中医证候要素研究的反思与对策

Thinking and Countermeasure of TCM Syndrome Elements Study

目的:分析证候研究中证候要素研究方法的不足,为证候研究的发展提出合理化建议。方法:采用计算机检索的方式,对2000年1月—2011年5月有关证候要素研究的文献进行检索并分析。结果:证候要素研究存在着相当多的问题:①对证候要素概念界定的不严格,部分研究所标称的证候要素并非是真正的证候要素。②对证候要素理论的背景及意义理解的不充分,采用先人工辨证后拆分证候要素的方式进行研究,违背证候要素理论提出的本义。③运用数理统计提取证候要素存在两个方面的问题:首先,很难做到正好将临床资料分成病性要素及病位要素,然后我们直接命名。多数是证候要素的组合,再人为进行拆分成病位证候要素和病性证候要素。拆分过程中人为因素明显。其次,对数理统计方法得出分类进行中医的理解并进行诠释,存在相当大的主观性。文章最后对证候要素理论进行了反思,对病性证候要素进行了有别于前人的界定。结论:证候研究中三个研究单元即证候、证候要素、单证是密不可分的,具体采用哪种研究单元要视具体情况而定。

Objective ： To analyze the disadvantages of research methods of syndrome elements in researches on syndromes, and to propose reasonable suggestions for the development of researches on syndromes. Methods：The computer searching method was applied for searching and frequency analysis of literature about syndrome elements frome January 2000 to May 2011. And concepts and methods were discussed. Results ： There were quite a number of problems among the researches on syndrome elements. ①The concepts of syndrome elements had not been strictly defined, as part of the nominal syndrome elements declared by some research institutes was not the true ones. ②The background and significance of the syndrome elements theory were insufficiently under- stood, as the research method with artificial differentiation employing first and then subdividing the syndrome elements went con- trary to the intention proposed by the syndrome elements theory. ③There were two aspects of the problem of extracting syndrome elements with mathematical statistics ： First, it was considerably difficult to subdivide the clinical data into elements of disease na- ture and elements of disease location and name them directly afterwards. Most of the cases were the combinations of syndrome ele- ments that should be artificially subdivided into elements of disease nature and elements of disease location. Artificial factors could be obvious during the process of subdividing. Secondly, there could be considerable subjectivity in classifying the mathematical statistics methods and understanding and interpreting them in a TCM way. Finally, on the basis of reflections on the syndrome ele- ments theory, elements of disease nature were unprecedented defined in manner different from what had been previously done. Conclusion：Syndrome complex, syndrome elements, and single syndrome, the three research units in syndrome research, were inex- tricably linked, while the specific kind of research units should be selected to employ according to the particular circumstances.