从《金匮》汤证辨析看仲景临床思维

Analysis of ZHANG Zhong-jing′s Clinical Thinking from Differentiation and Analysis of Decoction Syndromes in Synopsis of Golden Chamber

仲景《伤寒杂病论》创立的辨证论治体系不仅为后人树立临床辨证的典范,更重要的在于他所创建的临床思维方法成为我们永远效法的思维程式。祖国医学的思维方法,不但具有医学思维普遍的规律性,也更具有东方文化思维的特色。中医的著名典籍毫无例外地都从不同的角度、以不同的形式反映和记载了前人临床思维的过程和方法。通过学习、分析和研究《金匮要略》具体汤证认为,仲景临床思维的方法和特点是:①病为纲,证为目,病证结合为《金匮要略》辨证大法;②二向思维从阴阳高度整体上把握病情;③多端性思维为临床辨证提出多种思路;④层次分析思维法有利于复杂病证的辨析;⑤类比思维法简洁援比,借已知之情推求未知之理;⑥排他思维法排除相邻无关病证,即可破疑解难;⑦比较思维以两相对举比较,辨真别疑。

The system of syndrome differentiation created by ZHANG Zhong-jing in Treatise on Febrile and Miscellaneous Diseases not only set the norms of clinical syndrome differentiation for the future generations, but also more importantly is that he created the clinical thinking way will be always followed example of our thinking pro- gram. The thinking way of Chinese medicine shows not only the universal law of medical thinking but the charac- teristics of oriental culture more. The famous ancient books and records of Chinese medicine, without exception, all from different points of view and in different forms, reflected and recorded the previous process of predecessors＇ clinical thinking and methods. Through study, analysis and research of the specific decoction syndrome in Synopsis of Golden Chamber, I believe that ZHANG Zhong-jing＇s methods and characteristics of clinical thinking is that ① disease is as the key link, and syndrome is as the category. And the combination of disease and syndrome is as the fundamental law for syndrome differentiation in Synopsis of Golden Chamber. ②Thinking in two directions grasps the states of illness from yin and yang up to a height of entirety. ③Multiterminal thinking puts forward various ideas for the clinical syndrome differentiation. ④Level of thinking method is conducive to analyzing complex diseases. ⑤Analogy method takes aid as analog concisely to reason out the unknown through feeling the known. ⑥Exclusive method of thinking rules out the semblable and independent diseases and syndromes to solve questions or problems. ⑦Comparison method compares the relative two or more thought to identify the true or false.