Twelve Essentials of Dialectical Thinking in TCM Treatment
Dialectical treatment is a characteristic of TCM, and this characteristic relies on the thinking of TCM.
In the 35 years since I practiced medicine, I have gradually formed my own dialectical thinking mode in the clinical work, and I am willing to discuss with colleagues.
The first syndrome differentiation, pay attention to the first syndrome differentiation, we should first grasp the main syndrome, because the main syndrome is the main point of syndrome differentiation, the focus of treatment.
The main symptoms should be tackled from several aspects.
First, the main symptoms appear in the first sentence of the general question when the patient is appropriate. It is not only the main problem that the patient wants you to solve, but also the main problems of common diseases, such as stomach pain and headache. Second, find the main symptoms in the syndrome.For example, if the patient reports upset, palpitation, dizziness, tinnitus, difficulty falling asleep, obvious insomnia are the main symptoms; third, the patient does not know what the main disease is, and the doctor takes much effort to try to find out the main symptoms and main causes.
Differentiate the nature of the syndrome, pay attention to both syndrome and syndrome, both to identify the disease location, but also to identify the disease.
And identifying the nature of the disease is actually identifying the cold and heat of the disease.
The nature of syndrome differentiation is mainly the nature of syndrome differentiation.
Such as epigastric pain, the disease is located in the stomach, in its comorbidities, hi temperature is cold, hi press is virtual, and together, it is called cold.
Of course, identifying the nature of the disease can also identify tongue coating and pulse.
Such as the pulse Shen Chi weakness, its Shenzhuli, its Chizhuhan, weakness Zhuxu, together to distinguish, called Lixu cold card.
It should be noted that the clinical symptoms have overlapping or opposite symptoms, which requires the doctor to carefully consider, both the main and the definite, the authenticity of the true and false, and the distinction between the disease and the disease.
Dialectical evidence, pay attention to contact dialectics, multi-witness evidence.
Such as hypertensive patients, both cold qi stagnation type epigastric pain, and kidney yang deficiency five more diarrhea.
One is new disease, one is chronic disease; one is empirical evidence, one is deficiency syndrome; one is in the upper abdomen, one is in the lower abdomen; one is warm and scattered, and one is tonic.
Therefore, the selected party not only selected Liangfu pills for stomach pain, but also selected Shenshen pills for diarrhea.
After the epigastric pain is healed, and based on the main selection of Sishen Pill, Zhongtang Decoction is used to treat Wugengxie.
Therefore, in the identification of evidence, we must pay attention to the evidence in the evidence.
Only by grasping the connection between the two types of syndromes can we grasp the mechanisms of primary treatment, concurrent treatment, combined treatment, first treatment, and later treatment.
Differentiate the evidence outside the evidence, pay attention to the so-called evidence outside the evidence, refers to the clinical manifestations of more than two systems of disease syndromes.
Such as internal medicine syndrome, gynecological syndrome, facial features syndrome coexist.
How to tell?
The dialectical principle is that when treating the symptoms of certain system diseases, we must take into account the symptoms of other diseases, especially when the main syndrome and the syndrome are alternate or opposite, we must pay more attention to their complexity and complexityFeatures.
For example, the stomach is cold, the body is hot and humid, and the throat is a real fire. In the case where there are multiple evidences and there is evidence outside the evidence, we must coordinate and take care of each other.
Distinguish the static evidence, pay attention to the law-abiding static evidence, refer to the disease position of the disease, the disease manifests as a constant state period, or qi deficiency, or blood cold, or hot and humid liver disease .Once the syndrome is accurate and the effect can be achieved, the effect will not be better, and the law and the law can be observed.
Distinguish the evidence of dynamics and pay attention to the evidence of dynamics, which means that the clinical manifestations have changed after treatment.
For example, in the wet tropical zone, after the application of Longdan Xiegan Decoction, the amount of bands decreased, the band color changed from yellow to white, the band quality changed from thick to thin, the band taste was light, and the itching was removed, indicating that the damp and hot disease was mild.
At this time, is it more effective, follow the law and continue to consolidate the treatment according to the dampness and heat of the liver, or based on the existing symptoms of whiteness and thinness, and treat it according to the deficiency of the liver, and change to spleen and dampness?
How to make a decision depends on the doctor’s experience, frankness and wisdom, boldness and care, and clinical evidence needs to be flexible.
Distinguish the evidence without evidence, pay attention to the clinical evidence of cryptic evidence.
Such as the asymptomatic “small three-yang”, “big three-yang”, asymptomatic high blood sugar in diabetes, urinary occult blood suggested by laboratory tests, asymptomatic stones indicated by B-ultrasound, hydrocephalus, and early stages of various tumorsBecause they are undocumented, they are all undocumented.
Clinically, according to the individual’s medical history, physical fitness, personality, combined with clinical experience, through various modern physical and chemical testing methods, look for clues, find the hidden disease, from the undocumented can be identified as evidence.
Distinguish the miscellaneous syndromes and pay attention to leveling chronic gastritis. Whenever there is cold and heat in the clinical syndrome, the syndromes are mixed, and you can see that the stomach is full and you like the coldness, and you have dry mouth, bitter mouth, and yellow greasy heat.For example, you can see oral ulcers or dry stools. From this evidence of mixed heat and cold, I choose Banxia Xiexin Decoction and use the method of warming and clearing to balance the function of gastric epigastric regulation.
The same is true for treating falsehoods and falsehoods, and raising and lowering the syndromes.
Identify valid evidence and pay attention to the course of treatment. For patients who are effective after treatment, pay attention to the course of medication.
If you have a cold or heat syndrome, the course of the disease should be short, and the course of treatment should also be short.
For chronic patients, the clinical evidence may not be more effective, or make some fine-tuning to make the treatment gradually better.
It can be taken once a day, or once every other day, or even taken twice a day for two days.For slippery patients, the course of treatment is taken more than 1 month after the patient’s last abortion.
For patients with tremor syndrome, take long-term intervals to reduce the toxic and side effects of western medicine to increase the effectiveness of anti-tremor.
Differentiate the invalid evidence. Pay attention to the patients who are invalid after examining the drugs.
They belong to those who have no errors in dialectical medicine. Many of them have a long course of disease, and the evil spirit points to the same. The original prescription should be adhered to, and the prescription should not be changed easily, otherwise it will become more chaotic.
And for those who are wrong in dialectical use of drugs, they should carefully examine their causes, take immediate action and correct them in a timely manner.
Distinguish the evidence of first effect and then invalidation, and pay attention to the evolution of clinical evidence of first effect and then ineffectiveness, that is, the effect of taking a few doses is good, and the effect is not ideal.
There are two possibilities for this situation: one is that the medicine is strained but not changed, and it is the responsibility of the doctor, such as the type of cold and heat mixed in the stomach fullness.The suffering has stopped, indicating that the thermal image has been eliminated, and the deficiency of cold syndrome has become the main contradiction. After taking the Banxia Xiexin Decoction, its medicinal properties are cold, so it is not effective. When using Huangqi Jianzhong Tang, Lizhong Tang, Sijun TangThe second kind may be caused by the patient’s own factors, such as diet, living, emotional changes, etc. The doctor should help the patient find the cause, guide the patient to take the medicine, and pay attention to the conditioning method during the medication.
Distinguish the evidence of exacerbation after the drug, pay attention to the trial because of the patient’s exacerbation after taking the drug, in addition to improper use of drugs, there is also a conflict between the drug nature and the disease appears to worsen the condition.
The clinical permit must be treated differently and carefully.
Improper medication should be done in a timely manner.
Contestants of drugs and diseases should inform the patient before taking the medicine.
For those who have adverse reactions after the drug, find out the cause, or reduce the dosage, or change the time, or increase or decrease the Chinese medicine, or stop observation.
In short, we must take it seriously, and we must not take care of it.