论“独藏”辨识

Identification of“The Only Core Symptom Hidden in Many Symptoms”

辨证论治是传统中医诊疗的主要思维模式,在异病同治中的应用具有显著优势。然而,过度强调辨证论治,易忽略“病-症-因-机”。《伤寒杂病论》所云“但见一证便是”以柴胡证为例体现了抓主症思维在诊疗中的应用,然而直接将方与症对应有简化诊疗思维的倾向。基于此,提出“独藏”辨治理论,“独”作“单独”“独一个”之意,“藏”作“深藏”之意,通过辨识深藏在诸多症状中的独有核心症状,执简驭繁,从而实现中医辨病整体观与辨症精准化相结合。并以糖尿病周围神经病变、伏气温病、肥胖的辨识为范例,探讨以辨主症为核心,疾病为纲领,辨证为枢纽,上连审因,下达求机的“病-症-证-因机”相结合的“独藏”辨治思路,以期为现代中医诊疗思维提供指导。

Syndrome differentiation and treatment is a main thinking mode for diagnosis and treatment in tradi⁃tional Chinese medicine(TCM),and has significant advantages when used in the condition of“different diseases treated in the same way”.However,over-emphasis on syndrome differentiation and treatment tends to overlook the re⁃lation of disease,symptom,cause,and mechanism.Treatise on Cold Pathogenic and Miscellaneous Diseases(《伤寒杂病论》)holds that“one syndrome is enough”and introduces Chaihu(Radix Bupleuri)Decoction-related symptom as an example emphasizing the application of grasping main symptom in clinical diagnosis and treatment,but the direct matching of formulas and symptoms tends to simplify the thinking of diagnosis and treatment.Based on this,the theo⁃ry of“du cang(独藏,the only core symptom hidden in many symptoms)”has been proposed,for which“du”refers to“the only one”,while“cang”means“deep hidden”.By identifying the only core symptom hidden in many symp⁃toms,deducing simplicity into complexity,the integration of the holistic view of disease differentiation and the preci⁃sion of symptoms differentiation is realized.Taking the identification of diabetic peripheral neuropathy,latent-qi warm disease and obesity as examples,this paper discussed the differentiation and treatment thought of“du cang”,which focuses on distinguishing the main symptoms,takes disease as principle and syndrome differentiation as the hub,examines the causes and inspects the mechanism,integrating“disease-symptom-syndrome-cause and mecha⁃nism”so as to guide diagnosis and treatment thinking.