从“同病异证”到“同病类证”  

From "Different Patterns in the Same Disease" to "Analogous Patterns in the Same Disease"

作　　者：王文健[1] 沈自尹[2] 

机构地区：[1]复旦大学中西医结合研究所,上海200040 [2]复旦大学附属华山医院,上海200040

出　　处：《中国中西医结合杂志》2014年第1期9-12,共4页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：病证关系是中西医结合医学的一个重大科学问题。"同病异证"的病证关系理论对中西医结合和中医现代化起到了积极的推动作用,但目前在实际应用中往往被曲解:过分强调患者个体间的差异,而忽略同一疾病患者的基本病变,弱化对患者共性改变的辨证和治疗。"同病类证"的病证关系理论则将"同病异证"和辨证"微观化"紧密结合,通过对发病机制的认识来挖掘中医的核心病机;对基本病变的分析来辨析中医的主证;以"方证相应"理论来确立主方,指导主证的治疗;同一疾病患者个体间的差异,则可辨为共同主证下的"类证",并以主方为基础加减组成不同的"类方"治疗。"同病类证"较好地揭示了病和证之间的内在联系,完善和发展了"同病异证"的中西医结合研究思路和方法,是对中西医结合病证关系理论的重要创新。The relationship between disease in Western medicine （WM） and pattern in Chinese medicine （CM） is a key scientific issue in integrative medicine （IM）. The theory of ＂different patterns in the same disease＂ has greatly promoted the development of IM and the modernization of CM. However, this concept is frequently misinterpreted in the clinical practice. The individual difference was overempha- sized, while common changes among patients suffering from the same disease were neglected. As a re- sult, the identification and treatment of common changes based patterns were weakened. The theory of ＂analogous patterns in the same disease＂ combines the concept of ＂different patterns in the same dis- ease＂ and ＂microcosmic identification of patterns＂, which reveals the core mechanism of CM from the pathogenesis, and identifies the major pattern by analyses of manifestations and pathologic changes. And under the guidance of the theory of ＂formula corresponding to pattern＂, the major formula can be set for the major pattern. For those differences among individuals suffering from the same disease, they can be identified as different analogous patterns （subtypes） within a same major pattern, and can be treated with analogous formulae deriving from modified major formula. The theory of ＂analogous patterns in the same disease＂ clarifies the intrinsic relationship between the disease and pattern, perfects and develops the theory of ＂different patterns in the same disease＂, and it is an important innovation in thinking ways and research methods of IM.

关 键 词：中西医结合 同病异证 同病类证 

分 类 号：R241[医药卫生—中医诊断学]