“病脉证并治”溯源及与辨证论治的关系  

Origin of"Disease,Pulse,Syndrome Combined Treatment"and its Relationship with Syndrome Differentiation and Treatment

作　　者：范天田 王凤兰[2] FAN Tiantian;WANG Fenglan(Postdoctoral Research Station of China Academy of Chinese Medical Sciences,Beijing,100700;China Institute for History of Chinese Medicine and Medical Literature)

机构地区：[1]中国中医科学院博士后科研流动站,北京市东城区100700 [2]中国中医科学院中国医史文献研究所

出　　处：《中医杂志》2024年第16期1633-1638,共6页Journal of Traditional Chinese Medicine

基　　金：中国中医科学院中国医史文献研究所科研基本业务费自主选题项目(ZZ160528)。

摘　　要：“病脉证并治”是张仲景《伤寒杂病论》原创的中医诊疗模式,是理论指导实践的典范。通过回溯“病脉证并治”的起源、形成、诊疗模式的确立,以及辨证论治的提出与广泛运用发展史,认为“病脉证并治”起源于先秦“病-药”模式,秦后期出现了经方家“病-方-药”模式及医经家“病-脉-治”模式。东汉为“病脉证并治”模式的构建时期,形成了“以病为纲、脉证为目、治病求本”的病证结合诊疗模式,确立了一套辨识与治疗疾病本质的临床思维程序。后世医家在张仲景“病脉证并治”模式基础上进行拓展与发挥,直至明清时期辨证论治的提出,现代辨证论治模式的确立,当代演变为辨证论治基础上的病证结合模式,故认为辨证论治模式是当代对“病脉证并治”模式进一步的演变与发展。"Disease,pulse,and syndrome combined treatment"is a diagnosis and treatment model of traditional Chinese medicine(TCM)originally created by ZHANG Zhongjing in Treatise on Cold Damage and Miscellaneous Diseases(《伤寒杂病论》),and is a theory guided practice model.By tracing back the origin,formation and the establishment of the diagnosis and treatment model of"disease,pulse,and syndrome combined treatment",as well as the proposal and extensive application of syndrome differentiation and treatment,it is believed that"disease,pulse,and syndrome combined treatment"originated from the"disease-drug"model in the pre-Qin dynasty,and the"diseaseprescription-drug"model of the classical prescription school and the"disease-pulse-treatment"model of the medical classics school in the late Qin dynasty.In the Eastern Han dynasty,the model of"disease,pulse,and syndromes combined treatment"is constructed,forming a disease-symptom combined diagnosis and treatment model of"taking disease as the main principle,pulse and syndrome as the purpose,and treating the disease for its root cause",and establishing a set of clinical thinking procedures for identifying and treating the root of the diseases.Based on ZHANG's model of"disease,pulse,and syndrome combined treatment",later generations of doctors expanded and developed it further until Ming and Qing dynasties when treatment based syndrome differentiation is proposed,and then modern syndrome differentiation and treatment model is established.Furthermore,it develops into the diseasesyndrome combined model based on syndrome differentiation and treatment.It is thus considered that the syndrome differentiation and treatment model is a further evolution and development of the"disease,pulse and syndrome combined treatment"model in contemporary times.

关 键 词：病脉证并治 辨证论治 中医诊疗模式 《伤寒杂病论》 

分 类 号：R242[医药卫生—中医临床基础]