仲景“病脉证并治”逐级分类、循证推理之临床诊疗决策模式解析  

Analysis of ZHANG Zhong-jing’s clinical diagnosis and treatment decision-making model of‘disease-pulse-syndrome combined treatment’based on hierarchical classification and evidence-based reasoning

作　　者：邱旭东[1] 王町囡 钟相根[1] QIU Xu-dong;WANG Ding-nan;ZHONG Xiang-gen(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029

出　　处：《中华中医药杂志》2023年第5期2170-2173,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重点研发计划(No.2019YFC1709200,No.2019YFC1709201);北京中医药大学教育科学研究专项课题(No.XJZX2019)。

摘　　要：《伤寒杂病论》各篇以“病脉证治”冠名,对于仲景之临床诊疗决策模式可概括为“病脉证并治”。该诊疗模式首先区分“病”,在辨清“病”这一级母分类的基础上,再平“脉”辨“脉”,并结合“证”的不同进行细分类(子分类),最后诊疗决策,即定治。“病脉证并治”诊疗模式是临床诊疗过程的高度概括,其不仅强调临床诊疗的全过程,即辨病→平脉→析证→定治,而且体现临床诊疗决策的复杂性,每个环节都是基于证据之循证推理,即在辨病(病名、诊断依据、病因、病位、病程、鉴别诊断等)的前提下,观其脉(脉位、主脉、兼脉、死脉等)证(主证、兼证、变证、或然证、阴性症状、死证等),知犯何逆(诊疗决策),随证(证据、依据)治之。As each chapter of Treatise on Febrile and Miscellaneous Diseases was named'disease-pulse-syndrome combined treatment',ZHANG Zhong-jing's clinical diagnosis and treatment decision-making model could be summarized as'disease-pulse-syndrome combined treatment'.ZHANG Zhong-jing first differentiated the disease,then on the basis of the disease differentiation(parent classification),he further analyzed the pulse and the syndrome(sub classification),and finally determined the treatment.The mode of'disease-pulse-syndrome combined treatment'was a high generalization of the clinical diagnosis and treatment process.It not only emphasized the whole process of clinical diagnosis and treatment,that was,differentiated the disease→analyzed the pulse-→analyzed the syndromedetermined the treatment,but also reflected the complexity of clinical diagnosis and treatment decision-making.Each link was based on evidence-based reasoning:under the premise of disease differentiation(disease name,diagnosis basis,etiology,disease location,course of disease,differential diagnosis,etc.),observed the pulse(pulse position,main pulse,concurrent pulse,dead pulse,etc.)and syndrome(main syndrome,concurrent syndrome,deteriorated syndrome,probable disease,negative symptoms,death syndrome,etc.),knew what went wrong(diagnosis and treatment decision),and treated it according to the evidence.

关 键 词：病脉证并治 伤寒论 金匮要略 临床诊疗决策模式 逐级分类 循证推理 

分 类 号：R249[医药卫生—中医临床基础]