First, the key points of syndrome differentiation
Syndrome differentiation always belongs to positive evidence, but there is a difference between positive evidence and deficiency syndrome, so it is necessary to distinguish the excess from the deficiency of specimens. Generally, when you feel evil, you tend to be evil, but you usually tend to be empty. The excess of phlegm, water and blood stasis must be distinguished from the excess. In the early stage, phlegm and turbidity were dominant, and gradually phlegm and blood stasis were equally important, and qi stagnation, water and drink were common. In the later stage, phlegm and blood stasis are abundant, healthy qi is weak, and deficiency is equal to excess. Deficiency should be distinguished from the primary and secondary diseases of deficiency of both qi (yang) and yin, lung, heart, kidney and spleen. In the early stage, qi deficiency was dominant, or both qi and yin were deficient, and the disease was in lung, spleen and kidney; In the later period, qi deficiency affects yang, and even the deficiency of yin and Yang Can can be seen. The lesions are mainly lung, kidney and heart.
Second, the principle of treatment
Treatment should pay attention to two aspects: palliative and radical. According to the priority of the specimens, the focus is on eliminating pathogenic factors and strengthening the body resistance. According to the nature of pathogenic factors, the demonstrator should adopt the methods of eliminating pathogenic factors, dispersing lung, reducing qi and resolving phlegm, warming yang and promoting diuresis, and even inducing resuscitation, calming wind and stopping bleeding. Deficiency of essential qi should be based on nourishing the heart and lungs, tonifying the kidney and strengthening the spleen, or regulating both qi and yin, or giving consideration to both yin and yang. When healthy qi is about to be eliminated, it is necessary to strengthen the healthy qi and eliminate evil spirits in order to save yin and restore yang.
Third, the classification of syndrome differentiation and treatment
1. Phlegm blocking lung syndrome
Chest tightness, shortness of breath, slight fatigue, cough with excessive phlegm, white sticky or foamy color, fear of wind and easy sweating, anorexia, dull tongue, thin greasy or turbid fur, and slippery pulse.
Summary of syndrome mechanism: lung deficiency and spleen deficiency, phlegm obstruction in the middle, lung failure.
Treatment: reduce phlegm and qi, strengthen spleen and benefit lung.
Representative: Suzi Jiangqi Decoction and Sanzi Yangqin Decoction. Both of them can reduce qi, eliminate phlegm and relieve asthma, but Perilla Ginger Decoction is mild in nature, and is suitable for patients with upper excess and lower deficiency, and cold phlegm with asthma and cough. The failure of Sanzi Yangqin decoction is due to turbid phlegm, full lung and sticky phlegm.
Commonly used drugs: Perilla frutescens, Radix Peucedani and Semen Sinapis Albae for resolving phlegm and relieving asthma; Pinellia ternata, Magnolia Officinalis and Pericarpium Citri Tangerinae are used for eliminating dampness, resolving phlegm, promoting qi circulation and reducing adverse reactions; Atractylodis Rhizoma, Poria and Glycyrrhrizae Radix.
Too much phlegm, chest full can not lie flat, add prickly heat and radish seeds to clear the lungs, resolve phlegm and relieve asthma; Deficiency of both lung and spleen, easy sweating, shortness of breath and less phlegm. Codonopsis pilosula, Radix Astragali, Radix Saposhnikoviae, invigorating spleen and benefiting qi should be added as appropriate to replenish lung and consolidate exterior.
If it is induced by exogenous cold, phlegm turns from cold to drink, with asthma and cough, and phlegm is sticky with foam. For patients with exterior cold and internal drinking syndrome, Herba Ephedrae, Ramulus Cinnamomi, Herba Asari and Rhizoma Zingiberis are added to Zongxiaoqinglong Decoction to dispel cold and relieve hangover; Drink stagnation heat, dysphoria, wheezing and pulse floating, and use Xiaoqinglong and gypsum soup to clear stagnation heat; If phlegm is turbid and blood stasis, lip nails are purple and dark, and the tongue coating is muddy and greasy, Ditan Decoction can be added with Salvia Miltiorrhiza, Lumbricus, Peach Kernel, Carthami Flos, Paeonia Rubra, Leech, etc.
2. Phlegm-heat stagnation of lung syndrome
Cough, wheezing, chest tightness, dysphoria, glaring eyes, yellow or white sputum, sticky and hard to clear, or accompanied by body heat, slight aversion to cold, less sweating, thirst, red tongue, yellow or greasy fur, and slippery pulse.
Summary of syndrome mechanism: phlegm-heat blocking the lung, clearing away the excess of benefit, and lung-qi upwelling.
Treatment: clearing away lung-heat, resolving phlegm, lowering adverse qi and relieving asthma.
Representative: Miss Yue adds Pinellia decoction or mulberry bark soup. Dispelling lung heat before, it is used to suppress lung by drinking heat, with exterior evil, asthma and cough, eyes dislocated, body heat and pulse floating; Clearing lung and resolving phlegm at the rear is used for patients with phlegm-heat obstructing lung, dyspnea, chest tightness, coughing up yellow phlegm or sticky white phlegm.
Commonly used drugs: ephedra dispersing lung and relieving asthma; Scutellaria baicalensis Georgi, Gypsum Fibrosum, and Cortex Mori clear away lung heat; Almond, Pinellia ternata and perilla can eliminate phlegm, regulate qi and relieve asthma.
For patients with excessive phlegm-heat, chest fullness and qi stagnation, and sticky phlegm, Herba Houttuyniae, Rhizoma Fagopyri Fagopyri Esculenti, Fructus Trichosanthis, Clam Powder, Fritillaria Thunbergii, and weathered nitrate are added to clear away heat, resolve phlegm, and benefit lung; Phlegm asthma, not lying down, plus shoot dry, prickly heat, purging lung and relieving asthma; Phlegm-heat impairs body fluid and causes dry mouth. Add Trichosanthes Radix, Rhizoma Anemarrhenae and Rhizoma Phragmitis to promote fluid production and moisten dryness. For those with phlegm-heat obstructing the lung, obstruction of fu-organs, chest tightness, shortness of breath and constipation, yellow and mirabilite should be added to clear fu-organs, relieve heat, lower lung and relieve asthma; For those with less phlegm due to yin injury, the taste of bitter and cold should be reduced, and ginseng and Ophiopogon japonicus should be added to nourish yin.
3. Phlegm syndrome
Trance, indifference, delirium, restlessness, empty silk thread, lethargy, even coma, or accompanied by limb tremor, convulsion, cough, shortness of breath, unpleasant expectoration, white or yellow greasy fur, dark red or lavender tongue, and smooth pulse.
Summary of syndrome mechanism: phlegm affects the mind and induces liver wind.
Treatment: resolving phlegm, inducing resuscitation and calming wind.
Representative: Ditan Decoction. This recipe can clear phlegm, induce resuscitation, calm wind and relieve spasm, and can be used for patients with excessive phlegm, excessive wind phlegm, lethargy or lethargy, excessive phlegm and limb tremor.
Commonly used drugs: Pinellia, Poria, Orange, Danxing to resolve phlegm and stop wind; Zhuru and Fructus Aurantii Immaturus can clear away heat and phlegm, and benefit the diaphragm; Acorus calamus, Radix Polygalae and Radix Curcumae are used for inducing resuscitation, resolving phlegm and reducing turbidity. In addition, it can be taken with Zhibaodan or Angong Niuhuang Pill to clear the heart and enlighten the mind.
If phlegm-heat, body-heat, dysphoria, unconsciousness, yellow fur and red tongue are present, Lepidium, concretio silicea Bambusae and bamboo juice are added; Liver wind is shaking, Uncaria and Scorpio are added, and antelope horn powder is taken respectively; Blood stasis is obvious, the labial nail is cyanotic, and Salvia Miltiorrhiza, Carthamus tinctorius and Peach Blossom are added to promote blood circulation and dredge the pulse; Such as skin and mucous membrane bleeding, hemoptysis and hematochezia, use hemostatic drugs such as buffalo horn, Radix Rehmanniae, Cortex Moutan and Callicarpa.
4. Yang deficiency and water-dampness syndrome
Palpitation and palpitation, asthma and cough, thin expectoration, floating face, edema of lower limbs, even general edema, abdominal distension with water, abdominal distension, anorexia, short and red urine, chills, cyanosis of face and lips, white and slippery fur, dark and fat tongue, and deep and thin pulse.
Summary of syndrome mechanism: Yang deficiency of heart and kidney, internal stagnation of water and drink.
Treatment: Warming the kidney and strengthening the spleen, removing dampness by dissolving the drink.
Representative: Zhenwu decoction plus Wuling powder. Warming yang and promoting diuresis were used for edema of spleen and kidney yang deficiency type before; Activating the yang in the rear, transforming qi into water, combined with Zhenwu decoction, can enhance the function of diuresis and detumescence.
Commonly used drugs: Radix Aconiti Lateralis Preparata and Ramulus Cinnamomi for warming kidney and activating yang; Poria cocos, Atractylodes macrocephala, Polyporus, Alisma orientalis, and ginger for invigorating spleen and promoting diuresis; Radix Paeoniae Rubra promotes blood circulation and removes blood stasis.
If the edema is severe, the heart and lungs are suffocating, the palpitation is palpitation, and you can't lie on your back, add Aquilaria Resinatum, Black and White Ugly, Zanthoxylum bungeanum, Lepidium, and Evergreen Root to promote qi circulation and diuresis; Blood stasis is serious and cyanosis is obvious. Herba Lycopi, Carthami Flos, Saviae Miltiorrhizae Radix, Herba Leonuri and Cortex Acanthopanacis Senticosi are added to promote blood circulation and remove blood stasis. After the elimination of drinking water, you can refer to the treatment of lung and kidney qi deficiency syndrome.
5. Lung and kidney qi deficiency syndrome
Breathing is shallow and short, it is difficult to continue, the voice is low, and the breath is timid. Even if you open your mouth and lift your shoulders, you can't lie flat, cough, white phlegm like foam, adverse vomiting, chest tightness, palpitation, sweating and chills, or weak waist and knees, long urine, or light urine, pale tongue or dark purple, heavy and thin pulse, or knots.
Summary of syndrome mechanism: deficiency of both lung and kidney, loss of qi.
Treatment: tonify lung and kidney, reduce qi and relieve asthma.
Representative: Pingchuan Guben Decoction and Bufei Decoction. Supplementing lung and kidney in front, reducing qi and resolving phlegm, used for patients with lung and kidney qi deficiency, asthma and cough with phlegm; The function of the back part is to replenish lung and qi, and it is used for patients with weak lung qi deficiency, asthma, cough and shortness of breath.
Commonly used drugs: Radix Codonopsis (Ginseng), Radix Astragali, and Radix Glycyrrhizae Preparata for tonifying lung; Cordyceps sinensis, Radix Rehmanniae Preparata, Semen Juglandis, and umbilical cord for tonifying kidney; Schisandra chinensis converges lung qi; Spirit magnet, heavy fragrance returns to nature; Radix Asteris, Flos Farfarae, Perillae, Rhizoma Pinelliae, Pericarpium Citri Tangerinae, and eliminating phlegm and reducing qi.
Lung deficiency and aversion to cold, pale tongue, adding cinnamon, dried ginger and stalactites to warm the lungs and dispel cold; Yin injury, low fever, less red tongue coating, adding Ophiopogon japonicus, Polygonatum odoratum and Radix Rehmanniae to nourish yin and clear heat; Qi deficiency and blood stasis, neck pulse, cyanosis of face and lips, and angelica, salvia miltiorrhiza and sappan wood are added to promote blood circulation and dredge veins. If you see an asthma crisis, take Gecko powder or black tin with Shenfu decoction to replenish qi and kidney, and restore yang and strengthen the body resistance.
In the stable stage, you can often take Zhou Fei pills.