叙事医学实践对中医辨证行为的影响

Influence of Narrative Medicine Practice on the Syndrome Differentiation Behavior of Traditional Chinese Medicine

随着叙事医学在中国的快速发展,叙事医学实践将与中医实践深入结合。分析总结患者叙事特征的主体间性、时间性、独特性、因果/偶然性、伦理性对中医辨证行为的影响,包括:可在辨证与决策时增加眼部望诊信息与追问复述行为;提示病机诊断结论,简化主诉判断过程;增加气郁证等与情绪异常相关的证诊断结论,促成医生间辨证结果同质化的辨证策略;关注偶然性因素,重视形成固定的辨证路径;以患者的伦理观为指导制定辨证实践与研究的发展方向。

With the rapid development of narrative medicine in China, the practice of narrative medicine will be deeply combined with the practice of traditional Chinese medicine. The influence of intersubjectivity, time, uniqueness causality/chance and ethical characteristics on the TCM differentiation behavior is summerized, including that it can increase eye inspection information and follow-up retelling behaviors in syndrome differentiation and decision-making;prompt the diagnosis conclusion of pathogenesis, simplify the judgment process of main complaint;increase the diagnosis conclusion of syndromes related to abnormal mood such as Qi-stagnation syndrome, and promote qualitative dialectical strategy of the same syndrome differentiation results among doctors, pay attention to contingency factors and attach importance to the formation of a fixed dialectical path;formulate the development direction of dialectical practice and research based on the patient′s ethics.