北京中医药大学东直门医院 北京 100700
刘德,男,在读硕士生
# 刘宇,男,副主任医师,硕士生导师,主要研究方向:中医药防治危重症,E-mail:davidliuyu@sina.com
纸质出版日期:2023-07-30,
收稿日期:2022-11-01,
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刘德, 蒲婷婷, 孙晨阳, 等. 从权衡疗效与风险探讨仲景的临证决策[J]. 北京中医药大学学报, 2023,46(7):949-953.
LIU De, PU Tingting, SUN Chenyang, et al. Discussion on ZHANG Zhongjing’s clinical decision-making from the perspective of balancing efficacy and risk[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(7):949-953.
刘德, 蒲婷婷, 孙晨阳, 等. 从权衡疗效与风险探讨仲景的临证决策[J]. 北京中医药大学学报, 2023,46(7):949-953. DOI: 10.3969/j.issn.1006-2157.2023.07.010.
LIU De, PU Tingting, SUN Chenyang, et al. Discussion on ZHANG Zhongjing’s clinical decision-making from the perspective of balancing efficacy and risk[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(7):949-953. DOI: 10.3969/j.issn.1006-2157.2023.07.010.
在临床实践中,治疗方法带来的疗效与风险是共存的,既保证疗效又防范风险是关键问题。汗法是外感病治疗大法,而其风险为过汗伤津,仲景改麻黄汤为桂枝汤,既保证疗效又防止伤津。慢病轻治,如药物用量过大,可能出现虚不受药,仲景通过减少药物剂量、改变剂型来缓攻慢病,不图速效。杂病是虚实夹杂之症,仲景通过猪苓汤的方剂组成提示,治疗杂病的一般策略为以攻逐有形邪气为主,兼以扶正。形证相反为临床矛盾状态,仲景通过麦门冬汤和桂枝芍药知母汤的方剂组成提示,临证应循治疗全身状态为主、局部症状为辅的思路。
In clinical practice
the curative effect and the risk due to treatment coexist; that is
the key issue is to ensure the curative effect and minimize the risk. The method of qiaphoresis is a strategy to treat exogenous diseases
but its associated risk is impairment of fluid due to excessive sweating. ZHANG Zhongjing used
Mahuang Tang
instead of
Guizhi Tang
to ensure efficacy and prevention of excessive sweating. Mild treatment should be used on chronic diseases because excessive medication may lead to deficiency and lack of medication. Therefore
ZHANG Zhongjing reduced the dosage and changed the dosage form to slowly treat the disease instead of attempting to achieve quick efficacy. Miscellaneous disease is caused by deficiency and excess patterns. ZHANG Zhongjing suggested
through the formula structure of
Zhuling Tang
that the general strategy to treat miscellaneous disease is to attack the tangible evil through strengthening vital qi. When a patient’s local state was opposite to his systemic state
a state of clinical contradiction occurred. According to the prescriptional structure of
Zhuling Tang
and
Guizhi Shaoyao Zhimu Tang
ZHANG Zhongjing suggested that the treatment should be based on treatment of the systemic state with additional local symptoms.
临证决策治疗风险杂病伤寒论
clinical decision-makingtreatment riskmiscellaneous diseasesTreatise on Cold Pathogenic Diseases
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