HeJianXuePaiHeJianDoctrine河間學派

DaoshingNi

Medical Classics, Taoist Medicine, Formulary, and Shang Han Doctrines initiated are considered Classical Doctrines while the doctrines that were developed during Song Dynasty onward are considered Contemporary Doctrines. They are

He Jian Doctrine (Fire-Heat Pathology) Yi Shui Doctrine (Zang-Fu Differentiation) Gong Xie Doctrine (Pathogen Attacking) Dan Xi Doctrine (Excess Yang Deficient Yin) Ming Men Doctrine (Gate of Life) Wen Bing Doctrine (Warmth Disease)

While the last 100 years, the Integrated Medicine Doctrine is considered Modern Doctrine.

Life during the North Song Era 960-1127 AD

Liao Mongolian Tribes

Tibetan Tribes

West Xia

Song

Introduc6onTimeEnvironment

•  Song–Jin–YuanDynas6es,960-1368AD•  Establishmentofspecial6essuchaspediatricsandgynecology

•  Establishmentofspecialtopicsorapproachtodiseases

JinYuanFourMajorPhysicians⾦金金元四⼤大医家

Liu, Wan Su 刘完素

He Jian Xue Pai He Jian Doctrine

Zhang, Cong Zheng 张从正

Gong Xie Xue Pai Detoxification Doctrine

Li, Gao (Li, Dong Yuan) 李杲 (李东垣)

Pi Wei Xue Pai Spleen-Stomach Doctrine Part of Yi Shui Xue Pai

Zhu, Zhen Heng (Zhu, Dan Xi) 朱震亨 (朱丹丹溪)

Dan Xi Xue Pai Dan Xi Doctrine

SpecificTimeandPlace

•  SongJinDynas6es宋⾦金金时代 •  War6me•  Dr.Liu,WanSu刘完素 •  Born1,110AD,HeJiancountyofHeBeiProvince

•  NorthernChina,

Thefoundingenvironment

•  CenteredaroundFire-HeatPathology•  DryClimateandtoughweather•  IntakeofBeef,lamb,wheat,alcohol.•  Toughterrain,toughpeople.•  Evenwithwind-cold,frequentlytransformsintoheatordryness.

•  DuringSongDynasty–TaiPingHuiMinHeJiJuFang太平惠⺠民和剂局⽅方 –mostlywarmingandtonifying,cannotbeusedwellinheatcondi6ons.

Thefoundingenvironment

•  AtSongDynasty,emphasiswasonformulasandlessontheunderstandingofpathogenesis.

•  Dr.Liu,WanSu,basedonthefounda6onsfromNeijingandspent35yearsperfec6ngtheFire-Heattheories.

EightDis6nctFeaturesorContribu6onsofLiu,WanSu

1.  FrequencyofFire-HeatPathology火热⼴广泛 2.  “SixQicanalltransformtoFire”Doctrine六⽓气皆能化火3.  ExtremeofFiveEmo6onscreateHeat五志过极皆为热 4.  TreatmentofFire-HeatPathology火热病的治法5.  YangQiStagnancy阳⽓气怫郁6.  WuYunLiuQiPathology五运六⽓气病机7.  KangHaiChengZhiDiscussion亢害承制论 8.  Elabora6onofZaBing杂病的发挥

1.FrequencyofFire-HeatPathology

•  Originatesfromchapter74ofNeijingSuwenEssen6alsofDiseaseandTherapy

•  Neijing19E6ologies(NeijingBingJiShiJiuTiao内经病机⼗十九条)

HuangDiinquired,“Canyoupleasedescribethepathologyforeachorgansystemanditsconnec6onwiththeatmosphericinfluences?”

QiBoresponded,”Symptomsoftremorsandshakingofthelimbs,dizziness,andver6goareusuallycausedbywindandassociatedwithliver.Manycondi6onsofcontrac6onandspasmsareusuallyduetocoldandassociatedwiththekidneys.”………

WuZangBiJi–FiveZangE6ologyWuYunBingJi–FiveCyclesE6ology

All Wind Vertigo Liver

All Cold contractures Kidney

All Qi asthma/congestion Lung

All Damp swelling fullness Spleen

All pain, itch, rash Heart

NeijingSuwenNineteenE6ologies

•  Fain6ngandseizure,lockjawandshivers,acutevomi6ng,manicandrestlessness,edemaandpainareduetofire.(5)

•  Abdominaldistensionandswelling,borborygmusandtympani,vomi6ngoffoulmaierandacidregurgita6onandacutedysenterywithbloodystools,bodytorsionandturbidsecre6onsareusuallyduetoheat(4)

•  5belongstozang,1wind,1damp,1cold,1upper,1lower

Fire-HeatPathologyExpansion

•  Eventuallyexpandedto56typesofFire-HeatE6ologyoccupying80%ofalle6logies.

56typesofFire-HeatPathology

•  Asthma,vomi6ng,acidregurgita6on,acutediarrhea,bodytorsion,turbidurina6on,asciteswithtympani,rash,hives,opensores,tumor,nodules,fain6ng,swelling,nasalconges6on,epistaxis,hematemesis,bloodystools,feverandchill,shivers,fright,confusion,sadness,manic,restlessness,throatpain,6nnitus,hearingloss,blurryvision,sneezing,acutedisorders,delirium,etc.

2.SixQicanalltransformtoFire

•  Wind,damp,dryness,andcoldcanalltransformtofire.

•  Windoriginatesfromheat,heatisben本 andwindisbiao标,windcannotexistswithoutheat.

•  Ingeneralpathology,windtendstocombinewithheat.

InthecaseofVer6go

MetalWeakness

Metal cannotcontrol Wood

Wood over-abundance

Wood createsFire

Wind and Fireare Yang in

nature

Combines andmutually

feeding eachother

Yang energieslike to move

Createsvertigo,

dizziness

Therefore the treatmentshould be pungent and cool

DampandFire-Heat

•  Dampdiseasedoesnotoccuronitsown.•  Itisduetofire-heatstagnancycausingbodyfluidtostagnantcrea6ngwater-damp

•  Mostclinicalmanifesta6onsareswelling.•  Mostswellingisduetodamp-heatcombina6oncrea6ngsluggishurina6on.

•  Theherbsshouldbepungentbiierandcold

DrynessandFire-Heat

•  Drynessconsumesyinfluidandfrequentlytransformstofire-heat.

•  Bodyfluiddeficiency,blooddeficiency,yindeficiencycanallcausehyperac6vityofyangcrea6nginternalheat.

•  Winteriscoldandcontrac6ngandstagnantinnature.ThereisactuallymoredrynessthanSummermonths.

•  Nourishyintocoolheat

ColdandFire-heat

•  Excludingyangdeficiency(interiorcold)•  Twopossiblescenarios

Wind ColdInvasion

Yang QiStagnancy

No dispersioncreates Heat

Extreme ofCold

Transformsto Heat

ExtremeofFiveEmo6onscreatesHeat五志过极皆为热

•  Liu,WanSuisrecognizedofhisworkinexogenousfire-heatdiscussions,but

•  Hehasalsodidsomeworkinunderstandingsofinternalheatthroughthe“extremeoffiveemo6onscreatheat”.

•  Fiveemo6onalimbalancescancauseheatandheatcancausefiveemo6onalimbalances.

Anger Qi stasisstasis creates fire

Overexcitation

Overworrying

Sadness

Fear

Feeds Heart Fire

Qi stasisstasis creates fire

Qi stasisstasis creates fire

Kidney Water WeakensHeat Fire Rises

Fright Heart MovementMovement creates fire

4.TreatmentofFire-HeatPathology火热病的治法

•  BiaoZheng表证 •  LiZheng⾥里里证

BiaoZheng表证

•  Pungentcoolingorsweetcold•  MaHuangandGuiZhiarenotsuitable•  FrequentlyuseGanCao⽢甘草,HuaShi滑⽯石,CongBai葱⽩白,DouChi⾖豆豉.

•  BiaoZhengwithNeiRe,useFangFengTongShengSan防⻛风通圣散,ShuangJieSan双解散.

•  OruseTianShuiSan天⽔水散+LiangGeSan凉膈散

FangFengTongShengSan防⻛风通圣散

•  FangFeng,ChuanXiong,DangGui,ShaoYao,DaHuang,MangXiao,LianQiao,BoHe,MaHuang,ShiGao,JieGeng,HuangQin,BaiZhu,ZhiZi,JingJie,HuaShi,GanCao,ShengJiang.

•  防⻛风，川芎， 当归，芍药，⼤大黄，芒硝，连翘，薄荷，⿇麻黄，⽯石膏，桔梗，黄芩，⽩白术，栀⼦子，荆芥，滑⽯石，⽢甘草，⽣生姜。

•  Dispersewindrelievebiao,cleanseheatandpurge.

ShuangJieSan双解散

•  TianShuiSan+FangFengTongShengSan•  Measles,BiaoLiExcess

TianShuiSan天⽔水散

•  LiuYiSan六⼀一散,YiYuanSan益元散,TaiBaiSan太⽩白散。

•  HuaShi6,ZhiGanCao1,honey•  滑⽯石6，炙⽢甘草1•  Summerdampwithfever,restlessness,thirst,sluggishurina6onwithpain,SanJiaodampheat.

LiangGeSan(CoolDiaphragm)凉膈散

•  LianQiao,DaHuang,MangXiao,ZhiZi,HuangQin,BoHe,GanCao.连翘，⼤大黄，芒硝，栀⼦子，黄芩，薄荷，⽢甘草。

•  CookwithZhuYe⽵竹叶 andHoney.•  ClearUpperandMiddleJiaoheat.•  HeartFire,restlessness,thirst,redeyes,ver6go,drymouth,cankersores,crackedlips,hematemesis,epistaxis,cons6pa6on,sluggishurina6on,infan6leseizure.

LiZheng⾥里里证 •  Purga6onofFire-Heat•  ThreeScenarios

–  BiaoZhenggone,NeiRewithabdominaldisten6on,restlessness,pulsedeepexcess.

–  Deepheattoxincrea6ngdrythroat,asthma,abdominalpains,pulsedeepthready.

–  Dampheat.•  DaChengQiTang⼤大承⽓气汤 orSanYiChengQiTang三⼀一承⽓气汤

•  HuangLianJieDuSan黄连解毒散•  SmalldoseofHuangLienJieDuSan黄连解毒散orLiangGe

San凉膈散

DaChengQiTang⼤大承⽓气汤

•  DaHuang,HouPu,ZhiShi,MangXiao.•  ⼤大黄，厚朴，枳实，芒硝。 •  Cons6pa6on,fever,wirypulse,delirium,asthma;shanghancons6pa6onfor5-6days.

•  Acuteappendici6s,acuteintes6nalobstruc6on,acutecholecys66s.

SanYiChengQiTang三⼀一承⽓气汤

•  DaHuang,HouPu,ZhiShi,MangXiao,GanCao,ShengJiang.

•  ⼤大黄，厚朴，枳实，芒硝，⽢甘草，⽣生姜。 •  BiaoandLiFire-HeatPathology.

HuangLianJieDuTang黄连解毒汤

•  HuangLian,HuangBo,HuangQin,ZhiZi•  Ac6on:clearheat,relievetoxin,reduceswelling.

•  AllFire-Heatpathology,BothBiaoandLiFire-Heat,manic,restlessness,drythroat,drymouth,dryheaves,insomnia,hematemesisorepistaxis.

5.YangQiStagnancy阳⽓气怫郁

•  Liu,WanSu’sfocusisnotonlyonFire-Heatpathology,butalsothepatencyflowofQi.

•  ThegreatDaohasnoshapeorform.WithoutQi,nolifecanexists;transforma6onofQigivesbirthofalllives;changesofQicreateschangesinlives;abundanceofQistrengthentheorganism;deficiencyofQiweakenstheorganism;normalQipromotesharmoniouslives;derangedQicreatesdiseases;termina6onofQicausesthedeathoflife.

5.YangQiStagnancy阳⽓气怫郁

•  IfYangQiisstagnant,Fire-Heatdevelopscrea6ngmanydifferentpathologies.

•  Twodefini6ons.

Imbalance of LiuQi and Wu Zhi

Creates YangQi Stagnancy

Fire-HeatFormation

Actual Yang Re All Pathologies

TreatmentofYangQiStagnancy

•  Xuan,Qing,Tong宣清通三法 •  Disperse,Cleanse,Openmethodologies•  Pungent,Biier,ColdHerbs

– Xuan–toclearbiao,notswea6ng,toclearstagnancy–pungentcoolherbs

– Qing–toclearstagnantheat–biiercoldherbs– Tong–mainlypurging–pungent,biier,coldherbs

6.WuYunLiuQiBingJiXueShuoFiveCycles,SixQiPathology

•  Eventhoughhumanbeingscanmastertheirenvironmentandcreatesamicro-climateforherself,climate,weather,andenvironmentalchangesares6llveryinfluen6alincausingortriggeringdiseasesandimbalances.

•  FiveCycles–fiveelementalorfivezanginfluences

Overabundanceof Earth

Overacting onWater

Water cannotcontrol Fire Fire Pathology

Stomachache,acid

regurgitation,abdominaldistension,

rash and itch

Overabundanceof Fire

Overacting onMetal

Metal cannotcontrol Wood

WindPathology

Vertigo andspasms

Overabundanceof Wood

Overacting onEarth

Earth cannotcontrol Water Cold Pathology

Diarrhea, coldextremities

Overabundanceof Water

Overacting onFire

Fire cannotcontrol Metal

DrynessPathology

Cough, dryskin, dry

mouth, throat

Overabundanceof Metal

Overacting onWood

Wood cannotcontrol Earth

DampPathology

Swelling,borborygmus,

lethargy

7.KangHaiChengZhiDiscussion亢害承制论

•  WuYunLiuQiinter-suppor6ngandinter-controlling.

•  Toensureseekingforbalanceinconstantimbalance.

Ben Qi 本⽓气 Original Qi

Huo Qi 火⽓气 Fire Qi

Zao Qi 燥⽓气 Dryness Qi

Han Qi 寒⽓气 Cold Qi

Feng Qi ⻛风⽓气 Wind Qi

Re Qi 热⽓气 Heat Qi

Shi Qi 湿⽓气 Damp Qi

Zhong Qi 中⽓气 Middle Qi

Jueyin 厥阴 LV

Taiyin 太阴 SP

Shaoyin 少阴 HT

Shaoyang 少阳 GB

Taiyang 太阳 UB

Yangming 阳明 ST

Biao Qi 标⽓气 Manifestation Qi

Shaoyang 少阳 GB

Yangming 阳明 ST

Taiyang 太阳 UB

Jueyin 厥阴 LV

Shaoyin 少阴 HT

Taiyin 太阴 SP

8.Furtherelabora6ononmiscellaneousdiseases

•  HuangDiSuWenXuanMingLunFang–  AlsoknownasXuanMingLunFang

•  黄帝素问宣明论⽅方 •  1172AD•  15chapters,348formularies•  FangFengTongShengSan防⻛风通圣散 •  DiHuangYinZi地黄饮⼦子 •  GuiLingGanLuYin桂苓⽢甘露饮 •  66%combina6onofwarmingandcoolingherbs•  21%warming,13%cooling

DiHuangYinZi地黃飲子

•  生地 ShengDi3liang•  巴戟天 BaJiTian1liang

•  山茱萸 ShanZhuYu1liang

•  肉蓯蓉 RouCongRong1liang

•  石斛 ShiHu1liang•  炮附子 FuZi1liang•  茯苓 FuLing1liang

•  石菖蒲 ShiChangPu1liang

•  遠志 YuanZhi1liang•  肉桂 RouGui1liang•  麥冬 MaiDong1liang•  五味子 WuWeiZi.5liang

•  生薑 ShengJiang•  大棗 DaZao•  薄荷 BoHe

DiHuangYinZi地黃飲子

•  TonifyKidneyBenefitEssence

•  NourishHeartOpenOrifice

•  Stroke,LossofSpeech,especiallyKidneyYinandKidneyYangDeficiencytypes

•  LocomotorAtaxia-syphilisofthespinalcordcharacterizedbydegenera6onofsensoryneuronsandstabbingpainsinthetrunkandlegsandunsteadygaitandincon6nenceandimpotence

•  Meniere’sSyndrome•  Hyperthyroidism•  Neurasthenia•  ChronicNephri6s•  Infer6lity

GuiLingGanLuYin桂苓甘露飲

•  LiuYiSan六一散–  HuaShi滑

石

–  GanCao甘草

•  WuLingSan五苓散–  GuiZhi桂枝–  FuLing茯苓–  ZeXie澤瀉–  ZhuLing豬苓–  BaiZhu白朮

•  HanShuiShi寒水石•  ShiGao石膏

Liu Yi San + Wu Ling San + Han Shui Shi, Shi Gao 六一散 ＋ 五苓散 ＋ 寒水石，石膏

HeJianXuePai

•  Establishedfounda6onsfor– PathogenAiackingDoctrine– DanXiDoctrine– WarmthDiseaseDoctrine

Fever

•  Anadap6vemechanism,feveristhebody'sreac6ontopathogens;itaiemptstoraisecorebodytemperaturetolevelswhichwilldenature,debilitate,orkillthepathogen.Mostfeversarecausedbyinfec6onsandalmostallinfec6ousdiseasescancausefever.Whenapa6enthasorissuspectedofhavingafever,thatperson'sbodytemperatureismeasuredusingathermometer.Ifsuccessfulinriddingthebodyofaninvasivepathogen,feverisanimportantprotec6veimmunemechanismandshouldgenerallynotbesuppressed.However,thereareinstanceswhenfeverescalatestotemperatureswherethebodyisatriskofdestroyingitsowncellsandmustbebroughtundercontrolwithsuppressivemedica6on.

infec6on

•  Aninfec6onisthedetrimentalcoloniza6onofahostorganismbyaforeignspecies.Aninfec6onis,ineffect,awarinwhichtheinfec6ngorganismseekstou6lizethehost'sresourcesinordertomul6plyattheexpenseofthehost.Theinfec6ngorganism,orpathogen,interfereswiththenormalfunc6oningandperhapsthesurvivalofthehost.Colloquially,apathogenisusuallyconsideredamicroscopicorganismthoughthedefini6onisbroader,includingbacteria,parasites,fungi,viruses,prions,andviroids.Thebranchofmedicinethatfocusesoninfec6onsandpathogensisinfec6ousdiseases

Inflamma6on

•  Inflamma6onisthefirstresponseoftheimmunesystemtoinfec6onorirrita6onandmaybereferredtoastheinnatecascade.Inflamma6onischaracterizedbythefollowingquintet:redness(rubor),heat(calor),swelling(tumor),pain(dolor)anddysfunc6onoftheorgansinvolved(func6olaesa).

Viral infectious diseases AIDS – AIDS Related Complex – Chickenpox or Varicella – Common cold – Cytomegalovirus Infection – Colorado tick fever – Dengue fever – Ebola haemorrhagic fever – Epidemic parotitis – Flu – Hand, foot and mouth disease – Hepatitis – Herpes zoster – Influenza – Lassa fever – Measles – Marburg haemorrhagic fever – Infectious mononucleosis – Mumps – Poliomyelitis – Progressive multifocal leukencephalopathy – Rabies – Rubella – SARS – Smallpox or variola – Viral meningitis – West Nile disease – Yellow fever Bacterial infectious diseases Anthrax – Bacterial Meningitis – Brucellosis – Bubonic plague – Campylobacteriosis – Cat Scratch Disease – Cholera – Diphtheria – Endometriosis – Epidemic Typhus – Glanders – Gonorrhea – Hansen's Disease – Legionellosis – Leprosy – Leptospirosis – Listeriosis – Lyme Disease – Melioidosis – MRSA infection – Nocardiosis – Pertussis – Pneumococcal pneumonia – Psittacosis – Q fever – Rocky Mountain Spotted Fever or RMSF – Salmonellosis – Scarlet Fever – Shigellosis – Syphilis – Tetanus – Trachoma – Tuberculosis – Tularemia – Typhoid Fever – Typhus – Whooping Cough Parasitic infectious diseases African trypanosomiasis – Amebiasis – Ascariasis – Babesiosis – Chagas Disease – Clonorchiasis – Cryptosporidiosis – Cysticercosis – Diphyllobothriasis – Dracunculiasis – Echinococcosis – Enterobiasis – Fascioliasis – Fasciolopsiasis – Filariasis – Free-living amebic infection – Giardiasis – Gnathostomiasis – Hymenolepiasis – Isosporiasis – Kala-azar – Leishmaniasis – Malaria – Metagonimiasis – Myiasis – Onchocerciasis – Pediculosis – Pinworm Infection – Scabies – Schistosomiasis – Taeniasis – Toxocariasis – Toxoplasmosis – Trichinellosis – Trichinosis – Trichuriasis – Trypanosomiasis Fungal infectious diseases Aspergillosis – Blastomycosis – Candidiasis – Coccidioidomycosis – Cryptococcosis – Histoplasmosis Prion infectious diseases Bovine spongiform encephalopathy – Creutzfeldt-Jakob disease – Kuru

HeJianXuePaiEndingSummary

Contributedtobeierunderstandingofinfec6ousdiseases,inflamma6ons

andmiscellaneousdisorders