从“同病异证”到“同病类证”.pdf

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1、主垦亘堕合塞壹2014年1月第34卷第1期cJ1．『wM，January2014，Vo1．34，No．1从“同病异证”到“同病类证”王文健’沈自尹摘要病证关系是中西医结合医学的一个重大科学问题。“同病异证”的病证关系理论对中西医结合和中医现代化起到了积极的推动作用，但目前在实际应用中往往被曲解：过分强调患者个体间的差异，而忽略同一疾病患者的基本病变，弱化对患者共性改变的辨证和治疗。“同病类证”的病证关系理论则将“同病异证”和辨证“微观化”紧密结合，通过对发病机制的认识来挖掘中医的核心病机；对基本病变的分析来辨析中医的主证；以“方证相应”理论来确立主方，指导主证的治疗；同一疾病患者个体间

2、的差异，则可辨为共同主证下的“类证”，并以主方为基础加减组成不同的“类方”治疗。“同病类证”较好地揭示了病和证之间的内在联系，完善和发展了“同病异证”的中西医结合研究思路和方法，是对中西医结合病证关系理论的重要创新。关键词中西医结合；同病异证；同病类证FrOm。DiferentPatternsintheSameDisease。to。AnalogousPatternsintheSameDisease。WANGWen-jianandSHENZi-yin7InstituteofIntegrativeMedicine，FudanUniversity，Shanghai(200040)，China

3、2HuashanHospitalAffiliatedtoFudanUniversity，Shanghai(200040)，ChinaABSTRACTTherelationshipbetweendiseaseinWesternmedicine(WM)andpatterninChinesemedicine(CM)isakeyscientificissueinintegrativemedicine(IM)．Thetheoryof”differentpatternsinthesamedisease”hasgreatlypromotedthedevelopmentofIMandthemOdern

4、izatiOnOfCM．However．thisconceptisfrequentlymisinterDretedintheclinicalpractice．Theindividualdifferencewasoverempha·sized．whilecommonchangesamongpatientssufferingfr0mthesamediseasewereneglected．Asare—suit，theidentificationandtreatmentofcommonchangesbasedpatternswereweakened．Thetheoryof。’analogous

5、patternsinthesamedisease”combinestheconceptof”differentpatternsinthesamedis—ease”and”microcosmicidentificationofpatterns”．whichrevealsthecoremechanismofCMfrOmthepathogenesis．andidentifiesthemajorpatternbyanalysesofmanifestati0nsandpathologicchanges．Andundertheguidanceofthetheoryof”formulacorresp

6、ondingtopattern”，themajorformulacanbesetforthemajorpattern．Forthosedifferencesamongindividualssufferingfromthesamedisease，theycanbeidentifiedasdifferentanalogouspatterns(subtypes)withinasamemajorpattern，andcanbetreatedwithanalogousformulaederivingfr0mmodifiedmajorformula．Thetheoryof”analogouspat

7、ternsinthesamedisease”clarifiestheintrinsiCrelationshipbetweenthediseaseandpattern。perfectsanddevelopsthetheoryof”differentpatternsinthesamedisease”，anditisanimportantinnovationinthinkingwaysandresearchmethodsofIM．KEYWORDSin