辨证论治的短板和“辨变证以论治”

The Shortcomings of Treatment Based on Syndrome Differentiation and"Treatment Based on Changed Syndrome Differentiation"

辨证论治在当前临床应用中主要存在四个短板:第一,由于四诊本身的局限性,导致辨证信息采集的主观性高;第二,教科书式的辨病加辨证分型论治容易导致辨证的教条化倾向,使临证失去思维的活跃性;第三,四诊症状的辨证分类提纲,会导致一些更重要、更能反映身体最主要矛盾的症状或脉象被忽视;第四,平面化判断四诊信息,会导致病证的主次缓急分不清。针对这些短板,本文提出了"辨变证以论治":第一,着眼于脉诊;第二,执简驭繁以应无穷之变;第三,辨标本缓急,治有先后;第四,辨证要有时空观念,治疗要有主次;第五,临床不要囿于四诊和局限于辨证论治,要善于利用现代医学检查。

There are four shortcomings in the current clinical application of treatment based on syndrome differentiation:first,due to the limitations of the four diagnosis,the subjective degree of information collection is high;second,the textbook style of disease differentiation and treatment based on syndrome differentiation are easy to lead to the dogmatic tendency of syndrome differentiation,which makes the clinical syndrome lose the activity of thinking;third,the outline of syndrome differentiation and classification of four diagnosis symptoms will lead to the neglect of some more important symptoms or pulse conditions which can reflect the most important contradictions of the body;fourth,the plane judgment of the four diagnosis information will lead to the confusion of the primary and secondary urgency of the disease.In view of these shortcomings,this paper puts forward the idea of"treatment based on changed syndrome differentiation":first,we should focus on pulse diagnosis;second,we should keep simplicity and control complexity to cope with infinite changes;third,we should identify the manifestation or root cause and acute or chronic condition and to treat it successively;fifth,clinical practice should not be limited to four diagnosis and syndrome differentiation,but be good at using modern medical examination.