浅谈司内揣外辨证观  

Brief Discussion of Dialectic View of Governing Interior to Infer Exterior

作　　者：马胜[1] 扈培增[1] 姜建国[1] 

机构地区：[1]潍坊市益都中心医院,山东青州262500

出　　处：《河南中医》2015年第4期671-672,共2页Henan Traditional Chinese Medicine

基　　金：山东省中医药科技发展计划项目(编号:2011-Z-002)

摘　　要：司内而揣外出自《灵枢·外揣》,作为中医临床的两种辨证思维方法,历代医家以及教科书均较重视司外而揣内,很少提及司内而揣外,这种片面性直接影响了对辨证论治的全方位理解,进而影响到临床疑难性和复杂性疾病的诊疗。司内揣外辨证的基本涵义大致有以下五种意思:即按部位、色脉、望闻诊和问切诊、天人关系、有形无形之意,分出"内"和"外"。司内辨证思维的侧重点不是"揣外",而是"司内",不应停留于病家的外在脉证和体征方面去考虑问题,而应聚焦于机体的内在因素。内在因素包括阴阳关系,脏腑关系、气血关系、六淫致病特点等人体内部的生理、病理变化规律,并以此作为判断病机,确立治法,处方用药的依据。Governing interior and inferring exterior, originated from The Spiritual Pivot ~ Exterior lnterence, serves as two dialectic views in TCM clinic. Doctors of generations and the teaching materials value more governing exterior to infer interior than gover- ning interior to inter exterior and this one-sided view impact the comprehensive understanding of syndrome diffrentiation and treatment which may influence the diagnosis and treatment of the clinical difficult and complicated diseases. The fundamental con- notation of governing interior to infer exterior basically includes that the interior and exterior are distinguished from the five as- pects：location ,complexion and pulse,inspection-auscultation and olfaction-inten＇ogation-pulse talking and palpation diagnosis,re- lationship between the human and the heaven,the meaning of tangibility and intangibility. The emphasis of the syndrome differen- tiation by governing interior is governing interior rather than inferring the exterior. Therefore, doctors should not stay at the levels of the external pulse and symptoms of the patients but to focus on the internal factors of the body. The internal factors include the internal law of physical and pathological changes such as relationship between yin and yang,relationship between viscera, relation- ship between qi and blood,diseases caused by six climate exopathogens,on which the judgment of the pathogenesis and the pre- scription should be based.

关 键 词：“司内” “揣外” 辨证思维 阴阳 脏腑 气血 六淫 

分 类 号：R221.2[医药卫生—中医基础理论]