“同证异治”内涵析辨  

Analysis on The Connotation of "Same Syndrome and Different Treatment"

作　　者：李金霞[1,2,3] 周小青 赖丽娜[1,2,3] 郑彩杏 LI Jin-xia;ZHOU Xiao-qing;LAI Li-na;ZHENG Cai-xing(Hunan University of Chinese Medicine,Changsha 410208,China;Collaborative Center for Research and Innovation of Digital Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;Key CM Diagnostics Laboratory of Hunan Provinc,Changsha 410208,China)

机构地区：[1]湖南中医药大学,长沙410208 [2]湖南省高等学校数字中医药协同创新中心,长沙410208 [3]中医诊断学湖南省重点实验室,长沙410208

出　　处：《中国中医基础医学杂志》2021年第12期1868-1870,1974,共4页JOURNAL OF BASIC CHINESE MEDICINE

基　　金：湖南省自然科学基金青年基金项目(2021JJ40399)-基于网络药理学的五首活血化瘀方治疗血瘀证作用机制差异研究。

摘　　要：“同证异治”可因“证”所指范围、含义不同而有广义和狭义之分。广义“同证异治”指宏观辨为同一基础证的病证,因证的层次、兼夹等不同且治法多样,从而使用不同治法和方药其本质仍属证异而治异,反映出证候的细化不足,有必要对“证”的生物学基础进行诠释以推进证候细化分型。狭义“同证异治”因医生的主观因素和方药的多维性,在病因病机、病理层次等均相同的情况下,不同医生的治法与方药仍可能不同。该现象体现了中医药多成分、多靶点优势,也凸显出中医辨证客观化与定量不足的问题,四诊的客观化研究、类方的差异性研究可为探索“同证异治”内涵和取效机制提供支撑,推动辨证论治规范化、微观化及量化,有利于临床精准用药。Due to the different range and meaning of“Zheng”,"Same syndrome with different treatments"have broad connotation and narrow connotation.In a broad sense,"same syndrome with different treatment"refers to the same basic syndromes,due to the different levels and combinations of syndromes and the diversity of treatment methods,different treatment methods and formulas are used,which are still different syndromes with different treatments in nature.This reflects the lack of refinement of syndromes,and it is necessary to interpret the biological basis of syndromes in order to promote the refinement classification of syndromes.In a narrow sense,"the same syndromes with different treatment"refers to the same syndrome,namely etiology,pathogenesis and pathological levels are the same,be treated differently by different doctors due to the subjective factors of doctors and the multi-dimensional nature of prescriptions.This phenomenon reflects the advantage of multiple composition and targets of TCM prescription,also highlights the problem of shortage of objective and quantitative of diagnosis,objective research of the four diagnosis methods and atherness study of analogous prescriptions may provide support for the exploration of the connotation and effectiveness mechanism of"same syndrome with different treatment",by which means facilitate the standardization and quantization of the clinical diagnosis and improve pertinence of clinical prescription.

关 键 词：证 病证 同证异治 诊断 

分 类 号：R222.15[医药卫生—中医基础理论]