从《伤寒论》与《温热论》探讨中医辨证思维  

Exploring TCM Syndrome Differentiation Thinking Through Treatise on Cold Damage Diseases and Treatise on Warm-heat Diseases

作　　者：柳婷[1] 李鲜[1] LIU Ting;LI Xian(The Second Affiliated Hospital of Henan University of Chinese Medicine,Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou,Henan,China,450002)

机构地区：[1]河南中医药大学第二附属医院,河南省中医院,河南郑州450002

出　　处：《河南中医》2025年第4期487-489,共3页Henan Traditional Chinese Medicine

基　　金：河南省中医药传承与创新人才工程项目(仲景工程)中医药青苗人才培养项目{豫卫中医函[2021]16号};河南省中医药科学研究专项课题项目(2022ZY2016);李鲜全国名老中医药专家传承工作室项目{豫卫中医函[2022]3号}。

摘　　要：张仲景《伤寒论》创立了六经辨证体系,叶天士《温热论》创立了卫气营血辨证体系。伤寒与温病是外感表证的两大类型,两者在病邪性质、感邪途径、发病部位、传变趋势等方面均有差异,故分属不同的疾病类型,辨明疾病种属,有助于从整体上把握疾病的主要矛盾。在厘清疾病种属,明确疾病主要矛盾的前提下,抓主证,辨次证,别异同。张仲景虽未明确提出体质的概念,《伤寒论》中却处处蕴含着体质思想;《温热论》提出:“慎勿用血药,以滋腻难散”“务在先安未受邪之地”,体现了知常达变的思想。《伤寒论》与《温热论》不仅在学术上一脉相承,其辨证思维也具有统一性,两者都是医家运用中医理论知识,在临床实践中对复杂的疾病症状和体征进行去粗取精、去伪存真,从而准确辨识疾病本质,揭示其发展规律,最终实现从临证经验到提出新理论、建立新辨证体系的典范。Zhang Zhongjing′s Treatise on Cold Damage Diseases established the six-meridian syndrome differentiation system,while Ye Tianshi′s Treatise on Warm-heat Diseases established the defense-qi-nutrient-blood syndrome differentiation system.Cold damage and warm diseases represent two major categories of externally contracted exterior syndromes.They differ in pathogenic factors,routes of infection,disease locations,and progression patterns,thus belonging to distinct disease types,so clarifying the disease category aids in grasping the primary contradiction of the condition holistically.After identifying the disease type and its core conflict,practitioners should focus on the primary syndromes,differentiate secondary symptoms,and discern similarities and differences.Although Zhang Zhongjing did not explicitly propose the concept of physical constitution,Treatise on Cold Damage Diseases consistently reflects constitutional considerations.Treatise on Warm-heat Diseases points out,"Avoid blood-nourishing drugs that may induce stagnation" and "Prioritize stabilizing unaffected regions," emphasizing adaptability through understanding norms.Both works not only share an academic lineage,but also demonstrate unified thinking in syndrome differentiation.Both exemplify how physicians,by applying TCM theoretical knowledge,refine complex clinical symptoms and signs through practice,sifting the essential from the trivial and discerning the truth from falsehoods,to accurately identify disease nature,reveal its developmental patterns,and ultimately achieve a paradigm of leap and transformation from clinical experience to proposing new theories and establishing new dialectical systems.

关 键 词：中医辨证思维 《伤寒论》 《温热论》 伤寒 温病 六经辨证 卫气营血辨证 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]