中医辨证施治的发展与困惑

Development and confusion of differentiation of symptoms and signs in traditional Chinese medicine

目的:目前中医借助现代医学发展了辨证分型和微观辨证等新的辨证方法,同时也存在着很多困惑。从宏观辨证与微观辨证各自规律与特点做以初步探讨。方法:根据有关文献,从中医历来辩证施治的要素“证候与方药的证效关系”,以及传统辨证发展轨迹,在与现代医学微观结合中所遇到的矛盾等方面进行归纳总结。结果:①方证的对应关系是辩证的基础。②在辨证分型中,中医证候的变化与微观病理变化不同步,证候量、度的判断带有较大的随意性,常难以单用证候准确地反映出病变的实质。③把由证侯把握药效的辨证模式,改为微观指标与方药的研究方法,可扩充延伸中医辨证施治的研究范围,但须遵循原有的辩证模式。结论:中医辨证理论与方法是在直观范围内观察、实践、思考的结果,若进入现代医学微观范围则失去了自我,对此只能借助现代医学完善和发展自己。当前中医辨证施治的发展潮流,是在现代医学的介入下的,用不断发现新的微观因素重复循环寻找与中医证型相关性的研究,其方法仍属于宏观辨证的经验模式,缺乏的是临床有效方药的对应。

AIM： At present, the Chinese medicine develops classification of differentiation of symptoms and signs （DSS）, microscopic DSS and other new methods for DSS based on modem medicine, however, there are many confusion. In this paper, we preliminarily discuss the rules and characteristics of macroscopic and microscopic DSS. METHODS： According to the related literatures, we summarized contradiction appeared in microscopic integration of traditional Chinese medicine and modern medicine based on the essential factor in DSS ＂relationship between syndrome and medicine＂, and the traditional development path of DSS. RESULTS： ①The corresponding relations of prescription and symptoms were the foundation of DSS. ②In DSS classification, the changes of syndrome in Chinese medicine was not in concord with microscopic pathological changes, because its judgment on quantity and degree was very capricious, it is often difficult to accurately reflect the essence of pathological change. ③The change from efficacy decided by syndrome to research technique of microscopic indexes and side medicine may expand the research scope of DSS, but it should follow the original pattern of DSS. CONCLUSION： The DSS theory and method in Chinese medicine is the result of macroscopic observation, practice and ponder, it will lose itself if enters the microscopic scope of modern medicine, therefore, the DSS can consummate and to develop itself by draw support from the modern medicine. The current development trend of DSS in Chinese medicine is under the involvement of modern medicine, in which the relevant researches on diagnosis and treatment in Chinese medicine are unceasingly discovered by new microscopic factors repetitive cycle. This method still belongs to the macroscopic experience pattern, which lacking of correspondence of clinical effective prescription.