北京中医药大学：《中医诊断学》课程教学资源（课件讲稿）Complicated Syndromes of the Zang-Fu Organs

Case A 40 years old woman presented with early awakening for two months √ accompanied with palpitation dizziness poor appetite and memory abdomen distention,loose stools and lassitude enlarged tongue with pale color and white and thin coating,sallow complexion and weak pulse What syndrome is it 3 Tianfang Wang BUCM

A 40 years old woman presented with  early awakening for two months  accompanied with palpitation , dizziness , poor appetite and memory , abdomen distention, loose stools and lassitude enlarged tongue with pale color and white and thin coating, sallow complexion and weak pulse What syndrome is it ? Tianfang Wang BUCM 1 Case

9.6 Syndrome Differentiation of the Complicated Syndromes of the Zang-Fu Organs Definition: Syndromes in which more than two organs are involved at the same time,are known as complicated syndrome of the zang-fu organs. Tianfang Wang BUCM 2

9.6 Syndrome Differentiation of the Complicated Syndromes of the Zang-Fu Organs Tianfang Wang BUCM 2 Definition: Syndromes in which more than two organs are involved at the same time, are known as complicated syndrome of the zang-fu organs

The reasons for the appearance of complicated syndromes of the zang-fu organs? Zang-fu organs are physiologically correlated and pathologically influenced with each other. Tianfang Wang BUCM 2

The reasons for the appearance of complicated syndromes of the zang-fu organs？ Tianfang Wang BUCM 2 Zang-fu organs are physiologically correlated and pathologically influenced with each other

The basic causes for the occurrence >Exteriorly-interiorly related With the relation of generation, restriction,subjugation and reverse restriction according to the theory of five elements/phases Closely related functionally Tianfang Wang BUCM 3

Exteriorly-interiorly related With the relation of generation, restriction, subjugation and reverse restriction according to the theory of five elements/phases  Closely related functionally Tianfang Wang BUCM 3 The basic causes for the occurrence ？

Taking the heart as an example: liver Generation relationship: ·heart&liver: heart heart-liver blood deficiency kidney heart spleen: heart-spleen deficiency lung spleen Restriction relationship: heart lung: heart-lung qi deficiency [heart-kidney disharmony heart kidney: [heart-kidney yang deficiency Tianfang Wang BUCM

heart liver lung spleen kidney Taking the heart as an example: Generation relationship: • heart & liver: heart-liver blood deficiency • heart & spleen: heart-spleen deficiency Restriction relationship: • heart & lung: heart-lung qi deficiency • heart & kidney: heart-kidney disharmony heart-kidney yang deficiency Tianfang Wang BUCM 4

It is helpful to be familiar with the above relationship for identifying >the patho-mechanism and cause and effect of the complicated syndromes Tianfang Wang BUCM

It is helpful to be familiar with the above relationship for identifying  the patho-mechanism  and cause and effect of the complicated syndromes Tianfang Wang BUCM

9.6.1 Heart-Kidney Disharmony Syndrome It refers to the syndrome due to breakdown of the normal physiological coordination between the heart and the kidney with excess of the heart yang and deficiency of the kidney yin. Heart (Fire) Hyperactivity Normal of heart fire disturbs the mind Coordination of the heart and kidney Abnormal Disharmony of the Insufficient kidney Kidney (Water) heart and kidney yin fails to suppress heart fire

9.6.1 Heart-Kidney Disharmony Syndrome 7 It refers to the syndrome due to breakdown of the normal physiological coordination between the heart and the kidney with excess of the heart yang and deficiency of the kidney yin. Heart (Fire) Kidney (Water) Normal Coordination of the heart and kidney Abnormal Disharmony of the heart and kidney Hyperactivity of heart fire disturbs the mind Insufficient kidney yin fails to suppress heart fire

Manifestations Hyperactivity of heart fire:palpitation,mental restlessness,insomnia,dream-disturbed sleep Kidney deficiency:dizziness,tinnitus,seminal emission,aching of the lower back and knees Yin deficiency:feverish sensation in the palms and soles,tidal fever,night sweating,dry mouth and throat,red tongue with scanty coating and thready and rapid pulse. How to treat the syndrome? Tianfang Wang BUCM 8

Manifestations Hyperactivity of heart fire: palpitation, mental restlessness, insomnia, dream-disturbed sleep Kidney deficiency: dizziness, tinnitus, seminal emission, aching of the lower back and knees Yin deficiency: feverish sensation in the palms and soles, tidal fever, night sweating, dry mouth and throat, red tongue with scanty coating and thready and rapid pulse. How to treat the syndrome? Tianfang Wang BUCM 8

9.6.2 Heart-Spleen Deficiency Syndrome It is the deficiency syndrome due to insufficient heart blood and deficient spleen qi. heart blood (火) Chronic disease Chronic loss of blood Injuring of Worry beyond measure Improper diet spleen qi 脾 Tianfang Wang BUCM 9

9.6.2 Heart-Spleen Deficiency Syndrome Tianfang Wang BUCM 9 It is the deficiency syndrome due to insufficient heart blood and deficient spleen qi. • Chronic disease • Chronic loss of blood • Worry beyond measure • Improper diet spleen qi heart blood 脾 （土） 心 （火） Injuring of

Manifestations Heart blood Spleen gi deficiency deficiency Palpitation, Anorexia,fullness in the insomnia,dream- abdomen,loose stools,or disturbed sleep, purple ecchymosis,or dizziness,amnesia metrorrhagia and metrostaxia scanty menstruation with thin quality and light color sallow complexion,pale tongue and deficiency weak pulse Tianfang Wang BUCM 10

Manifestations Heart blood deficiency Spleen qi deficiency Palpitation, insomnia, dream￾disturbed sleep, dizziness, amnesia Anorexia, fullness in the abdomen, loose stools, or purple ecchymosis, or metrorrhagia and metrostaxia Tianfang Wang BUCM 10 scanty menstruation with thin quality and light color ,sallow complexion, pale tongue and weak pulse ? deficiency