《伤寒论》的辨证知机思维探讨

An exploration into the thinking of pattern⁃differentiation⁃deduced pathogenesis in Shanghan Lun

辨证知机、审机论治是中医临床诊疗的基本原则。《伤寒论》创立六经辨证论治体系,系统总结外感热病的病证演变规律,借外感以论杂病,载有112首经典方剂,倡导“病皆与方相应者乃服之”,辨病与辨证相结合,既有辨证论治的学问,也有辨证知机的奥妙。本文基于“机”之本义,从“微义”“关义”“宜义”3个角度出发,例举《伤寒论》六经辨证思维,“以方带证”分析经方的方证衍化关系及内涵,探讨《伤寒论》中所蕴含的辨证知机思维。本文强调在临床实践中,辨证知机,见微知著,洞烛先机,识机于病象之先,防患于未然;辨识机关,执简驭繁,洞悉病证之机要,牵一发而动全身;辨识机宜,把握时机,见机而作,乘机用势,顺势而为,因势利导。从辨证知机的角度解读《伤寒论》,为应用《伤寒论》相关理论指导临床实践提供思路与启发。

The basic diagnostic and treatment principles of traditional Chinese medicine are the pattern⁃differentiation⁃deduced pathogenesis and treatment based on examination of the pathogenesis.Shanghan Lun established a system of pattern differentiation of six meridians,systematically summarized the evolution laws of exogenous febrile disease,and discussed miscellaneous diseases as exogenous diseases.It contains 112 classic formulas and advocates that"those whose disease corresponds to the formulas should take them accordingly",combining disease differentiation and pattern differentiation,containing not only the knowledge of treatment based on pattern identification,but also the profundity of pattern⁃differentiation⁃deduced pathogenesis.Based on the original meaning of"pathogenesis",from the three angles of"subtle meaning","core meaning",and"appropriate meaning",this paper exemplifies the concept of pattern differentiation for six meridians in Shanghan Lun,analyzes the relationship and connotation of formula patterns of classical formulas in Shanghan Lun by"taking pattern with formulas",and explores the concept of pattern⁃differentiation⁃deduced pathogenesis in Shanghan Lun.This paper emphasizes that during the clinical practice of traditional Chinese medicine,it is important(i)to deduce the pathogenesis based on pattern differentiation,understand symptoms upon first onset,and deduce the pathogenesis before symptoms appear,thereby treating the disease at an early stage;(ii)to identify the most important concepts,solve complications with simple method,discern the core of the disease,and treat the entire body;and(iii)to optimize timing,act quickly,take advantage of opportunities,accept outcomes,and provide judicious guidance to patients.This paper serves to interpret Shanghan Lun based on pattern⁃differentiation⁃deduced pathological mechanism and provides ideas and inspiration for applying the theory of Shanghan Lun to guide clinical practice.