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1 第七章 辨证 Syndrome differentiation 辨证就是在中医基础理论指导下, 将四诊收集的症状和体征进行分析 综合, 对疾病当前的病理本质作出判断, 并概括为具体名称的诊断过程 Syndrome differentiation is a basic approach of recognizing and diagnosing diseases in TCM, through analyzing and differentiating symptoms and signs, we recognize the nature of diseases and make the diagnosis. 辨证 八纲辨证 Eight principles 气血津液阴阳病辨证 Qi, blood and body fluid 脏腑辨证 Differentiation in Zang and Fu 外感病辨证 Exogenous diseases

2 第三节脏腑病辨证 Syndrome differentiation on Zang-fu 脏腑病辨证是指运用脏腑经络 气血津液阴阳及病因的相关理论, 分析四诊所搜集得症状 体征等资料, 以辨明疾病所在的脏腑部位 原因 性质以及邪正盛衰的一种辨证方法 简言之, 即以脏腑的相关理论为依据, 对四诊资料进行分析的辨证方法 Syndrome differentiation on Zang-fu organs refers to the thinking method that the physician analysis the symptoms and signs from the four diagnostic by the related theories of Zang-fu organs, so as to clear the location of lesion, to find out the causative factors, to determine the nature of a disease, to judge the prosperity or declining of vital energy or pathogenic evil.

3 一 心与小肠病辨证 Differentiation in heart and S.I 心居胸中, 外有心包络裹护 心的主要生理功能是主血和藏神, 开窍于舌, 其华在面 心的病变主要表现在血液运行和神志活动的异常, 因此心脏病的常见症状有心悸怔忡, 心痛, 心烦, 失眠, 神昏, 神志错乱, 口舌生疮等 小肠病的常见症状为小便赤涩灼痛, 尿血 The main physiological function of the heart is dominating blood and houses mind, opens to tongue, and manifestoes on the face. It s pathogenic changes mainly refers to the irregulations of blood circulation and mental activities including such symptoms as palpitation, cardiac pain, irritability, insomnia, unconsciousness, mental disorder, moth or tongue ulcer. The common symptoms of the small intestine is burning pain in urination, and hematuria.

4 ( 一 ) 心气虚证 Heart Qi deficiency 概念 心气不足, 鼓动无力所表现的证候 It refers to the heart qi deficiency fails to promote the blood circulation. 临床表现 心悸或怔忡, 动则尤甚, 伴见精神疲惫, 气短, 身倦乏力, 自汗面色淡白, 舌淡苔白, 脉虚弱或结代 Palpitation with the aggravation whenever moving, accompanied with lassitude, short of breath, fatigue, spontaneous sweating, pale face, pale tongue with white coating, deficient and feeble pulse. 1 以心气不足, 鼓动无力为主要病机 It is the main pathogenesis that the heart qi deficiency fails to promote the blood circulation. 2 以心悸和气虚症状并见为辨证依据 It is the main pathogenesis that the palpitation and Qi deficiency exist simultaneously. 3 有身倦乏力, 自汗, 气短, 面色淡白等气虚的一般症状 Short of breath, fatigue, spontaneous sweating, short of breath, and pale face. 4 有心悸或怔忡, 动则尤甚, 脉虚弱或结代等心病的症状 Palpitation with the aggravation whenever moving, deficient and feeble pulse

5 ( 二 ) 心阳虚证 Heart Yang deficiency 概念 心阳虚衰, 失其温养, 虚寒内生所表现的证候 It refers to heart yang deficiency failure in warming, and then deficient cold produced. 临床表现 心悸或怔忡, 动则尤甚, 伴见心胸憋闷, 疼痛, 气短, 自汗, 形寒肢冷, 面色白光白或面唇青紫, 舌质淡胖, 苔白滑, 脉弱或结代 Palpitation with the aggravation whenever moving, oppression in the chest, hypopnea, cold extremities, spontaneous sweating, brightly whitish complexion, or purple lips, pale enlarged tongue with white slippery coating, soft and intermittent pulse. 1 以心阳虚衰, 虚寒内生为主要病机 It is the main pathogenesis that heart yang deficiency failure in warming, and then deficient cold produced. 2 以心气虚和寒象症状并见为辨证依据 It is the main pathogenesis that the heart qi deficiency and cold manifestation exist simultaneously. 3 心阳虚多由心气虚发展而来, 故见心悸或怔忡, 气短, 自汗, 脉弱或结代等心气虚的症状 Palpitation, hypopnea, spontaneous sweating due to Qi xu 4 有形寒肢冷, 面色白光白, 舌淡胖, 苔白滑等虚寒的症状 cold extremities, brightly whitish complexion, pale enlarged tongue with white slippery coating,

6 ( 三 ) 心阳暴脱证 Heart Yang collapse 概念 心阳衰极, 阳气突然外脱所表现的证候 It refers to the heart Yang is extremely deficient and suddenly collapse outward. 临床表现 在心阳虚证临床表现的基础上, 突然冷汗淋漓, 四肢厥冷, 呼吸微弱, 面色苍白, 或心痛剧烈, 口唇青紫, 神志昏糊, 或昏迷不醒, 舌淡紫, 脉微欲绝 Under the condition of heart yang deficiency, the patient suddenly appears profuse cold sweating, extremely cold extremities, weak respiration, pale face, or severe cardiac pain, purple lips and mouth, unconsciousness or coma, pale purple tongue with thread indistinctive pulse. 1 以心阳衰极, 突然外脱为主要病机 It is the main pathogenesis that the heart Yang is extremely deficient and suddenly collapse outward. 2 以心阳虚和亡阳症状并见为辨证依据 It is the main pathogenesis that the heart yang deficiency and Yang exhaustion exist simultaneously. 3 有冷汗淋漓, 四肢厥冷, 呼吸微弱, 面色苍白, 或心痛剧烈, 口唇青紫, 舌淡紫, 脉微欲绝, 甚至神志昏糊, 或昏迷不醒等心功能突然严重衰竭的症状 profuse cold sweating, extremely cold extremities, weak respiration, pale face, or severe cardiac pain, purple lips and mouth, unconsciousness or coma, pale purple tongue with thread indistinctive pulse.

7 ( 四 ) 心血虚证 Heart blood deficiency 概念 心血不足, 失其濡养功能所表现的证候 It refers to the heart blood deficiency fails to nourish the body. 临床表现 心悸, 失眠多梦, 健忘, 面色淡白而无华, 或萎黄不泽, 头晕目眩, 唇舌淡白, 脉细无力 Palpitation, insomnia and dreaminess, poor memory(amnesis), pale complexion, dizziness and vertigo, pale tongue and lips, thread and feeble pulse. 1 以心血不足, 心神失养为主要病机 It is the main pathogenesis that the heart blood deficiency fails to nourish the heart mind. 2 以心悸, 失眠多梦, 健忘和血虚症状并见为辨证依据 It is the main pathogenesis that the patient suffers with palpitation, insomnia and dreaminess, poor memory. 3 有面色淡白而无华, 或萎黄, 头晕目眩, 唇舌淡白, 脉细无力等血虚证的症状 pale complexion, dizziness and vertigo, pale tongue and lips, thread and feeble pulse. 4 有心悸, 失眠多梦, 健忘等心神失养的症状 Palpitation, insomnia and dreaminess, poor memory are due to malnourishment of heart mind.

8 ( 五 ) 心阴虚证 Heart yin deficiency 概念 心阴耗损, 虚热内扰所表现的证候 It refers to the heart yin deficiency produces the internal deficient heat. 临床表现 心悸, 心烦, 失眠多梦, 形体消瘦, 口燥咽干, 颧红盗汗, 午后潮热, 五心烦热, 舌红少津, 脉细数 Palpitation, irritability, insomnia and dreaminess, emaciated physique, dry mouth and throat, reddish cheek(flushing in zygomatic region) and night sweating, afternoon tidal fever, five center heat, dry and red tongue with thread and rapid pulse. 1 以心阴耗损, 虚热内扰心神为主要病机 It is the main pathogenesis that the consumption of heart Yin leads to deficient heat stirs heart mind. 2 以心悸, 心烦, 失眠多梦和虚热症状并见为辨证依据 It is the main pathogenesis that the palpitation, insomnia and deficient heat symptoms exist simultaneously. 3 有形体消瘦, 口咽干燥, 颧红盗汗, 五心烦热, 舌红少津, 脉细数虚热证的症状 emaciated physique, dry mouth and throat, reddish cheek and night sweating, five center heat, dry and red tongue with thread and rapid pulse. 4 有心悸, 心烦, 失眠多梦等为心病的症状 Palpitation, irritability, insomnia and dreaminess.

9 ( 六 ) 心火亢盛证 Excessive heart fire 概念 心火内炽所表现的证候 The heart fire inflames inside the body. 临床表现 心烦, 失眠, 甚则狂躁谵语, 或口舌生疮, 或吐血, 衄血, 伴发热, 口渴喜冷, 尿少色黄或灼痛, 大便秘结, 面色红赤, 舌尖红赤, 舌苔黄, 脉数有力 Irritability, insomnia, even mania and delirium, or mouth and tongue ulcer, or hematemesis, epistasis, accompanied with fever, thirst with the preference for cold drinking, yellow and scanty urine, constipation, red tip of the tongue with yellow coating, rapid pulse. 1 以心火内炽为主要病机 The heart fire inflames inside the body is the main pathogenesis. 2 以心的常见症状与实热证的一般表现共见为辨证依据 It is the main pathogenesis that the heart symptoms and excessive heat symptoms exist simultaneously. 3 有发热, 口渴, 饮冷, 小便短赤或灼痛, 大便秘结, 舌尖红赤, 苔黄, 脉数有力等热证的症状 以及吐血, 衄血等出血症状 fever, thirst with the preference for cold drinking, yellow and scanty urine, constipation, red tip of the tongue with yellow coalting, rapid pulse. 4 有心烦, 失眠, 甚则狂躁谵语等火热内扰心神的心病症状 Irritability, insomnia, even mania and delirium

10 ( 七 ) 心脉痹阻证 Heart vessel obstruction 概念 各种致病因素导致心脉痹阻不通, 血行不畅所表现的证候 It refers to the heart vessels obstruction or blood stagnation. 临床表现 心悸怔忡, 心胸憋闷疼痛, 痛引肩背内臂, 时作时止 或见痛如针刺, 舌紫暗, 或有瘀斑 瘀点, 脉涩或结代 ( 瘀血 ); 或见心胸闷痛, 体胖多痰, 身重困倦, 舌胖苔厚腻, 脉沉滑 ( 痰浊 ); 或见心胸剧痛, 得温痛减, 畏寒肢冷, 舌淡苔白润, 脉沉迟或沉紧 ( 寒凝 ); 或见心胸胀痛, 因情志波动而加重, 喜太息, 舌淡红或暗红, 脉弦 ( 气滞 ) Palpitation or severe palpitation, oppression in chest, choking depressed pain on the pericardium radiating to the shoulder, the back and the medial side of left forearm; stabbing pain with dark purple tongue with ecchymosed, choppy or knotted pulse; depressed pain in chest, fat physique and much sputum, sluggishness, enlarged tongue with thick greasy coating, deep slippery pulse; or sudden attack of severe pain relieved with warming, aversion to cold and cold extremities, pale tongue with white coating, deep slow or tense pulse; or distending pain in chest with the aggravation of emotional changes, sighing, red or deep red tongue with wiry pulse.

11 1 以心脉痹阻不通为主要病机 Heart vessels obstruction is key pathogenesis. 2 以心悸怔忡, 心胸憋闷疼痛的心病症状为辨证依据 It is the main pathogenesis that the patient suffers with palpitation,depressed pain in the chest. 3 有舌紫暗或有瘀斑 瘀点, 脉涩或结代等血瘀证的一般症状 Stabbing pain with dark purple tongue with ecchymosed, choppy or knotted pulse. 4 因痰浊阻痹心脉所致者, 可见心胸闷痛, 体胖多痰, 身重困倦, 舌胖苔厚腻, 脉沉滑 ; 若因阴寒凝滞心脉所致者, 可见心胸剧痛, 得温痛减, 畏寒肢冷, 舌淡苔白润, 脉沉迟或沉紧 ; 若因气滞, 心脉痹阻者, 可见心胸胀痛, 喜太息, 上述症状因情志波动而诱发或加重, 舌淡红或暗红, 脉弦等 Depressed pain in chest, fat physique and much sputum, sluggishness, enlarged tongue with thick greasy coating, deep slippery pulse are due to phlegm retention; sudden attack of severe pain relieved with warming, aversion to cold and cold extremities, pale tongue with white coating, deep slow or tense pulse are due to cold coagulation; distending pain in chest with the aggravation of emotional changes, sighing, red or deep red tongue with wiry pulse are caused by Qi stagnation.

12 ( 八 ) 痰蒙心神证 Phlegm stirring heart mind 概念 痰浊蒙闭心神, 以致精神 情志失常所表现的证候 It refers to the phlegm confuses heart mind and leads to the mental disorder. 临床表现 神志模糊, 甚则昏不知人 ; 或精神抑郁, 表情淡漠, 神志痴呆, 喃喃独语, 举止失常 ; 或突然仆倒, 不省人事, 四肢抽搐, 目睛上视, 口吐涎沫, 喉中痰鸣, 伴见面色晦滞, 胸脘满闷, 呕恶, 舌苔白腻, 脉滑 Mental confusion even unconsciousness; or depression, dull complexion, metal dementia, soliloquy, abnormal behavior; or abrupt falling down, coma, convulsion, starring eyes(fixed eyeballs upward), saliva overflowing from the mouth, sputum rumbling in the throat as the sounds of swine or sheep, accompanied with dull complexion, oppression in chest and abdomen, nausea, white greasy coating with slippery pulse. 1 以痰浊内盛, 蒙闭心神为主要病机 Excessive phlegm retention confuses heart mind. 2 以痰浊内盛和神志失常并见为辨证依据 phlegm retention and mental disorder 3 有神志模糊, 精神抑郁, 神识痴呆, 或突然昏扑, 不省人事等心神失常的要点 Mental confusion, depression, metal dementia, or abrupt falling down with unconsciousness 4 有喉中痰鸣, 胸闷呕恶, 苔腻脉滑等痰证的一般症状 sputum rumbling in the throat, oppressive chest and nausea, greasy coating and slippery pulse.

13 ( 九 ) 痰火扰神证 Phlegm fire disturbing heart mind 概念 痰火扰乱心神, 以致神志异常所表现的证候 It refers to the phlegm fire disturbs heart mind and leads to the mental disorder. 临床表现 心烦失眠, 重则神昏谵语或语言错乱, 哭笑无常, 狂躁妄动, 打人毁物, 伴见发热气粗, 面红目赤, 口渴喜冷, 吐痰黄稠或喉中痰鸣, 舌红苔黄腻, 脉滑数 Irritability and insomnia, even unconsciousness and delirium or divagation, being capricious in laughing and crying, attacking behavior; accompanied with fever and hyperpnea, reddish face and eyes, thirst with the preference for cold drinking, yellow and sticky sputum, or sputum rumbling in the throat, red tongue with yellow greasy coating,slippery and rapid pulse. 1 以痰火搏结, 扰乱心神为主要病机 Phlegm fire disturbs heart mind. 2 以痰火内盛和神志失常并见为辨证依据 Excessive phlegm fire and mental disorder. 3 有心烦失眠, 神昏谵语或语言错乱, 狂躁妄动等神志异常的症状 Irritability and insomnia, even unconsciousness and delirium or divagation, capricious 4 有吐痰黄稠, 喉中痰鸣, 发热气粗, 面红目赤, 口渴喜冷, 舌红, 苔黄腻, 脉滑数等痰火内盛的症状 yellow and sticky sputum, or sputum rumbling in the throat, fever and hyperpnea, reddish face and eyes, thirst with the preference for cold drinking red tongue with yellow greasy coating,slippery and rapid pulse.

14 ( 十 ) 小肠实热证 Excessive heat in Small Intestine 概念 心移热于小肠所表现的证候 It refers to the heart fire has been transformed into the small intestine. 临床表现 心烦, 口舌生疮, 小便涩痛色黄, 尿道灼热, 或尿血, 口渴, 舌尖红赤, 苔黄, 脉数 Irritability, ulcers in mouth and tongue, scanty dark urine with burning pain, or hematuria, thirst, red tip of the tongue, yellow coating and rapid pulse. 1 以心火炽盛, 下移小肠为主要病机 It is the main pathogenesis that the excessive heart fire has been transformed into the small intestine. 2 以心烦, 口舌生疮, 尿赤, 尿道灼热等症状为辨证依据 It is the main pathogenesis that the patient suffers Irritability, ulcers in mouth and tongue, scanty dark urine with burning pain, 3 有口渴, 舌红苔黄, 脉数等实热证的一般症状 thirst, red tip of the tongue, yellow coating and rapid pulse.

15 二 肺与大肠病辨证 Differentiation in lung and L.I. 肺居胸中, 上连气道, 开窍于鼻, 外合皮毛 肺的生理功能是主管呼吸, 辅心行血, 通调水道 肺病的常见症状有咳嗽, 气喘, 吐痰, 胸痛, 咯血, 声音嘶哑, 鼻塞流涕和水肿等 肺与大肠相表里 大肠为 传导之官, 能吸收水分, 排泄糟粕 大肠病的主要症状有便秘, 泄泻, 便血等 The main physiological function of the lung is in charge of breathing, supplements heart for blood circulation, and regulates the water metabolism. It s common manifestation as cough, asthma, sputum expectoration, chest pain, hemoptysis, celostomia, ruuning liquid nose, edema.

16 ( 一 ) 肺气虚证 Lung Qi deficiency 概念 肺气不足而致功能活动减弱所表现的证候 It refers to the lung Qi deficiency failure in opening and descending. 临床表现 咳喘无力, 气短, 动则益甚, 咳痰清稀, 语声低微, 神疲乏力, 懒言, 自汗, 易感冒, 面色淡白, 舌淡苔白, 脉弱 Feeble cough and dyspnea aggravated by movements, thin sputum, lower voice, lassitude and fatigue, unwilling to speak, spontaneous sweating, liability to catch cold, pale face, pale tongue with white coating, deficient pulse. 1 以肺气不足, 宣降无力为主要病机 It is the main pathogenesis that the lung Qi deficiency failure in opening and descending. 2 以咳喘无力, 吐痰清稀和气虚症状并见为辨证依据 It is the main pathogenesis that the patient suffers feeble cough and dyspnea, and thin sputum. 3 有神疲乏力, 懒言, 自汗, 面色淡白, 易感冒, 舌淡苔白, 脉弱等气虚证的一般症状 Lassitude and fatigue, unwilling to speak, spontaneous sweating, liability to catch cold, pale face, pale tongue with white coating, deficient pulse., 4 有咳喘无力, 气短, 咳痰清稀, 语声低微等呼吸功能减弱的症状 Feeble cough and dyspnea, thin sputum, lower voice are the weak function of breath.

17 ( 二 ) 肺阴虚证 Lung Yin deficiency 概念 肺阴亏耗, 虚热内扰, 肺失清肃所表现的证候 It refers to the lung Yin deficiency produces internal deficient heat.. 临床表现 干咳无痰, 或痰少而粘, 不易咯出, 甚或痰中带血, 胸痛, 声音嘶哑, 口干咽燥, 形体消瘦, 颧红, 盗汗, 五心烦热, 舌红少苔或无苔, 脉细数 或伴见气短乏力, 神疲倦怠等症状 Cough with little sticky sputum or no sputum, or blood stained sputum, chest pain, hoarseness, dry throat, emaciated physique, red cheek, night sweating, five center heat, red tongue with little or no coating, thread rapid pulse; or accompanied with hypopnea and fatigue, lassitude. 1 以肺阴亏耗, 虚热内扰为主要病机 lung Yin deficiency, internal deficient heat 2 以干咳或痰少而粘和虚热症状并见为辨证依据 Cough with little sticky sputum 3 有五心烦热, 颧红盗汗, 口干咽燥, 形体消瘦, 舌红少苔或无苔, 脉细而数等阴虚内热的症状 dry throat, emaciated physique, red cheek, night sweating, five center heat 4 有干咳, 咯血, 胸痛, 音哑等肺病的症状 Cough dry,hemoptysis, chest pain and hoarseness 5 若伴见气短, 乏力, 神疲倦怠, 则为肺的气阴两虚证 Hypopnea and fatigue, lassitude are due to both Qi and Yin deficiency.

18 ( 三 ) 风寒束肺证 Wind cold tightening the lung 概念 风寒之邪, 侵袭肺表, 肺卫失宣所表现的证候 It refers to the wind cold evil invades the body surface, lung qi fails to open and descend. 临床表现 咳嗽, 痰清稀色白, 甚或胸闷气喘, 喉痒, 恶寒, 微有发热, 鼻塞流清涕, 或身痛无汗, 舌苔薄白, 脉浮紧 Cough with white thin sputum, or chest oppression and asthma, itching in the throat, cold aversion, mild fever, stuff nose or running liquid nose, or body pain without sweating, thin white coating, floating and tense pulse. 1 以风寒外袭, 肺卫失宣为主要病机 wind evil invades the body surface, lung qi fails to open and descend 2 以咳嗽, 痰液清稀和风寒在表之象并见为辨证依据 3 有恶寒, 微有发热, 鼻塞流清涕, 或身痛无汗, 舌苔薄白, 脉浮紧等表寒证的一般症状 cold aversion, mild fever, stuff nose or running liquid nose, or body pain without sweating, thin white coating, floating and tense pulse. 4 有咳嗽, 痰清稀色白, 甚或胸闷气喘, 喉痒等为肺病的症状

19 ( 四 ) 风热犯肺证 Wind heat invading the lung 概念 风热之邪侵袭肺卫所表现的证候 It refers to the wind heat evil invading the lung and superficial areas. 临床表现 咳嗽, 痰稠色黄, 鼻塞流黄浊涕, 咽喉肿痛, 发热, 微恶风寒, 口微渴, 舌边尖红, 苔薄黄, 脉浮数 Cough with yellow thick sputum, turbid nasal discharge, sore throat, fever, mild aversion to cold, little thirst, red tip of the tongue with thin yellow coating, floating and rapid pulse. 1 以风热外袭, 肺卫失常为主要病机 the wind heat evil invading the lung and superficial areas. 2 以咳嗽, 痰黄稠和风热在表之象并见为辨证依据 Cough with yellow thick sputum, turbid nasal discharge, and superficial heat syndrome. 3 有发热, 微恶风寒, 口微渴, 鼻塞流黄涕, 舌边尖红, 苔薄黄, 脉浮数等表热证的一般症状 fever, mild aversion to cold, little thirst, red tip of the tongue with thin yellow coating, floating and rapid pulse 4 有咳嗽, 痰稠色黄, 或咽喉肿痛等肺病症状 Cough with yellow thick sputum, and sore throat belong to lung problem.

20 ( 五 ) 燥邪犯肺证 Dryness invading the lung 概念 燥邪侵犯肺卫, 肺的津液受伤所表现的证候 It refers to the dryness evil attacks lung and consumes the body fluid. 临床表现 干咳无痰或少痰, 痰粘难咯, 甚则胸痛, 痰中带血, 口 唇 鼻 咽干燥, 小便短少, 大便干结, 或身热微恶风寒, 少汗或无汗, 苔薄而干燥少津, 脉浮数或浮紧 Dry cough with little or no sputum, difficult to expectorate, even chest pain, bloody sputum, dry mouth, lips, nose and throat, scanty urine and constipation; or fever and mild aversion to cold, little sweating or no sweating, thin and dry coating with little moistened, floating rapid or tense pulse. 1 以燥邪侵袭, 肺卫受伤为主要病机 dryness evil attacks lung 2 以肺系症状和干燥少津之象并见为辨证依据 lung symptoms and dryness 3 有见口 唇 鼻 咽干燥, 小便短少, 大便干结, 苔薄而干燥少津燥邪伤津的一般症状以及干咳无痰, 或少痰, 痰粘难咯, 甚则胸痛, 痰中带血等肺病的症状 dry mouth, lips, nose and throat, scanty urine and constipation and dry cough with little or no sputum, difficult to expectorate, even chest pain, bloody sputum. 4 有发热, 微恶风寒, 少汗或无汗, 脉浮等表证的症状 fever and mild aversion to cold, little sweating or no sweating, floating pulse

21 ( 六 ) 热邪壅肺证 Heat retention in the lung 概念 热邪炽盛, 内壅于肺所表现的证候 It refers to the excessive heat is accumulated inside the lung. 临床表现 咳嗽, 痰稠色黄, 气喘息粗, 鼻翼煽动, 或胸痛, 咳吐脓血腥臭痰, 或衄血, 咳血, 伴见壮热, 口渴饮冷, 烦躁不安, 面赤, 大便干燥, 尿少色黄, 舌红苔黄, 脉滑数 Cough with yellow thick sputum, dyspnea and hyperpnea, fanning nose; or chest pain, cough with foul pus and blood; or epistasis, hemoptysis; Accompanied with hectic fever, thirst with preference for cold drink, irritability, red face, constipation and yellow scanty urine, red tongue with yellow coating, slippery and rapid pulse. 1 以热邪炽盛, 内壅于肺为主要病机 Excessive heat is accumulated in the lung. 2 以里热炽盛和肺病症状并见为辨证依据 internal excess heat and lung symptom 3 有壮热, 口渴饮冷, 烦躁不安, 面赤, 大便干燥, 尿少色黄, 舌红苔黄, 脉滑数里热炽盛的症状 hectic fever, thirst with preference for cold drink, irritability, red face, constipation and yellow scanty urine, red tongue with yellow coating, slippery and rapid pulse. 4 有咳嗽, 痰稠色黄, 或胸痛, 咳吐脓血痰, 气喘息粗, 鼻翼煽动, 或衄血, 咳血等肺病的症状 Cough with yellow thick sputum, dyspnea and hyperpnea, fanning nose; or chest pain, cough with foul pus and blood; or epistasis, hemoptysis.

22 ( 七 ) 寒痰阻肺证 Cold phlegm blocking the lung 概念 寒邪与痰浊交并, 壅阻于肺所表现的证候 It refers to the turbid phlegm blocks in the lung. 临床表现 咳嗽气喘, 痰稀色白量多, 胸闷, 或喘哮痰鸣, 形寒肢冷, 舌淡苔白, 脉濡缓或滑 Cough and asthma with profuse white sticky sputum, oppressive chest, dyspnea and sputum rale in the throat, cold feeling in four extremities, pale tongue with white coating, soft and moderate or slippery pulse. 1 以寒痰交阻, 壅滞于肺为主要病机 The turbid phlegm blocks in the lung. 2 以咳喘痰多突然发作和寒象并见为辨证依据 Acute onset of cough and asthma with profuse white sticky sputum, as well as cold manifestation. 3 有如形寒肢冷, 舌淡苔白, 脉濡缓或滑等里寒证的症状 cold feeling in four extremities, pale tongue with white coating, soft and moderate or slippery pulse. 4 有咳嗽气喘, 痰稀色白量多, 胸闷, 或喘哮痰鸣等肺病的症状 Cough and asthma with profuse white sticky sputum, oppressive chest, dyspnea and sputum rale in the throat

23 ( 八 ) 痰湿阻肺证 Phlegm retention blocking the lung 概念 痰浊阻塞于肺, 以致肺气上逆所表现的证候 It refers to the turbid phlegm obstructs in lung resulting in the reversed ascending of lung qi. 临床表现 咳嗽痰多, 色白而粘, 易于咯出, 胸闷, 甚则气喘痰鸣, 舌淡苔白腻, 脉滑 Cough with profuse white sticky sputum, which is easy to be expectorated out, oppressive chest, even dyspnea and sputum rale in the throat, pale tongue with white greasy coating, slippery pulse. 1 以痰湿阻塞于肺, 肺气上逆为主要病机 The turbid phlegm obstructs in lung resulting in the reversed ascending of lung qu. 2 以咳嗽痰多色白, 易咯出, 而寒热之象不明显为辨证依据 Cough with profuse white sticky sputum, which is easy to be expectorated out, and without cold or heat manifestation. 3 有咳嗽痰多, 易于咯出, 胸闷, 甚则气喘痰鸣, 舌淡苔白腻, 脉滑等肺病的症状 Cough with profuse white sticky sputum, which is easy to be expectorated out, oppressive chest, even dyspnea and sputum rale in the throat are due to lung problem.

24 ( 九 ) 大肠湿热证 Damp heat retention in Large Intestine 概念 湿热邪气阻滞大肠, 以致大肠传导失司所表现的证候 It refers to the damp heat evil obstructs in L.I. resulting in the irregulation of transportation in L.I. 临床表现 腹痛, 下痢脓血, 里急后重, 或暴注下泻, 气味秽臭, 肛门灼热, 尿少色黄, 或口渴, 或发热, 舌红苔黄腻, 脉濡数或滑数 Abdominal pain, dysentery with pus and beeding, tenesmus, or abrupt violent diarrhea with foul yellow stool, burning sensation in the anus, yellow and scanty urine, or thirsty, or fever, red tongue with yellow and greasy coating, soft rapid or slippery rapid pulse. 1 以湿热阻滞大肠, 传导失司为主要病机 The damp heat evil obstructs in L.I. resulting in the irregulation of transportation in L.I. 2 以下痢或泄泻和湿热之象并见为辨证依据 dysentery or diarrhea and damp heat 3 发热, 口渴, 尿少色黄, 舌红苔黄腻, 脉濡数等湿热内盛的表现 Fever, thirsty, yellow and scanty urine, red tongue with yellow and greasy coating, soft rapid or slippery rapid pulse indicate internal damp heat. 4 有腹痛, 下痢脓血, 里急后重, 或暴注下泻等大肠病的症状

25 ( 十 ) 大肠液亏证 Fluid insufficiency in Large Intestine 概念 津液不足, 大肠失其濡润所表现的证候 It refers to the body fluid deficiency fails to nourish the Large intestine. 临床表现 大便秘结干燥, 难以排出, 常数日一行, 或伴见口臭, 头晕, 口咽干燥, 舌红少津, 脉细涩 Constipation with dry stool, or only one defecation in several days, or accompanied with foul smell, dizziness and blurred version, dry mouth and throat, red and dry tongue with thread and choppy pulse. 1 以津液不足, 大肠失润为主要病机 The body fluid deficiency fails to nourish the L.I. 2 以大便燥结, 难以排出和津亏失润之象并见为辨证依据 Dry stool and body fluid deficiency failure in moistening the L.I. 3 有口咽干燥, 舌红少津, 脉细涩等津液亏损失润之燥象 Dry mouth and throat, red and dry tongue with thread and choppy pulse. 4 有大肠液亏, 传导失司之大便秘结干燥, 难以排出, 常数日一行等大肠病的症状 Constipation with dry stool, or only one defecation in several days- L.I. 5 可兼见浊气上逆之口臭, 头晕 Foul smell and dizziness due to reversed qi

26 ( 十一 ) 肠虚滑脱证 Large Intestine collapse due to deficiency 概念 大肠阳气虚衰, 失于固摄, 以致大肠滑脱失禁所表现的证候 It refers to the Yang Qi deficiency fails to control L.I. 临床表现 泻下无度, 或大便滑脱失禁, 甚则脱肛, 腹痛隐隐, 喜温喜按, 形寒肢冷, 舌淡苔白滑, 脉沉弱 Loose control of diarrhea, or incontinent defecation even prolapsed of rectum, slight pain in abdomen with the preference for hot compress, cold feeling in four extremities, pale tongue with white slippery coating, deep and weak pulse. 1 以大肠阳衰, 滑脱不禁为主要病机 Yang Qi deficiency and incontinent defecation 2 以泻下无度和虚寒之象并见为辨证依据 Loose control of diarrhea and cold 3 有腹痛隐隐, 喜温喜按, 形寒肢冷, 舌淡苔白滑, 脉沉弱等虚寒的症状 slight pain in abdomen with the preference for hot compress, cold feeling in four extremities, pale tongue with white slippery coating, deep and weak pulse. 4 有泻下无度, 或大便滑脱失禁, 甚则脱肛等大肠病的症状 Loose control of diarrhea, or incontinent defecation even prolapsed of rectum due to L.I.

27 三 脾胃病辨证 Differentiation in Spleen and Stomach 脾胃共处中焦, 为表里关系 脾主运化水谷, 胃主受纳腐熟, 脾主升, 胃主降, 共同完成饮食物的消化 吸收与输布 脾为气血生化之源, 又能统摄血液 脾的病变常见症状有腹胀腹痛, 泄泻或便溏, 浮肿, 出血, 肢体倦怠等 胃病常见的症状有胃脘疼痛, 恶心, 呕吐, 呃逆, 嗳气等 The main physiological function of the spleen and stomach is in charge of transportation and transformation. The coordination of spleen in ascending and stomach in descending will promote the digestion, absorption, and distribution of the food.the common pathogenic changes of spleen mainly refers to the abdominal distension and pain, diarrhea or loose stool, edema, bleeding and sluggishness, while the stomach relates with gastric pain, nausea and vomiting, hiccup and belching.

28 ( 一 ) 脾气虚证 Spleen Qi deficiency 概念 脾气不足, 运化失常所表现的证候 It refers to the spleen Qi deficiency fails to transportation and transformation. 临床表现 纳少, 腹胀, 饭后尤甚, 大便溏薄, 肢体倦怠, 少气懒言, 面色萎黄无华, 形体消瘦, 或浮肿, 舌淡苔白, 脉缓弱 Poor appetite, abdominal distension aggravated by feeding, loose stool, fatigue, hypopnea and unwilling to speak, yellow and atrophic face, emaciated physique, or edema, pale tongue with white coating, moderate and feeble pulse. 1 以脾气不足, 运化失常为主要病机 the spleen Qi deficiency fails to transportation and transformation. 2 以纳少, 腹胀, 便溏和气虚症状并见为辨证依据 Poor appetite, abdominal distension, loose stool, and Qi deficiency. 3 有肢体倦怠, 少气懒言, 面色萎黄无华, 舌淡苔白, 脉缓弱等气虚证的症状 fatigue, hypopnea and unwilling to speak, yellow and atrophic face, pale tongue with white coating, moderate and feeble pulse 4 有纳少, 腹胀, 便溏, 消瘦, 浮肿等脾虚症状

29 ( 二 ) 脾气下陷证 Spleen Qi prolapsed syndrome 概念 脾虚无力升举, 反而下陷所表现的证候 It refers to the spleen Qi deficiency fails in ascending, but reversed collapse downward. 临床表现 脘腹重坠作胀, 便意频数, 或久泄不止, 或脱肛, 子宫下垂, 胃下垂, 或小便如米泔 伴见纳少, 少气乏力, 肢体倦怠, 声低懒言, 头晕目眩, 舌淡苔白, 脉弱 Epigastric distension and sinking, frequent inclination to urination and defecation or chronic diarrhea, or prolapsed of rectum, uterus and stomach;or turbid urine as rice water,. Accompanied with poor appetite, hypopnea and fatigue, sluggishness, lower voice and unwilling to speak, dizziness and blurred vision, pale tongue with white coating, deficient and feeble pulse. 1 以脾气虚, 升举无力而陷下为主要病机 Spleen Qi deficiency fails in ascending, but reversed collapse downward. 2 以脾气虚和下陷症状并见为辨证依据 spleen Qi deficiency and sinking symptoms 3 有纳少, 肢体倦怠, 声低懒言, 头晕目眩, 舌淡苔白, 脉弱等脾气虚证的症状 poor appetite, sluggishness, lower voice and unwilling to speak, dizziness and blurred vision, pale tongue with white coating, deficient and feeble pulse. 4 有内脏下垂, 如胃下垂, 子宫脱垂, 脱肛, 以及便意频数, 或久泄不止, 小便如米泔等气陷特征 prolapsed of rectum, uterus and stomach and other organs

30 ( 三 ) 脾不统血证 Spleen failing to control blood 概念 脾气不足, 统血无权, 血溢出脉外所表现的证候 It refers to the spleen Qi deficiency fails in controlling the blood circulation.. 临床表现 便血, 尿血, 崩漏, 或月经量多, 或皮下出血 伴见纳少, 便溏, 神疲乏力, 少气懒言, 舌淡苔白, 脉细弱 Hemafecia, hematuria, metrorrhagia and metrostaxis, or profuse menstruation, or subcutaneous hemorrhage; accompanied with poor appetite, loose stool, lassitude, short of breath and unwilling to speak, pale tongue with white coating, thread and weak pulse. 1 以脾气不足, 统血无权为主要病机 Spleen Qi deficiency fails in controlling the blood circulation. 2 以出血和脾气虚症状为辨证依据 Bleeding and spleen qi deficiency 3 有纳少便溏, 神疲乏力, 少气懒言, 舌淡苔白, 脉细弱等脾气虚的症状 appetite, loose stool, lassitude, short of breath and unwilling to speak, pale tongue with white coating, thread and weak pulse 4 以出血为主症, 有血色淡, 病程长, 病势缓的特点 It is characterized as light color of bleeding with long course and chronic onset.

31 ( 四 ) 脾阳虚证 Spleen Yang deficiency 概念 脾阳虚衰, 阴寒内盛所表现的证候 It refers to the spleen yang deficiency produces the internal cold. 临床表现 腹胀纳少, 腹痛喜温喜按, 大便稀溏, 畏寒肢冷, 面白无华, 或肢体困倦, 或周身浮肿, 小便不利, 或白带量多清稀, 舌淡胖, 苔白滑, 脉沉迟无力 Abdominal distension and poor appetite, abdominal pain with the preference for hot compress, loose stool, cold aversion and cold in extremities, pale face, or fatigue, or edema on whole body, oliguria, or much dilute leucorrhoea, pale and enlarged tongue with white and slippery coating, deep, slow and feeble pulse. 1 以脾阳虚衰, 中焦阴寒内盛为主要病机 the spleen yang deficiency produces the internal cold. 2 以脾气不足和虚寒性症状并见为辨证依据 Spleen qi deficiency and deficient cold 3 有腹胀纳少, 大便稀溏, 肢体困倦, 或周身浮肿, 小便不利, 或白带量多清稀等脾病的症状 Abdominal distension and poor appetite, loose stool, fatigue, edema on whole body, oliguria, much dilute leucorrhoea 4 有腹痛喜温喜按, 畏寒肢冷, 舌淡胖, 苔白滑, 脉沉迟无力等虚寒的症状 abdominal pain with the preference for warm compress, cold aversion and cold in extremities, pale and enlarged tongue with white and slippery coating, deep, slow and feeble pulse.

32 ( 五 ) 脾阴虚证 Spleen Yin deficiency 概念 脾的阴液亏虚, 运化功能失常所表现的证候 It refers to the spleen yin deficiency influences the function of transportation and transformation. 临床表现 不饥不食, 涎少, 腹胀, 消瘦, 伴见五心烦热, 口唇干燥, 大便秘结, 小便短少, 倦怠乏力, 舌红无苔或光剥, 脉细数 Anorexia with little saliva, abdominal distension, emaciation, accompanied with five center heat, dry mouth and lips, constipation and scanty urine, fatigue,red tongue without coating or mirror-like coating, thread and rapid pulse. 1 以脾阴不足, 运化失常为主要病机 Spleen yin deficiency influences the function of transportation and transformation 2 以不饥不食, 腹胀, 大便秘结和阴虚之象并见为辨证依据 Anorexia, abdominal distension, constipation and Yin deficient symptoms. 3 有消瘦, 五心烦热, 口唇干燥, 小便短少, 舌红无苔或光剥, 脉细数等虚热的症状 Emaciation, five center heat, dry mouth and lips, scanty urine, red tongue without coating or mirror-like coating, thread and rapid pulse. 4 有不饥不食, 倦怠乏力, 腹胀, 大便秘结等脾病的症状 Anorexia, fatigue, abdominal distension, constipation due to spleen problem.

33 ( 六 ) 寒湿困脾证 Cold damp embarrassing spleen 概念 寒湿内盛, 中阳受困所表现的证候 It refers to the cold damp retention obstructs the middle-jiao Yang qi. 临床表现 脘腹胀满疼痛, 纳呆, 恶心, 呕吐, 大便溏泄, 肢体困重, 或浮肿, 小便不利 ; 面目肌肤发黄, 色泽晦暗如烟熏, 舌体胖苔白腻, 脉濡缓 Abdominal distension and pain, poor appetite, nausea and vomiting, loose stool, heavy and fatigue in extremities, or edema, oliguria; yellowish face, eyes and skin,or with dark color as steamed, enlarged tongue with white greasy coating, soft and moderate pulse. 1 以寒湿内盛, 中阳困阻为主要病机 cold damp retention obstructs the middle-jiao Yang qi. 2 以脾运失健和寒湿中阻症状并见为辨证依据 spleen failing in transportation and cold damp retention in middle Jiao. 3 有脘腹胀满疼痛, 纳呆, 恶心, 呕吐, 大便溏泄, 或水肿, 肢体困重等脾病的症状 Abdominal distension and pain, poor appetite, nausea and vomiting, loose stool, heavy and fatigue in extremities, or edema, 4 有黄疸晦暗如烟熏, 舌体胖苔白腻, 脉濡缓等寒湿偏盛的症状 Johnish as dark color as steamed, enlarged tongue with white greasy coating, soft and moderate pulse.

34 ( 七 ) 脾胃湿热证 Damp heat stagnated in spleen 概念 湿热内蕴中焦所表现的证候 It refers to the damp heat is accumulated in the middle Jiao. 临床表现 脘腹胀满, 肢体困倦, 小便短黄, 大便溏泄不爽, 纳少厌食, 恶心呕吐, 或面目肌肤发黄, 色泽鲜明如橘子色, 皮肤发痒 ; 或身热起伏, 汗出热不解 ; 舌红苔黄腻, 脉濡数 Abdominal distension, fatigue, yellow and scanty urine, unsmooth stool, poor appetite, nausea and vomiting, or yellowish face, eyes and skin, with bright color as orange, itching skin; or fever maintained after sweating; red tongue with yellow greasy coating, soft and rapid pulse. 1 以湿热蕴阻中焦, 脾胃失常为主要病机 The damp heat is accumulated in the middle Jiao influencing the spleen and stomach. 2 以脾运失健和湿热内阻症状并见为辨证依据 spleen failing in transportation and internal damp heat obstruction 3 有脘腹胀满, 肢体困倦, 尿少色黄, 大便溏泄不爽, 纳少厌食, 恶心呕吐等湿热蕴结脾胃的症状 Abdominal distension, fatigue, yellow and scanty urine, unsmooth stool, poor appetite, nausea and vomiting 4 有黄疸, 身热起伏, 汗出热不解, 舌红苔黄腻, 脉濡数等湿热蕴蒸表现

35 ( 八 ) 胃气虚证 Stomach Qi deficiency 概念 胃气不足, 受纳 腐熟功能减弱, 以致胃失和降所表现的证候 It refers to the stomach Qi deficiency fails receive and digest the food, and then leads to dysfunction of stomach in descending. 临床表现 胃脘隐痛, 或胀痛, 食后胀甚, 按之觉舒, 食欲减退, 时作嗳气, 气短神疲, 倦怠懒言, 舌质淡苔薄白, 脉虚弱 Slight pain around gastric region, or distending pain aggravated after feeding, desired to be pressed, poor appetite, sometimes belching, hypopnea and lassitude, fatigue and unwilling to speak, pale tongue with white coating, deficient pulse. 1 以胃气不足, 纳降失常为主要病机 the stomach Qi deficiency and dysfunction of stomach in descending 2 气虚和胃失和降症状并见为辨证依据 Qi deficiency and dysfunction of stomach in descending 3 有胃脘隐痛, 或胀痛, 食后胀甚, 按之觉舒, 食欲减退, 时作嗳气等胃气亏虚的症状 Slight pain around gastric region, or distending pain aggravated after feeding, desired to be pressed, poor appetite, sometimes belching 4 有气短神疲, 倦怠懒言, 舌质淡苔薄白, 脉虚弱等气虚的症状

36 ( 九 ) 胃阴虚证 Stomach Yin deficiency 概念 胃阴不足, 胃失濡润, 和降失常所表现的证候 It refers to the stomach Yin deficiency fails to nourish and then leads to dysfunction of stomach in descending. 临床表现 胃脘隐隐灼痛, 饥不欲食, 或食而甚少, 或胃脘嘈杂, 脘痞不舒, 或干呕呃逆, 伴见口咽干燥, 大便干结, 小便短少, 舌红少苔或无苔, 脉细而数 Dull and burning stomachache, hunger with little feeding or without appetite, or gastric regurgitation and discomfort, or retching and hiccup, accompanied with dry in mouth and throat, constipation, and scanty urine, red tongue with little or no coating, thread and rapid pulse. 1 以胃阴不足, 纳降失常为主要病机 Stomach Yin deficiency and dysfunction of stomach in descending. 2 胃失和降与阴虚之象并见为辨证依据 dysfunction of stomach in descending. 3 有口咽干燥, 大便干结, 小便短少, 舌红少苔或无苔, 脉细而数等阴虚证的症状 dry in mouth and throat, constipation, and scanty urine, red tongue with little or no coating, thread and rapid pulse are due to yin deficiency. 4 有胃脘隐隐灼痛, 饥不欲食, 或食而甚少, 或胃脘嘈杂, 脘痞不舒, 或干呕呃逆等胃失纳降的症状

37 ( 十 ) 胃阳虚证 Stomach Yang deficiency 概念 胃阳不足, 虚寒内生, 以致胃气失和所表现的证候 It refers to the stomach Yang deficiency produces the internal deficient cold. 临床表现 胃脘绵绵冷痛, 时发时止, 喜温喜按, 泛吐清水, 食少脘痞, 口淡不渴, 倦怠乏力, 畏寒肢冷, 舌质淡嫩或淡胖, 脉沉迟无力 Slight and cold pain in stomach with the preference for warm compress, vomiting with clear water, poor appetite and gastric discomfort, tastelessness and no thirsty, fatigue, cold aversion and cold extremities, pale and tender or enlarged tongue, deep, slow and feeble pulse. 1 以胃阳不足, 失于和调为主要病机 stomach Yang deficiency and dysfunction of stomach in descending. 2 以胃失和降和虚寒症状并见为辨证依据 dysfunction of stomach in descending and deficient cold symptoms. 3 有畏寒肢冷, 口淡不渴, 倦怠乏力, 舌质淡嫩或淡胖, 脉沉迟无力等阳虚内寒证的症状 cold aversion and cold extremities, tastelessness and no thirsty, fatigue, pale and tender or enlarged tongue, deep, slow and feeble pulse. 4 有胃脘绵绵冷痛, 时发时止, 喜温喜按, 泛吐清水, 食少脘痞等胃病的症状 Slight and cold pain in stomach with the preference for warm compress, vomiting with clear water, poor appetite and gastric discomfort.

38 ( 十一 ) 胃热 ( 火 ) 证 Stomach heat (fire) syndrome 概念 胃中火热炽盛, 使胃的功能失常所表现的证候 It refers to the excessive fire inflames inside the stomach affecting the function of stomach. 临床表现 胃脘灼痛, 拒按, 或消谷善饥, 或见口臭, 或牙龈肿痛溃烂, 齿衄, 渴喜冷饮, 大便秘结, 小便短黄, 舌红苔黄, 脉滑数 Burning pain in the epigastrium, refuse to be pressed, or polyorexia, or foul smell, or swelling and erosion or bleeding in the gums, thirst with preference for cold drink, constipation and yellow scanty urine, red tongue with yellow coating, slippery and rapid pulse. 1 以火热炽盛, 胃气失和为主要病机 Excessive fire inflames inside the stomach affecting the function of stomach in descending. 2 以胃脘灼痛及实火内炽症状并见为辨证依据 Burning pain in the epigastrium and the excessive fire inflames inside the stomach 3 有渴喜冷饮, 大便秘结, 小便短黄, 舌红苔黄, 脉滑数等如火热内炽的症状 thirst with preference for cold drink, constipation and yellow scanty urine, red tongue with yellow coating, slippery and rapid pulse. 4 有胃脘灼痛, 拒按, 消谷善饥, 口臭, 或牙龈肿痛溃烂, 齿衄等火热灼胃的症状 Burning pain in the epigastrium, refuse to be pressed, or polyorexia

39 ( 十二 ) 胃寒证 Stomach cold deficiency 概念 寒邪犯胃, 使胃的功能失常, 以胃脘冷痛为主症的证候 It refers to the cold evil invades the stomach, and leads to mainly stomachache. 临床表现 胃脘冷痛, 痛势剧烈, 拒按, 得温稍减, 遇冷痛剧, 或恶心呕吐, 畏寒肢冷, 口淡不渴, 舌淡苔白润, 脉弦或沉紧 Severe cold pain in epigastrium, refused to be pressed, aggravated by cold and alleviated by warmth, or nausea and vomiting, cold aversion and cold extremities, tastelessness an no thirsty, pale tongue with white moistened coating, wiry or deep tense pulse. 1 以寒邪犯胃, 或胃阳不足为主要病机, 故有实寒与虚寒之分 Cold evil invades the stomach, or stomach Yang deficiency, 2 以胃脘冷痛, 遇冷痛剧为辨证依据 cold pain in epigastrium,aggravated by cold 3 有形寒肢冷, 口淡不渴, 舌淡苔白润, 脉弦或沉紧等寒证的症状 cold aversion and cold extremities, tastelessness an no thirsty, pale tongue with white moistened coating, wiry or deep tense pulse. 4 有胃脘冷痛, 痛势剧烈, 拒按, 得温稍减, 遇冷痛剧, 或恶心呕吐等寒凝气机, 胃气失和的症状 Severe cold pain in epigastrium, refused to be pressed, aggravated by cold and alleviated by warmth or nausea and vomiting

40 ( 十三 ) 食滞胃肠证 Food stagnation in stomach and intestine 概念 饮食停滞胃肠而表现为食积的证候 It refers to the indigested food is remained inside the stomach and intestine. 临床表现 脘腹胀闷疼痛, 拒按, 厌食, 嗳腐酸馊 ; 或呕吐酸腐食臭, 吐后胀痛减轻 ; 或肠鸣矢气, 大便溏泄, 泻下物酸腐臭秽, 舌苔厚腻, 脉滑 Distending pain in the epigastrium, refused to be pressed, anorexia and eructation with fetid odor and acid regurgitation; distending pain can be relieved after vomiting with fetid and indigested food; or borborygmus, putrid or rotten stool, thick greasy coating, slippery pulse. 1 以饮食停滞, 胃肠失调为主要病机 food stagnation and irregulation of st. and I 2 以脘腹胀满疼痛, 呕吐酸腐食臭为辨证依据 Distending pain in the epigastrium and vomiting with fetid and indigested food 3 有脘腹胀闷疼痛, 拒按, 厌食, 嗳腐酸馊 ; 或呕吐酸腐食臭, 舌苔厚腻, 脉滑等食滞于胃的症状 Distending pain in the epigastrium, refused to be pressed, anorexia and eructation with fetid odor and acid regurgitation; distending pain can be relieved after vomiting with fetid and indigested food 4 有肠鸣矢气, 大便溏泄, 泻下物酸腐臭秽等食伤于肠, 传导失常的表现

41 ( 十四 ) 胃腑气滞证 Qi stagnation in stomach 概念 胃气壅滞, 和降失常所表现的证候 It refers to the stomach qi stagnation fails to descending. 临床表现 胃脘胀满疼痛, 拒按, 嗳气, 呃逆, 恶心, 呕吐, 不思饮食, 大便秘结, 或腹胀肠鸣, 舌苔白, 脉弦涩 Epigastric distention and pain, refused to be pressed, belching and hiccup, nausea and vomiting, anorexia, constipation, or abdominal distension and borboryhmus, white coating, wiry and choppy pulse. 1 本证以胃气壅滞, 失于和降为主要病机 The stomach qi stagnation and dysfunction of stomach in descending. 2 以胃脘胀满疼痛, 脉弦涩为辨证依据 Epigastric distention and pain,wiry pulse 3 可见胃脘胀满疼痛, 嗳气, 呃逆, 恶心, 呕吐等气滞胃腑, 失于和降的定位症状 Epigastric distention and pain, refused to be pressed, belching and hiccup, nausea and vomiting

42 ( 十五 ) 胃腑血瘀证 Blood stagnation in stomach 概念 瘀血积滞胃腑所表现的证候 It refers to the blood stasis in stomach. 临床表现 胃脘疼痛如针刺, 或如刀割, 固定不移, 痛处拒按, 进食后加剧, 伴有食少, 消瘦, 或吐血, 或大便色黑, 面色紫暗, 舌紫暗, 或有瘀斑 瘀点, 脉涩 Epigastric stabbing pain as puncturing or knife-cutting, the pain is fixed with tenderness and aggravation after feeding; accompanied with poor appetite, emaciation, or hematemesis, or dark blood stool, purple dark face, purple and dark tongue or with ecchymosis and blood marks, choppy pulse. 1 以胃腑血行瘀阻为主要病机 The blood stasis in stomach 2 以胃脘疼痛和瘀血之象并见为辨证依据 Gastric pain and blood stagnation 3 有疼痛固定不移, 痛处拒按, 面色紫暗, 舌紫暗, 或有瘀斑 瘀点, 脉涩等瘀血证的一般症状 The pain is fixed with tenderness, purple dark face, purple and dark tongue or with ecchymosis and blood marks, choppy pulse. 4 有胃脘疼痛如针刺, 或如刀割, 食少, 消瘦, 或吐血, 或大便色黑等胃病症状 Epigastric stabbing pain as puncturing or knife-cutting, accompanied with poor appetite, emaciation, or hematemesis, or dark blood stool.

43 ( 十六 ) 胃肠实热证 Excessive heat in stomach and intestine 概念 邪热入里, 与肠中糟粕相搏, 燥屎内结所表现的证候 It refers to the heat evil enters the intestine and combines with the remained feces.. 临床表现 高热, 或日晡热甚, 腹部硬满疼痛, 拒按, 大便秘结, 或热结旁流, 气味恶臭, 汗出口渴, 甚则神昏谵语, 狂乱, 小便短黄, 舌红苔黄燥, 或焦黑起芒刺, 脉沉实有力 High fever, or afternoon fever, abdominal fullness and pain with tenderness, constipation or fecal impaction due to heat with fetid watery discharge, sweating and thirsty, even unconsciousness and delirium, mania, yellow scanty urine, red tongue and yellow dry coating, or dark sprinkled tongue, deep forceful pulse. 1 以胃肠实热炽盛为主要病机 Excessive heat retention in stomach and intestine. 2 以腹部硬满疼痛, 大便秘结和里热炽盛之象并见为辨证依据 abdominal fullness and pain, constipation, and internal excess heat retention. 3 有高热, 或日晡热甚, 汗出口渴, 甚则神昏谵语, 狂乱, 尿少色黄, 舌红苔黄燥, 或焦黑起芒刺, 脉沉实有力等里热炽盛的症状 High fever, or afternoon fever, sweating and thirsty, even unconsciousness and delirium, mania, yellow scanty urine, red tongue and yellow dry coating, or dark sprinkled tongue, deep forceful pulse. 4 有腹部硬满疼痛, 拒按, 大便秘结, 或热结旁流, 气味恶臭等热炽肠胃的症状 fecal impaction due to heat with fetid watery discharge

44 四 肝与胆病辨证 Differentiation on Liver and G.B. 肝位于右胁, 其生理功能为疏通全身气机和藏血 肝病常见的症状有胸胁 乳房 少腹胀痛或窜痛, 头部胀痛, 头晕目眩, 情志抑郁, 或急躁易怒, 肢麻手颤, 四肢抽搐, 消化异常, 以及目疾, 月经不调, 睾丸疼痛等 胆附于肝, 为中精之府, 其生理功能为贮藏胆汁, 排泄胆汁, 以助消化 胆病常见症状有口苦, 黄疸, 惊悸, 胆怯等 The main physiological function of the liver is in charge of promotion of free flow of whole body s Qi and storing the blood. The common pathogenic changes of liver mainly refers to the distending or running pain in the chest, hypochondriac region, breast or lower abdomen. Headache, dizziness and vertigo, depression, or irritability or easy to get angry, numbness or trembling in hands, indigestion, or eye problem, irregular menstruation, or testis pain.

45 ( 一 ) 肝气郁结证 Liver Qi stagnation 概念 肝失疏泄, 气机郁滞所表现的证候 It refers to the liver qi fails to promote the free flow of Qi resulting in the Qi stagnation. 临床表现 胸胁 少腹胀痛或窜痛, 胸闷善太息, 情志抑郁或易怒, 或咽喉如梗, 吞之不下, 吐之不出 ; 或瘿瘤 ; 或妇女乳房胀痛, 或月经不调, 痛经或闭经 ; 或形成癥块 ; 舌苔薄白, 脉弦或涩 Distending or unfixed pain in the hypochondriac, chest or lower abdomen,oppressive chest with signing, depression or anger, obstruction in the throat with the feeling of difficult to swallow and spit, or goiters, or in female distending pain in the breast, or irregular menstruation, dysmenorrhea, or amenorrhea. Or masses; pale tongue with white coating, wiry or choppy pulse. 1 以肝失疏泄, 气机郁滞为主要病机 Liver qi stagnation failure in promotion. 2 以情志抑郁, 胸胁 少腹胀痛或窜痛, 脉弦为辨证依据 depression and pain 3 有胸胁 少腹胀痛或窜痛, 胸闷善太息, 情志抑郁或易怒, 脉弦等肝病症状 Distending or unfixed pain in the hypochondriac, chest or lower abdomen,oppressive chest with signing, depression or anger due to liver.

46 ( 二 ) 肝火上炎证 Liver fire inflaming upward 概念 肝火炽盛, 气火上逆所表现的证候 It refers to the excessive liver fire inflames upward. 临床表现 头晕胀痛, 耳鸣如潮, 或突然耳聋, 耳内流脓肿痛, 或两目赤肿, 急躁易怒, 胁肋灼痛, 口苦, 不寐, 或噩梦纷纭, 面红目赤, 或吐血, 衄血 ; 大便秘结, 小便短黄, 舌红苔黄, 脉弦数 Dizziness and distending pain, tinitus as tide, or sudden deaf with swelling and pus in the ears, or swollen and congested eyes, irritation and anger, burning pain in the hypochondriac region, bitter in the mouth, insomnia, or nightmares, flushed face and reddish eyes, or hematemesis and epistasis; constipation, yellow and scanty urine, red tongue and yellow coating, wiry pulse. 1 以肝火炽盛, 气火上逆为主要病机 excessive liver fire inflaming 2 以肝经循行部位实火炽盛为辨证依据 fire inflaming in liver meridians 3 有头晕胀痛, 耳鸣如潮, 或突然耳聋, 耳内流脓肿痛, 或两目赤肿, 或胁肋灼痛, 急躁易怒, 口苦等肝经火盛的症状 Dizziness and distending pain, tinitus as tide, or sudden deaf with swelling and pus in the ears, or swollen and congested eyes, irritation 4 可兼见不寐, 噩梦纷纭, 面红目赤, 或吐血, 衄血, 大便秘结, 尿少色

47 ( 三 ) 肝血虚证 Liver blood deficiency 概念 肝血不足, 所属组织器官失养所表现的证候 It refers to the liver blood deficiency fails to nourish the organs and tissues. 临床表现 头晕目眩, 面白无华或萎黄, 爪甲不荣, 视物模糊, 或夜盲 ; 或肢体麻木, 关节拘急不利, 手足震颤 ; 或妇女月经量少, 色淡, 甚则闭经, 舌淡, 脉细 Dizziness and blurred vision, pale and atrophic complexion, pale nails, blurred eyesight, or night blindness, or numb limbs and tense tendons, trembling on extremities; or in female menstruation with scanty and light colored discharge or even amenorrhea, pale tongue with thread pulse. 1 以血液不足, 肝失所养为主要病机 blood deficiency fails to nourish the organs 2 以筋脉 头目 爪甲失养和血虚症状并见为辨证依据 pale nails, dizziness 3 有面白无华或萎黄, 舌淡, 脉细等血虚的症状 pale and atrophic complexion 4 有头晕目眩, 爪甲不荣, 视物模糊, 或夜盲, 或肢体麻木, 关节拘急不利, 手足震颤, 或妇女月经量少, 色淡, 甚则闭经等肝血不足, 经脉头目等组织失养的肝病症状 Dizziness and blurred vision, pale nails, blurred eyesight, or night blindness, numb limbs and tense tendons, extremities; or in female menstruation with scanty and light colored discharge or even amenorrhea due to liver blood deficiency.

48 ( 四 ) 肝阴虚证 Liver Yin deficiency 概念 肝阴不足, 虚热内扰所表现的证候 It refers to the liver Yin deficiency produces the internal deficient heat. 临床表现 头昏耳鸣, 两目干涩, 胁肋灼痛, 或手足蠕动, 形体消瘦, 口咽干燥, 五心烦热, 潮热盗汗, 面部烘热, 舌红少苔或无苔, 脉细弦数 Dizziness and tinitus, dryness on eyes, burning pain in hypochondriac region, or trembling on extremities, emaciated physique, dry mouth and throat, five center heat, tidal fever and night sweating, flushed complexion, red tongue with little or no coating, thread, wiry and rapid pulse. 1 以肝阴不足, 虚热内扰为主要病机 liver Yin deficiency produces the deficient heat. 2 以筋脉 头目失养和阴虚虚热症状并见为辨证依据 trembling on extremities 3 有形体消瘦, 五心烦热, 口干咽燥, 潮热盗汗, 面部烘热, 舌红少苔或无苔, 脉细弦数等虚热的症状 emaciated physique, dry mouth and throat, five center heat, tidal fever and night sweating, flushed complexion, red tongue with little or no coating, thread, wiry and rapid pulse. 4 有头昏耳鸣, 两目干涩, 胁肋灼痛, 或手足蠕动等筋脉 头目失养的肝病症状 Dizziness and tinitus, dryness on eyes, burning pain in hypochondriac region,

49 ( 五 ) 肝阳上亢证 Liver Yang ascending 概念 肝肾阴虚, 阴不制阳, 肝阳偏亢所表现的证候 It refers to the liver and kidney Yin deficiency fails to control liver Yang--ascending. 临床表现 眩晕耳鸣, 头目胀痛, 面红目赤, 急躁易怒, 心悸失眠, 头重脚轻, 步履不稳, 腰膝酸软, 舌红, 脉弦有力或弦细数 Dizziness and tinitus, distending pain in head, reddish face and congested eyes, irritation and anger, palpitation, insomnia, heavy head, unstable walking, lassitude in loins and legs, red tongue, wiry and forceful or wiry thread pulse. 1 以肝肾阴虚, 肝阳偏亢为主要病机 Liver yang ascending due to deficiency 2 以头目眩晕胀痛, 腰膝痠软, 头重脚轻, 病程较长为辨证依据 distending pain in head, lassitude in loins and legs, heavy head, and long disease course. 3 可见眩晕耳鸣, 头目胀痛, 面红目赤, 急躁易怒, 心悸失眠等肝阳升发太过, 气血上逆的症状 Dizziness and tinitus, reddish face and congested eyes, irritation and anger, palpitation, insomnia due to over ascending of liver 4 可见腰膝痠软, 头重脚轻, 步履不稳, 舌红, 脉弦或弦细数等肝肾阴虚的表现 lassitude in loins and legs, heavy head, unstable walking, due to defi.

50 ( 六 ) 肝风内动证 Internal stirring of Liver wind 肝风内动证是指以眩晕欲仆, 抽搐, 震颤等 动摇不定 症状为主要特征的一类证候 常由肝阳上亢 高热 阴虚 血虚等进一步发展所致 根据病因病性的不同, 临床主要分为肝阳化风 热极生风 阴虚生风和血虚生风四种证型 The main physiological function of the liver is in charge of promotion of free flow of whole body s Qi and storing the blood. The common pathogenic changes of liver mainly refers to the distending or running pain in the chest, hypochondriac region, breast or lower abdomen. Headache, dizziness and vertigo, depression, or irritability or easy to get angry, numbness or trembling in hands, indigestion, or eye problem, irregular menstruation, or

51 1. 肝阳化风证 Liver Yang changing to wind 概念 肝阳升发太过, 亢逆无制所导致的一种动风证候 It refers to the over ascending of liver yang results in internal wind stirring. 临床表现 眩晕欲仆, 头摇, 头痛, 肢体震颤, 项强, 步履不正, 手足麻木, 语言謇涩, 或突然昏倒, 不省人事, 口眼歪斜, 半身不遂, 喉中痰鸣 舌红苔白腻, 脉弦细有力或弦滑 Serious dizziness, headache with some shakes, trembling on head and extremities, stiff neck, unstable walking, numbs in extremities, dysphasis; or sudden syncope with unconsciousness, facial paralysis, hemiplegia, sputum rumbling in the throat, red tongue and white greasy coating, wiry thred forceful or wiry slippery pulse. 1 以肝阳升发太过而亢逆无制为主要病机 The over ascending of liver yang 2 以平素即有头晕目眩等肝阳上亢症状, 又突见动风之象, 甚或突然昏倒, 半身不遂等症为辨证依据 Dizziness and vertigo, then sudden syncope, hemiplegia. 3 有眩晕欲仆, 头摇, 头痛, 手足麻木, 肢体震颤, 项强, 步履不正, 舌红苔白腻, 脉弦细有力或弦滑等肝阳化风的症状 trembling on head and extremities, headache 4 有突然昏倒, 不省人事, 口眼歪斜, 半身不遂等肝风夹痰, 蒙蔽清窍的症状 unconsciousness, facial paralysis, hemiplegia

52 2. 热极生风证 Excess heat producing wind 概念 热邪炽盛, 耗伤津液, 筋脉失养所表现的动风证候 It refers to the excess heat consumes the body fluid failure in nourishing tendons. 临床表现 高热, 心烦, 或躁扰如狂, 或神昏, 手足抽搐, 颈项强直, 牙关紧闭, 两目上视, 角弓反张, 舌质红绛苔黄燥, 脉弦数 High fever,irritability, irritation as mania, convulsion or trembling extremities, stiff neck, mouth closed tightly, starring eyes, opisthotonoes, deep red tongue with yellow coating, wiry and rapid pulse. 1 以以热伤阴津, 筋脉失养而风动为主要病机 the excess heat consumes the body fluid failure in nourishing tendons. 2 以高热和动风之象并见为辨证依据 High fever and convulsion 3 有高热, 心烦, 或躁扰如狂, 舌质红绛苔黄燥, 脉弦数等实热的症状 High fever,irritability, irritation as mania and deep red tongue with yellow coating, wiry and rapid pulse due to excess heat. 4 有手足抽搐, 颈项强直,` 牙关紧闭, 角弓反张等肝风的症状 convulsion or trembling extremities, stiff neck, mouth closed tightly, starring eyes, opisthotonoes due to liver wind.

53 3. 阴虚动风证 Yin deficiency producing wind 概念 阴液亏虚, 筋脉失养所表现的动风证候 It refers to the Yin deficiency fails to nourish the tendons and vessels. 临床表现 手足蠕动, 眩晕耳鸣, 潮热颧红, 口咽干燥, 形体消瘦, 舌红无苔, 脉细数 Trembling extremities, dizziness and vertigo, tidal fever and reddish cheek, dry mouth and throat, emaciated physique, red tongue with no coating, thread and rapid pulse. 1 以阴液亏虚, 筋脉失养而风动为主要病机 Yin deficiency fails to nourish the tendons and vessels. 2 以阴虚和动风之象并见为辨证依据 Yin deficiency and wind stirring 3 有眩晕耳鸣, 潮热颧红, 口咽干燥, 舌红无苔, 脉细数等虚热的症状 dizziness and vertigo, tidal fever and reddish cheek, dry mouth and throat, red tongue with no coating, thread and rapid pulse due to deficient heat 4 有手足蠕动等虚风内动的肝病症状 Trembling extremities due to wind stirring

54 4. 血虚生风证 Blood deficiency producing wind 概念 血液亏虚, 筋脉失养所表现的证候 It refers to the blood deficiency fails to nourish the tendons and vessels. 临床表现 手足震颤, 肌肉瞤动, 肢体麻木, 眩晕耳鸣, 爪甲 口唇色淡, 面白无华, 舌质淡白, 脉细弱 Trembling extremities, muscular twitching and cramp, numb extremities, dizziness and vertigo, pale lips and nails, pale face, pale tongue with light white coating, thread and weak pulse. 1 以血虚而致风动为主要病机 the blood deficiency fails to nourish the tendons and vessels. 2 以血虚和动风之象并见为辨证依据 blood deficiency and wind stirring 3 有眩晕耳鸣, 爪甲 口唇色淡, 面白无华, 舌质淡白, 脉细弱等血虚的症状 dizziness and vertigo, pale lips and nails, pale face, pale tongue with light white coating, thread and weak pulse due to blood deficiency. 4 有肢体麻木, 手足震颤, 肌肉瞤动等风动的症状 Trembling extremities, muscular twitching and cramp, numb extremities due to wind stirring.

55 ( 七 ) 肝胆湿热证 Damp heat retention in liver and gall bladder 概念 湿热蕴结肝胆, 或肝经湿热所表现的证候 It refers to the damp heat retention in liver meridian or with gall bladder. 临床表现 胁肋灼热胀痛或胁下痞块, 腹胀, 厌食, 口苦, 恶心呕吐, 大便不调, 小便短黄 ; 或身目发黄, 黄色鲜明, 或寒热往来, 或身热不扬 ; 或阴部瘙痒, 带下色黄味臭 ; 或阴部湿疹, 灼热瘙痒 ; 或睾丸肿胀热痛 舌红苔黄腻, 脉弦数或滑数 Distending pain and masses in the hypochondriac region, abdominal distention, anorexia, bitter mouth, nausea and vomiting, irregular stool, yellow scanty urine; or bright yellow tint of sclera and skin, or alternate attacks of chill and fever, or recessive fever,; or itching in the pubic region(vulva), yellow and fetid leukorrhea; or eczema in pubic region with burning and itching; or swelling and burning pain in the testis. Red tongue and yellow greasy coating, wiry or slippery rapid pulse. 1 以湿热蕴结肝胆, 疏泄失常为主要病机 2 以胁肋胀痛, 厌食腹胀, 身目发黄, 阴部瘙痒和湿热内蕴症状并见为辨证依据 3 有身热不扬, 大便不调, 小便短黄, 舌红苔黄腻, 脉弦数或滑数等湿热内盛的特征 4 有胁肋灼痛, 胀痛, 胁下痞块, 黄疸, 口苦, 或寒热往来, 外阴瘙痒, 带下黄臭, 睾丸肿痛等肝失疏泄, 气机不畅的症状 5 可兼见腹胀, 厌食, 恶心呕吐等肝病横犯脾胃的症状 damp heat retention in liver meridian or with gall bladder.

56 ( 八 ) 寒滞肝脉证 Cold stagnation in liver meridian 概念 寒邪凝滞肝经所表现的证候 It refers to the cold evil invades and stagnates the live meridian. 临床表现 少腹牵引睾丸坠胀冷痛, 或阴囊收缩引痛, 得温则减, 遇寒加重 ; 形寒肢冷, 舌淡苔白润, 脉沉紧或弦紧 Sinking and cold distending pain in lower abdomen or testis, testicular contraction and dragging pain with the preference for hot compress and aggravation with coldness; cold feeling around body and cold extremities, pale tongue with white and moistened coating, deep and tense or wiry and tense pulse. 1 以寒邪凝滞肝脉为主要病机 cold evil invades and stagnates the live meridian. 2 以少腹 睾丸 阴囊坠胀冷痛为辨证依据 Sinking and cold distending pain in lower abdomen or testis 3 有形寒肢冷, 舌淡苔白润, 脉沉紧或弦紧等寒证的症状 cold feeling around body and cold extremities, pale tongue with white and moistened coating, deep and tense or wiry and tense pulse due to cold 4 有少腹冷痛, 睾丸坠胀疼痛, 或阴囊收缩冷痛等寒袭肝经的症状 Sinking and cold distending pain in lower abdomen or testis due to cold in liver meridian.

57 ( 九 ) 胆郁痰扰证 Gall bladder stagnation with phlegm stirring 概念 胆气郁滞, 痰热内扰所表现的证候 It refers to the Gall bladder Qi stagnation and phlegm heat retention inside. 临床表现 胆怯易惊, 惊悸不宁, 失眠多梦, 烦躁不安, 胸胁闷胀, 头晕目眩, 口苦, 恶心, 呕吐, 舌苔黄腻, 脉弦数或滑数 Timidity with easy to be worried, palpitation, insomnia and dreaminess, irritation, oppressive chest, dizziness and vertigo, bitter taste in the mouth, nausea and vomiting, yellow and greasy coating, wiry rapid or slippery rapid pulse. 1 以痰热内扰, 胆气郁滞不畅为主要病机 phlegm heat retention and Qi stagnation 2 以惊悸心烦失眠, 眩晕, 舌苔黄腻为辨证依据 palpitation, insomnia and dizzi 3 有胆怯易惊, 或惊悸不宁, 胸胁闷胀等胆病症状 Timidity with easy to be worried, palpitation, oppressive chest due to gall bladder problem 4 有头晕目眩, 烦躁不安, 多梦, 口苦, 恶心, 呕吐, 舌苔黄腻, 脉弦数或滑数等痰热内扰的症状 dizziness and vertigo, bitter taste in the mouth, nausea and vomiting, yellow and greasy coating, wiry rapid or slippery rapid pulse due to phlegm heat retention inside.