再谈《中医诊断学》九版教材存在的问题——兼答吴长汶等的《商榷》

On the Problems in the Textbook of the Ninth Edition of Diagnostics of Traditional Chinese Medicine:Answering Wu Changwen and Others’ Discussion

作者在阅读九版教材《中医诊断学》（《中诊》）的过程中发现书中存在一些需要进一步探讨的问题：一是在四诊中对某些症状、体征论述的面太窄;二是某些论述与临床不符。论述面太窄,容易误导学习者。如黄疸的成因,只论述了湿热和寒湿两种,而胆管阻塞并未述及,胰腺癌、乏特氏壶腹癌、总胆管癌等是常见的引起胆道梗阻的疾病,其所产生的黄疸并非湿热、寒湿所致,若按教材所论,以治湿热或寒湿之法治之,就是误诊,会产生严重的后果。低热一症,《中诊》只言其由阴虚、气虚、气阴两虚及郁热所致,但湿热蕴胆证（慢性胆囊炎）、下焦湿热证、膀胱湿热证（慢性肾盂肾炎、慢性膀胱炎）、慢性乳蛾、慢性脓耳、鼻渊等皆可出现低热,而上述病证多由湿热所致,若按《中诊》所言治之,恐怕难见其效。干咳一症,教材仅言其由阴虚肺燥或燥邪犯肺引起,但临床风热蕴结咽喉（咽炎）、肺癌、喉癌、支气管癌、支气管异物、自发性气胸、悬饮及外耳道刺激、心阳虚引起的肺瘀血等均可出现干咳,皆非阴虚肺燥或燥邪犯肺所致。教材中尚有不少类似的症状表述,若运用中医理论和中医术语,将其补充完整,使之更符合临床,这是对《中医诊断学》的充实和提高,绝非中医西化,而是洋为中用。

The author found that there are some problems need to be further discussed in the course of reading the textbook of the ninth edition of Diagnostics of Traditional Chinese Medicine. These problems include：the discussion of some symptoms and signs in the four examinations is too narrow and some statements do not accord with clinical practice,which is easy to mislead learners. For example,the causes of jaundice are only discussed damp heat and damp cold,however bile duct obstruction is not described. Pancreatic cancer,vater＇s ampullary carcinoma,and total bile duct cancer are common diseases that cause biliary obstruction which is not caused by damp heat and damp cold,if treated according to the textbook will have serious consequences. Low heat is only caused by yin deficiency,qi deficiency,qi and yin deficiency and stagnation of heat in Diagnostics of Traditional Chinese Medicine. But low heat may also appear in chronic cholecystitis,chronic pyelonephritis,chronic cystitis,chronic moths,chronic purulent ears,nasosinusitis and so on which are mostly caused by damp heat. It is hard to get good effect if treated according to the book of Diagnostics of Traditional Chinese Medicine. In the textbook,dry cough is only caused by yin deficiency and lung dryness or pathogenic dryness invading the lung. However,dry cough can occur in pharyngitis caused by wind heat,lung cancer,laryngeal cancer,bronchial cancer,bronchial foreign body,spontaneous pneumothorax,pleural effusion,external auditory canal stimulation,and pulmonary blood stasis caused by heart yang deficiency which are not caused by yin deficiency and lung dryness or pathogenic dryness invading the lung. There are a lot of similar symptoms in the textbook. On the basis of the theory of traditional Chinese medicine and its terminology we can complement it,make it closer to the clinical practice so as to enrich and improve Diagnostics of Traditional Chinese Medicine which is not westernization of traditional Chinese medicine,but the foreign serving China.