for the syndrome.The mechanism of tongue image discussed in the general theory of white moss tongue,yellow moss tongue,black moss tongue,red tongue and slightly caramelized moss tongue was appropriate to the theory of Wang’s yangming disease and had Wang Mengying’s personal academic characteristics.The compilation style of Wang Mengying’s medical cases was the chronological style.From the perspective of time deduction,the chronological sequence of Wang Mengying’s medical cases was Huichun Lu,Renshu Zhi,Wangshi Yi’an Sanbian,Guiyan Lu,and Chengfu Yiying.Correspondingly,more and more medical cases were recording tongue images.In terms of time axis,Wang Mengying’ s cases gradually highlighted the guiding role of tongue diagnosis in medical cases.The syndrome differentiation mode of disease--symptoms(tongue)--syndrome--prescription of malaria,dysentery,cough,stomach disease and cold disease in the medical cases reflected Wang Mengying’ s thought of diagnosis of tongue syndrome differentiation.The yellow moss tongue,white moss tongue,purple red tongue,black moss tongue and greasy moss tongue of these 5 diseases corresponded to the syndrome types,which was the objective indication that guided the classical prescription to use.The syndrome differentiation pattern of disease-symptoms(tongue)-syndrome-prescription paved the way for the study of the corresponding relationship of syndrome(tongue)--prescription(classical prescription),which helped to deepen the understanding of Wang Mengying’ s thought of tongue syndrome differentiation.Wang Mengying’s medical cases embodied the corresponding relationship of syndrome(tongue)--prescription(classical prescription).Purple red tongue--rhizoma coptidis prescription and yellow moss tongue--gypsum prescription were consistent with the discussion in Tongue Differentiation that the purple red tongue revealed the heart fire and the yellow moss tongue showed the yang ming stomach fire,which demonstrated the clinical reference significance of tongue syndrome differentiation in Tongue Differentiation.83 classical prescriptions in the five medical cases were corrected through the tongue syndrome differentiation,which enriched the correction indication of classical prescription system in Treatise on Febrile Disease. |
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