| Background:Zhi-Yin is an important part of Synopsis of the Golden Chamber,however,at present,there are few literatures focusing on the occurrence,development and evolution of Zhi-Yin disease,the interpretation of Zhi-Yin prescriptions are isolated from each other,and there are few discussions involving the internal relationship between various clauses.From the perspective of Zhang Zhongjing’s clinical diagnosis and treatment decision-making model of "DiseasePulse-Syndrome combined Treatment",this study mainly explores the experience of Zhang Zhongjing on the diagnosis and treatment of Zhi-Yin disease.Objective:Chapter Ⅰ:This part discusses the connotation of Zhang Zhongjing’s clinical diagnosis and treatment decision-making model,which is "Disease-Pulse-Syndrome combined Treatment"based on hierarchical classification and evidence-based reasoning.Chapter Ⅱ:Research on the meaning of the disease name of Zhi-Yin,this part clarifies the disease category of Zhi-Yin in Synopsis of the Golden Chamber,and tries to interpret it with modern related theories.Chapter Ⅲ:From the perspective of philology and linguistics,this part investigates and clarifies the original meaning of Zhang Zhongjing’s prescription for the treatment of Zhi-Yin.Sorts out the annotations and changes of later generations of doctors.At the same time,a reasonable modern interpretation of Zhi-Yin prescriptions is proposed.Chapter Ⅳ:To explore the outline of diagnosis and treatment of Zhi-Yin from the perspective of clinical application.Methods:Chapter Ⅰ:Based on the original records of Zhang Zhongjing’s writings,following the decision-making process of "differentiates the disease→ analyzes the pulse→ analyzes the syndrome→determines the treatment",this part tries to explore the connotation of Zhang Zhongjing’s clinical diagnosis and treatment decision-making model of "Disease-PulseSyndrome combined Treatment",and analyzes in combination with specific clauses.Chapter Ⅱ:From the perspective of philology,this part tries to discusse the disease category of Zhi Yin in Synopsis of the Golden Chamber under the guidance of Zhang Zhongjing’s diagnosis and treatment decision-making model of "Disease-Pulse-Syndrome combined Treatment". Then,the disease connotation of Zhi-Yin from the perspective of chronic pulmonary heart disease in modern medicine is interpreted.Chapter Ⅲ:This part tries to make textual research on the original meaning of Zhang Zhongjing’s prescriptions of Zhi-Yin and study its later evolution,the specific methods include:Version collation:Based on the Deng Zhen’edition,this article compares with the other five vertions that from Wu Qian,Zhao Kaimei,Xu Rong,Yu Qiao and Zhao Yide.At the same time,refers to the different discussions on Zhang Zhongjing’s prescriptions of Zhi-Yin in later classics such as Mai Jing,Bei Ji Jin Yao Fang and Waitai Miyao Fang and so on,and verifies the correctness and error of those with large differences,in order to maximize the approximation of the original appearance.Textual research:According to the relevant corpus of the Qin and Han Dynasties and before,conducts textual research on the meaning of Zhang Zhongjing’s prescription for the treatment of Zhi-Yin,researches literal meanings and corrects unreasonable punctuation in sentences in order to look for the original meaning of Zhang Zhongjing.Analyses of difficult problems:Analyzes the similarities and differences between later annotators on Zhang Zhongjing’s original text,so as to trace back to the origin.Combined with the results of textual research,analyzes some relevant problems such as clauses,prescriptions and herbs.At the same time,under the guidance of Zhang Zhongjing’s diagnosis and treatment decision-making model of "Disease-Pulse-Syndrome combined Treatment",the application experience of Zhang Zhongjing’s prescription of Zhi-Yin is discussed.Chapter Ⅳ:Combined with the research results of Part Ⅰ,Part Ⅱ and Part Ⅲ,this part discusses the diagnosis and treatment outline of Zhi-Yin under the guidance of Zhang Zhongjing’s diagnosis and treatment decision-making mode of "Disease-Pulse-Syndrome combined Treatment".Results:The mean results of Chapter Ⅰ:The "Disease-Pulse-Syndrome combined Treatment" is the unique clinical diagnosis and treatment mode founded by Zhang Zhongjing.In this model,Zhang Zhongjing first differentiated the disease,then on the basis of the disease differentiation(parent classification),he further analyzed the pulse and the syndrome (sub classification),and finally determined the treatment.Not only emphasizes the whole process of clinical diagnosis and treatment,that is,differentiates the disease→analyzes the pulse→analyzes the syndrome→determines the treatment,but it also reflects the complexity of clinical diagnosis and treatment decision-making.Each link is based on evidence-based reasoning:under the premise of disease differentiation,observes the pulse and syndrome,knows what goes wrong,and treats it according to the evidence.The main results of Chapter Ⅱ:The "Zhi" of Zhi-Yin should be interpreted as "support",that is,the fluid retention supports on the chest diaphragm.Zhi-Yin is a kind of disease characterized (the main syndrome) by wheezing,shortness of breath,even unable to lie down and swelling.It is usually accompanied by a history of chronic cough,and can be triggered by external pathogens,the injury of the fluid retention can aggravate the disease,and a variety of complex clinical manifestations (concurrent syndrome) may occur in the process of the disease.At the same time,from the perspective of chronic pulmonary heart disease in modern medicine,the interpretation witch combine with modern clinical medicine of Zhi-Yin’s"Disease-Pulse-Syndrome combined Treatment" of "Synopsis of the Golden Chamber" is made preliminary.The main results of Chapter Ⅲ:1.Mufangji Decoction:The dosage of traditional Chinese medicine Shigao in the prescription Mufangji Decoction is recorded as "twelve pieces,each as big as an egg",which actually means that the plaster of twelve pieces as big as a chicken egg is decocted in water without breaking.This is an example of ancient people "qu xiang yong yao",that is,to use its heavy falling nature to treat the symptoms of wheezing.The "Deficiency" and "Excess" is refers to the disease situation,it implies a tentative treatment:the Deficiency Syndromes should not be treated with purging,however the Excess Syndromes need to use Mangxiao.Among modern diseases,the symptoms of acute exacerbation of chronic pulmonary heart disease (such as wheezing,epigastric discomfort,cyanosis,etc) are similar to those recorded in Mufangji Decoction.2.Zexie Decoction:The dizziness treated by Zexie Decoction is one of the symptoms in the pathogenesis of Zhi-Yin.Among modern diseases,the neuropsychiatric symptoms of acute exacerbation of chronic pulmonary heart disease combined with pulmonary encephalopathy(such as dizziness,headache,etc) are very similar to those recorded in the clauses of Zexie Decoction,and diuresis is the common point in treating this syndrome in Chinese medicine and Western medicine.3.Houpu Dahuang Decoction:Based on the different records of Bei Ji Jin Yao Fang and Waitai Miyao Fang,Houpu Dahuang Decoction’s clauses should have "vomiting blood"symptoms,in addition,the "chest full" should be "belly full".Hopu Daihuang Decoction is aimed at the symptoms of blood vomiting and abdominal fullness,which happenes in the process of Zhi-Yin.Among modern diseases,the symptoms of chronic cor pulmonale complicated with gastrointestinal bleeding during acute exacerbation (such as spitting blood,abdominal distention,etc) are close to those recorded in the clauses of Hopu Dahuang decoction.4.Tingli Dazao Xiefei Decoction:The dosage of Tinglizi in Tingli Dazao Xiefei Decoction is recorded as "as big as a Danwan(bullet for slingshot)",it might has the text lost because of the ages,the dosage can refer to the different description "as big as a Dazao" from Bei Ji Jin Yao Fang.This prescription is used to treat dyspnea during the process of of Zhi-Yin,and the patients themselves may have a history of chronic lung diseases.Among modern diseases,The symptoms of patients with chronic obstructive pulmonary disease in the acute exacerbation stage of chronic pulmonary heart disease (such as wheezing,dyspnea,etc) are similar to those recorded in the clauses of Tingli Dazao Xiefei Decoction.5.Xiaobanxia Decoction/Xiaobanxia plus Fuling Decoction:Xiaobanxia Decoction/Xiaobanxia plus Fuling Decoction can only treat the complications of Zhi-Yin,such as vomiting without thirst,ruffian heart,dizziness,palpitation,etc.Among modern diseases,the symptoms of patients with acute exacerbation of chronic pulmonary heart disease complicated with digestive system reaction or pulmonary encephalopathy (such as nausea,vomiting,epigastric discomfort,dizziness,headache,etc) are close to the records of Xiaobanxia decoction/Xiaobanxia plus Fuling Decoction’s clauses.6.Jijiao Lihuang Wan:Jijiao Lihuang Wan’s intention to make pills is to reduce the drug resistance of Violent,but also take into account the factors of patients with abdominal distention and do not want to drink water.The note at the end of the prescription is described as "there is body fluid in the mouth".After textual research,this article believes that the word "zhi(stop)"is missing in the sentence.The original text should be "there is body fluid in the mouth,stop",that is to say,the body fluid in the mouth is the reaction after the medication takes effect.This prescription is used to treat bdominal distention caused by water during the process of of ZhiYin.In modern diseases,the symptoms of patients with acute exacerbation of chronic pulmonary heart disease complicated with peritoneal effusion (such as dry mouth,abdominal distention,etc)are close to the record of Jijiao Lihuang Wan’s clauses.7.Wuling Power:The "thin people" recorded in Wuling Power’s clauses refers to those who are emaciated because of illness.This prescription is used to treat patients with recurrent attacks of "Zhi-Yin",who are already sick and weak,with moisture spreaded allover.Among modern diseases,the symptoms of patients with acute exacerbation of chronic pulmonary heart disease complicated with abnormal renal function (such as muscle twitch,nausea,vomiting,dizziness,headache,etc) were similar to those recorded by Wuling Power’s clauses.8.Shizao Decoction:Through exegesis,the "cough accompanied by irritability" recorded in Shizao Decoction text should be "cough frequently",which means cough breaks out repeatedly.The prescription is used to treat patients in the late stage of Zhi-Yin,in which"moisture" fills the chest,causing frequent coughing and even chest pain.Among modern diseases,the symptoms of patients with acute exacerbation of chronic pulmonary heart disease complicated with pleural effusion,or even complicated with tuberculous pleurisy due to low immunity (such as cough,chest pain,etc) are similar to those recorded in Shizao Decoction.9.Xiaoqinglong Decoction and the later prescriptions:After research,the records of Xiaoqinglong Decoction and following prescription are the correct treatment for Zhi-Yin,and should not be regarded as the description of the wrong treatment.Here,in the form of a medical case,the whole process of the treatment of Zhi-Yin triggered by external pathogen forces is reproduced,which reflects Zhang Zhongjing’s thought of step-by-step diagnosis and treatment in the differentiation and treatment of difficult diseases.Among modern diseases,patients with chronic pulmonary heart disease aggravated by acute respiratory tract infection and complications of digestive system and nervous system in the course of treatment showed symptoms (such as wheezing,inability to lie flat,nausea,vomiting,dizziness,headache,etc)similar to those recorded in the prescriptions’s clauses after Xiaoqinglong Decoction.The mean results of Chapter Ⅳ:The main diagnostic point of Zhi-Yin are the history of chronic cough,often causes acute exacerbation of the disease due to external pathogens,and the injury of the fluid retention.The typical symptoms are wheezing,inability to lie flat,swelling of limbs or face.It should be clinically differentiated from Fei-Yong,Fei-Zhang and Xiong-Bi;In terms of treatment,the treatment of Zhi-Yin in remission stage is mainly to invigorate the spleen and stomach,reduce phlegm warmly,and the method is Wai Tai Fuling Decoction;In the treatment of acute exacerbation of Zhi-Yin,the main formula should be established first according to the main syndrome.Those who are aggravated by external pathogens should be treated with Xiaoqinglong Decoction to disperse the cold,and person with heavy pathogenic fluid-reteneion should be treated with Mufangji Decoction to promote diuresis and calm asthma.At the same time,corresponding treatment measures should be actively taken for concurrent syndromes,such as those who are dizzy(Zexie Decoction),those who are full of vomiting blood (Houpu Dahuang Decoction),etc.Conclusions and Significance:1.The clinical diagnosis and treatment mode of "Disease-Pulse-Syndrome combined Treatment" is a high summary of Zhang Zhongjing’s clinical diagnosis and treatment process,which embodies Zhang Zhongjing’s diagnosis and treatment principle of "observes the pulse and syndrome,knows what goes wrong,and treats it according to the evidence.",and is a vivid embodiment of Zhang Zhongjing’s flexible diagnosis and treatment methods.It is of great significance for Zhang Zhongjing’s academic research,especially the study of specific diseases,to grasp the clinical diagnosis and treatment decision-making mode of "Disease-PulseSyndrome combined Treatment".2.From the perspective of modern medicine,chronic pulmonary heart disease has many similarities with Zhi-Yin in Synopsis of Golden Chamber in terms of pathogenesis,clinical manifestations,disease progression and treatment principles,ect.Zhang Zhongjing may have observed the similar or even the same disease occurrence and development process as chronic pulmonary heart disease in clinical practice,which eventually formed the main content of Synopsis of the Golden Chamber on the Disease-Pulse-Syndrome combined Treatment of ZhiYin disease.The academic value and innovation of this study:1.Starting with edition collation and textual research on the meaning of words,this paper makes a detailed investigation on the records of Zhang Zhongjing’s prescription for the treatment of Zhi-Yin,combs the notes of medical experts in past dynasties,and tries to clarify the original meaning of Zhang Zhongjing from source to flow.The longitudinal research method,perspective and specific results provide a useful reference for the literature theoretical research of miscellaneous diseases in Synopsis of the Golden Chamber.2.Based on the analyses of Zhang Zhongjing’s clinical diagnosis and treatment decisionmaking model of hierarchical classification and evidence-based reasoning,that is,"DiseasePulse-Syndrome combined Treatment",this paper discusses the application experience of Zhang Zhongjing’s prescriptions in the diagnosis and treatment of Zhi-Yin,and preliminarily outlines the dynamic evolution law and diagnosis and treatment procedures of the occurrence and development of Zhi-Yin.This horizontal research method,perspective and specific results provide a new model for the research on the diagnosis and treatment outline of miscellaneous diseases in Synopsis of the Golden Chamber.3.On the premise of researching the meaning of the disease name and clarifying the disease category of Zhi-Yin,based on the perspective of chronic pulmonary heart disease,this paper attempts to make a modern interpretation of Zhi-Yin disease in the Synopsis of the Golden Chamber,integrates the isolated interpretation of Zhang Zhongjing’s Zhi-Yin prescriptions into an organic whole,provides a basis for the accurate application of Zhi-Yin prescriptions in the clinical diagnosis and treatment of Zhi-Yin disease,and actively explores the prevention and treatment of major diseases guided by the classics of Traditional Chinese Medicine. |
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