Discussion about different treatments for the same disease and the same treatment for different diseases of Shanghan Lun

Chao-Ning Zhang

1 Gansu university of Traditional Chinese Medicine, Gansu, China.

Abstract Different treatment for the same disease is that different treatment is based on different pathogenesis namely different syndrome. And the same treatment for different diseases is due to the same pathogenesis in other word the same syndrome. The essence of them is that treatments are based on corresponding syndrome. And the combination of disease differentiation and syndrome differentiation is the precondition of them. Shanghan Lun is the first work about treatment variation based on syndrome differentiation. It contains the principle of them. This paper sets forth them of Shanghan Lun in above-mentioned aspects.

Keywords∶ Shanghan Lun, Traditional Chinese Medicine

Background

Different Treatment for the Same Disease(DTSD) is that because of the patients’ diverse constitutions or disparate attack time, in different stage of illness, unlike pathogenesis appears and shows diverse syndrome, so there are different treatments and prescriptions of Chinese Herbal medicine for the same disease. While the Same Treatment for Different Disease (STDD) is that in lesion process, if various diseases have the identical pathogenesis just the alike syndrome,the same therapy and prescription of Chinese Herbal medicine can be used [1-3].

Both of them are relatively spoken, and are all concerning differentiation of syndrome,as well as treatment based on corresponding syndrome. It is namely called "the same therapy for the same syndrome" and "different therapy for different syndrome". It is also the soul of treatment variation based on syndrome differentiation of Traditional Chinese Medicine(TCM). And Shanghan Lun is the first work about this. Although it doesn't definitely put forward the conception of DTSD and STDD,it well embodies them under the guidance of the thought of treatment variation based on syndrome differentiation, which is described as twelve words of therapeutic rule in Shanghan Lun. Its meaning is that by feeling a patient's pulse, asking symptoms and watching signs,then carefully distinguishing above all, the crucial reason of disease and pathogenesis are known and different treatments are on the basis of corresponding syndromes [4-7]. In this paper I discuss and analyze the two therapeutic principles of Shanghan Lun.

The essence of them is treatment based on the homologous syndrome.

Syndrome is the mirror of pathogenesis at certain stage in lesion process of the disease.It is composed of a set of symptoms and signs that can explain the essence of the lesion stage.It is also the generalization and reflex on the essence of different type of pathogenesis. It has the characteristic of timeliness, spatiality, and dynamic nature. So the same disease possibly has many various syndromes, and numerous different diseases can also have the identical syndrome. Treatment based on the corresponding syndrome is the spiritual substance of the two treatment rules [8-11].

The same disease with different syndrome is treated differently.

Shanghan Lun establishes the theoretical system of syndrome differentiation of six meridians.It is one kind of treatment variation based on syndrome differentiation. For the identical disease, due to various factors such as the patient’s constitution etc, there are different kinds of syndromes. For the diverse syndromes,various treatments are used. Shanghan Lun includes the two diagnosis and therapeutic principles everywhere [12-13].

For example, Tai yang disease has the exterior syndrome and fu-organ syndrome. The exterior syndrome is separated into the cold-attack and wind-attack syndrome. The former pathogenesis is that wind-cold evil fetters body surface,defensive yang is obstructed and nutritive yin is in stasis. The latter is that wind-cold evil invades the exterior, defensive yang doesn't solidify and there has disharmony between nutritive yin and defensive yang. Thus there are two kinds of decoctions of herbal medicine. One is Mahuang decoction which can dispel exogenous evil by diaphoresis and make inhibited lung-qi open meanwhile relieve asthma. Another is Guizhi decoction that can also remove the exterior evil and reconcile nutritive yin and defensive yang.

As far as Yang ming disease is concerned,if it is treated by mistake, different outcomes and changes come into being. For instance,there is the syndrome of Zhizichi decoction whose pathogenesis is chest and diaphragm are disturbed by heat evil. And there is the syndrome of Baihu decoction which is named of group of seven stars in the western sky,whose pathogenesis is that invisible heat evil is full of inside and outside. There also has the syndrome of Baihu decoction add ginseng,whose pathogenesis is heat evil is flaming, body fluid and qi are all damaged. Besides, there has the syndrome of Zhuling decoction whose pathogenesis is that heat evil is ablaze and body fluid is harmed, heat and water-dampness bond together.

The above shows Zhang zhongjing's ideology of trying to remedy the varied syndrome and treating the same disease differently. It also embodies the thought of treatment variation based on syndrome differentiation as what mentioned before [14-15].

The diarrhea in Shanghan Lun covers three types of syndromes. One is deficient-cold syndrome, its pathogenesis is that shit is out of control due to lack of spleen-kidney yang.Taohua decoction can remedy it by jamming intestinal tract. Another pathogenesis is that liver meridian's damp and heat force large intestine downward, so diarrhea comes into being. It is called the syndrome of Baitouweng decoction, whose function is clearing away heat, eliminating dampness, cooling blood, and healing diarrhea. The last one is the syndrome of Huangqin decoction. Its pathogenesis is that the heat evil of Shao yang forces intestinal tract inward, moreover the function of rise and fall of stomach and intestine is abnormal. Its rule of treatment is clearing away heat and healing diarrhea.

For the syndrome of sore throat of Shao yin disease, on account of different pathogenesis,there have different treatments. For example, if Shao yin is short of yin, fire of deficiency type will burn up. The relevant symptoms include slight throat-ache, slightly red and swollen throat, often with diarrhea, fullness sensation in chest, and being perturbed. It can be treated by Zhufu decoction whose function is nourishing kidney, moistening lung, mediating spleen and stomach and healing diarrhea. If phlegm-heat is obstructing throat and throat is harmful, it will be sore, red and swollen. Even fester and hoarseness can appear, or one can't speak. Rice vinegar decoction is used for remedying it,which can clear away heat, drive out sputum,heal sore, and remove swell. If cold evil invades the throat and phlegm-damp coheres, the throat is painful, not red and swollen. Banxia decoction can treat it, whose function is activating yang,dispelling cold, eliminating phlegm, and undoing agglomeration.

The name of insomnia doesn't be presented definitely in Shanghan Lun. But there are three types of syndromes whose main symptoms include being perturbed and failing to fall asleep. One is the syndrome of rhizome of Huanglianejiao decoction. Its pathogenesis is fire excess from yin deficiency and breakdown of the normal physiological coordination between heart-yang and kidney-yin. It can use the method of treating yin-deficiency by reinforcing bodyfluid, clearing away heat, and restoring normal coordination between heart and kidney. The other one is the syndrome of Gegen decoction,whose pathogenesis is lack of kidney-yin, heat excess from yin-deficiency, water-dampness and heat bonding together. Its rule of treatment is exhausting water-dampness, clearing away heat, and nourishing yin-fluid. The last one is the syndrome of Zhizichi decoction whose pathogenesis is that invisible heat-evil disturbs chest and diaphragm, but yin-fluid is not hurt.Its therapeutic rule is dispersing and eliminating the stasis heat evil.

Different disease with the same syndrome is treated similarly.

Shanghan Lun is praised as the originator of medical classical prescription, and it has 113 Traditional Chinese Medicine prescriptions(lack of one). The reason that it is enduring is the method of treatment based on syndrome differentiation and DTSD.

So long as there is the same pathogenesis for various diseases, there has the same treatment.For example, Wuzhuyu decoction is referred in three sections in Shanghan Lun. One is clause 243, which is about the vomit of deficiency-cold syndrome of Yang ming disease and Wuzhuyu decoction is used for treating the vomit. The other one is clause 309, which is about the emesis of yang asthenia causing yin sthenia of Shao yin. And turbid yin invades the stomach.It is also treated with Wuzhuyu decoction. The last one is clause 378, which discusses that the cold evil in liver meridian violates stomach, and emesis comes from stomach- qi upward reversal.It is still remedied with Wuzhuyu decoction.The above various diseases are all treated with the same decoction because their pathogenesis is severe pathogenic cold is filled within the body and turbid yin goes upward. So the same treatment is used for different diseases. For another example, Gegen decoction can exhaust water-dampness, get rid of heat, and nourish yinfluid. It is used for treating the heat syndrome of Yang ming disease and heat transformation of Shao yin disease. As its pathogenesis is lack of kidney-yin, heat excess from yin deficiency,water-damp and heat bonding together.

The function of Wuling powder is relieving exterior evil, as well as activating yang,transforming qi and alleviating water-dampness retention. So it can remedy fluid stagnated syndrome of Tai yang disease and cholera. For they have the same pathogenesis of adverse qitransforming and exterior evil existing.

Dachengqi decoction is mentioned in 19 clauses in Shanghan Lun. It can treat the syndrome of Yang ming viscera filled with dryness-heat evil and excessive pathogen. In addition, it can treat the syndrome of yin-fluid loss of Shao yin disease due to dryness-heat.For they also have the same pathogenesis of cohering of dryness-heat evil and excessive pathogen such as dry-hard excrement in the gut and yin-fluid loss from excessive drynessheat. Thus they are all treated with Dachengqi decoction, which can potently purge and fiercely eliminate the dryness-heat evil and excessive pathogen. The three syndromes of needing acute purgation of Yang ming and Shao yin disease are all treated with it to save yin-fluid by sweeping away the dryness-heat evil.

Wumei pills can clear away the upper heat evil, get rid of deficiency-cold evil by warmly invigorating kidney-yang, make roundworms quiet and relieve pain. It also has the function of nourishing liver, replenishing yin-fluid,blocking intestinal tract and anti-diarrhea effect.So it can treat the long-time diarrhea as well as the syndrome of syncope and ice-cold limbs caused by roundworms, activities. As they have the same pathogenesis of cold-heat jumble,and concurrence of deficiency syndrome and excessive pathogen prevailing syndrome.

This shows that the theoretical system of treatment variation based on syndrome differentiation of integration of theory-methodrecipe-medicines contained in Shang Han Lun includes the principle of DTSD and STDD.When they are used in clinic, pathogenesis i.e.syndrome differentiation is the key factor and different treatment based on corresponding syndrome is their nature. If pathogenesis is uniform, treatment is identical, and vice versa[16,17].

The combination of disease differentiation and syndrome differentiation is the precondition of DTSD and STDD.

Disease is the intact abnormal living process possessing the specific pathogenic factor,attack law and pathologic evolution. It has the constant clinical symptom and sign, main point of diagnosis, identification with similar illnesses etc.

The disease discrimination can provide the basis for treatment. While diagnosing and curing illness with the theory of TCM in clinic,what kind of disease is firstly distinguished.Then relying on different pathogenesis,unlike syndrome is discriminated. So there is different treatment. The combination of disease differentiation and syndrome differentiation is the premise of DTSD and STDD. But the rule of "disease differentiation firstly and taking syndrome differentiation as the principal thing"must be remembered [18,19].

Shanghan Lun reveals the diagnosis and treatment rule of exogenous febrile diseases and miscellaneous diseases. In terms of every title"discriminating some disease-pulse-syndrome and treating", it elaborates the syndrome differentiation of six meridians in the aspects of distinguishing disease, identifying pulse,differentiating syndrome and establishing treatment rule. It shows the thinking process of TCM of combination of disease differentiation and syndrome differentiation.

For example when Yang ming disease is set forth, the outline is explained firstly, and it reflects the pathogenesis characteristic of dryness-hot and excessive pathogen prevailing.Then the two causes of its formation are expounded. One is that the evil coming from other meridian invades Yang ming meridian,such as Tai yang or Shao yang disease is treated by error, the body-fluid is harmed, and the heatevil transforms dryness-hot evil. Another is that one has the consistent corporeity abounding with yang qi, if there is remaining food in the stomach, he is infringed by dryness-heat-evil,then it is directly transformed into drynesshot-evil and excessive pathogen, so Yang ming disease comes into being immediately.It is divided into heat syndrome and excessive pathogen syndrome. According to different syndrome, there are heat-clearing method and purgative method. At last, the prognosis of Yang ming disease is stated.

In the piece of discriminating Shao yin diseasepulse-syndrome and treating, two causes of its formation is also presented. Its outline is "One has feeble and thin pulse, and is weak just like seeming asleep, really not asleep" and it reveals the pathogenesis characteristic of especially collapse of kidney-yang. It is deficient of heart and kidney's yin and yang too. According to its nature, it is divided into cold transformation syndrome, heat transformation syndrome and Yang-qi stasis syndrome. There are three representative prescriptions for above three syndromes. One is Sini decoction which is the represent of remedying the collapse by restoring yang. Another is Huanglianejiao decoction which is the represent of eliminating heat evil and nourishing yin-fluid. The last one is Sini powder which is the represent of dispersing the closed and stasis yang qi. The key factor of prognosis is the saving of yang qi.

Thus it can be seen that the exposition of every meridian disease is the thoroughly understanding about forming causes,pathogenesis, pulse, symptom, treatment, and prognosis of the disease. It embodies that the combination of disease differentiation and syndrome differentiation is one of the features of Shanghan Lun. Every meridian disease is treated differently according to different syndrome.If they have the same pathogenesis, different meridian diseases are treated identically. This contains the rule of diagnosis and treatment of DTSD and STDD.

The principle of DTSD and STDD contained in Shanghan Lun broadens the thought of doctors at later ages in clinic. It also provides the rule of treatment variation based on syndrome differentiation for every clinical department.It is the criterion of DTSD and STDD that treatment variation is based on pathogenesis discrimination as well as disease differentiation and syndrome differentiation must be combined[20].