The Historical Development Of The Concept And Treatment Of Ribside Pain Prior To The Ming Dynasty

Ribside pain is a kind of common self-awareness symptom in medicine, but in the ancient books of TCM after the Song dynasty,"Ribside pain" meant to be a disease which is presented as rib-side pain. The abundanant discussions about the ribside pain before the Ming dynasty reflected their understanding of the ribside pain which gradually deepen and enriched the treatment experience.In the medical texts from Mawangdui, there has been the record of ribside pain which was the earliest origin of it in the existing books. In nei jing and other works, some similar terms were used such as "xie tong","xie xia tong","xiong xie tong","xin xie tong" and so on. In the zhubingyuanhoulun and waitaimiyao, ribside pain symptoms were also treated as monograph, but it was always confused with other conditions. So, at that time ribside pain was only meant to be the symptoms of rib-side pain.At that time, the understanding of the etiology and pathogenesis of ribside pain was given priority and also had been aware of the factors with cold evil, phlegm retention, blood stasis and qi stagnation. The zhubingyuanhoulun, it made a specific explaination on the etiology and pathogenesis of ribside pain closely related with viscera meridian, and then the theory was carried forward by waitaimiyao, taipingshenghuifang and shengjizonglu.Because of the emphasis on cold evil cause, the treatment of the ribside pain was given priority with warm.Also, the treatment of acupuncture and medicine were used.What was the combition of the internal and external therapy?All in all, the understanding of ribside pain was inadequate at that time, but it was based on the theoretical and clinical basis of ribside pain.1. The period of Song, Jin and Yuan dynasties:The understanding and treatment of ribside pain in the period of Song, Jin and Yuan dynasties had made a great progress, whose performance showed much difference from the previous.In the book shengjizonglu,"xie lei tong" belonged to the diseases of heart and stomach, while "xie tong" belonged to the chest discomfort. This was the first time that made clear about the differences between the both. At the same time, the book shengjizonglu, fused the etiology and pathogenesis and treatment of ribside pain together, according to the theory first and then the formula. From then on,"xietong" had become the name of the disease, and had a new meaning.Diet and qi stagnation, alcohol consumption, tiredness have been proposed as the pathogenesis in the period of Song, Jin and Yuan Dynasties. In addition, the pathogenesis and etiology had been summarized by YAN Yong-he as exhaustion, extremely cold, hernia and accumulation. YANG Shi-ying summarized the etiology of ribside pain into the4factors:wind, water, gas and blood. WEI Yi-lin also summarized the causes of ribside pain into three kinds of factors, including typhoid fever and qi stagnation, seven emotions. All the above has basically covered the previous discussions.In Song dynasty, stagnation of qi was the main factor for the pathogenesis of ribside pain. These improvements abundantly gave rise to the treatment by formulas and medicine. Represented by combination, clove fragrant dry medicine began to be used in great quantities, to the pharmacopoeia taipinghuiminhejijufang and agent reached to its peak. This kind of medicine which has both the nature of the warm and facilitating, gradually replaced warm cold medicine such as cinnamon, monkshood and arum. This has affected the treatment of ribside pain in the period of Song, Jin and Yuan Dynasties.Taipingshenghuifang and shengjizonglu followed the example of waitaimiyao and adopted the style of theory first and formulas and medicine next, which intended to emphasize using of theory to guide clinical treatment. This discussion on combination of pathogenesis and treatment inspired the later generation to treatment based on syndrome differentiation. YAN Yong-he adopted different treatments according to different etiology and pathogenesis, which already had the ideas of treatment based on syndrome differentiation. WEI Yi-lin paid more attention to treatment based on syndrome differentiation of ribside pain and put forward the general treatment according to the side effects of ribside pain.Especially, Danxi School’s discussion on the etiology, pathogenesis and treatment of ribside pain was the most detailed and was at the height of the understanding of ribside pain before Ming dynasty. At the side the etiology and pathogenesis of ribside pain, Danxi School mainly summarized as suffered, wood and gas solid, died of blood, sputum lingers, liver five factors and also put forward the exogenous, food, housing, damp heat, Yin deficiency. Damp heat and Yin deficiency were first put forward to the treatment according to pathogenesis differentiation, respectively, to form the dialectical therapy.Anyway, since the Song dynasty, especially the Jin Yuan Period, ribside pain increasingly became an independent disease, acknowledgement of ribside pain about the understanding of the etiology and pathogenesis was more abundant, treatment gradually shifted from focus on warm cold to pay attention to promot the circulation of qi. Eventually treatment was based on syndrome differentiation of ribside pain.