《临证指南医案》痞病之证素分析

An Analysis of Syndrome Factors of Abdominal Fullness and Distention in Case Records as a Guide to Clinical Practice

目的:分析《临证指南医案》痞病的证素分布规律。方法:以《对古今有关证素概念的梳理》中提到的120余项证素为主,对《临证指南医案》中痞病的39则医案的证素进行初步提取。结果:初步提取病位证素18项,分别为头、面、目、神、胸、膈、肺、心上、心下、脘腹、中脘、脘中、中焦、大肠、厥阴、肝、四肢及气分;病性证素13项,分别为:湿、寒、暑、热、痰、食、气滞、气闭、嗔怒、惊、气虚、汁消及阳微。继而提取规范共性证素,病位证素7项,分别为胃、胸膈、脾、肺、肝、大肠和神;病性证素13项,分别为热、气滞、湿、寒、暑、痰、阳虚、气虚、阴虚、食积、气闭、怒和惊。然后由证素组合基本证型28项,再由基本证型或证素组合反映病案机理的复合证型。结论:证素的使用可揭示病证之要点,将其连贯分析,可明病机机转中各要素关系,为辨证明确思路,为进一步指导临床奠定基础。

Objective：To analyze the syndrome factors distribution laws of abdominal fullness and distention in Case Records as a Guide. to Clinical Practice. Methods：According to the more than 120 syndrome factors mentioned in The Pectination of the Concept of Syndrome Factors in Ancient and Modern, Times, the syndrome factors of abdominal fullness and distention in 39 medical cases in Case Records as a Guide to Clinical Practice were first extracted. Results： There were 18 syndrome factors of disease location first extracted, including head, face, eyes, brain, chest, diaphragm, lung, upper heart, lower heart, abdomen, Zhongwan （ CV 12 ）, Xiawan （CV 10）,middle-jiao,large intestine, yueyin ,liver, limbs and qi system. The syndrome factors of disease nature were as follows： dampness, cold, summer heat, heat, phlegm, food retention, qi stagnation, qi closure, anger, terror, qi deficiency and yang deficiency. Then the standard common syndrome factors were extracted, including 7 syndrome factors of disease location ： stomach, chest, spleen, lung,liver, large intestine and brain. Plus 13 syndrome factors of disease nature ; heat, qi stagnation, dampness, cold, summer heat, phlegm, yang deficiency, qi deficiency, yin deficiency, food retention, qi closure, anger, and terror. Then there were 28 basic syndromes of the combination of the syndrome factors, and then tile compound syndrome types were combined by basic syndrome types or syndrome factors to show the related medical record mechanism. Conclusion：The use of syndrome factors can reveal the main points of disease syndrome. If we analyze them coherent]y, we can clarify the relationship between various factors in pathogenesis, and clarify the train of thought for differentiation of symptoms and signs, and lay a foundation for further guiding clinical practice.