Post on 18-Mar-2021
HeJianXuePaiHeJianDoctrine河間學派
DaoshingNi
Medical Classics, Taoist Medicine, Formulary, and Shang Han Doctrines initiated are considered Classical Doctrines while the doctrines that were developed during Song Dynasty onward are considered Contemporary Doctrines. They are
He Jian Doctrine (Fire-Heat Pathology) Yi Shui Doctrine (Zang-Fu Differentiation) Gong Xie Doctrine (Pathogen Attacking) Dan Xi Doctrine (Excess Yang Deficient Yin) Ming Men Doctrine (Gate of Life) Wen Bing Doctrine (Warmth Disease)
While the last 100 years, the Integrated Medicine Doctrine is considered Modern Doctrine.
Life during the North Song Era 960-1127 AD
Liao Mongolian Tribes
Tibetan Tribes
West Xia
Song
Introduc6onTimeEnvironment
• Song–Jin–YuanDynas6es,960-1368AD• Establishmentofspecial6essuchaspediatricsandgynecology
• Establishmentofspecialtopicsorapproachtodiseases
JinYuanFourMajorPhysicians⾦金金元四⼤大医家
Liu, Wan Su 刘完素
He Jian Xue Pai He Jian Doctrine
Zhang, Cong Zheng 张从正
Gong Xie Xue Pai Detoxification Doctrine
Li, Gao (Li, Dong Yuan) 李杲 (李东垣)
Pi Wei Xue Pai Spleen-Stomach Doctrine Part of Yi Shui Xue Pai
Zhu, Zhen Heng (Zhu, Dan Xi) 朱震亨 (朱丹丹溪)
Dan Xi Xue Pai Dan Xi Doctrine
SpecificTimeandPlace
• SongJinDynas6es宋⾦金金时代 • War6me• Dr.Liu,WanSu刘完素 • Born1,110AD,HeJiancountyofHeBeiProvince
• NorthernChina,
Thefoundingenvironment
• CenteredaroundFire-HeatPathology• DryClimateandtoughweather• IntakeofBeef,lamb,wheat,alcohol.• Toughterrain,toughpeople.• Evenwithwind-cold,frequentlytransformsintoheatordryness.
• DuringSongDynasty–TaiPingHuiMinHeJiJuFang太平惠⺠民和剂局⽅方 –mostlywarmingandtonifying,cannotbeusedwellinheatcondi6ons.
Thefoundingenvironment
• AtSongDynasty,emphasiswasonformulasandlessontheunderstandingofpathogenesis.
• Dr.Liu,WanSu,basedonthefounda6onsfromNeijingandspent35yearsperfec6ngtheFire-Heattheories.
EightDis6nctFeaturesorContribu6onsofLiu,WanSu
1. FrequencyofFire-HeatPathology火热⼴广泛 2. “SixQicanalltransformtoFire”Doctrine六⽓气皆能化火3. ExtremeofFiveEmo6onscreateHeat五志过极皆为热 4. TreatmentofFire-HeatPathology火热病的治法5. YangQiStagnancy阳⽓气怫郁6. WuYunLiuQiPathology五运六⽓气病机7. KangHaiChengZhiDiscussion亢害承制论 8. Elabora6onofZaBing杂病的发挥
1.FrequencyofFire-HeatPathology
• Originatesfromchapter74ofNeijingSuwenEssen6alsofDiseaseandTherapy
• Neijing19E6ologies(NeijingBingJiShiJiuTiao内经病机⼗十九条)
HuangDiinquired,“Canyoupleasedescribethepathologyforeachorgansystemanditsconnec6onwiththeatmosphericinfluences?”
QiBoresponded,”Symptomsoftremorsandshakingofthelimbs,dizziness,andver6goareusuallycausedbywindandassociatedwithliver.Manycondi6onsofcontrac6onandspasmsareusuallyduetocoldandassociatedwiththekidneys.”………
WuZangBiJi–FiveZangE6ologyWuYunBingJi–FiveCyclesE6ology
All Wind Vertigo Liver
All Cold contractures Kidney
All Qi asthma/congestion Lung
All Damp swelling fullness Spleen
All pain, itch, rash Heart
NeijingSuwenNineteenE6ologies
• Fain6ngandseizure,lockjawandshivers,acutevomi6ng,manicandrestlessness,edemaandpainareduetofire.(5)
• Abdominaldistensionandswelling,borborygmusandtympani,vomi6ngoffoulmaierandacidregurgita6onandacutedysenterywithbloodystools,bodytorsionandturbidsecre6onsareusuallyduetoheat(4)
• 5belongstozang,1wind,1damp,1cold,1upper,1lower
Fire-HeatPathologyExpansion
• Eventuallyexpandedto56typesofFire-HeatE6ologyoccupying80%ofalle6logies.
56typesofFire-HeatPathology
• Asthma,vomi6ng,acidregurgita6on,acutediarrhea,bodytorsion,turbidurina6on,asciteswithtympani,rash,hives,opensores,tumor,nodules,fain6ng,swelling,nasalconges6on,epistaxis,hematemesis,bloodystools,feverandchill,shivers,fright,confusion,sadness,manic,restlessness,throatpain,6nnitus,hearingloss,blurryvision,sneezing,acutedisorders,delirium,etc.
2.SixQicanalltransformtoFire
• Wind,damp,dryness,andcoldcanalltransformtofire.
• Windoriginatesfromheat,heatisben本 andwindisbiao标,windcannotexistswithoutheat.
• Ingeneralpathology,windtendstocombinewithheat.
InthecaseofVer6go
MetalWeakness
Metal cannotcontrol Wood
Wood over-abundance
Wood createsFire
Wind and Fireare Yang in
nature
Combines andmutually
feeding eachother
Yang energieslike to move
Createsvertigo,
dizziness
Therefore the treatmentshould be pungent and cool
DampandFire-Heat
• Dampdiseasedoesnotoccuronitsown.• Itisduetofire-heatstagnancycausingbodyfluidtostagnantcrea6ngwater-damp
• Mostclinicalmanifesta6onsareswelling.• Mostswellingisduetodamp-heatcombina6oncrea6ngsluggishurina6on.
• Theherbsshouldbepungentbiierandcold
DrynessandFire-Heat
• Drynessconsumesyinfluidandfrequentlytransformstofire-heat.
• Bodyfluiddeficiency,blooddeficiency,yindeficiencycanallcausehyperac6vityofyangcrea6nginternalheat.
• Winteriscoldandcontrac6ngandstagnantinnature.ThereisactuallymoredrynessthanSummermonths.
• Nourishyintocoolheat
ColdandFire-heat
• Excludingyangdeficiency(interiorcold)• Twopossiblescenarios
Wind ColdInvasion
Yang QiStagnancy
No dispersioncreates Heat
Extreme ofCold
Transformsto Heat
ExtremeofFiveEmo6onscreatesHeat五志过极皆为热
• Liu,WanSuisrecognizedofhisworkinexogenousfire-heatdiscussions,but
• Hehasalsodidsomeworkinunderstandingsofinternalheatthroughthe“extremeoffiveemo6onscreatheat”.
• Fiveemo6onalimbalancescancauseheatandheatcancausefiveemo6onalimbalances.
Anger Qi stasisstasis creates fire
Overexcitation
Overworrying
Sadness
Fear
Feeds Heart Fire
Qi stasisstasis creates fire
Qi stasisstasis creates fire
Kidney Water WeakensHeat Fire Rises
Fright Heart MovementMovement creates fire
4.TreatmentofFire-HeatPathology火热病的治法
• BiaoZheng表证 • LiZheng⾥里里证
BiaoZheng表证
• Pungentcoolingorsweetcold• MaHuangandGuiZhiarenotsuitable• FrequentlyuseGanCao⽢甘草,HuaShi滑⽯石,CongBai葱⽩白,DouChi⾖豆豉.
• BiaoZhengwithNeiRe,useFangFengTongShengSan防⻛风通圣散,ShuangJieSan双解散.
• OruseTianShuiSan天⽔水散+LiangGeSan凉膈散
FangFengTongShengSan防⻛风通圣散
• FangFeng,ChuanXiong,DangGui,ShaoYao,DaHuang,MangXiao,LianQiao,BoHe,MaHuang,ShiGao,JieGeng,HuangQin,BaiZhu,ZhiZi,JingJie,HuaShi,GanCao,ShengJiang.
• 防⻛风,川芎, 当归,芍药,⼤大黄,芒硝,连翘,薄荷,⿇麻黄,⽯石膏,桔梗,黄芩,⽩白术,栀⼦子,荆芥,滑⽯石,⽢甘草,⽣生姜。
• Dispersewindrelievebiao,cleanseheatandpurge.
ShuangJieSan双解散
• TianShuiSan+FangFengTongShengSan• Measles,BiaoLiExcess
TianShuiSan天⽔水散
• LiuYiSan六⼀一散,YiYuanSan益元散,TaiBaiSan太⽩白散。
• HuaShi6,ZhiGanCao1,honey• 滑⽯石6,炙⽢甘草1• Summerdampwithfever,restlessness,thirst,sluggishurina6onwithpain,SanJiaodampheat.
LiangGeSan(CoolDiaphragm)凉膈散
• LianQiao,DaHuang,MangXiao,ZhiZi,HuangQin,BoHe,GanCao.连翘,⼤大黄,芒硝,栀⼦子,黄芩,薄荷,⽢甘草。
• CookwithZhuYe⽵竹叶 andHoney.• ClearUpperandMiddleJiaoheat.• HeartFire,restlessness,thirst,redeyes,ver6go,drymouth,cankersores,crackedlips,hematemesis,epistaxis,cons6pa6on,sluggishurina6on,infan6leseizure.
LiZheng⾥里里证 • Purga6onofFire-Heat• ThreeScenarios
– BiaoZhenggone,NeiRewithabdominaldisten6on,restlessness,pulsedeepexcess.
– Deepheattoxincrea6ngdrythroat,asthma,abdominalpains,pulsedeepthready.
– Dampheat.• DaChengQiTang⼤大承⽓气汤 orSanYiChengQiTang三⼀一承⽓气汤
• HuangLianJieDuSan黄连解毒散• SmalldoseofHuangLienJieDuSan黄连解毒散orLiangGe
San凉膈散
DaChengQiTang⼤大承⽓气汤
• DaHuang,HouPu,ZhiShi,MangXiao.• ⼤大黄,厚朴,枳实,芒硝。 • Cons6pa6on,fever,wirypulse,delirium,asthma;shanghancons6pa6onfor5-6days.
• Acuteappendici6s,acuteintes6nalobstruc6on,acutecholecys66s.
SanYiChengQiTang三⼀一承⽓气汤
• DaHuang,HouPu,ZhiShi,MangXiao,GanCao,ShengJiang.
• ⼤大黄,厚朴,枳实,芒硝,⽢甘草,⽣生姜。 • BiaoandLiFire-HeatPathology.
HuangLianJieDuTang黄连解毒汤
• HuangLian,HuangBo,HuangQin,ZhiZi• Ac6on:clearheat,relievetoxin,reduceswelling.
• AllFire-Heatpathology,BothBiaoandLiFire-Heat,manic,restlessness,drythroat,drymouth,dryheaves,insomnia,hematemesisorepistaxis.
5.YangQiStagnancy阳⽓气怫郁
• Liu,WanSu’sfocusisnotonlyonFire-Heatpathology,butalsothepatencyflowofQi.
• ThegreatDaohasnoshapeorform.WithoutQi,nolifecanexists;transforma6onofQigivesbirthofalllives;changesofQicreateschangesinlives;abundanceofQistrengthentheorganism;deficiencyofQiweakenstheorganism;normalQipromotesharmoniouslives;derangedQicreatesdiseases;termina6onofQicausesthedeathoflife.
5.YangQiStagnancy阳⽓气怫郁
• IfYangQiisstagnant,Fire-Heatdevelopscrea6ngmanydifferentpathologies.
• Twodefini6ons.
Imbalance of LiuQi and Wu Zhi
Creates YangQi Stagnancy
Fire-HeatFormation
Actual Yang Re All Pathologies
TreatmentofYangQiStagnancy
• Xuan,Qing,Tong宣清通三法 • Disperse,Cleanse,Openmethodologies• Pungent,Biier,ColdHerbs
– Xuan–toclearbiao,notswea6ng,toclearstagnancy–pungentcoolherbs
– Qing–toclearstagnantheat–biiercoldherbs– Tong–mainlypurging–pungent,biier,coldherbs
6.WuYunLiuQiBingJiXueShuoFiveCycles,SixQiPathology
• Eventhoughhumanbeingscanmastertheirenvironmentandcreatesamicro-climateforherself,climate,weather,andenvironmentalchangesares6llveryinfluen6alincausingortriggeringdiseasesandimbalances.
• FiveCycles–fiveelementalorfivezanginfluences
Overabundanceof Earth
Overacting onWater
Water cannotcontrol Fire Fire Pathology
Stomachache,acid
regurgitation,abdominaldistension,
rash and itch
Overabundanceof Fire
Overacting onMetal
Metal cannotcontrol Wood
WindPathology
Vertigo andspasms
Overabundanceof Wood
Overacting onEarth
Earth cannotcontrol Water Cold Pathology
Diarrhea, coldextremities
Overabundanceof Water
Overacting onFire
Fire cannotcontrol Metal
DrynessPathology
Cough, dryskin, dry
mouth, throat
Overabundanceof Metal
Overacting onWood
Wood cannotcontrol Earth
DampPathology
Swelling,borborygmus,
lethargy
7.KangHaiChengZhiDiscussion亢害承制论
• WuYunLiuQiinter-suppor6ngandinter-controlling.
• Toensureseekingforbalanceinconstantimbalance.
Ben Qi 本⽓气 Original Qi
Huo Qi 火⽓气 Fire Qi
Zao Qi 燥⽓气 Dryness Qi
Han Qi 寒⽓气 Cold Qi
Feng Qi ⻛风⽓气 Wind Qi
Re Qi 热⽓气 Heat Qi
Shi Qi 湿⽓气 Damp Qi
Zhong Qi 中⽓气 Middle Qi
Jueyin 厥阴 LV
Taiyin 太阴 SP
Shaoyin 少阴 HT
Shaoyang 少阳 GB
Taiyang 太阳 UB
Yangming 阳明 ST
Biao Qi 标⽓气 Manifestation Qi
Shaoyang 少阳 GB
Yangming 阳明 ST
Taiyang 太阳 UB
Jueyin 厥阴 LV
Shaoyin 少阴 HT
Taiyin 太阴 SP
8.Furtherelabora6ononmiscellaneousdiseases
• HuangDiSuWenXuanMingLunFang– AlsoknownasXuanMingLunFang
• 黄帝素问宣明论⽅方 • 1172AD• 15chapters,348formularies• FangFengTongShengSan防⻛风通圣散 • DiHuangYinZi地黄饮⼦子 • GuiLingGanLuYin桂苓⽢甘露饮 • 66%combina6onofwarmingandcoolingherbs• 21%warming,13%cooling
DiHuangYinZi地黃飲子
• 生地 ShengDi3liang• 巴戟天 BaJiTian1liang
• 山茱萸 ShanZhuYu1liang
• 肉蓯蓉 RouCongRong1liang
• 石斛 ShiHu1liang• 炮附子 FuZi1liang• 茯苓 FuLing1liang
• 石菖蒲 ShiChangPu1liang
• 遠志 YuanZhi1liang• 肉桂 RouGui1liang• 麥冬 MaiDong1liang• 五味子 WuWeiZi.5liang
• 生薑 ShengJiang• 大棗 DaZao• 薄荷 BoHe
DiHuangYinZi地黃飲子
• TonifyKidneyBenefitEssence
• NourishHeartOpenOrifice
• Stroke,LossofSpeech,especiallyKidneyYinandKidneyYangDeficiencytypes
• LocomotorAtaxia-syphilisofthespinalcordcharacterizedbydegenera6onofsensoryneuronsandstabbingpainsinthetrunkandlegsandunsteadygaitandincon6nenceandimpotence
• Meniere’sSyndrome• Hyperthyroidism• Neurasthenia• ChronicNephri6s• Infer6lity
GuiLingGanLuYin桂苓甘露飲
• LiuYiSan六一散– HuaShi滑
石
– GanCao甘草
• WuLingSan五苓散– GuiZhi桂枝– FuLing茯苓– ZeXie澤瀉– ZhuLing豬苓– BaiZhu白朮
• HanShuiShi寒水石• ShiGao石膏
Liu Yi San + Wu Ling San + Han Shui Shi, Shi Gao 六一散 + 五苓散 + 寒水石,石膏
HeJianXuePai
• Establishedfounda6onsfor– PathogenAiackingDoctrine– DanXiDoctrine– WarmthDiseaseDoctrine
Fever
• Anadap6vemechanism,feveristhebody'sreac6ontopathogens;itaiemptstoraisecorebodytemperaturetolevelswhichwilldenature,debilitate,orkillthepathogen.Mostfeversarecausedbyinfec6onsandalmostallinfec6ousdiseasescancausefever.Whenapa6enthasorissuspectedofhavingafever,thatperson'sbodytemperatureismeasuredusingathermometer.Ifsuccessfulinriddingthebodyofaninvasivepathogen,feverisanimportantprotec6veimmunemechanismandshouldgenerallynotbesuppressed.However,thereareinstanceswhenfeverescalatestotemperatureswherethebodyisatriskofdestroyingitsowncellsandmustbebroughtundercontrolwithsuppressivemedica6on.
infec6on
• Aninfec6onisthedetrimentalcoloniza6onofahostorganismbyaforeignspecies.Aninfec6onis,ineffect,awarinwhichtheinfec6ngorganismseekstou6lizethehost'sresourcesinordertomul6plyattheexpenseofthehost.Theinfec6ngorganism,orpathogen,interfereswiththenormalfunc6oningandperhapsthesurvivalofthehost.Colloquially,apathogenisusuallyconsideredamicroscopicorganismthoughthedefini6onisbroader,includingbacteria,parasites,fungi,viruses,prions,andviroids.Thebranchofmedicinethatfocusesoninfec6onsandpathogensisinfec6ousdiseases
Inflamma6on
• Inflamma6onisthefirstresponseoftheimmunesystemtoinfec6onorirrita6onandmaybereferredtoastheinnatecascade.Inflamma6onischaracterizedbythefollowingquintet:redness(rubor),heat(calor),swelling(tumor),pain(dolor)anddysfunc6onoftheorgansinvolved(func6olaesa).
Viral infectious diseases AIDS – AIDS Related Complex – Chickenpox or Varicella – Common cold – Cytomegalovirus Infection – Colorado tick fever – Dengue fever – Ebola haemorrhagic fever – Epidemic parotitis – Flu – Hand, foot and mouth disease – Hepatitis – Herpes zoster – Influenza – Lassa fever – Measles – Marburg haemorrhagic fever – Infectious mononucleosis – Mumps – Poliomyelitis – Progressive multifocal leukencephalopathy – Rabies – Rubella – SARS – Smallpox or variola – Viral meningitis – West Nile disease – Yellow fever Bacterial infectious diseases Anthrax – Bacterial Meningitis – Brucellosis – Bubonic plague – Campylobacteriosis – Cat Scratch Disease – Cholera – Diphtheria – Endometriosis – Epidemic Typhus – Glanders – Gonorrhea – Hansen's Disease – Legionellosis – Leprosy – Leptospirosis – Listeriosis – Lyme Disease – Melioidosis – MRSA infection – Nocardiosis – Pertussis – Pneumococcal pneumonia – Psittacosis – Q fever – Rocky Mountain Spotted Fever or RMSF – Salmonellosis – Scarlet Fever – Shigellosis – Syphilis – Tetanus – Trachoma – Tuberculosis – Tularemia – Typhoid Fever – Typhus – Whooping Cough Parasitic infectious diseases African trypanosomiasis – Amebiasis – Ascariasis – Babesiosis – Chagas Disease – Clonorchiasis – Cryptosporidiosis – Cysticercosis – Diphyllobothriasis – Dracunculiasis – Echinococcosis – Enterobiasis – Fascioliasis – Fasciolopsiasis – Filariasis – Free-living amebic infection – Giardiasis – Gnathostomiasis – Hymenolepiasis – Isosporiasis – Kala-azar – Leishmaniasis – Malaria – Metagonimiasis – Myiasis – Onchocerciasis – Pediculosis – Pinworm Infection – Scabies – Schistosomiasis – Taeniasis – Toxocariasis – Toxoplasmosis – Trichinellosis – Trichinosis – Trichuriasis – Trypanosomiasis Fungal infectious diseases Aspergillosis – Blastomycosis – Candidiasis – Coccidioidomycosis – Cryptococcosis – Histoplasmosis Prion infectious diseases Bovine spongiform encephalopathy – Creutzfeldt-Jakob disease – Kuru
HeJianXuePaiEndingSummary
Contributedtobeierunderstandingofinfec6ousdiseases,inflamma6ons
andmiscellaneousdisorders