A Study On Pathogenesis-treatment System Of Chest Impediment Based On Case Records In Ming And Qing Dynasties

Objective: Based on the study of case records of chest impediment in Ming and Qing dynasties,the paper probes into the pathogenesis-treatment system of chest impediment.Methods: Case records of chest impediment from Chinese Medical Classic as a major reference,supplemented by other medical works such as Classified Case Records,we collect and screen the records that meet our standard,analyze disease cause,therapy and location by Excel,extract factors such as disease cause,symptom,syndrome and medication,put them in TCMISS to build a database.Methods of frequency analysis,association rule analysis are employed in data analysis.Result: 1.Distribution of records: 1641 cases are retrieved,1205 of which are excluded by preliminary screening,and 216 cases from 62 places meet our standard after a second screening.2.Causes of disease: 9 kinds of causes are distinguished,among which emotional disharmony is the primary.Other causes include exogenous pathogens(cold,summerheat),deficiency of zang-fu organs,heart disorder,overwork and over-rest(strain),improper treatment(improper medication),irregular diet(overeating,alcohol),aging and so on.3.Location of disease: The heart is most responsible for chest impediment,followed by heart and spleen,heart and liver.It shows that the heart is the main location of chest impediment and liver,lung,spleen and kidney are often affected.4.Symptoms: 196 symptoms are distinguished,and the most frequent 5 ones are chest pain,cardiodynia,choking sensation in chest,backache and unsmooth pulse,which can be classified as chest pain and cardiodynia.5.Medication: 249 herbs are identified,and the most frequent 5 ones are Poria,Pinellia Tuber,Longstamen Onion Bulb,Cassia Twig and Dried Tangerine Peel,with the function of revolving phlegm and activating yang.Besides,qi tonifying herbs are adopted,including Liquorice Root,Ginseng,White Atractylodes Rhizome,Chinese Date and Astragalus.Blood-activating and stasis-resolving herbs are also used,including Yanhusuo,Peach Seed,Turmeric Root Tuber and Salvia Root.qi-regulating herbs and yang assisting herbs are also employed,including Dried Tangerine Peel,Immature Orange Fruit,Nutgrass Galingale Rhizome,Pummelo Peel,Dried Ginger,Cassia Bark,Prepared Common Monkshood Daughter Root and so on.6.Syndrome: 28 syndromes are recognized,mainly including phlegm obstruction leading to qi stagnation,yang block leading to qi stagnation,deficiency of yang qi,qi stagnation leading to blood stasis,congealing cold and qi stagnation,heart blood stasis and obstruction,deficiency of qi and blood.7.Therapy: 10 treatment methods are indentified,including resolving,warming,tonifying,etc.8.Pathogenesis-treatment-formula association:(1)Endogenous turbid phlegm and qi movement disorder manifest as phlegm accumulation leading to qi stagnation syndrome;methods of regulating qi,revolving phlegm,activating yang are adopted,and thus Snakegourd Fruit,Chinese Chive and Pinellia Decoction is preferred.(2)Disorder of yang qi manifests as yang block leading to qi stagnation syndrome;methods of activating yang,regulating qi,revolving phlegm and excreting water are adopted,and thus Cassia Twig,Snakegourd Fruit and Chinese Chive Decoction is preferred.(3)Yang qi deficiency and qi movement disorder manifest as yang qi deficiency syndrome;methods of tonifying yang and replenishing qi are adopted,and thus Ginseng and Aconite Decoction is preferred.(4)Qi movement disorder and unsmooth blood circulation manifest as qi stagnation leading to blood stasis syndrome;methods of regulating qi,revolving stasis and activating qi are adopted,and thus Cinnamon Twig and Poria Pill,Collaterals-Activating Efficacious Pill are preferred.(5)Yang qi disorder,cold congealing and qi movement disorder manifest as cold congealing leading to qi stagnation syndrome;methods of regulating qi,dispersing cold,warming yang and activating qi are adopted,and thus Immature Orange Fruit,Chinese Chive and Cinnamon Twig Decoction is preferred.(6)Blood stasis and unsmooth pulse manifest as heart blood stasis and obstruction syndrome;methods of activating blood and revolving stasis are adopted,and thus Blood House Stasis-Expelling Decoction is preferred.(7)heart deficiency and blood deficiency manifest as deficiency of qi and blood syndrome;methods of tonifying,producing blood and tranquilizing spirit are adopted,and thus Ten Major Tonics Decoction is preferred.Conclusion: In the Ming and Qing dynasties,the pathogenesis of chest impediment fits into root deficiency and branch excess.Healthy qi deficiency is not evident when disease occurs while pathogenic qi is relative strong.Root deficiency mainly manifests as yang deficiency,accompanied by qi deficiency and yin deficiency.Branch excess mainly manifests as phlegm accumulation,accompanied by blood stasis,qi stagnation,yang block and cold congealing.Thus,phlegm accumulation leading to qi stagnation,yang block leading to qi stagnation,yang qi deficiency,qi stagnation leading to blood stasis,congealing cold and qi stagnation,heart blood stasis and obstruction,deficiency of qi and blood are the main syndromes of chest impediment.Herbs with functions of regulating qi,revolving phlegm,activating yang,activating blood and tonifying are most frequently adopted in treatment.