张仲景“平人”观对临床“无症可辨”的启示

Enlightenment of ZHANG Zhongjing’s “Ping Ren”(平人) View on Clinical “No Syndromes for Differentiation”

'平人'通常被认为是健康人。通过对《伤寒杂病论》相关条文的分析,可以发现,张仲景所谓'平人'只是貌似无病之人,其实质是内有邪气伏藏或内有虚损之人。其特点与临床中'无症状'型患者相似。根据张仲景'平人'观的特点,当遇临床'无症可辨'时可参考如下策略:做到四诊合参,尤重舌、脉、腹诊;细询病史,知晓伏邪的成因及类型特点;辨析体质,了解疾病发展的倾向性及对某种邪气的易感性;明确诱因,饮食劳倦或情志刺激往往会打破'无症可辨'的假象。

'Ping Ren'(平人)is generally considered to be healthy people.Through the analysis of the relevant provisions of Treatise on Cold Pathogenic and Miscellaneous Diseases(《伤寒杂病论》),it can be found that ZHANG Zhongjing’s so-called'Ping Ren'is only a person who seems to be disease-free.The essence is that there are people who have hidden pathogenic qi or have internal damage.Its characteristics are similar to those of'no symptoms'patients in the clinic.According to the characteristics of ZHANG Zhongjing’s'Ping Ren'concept,when the clinical'no syndromes for differentiation'was met,the following strategies can be used:to achieve the fourdiagnosis,especially the tongue,pulse,and abdominal diagnosis;to consult the medical history and know the cause of the hidden pathogen,and type characteristics;discriminate constitution,understand the tendency of disease development and susceptibility to certain evils;clear incentives,diet fatigue or emotional stimuli,which can often break the illusion of'no syndromes for differentiation'.