明清医家痹病证治规律研究
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摘要
痹病,古称“痹”、“风湿”、“痹证”等,与现代医学的风湿病、痛风、骨关节炎等结缔组织疾病、代谢性疾病、骨关节疾病等相符。明清医学在中医历史发展中具有十分重要的地位,其医学文献十分丰富。明清医家积累了大量的治痹经验,现代研究与应用证实其实用有效,在临床上也得到较为广泛的应用。
一、研究目的
本研究旨在对治痹医案运用SPSS软件包进行频数分析,同时对明清主要医家、医著中与痹病相关的文献资料进行搜集、整理、归纳、分析、评价,结合文献研究与医案研究,对明清医家的痹病证治规律进行探讨,以便将其结果指导中医临床,并为今后的研究奠定基础。
二、研究方法
查阅来自于湖南电子音像出版社出版的第三版电子版《中华医典》,使用《中华医典》软件中的检索功能。其中符合收录标准的有318例。采用统计软件包SPSS软件12.0进行数据管理和统计分析。对所有药物的使用频次进行统计。
三、研究结果
(一)虚实证型统计结果
318例治痹医案实证为主证型占63.21%,虚证为主证型占36.79%。实证中以风寒湿型、湿热型的比例最大,分别占全部医案总数的25.47%、15.72%。虚证则以营血虚、肝肾亏虚、气血亏虚为最多,分别占全部医案总数的11.00%、10.69%、9.12%。318例治痹医案中当归、茯苓、桂枝、秦艽、桑枝、防己、防风、薏苡仁等药物使用频次最高。
(二)方药的类别分析
对所有318首方剂中的用药进行频次统计,涉及药物267味。总药次计3129次。祛风湿药、利水渗湿药、补血药、活血化瘀药、解表药、补气药、清热药所占比例较大。58味高频次药性昧归经分析如下:苦昧所占比例最大,其次为甘味、辛味。性以温热最多,其次为寒、微寒,再次为平。其药物归经虽涉及全身脏腑,但以肝、肾、脾经为最多。
(三)证型特点及用药
1.风寒湿型痹病以疼痛游走、疼痛剧烈、重着为特点,可用祛风散寒除湿法进行治疗。当归、桂枝、茯苓、防己、防风、秦艽、桑枝、独活等药物的使用频次最高。
2.暑湿型痹病以身重痛而热、心烦口渴为特点,可用轻清淡渗法进行治疗。薏苡仁、防己、陈皮、杏仁、通草、防风、竹叶、桑枝、扁豆叶等药物的使用频次最高。
3.热痹以红肿热痛、痛暴而猛为特点,可用清热法进行治疗。栀子、丹皮、当归、生地、石膏、桑枝、羚羊角、忍冬藤等药物的使用频次最高。
4.痰饮型痹以脉滑、眩冒呕恶为特点,可用祛痰燥湿兼理气法进行治疗。陈皮、茯苓、半夏、当归、黄芩、黄柏、苍术、羌活、威灵仙、红花等药物的使用频次最高。
5.湿热痹以关节灼热肿痛、疼痛而重为特点,可用渗湿清热法进行治疗。防己、桑枝、薏苡仁、萆薢、茯苓、石膏、秦艽、桂枝、独活等药物的使用频次最高。
6.营血亏虚型以筋脉拘挛、屈伸不利、脉细为特点,可用养血熄风、祛风活络法进行治疗。当归、白芍、秦艽、生地、桑枝、杜仲、桑寄生、白蒺藜等药物的使用频次最高。
7。阳虚型以关节冷痛、畏寒、脉微或沉迟为特点,可用温通法、水中补火法进行治疗。附子、桂枝、白术、熟地、茯苓、杜仲、甘草、鹿茸、枸杞、狗脊、当归等药物的使用频次最高。
8.气血亏虚型以汗后或产后,或体弱、久病身痛,脉细弱为主要特点,可用补益气血佐祛风法进行治疗。当归、黄芪、人参、白术、防风等药物的使用频次最高。
9.肝肾亏虚型以腰膂腿膝足等处疼痛、关节变形挛痛、尺脉细为特点,可用益精填髓、强壮筋骨法进行治疗。当归、杜仲、鹿茸、茯苓、熟地、菟丝子、枸杞、补骨脂等药物的使用频次最高。
10.气滞型以脉弦、胁肋胀痛为特点,可用疏肝理气法进行治疗。当归、陈皮、香附、延胡索、乳香、白芍、红花等药物的使用频次最高。
11.瘀血型以腰部刺痛固定,脉涩或芤为特点,可用下瘀血法进行治疗。桃仁、大黄、甘草、附子、桂枝、当归、穿山甲、肉桂等药物的使用频次最高。
12.津亏型以身痛不能转侧、手足瘛疭、口干躁烦为特点,可用滋阳明法进行治疗。生首乌、生地、秦艽、黄芩、枳实、桔梗、茯苓、石斛、甘草等药物的使用频次最高。
四、结论
结合文献研究与医案研究,总结出明清医家痹病证治规律如下:
(一)辨析痹病概念
1.痹的含义
大部分明清医家都认为“痹”是指外邪侵袭机体,脏腑经脉气血闭阻不通的病理机制。
2.痹病病名
风痹即行痹,其痛行走不定,又称为“流火”、“走注”、“鬼箭”,亦有医家称为“痛风”、“历节风”。寒痹即痛痹,许多医家亦称之为“痛风”、“历节风”、“白虎历节风”。湿痹即着痹,其痛着而不移,许多医家(如尤在泾、李用粹等)认为亦包括麻木不仁。
(二)对痹病病因病机的探讨,主要包括强调热邪、暑邪、痰瘀致痹、重视阴血在痹病中的特殊地位、重视肝肾亏虚致痹。
(三)探求辨证规律,探求辨证规律,包括注重患者体质、了解新病久病、区分轻重缓急、辨寒热虚实、注意患病部位。其中,注意患病部位包括体表上下部位、病邪深浅部位、三焦部位、卫气营血、在经与在络。
(四)探求治疗规律
1.祛温邪,独树一帜
(1)渗湿清热法
(2)泄法(包括清热泻火、清热凉血等)
2.甘温培中,补益后天
3.益精填髓、血肉有情以实先天
4.治风先治血,血行风自灭。包括养血补血、温阳活血、行气活血、活血化瘀、养血(阴)熄风。
5.重视从经络论治
(1)善从阳明论治。包括宣通清解法与补益法。
(2)诸痹独取太阴
(3)奇脉论治。包括治分虚实、强调通络、补益肝肾、务在气血调和。
(4)久病入络的治疗。包括“通络”是治疗络病的总原则、虚实异治、治络须护胃气、重在痰瘀。
6.引经药的使用
Background
Arthralgia Syndrome is one of the difficult and complicated diseases. Traditional Chinese Medicine have obvious,advantages in its prevention and cure.The experiments of curing Arthralgia Syndrome by the physicians of the Ming-Qing Dynasty are practical and effective.They also have influences in the curing methods of Arthralgia Syndrome to the physicians of later ages.But the research about.this area focus a few physicians of Ming-Qing Dinasty.So the experiments treating Arthralgia Syndrome by the physicians of Ming-Qing Dynasty are studied not widely and deeply enough.We should pay more attention to the other physicians of the Ming-Qing Dynasty.Their experiments about Arthralgia Syndrome are worth excavating deeper and arranging better.
Purpose
This subject will study the documents and materials about Arthralgia Syndrome written by the major physicians of the Ming-Qing Dynasty by collecting, arranging,analyzing,concluding and appraising.And it will take statistics from the medicine cases about Arthralgia Syndrome written by the physicians of the Ming-Qing Dynasty.The pattern how the physicians of the Ming-Qing Dynasty understood and treated Arthralgia Syndrome will be hoped to get from all the work.The result of this research will be used in guiding the clinical work of TCM.It may raise the effect of the treatment of Arthralgia Syndrome.
Method
Some medicine cases about Arthralgia Syndrome written by the physicians of the Ming-Qing Dynasty will be analyzed and imported into data base.The syndromes and using of herbs will be analyzed through mathematics and physics statistical methods.Then,physicians' original views and treatments about Arthralgia Syndrome in the Ming-Qing Dynasty will be collected,arranged.At last,combining the.literature research and medical case research,the rule of the treatment based on Syndrome differentiation to Arthralgia Syndrome of the Ming-Qing Dynasty will be analyzed,concluded and appraised.
Result
1.12 kinds of syndromes is divided from 318 cases about Arthralgia Syndrome of the Ming-Qing Dynasty,and the syndrome of wind-cold-dampness and dampness-heat is used mostly often.Deficiency syndrome takes 36.79%in 318 cases about Arthralgia Syndrome of the Ming-Qing Dynasty while excess syndrome which takes 63.21%.The extensional herbs used mostly are Radix Angelieae Sinensis,Poria,Ramulus Cinnamomi,Radix Gentianae Macrophyllae,Ramulus Mori, Sinomenium Acutum,Raidix Saposhnikoviae,Semen Coicis.
2.The syndrome of wind-cold-dampness has the feature:ache transmigration, severe ache,heaviness-immobility,lt can be managed by expelling wind, removing cold and dispelling dampness.The extensional herbs used mostly are Radix Angelicae Sinensis,Ramulus Cinnamomi,Poria,Sinomenium Acutum,Raidix Saposhnikoviae,Radix Oentianae Macrophyllae,Ramulus Mori,Radix Angelicae Pubescentis.
3.The syndrome of summer hygrosis has the feature:heat,heaviness and pain.of the body,feeling upset and thirsty.It can be managed by light clearing and leaking.The extensional herbs used mostly are Semen Coicis Sinomenium Acutum PericarDium Citri Reticulatae Semen Armeniacae Amarum,Medulla Tetrapanacis,Raidix Saposhnikoviae,Henon Bamboo Leaf,Ramulus Mori,Hyacinth Dolichos Leaf.
4.The syndrome of heat has the feature of heat,redness,swelling and pain of the arthrosis,sudden and violent ache.lt can be managed by cooling heat.The extensional herbs used mostly are Fruetus Gardeniae、Cortex Moutan,Radix Angelicae Sinensis,Rehmannia Dride Rhizome,Gypsum Fibrosum,Ramulus Mori, Cornu Saigae Tataricae,Caulis Lonicerae.
5.The syndrome of Phlegm -water pathogen has the feature:slippery pulse, dizzy vertigo,vomiting and nausea,lt can be managed by eliminating phlegm, depriving the evil wetness.The extensional herbs used mostly are Pericarpium Citri Reticulatae,Poria,Rhizoma Pinelliae,Radix Angelicae Sinensis,Radix Scutellariae,Cortex Phellodendri,Rhizoma Atracylodis,Rhizomza Seu Radix Notopterygii,Radix Clematidis,Flos Carthami.
6.The syndrome of dampness-heat has the feature:heat,redness,swelling, heaviness and pain of the arthrosis,lt can be managed by excreting dampness and cooling heat.The extensional herbs used mostly are Sinomenium Acutum, Ramulus Mori,Semen Coicis,Rhizoma Dioscoreae Septemlobae,Poria,Gypsum Fibrosum,Radix Gentianae Macrophyllae,Ramulus Cinnamomi,Radix Angelicae Pubescentis.
7.The syndrome Of nutrient QI and blood asthenia has the feature: tendon and vessel contracture,unfavourable flexion and extension with thin pulse.It can be managed by nourishing blood to stop wind,eliminating wind and activating collaterals.The extensional herbs used mostly are Radix Angelicae Sinensis,Raidix Paeoniae Alba,Radix Gentianae Macrophyllae, Rehmannia Pride Rhizome,Ramulus Mori,Cortex Eucommiae,Herba Taxilli,Fructus Tribuli.
8.The syndrome of yang asthenia has the feature:arthrosis crymodynia, chilly with minute or sunken,slow pulse.It can be managed by warming through and reinforcing fire from water.The extensional herbs used mostly are Radix Aconiti Lateralis Preparata,Ramulus Cinnamomi,Rhizoma Atractylodis Macrocephalae,Radix Rehmanniae Preparata,Poria,Cortex Eucommiae,Radix Glycytthizae,Cornu Cervi Pantotrichum、Fructus Lycii、Rhizoma Cibotii、Radix Angelicae Sinensis.
9.The syndrome of QI-blood asthenia has the feature:after perspiration or childbirth,or physically weak,or invalidism with thin-weak pulse.It can be managed by replenishing qi and blood.The extensional herbs used mostly are Radix Angelicae Sinensis、Radix Astragali、Radix Ginseng、Rhizoma Atractylodis Macrocephalae、Raidix Saposhnikoviae.
10.The syndrome of liver-Kidney asthenia has the feature:waist,leg, knee or foot ache and arthrentasis.It can be managed by tonifying essence, filling marrow,strengthening bone and musculature.The extensional herbs used mostly are Radix Angelicae Sinensis,Cortex Eucommiae,Cornu Cervi Pantotrichum,Poria,Radix Rehmanniae Preparata,Semen Cuscutae,Fructus Lycii, Fructus Psoraleae.
11.The syndrome of qi stagnation has the feature of taut pulse and hypochondrium distending pain.It can be managed by dispersing the depressed liver-energy and regulating qi.The extensional herbs used mostly are Radix Angelicae Sinensis,Pericarpium Citri Reticulatae,Rhizoma Cyperi,Rhizoma Corydalis、Olibanum、Raidix Paeoniae Alba、Flos Carthami.
12.The syndrome of blood stasis has the feature of the waist pricking pain with immobility,lt can be managed by purgation.The extensional herbs used mostly are Semen Persicae、Radix Et Rhizoma Rhei、Radix Glycytthizae、Radix Aconiti Lateralis Preparata、Ramulus Cinnamomi、Radix Angelicae Sinensis、Squama Manitis、Cortex Cinnamomi.
13.The syndrome of deficient body fluid has the feature:painful body unable to move around、convulsive limbs、dry mouth、restlessness.lt can be managed by nourishing Yangming.The extensional herbs used mostly are Radix Polygoni Multiflori、Rehmannia Dride Rhizome、Radix Gentianae Macrophyllae、Radix Scutellariae、Fructus Aurantii Immaturus、Radix Platycodi、Poria、Herba Dendrobii、Radix Glycytthizae.
Conclusion:
1.Differentiating and analysing the concept of arthralgia syndrome
Most of the physicians in the Ming-Qing Dynasty thought "bi" meant qi and blood of viscera and meridians with impatency and stagnation resulted from exogenous pathogen invading the body.
2.Investigating the etiopathogenisis and pathogenesis
(1)Emphasizing pathogenic heat、pathogenic summer-heat.
(2)Emphasizing special rank of blood and body fluid.
(3)Thinking highly of liver-Kidney asthenia.
(4)Emphasizing phlegm and stasis.
3.Hunting the rule in differentiation of symptoms and signs.
(1)Paying attention to body constitution.
(2)Geting the message:neopathy or invalidism.
(3)Distinguishing order of importance and urgency.
(4)Paying attention to the position of disease.
①Superior or inferior part on body surface
②Deep or superficial part of pathogen
③Part of triple warmer
④Wei Qi Ying Xue
⑤Presence of meridian and vessels or collaterals
(5)Grasp the feature of the syndrome
4.Hunting the rule of cure
(1)Eliminating warm pathogen
①Excreting dampness and cooling heat
②Decreasing
(2)Cultivating the middle-JIAO with sweet-warm to benefit being postnatal
(3)Tonifying essence filling marrow and nourishing by flesh and blood with sentiment to enrich the innateness
(4)Zhi Feng Xian Zhi Xue,Xue Xing Feng Zi Mie
①Nourishing the blood
②Warming yang and promoting blood flow
③Promoting qi to activate blood
④Promoting blood flow and removing blood stasis
⑤Benefiting blood(body fluid)and stopping endogenous wind
(5)Cure from meridian
①Cure from ST:announcing through and cooling-relieving therapy; tonification
②Taking LU alone for various arthralgia syndromes
③Cure from eight extra meridians:distinguishing excess and deficiency, emphasizing communicating collaterals:benefiting liver-Kidney;the key point is coordinati.on between QI and blood
④Pathogen usually intruding into collateral in protracted disease: communicating collaterals is the principle of curing collaterals-disease: cure differentiation of excess and deficiency;guarding gastric qi;laying stress on phlegm and stasis
(6)Heterozygosis cure
一、研究目的
本研究旨在对治痹医案运用SPSS软件包进行频数分析,同时对明清主要医家、医著中与痹病相关的文献资料进行搜集、整理、归纳、分析、评价,结合文献研究与医案研究,对明清医家的痹病证治规律进行探讨,以便将其结果指导中医临床,并为今后的研究奠定基础。
二、研究方法
查阅来自于湖南电子音像出版社出版的第三版电子版《中华医典》,使用《中华医典》软件中的检索功能。其中符合收录标准的有318例。采用统计软件包SPSS软件12.0进行数据管理和统计分析。对所有药物的使用频次进行统计。
三、研究结果
(一)虚实证型统计结果
318例治痹医案实证为主证型占63.21%,虚证为主证型占36.79%。实证中以风寒湿型、湿热型的比例最大,分别占全部医案总数的25.47%、15.72%。虚证则以营血虚、肝肾亏虚、气血亏虚为最多,分别占全部医案总数的11.00%、10.69%、9.12%。318例治痹医案中当归、茯苓、桂枝、秦艽、桑枝、防己、防风、薏苡仁等药物使用频次最高。
(二)方药的类别分析
对所有318首方剂中的用药进行频次统计,涉及药物267味。总药次计3129次。祛风湿药、利水渗湿药、补血药、活血化瘀药、解表药、补气药、清热药所占比例较大。58味高频次药性昧归经分析如下:苦昧所占比例最大,其次为甘味、辛味。性以温热最多,其次为寒、微寒,再次为平。其药物归经虽涉及全身脏腑,但以肝、肾、脾经为最多。
(三)证型特点及用药
1.风寒湿型痹病以疼痛游走、疼痛剧烈、重着为特点,可用祛风散寒除湿法进行治疗。当归、桂枝、茯苓、防己、防风、秦艽、桑枝、独活等药物的使用频次最高。
2.暑湿型痹病以身重痛而热、心烦口渴为特点,可用轻清淡渗法进行治疗。薏苡仁、防己、陈皮、杏仁、通草、防风、竹叶、桑枝、扁豆叶等药物的使用频次最高。
3.热痹以红肿热痛、痛暴而猛为特点,可用清热法进行治疗。栀子、丹皮、当归、生地、石膏、桑枝、羚羊角、忍冬藤等药物的使用频次最高。
4.痰饮型痹以脉滑、眩冒呕恶为特点,可用祛痰燥湿兼理气法进行治疗。陈皮、茯苓、半夏、当归、黄芩、黄柏、苍术、羌活、威灵仙、红花等药物的使用频次最高。
5.湿热痹以关节灼热肿痛、疼痛而重为特点,可用渗湿清热法进行治疗。防己、桑枝、薏苡仁、萆薢、茯苓、石膏、秦艽、桂枝、独活等药物的使用频次最高。
6.营血亏虚型以筋脉拘挛、屈伸不利、脉细为特点,可用养血熄风、祛风活络法进行治疗。当归、白芍、秦艽、生地、桑枝、杜仲、桑寄生、白蒺藜等药物的使用频次最高。
7。阳虚型以关节冷痛、畏寒、脉微或沉迟为特点,可用温通法、水中补火法进行治疗。附子、桂枝、白术、熟地、茯苓、杜仲、甘草、鹿茸、枸杞、狗脊、当归等药物的使用频次最高。
8.气血亏虚型以汗后或产后,或体弱、久病身痛,脉细弱为主要特点,可用补益气血佐祛风法进行治疗。当归、黄芪、人参、白术、防风等药物的使用频次最高。
9.肝肾亏虚型以腰膂腿膝足等处疼痛、关节变形挛痛、尺脉细为特点,可用益精填髓、强壮筋骨法进行治疗。当归、杜仲、鹿茸、茯苓、熟地、菟丝子、枸杞、补骨脂等药物的使用频次最高。
10.气滞型以脉弦、胁肋胀痛为特点,可用疏肝理气法进行治疗。当归、陈皮、香附、延胡索、乳香、白芍、红花等药物的使用频次最高。
11.瘀血型以腰部刺痛固定,脉涩或芤为特点,可用下瘀血法进行治疗。桃仁、大黄、甘草、附子、桂枝、当归、穿山甲、肉桂等药物的使用频次最高。
12.津亏型以身痛不能转侧、手足瘛疭、口干躁烦为特点,可用滋阳明法进行治疗。生首乌、生地、秦艽、黄芩、枳实、桔梗、茯苓、石斛、甘草等药物的使用频次最高。
四、结论
结合文献研究与医案研究,总结出明清医家痹病证治规律如下:
(一)辨析痹病概念
1.痹的含义
大部分明清医家都认为“痹”是指外邪侵袭机体,脏腑经脉气血闭阻不通的病理机制。
2.痹病病名
风痹即行痹,其痛行走不定,又称为“流火”、“走注”、“鬼箭”,亦有医家称为“痛风”、“历节风”。寒痹即痛痹,许多医家亦称之为“痛风”、“历节风”、“白虎历节风”。湿痹即着痹,其痛着而不移,许多医家(如尤在泾、李用粹等)认为亦包括麻木不仁。
(二)对痹病病因病机的探讨,主要包括强调热邪、暑邪、痰瘀致痹、重视阴血在痹病中的特殊地位、重视肝肾亏虚致痹。
(三)探求辨证规律,探求辨证规律,包括注重患者体质、了解新病久病、区分轻重缓急、辨寒热虚实、注意患病部位。其中,注意患病部位包括体表上下部位、病邪深浅部位、三焦部位、卫气营血、在经与在络。
(四)探求治疗规律
1.祛温邪,独树一帜
(1)渗湿清热法
(2)泄法(包括清热泻火、清热凉血等)
2.甘温培中,补益后天
3.益精填髓、血肉有情以实先天
4.治风先治血,血行风自灭。包括养血补血、温阳活血、行气活血、活血化瘀、养血(阴)熄风。
5.重视从经络论治
(1)善从阳明论治。包括宣通清解法与补益法。
(2)诸痹独取太阴
(3)奇脉论治。包括治分虚实、强调通络、补益肝肾、务在气血调和。
(4)久病入络的治疗。包括“通络”是治疗络病的总原则、虚实异治、治络须护胃气、重在痰瘀。
6.引经药的使用
Background
Arthralgia Syndrome is one of the difficult and complicated diseases. Traditional Chinese Medicine have obvious,advantages in its prevention and cure.The experiments of curing Arthralgia Syndrome by the physicians of the Ming-Qing Dynasty are practical and effective.They also have influences in the curing methods of Arthralgia Syndrome to the physicians of later ages.But the research about.this area focus a few physicians of Ming-Qing Dinasty.So the experiments treating Arthralgia Syndrome by the physicians of Ming-Qing Dynasty are studied not widely and deeply enough.We should pay more attention to the other physicians of the Ming-Qing Dynasty.Their experiments about Arthralgia Syndrome are worth excavating deeper and arranging better.
Purpose
This subject will study the documents and materials about Arthralgia Syndrome written by the major physicians of the Ming-Qing Dynasty by collecting, arranging,analyzing,concluding and appraising.And it will take statistics from the medicine cases about Arthralgia Syndrome written by the physicians of the Ming-Qing Dynasty.The pattern how the physicians of the Ming-Qing Dynasty understood and treated Arthralgia Syndrome will be hoped to get from all the work.The result of this research will be used in guiding the clinical work of TCM.It may raise the effect of the treatment of Arthralgia Syndrome.
Method
Some medicine cases about Arthralgia Syndrome written by the physicians of the Ming-Qing Dynasty will be analyzed and imported into data base.The syndromes and using of herbs will be analyzed through mathematics and physics statistical methods.Then,physicians' original views and treatments about Arthralgia Syndrome in the Ming-Qing Dynasty will be collected,arranged.At last,combining the.literature research and medical case research,the rule of the treatment based on Syndrome differentiation to Arthralgia Syndrome of the Ming-Qing Dynasty will be analyzed,concluded and appraised.
Result
1.12 kinds of syndromes is divided from 318 cases about Arthralgia Syndrome of the Ming-Qing Dynasty,and the syndrome of wind-cold-dampness and dampness-heat is used mostly often.Deficiency syndrome takes 36.79%in 318 cases about Arthralgia Syndrome of the Ming-Qing Dynasty while excess syndrome which takes 63.21%.The extensional herbs used mostly are Radix Angelieae Sinensis,Poria,Ramulus Cinnamomi,Radix Gentianae Macrophyllae,Ramulus Mori, Sinomenium Acutum,Raidix Saposhnikoviae,Semen Coicis.
2.The syndrome of wind-cold-dampness has the feature:ache transmigration, severe ache,heaviness-immobility,lt can be managed by expelling wind, removing cold and dispelling dampness.The extensional herbs used mostly are Radix Angelicae Sinensis,Ramulus Cinnamomi,Poria,Sinomenium Acutum,Raidix Saposhnikoviae,Radix Oentianae Macrophyllae,Ramulus Mori,Radix Angelicae Pubescentis.
3.The syndrome of summer hygrosis has the feature:heat,heaviness and pain.of the body,feeling upset and thirsty.It can be managed by light clearing and leaking.The extensional herbs used mostly are Semen Coicis Sinomenium Acutum PericarDium Citri Reticulatae Semen Armeniacae Amarum,Medulla Tetrapanacis,Raidix Saposhnikoviae,Henon Bamboo Leaf,Ramulus Mori,Hyacinth Dolichos Leaf.
4.The syndrome of heat has the feature of heat,redness,swelling and pain of the arthrosis,sudden and violent ache.lt can be managed by cooling heat.The extensional herbs used mostly are Fruetus Gardeniae、Cortex Moutan,Radix Angelicae Sinensis,Rehmannia Dride Rhizome,Gypsum Fibrosum,Ramulus Mori, Cornu Saigae Tataricae,Caulis Lonicerae.
5.The syndrome of Phlegm -water pathogen has the feature:slippery pulse, dizzy vertigo,vomiting and nausea,lt can be managed by eliminating phlegm, depriving the evil wetness.The extensional herbs used mostly are Pericarpium Citri Reticulatae,Poria,Rhizoma Pinelliae,Radix Angelicae Sinensis,Radix Scutellariae,Cortex Phellodendri,Rhizoma Atracylodis,Rhizomza Seu Radix Notopterygii,Radix Clematidis,Flos Carthami.
6.The syndrome of dampness-heat has the feature:heat,redness,swelling, heaviness and pain of the arthrosis,lt can be managed by excreting dampness and cooling heat.The extensional herbs used mostly are Sinomenium Acutum, Ramulus Mori,Semen Coicis,Rhizoma Dioscoreae Septemlobae,Poria,Gypsum Fibrosum,Radix Gentianae Macrophyllae,Ramulus Cinnamomi,Radix Angelicae Pubescentis.
7.The syndrome Of nutrient QI and blood asthenia has the feature: tendon and vessel contracture,unfavourable flexion and extension with thin pulse.It can be managed by nourishing blood to stop wind,eliminating wind and activating collaterals.The extensional herbs used mostly are Radix Angelicae Sinensis,Raidix Paeoniae Alba,Radix Gentianae Macrophyllae, Rehmannia Pride Rhizome,Ramulus Mori,Cortex Eucommiae,Herba Taxilli,Fructus Tribuli.
8.The syndrome of yang asthenia has the feature:arthrosis crymodynia, chilly with minute or sunken,slow pulse.It can be managed by warming through and reinforcing fire from water.The extensional herbs used mostly are Radix Aconiti Lateralis Preparata,Ramulus Cinnamomi,Rhizoma Atractylodis Macrocephalae,Radix Rehmanniae Preparata,Poria,Cortex Eucommiae,Radix Glycytthizae,Cornu Cervi Pantotrichum、Fructus Lycii、Rhizoma Cibotii、Radix Angelicae Sinensis.
9.The syndrome of QI-blood asthenia has the feature:after perspiration or childbirth,or physically weak,or invalidism with thin-weak pulse.It can be managed by replenishing qi and blood.The extensional herbs used mostly are Radix Angelicae Sinensis、Radix Astragali、Radix Ginseng、Rhizoma Atractylodis Macrocephalae、Raidix Saposhnikoviae.
10.The syndrome of liver-Kidney asthenia has the feature:waist,leg, knee or foot ache and arthrentasis.It can be managed by tonifying essence, filling marrow,strengthening bone and musculature.The extensional herbs used mostly are Radix Angelicae Sinensis,Cortex Eucommiae,Cornu Cervi Pantotrichum,Poria,Radix Rehmanniae Preparata,Semen Cuscutae,Fructus Lycii, Fructus Psoraleae.
11.The syndrome of qi stagnation has the feature of taut pulse and hypochondrium distending pain.It can be managed by dispersing the depressed liver-energy and regulating qi.The extensional herbs used mostly are Radix Angelicae Sinensis,Pericarpium Citri Reticulatae,Rhizoma Cyperi,Rhizoma Corydalis、Olibanum、Raidix Paeoniae Alba、Flos Carthami.
12.The syndrome of blood stasis has the feature of the waist pricking pain with immobility,lt can be managed by purgation.The extensional herbs used mostly are Semen Persicae、Radix Et Rhizoma Rhei、Radix Glycytthizae、Radix Aconiti Lateralis Preparata、Ramulus Cinnamomi、Radix Angelicae Sinensis、Squama Manitis、Cortex Cinnamomi.
13.The syndrome of deficient body fluid has the feature:painful body unable to move around、convulsive limbs、dry mouth、restlessness.lt can be managed by nourishing Yangming.The extensional herbs used mostly are Radix Polygoni Multiflori、Rehmannia Dride Rhizome、Radix Gentianae Macrophyllae、Radix Scutellariae、Fructus Aurantii Immaturus、Radix Platycodi、Poria、Herba Dendrobii、Radix Glycytthizae.
Conclusion:
1.Differentiating and analysing the concept of arthralgia syndrome
Most of the physicians in the Ming-Qing Dynasty thought "bi" meant qi and blood of viscera and meridians with impatency and stagnation resulted from exogenous pathogen invading the body.
2.Investigating the etiopathogenisis and pathogenesis
(1)Emphasizing pathogenic heat、pathogenic summer-heat.
(2)Emphasizing special rank of blood and body fluid.
(3)Thinking highly of liver-Kidney asthenia.
(4)Emphasizing phlegm and stasis.
3.Hunting the rule in differentiation of symptoms and signs.
(1)Paying attention to body constitution.
(2)Geting the message:neopathy or invalidism.
(3)Distinguishing order of importance and urgency.
(4)Paying attention to the position of disease.
①Superior or inferior part on body surface
②Deep or superficial part of pathogen
③Part of triple warmer
④Wei Qi Ying Xue
⑤Presence of meridian and vessels or collaterals
(5)Grasp the feature of the syndrome
4.Hunting the rule of cure
(1)Eliminating warm pathogen
①Excreting dampness and cooling heat
②Decreasing
(2)Cultivating the middle-JIAO with sweet-warm to benefit being postnatal
(3)Tonifying essence filling marrow and nourishing by flesh and blood with sentiment to enrich the innateness
(4)Zhi Feng Xian Zhi Xue,Xue Xing Feng Zi Mie
①Nourishing the blood
②Warming yang and promoting blood flow
③Promoting qi to activate blood
④Promoting blood flow and removing blood stasis
⑤Benefiting blood(body fluid)and stopping endogenous wind
(5)Cure from meridian
①Cure from ST:announcing through and cooling-relieving therapy; tonification
②Taking LU alone for various arthralgia syndromes
③Cure from eight extra meridians:distinguishing excess and deficiency, emphasizing communicating collaterals:benefiting liver-Kidney;the key point is coordinati.on between QI and blood
④Pathogen usually intruding into collateral in protracted disease: communicating collaterals is the principle of curing collaterals-disease: cure differentiation of excess and deficiency;guarding gastric qi;laying stress on phlegm and stasis
(6)Heterozygosis cure
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