基于《伤寒论》“反”字条文的辨证策略研究  

Research on Differentiation Syndrome Strategy Based on"Fan"Clause in Treatise on Febrile Diseases

作　　者：韩颖[1] 刘刃 霍金[1] 王拓然 王莹莹[1] 刘宇桐 杨金洪[1] HAN Ying;LIU Ren;HUO Jin;WANG Tuo-ran;WANG Ying-ying;LIU Yu-tong;YANG Jin-hong(Institute of Acupuncture and Moxibustion,China Academy of Chinese medical Sciences,Beijing 100700,China;The Third Clinical Medical College,Nanjing University ofChinese Medicine,Nanjing 210028,China)

机构地区：[1]中国中医科学院针灸研究所,北京100700 [2]南京中医药大学第三临床医学院,南京210028

出　　处：《中国中医基础医学杂志》2022年第4期493-496,517,共5页JOURNAL OF BASIC CHINESE MEDICINE

基　　金：中央级公益性科研院所基本科研业务费专项资金(ZZ201813009)-针灸联合穴位注射治疗难治性面瘫气虚血瘀型临床研究。

摘　　要：目的:总结《伤寒论》通过“反”字强调的辨证策略。方法:通过阅读原文与文献确定32条相关条文,统计“反”字所纠正的证候诊断,明确“反”字后内容类型、“反”字前后内容的关系,分析疾病信息在该条文的价值。结果:“反”字后的内容指导虚实、寒热的鉴别与血瘀、水湿证的辨析,可归类为寒热与汗、大小便、脉、饮食、情绪、头身、胸腹、治疗过程、舌象。“反”字前后内容存在几种情况:前者为某证的典型证候,后者为该证相左的证候;或前者为两证的共性证候,后者为两证的鉴别要点;前者为无效的治法或误治,后者为治疗的不良反应,后者增加了前者辨证诊断的细节。在疾病核心病机的指导下,张仲景整合“反”字前后的病情信息,形成对患者的证候诊断。结论:在形成辨证诊断时,以疾病核心病机为指导形成证候诊断预判,以“相左证候”“证诊断鉴别要点”“药物治疗反应”“诊断细节信息”等维度反思信息采集的完整性与辨证结果的正确性、精准性。Objective To summarize the differentiation strategies of treatise on Febrile Diseases suggested by the clauses containing word“Fan”.Methods:Through reading the original text and related literature,32 related clauses of Treatise on Febrile Diseases were included in the analysis.To sort out the syndrome diagnosis corrected in"Fan"clauses,to clarify the type of content after the word“Fan”,the relationship between the content before and after the word“Fan”and to analysis the value of disease information in"Fan"clauses.Results Contents after word“Fan”guided the differentiation of deficiency and excess,cold and heat,blood stasis and dampness syndrome.The content after word“Fan”can be classified as cold and heat and sweat,defecation and urination,pulse,diet,mood,head and body,chest and abdomen,treatment process,tongue manifestation.There are the following relations between the content before the word“Fan”and the content after the word“Fan”.The former is the typical syndrome of a certain syndrome,and the latter is the opposite syndrome;the former is the common syndrome of two syndromes,and the latter is the key point of differentiation of two syndromes;the former is invalid treatment or mistreatment,and the latter is the adverse reaction of treatment;the latter increases the details of syndrome diagnosis of the former.Under the guidance of the core pathogenesis of the disease,ZHANG Zhong-jing integrated all the information to form the syndrome diagnosis of the patients.Conclusion In the formation of syndrome diagnosis,we should take the core pathogenesis of the disease as the guidance to form syndrome diagnosis prediction,and reflect on the integrity of information collection and the correctness and accuracy of syndrome differentiation results from the dimensions of opposite syndrome,key points of syndrome differentiation,drug treatment response,and information that can enrich the details of syndrome diagnosis.

关 键 词：《伤寒论》 辨证策略 “反”字 

分 类 号：R222.19[医药卫生—中医基础理论]