基于病-证-治结合的核心方证研究思路

Research ideas of core formulas-syndromes based on disease-syndrome-treatment combination

病证关系是当前中西医结合研究的热点和关键。根据侧重不同,病证结合又可以分为以证为纲的同病异治、异病同治和以病为纲的同证异治、异证同治2种模式。现代医学辨病结合中医学辨证及核心病机的研究思路是当前主流模式。然而,研究发现,在当前病证结合及核心病机的研究中,存在病证异质及证治分离趋势。鉴于此,提出核心方证的研究思路与模式。根据方证对应理论,核心方证是对既往核心病机研究的深化,是在现代医学明确诊断疾病的前提下,抓住主要矛盾,凝练、总结得出疾病的最常见方证诊断。核心方证研究包括方证诊断标准研究,疾病的方证分布规律研究,方证基础上的药证演变规律研究,方证合方规律研究以及方证动态演变规律研究。方证诊断标准研究,即通过对古代文献、临床经验、医案等筛选,综合运用专家咨询、因子分析、聚类分析等,通过破译经典医籍中的方证记载、临床运用经验及相关药证,进而凝练提出的包含疾病、症状、体征、病理生理等关键信息在内的方证诊断信息。疾病的方证分布规律研究,是指在方证诊断标准建立的基础上,通过文献及临床横断面调查研究总结凝炼而成的疾病所包含具体方证类型。方证基础上的药证演变规律,即在明确的方证诊断基础上,通过文献与临床研究,探索其所合并出现药证的规律。方证的合方规律研究,是指某疾病的核心方证常固定性地与其他方证合方出现。方证动态演变规律是指疾病在发生发展过程中,随着时间和空间的改变而出现的方证之间不断转变过程。核心方证的提出有利于实现病-证-治三者统一,有利于深化病证结合研究模式。

The relationship between disease and syndrome is a research focus in integrated traditional Chinese and western medicine.Depending on the focus,the disease-syndrome combination for treatment is manifested as the different treatment methods for the same disease and the same treatment method for different diseases based on the syndrome,and different treatment methods for the same syndrome and the same treatment method for different syndromes ba sed on the disease.The mainstream model is the combination of disease identification in modern medicine with syndrome identification and core pathogenesis in traditional Chinese medicine.However,current research on the combination of disease and syndrome and core pathogenesis tends to focus on the heterogeneity between disease and syndrome and the separation of syndrome and treatment.Therefore,the study proposed the research idea and model of"core formulas-syndromes"(CFS).According to the theory of formula-syndrome correspondence,the research idea of CFS deepens the research on core pathogenesis,which aims to summarize the core formulas and syndromes for diseases.The research fields include diagnostic criteria for the indications o f formulas,distribution patterns of formulas and syndromes for diseases,the evolution of medicinal-syndrome based on formulas-syndromes,formula combination law based on formulas-syndromes,and the dynamic evolution of formulassyndromes.Through the summary of ancient classics,clinical experience,and medical records,and with the methods of expert consultation,factor analysis,and clustering analysis,research on the diagnostic criteria for the indications of formulas a ims to explore the diagnosis information such as the diseases,symptoms,signs,and pathophysiology.The research on the distribution patterns of formulas and syndromes for diseases tends to summarize the specific types of formulas and syndromes for the diseases through literature research and clinical cross-sectional studies based on the establishment of diagnostic criteria for the indications of formulas.The research on the evolution of medicinal-syndrome aims to clarify the medicinal-syndrome law through literature and clinical research.The formula combination law refers to the fact that the core prescriptions for a disease often appear in combination with other prescriptions on a regular basis.The dynamic evolution of formulas-syndromes refers to the continuous transformation and change of formulas and syndromes in the process of disease development with changes in time and space.The CFS is conducive to the unification of disease,syndrome and treatment and to the deepening of the research model of disease and syndrome integration.