基于中医临床思维模式构建的“六维辨识”体系要略  

Outline of the Six-Dimensional Differentiation System Based on the Clinical Thinking Mode of Traditional Chinese Medicine

作　　者：王桂彬 司徒红林[1] 林毅[1] WANG Gui-Bin;SITU Hong-Lin;LIN Yi(Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广东省中医院,广东广州510120

出　　处：《广州中医药大学学报》2024年第10期2538-2546,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(编号:2018YFC1704100);广东省中医院中医药科学技术研究专项(编号:YN2023QN09);林毅全国名中医传承研究工作室项目(国中医药办人教函[2018]119号)。

摘　　要：中医学是认识人体生理状态和疾病过程的医学,既有一般思维方法的普适性,又有东方文化思维的特殊性。该文从中医临床思维模式构建的必要性出发,回归中医哲学体系,重新审视、剖析疾病本质思维规律的重要性,提出涵盖辨病、辨证、辨症、辨机、辨体、辨气的中医临证“六维辨识”思维理念。“六维辨识”思维指导下的中医临床诊疗立足于整体大局观,倡导辨病与辨证相结合;辨症基于主症,可明晰疾病病机转化、病势进退、病证演变;辨机要求临证之际应注重病机演变,据证施治,依症加减;辨体需根据患者体质,结合疾病之病因、病位、病性、病势,详细参辨;辨气应依据机体正气盛衰、邪气强弱来综合考虑,做到因人、因时、因地制宜。“六维辨识”旨在阐释辨病要素、识证参法、据症化裁、机态辨识的内在机理,有助于临证对疾病、病机、证候、治疗的全面把握,可为疾病的准确治疗提供理论基础。Traditional Chinese medicine(TCM)is a medical science about the physiological state and disease process of human body.It contains the universality of general thinking methods and the particularity of oriental cultural thinking.Starting from the necessity of the construction of clinical thinking mode of TCM and based on the philosophical features of TCM,this paper re-examines and analyzes the importance of the thinking mode for the nature of disease,and puts forward the six-dimensional differentiation system for TCM clinical practice,which covers disease differentiation,syndrome differentiation,symptom differentiation,pathogenesis differentiation,constitution differentiation and qi differentiation.Guided by the thinking mode of six-dimensional differentiation system,the TCM clinical practice exerts holistic view:disease differentiation is advocated to combine syndrome differentiation;symptom differentiation is mainly for the primary symptoms,which can clarify the transformation of pathogenesis,the progression of the disease,and the evolution of the syndromes;pathogenesis differentiation focuses on the evolution of pathogenesis,and treatment based on syndrome differentiation and modification of drugs based on symptoms are required;constitution differentiation should be made on the basis of the patient's constitution,and detailed identification of the etiology,disease location,disease nature,and progression of the disease should also be conducted;qi differentiation should be made on the basis of the comprehensive consideration of the exuberance and decline of healthy qi and pathogenic qi,thus to ensure the treatment adapting to the individuality,climate,and environment.The establishment of six-dimensional differentiation system aims to expound the internal mechanism of key points for disease differentiation,therapeutics based on syndrome differentiation,drug modification according to symptom differentiation,and differentiation of pathogenesis and illness state,which is helpful to the overall grasp of the disease,pat

关 键 词：中医临床思维模式 六维辨识 辨病 辨证 辨症 辨机 辨体 辨气 

分 类 号：R2-03[医药卫生—中医学]