影响中医临床疗效的内在逻辑结构和复叠多变量组分析研究

Analysis of Internal Logical Structure and Overlapping Multiple Variable Group Affecting the Clinical Effect of Chinese Medicine

中医临床的诊治过程是一个有机的整体,治疗前是辨证论治结论的得出过程,治疗后是辨证论治结论的实施过程。既往中医疗效评价主要体现在治疗后的症状体征及实验室指标等方面的变化,反映的是临床过程的外在逻辑结构,而对影响辨证论治结论准确性的客观因素缺少系统的认识与细致分析,更缺乏对临床过程内在逻辑结构的研究。通过分析中医临床过程的整体基本路径,可以梳理出影响辨证论治结论准确性的内在因素,由定因、定位、定性→对证、对症、对病→因人、因时、因地3个部分组合成的多变量组,共9个具体的多变量因子,反映出了临床过程客观存在的内在逻辑结构。深入分析临床案例的复杂证候群,发现多变量组会同时复叠出现,深化研究复叠多变量因子组存在的内在规律,是提高辨证论治水平与临床疗效的重要途径。

The diagnosis and treatment process of Chinese medicine clinic is an organic whole. Before treatment,there is a process of drawing conclusion by treatment based on syndrome differentiation. After treatment,there is a process of carrying out the conclusion. Previous Chinese medicine effect evaluation is mainly embodied in changes of symptoms,signs and laboratory indexes after therapy,which reflects the external logical structure of clinical process,but lack of systematical understanding and detailed analysis on objective factors that may influence the conclusion accuracy of treatment based on syndrome differentiation,and lack of research on internal logical structure of clinical process. By analyzing the whole basic path of Chinese medicine clinical process,the authors summarize the internal factors influencing the conclusion accuracy of treatment based on syndrome differentiation： a multiple variable group contributed by 3 parts,i. efrom determining cause,focus and nature,to aiming at syndrome,symptom and disease,to in accordance with patient＇s individuality,seasonal conditions and local conditions. There are 9 specific multi variable factors,which may reflect the internal logical structure of clinical process. Deep analysis of complex syndromes of clinical cases,finding out that multiple variable groups may come out and get overlapped at the same time and further research on the inner law of overlapping multi variable factor groups are significant ways to improve the level of treatment based on syndrome differentiation and clinical effect.