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Traditional Chinese medicine believes that the liver, spleen and stomach have their own physiological uses and coordinate with each other; Pathologically, the two affect and change each other. The onset of liver disease is in the liver, which also involves the spleen and stomach. Countless physicians in the past dynasties held this view and discussed it. In the first chapter of synopsis of the golden chamber, it is put forward that "seeing the diseases of the liver, knowing that the liver spreads the spleen, and strengthening the spleen first", and then the theory of "strengthening the spleen due to liver diseases" has been passed down and explored and innovated by doctors in past dynasties. The theory of "Yang Ming excess, too Yin deficiency" put forward by Ke Yunbo, a physician in Qing Dynasty, also has important guiding significance in the process of syndrome differentiation and treatment of liver diseases.

1 The exact meaning of "actually Yangming, deficiency is Taiyin"

Yangming includes the large intestine meridian of hand Yangming and stomach meridian of foot Yangming; Taiyin includes hands Taiyin lung and feet Taiyin spleen. Yangming and Taiyin actually refer to "Yangming" and "Taiyin", mainly referring to the stomach and spleen, which highly summarizes the pathological characteristics of Yangming disease and Taiyin disease. "Excess" and "deficiency" reflect the essence of Yangming disease and Taiyin disease. In the pathological state, the function of stomach's absorption and decomposition is abnormal, which leads to the disharmony of stomach and the rise and fall of stomach qi, and then tangible things stay in the gastrointestinal tract, forming the pathogenesis change of "pathogenic qi is abundant but solid". Stomach-fu deficiency syndrome is mostly caused by the loss of spleen health and spleen deficiency. The main pathological changes of spleen disease are dysfunction of transport and transformation, Shui Gu's loss of body fluid, insufficient source of qi and blood metaplasia, and spleen's failure to control serum yang. Pathogens of cold-dampness or damp-heat enter the middle energizer and invade the spleen, because the spleen is easily trapped by dampness, and there will be syndromes of spleen losing health. At the same time, a long illness will also make the spleen lose its health and cause spleen deficiency syndrome. Therefore, the spleen is a disease, which often presents a virtual image. Therefore, the essence of Yangming disease is mostly true, and Taiyin spleen disease is easy to see deficiency syndrome. The meaning of "actually Yangming, deficiency is Taiyin" comes from this. "Taiyin and Yangming are exterior and interior, and the spleen and stomach are also veins. Yang, the atmosphere is outside the main body; Yin, ground qi, subject included; Therefore, Taoist Yang and Vaginal Deficiency [1] also embodies this view.

"Actually Yangming, deficiency is Taiyin" embodies the syndrome differentiation and treatment of liver disease.

"In fact, Yangming, deficiency is Taiyin" mainly reflects the characteristics of spleen and stomach diseases. In the clinical diagnosis and treatment of liver diseases, we often face the problem of determining the treatment site. Many patients with modern liver diseases are diagnosed by modern medical examination. The clinical manifestations are anorexia, fatigue, abdominal distension, diarrhea and other symptoms, which are not simply caused by the dysfunction of "liver", but often involve spleen, stomach, liver and kidney. Therefore, in the treatment of drugs, we should not simply stick to "liver disease", but focus on the pathogenesis characteristics of "Yangming excess and Taiyin deficiency" under the guidance of the overall concept of traditional Chinese medicine. In fact, Yangming syndrome is more common in liver depression and qi stagnation, excessive liver fire, damp-heat in liver and gallbladder, and blood stasis blocking collaterals. Disorder of liver-qi is the main mechanism that leads to abnormal ascending and descending of qi, loss of stomach, and retention of tangible things in gastrointestinal tract. Patients have a group of liver-stomach disharmony syndrome, such as eating too little, swallowing too much acid, epigastric pain and so on. The syndrome of "deficiency leading to Taiyin" is a kind of deficiency syndrome or concurrent syndrome in the development of chronic liver disease, which is mostly manifested as Taiyin and spleen deficiency.

Professor Deng Tietao put forward the theory of five zang-organs in 1975. In the five zang-organs paired correlation model, the liver and spleen are closely related. Professor Deng Tietao believes that the onset of liver disease is not only in the liver, but also in the spleen. If the drainage function of the liver is normal, the spleen and stomach will rise and fall moderately, so there is a saying that "the soil is made of wood" and "the wood depends on the soil". Under pathological conditions, if liver diseases are not treated promptly and effectively, the disease will further develop, often leading to spleen dysfunction. When the liver loses the function of regulating qi, bile secretion is abnormal, which further affects the digestion and absorption of food by the spleen and stomach, resulting in the syndrome of "wood does not disperse soil" or "disharmony between liver and spleen" Clinical symptoms include fullness in chest and hypochondrium, abdominal distension and pain, diarrhea and loose stool. If the disease develops further, it will lead to stagnation of liver qi, spleen deficiency, loss of appetite, abdominal distension, pain, belching and acid swallowing, thin stool and other spleen deficiency syndromes. Loss of spleen transport will inevitably lead to stagnation of body fluid, formation of wet, phlegm and other pathological products, and even edema. Therefore, the article is quite right: "Wet swelling belongs to the spleen". At the same time, spleen deficiency leads to insufficient biochemical sources of qi and blood, which can not be turbid, and the liver loses the nourishment of qi and blood, and its function is further damaged. In such a vicious circle, spleen deficiency and liver depression, water dampness, phlegm and blood stasis coexist, forming a syndrome of deficiency and excess. These deficiency syndromes or mixed syndromes are common in decompensated cirrhosis and advanced liver cancer. Therefore, we should attach great importance to the clinical application of Yangming's "deficiency is Taiyin" in the treatment of chronic liver disease at different stages. Xiaochaihu decoction for shaoyang disease, Xiaoyao powder contained in Taiping Huimin and Prescription Bureau, which was founded by Zhongjing, are the products of soothing the liver, softening the liver and invigorating the spleen at the same time, and are widely used in clinical practice.

3 cases of medical records

Case 1: Li, male, 45 years old, was first diagnosed on March 2, 2009. He was admitted to the hospital for recurrent swelling and pain under the right hypochondrium. Paroxysmal pain under the right hypochondriac occurred half a month ago, and the symptoms did not improve significantly after anti-inflammatory and symptomatic treatment in the local hospital. Symptoms include hypochondriac swelling and pain, nausea and vomiting, abdominal distension and anorexia, dry mouth and bitter taste, constipation, Huang Chi in urine, yellow greasy tongue coating and slippery pulse. At the beginning of syndrome differentiation and treatment, the author thought that the disease was caused by damp-heat, and only drugs for clearing damp-heat in liver and gallbladder were given. After adding and subtracting Qin Huang talc decoction for 3 days, the symptoms did not improve significantly. After identification, the patient has the syndrome of excess heat in stomach fu-organs, and rhubarb, immature bitter orange and other drugs are added to clear Yangming's stomach heat. All the symptoms improved after taking 2 days, and disappeared after taking 3 doses.

Reporter: In the development of liver disease, it is common that damp-heat is combined with disease. If the pathogenic heat is excessive, or even accumulated over time, the syndrome of excessive stomach heat will appear. When using drugs in legislation, we should not only consider the damp-heat in the liver and gallbladder, but also consider the excessive stomach heat, and increase the products of purging heat such as yellow and immature bitter orange. Ye's theory that "the fu-organs should be unblocked, that is, they should be supplemented" advocates the method of lowering the stomach, so that the stomach qi can be reduced [2]. It can be seen that in the treatment of liver diseases, we should know its constant changes, attach importance to Yangming's fu-organs, and aim at quasi-law.

Case 2: Pang Mou, male, 66 years old, was first diagnosed on July 2, 20091day. Because of repeated abdominal distension for 3 years, he was admitted to hospital in February and was diagnosed as decompensated stage B of hepatitis cirrhosis. Symptoms: abdominal distension, dry mouth and thirst, loss of appetite, noisy stomach and discomfort, emaciation, dry stool, red tongue with little fur and thready pulse. Syndrome belongs to yin deficiency of liver and kidney. After 6 doses of Dabuyin Pills were added and subtracted, the symptoms of patients were relieved, but not obvious, so "deficiency is Taiyin" should be considered. Therefore, on the basis of the above, Radix Adenophorae and Radix Ophiopogonis decoction were added to supplement Taiyin. After taking the dose of 10, the abdominal distension disappeared and the other symptoms were basically improved.

Press: Ascites has the saying that "Yang deficiency is easy to treat and Yin deficiency is difficult to adjust" in the syndrome of distension deficiency. Water is yin evil and yang is metaplasia. Therefore, it is easier for patients with yang deficiency to subside ascites by warming yang and promoting diuresis. If it is yin deficiency, warming yang is easy to hurt yin, nourishing yin and helping dampness, and the treatment is quite difficult. At this time, a syndrome of yin deficiency, if only consider the deficiency of liver and kidney yin fluid and prescribe drugs, may be difficult to get results. Clinical treatment should be combined with "deficiency is Taiyin". Tang Rongchuan, a Qing dynasty man, pointed out: "Spleen yang is insufficient, and it will not turn, and spleen yin is insufficient, and it will still turn." For example, when cooking in a pot, the bottom of the pot is not cooked without fire, and the pot is not cooked without water "[2]. Therefore, due to yin deficiency and toxic swelling, we should not only pay attention to liver and kidney yin deficiency, but also pay attention to spleen yin deficiency, and give yin nourishing agents to restore stomach yang, so that the water will clear itself.

Of course, the therapeutic viewpoint of "Yang Ming in fact and Taiyin in deficiency" can never be generalized. It is only suggested that the clinical treatment should be based on syndrome differentiation of the main disease and syndrome, especially the treatment of excess and deficiency mixed with middle energizer syndrome, in order to improve the clinical efficacy.