基于膜系理论的六维辨证思路

马雪颜; 田园硕; 王洋; 秦雪颖; 刘铁钢; 谷晓红

doi:10.14148/j.issn.1672-0482.2023.0701

基于膜系理论的六维辨证思路

doi: 10.14148/j.issn.1672-0482.2023.0701

1.
北京中医药大学中医学院, 北京 100029
2.
北京中医药大学东直门医院, 北京 100700
3.
北京中医药大学第三附属医院, 北京 100029

基金项目:

中国科学院重点部署项目 QYKJZD-SSW-SLH02

中国科学院重点部署项目 QYKJZD-SSW-SLH02-02

详细信息

作者简介:
马雪颜，女，助理研究员, E-mail: 1366119843@qq.com

谷晓红, 教授, 主任医师, 博士生导师, 北京中医药大学中医疫病研究院院长, 兼任教育部中医学类教学指导委员会主任委员, 全国中医药教育发展中心主任, 中国老年学及老年医学副会长, 中华预防医学会副会长, 中华中医药学会感染病分会主任委员。国家中医药管理局中医疫病学传承创新团队负责人, 国家级重点学科中医临床基础学科温病学学术带头人。第七批全国老中医药专家学术经验继承工作指导老师、首都名中医、全国首届态出女医师。获得多项国家教学成果奖, 主持国家重点研发计划项目等多项国家级及省部级课题，承担中国科协中医疫病学学科发展报告项目。国务院新冠疫情联防联控专家组成员。科技基础资源调查专项“疫病文献辑录及中医药防治疫病知识体系构建与应用研究”项目负责人

通讯作者:
谷晓红，女，教授，主任医师，主要从事膜系理论及临床应用的研究, E-mail: guxh1003@126.com

中图分类号: R241.9
计量
- 文章访问数: 270
- HTML全文浏览量: 39
- PDF下载量: 71
- 被引次数: 0
出版历程
- 收稿日期: 2023-01-30
- 网络出版日期: 2023-08-17
- 发布日期: 2023-08-10

A Six-Dimension Syndrome Differentiation Approach Based on Membrane System Theory

1.
School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
2.
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
3.
Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China

摘要

摘要: 从辨病因、病性、病位、病期、病势、病理六个方面，探讨基于膜系理论的辨证思路。强调辨病因时应综合考虑致病因素与膜系内证态，关注病因的动态性；辨病性时应关注寒热属性，尤其是膜系阻滞所致的寒热夹杂；辨病位时判断是否存在多系统膜系的损伤；辨病期时要辨析疾病所处的卫气营血阶段；辨病势时对比分析正邪力量变化；辨病理时应判断是否存在膜系气机阻滞、水液代谢失常、矛盾性质的病理状态共存等变化。强调从整体观、系统论的角度认识全身膜系的生理病理特点，为临床诊治疾病，尤其是感染性疾病、多系统病证、反复发作性病证、病因不明的疑难性病证等的诊治提供参考。
- 膜系理论 /
- 六维辨证 /
- 整体观 /
- 系统论 /
- 辨证思路
Abstract: This article explores the dialectical approach based on membrane theory by identifying the cause, nature, location, stage, trend, and pathology of the disease. It emphasizes that when identifying the cause of the disease, comprehensive consideration should be given to the pathogenic factors and the syndromes within the membrane system, and attention should be paid to the dynamic nature of the cause; when identifying the nature of the disease, pay attention to the cold and hot attributes, especially the cold and hot inclusions caused by membrane blockage; when identifying the location of the disease, determine whether there is multi-system membrane damage; when identifying the stage of the disease, it is necessary to distinguish Wei, Qi, Ying, blood stages; when identifying the tendency of the disease, compare and analyze the change of healthy and evil Qi; When identifying the pathology of the disease, it is necessary to determine whether there are changes such as membrane Qi block, abnormal water and liquid metabolism, and coexistence of contradictory pathological states. The article emphasizes the understanding of the physiological and pathological characteristics of the systemic membrane system from the perspective of the holistic view and system theory, which provides references for clinical diagnosis and treatment of diseases, especially infectious diseases, multi-system diseases and syndromes, recurrent diseases and syndromes, and difficult diseases and syndromes with unknown etiology.
- membrane theory /
- six-dimension syndrome differentiation /
- holistic view /
- system theory /
- syndrome differentiation approach

HTML全文

参考文献(28)

[1]	孔光一, 赵岩松, 严季澜, 等. 少阳三焦膜系病机探讨[J]. 北京中医药大学学报, 2011, 34(3): 149-150, 158. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB201103002.htm KONG GY, ZHAO YS, YAN JL, et al. Pathogenesis of triple energizer membrane system of Shaoyang[J]. J Beijing Univ Tradit Chin Med, 2011, 34(3): 149-150, 158. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB201103002.htm
[2]	姜欣, 谷晓红, 于河, 等. 再论三焦膜系[J]. 中华中医药杂志, 2019, 34(5): 1851-1854. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201905002.htm JIANG X, GU XH, YU H, et al. Re-discussion on triple energizer membrane system[J]. China J Tradit Chin Med Pharm, 2019, 34(5): 1851-1854. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201905002.htm
[3]	马雪颜, 马乾, 刘铁钢, 等. 膜系理论及其在疑难病诊疗中的应用[J]. 中华中医药杂志, 2022, 37(4): 2056-2061. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202204045.htm MA XY, MA Q, LIU TG, et al. Application of the membrane system theory in diagnosis and treatment of complicated diseases[J]. China J Tradit Chin Med Pharm, 2022, 37(4): 2056-2061. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202204045.htm
[4]	唐宗海. 血证论[M]. 北京: 人民卫生出版社, 2005: 14. TANG ZH. Blood Syndrome Theory[M]. Beijing: People's medical publishing house, 2005: 14.
[5]	张锡纯. 重订医学衷中参西录: 上[M]. 北京: 人民卫生出版社, 2018: 560. ZHANG XC. Revising Records of Chinese Medicine with Reference to Western Medicine: Part 1[M]. Beijing: People's health publishing house, 2018: 560.
[6]	MYERS TW. 解剖列车——徒手与动作治疗的肌筋膜经线[M]. 北京: 军事医学科学出版社, 2015. MYERS TW. Anatomic Train—Myofascial Meridian for Freehand and Movement Therapy[M]. Beijing: Military medical science press, 2015.
[7]	MCDERMOTT MR, BIENENSTOCK J. Evidence for a common mucosal immunologic system. Ⅰ. Migration of B immunoblasts into intestinal, respiratory, and genital tissues[J]. J Immunol, 1979, 122(5): 1892-1898. doi: 10.4049/jimmunol.122.5.1892
[8]	MCDERMOTT MR, CLARK DA, BIENENSTOCK J. Evidence for a common mucosal immunologic system. Ⅱ. Influence of the estrous cycle on B immunoblast migration into genital and intestinal tissues[J]. J Immunol, 1980, 124(6): 2536-2539. doi: 10.4049/jimmunol.124.6.2536
[9]	李德众, 庞立健, 袁佺, 等. 北方新型冠状病毒感染"因机证治"[J]. 中华中医药学刊, 2023, 41(5): 18-23. LI DZ, PANG LJ, YUAN Q, et al. New coronavirus infection "cause and syndrome-based treatment" in the north[J]. Chin Arch Tradit Chin Med, 2023, 41(5): 18-23.
[10]	黄兰英, 李其忠. "审证求因"源流探析[J]. 吉林中医药, 2010, 30(3): 185-187. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL201003004.htm HUANG LY, LI QZ. An analysis of the origin of "examining evidence and seeking cause"[J]. Jilin J Tradit Chin Med, 2010, 30(3): 185-187. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL201003004.htm
[11]	钱潢. 伤寒溯源集[M]. 上海: 上海科学技术出版社, 2021: 22. QIAN H. Tracing to the Source of Treatise on Cold Damage[M]. Shanghai: Shanghai scientific & technical publishers, 2021: 22.
[12]	黄帝内经素问[M]. 北京: 人民卫生出版社, 2005. The Yellow Emperor's Inner Classic: Basic Questions[M]. Beijing: People's medical publishing house, 2005.
[13]	肖述铜, 徐凡, 黄卫东. 心血管疾病与牙周炎关系的研究进展[J]. 临床口腔医学杂志, 2018, 34(2): 120-122. https://www.cnki.com.cn/Article/CJFDTOTAL-LCKY201802020.htm XIAO ST, XU F, HUANG WD. Research progress on the relationship between cardiovascular diseases and periodontitis[J]. J Clin Stomatol, 2018, 34(2): 120-122. https://www.cnki.com.cn/Article/CJFDTOTAL-LCKY201802020.htm
[14]	漆晓玲, 甘廷彬, 黄姣. 慢性牙周炎和慢性肾病相关关系的研究进展[J]. 国际口腔医学杂志, 2021, 48(1): 18-22. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKQ202101004.htm QI XL, GAN TB, HUANG J. Research progress on the relationship between chronic periodontitis and chronic kidney disease[J]. Int J Stomatol, 2021, 48(1): 18-22. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKQ202101004.htm
[15]	张静, 刘永, 罗敏, 等. 辛开苦降法中药方剂对功能性消化不良寒热错杂证患者的治疗作用研究[J]. 中国中西医结合消化杂志, 2022, 30(10): 708-712. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW202210005.htm ZHANG J, LIU Y, LUO M, et al. The therapeutic effect of Xinkai Kujiang Compound on functional dyspepsia patients of cold heat complicated syndrome[J]. Chin J Integr Tradit West Med Dig, 2022, 30(10): 708-712. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW202210005.htm
[16]	谈钰濛, 胡骏, 赵晖, 等. 半夏泻心汤治疗2型糖尿病寒热错杂证的随机对照临床研究[J]. 中医杂志, 2022, 63(14): 1343-1349. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202214008.htm TAN YM, HU J, ZHAO H, et al. Type 2 diabetes mellitus of cold and heat in complexity syndrome treated with Banxia Xiexin Decoction: A randomized controlled trial[J]. J Tradit Chin Med, 2022, 63(14): 1343-1349. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202214008.htm
[17]	李树岗, 杨德富. 桂枝芍药知母汤治疗寒热错杂型类风湿性关节炎疗效观察[J]. 中医学报, 2018, 33(6): 1115-1119. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201806046.htm LI SG, YANG DF. Observation on curative effect of Guizhi Shaoyao Zhimu Decoction in treating rheumatoid arthritis with cold and heat complicated type[J]. Acta Chin Med, 2018, 33(6): 1115-1119. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201806046.htm
[18]	凌桂华, 肖静, 叶晟桢, 等. 陈明岭教授运用经方从寒热错杂辨治难治性皮肤病[J]. 四川中医, 2022, 40(5): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202205005.htm LING GH, XIAO J, YE SZ, et al. Professor Chen mingling has used classic prescriptions to differentiate and treat refractory skin diseases from "cold-heat complex"[J]. J Sichuan Tradit Chin Med, 2022, 40(5): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202205005.htm
[19]	谷晓红. 基于卫气营血辨证谈温病六维辨证观[J]. 中国科学: 生命科学, 2016, 46(8): 1038-1041. https://www.cnki.com.cn/Article/CJFDTOTAL-JCXK201608018.htm GU XH. Discussion on six-dimensional syndrome differentiation view of febrile diseases based on syndrome differentiation of Wei-qi and Ying-blood[J]. Sci China Life Sci, 2016, 46(8): 1038-1041. https://www.cnki.com.cn/Article/CJFDTOTAL-JCXK201608018.htm
[20]	南京中医学院. 诸病源候论校释: 上册[M]. 北京: 人民卫生出版社, 2009: 466. Nanjing College of Chinese Medicine. Commentary on the Origin of Various Diseases Annotation: Volume 1[M]. Beijing: People's health publishing house, 2009: 466.
[21]	成无己. 伤寒明理论[M]. 北京: 中国中医药出版社, 2007: 75. CHENG WJ. Concise Supplementary Exposition on Cold Damage[M]. Beijing: China press of traditional Chinese medicine, 2007: 75.
[22]	任爽, 刘妍彤, 张杰. "水、湿、痰、饮"实质及治疗原则探析[J]. 中国中医基础医学杂志, 2021, 27(1): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202101007.htm REN S, LIU YT, ZHANG J. Essence and treatment principle of "water, dampness, phlegm and fluid"[J]. J Basic Chin Med, 2021, 27(1): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202101007.htm
[23]	赵进喜, 贾海忠, 王三虎, 等. 痰饮水湿, 同中有异; 辨证论治, 务求精细[J]. 环球中医药, 2021, 14(10): 1781-1785. https://www.cnki.com.cn/Article/CJFDTOTAL-HQZY202110015.htm ZHAO JX, JIA HZ, WANG SH, et al. Phlegm and water are wet, and there are differences in the same; Treatment based on differentiation of symptoms and signs, to be precise[J]. Glob Tradit Chin Med, 2021, 14(10): 1781-1785. https://www.cnki.com.cn/Article/CJFDTOTAL-HQZY202110015.htm
[24]	姚荷生, 姚梅龄, 姚芷龄. 三焦辨证——焦膜病辨治[J]. 江西中医药, 2009, 40(1): 5-9. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY200901004.htm YAO HS, YAO ML, YAO ZL. Three Jiao syndrome differentiation: Diagnosis and treatment of Jiao Membrane Disease[J]. Jiangxi Tradit Chin Med, 2009, 40 (1): 5-9. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY200901004.htm
[25]	刘完素. 素问病机气宜保命集[M]. 北京: 中国中医药出版社, 2007: 20. LIU WS. Collection of Writings on the Mechanism of Disease, Suitability of Qi, and the Safeguarding of Life as Discussed in the Basic Questions[M]. Beijing: China traditional Chinese medicine press, 2007: 20.
[26]	张仲景. 伤寒论[M]. 北京: 人民卫生出版社, 2008: 46. ZHANG ZJ. Treatise on Cold Damage[M]. Beijing: People's health publishing house, 2008: 46.
[27]	周学海. 读医随笔[M]. 北京: 中国中医药出版社, 2007: 90. ZHOU XH. Random Notes While Reading about Medicine[M]. Beijing: China press of traditional Chinese medicine, 2007: 90.
[28]	何梦瑶. 医碥[M]. 北京: 中国中医药出版社, 2009: 21. HE MY. Danger Zone of Medicine[M]. Beijing: China press of traditional Chinese medicine, 2009: 21.