| Objective:Based on the long-standing diversified problems in the classification of syndrome differentiation methods of traditional Chinese medicine and the need for uniform research,under the guidance of classical traditional Chinese medicine theory of syndrome differentiation and treatment,this study starts from the principles of syndrome differentiation based on the three-dimensional integration of etiology,disease location and pathogenesis,take the selected works on the classification of diseases and syndrome with certain influence in the academic development system of febrile diseases as the main research objects,systematically sort out and study the syndrome differentiation and classification methods in febrile disease,comprehensively extract the set of syndrome differentiation and classification elements contained in the representative works of febrile disease,and clarify the attribution relationship between each other.At the same time,analyzes and evaluates the characteristics and advantages and disadvantages of the syndrome differentiation classification framework of febrile disease,which are representative and typical among them,then derive and refine the basic framework of syndrome differentiation of febrile diseases with wide coverage,inclusive and systematic logical structure.It will lay the necessary foundation and provide important reference for the further integration of the syndrome differentiation program of cold and warm and the internal and exogenous diseases,and the establishment of a more unified and universal system of syndrome differentiation and taxonomy of traditional Chinese medicine.Methods:(1)Literature collation method:first,summarize the literatureon the research of TCM syndrome differentiation and classification method.Second,collect the literature data on the syndrome differentiation method in the representative works of febrile disease,extract the element information of the syndrome differentiation and the relationship framework of the syndrome differentiation elements,and establish the data table and its structural relationship table of the relevant syndrome differentiation elements.(2)Ontology analysis method:With the help of informatics ontology analysis method,take the examples of syndrome identification and classification in the works as the object of description,standardize the terms of the syndrome identification and classification elements derived from selected works on febrile disease,determine the class and attributes of the syndrome identification and classification,classify and identify the types and attributes of the syndrome identification and classification examples,in order to standardize the data table and the structural relationship table of the syndrome identification and classification elements,in order to obtain a standardized and systematic identification result.(3)Comparison and induction methods:From the logic of the classification elements and the structuring of the element relationships,comparative analysis of the strengths,weaknesses and characteristics of various syndrome differentiation and classification frameworks,extracts their respective advantages,communicates with each other,complements each other,and sum up a basic framework of syndrome differentiation and classification of febrile diseases with a more complete structure,a more tolerant connotation,and a clearer outline.Results : 1.Based on the selected 36 representative works on febrile disease,the elements of disease and syndrome classification in the field of febrile disease have been sorted out and summarized more comprehensively.(1)Draw a collection of the elements of disease and syndrome classification.A total of 45 items in 10 categories:1)etiological elements;2)disease location elements;3)pathological transformation factors;4)disease state factors;5)syndrome differentiation reference factor factors;6)original syndrome and change syndrome and both syndrome classification syndrome factors;7)classification of syndromes by treatment method factors;8)classification of syndromes by prescription factors;9)classification of syndromes by type of disease and symptoms factors;10)other classification of syndromes factors(look,colour,shape and smell,eyes,ears,nose,throat,chest and abdomen,lip,tongue,tongue fur,tooth and pulse,taboo,suspected syndrome).Among them the classification of diseases and syndromes includes 1pathogen classification(cause),15 disease position classifications(six meridians,outer and inner meridians,meridians and viscera,yin and yang,upper,middle and lower,internal and external divisions,sanjiao divisions,ying wei qi and blood,body fluid,spirit,vitality,yuan yin and yuan yang,odd meridian,eight meridians,acupoints,disease location measurement,and other regional diseases position),7 categories of pathogenesis(qihua,yin and yang,cold and heat,the deficiency of vital qi,the excess of evil qi,abnormal,other pathological mechanisms),6 diseasesyndrome relationships(original syndrome and change syndrome and both syndrome,combined diseases and comorbidities,evil attack on paired channels,combined folder,contraindication,transmission syndrome,suspected syndrome),29 items in total.As well as there are 7 classifications of disease status(stage of disease course,transmission,onset,bad syndrome,severity of disease,trend of disease,vitality of disease).There are 1 disease classification(disease type);1 symptom classification(symptoms);2 treatment rules and treatment methodsclassification (differentiated by treatment method and prescription);2 classifications by reference factors(Sick body and time of illness);3 other categories(look,colour,shape and smell,eyes,ears,nose,throat,chest and abdomen,lip,tongue,tongue fur,tooth and pulse).It can be seen from the above that the items related to syndrome differentiation account for nearly two-thirds of the total.It highlights that many physicians in febrile disease have paid great attention to the connotation of syndrome differentiation.(2)Calculate the proportion of each category item in detail.Through the frequency and proportion of each classified item in 36 works,it shows its actual importance:the etiology classification accounts for a relatively large amount(31-86.1%).In the classification of disease locations,the recognition of the classification of meridians and collaterals,viscera,six channels,Yingwei Qi and blood,and Sanjiao ranks in the forefront(respectively:31-86.1%,25-69.4%,23-63.89%,19-52.78%).It is also common to pay attention to the eight key elements of the outside and inside,cold and heat,the deficiency of vital qi and the excess of evil qi(respectively:24-66.67%,20-55.56%,28-77.78%,22-61.1%,with abnormal 23-63.89%).There are also many proposals for the theories of combined diseases and comorbidities,combined syndromes,original syndrome and change syndrome and both syndrome and qi transformation(11-30.56%,17-47.2%,10-27.78%,24-66.67%,respectively).There are also certain considerations for the classification of Yin and Yang,upper,middle and lower,body fluid,internal and external divisions(respectively:15-41.67%,12-33.3%,11-30.56%,8-22.2%).For the relationship between disease and syndrome,there is also a clear distinction between the original syndrome and change syndrome and both syndrome.There are also many doctors who raised suspected evidence(10-27.78%).Individual doctors put forward the classification concepts of eye,ear,nose,throat,chest and abdomen,contraindications,and transmission syndromes(2-4,5.56%-11.1%).This has positive significance for understanding the diversity of disease and syndrome and its relationship.In addition,the classification of lips,tongue,tongue,teeth,veins,look,color,shape and taste also account for a certain proportion(respectively:19-52.78%,8-22.2%).Regarding the reference factors of syndrome differentiation classification,the proportion of disease body and disease time classification is also quite large(respectively: 24-66.67%,9-25%).All in all,although the classification of diseases and syndromes can be done from multiple perspectives.However,no matter what aspects are used to classify disease syndromes,it is impossible to break away from the core elements of disease-the cause,location and pathogenesis,but can only reflects the three-dimensional and diversified relationship of disease syndromes from multiple perspectives.2.This article is an integrated study of the mainstream trend of syndrome differentiation and classification methods of the school of febrile diseaseIn this paper,the syndrome classification methods of the school of febrile disease has been analyzed statistically by the classification elements.Through the frequency of occurrence in the works,the important coefficient of the works,and the order of each element in the classification framework of the works,the three factors,to focus on the internal weights of different classification elements in the construction of syndrome differentiation methods,and to provide elementary basis for further exploring the general framework of the mainstream development of the syndrome differentiation methods of the school of febrile disease.Based on “a statistical list of 36 selected works on febrile disease,the main syndrome differentiation and classification methods and the weights of classification elements”,the classification elements of the syndrome differentiation and classification method are analyzed from three levels of statistical analysis from items(objective presenters of the literature)to item induction(the subdivided items are merged with the inherent identity),and then to the big category merger(further big categories merging on the basis of the item induction).According to the mainstream trend of the syndrome differentiation method of the school of febrile disease,the characteristics of the weight distribution of the classification elements at different levels can be drawn:(1)The characteristics of the weight distribution of the classification elements at the sub-item levelThe weight analysis of the subdivision items of the classification elements is the most basic and most important analysis work.In order to more objectively reflect the inherent weights of the subdivision elements in the literature of works,this article adopts the cumulative number of the works,the coefficients of the works and the order in the classification framework of the works,these three aspects are used to comprehensively calculate the weight of each subdivided element,that is,"three-dimensional fixed point" evaluation.It is possible to analyze and derive the internal weight of each subdivision element and its position and relationship in the system architecture.The layout features are as follows:Although there is a wide range of 50 items,However,focusing on the first 17 items(the cumulative weight accounting for 98.52% of the total weight),which represents the mainstream option of this school.1.Type of disease,—2.Six meridians,—3.Viscera,—4.Sanjiao,—5.Main symptom,—6.Weiqiyingxue,—7.Treatment,—8.Severity of illness,—9.Outside and inside,-10.Etiology,-11 Deficiency and Excess,-12.Cold and heat,-13.Qi and blood,-14.Similar syndrome,-15.Yin and Yang,-16.Twelve meridians,-17.Patient's Physique;Among them,the first 6 items: 1.Types of diseases—2.Six meridians—3.Viscera—4.Sanjiao—5.Main symptoms—6.Weiqiyingxue,with a cumulative weight accounting for 85.27% of the total weight,these 6 items should be used as the indispensable core elements for constructing the syndrome differentiation method of the school of febrile disease.The result can be seen that the six meridians classification actually ranks first,and the classification of the viscera and the Sanjiao is more important than the classification of Weiqiyingxue.This phenomenon is inconsistent with the teaching material of febrile disease that emphasizes Weiqiyingxue and Sanjiao Syndrome Differentiation Program,which can be considered as the latter is limited framework that highlights the characteristics and advantages of the main diseases such as wind heat,warm heat,dampness heat,and summer dampness.That is to say,in the multidimensional classification of disease position,the importance of the division of Sanjiao and Weiqiyingxue should be emphasized,but the necessity of identifying the six meridians,viscera and meridians in a complete and comprehensive model of syndrome differentiation should not be denied.(2)Layout characteristics of comprehensive weight values of similar merging level of classification elementsThe merged medium project level,its core element composition and relationship still maintain the basic layout of the sub-project level,that is,the first 6 items: 1.Disease types-2.Meridians-3.Viscera meridians-4.Sanjiao-5.Symptoms —6.Weiqiyingxue and body fluid,etc.It replaces the six meridians,zangfu organs,Weiqiyingxue of subdivision items with the meridian system,zangfu meridian,and Weiqiyingxue and body fluid that containing the relationship.In addition,with the sum of the weights in the merging,the weights of each item increase accordingly,and the items with a weight> 0.01 also increase to the top 10 items(that is,7.Mistake treatment—8.Patient's physique,disease time,disease state,etc.—9.Outside and inside,etc.—10.The pathogenesis of deficiency,excess,cold and heat,yin and yang,ascending,descending and exiting and entering,etc.).The variety of element classification is enriched and complete,especially the outside and inside items related to the disease location,the deficiency,excess,cold,heat,and yin and yang items based on pathogenesis,so that the composition of the syndrome differentiation method is more complete,and it is possible to summarize the overall framework.(3)The characteristics of the weight distribution of the classification elements at the classification level of the major categoriesThrough the merging of major categories,the following major categories constitute groups and the ranking relationships of weights are obtained: 1.Diseases position,2.Types of diseases,3.Diseases symptoms,4.Pathogenesis,5.Disease treatment,6.Disease status,7.Etiology,8.Concurrent disease,9.Others.Based on the above comprehensive analysis of the characteristics of the three-level weight distribution of the list,it can be known that the basic framework of clinical diagnosis and treatment naturally formed by febrile disease doctors is a mixed type of disease,syndrome,symptom,and treatment,but still focuses on syndrome differentiation.The disease position score is the largest,but the detailed classification has a scattered and multidimensional center of gravity.That is: the total weight of disease position accounts for 38.74% of the total weight value,but it includes: 2.Meridian system,3.Zangfu meridian,4.Sanjiao,9.Outside and inside and other different positioning methods.It shows that in clinical diagnosis and treatment,the position of disease differentiation is still the most important item in most doctors of febrile disease,but there are various positioning methods,probably because of the abundant disease types of febrile diseases,the distribution characteristics of syndrome types have not only the common features of febrile diseases,but also the characteristics of specific disease types.3.A comparative analysis and overall assessment of the representative classification frameworks in the school of febrile disease.The results are as follows:(1)The element relationship framework of the symptom classification method is not limited to what is shown in the textbook,but presents a diversified distribution.There are as many as ten types in the first and second classifications.There are fusion disease names and prominent corresponding treatments,such as "disease symptom combined treatment method classification";those who have a combination of disease causes and disease position,such as "six qi combined with six meridians classification";those with a combination of pathogenesis and disease name,such as "external and internal cold and heat combined disease symptom classification";those with a combination of pathogenesis and disease position,such as "weiqiyingxue combined with tongue and tooth identification classification";those with disease location combined with pathogenesis,such as "classification of six meridians and sanjiao combined with six main points";those with disease name combined with disease position,such as "disease symptom combined with six meridians classification";those with disease name combined with pathogenesis and disease position,such as "disease symptom combined with weiqiyingxue sanjiao classification";those who have detailed specific disease positions,such as "six meridians and visceral classification";those who have reference to the disease and syndrome relationship,such as "original syndrome and both syndrome and similar symptom and change syndrome classification";those with reference to the disease course,such as "diseases symptom or combined disease course classification".It can be seen that because the elements of syndrome differentiation and classification involve multiple aspects such as the cause,location,pathogenesis,disease name,disease course,disease state,and treatment methods.Therefore,the classification framework is also diversified,however each classification framework has advantages and disadvantages.However,due to historical conditions and the limitations of various medical theories,fail to fully learn from each other and complement each other's strengths,and thus failed to form a fully compatible classification framework.Moreover,if you can carefully examine the classification frameworks,you can find that most of the classification levels are roughly inaccurate,the classification levels are not uniform,the classification of syndromes and treatments are incomplete,the distribution of disease syndromes is different,and so on.In this way,in fact,the febrile disease school's disease syndrome classification framework is still in a state of undetermined contention.(2)The syndrome differentiation classification framework has begun to entered a stage of integration and development.First of all,"syndrome differentiation of epidemic febrile disease" is based on the outline of the above,middle,and lower sanjiao classifications.The two-level classification is combined with the disease types,and the three-level classification uses different classification methods according to the different types of diseases,such as six meridians classifications,classification of etiology and pathogenesis,classification of viscera,classification of internal and external and qi and blood,etc.It highlights the key points and characteristics of the classification of various diseases and meridians,which is conducive to grasping the key points of the disease and the common occurrence of febrile diseases.Although this book is innovative and systematic in its classification system,it still does not break the limitations of disease classification.Moreover,the classification methods of the three and four levels under the upper,middle and lower sanjiao classification schemes are different.While highlighting the key disease syndromes elements and types of febrile disease,there is a tendency to omit non-key disease syndromes elements and types.In addition,due to the need for centralized teaching of higher education of Chinese medicine,taking the "Interpretation of Febrile Diseases" edited by Nanjing College of Traditional Chinese Medicine as the forerunner and subsequent textbooks of Febrile Diseases,they explored the classification model of diseases type combined with weiqiyingxue and sanjiao,borrowed from the advantages of classification methods such as the classification of viscera and meridians,and the classification of six elements,and adopted a variety of classification methods for each disease.The classification method combining Weiqiyingxue and Sanjiao under the type of disease further enriches and refines the content of the classification subheadings,and establishes a more specific framework system of prescriptions and syndromes from the classification of weiqiyingxue and sanjiao to specific etiology and pathogenesis,so that the syndrome identification classification is more specific,more accurate in guiding clinical practice,more recognized in theory,and more recognized by future generations.This has become the basic framework used in the compilation of modern college textbooks.However,it still has areas that are not fully connected and standardized.Of course,it is not a big problem to use it as a guide for preliminary study and research on Febrile Diseases.However,to comprehensively and systematically display the structured framework of disease and syndrome classification in febrile disease,there are some problems in scientific expression and theoretical understanding.In short,the key issue that has not yet been resolved in the current febrile disease textbooks' syndrome differentiation and classification framework is how to construct a logical and systematic differentiation of syndromes classification framework that can clearly reflect the current classification of febrile disease syndromes in the current febrile diseases and to accommodate future development of febrile diseases.4.Preliminary derivation and construction of the basic framework of syndrome differentiation and classification of febrile diseasesBased on the above research,this article believes that the basic common framework can be initially constructed at the general level for the differentiation and classification method of febrile disease,and then design an adjustable method in combination with disease types in the disease position.Overall framework: It consists of three parts: front,middle and back.Prefix part(first classification of disease,supplemented by classification of symptoms): the prefix for disease identification,which can be absent.The central part(distribute the cause of disease first,then divide the disease position,then divide the pathogenesis): namely the main body of syndrome differentiation,the necessary focus.Subsequent part(or according to disease status,or according to disease treatment,or according to both disease):Combination of immediate syndrome and disease,auxiliary option.Adjustable method: Warm-fever diseases,first divide Weiqiyingxue,then Sanjiao,then divide the twelve meridians of hands and feet;damp-heat disease: divide into sanjiao first,then divide the twelve meridians of hands,feet,and then divide the Weiqiyingxue;Mixed diseases of cold and heat: first divide the twelve meridians of the hands and feet,then divide the Sanjiao,and then divide the Weiqiyingxue.Conclusion:1.In terms of clinical diagnosis and treatment framework,the school of febrile disease originally had diverse classifications and diversified frameworks,but from the mainstream point of view,it generally presents a basic pattern of mixed disease,syndrome,symptom,and treatment.From the perspective of major categories,the classification is expressed from multiple perspectives based on the disease cause,disease location,pathogenesis,disease situation,disease combination,disease treatment,disease type,disease symptoms,etc.,which is more inclusive,but still focuses on the differentiation of syndromes.2.In terms of syndrome differentiation and classification of the school of febrile disease,the elements of syndrome differentiation and classification are rich and extensive(nearly more than 45 items),but in terms of ten categories,the connotation is still based on the classification of disease types(including etiology)combined with disease position and pathogenesis.Among them,the multi-angle reclassification of disease places(locations)is a prominent aspect of most doctors in febrile disease.For example,there are differences in meridian,zang-fu meridian,sanjiao,exterior and interior.3.The school of febrile disease is based on the framework of syndrome differentiation,although it can be carried out from multiple perspectives,it is impossible to break away from the three major aspects of disease cause,disease position,and pathogenesis,while other aspects indirectly and laterally strengthen the three-dimensional structure and diversity related of these three major elements.4.The generalized design of the syndrome differentiation method of febrile disease is proposed to be based on the classification of the disease position first,and the sanjiao as the first outline,the twelve meridians of the hands and feet are the big eyes,the Weiqiyingxue and body fluid is divided into detailed categories,and then the etiology and pathogenesis classification are combined in turn,form a multi-level and multi-dimensional systemic syndrome classification framework of febrile disease.It not only maintain the characteristics and advantages of the teaching materials,but also to improve the wide coverage and compatibility of febrile diseases,and to facilitate the development of the convergent development of the cold and warm schools. |
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