案例推理框架下的方证辨证探析  

An Exploration of Formula-Syndrome Differentiation in the Framework of Case-Based Reasoning

作　　者：原文静 赵进喜[1] 孟庆刚[2] YUAN Wenjing;ZHAO Jinxi;MENG Qinggang(Dongzhimen Hospital,Bejjing University of Chinese Medicine,Beijing,100700;Bejjing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院,北京市100700 [2]北京中医药大学

出　　处：《中医杂志》2024年第14期1423-1427,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82174530)。

摘　　要：案例推理是认知科学领域中的一种从经验中推理从而解决当前问题的方法,具有知识获取容易、操作步骤简单、推理效率可随经验累积提高等优势。方证辨证是以方剂的适应病证范围、病机、治法、禁忌证等为依据为当前病证确定诊断和治疗方案的辨证施治方法。从概念、适用领域、实施步骤的角度进行分析,认为方证辨证的概念属于案例推理的范畴,中医临床诊疗属于案例推理的适用领域,方证辨证的步骤与案例推理的步骤一致。基于案例推理方法的特点分析方证辨证的优势、局限性及辨证过程中需注意的问题,提出提升方证辨证能力的四个策略,包括积累方证经验、培养抓主症能力、积累规则库以提升随症加减的能力、提升评估治疗方案效果并获取对应反馈的能力,以期推动方证辨证的临床应用。Case-based reasoning is a method of reasoning from experience to solve current problems in the field of cognitive science,which has the advantages of easy acquisition of knowledge,simple operation steps,and the ability to improve the efficiency of reasoning with the growth of experience.Formula-syndrome differentiation is a method of differentiation and treatment based on the scope of the adapted disease,disease mechanism,therapeutic methods,and contraindications of the formula.Analysed from the perspectives of concept,applicable field,and implementation steps,it is believed that the concept of formula-syndrome differentiation belongs to the scope of case-based reasoning,the clinical diagnosis and treatment of traditional Chinese medicine belongs to the applicable field of case-based reasoning,and the steps of formula-syndrome differentiation are consistent with the process of case-based reasoning.Based on the characteristics of case-based reasoning,we analyse the advantages,limitations and problems to be noted in the process of formula-syndrome differentiation,and put forward four strategies to improve the ability of formula-syndrome differentiation,including accumulating experience on formulas and syndromes,cultivating the ability to grasp the main symptoms,accumulating a rule base to improve the ability to modify formulas according to the symptoms,and improving the ability to assess the effect of treatment plans and obtain corresponding feedback,with a view to promoting the clinical application of formula-syndrome differentiation.

关 键 词：案例推理 方证辨证 主症 辨证论治 

分 类 号：R289[医药卫生—方剂学]