Chapter 7: Clinical Chinese Medicine Western medicine became the dominant medicine after its introduction into China, and the identification of medical errors is based on Western medicine as the standard, therefore, the medical practice of Chinese physicians is required to be based on Western medical diagnosis and treatment, supplemented by Chinese medicine. If readers find that the contents of this book differ from the textbook, the textbook must prevail. After the western medical consultation and treatment is completed, the knowledge in this book will be used to assist the treatment. Zhang Denghua, Hyperbaric Oxygen Therapy Center, Affiliated Hospital of Inner Mongolia Medical University The form of the catalog of the Western medical book is: eight systems as the outline, organs as subheadings, syndromes or diseases as secondary subheadings. In this book, the catalog is prepared by combining the Chinese medicine’s internal organs dialectic and the Western medicine catalog, i.e., the eight systems of Western medicine as the outline, and the “evidence” as the subheading. The “evidence” in this book is equivalent to the status of a disease or syndrome in Western medicine. Section 1: Chinese medicine’s understanding of fever 1: Epidemics and plagues The Su Wen – Treatise on the Method of Stabbing says: “When the five epidemics arrive, they all infect each other, regardless of their size.” About five infectious diseases begin to be prevalent from person to person, and can affect rich and poor, adults and children alike. The Treatise on Pestilence says: “Pestilence is a disease that is not wind, not cold, not summer, not humidity, but a different kind of gas in heaven and earth.” The cause of plague is not wind, cold, heat, or dampness, but another substance called “foreign gas” that can infect the human body and exists in nature. “Epidemic” is also known as epidemic, and because of the fever, it is also called plague and pestilence, which have obvious epidemic and infectious characteristics. The “foreign gas” is the disease-causing microorganism that later became known in Western medicine. The contagiousness of chronic infectious diseases was not easily detected and therefore discovered late; for example, the contagiousness of tuberculosis was discovered only about 100 years ago; and the contagiousness of AIDS was discovered only in the 1980s; therefore, the plague referred to here in Chinese medicine refers to virulent infectious diseases. 2 Chinese medicine had cited cold as the cause of the disease When the body loses too much heat under normal circumstances, chills and chills will occur. During the period of rising body temperature in acute fever, symptoms of fear of cold and chills can also occur, but early Chinese medicine believed that the causes of both were the same, so cold evil also became the cause of fever in Chinese medicine. The Nei Jing classifies fever as “typhoid” and advocates the use of pungent and warm medicines to disperse the cold. 3 The concept of typhoid fever The Su Wen – Treatise on Fever says: “If a person is injured by cold, he is suffering from fever.” “Nowadays, all those who suffer from fever are like typhoid.” If the human body is attacked by cold, it will suffer from febrile diseases. Nowadays, febrile illnesses are caused by the invasion of cold into the body, and they belong to the “typhoid” category of illnesses. Cold is the cause of febrile diseases. Feverish diseases are classified as such. The Book of Difficulties – 58th Difficulty says: “There are five types of typhoid fever: stroke, typhoid fever, damp fever, fever, and warm fever.” The broad typhoid evidence is divided into five categories: stroke evidence, narrow typhoid evidence, damp-temperate evidence, fever, and warm disease. Clinically, diseases with fever symptoms account for about half of all diseases and are classified as a separate category in Chinese medicine. The clinical manifestations of fever are more comprehensively described in the Nei Jing than in the Nei Jing: according to the characteristics of the disease, they are classified as wind, damp, hot and warm, and are also considered to be caused by “injury due to cold”. The narrow sense of typhoid refers to the appearance of the disease of fear of cold, the narrow sense of typhoid in Chinese medicine is broader than the western typhoid disease, which refers to the performance of typhoid bacillus infection of the human body. The broad sense of typhoid mainly includes infectious diseases in Western medicine, followed by non-infectious diseases, for example, rheumatic fever. By the Ming and Qing dynasties, Chinese medicine discovered that people who did not suffer from cold could also suffer from febrile diseases, and that fever symptoms were not necessarily accompanied by fear of cold, so the name typhoid was abandoned and replaced by warm disease. Feverish diseases are referred to as “feverish diseases”. In terms of the human body, an increase in body temperature is considered by Chinese medicine to be caused by the excessive action of “fire” in the body, and this “fire” is called heat. These symptoms are accompanied by flushing of the face, deep and rapid breathing, red tongue, thick tongue coating, yellow coating, rapid pulse, local redness, swelling and pain, etc. These symptoms are called “heat signs” in Chinese medicine. Self-sensory fever is a normal body temperature, but the patient feels hot, such as hot flashes in menopausal syndrome, and hot palms in plant nerve disorders. 5 Summer dampness is characterized by thin stools containing a lot of water, and therefore belongs to the “dampness” in Chinese medicine. Diseases like dysentery, with fever, often occur in the summer season, so Chinese medicine calls it “summer dampness” and considers the climate itself to be the cause of the disease, while Western medicine considers these diseases to be related to the season, but not the cause of the disease, but the bacteria like dysentery bacillus. 6 The six meridians are recognized in Chinese medicine in a similar way to the eight systems of the human body in Western medicine. When they are attacked by external evil, the corresponding clinical manifestations appear in the parts of the disease that follow their course. As in Western medicine, TCM adds the name of the diseased tissue to the name of the diagnosis: in the six meridians of TCM, the tissue structure where the disease occurs is the six meridians; this method of classifying diseases in TCM is similar to that of Western internal medicine. The order of transmission in the Internal Canon is based on the six elements of the calendar: Sun → Yangming → Shaoyang → Taiyin → Shaoyin → Conjunctive Yin. The order of transmission is from outside to inside, that is, from Yang to Yin. Chinese medicine believes that the rate of transmission is synchronized with astronomical phenomena, and that one meridian changes every day in this order. The “Su Wen – heat theory” said: “Typhoid fever one day, the giant Yang received, so the head and neck pain, waist and spine strong; two days, Yang Ming received, Yang Ming main flesh, the pulse of the nose, contact in the eyes, so the body heat, eye pain and nose dry, can not sleep. On the third day, Shaoyang is affected by the, Shaoyang is the main gallbladder, its pulse follows the wakefulness, complex in the ear, so the chest and deafness, …… four days, Taiyin is affected by the, Taiyin pulse in the stomach, complex in the quarrel, so the abdomen full and quarrel dry. On the fifth day, Shao-Yin is affected by the Shao-Yin pulse through the kidneys, complex in the lungs, the tongue, so the mouth is dry and dry tongue and thirst. On the sixth day, the Turk’s Yin is affected by it, and the Turk’s Yin vein follows the Yin apparatus and is connected to the liver, so it is annoying and full and the sac is shrunken.” On the first day of cold invasion, the foot solar bladder meridian is invaded, with pain in the head and lumbar spine; on the second day, the foot yangming stomach meridian is involved, which controls the growth of muscles and travels through the nose and eyes, resulting in generalized fever, eye pain and nasal dryness, and inability to sleep; on the third day, the foot shaoyang gallbladder meridian is involved, which controls the growth and functional activity of the gallbladder and travels through the lateral chest and around the ears, resulting in chest pain and deafness On the fourth day, the foot Taiyin Spleen meridian is involved, which travels through the stomach and throat, resulting in abdominal fullness and dry throat; on the fifth day, the foot Shaoyin Kidney meridian is involved, which travels through the kidneys, lungs and tongue root, resulting in dry mouth and thirst. On the sixth day, the Foot Conjunctive Yin Liver meridian is involved, which travels through the genitals and the liver, hence the symptoms of irritability, abdominal fullness and scrotal tightness. The main elements of the theory of identification of the six meridians of the Nei Jing are described in the “Table of Identification of the Six Meridians of the Nei Jing”: Table of Identification of the Six Meridians of the Nei Jing Meridians of the Nei Jing Meridians of the Nei Jing Sun Head and neck pain, lumbar spine straightening Yang Ming Fever, eye pain, dry nose, insomnia Shao Yang Chest pain, hypochondriacal pain, deafness Tai Yin Abdominal distension, quarrelsome dryness Shao Yin Dry mouth, dry tongue and thirst Jurgyin Irritability, abdominal distension, scrotal pain The main contents of the Treatise on Typhoid are described in the Table of the Six Meridians of the Treatise on Typhoid: Table of the Six Meridians of the Treatise on Typhoid Lesions Meridians Main clinical manifestations Sun Typhoid Fever Fear of cold, mild fever, generalized pain, shortness of breath. Stroke Excessive sweating, fear of wind, mild chilliness, moderate fever, headache. Yangming Jing Evidence High fever, profuse sweating, marked thirst, fear of heat, flushed face, irritability, yellow dry tongue coating, and flooded pulse. Internal organs evidence Fever, persistent sweating, constipation, abdominal distension, abdominal pain and refusal to press, yellowish stain, solid pulse. Shao Yang Cold and heat (flaccid fever or periodic fever), distension and pain in the chest and hypochondrium, bitter mouth, dry throat, dizziness, and dizziness, with a string pulse. Taiyin Abdominal distension, vomiting, abdominal discharge, mild chronic abdominal pain, with a tendency to press, yellowish tinge, pale tongue, white fur, sluggish pulse. Shao-Yin Cold transformation Fear of cold, weakness, cold hands and feet, diarrhea, no thirst in the mouth. Heat transformation Irritability, insomnia, dry mouth and throat, yellow urine, purple-red tongue, dryness, little moss, fine pulse. Foot Conjunctive Yin Fear of cold, hunger without desire to eat, vomiting after eating, vomiting roundworms. 7 Identification of Wei-Qi and Ying-Blood The Internal Classic and the Treatise on Typhoid considered the site of fever to be the six meridians. In fact, fever is systemic and is not limited to the areas where the meridians flow. According to Ye Tianshi of the Qing Dynasty, the fever should be in the tissues of the whole body, i.e., “Wei Qi and Ying Blood”, and Qi refers to Rong Qi. It was also believed that the external evil causing the disease was mainly warm evil, and the name of the disease was changed from “typhoid fever” to “warm disease”. In addition, the order of transmission is inferred from the results of observation, which is also different from before. The Wei-Qi-Ying-Blood method is to divide the total course of febrile diseases into four stages. Each stage is called a “division”, and the four stages are called Wei, Qi, Ying and Blood divisions. It is also believed that the pathway for heat to invade the body is generally from the outside to the inside, i.e., Wei Branch → Qi Branch → Ying Branch → Blood Branch. For the main contents, please refer to the “Table for Identification of Wei-Qi and Ying-Blood”: Wei-Qi and Ying-Blood Identification Table Lesion site Main clinical manifestations Wei Fever, fear of cold, fear of wind, thirst, cough. Qi Lung Fever, cough, shortness of breath, thirst, yellow fur. Chest and diaphragm Fever, irritability, yellow fur. Stomach High fever, thirst, excessive sweating, shortness of breath, red-yellow urine, yellowish stain, yellow dry moss, large pulse. Large intestine Low fever, constipation, diarrhea, abdominal pain, abdominal distension, excessive sweating, yellow moss, dryness, and a sunken solid pulse. Bile Flaccid fever or periodic fever, bitterness in the mouth, pain in the quarter ribs, abdominal distension, nausea, yellow, slightly greasy moss, and a subtle pulse. Spleen Low fever, abdominal distension, nausea, weakness, greasy moss, moist pulse. Continued Table Lesion site Main clinical manifestations Camp Nocturnal fever, incipient rash, restlessness, insomnia, delirium, red tongue, thin pulse. Blood Bleeding tendency, marked rash, restlessness, coma. Conclusion: The above 3 tables are not 3 different dialectical methods. For example, the “Wei-Qi-Ying-Blood Dialectical Table” is a development and refinement of the first two tables. In Chinese medicine theory, some people also think that the tissue of fever is Sanjiao. However, here the concept of San Jiao is referred to by the internal organs: the upper jiao refers to the lung, heart and pericardium; the middle jiao refers to the stomach, large intestine and spleen; and the lower jiao refers to the kidney, liver and bladder. For the identification of the three jiao, see the table of identification of the three jiao: Table of identification of the three jiao Location of lesions Main clinical manifestations Upper jiao Lung Wei Mild fever, fear of cold, headache, thirst, cough, white fur, floating pulse. Lung Qi Fever, fear of wind, mild chilliness, thirst, cough, asthma, yellow fur, pulse count. Pericardium Coma, delirium (unable to respond), cold extremities, red-red tongue. Middle Jiao Stomach High fever, fear of heat, thirst, shortness of breath, yellowish tinge, flushed face, congested conjunctiva or sclera, yellow dry moss, pulse is torrential. Large intestine Low fever, excessive sweating, constipation, discomfort in urination, yellow and black moss, burning and dryness. Spleen Low fever, chest tightness, abdominal distension, nausea, vomiting, weakness, yellowish tinge. Lower Jiao Kidney Heat in the hands and feet, fever, red face, dry mouth and throat, deficient pulse. Liver Cold extremities, pronounced intestinal tinnitus, writhing hands and feet. Summary: The above four tables are a summary of the common patterns of febrile diseases in Chinese medicine and are segmented in what is called the natural order in Chinese medicine. Each of the horizontal cells on the right is a group of clinical manifestations, and each group of manifestations has a certain degree of correlation with each other, which is called “a certain certificate” in TCM, similar to a syndrome in Western medicine. For this reason, the following is only a partial list of the eight syndromes: 9 The eight syndromes include superficial, internal, cold, heat, deficiency, actual, yin and yang, and are used to recognize, analyze and classify diseases. 9.1 Superficial evidence 9.2 Internal evidence 9.3 Cold evidence 9.4 Heat evidence Section 2 Clinical manifestations of fever 1 Superficial cold evidence 2 Superficial deficiency evidence 3 Qi fever evidence 4 High fever 5 Correspondence between cold and fever 6 Deficiency fever 7 Congestive rash 8 Hemorrhagic rash Section 3 Throat and respiratory diseases 1 Sore throat