Treatment Based Upon Syndrome Differentiation
Treatment based upon syndrome differentiation is the distinguishing feature of
TCM, and represents the application of TCM theories in clinical practice. It also is the manifestation of the philosophy of dialectic materialism.
Syndrome differentiation refers to analyzing and summarizing the relevant information gathered from the four diagnostic methods (inspection,auscultation and olfaction ,interrogation ,and pulse feeling and palpation), and considering this information in the context of a particular syndrome in order to probe into the essence of the disease. Treatment involves establishing the appropriate therapeutic principles and methods based upon this analysis. Syndrome differentiation is the premise and basis of treatment, while treatment is the medium and method of curing disease.
Syndrome, or symptom complex, is different from symptom. Symptom refers to the
clinical manifestation of disease, such as cough, vomiting, or headaches. Syndrome, on the other hand, refers to the pathological generalization of a group of closely related symptoms on a given stage in the couse of disease development. Because a syndrome can demonstrate the specific part, reason, property, and relationship of the evils and the body resistance and essence of pathological change at a given point of the disease's development,it can provide a more multi-faceted view of the development and essence of a disease than a symptom.
A syndrome derives the typical status of a reaction process within a body. No matter how complicated the evils are, a specific body is always affected and subject to reaction based upon them. The structure and mechanism of the body is limited,as is the typical reaction status. Clinically, a TCM doctor obtains pathological information directly from his observations, then analyzes and summarizes the information. Finally, the functional status of the patient is distinguished, providing the foundation for syndrome differentiation.Thus ,disease is understood in terms of the bodies reactivity ,and it is recognized that the inherent relationship of clinical manifestations is one of analyzing the existing symptoms
and signs.
It is important to point out that TCM uses a series of qualitative analysis methods in which to separate aspects of the body from one whole unit into two units. This practice is an effective and efficient method of grasping principal contradiction inherent in all things. Applied to medicine ,the added ability of this method to analyze and discriminate is immeasurable.
Treatment based on syndrome differentiation is the basic principle of diagnosis of disease. One disease may include several different syndromes, and conversely, different diseases may exhibit the same syndrome in the course of their development. Thus, TCM may treat different diseases with the same therapeutic method ,or it may treat the same disease with different methods.
Treatment of the same disease with different methods may differ due to the
patient's constitution, climatic and seasonal changes, geographical localities, or differences in manifestation or pathogenesis. For example, in the initial stage of measles, a therapy of expelling the evils from-the body and promoting the eruption of measles should be used;in the middle stage of the condition, treatment should involve clearing away the patient's lung-heat ;while in the later stages ,a remedy should be used to nourish yin and clear away heat in order to treat the surplus heat and impairment of stomachyin and lung-yin.
In the alternate case treating different diseases with the same therapeutic principle the diseases exhibit a syndrome with the same characteristics. For instance, chronic dysentery ,and prolapse of the rectum and uterus ,are different diseases, but exhibit the same syndrome of sinking middle-qi at a certain pathological stage of development.Thus, both can be treated with the prescription of nourishing and elevating middle-qi.Heart diseases ,nephritis ,and asthma all exhibit syndromes such as soreness and weakness in the loin and knees ,cold limbs and cold feelings of the body caused by the deficiency and impairment of kidney-yang. All of these diseases can be treated with the prescription of warming and invigorating the kidney-yang.
TCM not only pays attention to the similarities and differences of diseases,but also places an emphasis on the similarities and differences between syndromes. The inner essence of treatment based upon syndrome differentiation is to adopt different problemsolving methods in response to different qualities of contradictions in the course of diseasedevelopment.
Chapter 74 in Plain Questions states: "It is imperative to observe the conditions of yin and yang and to make yin and yang balance. "Physiologically, the imbalance of yin and yang includes excess and deficiency, and the aim of treatmest lies in regulating and assisting the control system of the body ,and reestablishing normal dynamic balance. Thus,the therapeutic methods of TCM always pay close attention to both the positive and negative sides. Treatment aims to study the corresponding relationship between given syndromes and given prescriptions and herbs. It dispels the evils without impairment of the body resistance,nourishes yang without impairment of yin,and strengthens the body resistance to eliminate the evils. Deficient syndromes are treated with invigorating herbs,while excess syndromes are given purging herbs. Likewise,cold-syndromes are given hotnatured herbs,heat-syndromes are treated with herbs of a cool or cold nature. The governor of water is strengthened to restrain the hyperactivity of yang,and the source of fire is boosted to eliminate an abundance of yin.
In conclusion,the body is closely related to its external envirenment,and an organic whole of unity of opposites. Based upon this premise,TCM observes the reaction status of the body and its surrounding, and attempts to understand the essence of disease from clinical symptoms. It seizes upon the principal contradiction of the reaction status of the body,and makes the body reestablish new relative balance, thus curing disease by applying dynamic balance theory and many different types of therapeutic methods.
Brief Summary :
This Chapter has dealt with the basic concepts , contents, laws, and methods of TCM, thus providing a foundation for dealing with other TCM topics. The philosophical basis of the theoretical system of TCM is ancient dialectic materialism. The fundamental characteristics of TCM are ˘Ůthe holistic concept,and ˘Útreatment based upon syndrome differeniation. The holistic concept, the integrity and unity of the body, and the integral relationship between the body and the natural environment all are central to an full understanding of TCM.
