one, eight classes are divided into yin and yang

The most basic programmatic dialectical method of traditional Chinese medicine-eight classes of syndrome differentiation. There are also six meridians syndrome differentiation, Wei Qi Ying Xue syndrome differentiation and triple energizer syndrome differentiation for exogenous febrile diseases. Differentiation of zang-fu organs based on internal medical diseases; It is used to guide the clinical differentiation of meridians in acupuncture and moxibustion; And

the so-called "eight-outline syndrome differentiation" means that we must first distinguish the yin, yang, exterior, interior, cold, heat, deficiency and excess of the disease, that is. Among the eight cardinal principles, yin and yang are the general principles, so yin and yang should be used to control exterior, interior, cold and heat, and excess and deficiency. Interior, deficiency and cold belong to yin syndrome, while exterior and heat belong to yang syndrome.

(1) Differentiation of exterior and interior

Differentiation of exterior and interior in TCM refers to the identification of the lesion site and lesion level. Inside and outside are yin and yang. Compared with fur and sinews, fur is the table, and sinews are the inside; Compared with the six fu organs, the muscle is the exterior and the six fu organs are the interior; Compared with the five internal organs, the six internal organs are the exterior and the five internal organs are the interior. In fact, Chinese medicine pays more attention to the identification of exterior-interior syndrome and has more clinical value in the diagnosis and treatment of exogenous diseases.

it is important to distinguish exterior from interior because the etiology, pathogenesis, treatment principles and methods of exterior-interior syndrome are completely different; Unclear judgment on the inside and outside will lead to serious consequences of mistreatment. ?

Most diseases in the exterior are caused by the invasion of exogenous pathogens; Diseases in the stomach are often related to disharmony between qi and blood. ?

the invasion of external evils, the struggle between good and evil, and the contradiction belongs to the contradiction between ourselves and the enemy; The disharmony between qi and blood, evil from internal injury, and the nature of contradiction belongs to contradictions among the people.

To treat exterior pathogens, sweating and exorcism are the first task, and quick results are sought. The so-called "treating exogenous pathogens like a general". Treating internal syndrome, focusing on harmonizing qi and blood, often needs to slow down the picture, the so-called "treating internal injuries like phases."

If the exterior syndrome is puzzling, it will attack the interior, while the healthy qi is struggling to resist evil on the exterior, but the body is in a state of chaos due to poison, and evil spirits will inevitably take the opportunity to enter, and the illness will be aggravated. Attacking exterior syndrome due to disharmony between interior syndrome and exterior syndrome, disharmony between qi and blood in the body, and attacking exterior syndrome due to failure to cure interior syndrome, are just consuming vital qi, and interior syndrome is even worse.

what's in the table and what's in the table? how to judge?

there are two criteria to distinguish, one is aversion to cold, and the other is pulse floating.

aversion to cold means fear of cold, but this fear of cold doesn't work even if you cover it with a thick coat, and it still chills. Whenever you see the symptoms of aversion to cold, it must mean that there is evil in the table. As the saying goes, "if you have a bad cold, you will have a bad exterior."

Pulse floating means that the pulse condition is very superficial. As soon as your hand touches the skin of Cunkou, you can feel a strong pulse. After pressing it hard, the pulse intensity decreases. It is also a symbol of righteousness and rising up against evil.

(2) Distinguishing cold and heat

▌ 1?

patient, male, 58 years old. Suffering from "stomach trouble" for nearly 31 years, I underwent gastrointestinal barium radiography in a hospital and was diagnosed as "duodenal ulcer". After eating a small amount of white wine the night before, the patient suddenly suffered from paroxysmal colic in the epigastric region at 11 o'clock that night, which spread to the right flank, accompanied by belching and acid, bitter mouth and dry mouth, like pressing hands, cold face and limbs, slightly sweating, and the pain can be relieved by drinking hot boiled water. The tongue is ruddy, the coating is yellowish and thick, and the pulse is tight and numerous.

This is a medical record of Fang Xianming, a teacher from Guangxi College of Traditional Chinese Medicine. Is the stomach pain in this patient cold, hot or a mixture of cold and heat?

let's analyze it.

The patient's mouth is bitter and dry, the red tongue coating is yellowish and thick and greasy, and the pulse rate seems to be the manifestations of heat syndrome. When the patient went to the outpatient department of a hospital for medical treatment, the doctor in charge was also diagnosed as "stomach pain caused by liver fire invading the stomach" according to the above-mentioned "heat image" and combined with the symptoms and characteristics of epigastric pain, and was treated with Longdan Xiegan Decoction.

However, after taking 1 dose of medicine, the stomachache is aggravated, accompanied by abdominal distension, frequent belching, anorexia, nausea, vomiting and salivation, and poor stool. What's the problem? After careful observation, we can find that in addition to the above-mentioned fever, there is a symptom that is particularly noticeable, that is, "drinking hot boiled water can relieve pain."

Combined with some other manifestations, such as red tongue but not moist, epigastric pain as colic, cold limbs and so on, it can be judged that the current pain of patients is mainly cold. Then there is the reaction that the pain is aggravated after taking the cold-cooling drug Gentiana, which can further confirm that the pain is caused by cold. Combined with the comprehensive diagnosis of systemic symptoms, the patient belongs to cold and heat mixed with dampness, and the current treatment should be mainly to dispel cold.

▌ Medical record 2

Yang, female, 31 years old. Suffering from abdominal pain, high fever and constipation at first. I have been ill for 4 days. I used enema to relieve constipation, which led to abdominal pain, vomiting and diarrhea, cold limbs, restlessness, blue face and slight pulse. After taking a large dose of Fuzi Lizhong decoction (reuse Fuzi), the condition worsened after taking it. Symptoms: blue face, mental annoyance, cold limbs, vomiting and diarrhea, fever, bad breath, cold caused by thirst, and dry lips. The tongue is purple and the pulse is closed. Careful examination: although the back of the hand is cold, the palm is hot.

On the surface, the patient's face is blue, his limbs are cold and his pulse is heavy, all of which are cold. See also fever, bad breath, heavy breath, thirst leading to cold, and dry mouth and lips, all of which are heat symptoms. It seems that cold and heat meet, but it is not. The patient's problem is that the Yang-heat in the body is too strong and the Yin-heat is weak, and it is unable to restrict the hyperactivity of Yang-heat, but it is excluded by Yang-heat, resulting in the appearance of true heat in the body and false cold on the body surface. The so-called true heat and false cold.

second, determine the principle of disease treatment with yin and yang

the fundamental cause of the occurrence and development of diseases is the imbalance of yin and yang. Therefore, it is the basic principle of treatment to adjust yin and yang, make up for deficiency and diarrhea, and restore the relative balance of yin and yang.

1) the treatment principle that yin and yang are superior to each other-damaging its excess (actually purging it)

yin and yang are superior to each other, that is, the excess of yin and yang is excess, so the treatment principle is "damaging its excess" and "actually purging it". It includes two aspects: those who are hot are cold and those who are cold are hot. ?

①? Heat is cold: yang wins heat, which is a true heat syndrome. It is called "heat is cold" to promote cold-cooling drugs to control yang and treat heat with cold.

Shuanghuanglian oral liquid for exterior-heat cold;

Internal heat should be divided into zang-fu organs: lung heat coughing up yellow phlegm, using Houttuynia cordata tablets or acute branch syrup; Liver heat, red eyes and swelling, Longdan Xiegan Pill;

For heart-fire tongue ulcer, upset and insomnia, use Zhusha Anshen Pill or lotus plumule to soak in water;

Huanglian Shangqing Pill or Niuhuang Qingwei Pill is used for stomach fire, bitter taste and halitosis.

All these are the applications of "heat is cold".

②? Cold leads to heat: Yin prevails over cold, which is a true cold syndrome. It is advisable to use warm drugs to control its yin and treat cold with heat, that is, "cold leads to heat".

Ganmao Qingre Granule for exterior cold and common cold;

cold pathogens should be divided into zang-fu organs: cough due to lung cold and thin phlegm, which should be treated with Tongxuan Lifei Pill; Stomach cold and stomachache, treated with Liangfu Pill; Liver cold, small intestinal hernia and less abdominal cold pain were treated with Tiantai Wuyao Powder. All these are the applications of "the cold is hot".

yang-excess leads to heat, while yang-excess leads to yin disease, that is, excess of yang-excess is easy to consume yin fluid. Yin-excess is cold, and yin-excess is yang disease, that is, yin-excess is easy to damage yang qi. Therefore, when adjusting the partial victory of yin and yang. Attention should be paid to the existence of corresponding yin or yang decline.

if yin or yang is dominant and the opposite party does not constitute a virtual loss, the method of "damaging it more than enough" can be adopted.

If the opposite party is weak, it should give consideration to its shortcomings and cooperate with the method of supporting yang or benefiting yin. Fuyang can be dried ginger, cinnamon, etc., and Yiyin can be lily, ebony, Sydney, etc.

2) Treatment principle of yin-yang deficiency-make up its deficiency (deficiency will make up for it)

Yin-yang deficiency, that is, deficiency of yin and yang, is a deficiency syndrome, so the treatment principle is "make up its deficiency" and "deficiency will make up it". Including supporting yang and benefiting fire, nourishing yin and strengthening water.

①? Supporting yang and benefiting fire (the source of benefiting fire, treating yang by yin diseases): If yang deficiency can't control yin, the excess of yin belongs to deficiency-cold syndrome, so it is not appropriate to use pungent and warm herbs to disperse yin cold, and the method of "benefiting fire to eliminate yin stagnation" should be used, that is, the method of supporting yang and benefiting fire to eliminate yin excess.

"Benefiting the source of fire to eliminate yin" is Bing Wang's annotation on Su Wen Zhi Zhen Da Lun that "those who are hot but cold take Yang". It is to treat cold syndrome with pungent and hot drugs, but the cold is more serious. This is not a cold syndrome caused by exogenous cold pathogen, but a deficiency cold caused by deficiency of kidney yang (true yang). Therefore, drugs for warming and tonifying kidney yang should be used to supplement the fire, so as to eliminate the excessive yin cold, which is also called "treating yang with yin disease". The term "yin disease" here is different from the meaning of "yin disease" in "Yang wins yin disease".

the yin disease of "yang wins yin disease" refers to the deficiency of yin qi caused by excess of yang evil, while the yin disease in "treating yang with yin disease" emphasizes the deficiency of cold syndrome caused by yang deficiency, which is called yin disease because of its yin nature. Because it is caused by deficiency of yang qi, it is necessary to "treat yang" and "replenish it".

②? Nourishing yin and strengthening water (the master of strengthening water and treating yin with yang diseases): Yin and Yang are on the decline, that is, the deficiency of Yin or Yang is insufficient, or it is yin deficiency or yang deficiency. Yang hyperactivity caused by yin deficiency can't control Yang, which belongs to deficiency-heat syndrome. Generally, the heat can't be directly reduced by bitter cold medicine, so we must use the method of "strengthening water to control sunshine", that is, nourishing yin to strengthen water to inhibit Yang hyperactivity.

"Strong water is the master to control sunshine" is a comment by Bing Wang in Tang Dynasty on "On the Truth of Su Wen", which says "those who are cold but hot take the shade". That is to say, bitter cold medicine is used to treat heat syndrome, but the heat does not subside, and instead it increases weight. This is not excess excess heat syndrome, but deficiency heat due to deficiency of kidney yin (true yin), so the treatment should be based on nourishing yin and tonifying kidney water, so as to eliminate excessive yang heat. It is also called "Yang disease treating Yin", and the meaning of "Yang disease" here is different from that in "Yin wins Yang disease".

The "Yang disease" of "Yin prevails over Yang disease" refers to the deficiency of Yang qi caused by excess of Yin evil, while the "Yang disease" in "Yang disease treating Yin" emphasizes the "deficiency-heat syndrome" caused by Yin deficiency, which is called "Yang disease" because it is caused by deficiency of Yin qi, so to treat Yin means to replenish Yin.

Third, analyze the performance of drugs with Yin and Yang

Yin and Yang are used in the treatment of diseases, not only to determine the treatment principles, but also to summarize the sexual and taste functions of drugs as the basis for guiding clinical medication.

When treating with traditional Chinese medicine, we just use the drug's bias to correct the corresponding problems in the human body. Treat heat with cold medicine and cold with hot medicine; Tonify drugs to treat deficiency, and laxatives to treat excess. If doctors can't distinguish between cold and heat of diseases, taking cold as heat and heat as cold, medication will be wrong. If the consequences are light, they will be ineffective, and if they are heavy, they will harm people. We must be cautious.

generally speaking, the performance of drugs is mainly determined by their qi (nature), taste and ups and downs, and the qi, taste and ups and downs of drugs can be summarized and explained by yin and yang.

medicinal properties: it mainly refers to the four medicinal properties of cold, cool, hot and warm, also known as "four qi". Among them, cold belongs to yin (cool is second to cold), and warm belongs to yang (warm is second to heat). Generally speaking, drugs that can relieve or eliminate heat syndrome are mostly cold or cool, such as Gardenia and Scutellaria baicalensis Georgi. On the contrary, drugs that can alleviate or eliminate cold syndrome are generally warm or hot, such as dried ginger and aconite.

five flavors: sweet, pungent, sour, bitter and salty. Some drugs have astringent taste, so there are actually more than five kinds, but they are still customarily called five flavors. Among them, pungent, sweet and light belong to yang, bitter and salty belong to yin.

Therefore, Su Wen Zhi Zhen Da Lun says: "Sweet and sweet diffuse into Yang, sour and bitter overflow into Yin, salty overflow into Yin, and light taste seeps into Yang." If spicy, it can disperse, promote qi and blood circulation, and be yang; Sweet taste, with tonic effect, is yang; Sour taste, which has the effect of convergence and astringency, is yin; Bitter taste, with the function of releasing fire and drying dampness, is yin. Salty taste is soft and hard, and people's blood is divided and enters the kidney, which is yin. The "surge" here means "pass", and the surge is understood as pass, that is, discharge downward. Light taste is attached to sweetness, which has the effect of strengthening the spleen, diminishing seepage and promoting diuresis, and is yang.

ups and downs: that is, up means up, down means down, floating means divergence, sinking means convergence and defecation. Generally, drugs with the effects of invigorating yang, expelling wind, dispelling cold, vomiting and inducing resuscitation go up and down, and most of them rise and float, and those who rise and float are yang; However, drugs with purgation, clearing away heat, diuresis, calming nerves, suppressing yang and calming wind, eliminating stagnation, lowering adverse flow, astringing, etc., all subside inward, and those who subside are yin.

In short, the treatment of diseases is to determine the treatment principle according to the situation that Yin and Yang are superior to each other. Combined with the yin and yang properties of the drug, the corresponding drugs are selected to correct the imbalance of yin and yang caused by the disease, so as to achieve the purpose of curing the disease.