“独处藏奸”理论探微

Explore the Theory of“Single or Unusual Clinical Manifestation Indicating Root Causes”

[目的]探求“独处藏奸”理论的内涵及其临床运用。[方法]通过查阅《黄帝内经》等中医古籍,探寻“独处藏奸”理论之沿流溯源及其含义,并结合后世《伤寒杂病论》《温热论》《临证指南医案》《温病条辨》等古籍中运用此理论辨舌脉以及其他症状的相关论述以及医案演绎,阐释其临床意义。[结果]“独处藏奸”理论源于《内经》,是指单独或者反常的临床表现具有重要的意义。该理论对后世伤寒、温病医家诊察单独或反常的脉、症、舌之阴阳、寒热、表里、虚实及其反映的病位与治疗有很大的启发,是否需要舍弃“独处”是医者需要权衡考虑的重点。[结论]当出现病证难以明确、辨证不易统一的情况时,尤其要注意单独、反常的临床表现,这些临床表现看似次要,实则为疾病全局之关键。谨守“独处藏奸”理论,审慎判断,对临床正确诊治大有裨益。

[Objective]To explore the connotation of the theory of“single or unusual clinical manifestation indicating root causes”and its clinical application.[Methods]By reviewing Inner Canon of the Yellow Emperor and other ancient Chinese medical texts,the origin and meaning of the theory of“single or unusual clinical manifestation indicating root causes”were explored,and it interpreted its clinical significance in the light of the related discussions on the identification of tongue,pulse and other symptoms and medical cases in the later treatises on Treatise on Miscellaneous Diseases of Typhoid Fever,Treatise on Epidemic Febrile Diseases,Medical Records for Clinical Guidance,and Item Differentiation of Warm Febrile Diseases.[Results]The theory of“single or unusual clinical manifestation indicating root causes”is originated from Inner Canon of the Yellow Emperor,which means that the single or unusual clinical manifestation has important clinical significance.It is a great inspiration to later generations of cold pathogenic physicians and epidemic febrile physicians in diagnosing the Yin and Yang,cold and heat,exterior and interior,deficiency and actuality of the single or unusual pulse,symptoms and tongue,as well as the disease location they reflect and treatment.Whether it needs to be discarded is the key point that doctors need to weigh and consider.[Conclusion]When the disease is difficult to be clearly identified and the syndrome differentiation is not easily unified,it is especially important to pay attention to certain clinical manifestations that are single or unusual.These clinical manifestations may seem to be of secondary importance,but they are actually the key to the disease.Observing this principle and making prudent judgments will be beneficial to clinical diagnosis and treatment.