Treatise on febrile disease is a combination of theory and practice of clinical medical work, its contribution to clinical medicine of traditional Chinese medicine is founded the unique theoretical system of six-channel differentiation and melting France medicine as one of the rule of treatment based on syndrome differentiation, which laid a foundation for clinical medicine of traditional Chinese medicine.

The complex pathogenesis involved in the treatise on febrile diseases is characterized by multiple meridians, multiple viscera and diseases, as well as internal diseases, deficiency and reality, and confusion between Yin and Yang. In addition, a variety of pathogenic mixed, such as fever or hot and humid and miscellaneous, blood stasis, water hot knot, etc, thus forming a complex pathogenesis, causes the illness is complex, long course of disease, affect the visceral functions, and even produce change certificate, bad certificate, bring certain difficulty to cure, so this kind of situation should belong to the category of "complex pathogenesis syndrome". The correct analysis and understanding of complex pathogenesis syndromes are of great guiding significance to the legislation of present syndromes and the organization of drug delivery. The author tries to list with disease, attaches great importance to the overall concept and principal contradiction, fever and, "attack" with their income, attaches great importance to the dosage, five aspects to illustrate by the party a little tips for the treatment of complex pathogenesis syndrome.

First, we should grasp the principle of treating superficial and identical diseases

The complicated pathogenesis syndromes commonly seen in clinical practice are mostly apparent diseases, while apparent diseases are described the most in the treatise on febrile diseases and give us the greatest enlightenment.

Read the full text of zhong jing's treatise on febrile diseases. Taiyang minghe disease, when the sun disease is obvious and the early onset of yangming disease is not very serious, urgent treatment of its standard, must first off the table, the table to attack. Article 48 of treatise on febrile diseases: "when the sun first becomes ill, it begins to sweat, but it does not sweat well. If the sun does not give up, do not go down, it will be rebellious, so that you will sweat less. The sun's disease is not over, and the yangming syndrome is known as the dissident, called taiyang mingjiu disease, which continues to sweat out, is the yangming syndrome. If you do not hate the cold, you can testify to the sun. If the sun is not sick, do not go down, you can use a small sweat method, the first solution.

When Yang Ming's disease is more complicated than sun's syndrome, when it is treated together from the outside, if you only solve the watch at this time, it will cause tianjin fluid injury and Yang Ming li's heat is more serious. If only attack the inside, then empty its inside and bring evil into the inside to cause a full of disease. So too Yang minghe disease in the face of the same disease, when the first table, or in the face of the same treatment, but by no means the table but attack. For example, article 38 of the treatise on typhoid fever: "if the sun has a stroke, the pulse rises tight, the fever, the evil cold, the body aches and pains, does not sweat but is agitated, the great qinglong soup Lord." Pulse buoyancy, fever, cold, body pain are the solar evidence. Not sweat out and be agitated, it is because show evidence cannot sweat out, show evil spirits do not understand to pass in, the reason that the inside heat cannot cross out, at this time Yang Ming li heat already very much, call too Yang minghe disease. Due to the fact that both the solar surface demonstration and the solar heat in Yang Ming li are very serious, the solar surface evidence of the great qinglong decoction and the heat in qingyang mingli are given in order to gain the effect of double dissolution in the surface. In addition, this law can also be seen in article 34 of the treatise on febrile diseases, the certificate of pueraria baicalensis decoction, and the certificate of ginkgo shigan decoction in articles 63 and 162.

As for the sun signs with the deficiency of cold taiyin disease, treatment must first support the deficiency in the first, then exogenous evil. If only look at the card table, continuous sweating, table card, although a decline, but soon again and again the same, because of the insufficiency in the cold in the patients with the condition sweating can nourish more wounded body fluid, sun be the spirit of vital qi, unable to resist evil will bring in more at the table. At this time, the deficiency in the first aid, cold, AIDS positive qi, give attention to the table, can drive out evil spirits. If the sun signs, such as syncopation, low interest, and other Yin cold heavy syndrome, should be first rescued, only then the inner harmony can save the watch, this is also the midview surface tongzhi law. Article 91 of the treatise on febrile diseases: "typhoid fever, if cured, can continue to clear the valley of li qing. Back body pain, clear self - conditioning, urgent to save the table. Rescue li yi si adverse soup, rescue table yi guizhi soup." Typhoid, when sweating, and cure the misuse of branch, to the valley of the qing dynasty, the disease by table, transfer into both table card and cold in the sun in the disease, although there are table card at this time, is also appropriate USES four inverse soup first aid, in its, and then save the table. For example, article 372 of the treatise on febrile diseases states, "if the lower abdomen is full of distension and the body is painful, the first thing you should do is to take it into consideration. Wen li yi si adverse soup, attack table yi guizhi soup." This article more clearly defined the sun too Yin syngamy when the emergency treatment of the method.

In addition, if the sun is too Yin and the disease is not very cold in the deficiency, it should be treated together. For example, article 163 of the treatise on febrile diseases: "the sun's disease has not been eliminated, but the number of it, then the co-heating and the benefit, the benefit not only, the heart under the ruffian hard, the incomprehension, guizhi ginseng soup Lord." Sun disease still unanswered, fever, body ache thereof not guizhi soup treatment solution, instead of under the frequent faults, large gas, then make the table in the thermal invagination and virtual facies association, formed in the stomach qi deficiency in, tables, and out of virtual evil confused with disease sun lunar disease, because of its cold in card is less, so the cure with cassia twig nourish in the ginseng soup to save, to list main pathogenesis.

Lunar disease of deficiency cold syndrome, and often and drinking water, or and tianjin blood deficiency, in addition the evil more than drink syndrome in treatise on febrile disease, treatment can't nourish or temperature in the first, must at the same time of nourish and Juan drink. Article 40: such as "treatise on febrile diseases", which "typhoid table don't understand, the heart has the moisture, retching, fever, cough, or thirst, or, or cry, or urination, lower abdomen, or asthma, small qinglong decoction of god." Typhoid table don't understand, the heart have hydrosphere, indicate this card for card outside in the cold drink, namely the sun lunar disease, so the treatment of the sun with a small qinglong decoction solution table, at the same time by the cold drink, within the table with closing a total solution. For example, article 71 of the treatise on febrile diseases: "if the pulse floats, the urine is unfavorable, the slight heat, the thirst quencher, the wuling powder Lord." Pulse buoyancy and slight heat are inscrutable. It is bad to urinate and quench thirst. This also is the sun too Yin concomitant disease, there is cold drink in, so with the five ling powder solution table benefit drink, the same treatment in the surface. Article 50 of the treatise on febrile diseases: "if the pulse is tight, it is advisable to sweat out the body pain; Do not sweat if you are late in your ruler. How do you know? Not enough glory, not enough blood." Article 62 of treatise on febrile febrile diseases: "after sweating, the body aches, veins sink late, cassia twig add paeoniflorum ginger one or two ginseng two new add soup advocate." Card table and see the body pain, appropriate USES ephedra soup sweating to remove, but the pulse condition, the upper part of cunkou pulse late reflects a stomach empty, insufficiency of body fluid in the gas, as the sun lunar disease, both tianjin blood deficiency, so the treatment with cassia twig newly added Shang Wen helps nourish, tianjin.

Anyhow, treatise on febrile disease table with successively principle has its regularity and flexibility of diagnosis and treatment of disease, zhongjing "centralizer exorcism", fully embodies the "urgent is put to its standard", "taking sun be the spirit", "save fluid" idea of treatment based on syndrome differentiation, master its principle and flexible use, no doubt to clinical treatment of complex pathogenesis syndrome have important guiding significance.

Second, we should attach importance to the overall concept and major contradictions

Teacher liu duozhou once proposed that the key to using the classics lies in grasping the main syndromes, which not only improves the efficiency of syndrome differentiation, but also expands the scope of use of the classics. However, many people tend to think that, as long as a patient's master card is grasped and the prescription for this master card is used, it will be effective, but it is not. Clinical patients have complicated pathogenesis, sometimes including multiple syndromes in six classics and multiple prescriptions. At this time, the patient's overall condition must be taken into account to be effective.

The author also treated a cold patient, xu mou, female, 23 years old. Chief complaint: low heat for 8 days. Patients after 8 days ago catch cold catch cold symptoms such as fever, bad cold, see a doctor in a hospital emergency department, gives anti-infection after symptomatic treatment, such as fever heat potential decline, but there are still a low thermal, retching, since morning with sore throat, mouth, thirst, drink water more. His treatment with xiaochaihu granule is invalid after 5 days, please consult the author. May see a low-calorie, self-test temperature 37.6 ℃, fatigue, mouth thirsty to drink, sore throat, yellow sputum, morning when brushing your teeth vomiturition, no evil cold, bitter mouth, mainland, food, not beautiful, can sleep, tongue reddish, moss thin white, pulse string.

This patient is febrile outside feeling, because mistreatment and appear low heat not to return, one of its most main symptoms is morning dry vomiting, dry mouth is obvious. Dry vomiting is one of the four symptoms of bupleurum decoction. Article 10 of the treatise on febrile diseases: "typhoid fever, stroke, have firewood hu card, but see a card is, need not know." See "dry vomiting" this one card can give small bupleurum soup, but still want to combine the patient's overall condition and medication. Due to the "blood-weak qi is fully rationalized", the patient has no exogenous disease and is transported half a table and half a mile, while dry vomiting, fatigue, pharyngeal pain, numbness and low fever do not recede. The patient has sore throat, dry mouth thirst to drink, and occasionally coughs yellow phlegm, which is a syndrome of evil depression. Clinical common half exterior and half solid heat syndromes of shaoyang disease, often with yangming disease, if not to "fundamental" method in the treatment of solid heat yangming disease, shaoyang disease of half exterior and half solid heat cannot fundamentally solved.

To sum up, the patient was diagnosed with xiaoyang-yang minghe disease after six rounds of differentiation, which was accompanied by radix platycodonis, taking the meaning of tangerine decoction, removing phlegm, removing phlegm and relieving cough. Coicis seed also has the function of removing phlegm and discharging pus. Prescription: bupleurum 12g, huangqin 10g, qingbanxia 12g, dangshen 10g, liquorice 6g, gypsum 45g, orange peduncle 10g, coicis coicis 18g, ginger 10g, dates 10g. Results: after taking 1 dose, the symptoms of hypothermia disappeared, and the pain of pharynx was significantly reduced. The former doctor gave the patient small bupleurum granule, which indicated that the doctor had identified the patient's position in shaoyang, but ignored the patient's pharynx pain, dry mouth thirst to drink, occasionally coughing yellow sputum and other Yang Ming li heat. Shaoyang minghe disease, it is not enough to simply use the small bupleurum decoction and the solution of shaoyang, the reconciliation of the process, must be combined with qingyang mingli heat, disease can be solved. Therefore, it is necessary to pay attention to the overall condition of patients, grasp the holistic concept of the menstrual side, and give treatment with the syndrome.

However, some doctors overemphasize the whole concept in clinical practice, ignore the main contradictions of patients, and fail to take effect. The author treated a patient with a fever after bladder cancer surgery, female, 76 years old. Chief complaint: intermittent fever for a week. A week ago, no obvious incentives in patients with a bad cold, fever, body pain, cough, and fever reducer for antibiotics, poor curative effect, hence visits to a physician, quartering disease see: fever, 38.3 ℃, the highest cough, sputum less color white, sore throat, headache, evil cold, dry mouth, mouth less, mainland. Tongue red, moss white, pulse floating string. The doctors think less of the sun Yang Yang Ming and disease, to the small bupleurum decoction and nourish MaXingShi sweet soup, less settlement in qing Yang, SAN Yang disease, treatment and patients' age, basic disease is more, weak spleen and stomach function, add coke hawthorn; The patient also suffers from deficiency of Yin and deficiency of Yin and deficiency of jin. Considering the deficiency of Yin and jin in the patient, there must be a disturbance of deficiency heat, adding artemisia annua and patchouli to clear deficiency heat; The patient has the basic disease of tumor again, add with black ginseng again above fight a tumor, in addition add with orange peduncle, mulberry white skin to strengthen the work of heat purify phlegm. 12 g 15 g prescription: radix bupleuri, radix scutellariae, qing pinellia 9 g, ephedra 9 g, honey almond 9 g, plaster stone 30 g, white mulberry root-bark 15 g, zhejiang bei 9 g, 9 g, platycodon xuan 12 g, ageratum 9 g, 6 g, cicada forsythia 10 g, 9 g, magnolia bark Dan skin 9 g, 12 g raw radix rehmanniae, coke hawthorn 15 g, 12 g, jade bamboo artemisia annua 15 g. Three doses of water, one dose a day. From the perspective of prescription thinking, the doctor considers that the patient's pathogenesis syndrome should be comprehensive and there is no omission, so that the prescription should be very effective. However, it didn't work out. After taking three doses of the medicine, the patient still had a fever and was recommended for treatment. Burn the symptom to see: fever, headache, evil cold, cough, dry mouth bitter, phlegm little color yellow and white phase hold concurrently, do not have pharynx pain, accept little, two then tone. Tongue red, moss white, pulse floating string. At this time, the author considered the evil cold, fever, headache for the sun disease, mouth pain, pulse string for the little Yang disease; Red tongue, cough, dry mouth to yangming disease, syndrome differentiation and disease of too little Yang Yang Ming Yang, treatment with small bupleurum soup and less Yang, MaXingShi nourish the hot soup, soup heat phlegm, magnolia bark with pinellia and platycodon grandiflorum, h. cordata strengthen heat phlegm. 25 g prescription: radix bupleuri, radix scutellariae, 10 g, pinellia 10 g, dangshen, 15 g main licorice 8 g, ginger 10 g, jujube 15 g, magnolia bark 30 g, poria cocos 30 g, 8 g ephedra, almond 10 g, plaster stone 30 g, platycodon grandiflorum 15 g, 20 g h. cordata. Results: after taking one dose, the patient recovered from fever and did not have a fever. Why does the former doctor differentiate the evidence accurately, "consider thoroughly", on the treatment "everything", why is invalid? The author considers that patients are mainly suffering from fever at present, and prescribing drugs is "comprehensive", which will affect the therapeutic effect of fever instead.

Therefore, clinical use of the party in addition to pay attention to the overall concept, in the add and subtract, not "is hard to see the forest through the trees", "didn't see the forest for the trees", at the same time, also can't "be", ignore the principal contradiction of patients, in order to take effect.

Third, we should attach importance to the combination of heat and cold

The combination of cold and heat is another great way to treat mixed cold and heat, such as "the sun stroke, pulse floating tight, heat, evil cold, body pain, not sweat and irritability, big qinglong soup Lord". The great qinglong decoction certificate not only has the solar surface evidence of wind and cold, but also has the inner heat evidence of wei Yang being repressed, depressed and heated. Wind chill bundle watch, then evil cold fever, body pain, no sweat; There is stagnation of heat, heat disturb its Yang and fidget. Zhang zhongjing used xinwen ephedra and cold gypsum for the company, the solution of the surface to remove vexation, heat, cold and heat, the surface of the cold with the heat of ephedra and disperse, tired of heat to get gypsum cold and inside solution. If "but full and not painful" the PI card, treat with half summer xie xin soup, is typhoid by mistake, damage spleen and stomach, evil heat is trapped inside, rise and loss of division, cold and heat mixed in. This recipe USES cold and warm, dry ginger, semi-xia xinwen disperses cold, huanglian, huangqin bitter cold and heat, xinkaikuaifall, can rise and fall and eliminate rupianman. Also like chai hu GUI zhi jiang tang, huanglian tang, rhubarb aconite soup and so on.

This kind of opposite-drug combination is designed for the disorder of the disease and mixed evidence. However, when these drugs enter the body with completely opposite properties, will their effects cancel each other out? Xu da-chun once had a brief explanation: "the nature of covering medicine is to do its best, the assailant must be strong, the complainant must be weak... ... If rhubarb and ginseng are used together, rhubarb will be able to remove and solidify gradually, and will never harm the positive qi. The ancient system of the law, separate from the dirty, there is the way of god. ... ... The same meaning applies to all cold and heat. Drugs have cold, heat, for some time,, have good at it, under certain conditions can be selectively used for human body parts, such as cold medicine until it is hot, hot medicine of its cold, tonic to return its are virtual, tapping medicine into the evil reality, drugs, sex with all, since there is no mutual restraint. As white tiger in cassia twig decoction treated have a fever and malaria table and cold temperature, an xin cool heat b. white tiger in heat, combination XinWen divergence of cassia twig remove in the table of the cold, cold and, in a table, although the cold temperature gas, but parallel and play its function, make the list was not solution. One of the major features of this mid - day adverse drug use.

I have treated a patient with insomnia, male, 60 years old. Chief complaint: interrupted insomnia for more than 3 months. 3 months ago, the patient had no obvious inducement to suffer from insomnia and had a lot of dreams. He had taken traditional Chinese medicine and traditional Chinese medicine decoction, which had poor curative effect. Engraving disease see: insomnia, less, abdominal distension, loose, 2-3 times per day, leg cool, knee cool, lobster is serious, the mouth, since morning but, pink tongue, tongue, body fat, with teeth marks, moss white, pulse string and weight according to the weak. The author consider patients mouth bitter since morning, pulse string, consider to shaoyang disease, less sodium, abdominal distension, loose, legs, cool, cool double knee joint, the tongue body fat big, there are teeth marks, whitish, pulse according to the weakness, heavy in consideration for the lunar disease of cold. The comprehensive syndrome differentiation is the syndrome of mixed cold and heat. The prescription of chai hu GUI zhi gan jiang tang was 25g of bupleurum, 8g of huangqin, 10g of cassia twig, 10g of dried ginger, 10g of trichoderma powder, 10g of raw oysters and 1 of prepared liquorice