《伤寒杂病论》“常变”思维临床应用  

Examples of Clinical Application of Dialectical Thinking of "Regular Changes" in Treatise on Cold Damage and Miscellaneous Diseases

作　　者：孙鸿昌[1] 蔡超产 陈晓辉[1] SUN Hong-chang CAl Chao-chan CHEN Xiao-hui(Henan University of TCM ,Zhengzhou, Henan,China ,45004)

机构地区：[1]河南中医药大学,河南郑州450046

出　　处：《河南中医》2017年第10期1692-1694,共3页Henan Traditional Chinese Medicine

基　　金：河南中医药大学2011年博士基金项目(编号:BSJJ2011-23)

摘　　要：常变辨证思维,核心理念是"知常达变"。病机的稳定性为"常",病机的非常规性为"变"。仲景既有"浮则为风"之说,又有"浮则为虚"之论,"浮则为风"为浮脉主病之常理,"浮则为虚"为浮脉主病之变法应用,切脉诊病要有"常变"观念,关键在于具体问题具体分析,脉证和参,把握病机,辨证施治。强调知常达变,要求中医的临床思维分析,要全面,忌偏执;要动态,忌讳僵死;要联系,忌孤立。总之,善于运用唯物辨证法的观点去分析问题,解决问题。但是在临床上,一个浮脉到底对应风还是虚,半夏泻心汤到底是治疗心下痞、腰痛或是下利等等,仅仅有常变观念还不够,还要有脉与证的对应,证与脉的一致,"脉证合参"才是辨证思维和方药准确应用从而取效的关键所在。The core idea of dialectical thinking of regular changes is ＂ understanding the particularity of things through grasping the general laws ＂. The stability of the pathogenesis is regularity,and the unconventional feature of the pathogenesis is ＂ change＂.ZHANG Zhong-jing has both the theory of ＂ floating due to wind＂ and the theory of ＂ floating due to deficiency＂. ＂ Floating due to wind＂ is the regular reason for the main diseases of floating pulse,while ＂ floating due to deficiency＂ is the flexible application of the main diseases of floating pulse. Pulse-taking and diagnosis should have the concept of ＂ regular changes＂,and the key lies in the concrete analysis of concrete problems,marking a diagnosis according to both pulse condition and syndrome manifestation,grasping pathogenesis,and syndrome differentiation. Understanding the particularity of things through grasping the general laws requires comprehensive TCM clinical thinking analysis rather than partial,dynamic rather than static,contacted rather than isolated.In short,doctors should be good at using materialist dialectics point of view to analyze problems and solve problems. But in clinical practice,a floating pulse is related to wind or deficiency; Pinellia Heart-Draining Decoction is used to treat epigastric fullness,waist pain or diarrhea,etc. Such similar questions show that only having regular changes is not enough,the corresponding pulse and syndrome is also necessary. Therefore, ＂ marking a diagnosis according to both pulse condition and syndrome manifestation＂ is the key to the dialectical thinking and prescription application so as to achieve good efficacies.

关 键 词：《伤寒杂病论》 “常变” “知常达变” “脉证合参” 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]