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The procedural diagnosis and treatment of internal diseases generally include:1)to recognize the disease according to the information obtained through four diagnostic methods;2)to identify the location and nature of the disease; 3)to infer the cause and determine the pathogenesis of the disease; 4)to design the therapeutic principle and method; 5)to select applicable drugs and formulate a prescription.
TCM syndrome differentiation methods are usually applied during the diagnostic procedures:visceral syndrome differentiation,differentiation of qi-blood and body fl uid syndrome,disease-cause pattern differentiation,six-meridian syndrome differentiation,Wei-Qi-Ying-Xue syndrome differentiation,and triple energizer syndrome differentiation.
The human body is an organic whole centered by fi ve internal organs.It is not uncommon for internal organs to be affected when the body faces pathological changes leading to internal diseases.Visceral syndrome differentiation is therefore not only the most important method of internal diseases differentiation but also the most commonly practiced.Six-meridian syndrome differentiation,Wei-Qi-Ying-Xue syndrome differentiation,and triple energizer syndrome differentiation are mainly used for the differentiation of exopathic febrile diseases and epidemic febrile diseases.
Internal medicine is the most extensive clinical discipline that covers various categories of internal diseases.Some diseases present manifestations similar to those of internal diseases at an early stage,thus detailed differentiation with the diagnosis is critical.To avoid any in-correct diagnosis and delaying treatment for patients,the practitioner should be responsible for fulfilling the below 3 steps:
1.Conduct an overall analysis of the patient’s condition.
The premise of correct syndrome differentiation and diagnosis is to collect complete information through four diagnostic methods and to achieve the results from physical and laboratory examinations.The holistic view of TCM plays its role in the overall analysis of the patient’s condition and directs the syndrome differentiation.
2.Reveal dominant aspects of a disease.
The dominant aspect of a disease refers to the symptoms or signs that re fl ect the fundamental pathogenesis and rule the development of such disease.Clinically,identi fi cation of dominant aspects is essential when dealing with any given disease.Such dominant aspects even revealed easily through the etiologic and pathogenic analysis,are not necessarily apparent and observed.Diagnosis with focus on dominant symptoms and signs is a crucial therapeutic strategy.
3.Differentiate principal and secondary aspects,insidious and acute conditions.
Differentiating principal and secondary aspects are imperative when determining the therapeutic principle and methods for an internal disease.Biao,the secondary aspect,refers to the manifestation of a disease.Ben,the root or the principal aspect,refers to fundamental nature of a disease.Differentiating the principal and secondary aspects enables practitioners to identify the essential cause of the disease and to provide accurate diagnosis and proper treatment accordingly.
Theoretically rigorous and methodologically diversi fi ed,the therapeutics of TCM internal medicine comprises therapeutic principles and methods.Therapeutic principles are formulated according to the basic theory of TCM and syndrome differentiation.Therapeutic methods can be summarized as two main types of internal and external treatments,each with multiple and speci fi c methods.
1.Therapeutic principles
Therapeutic principles have instructive signi fi cance for choosing a therapy and formulating a prescription during the process of treatment.These principles can be summarized as treating the human body as an organic whole,searching for the primary cause of disease in treatment,and using the treatment in accordance with three categories of etiologic factors.
2.Treating the human body as an organic whole.
The human body is an organic whole,and zang-fu organs are interrelated physiologically and in fl uenced one another pathologically.Given the human body is closely related to nature,diseases at any part can affect the whole body.It is inadequate to purely treat the diseases of any single part.Thus,more attention should be paid to nursing the whole body to achieve the objective of treating local pathological changes.Treatment should also be done with the consideration of climate,locality,constitution,and other factors.
3.Searching for the primary cause of disease in treatment.
Primary and secondary causes of diseases are relative.Analyzing and differentiating symptoms help physicians to recognize the nature of diseases,to distinguish the primary from the secondary cause,and to determine corresponding therapy.With this principle,it is necessary to grasp“routine treatment and treatment contrary to the routine”,“treatment of symptoms and treatment of causes”and“strengthening the body resistance and eliminating pathogenic factor”.
4.Using the treatment according to the three categories of etiologic factors.
The underlying principles of treatment should vary with individual cases,climatic conditions,and environmental factors.
(1)Individuality-concerned treatment
The principles of treatment should be decided according to the individual factors,such as sex,age,constitution,etc.When a female patient is treated,her conditions of menstruation,pregnancy,and postpartum period must be taken into consideration.In general,dosage for young children should be less than that for adults.Replenishing methods should be recommended for the elderly.The invigorating method with warm drugs should be avoided for the patients with a yang-heat constitution,while cold drugs should be used with caution for the patients with a yin-cold constitution.
(2)Climate-concerned treatment
Seasonal and climatic conditions exert a certain in fl uence on the physiological function and pathological changes of the human body.The principles of treatment should be decided in accordance with the climate of the season.
(3)Environment-concerned treatment
Principles of treatment should be chosen in accordance with the environmental factors.People in a higher altitude region of northwestern China are easily affected by pathogenic cold-dryness due to the cold and dry climate; their conditions should,therefore,be treated with warming method to moisturize dryness.In southeastern China,people in a low-lying region tend to have disorders with damp-heat due to humidity and warm climate; their conditions should,therefore,be treated with methods for clearing heat and resolving dampness.Spectrums of disease are different in different regions,thus,speci fi c and appropriate principles should be adopted accordingly.