| "Categorized formula" is an excellent entry point for the study of theory,method and prescriptions in Chinese medicine.The emergence and evolution of related research have always revolved around the core ideas of syndrome differentiation and treatment in traditional Chinese medicine.Categorized formula is not only a collection of similar prescriptions,but also a method of classifying prescriptions.The related research is efficient and effective.At the theoretical level,it is a learning process for the compatibility principles of previous generations and the law of prescription derivation.At the clinical level,mastering a group of similar prescriptions also grasps the key points of differentiation and treatment of related common diseases and syndromes and the method of prescription.In this study,we use the categorized formula as an entry point to grasp the characteristics of similar composition structure and similar efficacy and treatment methods,and explore the rules of evidence and treatment of "categorized formulas for treating cold" involved in "Treatise on Cold Damage and Miscellaneous Diseases" and the outpatient medical cases of Chief Physician Kuiwu Yao to summarize the experience of treating cold.Objective1 To investigate the rules of evidence and treatment of "categorized formulas for treating cold" in the "Treatise on Cold Damage and Miscellaneous Diseases" based on data mining technology,and to compare and analyze the prescriptions of "categorized formulas for treating cold" in the"Treatise on Cold Damage and Miscellaneous Diseases","Treatise on Cold Damage ",and "Essentials from the Golden Cabinet" with the relevant Chinese medicines and their core formulas.The experience Zhongjing Zhang in treating cold disease was summarized primarily.2 Based on the data mining technology,we analyzed the patterns of "categorized formulas for treating cold" used by our supervisor,Dr.Kuiwu Yao,and analyzed his academic thoughts on cold diseases by combining the interview method.Methods1 Through literature research,we sorted out the understanding of cold diseases and academic ideas of treating cold by medical practitioners in the past generations.2 We extracted the original texts and prescriptions related to the treatment of cold in the 2013 edition of the People’s Health Publishing House’s "Corrections and Annotations to Treatise on Cold Damage" and"Corrections and Annotations to Essentials from the Golden Cabinet",and established the databases of " Treatise on Cold Damage and Miscellaneous Diseases","Treatise on Cold Damage",and"Essentials from the Golden Cabinet",respectively.Microsoft Excel 2019 software was used to conduct frequency statistics and comparative analysis on the information of disease names,symptoms,symptoms,tongue and pulse,and traditional Chinese medicine.The IBM SPSS Modeler 18.0 software and IBM SPSS Statistics 26.0 software were used to analyze the data by association rules and hierarchical clustering,draw visualized Chinese medicine co-occurrence network and Chinese medicine clustering dendrograms,and compare and analyze the results with professional knowledge to summarize the application of the "categorized formulas for treating cold" and the experience in treating cold of Zhongjing Zhang.3 Collected the information on the cases who applied the"treatment of cold formula" and met the criteria of nadir from August 2020 to August 2022 in the outpatient clinic of the Department of Cardiovascular Medicine,Guang’anmen Hospital,Chinese Academy of Traditional Chinese Medicine,Dr.Kuiwu Yao.The frequency and frequency statistics of general information such as age,gender,consultation time,and related diseases,certificates,prescriptions and medicines were conducted by using Excel,and the association rule analysis and clustering of the Chinese medicines involved were performed by using SPSS software to discover the patterns of disease names,certificate symptoms,core group prescriptions,and commonly used medicine pairs.4 Combined with the interview method,we summarized the academic views of cold disease of Chief Physician Kuiwu Yao,summarized the understanding of cold disease,and summarized the common prescriptions and core treatments for cold.Results1 The origin of cold disease research can be divided into four main periods:(1)the Qin and Han dynasties laid the theoretical foundation and clinical therapeutics.Under the foundation of two classical works,"Huangdi’s Inner Canon of Medicine" and"Treatise on Cold Damage and Miscellaneous Diseases",the theoretical system of cold diseases was initially constructed,and the theory was combined with clinical practice.The six meridians system of identification and the system of identification of the internal organs and meridians of disease and evidence were formed,and these two had different concentration on the identification and treatment of external cold diseases and internal cold diseases,but they could be organically combined and mutually referenced for the practical application in the identification of complex symptoms of cold diseases.(2)During the Wei,Jin,Sui,and Tang dynasties,the theory of cold diseases was inherited and developed,among which cold epidemics belonged to a special type of cold diseases,and the "cause-mechanism-evidence-treatment" of cold epidemics was recorded in many medical books during this period,marking the initial formation of the theory system of cold epidemics.(3)During the Song,Jin,and Yuan dynasties,schools of thought emerged,and the understanding and treatment of cold diseases were characterized by distinctive schools,with the Hejian School and the Yishui School as representatives,and in the development of the theoretical system of cold diseases,the warming and tonic ideas of the Yishui School were particularly prominent.(4)During the Ming and Qing dynasties,the school of warming and tonicity was gradually conceived and formed,the "doctrine of the destiny gate" was formed and continuously improved,and the school of "Huo Shen" with the idea of reinforcing yang as the core was born,which was of great significance to the development of the ideas of cold disease identification and treatment.2 The original data included in the data mining study were:37 prescriptions from"Treatise on Cold Damage",involving 36 Chinese herbs,and 66 relevant paragraphs;59 prescriptions from "Essentials from the Golden Cabinet",involving 77 Chinese herbs,and 69 relevant paragraphs;83 prescriptions from "Treatise on Cold Damage and Miscellaneous Diseases",involving 81 Chinese herbs,and 135 relevant paragraphs.From the analysis of the results,it can be seen that(1)the cross-analysis of highfrequency symptoms,tongue and pulse,symptoms and evidence can reveal that the subtle differences between similar symptoms in external cold diseases and internal cold diseases cannot be ignored,and in some cases may become the key point for disease identification.For example,the symptoms of aversion to cold,cold fear,and wind fear are different reactions of the body to cold stimuli,and there are also differences between extremely cold limbs and cold limbs,which have different cold damage pathogenesis behind them.External cold diseases are usually accompanied by fever or different sweating conditions,and related to the pathogenesis of disharmony between Ying and Wei due to its cold damage to Yang,with a shorter and more acute course of illness.In general,the changes of tongue and pulse were not obvious.The pathogenesis of inner cold disease is yang deficiency,turbidity caused by dampness of water and phlegm,which presents a series of changes in tongue and pulse.There are often complex syndromes of mixed cold and heat and the mutual appearance of deficiency and substance.This disease is longer and slower than external cold diseases.(2)The treatment of "Yang-oriented Xin-Gan","Yang-tonic Gan-Wen" and "Channel-smooth Xin-Wen" is the way of presentations about the fundamental principle of "treating cold with warmth".It also reflects experience in treating cold by attaching importance to "qi transformation".(3)The treatment method of "warming and harmonizing" guides the diagnosis and treatment.On the basis of "protecting yang qi and taking care of stomach qi",Zhongjing Zhang often uses both cold and warm to treat mixed cold and hot symptoms or to remove the nature and store the effect to enhance the therapeutic effect,with the goal of balancing yin and yang to achieve yin-yang harmony.(4)A comparative analysis of the patterns of traditional Chinese medicine reveals that the three herbs"cassia twig,fresh ginger,and dried ginger rhizome" are widely used,while "prepared liquorice root,prepared aconite root,jujube,and ginseng" are also frequently used,but there are differences in the three works."Cinnamon Twig Decoction","Poria,prepared liquorice root,Chinese magnolivine fruit,dried ginger rhizome,and Manchurian wild ginger Decoction","Frigid Extremities Decoction" are the core formulas."Cassia twig&Licorice&Ginger","Dried ginger rhizome&Pungent Pungent&Chinese magnolivine fruit&Pinellia rhizome","Prepared aconite root&Ovate atractylodes","Dried ginger rhizome&Aconite root",and "Aconite&Honey" are the core medicine groups.For example,the indications for fresh ginger and dried ginger rhizome are different.Fresh ginger is commonly used for the evidence of disharmony between Ying and Wei,dried ginger rhizome is commonly used for the disease of water and qi metabolic disorders.(5)In the process of data mining,the information of symptoms,tongue and pulse,which appear less frequently,sometimes also have important suggestive effects and often become the key to the differential diagnosis of diseases and symptoms.For example,the frequency of "tongue moistening" in the tongue information of "The Treatise on Cold Damage" and "Essentials from the Golden Cabinet" is low,but it is very important for identifying the surplus and deficit of yin and fluid in the diagnosis and treatment of cold diseases,which directly affects the prescription of medicine.And it is the key to identifying the application of medicines to nourish yin and promote fluid,identifying the application of medicines to nourish yin and promote body fluid or dry dampness,and promoting water under the guidance of "warming and harmonizing".3 Through the data mining of 448 cases about "categorized formulas for treating cold" applied by Dr.Kuiwu Yao,from August 2020 to August 2022,we can find the patterns of evidence and treatment of "treatment of cold" prescriptions applied by Dr.Yao,which are described as follows:(1)Identification of diseases needs to focus on the holistic concept,the "three causes of disease" is applied to the treatment of cold diseases,and the "spring and summer nourishment of Yang" is emphasized.(2)The "categorized formulas for treating cold" can be found in the treatment of internal,external,gynecological,and pediatric diseases by the tutor,and the application focuses on the identification of symptoms and the examination of causes and treatment.(3)The identification of symptoms,including sweating,bowel movements,and personality traits,is often combined with the tongue and pulse for the identification of cold and heat,while symptoms such as "weakness,loose stools,fear of cold,swelling and shortness of breath" help to identify "deficiency,Yang deficiency,spleen deficiency,dampness,and water retention" in cold diseases."(4)Emphasis on Yang qi,but not bound to the warm method,classic formula and common prescriptions are used together,and cold-natured herbs are used with these prescriptions.Advocating the use of both cold and warm method for flexible treatment,while taking care of the stomach qi.The treatment is often based on warming the Yang,smoothing the pulse,promoting water metabolism,venting the turbidity,treating the Qi and Yin,nourishing the Yin and generating fluid,nourishing the Blood and softening the meridians,and clearing the heat.(5)Treating cold and regulating Qi and Blood together,treating deficiency and obstruction differently,and harmonizing Blood vessels.The treatment is often based on the two aspects of deficiency and reality.Those who are mainly deficient should focus on tonifying Qi and Blood,often combined with Pu’s Shuanghe Powder;those who are mainly obstructed should focus on harmonizing Blood vessels,often using Huangqi Chi Feng Decoction.(6)Emphasis should be placed on warming and supporting the ruler’s yang(heart yang)to treat the cold,and on tonifying the stomach and kidney yang,while not forgetting to harmonize the liver and spleen.It is often cured with Cinnamon Twig and liquorice root Decoction or Cinnamon Twig Decoction with addition and subtraction to warm and support the ruler’s yang,Liang Fu Pill to warm and promote the stomach yang,eucommia bark and Himalayan teasel root to tonify the kidney yang,and Frigid Extremities Powder to harmonize the liver and spleen.(7)"Move" is the constant method to harmonize yin and yang,and wind medicine helps to move,so that qi movement is set in order.4 Dr.Kuiwu Yao,the chief physician,understands the pathogenesis of cold disease based on the theory of "yang transforming into qi,while yin constituting form".That is,"yang transforming into Qi" is not sufficient as the fundamental pathogenesis of cold disease,and"yin constituting form" is too much as the key pathogenesis.The key factor for the change of the symptoms of cold disease is too much "yang transforming qi",and the important factor for the prolongation of cold disease is not enough "yin forming".Inheriting the academic thought of "qi-hua" in treating cold,the four methods of treating cold are refined:"warming","unblocking","tonifying" and "moving".The therapy of"warming" is to regulate the constitution categories,to inspire the vital gate,and to promote the function of sanjiao;"unblocking" is targeted for treating symptoms and being aim-oriented treatment;"supplementing" treats root causes to achieve mutual improvement of yin and yang and concomitance of form and spirit,and "moving" is the main idea of the movement of sanjiao and the effect of wind-dispelling medicinals.ConclusionThe theory of cold disease has a long history,and the understanding of cold disease and the academic thought of treating cold disease have a deep foundation in Chinese medicine theory and clinical practice.Many later generations of doctors inherited and innovated on the basis of the knowledge of cold diseases in the classic works of"Huangdi’s Inner Canon of Medicine" and "Treatise on Cold Damage and Miscellaneous Diseases",and developed the highly distinctive school of warming and tonicity and the school of "Huo-Shen".The treatment from Zhongjing Zhang of cold emphasizes the identification of external cold diseases and internal cold diseases,and focuses on the identification of the severity of the disease,the mismatch between cold and heat,the location of the disease,and the intermingling of the evil;in terms of legislation and prescriptions,he attaches importance to "qi-hua" and always upholds the concept of "warmth and harmony".In terms of legislation and prescriptions,keeping to the perspectives of "Yang-oriented Xin-Gan","Yang-tonic Gan-Wen" and"Channel-smooth Xin-Wen","Cinnamon Twig Decoction","Poria,prepared liquorice root,Chinese magnolivine fruit,dried ginger rhizome,and Manchurian wild ginger Decoction","Frigid Extremities Decoction" are used as the core formulas.Dr.Yao emphasizes the concept of "qi-hua" and always upholds the concept of "warm and harmonious" in treating cold,from "pungent and sweet to transform yang","sweet and warm to help yang" and "pungent and warm to help pass-through".Dr.Kuiwu Yao has widely applied the "categorized formulas for treating cold" to various clinical diseases,we combine the identification of diseases with the identification of evidence,paying attention to the three causes,and integrate the idea of "nourishing Yang in spring and summer" into his prescriptions,and use the combination of classic and common formulas to warm and support the ruler’s yang(heart yang),promote the stomach Yang and tonify the kidney yang.Based on the theory of "Yang transforming into qi,while yin constituting form",we understands the pathogenesis of cold diseases,inherits the academic thought of "qi-hua" in treating cold,and refines four methods of treating cold,namely "warming,unblocking,tonifying,and moving",and broadened the ideas of treating cold diseases. |
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