synonymWei Qi Ying Xue(Syndrome of exogenous febrile disease) generally refers to the differentiation of qi and blood
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Wei Qi Ying Xue, atTraditional Chinese MedicineThere are two meanings and contents in, one isphysiological functionFor example, it represents the physiological function of the human body. First, it refers to the pathological process of warm fever, which represents the four stages of the depth of the disease.
Diagnostic terms.One of the dialectical methods.It is used for syndrome differentiation of epidemic febrile disease and was created by Ye Tianshi in the Qing Dynasty.That isExogenous febrile diseaseThe pathological process can be divided into four stages: Wei fen, Qi fen, Ying fen and Xue fen, each with its own phase
The syndrome characteristics should be.The disease is conversely transmitted from Wei, Qi, Ying and blood to Ying and blood.Among them, two points of syndromes that appear at the same time are called the same disease.Wei fen is divided into exterior syndrome stage, and different causes should be identified;Qi is divided into hot stage, and it should be distinguished whether the heat evil gathers or not;In case of damp heat, the weight of heat and humidity shall be distinguished;The pathogenic factors are deeply trapped in the camp and the blood is divided into the stages of yin injury leading to entrapment or bleeding, and the pathological changes of the heart, liver, kidney and other organs must be clearly identified, so as to establish the content of syndrome differentiation from the etiology, stage, location, transmission and degree of pathological changes.
Historical evolution
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The publication of the Internal Classic marks the transition of traditional Chinese medicine from simple experience to systematic theoretical summary,Syndrome differentiation of wei qi ying bloodIt also sprouted.Lingshu Camp Health Association said:“Qingzhe is the camp，The turbid is the guard, camp in the pulse,Guard outside the pulse。”"Su Wen · Bi Lun" said: "The guard is also the fierce qi of water and grain. Its qi is fast and smooth, and cannot enter into the pulse. So it follows the skin, divides the meat, smokes it into the blind membrane, and spreads it on the chest and abdomen." "Lingshu · Jue Qi" said: "The development of the upper energizer, spreads the grain flavor, smokes the skin, fills the body, and smoothes the hair. If the fog and dew are used, it is called qi." "Su Wen · Bi Lun"It said: "The camp is the essence of the valley, which is harmonious in the five zang organs and sprinkled on the six fu organs." It can be seen that the Neijing is the source of the differentiation of syndromes of Wei Qi, Ying Xue.
《Dysmenorrhea》On the basis of Neijing, this paper further elucidates Wei Qi Ying Xue.Such as《Difficult Classic · Thirty two Difficulties》"The heart is the blood, the lung is the qi, blood is the honor, and qi is the guard, which is called the honor guard".The exertion of this theory has a great influence on the formation of the program of syndrome differentiation of Wei Qi Ying Xue.
In the late Eastern Han Dynasty,Zhang ZhongjingSeeking ancient precepts, absorbing various prescriptions, and combining clinical practice experience《Treatise on typhoid and miscellaneous diseases》, withSyndrome differentiation of six meridiansExplain the depth of the disease on the outside and inside, and introduce Wei Qi Ying Xue into the field of exogenous diseases to treat the disease based on syndrome differentiation.For example, Article 95 of Treatise on Febrile Diseases: "The sun disease refers to those who have fever and sweat, which is the glory of the weak and the strength of the strong, so they sweat. Those who want to follow the evil wind should use Guizhi Decoction." It briefly explains the exogenous pathological mechanism of sweating and fever.Article 50 points out: "If the pulse is floating and tight, it should be solved by sweating. If the ruler is late, you should not sweat. How can you know? It is because of the lack of glory qi and the lack of blood." It shows that although the patients with glory and blood deficiencyExogenous wind chill, and do not sweat.On the basis of absorbing the theoretical essence of Treatise on Febrile Diseases and Miscellaneous Diseases, Ye Tianshi founded the syndrome differentiation of Wei Qi Ying Xue.It can be seen that Zhongjing pioneered the syndrome differentiation of Wei Qi Ying Xue.
The Jin, Sui and Tang dynasties are an important period in the history of the development of traditional Chinese medicine, and clinical physicians' understanding of Wei Qi and Ying Xue has also been deepening.When sorting out Treatise on Febrile Diseases, Wang Shuhe of the Jin Dynasty further expounded the external disease with the theory of Wei Qi Ying Xue.
During the Song, Jin and Yuan Dynasties, Chinese medicine has made great progress from practice to theory, and the syndrome differentiation of Wei Qi Ying Xue has also been further developed and improved.On the basis of inheriting the theory of Wei Qi and Ying Xue in Treatise on Febrile Diseases to analyze the pathogenesis of exogenous diseases, Song Chengwuji's Theory on Febrile Diseases of Ming Dynasty has played a great role.
the Ming dynastyWith the development of febrile diseases, the syndrome differentiation of Weiqi Yingxue has been further developed.Wu Youke first put forward the concept of evil in "qi" and "blood" in his Treatise on Epidemic Disease, pointing out that "all epidemic evils stay in qi to solve the battle sweat, and stay in blood to solve the hair spot." He also pointed out that "the evil of epidemic disease is hidden in the membrane at the beginning, and is deeply rooted. When it happens, it is combined with the camp and the guard, and the camp and the guard of the guest evil channel are all injured by it."At the same time, it is clearly believed that the syndrome of Wei Qi Ying blood is different from the syndrome of shallow and deep. The so-called "evil hurts people, first hurts qi, then hurts blood" "Qi belongs to Yang and is light and clear, while blood belongs to Yin and is heavy and turbid. It is easy to disperse the evil in the division of qi, and the evil in the division of blood is constantAdhesive hysteresis”。Wu explained the pathogenesis of febrile diseases by using the theory of "Wei Qi Ying Xue", which laid a foundation for the Qing Dynasty febrile disease experts to further use "Wei Qi Ying Xue" to differentiate the pathogenesis.
In the Qing Dynasty, people's understanding of epidemic febrile diseases was increasingly rich.In practice, febrile disease experts found that the original six channel syndrome differentiation was difficult to deal with the complicated clinical practice, and the six channel syndrome differentiation needed to be broken through.Ye Tianshi, a famous epidemic febrile disease expert, has fully absorbed the theoretical essence of Wei Qi Ying Xue in the Internal Classic, Difficult Classic, Treatise on Febrile Diseases and other works. Inspired by the syndrome differentiation of the six meridians, he has absorbed the theoretical achievements of the above physicians in the past dynasties in using the theory of Wei Qi Ying Xue to elucidate the pathogenesis of exogenous diseases, and creatively summarized the syndrome differentiation of Wei Qi Ying Xue in combination with the rich experience of Ping Sheng in treating epidemic febrile diseases.
In the chapter of exogenous febrile diseases, Ye systematically discussed the etiology and pathogenesis, depth and severity, different stages of disease course, transmission and change rules, and syndrome differentiation and treatment of febrile diseases.Ye Shi pointed out that "the common view is that the dialect after Wei is qi, and the dialect after Ying is blood", which reflects the general law of the four pathological stages of epidemic febrile disease.And pointed out that“Warming up evilThe lung is the first to be attacked and the pericardium is transmitted inversely."The lung governs qi and blood, and the heart governs blood and blood," which links the pathological changes of four different pathological stages of epidemic febrile disease, namely, the defence of qi and blood, with the specific zang fu organs."In Weihan, you can clear your qi when you reach it, and you can still enter the campDiathermy to gas”"If you enter blood, you are afraid of consuming blood and moving blood, and straight whiskers cool blood and disperse blood" points out the treatment methods at different stages of Weiqi Yingxue.
To sum up, the syndrome differentiation of Wei Qi Ying Xue is constantly improved and developed on the basis of practice. Its academic origin is from the Internal Classic and was established in the Qing Dynasty, during which it experienced a long historical process.The establishment of the program of syndrome differentiation of Weiqi Yingxue adapts to the new field of exogenous fever, expands the scope of syndromes of exogenous fever, makes up for the deficiency of syndrome differentiation of the six meridians, forms the pattern of syndrome and treatment of typhoid and warm diseases of Weiqi Yingxue, improves and enriches the methods and contents of syndrome differentiation of TCM for exogenous fever, and plays an important guiding role in clinical treatment.[1]
Discussion on each syndrome
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Weifen disease
It is the initial stage of hyperthermia, characterized by fever, mild aversion to cold, headache and body pain, thin white tongue coating, and floating pulse.Due to the season of onset, different manifestations may occur due to different nature of pathogenic factors and human reactivity.Common ones are:
(1) Wind temperature exterior syndrome (mostly seen in the early stage of influenza, epidemic cerebrospinal meningitis and other diseases)
Main syndrome: It has the characteristics of Weifen disease, but has severe fever and mild aversion to cold, and has nasal congestion, runny nose, cough, slight thirst, red tongue edge, and floating pulse.
Syndrome differentiation: It usually occurs in spring and winter, and it is caused by the invasion of exogenous pathogenic factors of wind and temperature into the lung.Wenxie belongs to heat, so it is very hot. The tongue edge is sharp red, and the pulse number is high.Heat evils hurt fluid, so you are thirsty.amount toEight principles dialectics"Superficial heat syndrome" in.
Main syndrome: It has the characteristics of Weifen disease, and has heavy head, heavy limbs, sore joints, white and greasy tongue coating, and slow pulse.
Syndrome differentiation: This syndrome mostly occurs in the rainy season.The disease is caused by the evil of dampness and heat invading the Wei Biao.The wet nature is heavy, so you can see head swelling, body weight, white and greasy fur, etc.
Treatment: Remove the exterior and remove dampness.
(3) Autumn dryness exterior syndrome (seen in some influenza, colds, diphtheria, etc.)
Main syndromes: headache and body heat, slight aversion to wind cold, no sweat or less sweat, dry cough without sputum or less sticky sputum, difficult to cough up, dry nose and throat, cleft lip, thin white and dry tongue coating, and thin pulse.
Syndrome differentiation: Qi of autumn dryness is external“Dry wins dry”Therefore, the mouth, nose and throat are dry with little body fluid.The lung system is fluid dry, so dry cough or cough with less phlegm.
Treatment: spicy, cool and sweet, light, penetrating and protecting the lung.
Qi division disease
It is the second stage of hyperthermia, characterized by severe fever without aversion to cold, thirst, yellow fur and pulse number.When diseases and evils invade qi, both evil and healthy qi are abundant,More Qi is fireTherefore, the syndrome of qi divided heat appears.In addition to humidity and temperature, all types of Weifen disease are transformed into heat and fire after being introduced into Qifen.Due to the different viscera and parts where Qi is separated from Qi, the nature and degree of feeling evil are different, so there are many types of syndromes reflected.Common:
Principal certificate:GasifyingThe disease is characterized by severe fever, thirst, sweat, strong pulse, dry and yellow tongue coating, red face, upset, delirium, convulsions, etc.
Syndrome differentiation: This syndrome is characterized by excessive heat of qi, so the hot face is red, the hot inside burns the body, and the sweating occurs.Heat, sweat and thirst.Heat disturbs the mind, while delirium disturbs the mind.The extreme heat generates wind and convulsions.
Treatment: clearing away heat and promoting fluid production.
Main syndrome: It has the characteristics of qi division disease, and has dry throat and burning pain,hoarsenessThe throat has decayed white spots, and the neck is swollen.
Syndrome differentiation: The heat of the lung and stomach steams the throat, so the throat is dry, hot, burning, and hoarse.It causes the fire of liver and gallbladder to attack, the phlegm to condense, the neck to swell, and the throat to have white spots.
Treatment: expel lung, clear fire and relieve heat.
(3) Pathogenic heat obstructs the lung (seen in someAcute bronchitis，Lobar pneumonia, bronchiectasis with infection, lung abscess, etc.)
Main syndrome: It has the characteristics of Qifen disease, cough, asthma, chest pain, yellow and thick sputum, and hot sweating.
Syndrome differentiation: pathogenic wind heat hurts the lung,SearingBody fluid becomes phlegm,Phlegm heat obstructing lung, lung loss, cough, asthma, chest pain, yellow and sticky sputum.There is no exterior syndrome due to internal heat, so the sweat is hot.
Treatment: promote and reduce lung heat
(4) Stagnant heat in the chest and diaphragm (seen in some influenza,Typhus, scarlet fever, pneumonia, etc.)
Main symptoms: stuffy chest, hot, hot face, red lips, thirst, constipation.
Syndrome differentiation: Yangming meridian is divided into dryness and heat, and the evil heat is concentrated in the chest and diaphragm, so the chest is stuffy and irritable.The dry heat turns to fire and the face is hot and the lips are red.Heat consumes body fluid and causes thirst and constipation.
（5）Stomach intestine excess heat(See some influenza, Japanese encephalitis, acute suppurative appendicitis, intestinal obstruction, etc.)
Main syndromes: high fever or afternoon hot flushes, constipation of stool or diarrhea, yellow odor, thin water, full abdominal distention, abdominal pain, refusal to press, irritability and delirium, red tongue, yellow fur, or gray black, prickling, and powerful pulse.
Syndrome differentiation: the heat evil enters into the body and fights with the accumulation of stagnation. It is burnt in the middle coke, and the stomach and intestines are blocked by qi, so it is hot, full, distended, painful, and refused to press, and constipation.If the heat disturbs the gods, they will be agitated; if the heat disturbs the pericardium, they will be delirious.Heat hurts body fluid, so the tongue is red and the fur is yellow and dry.
Main symptoms: body heat, chest tightness, abdominal pain, thirst, poor urination, uncomfortable stool, or diarrhea, yellow white and thick coating, slow pulse.
Syndrome differentiation: Dampness and heat block qi, so body heat does not rise.Damp heat in the upper energizer will lead to chest tightness and thirst.In the middle energizer, the abdomen will be full.In the lower energizer, the stool is uncomfortable or diarrhea, and the urine is not smooth.
Ying fen disease
It is a serious stage of pathogenic invagination of warm and hot diseases.Most of them are confused by qi division disease and spread into the camp;It can also be transferred from Wei Fen to Ying Fen without Qi Fen, that is, "reverse transfer of pericardium";Or Wenxie goes straight to Yingfen.Ying is the vitality in the blood, the predecessor of blood, which is connected to the heart. Therefore, Ying Fen disease is characterized by the lesion of damaged Ying Yin and disturbed mindThe body is very hot at night, upset and sleepless, vague rash, dark tongue without moss, fine pulse, etc., and the blood score is between the gas score and the blood score. If the blood score changes from the blood score to the blood score, it indicates that the patient's condition is improved, and if the blood score changes from the blood score to the blood score, it indicates that the patient's condition is serious.
Main syndromes: fever at night, thirst at the mouth, restlessness, sometimes delirium, faint spot diagnosis, dark tongue without moss, and thin pulse.
Syndrome differentiation: The evil heat sinks into the camp, and the camp yin is depleted, so the fever is intense at night, the tongue is red without moss, the pulse is thin, the evil heat is rising, and the mouth is not thirsty.The Ying Qi is connected to the heart. The Ying Fen is hot, and the mind is disturbed, so you can't sleep and sometimes have delirium.The heat is channeling blood and the spot diagnosis is faint.
Treatment: clear the camp and release heat.
(2) Heat entering the pericardium (mostly seen in various encephalitis, meningitis, septicemia, toxic dysentery, heatstroke, etc.)
Main syndrome: In addition to the characteristics of the disease, it is accompanied by different levels of consciousness disorders, such as apathy, speech difficulties, slow reaction, hallucination, grasping the air to touch the bed, delirium, incontinence of urine and urine, red tongue, slippery pulse.
Syndrome differentiation: heat evil invades the pericardium and blocks the heart orifices.
Treatment: clear the camp to relieve heat, clear the heart and open the mind.
(3) Hot liver wind (mostly seen in encephalitis, meningitis and various infectious diseasesToxic encephalopathyEtc.)
Main symptoms: strong heat and thirst, dizziness, distention and pain, red eyes and worry,Manic disturbance of limbsIt can even be characterized by convulsions, convulsions, tongue tremors, or hyperkeratosis, red and dry tongue, and pulse strings.
Differentiation of symptoms and signs: pathogenic heat is so intense that it causes liver wind, so it can strengthen heat and eliminate specific symptoms, convulsions, convulsions,opisthotonos, dizziness, swelling and pain caused by disturbing the orifices.The evil heat consumes the fluid and injures the palace, but the eyes are red, upset, and thirsty.
Treatment: clearing the liver and calming the wind.
(4) The disease is the same in the camp and health (seen in the early stage of influenza, toxic pneumonia, Japanese encephalitis and other diseases)
Main symptoms: slight aversion to cold, headache and body pain, chest tightness and cough, night heat and sleeplessness, or rash, crimson tongue and pulse count.
Syndrome differentiation: the evil of lung and body is still unsolved, so it is slightly evil to wind and cold, headache and body pain.The evil heat binds the lung, the lung loses circulation and falls, and the chest is stuffy and coughs.The evil of Wei Fen goes against Ying Fen and has a rash, a red tongue without moss, and sleeplessness at night.
Main syndrome: Qi syndrome occurs in Ying Fen disease, or Ying Fen syndrome occurs in the aggravation of Qi Fen disease, which can be the same disease of Qi and Ying, with red tongue and yellow white fur.
Syndrome differentiation: the excess heat of qi component causes acute injury to Ying Yin, or the heat of Ying component penetrates outward, resulting in gradual growth of stomach qi.
It is the most serious stage in the development of febrile diseases.The main pathological changes of blood syndrome were heart, liver and kidney.In addition to more serious syndromes, the clinical manifestations are characterized by blood movement and yin injury.The main manifestations are fever, nocturnal symptoms, accompanied by mental symptoms, bleeding, macula, reddish tongue, and thin pulse.Hot blood transfusionThere are two sources: one is the direct flow of qi into blood;The second is from the battalion.
(1) Qi and blood burn (seen in some cases of intestinal typhoid, millet tuberculosis, leptospirosis and other bleeding complications)
Main symptoms: strong heat, thirst, restlessness, red tongue and yellow fur, or skin spots, or even hematemesis, bleeding, etc.
Syndrome differentiation: heat toxin of qi and heat toxin of blood are both hot, and strong heat, thirst, and yellow fur are the signs of excess heat of qi.Crimson tongue and irritability are the signs of heat disturbing blood circulation.When the heat enters the blood and forces the blood to move, there will be spots, hematemesis, and bleeding.
Treatment: clear qi and cool blood.
(2) Excess blood heat (seen in some epidemic cerebrospinal meningitis, typhus, leptospirosis, anaphylactoid purpura, etc.)
Main syndrome: On the basis of the Ying Fen syndrome, there is more manic, rash revealed, bleeding (including hematemesis, bleeding, blood in stool, blood in urine and occasional menstrual blood), and purplish tongue.
Syndrome differentiation: the heart governs blood, blood heat disturbs the heart, and restlessness disturbs the mind.The blood heat is rampant, so there is a rash and various bleeding syndromes. The blood heat is very serious, so the tongue is purple.
Treatment: cooling blood and dispersing blood.
(3) Traumatic yin deficiency syndrome (seen in patients with severe mixed dehydration)
Main syndromes: low fever, hot in the evening and cold in the morning, hot in the five hearts, dry throat and dry mouth, deafness, fatigue and sleepiness, reddish fur on the tongue, and thin pulse.Or you can see the lips wither and the tongue shrink, the teeth dry and dry, the hands and feet twitch, palpitations, weak or thin pulse.
Syndrome differentiation: pathogenic heat enters the body and burns yin fluid. Yin deficiency and yang hyperactivity interfere with each other, so we can see five heart upset heat and hot flushes.Yin essence is deficient and can not nourish all orifices, so the mouth and tongue are dry and deaf.Yin is weak and the spirit is deprived, so the spirit is tired and sleepy.The true yin is depleted, the liver and kidney essence and blood are insufficient, the tendons cannot be nourished, and the muscles and veins are cramped, soPeristalsis of hands and feet, even convulsions.Yin deficiency can not nourish the organs and tissues of the zang fu organs, so the lips wither and the tongue shrink, the teeth dry and dry, and the heart palpitates.Yin deficiency can not converge Yang, and Yin and Yang are disharmonious, so the pulse is large and numerous, or small and fast.
Treatment: nourishing yin and blood.[2]
Diagnostic significance
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1. Identify the lesion site:
The main surface of Wei Fen syndrome is that the lesions are mostly located in the fur, muscle striae, limbs, head and face, nose and throat, and lungs;
Qi syndrome is mainly internal, and pathological changes are mostly inlung、Sternophrenic、spleen, stomach, intestine, gallbladderbladderEtc;
Ying fen syndrome is that pathogenic heat goes deep into the heart and the disease is in the heart and pericardium;
The syndrome of blood points often invades the heartliver, Kidney.
2. Differentiate the stages of disease course:
Disease and pathogen enter the four stages from Wei to Qi, from Qi to battalion, and from battalion to blood, which indicates that the disease and pathogen go deeper and deeper, and the severity of the disease gradually worsens.
3. Explain the law of disease pathogen transmission:
The transmission order of febrile diseases is generally from the exterior to the interior, from Wei fen to Qi fen, Ying fen and blood fen, from the exterior to the interior, from light to heavy, which is called sequential transmission;
If Wei Fen's evil is transmitted directly to the pericardium or blood circulation without Qi Fen, it is called reverse transmission;
If the onset occurs in the qi, nutrient and blood, it is the internal occurrence of latent pathogens;
In the process of transformation, Wei Fen's evil was gone, and he also saw Qi Fen or Ying Fen certificateDefence and qi are the same diseaseOr both the battalion and the public health are sick;
The evil of qi is still unsolved, but the witness of qi and blood is the same disease of qi and blood or the burning of both qi and blood.
Whether it is transmitted or not depends on the type of disease pathogen, the degree of feeling pathogen, the strength of constitution, and whether treatment and nursing are appropriate.[3]
