《中医诊断学》九版教材存在的问题

作者在阅读九版教材《中医诊断学》(简称教材)的过程中,发现《教材》存在一些需要进一步探讨的问题:一是在四诊中对某些症状、体征论述的面太窄。二是某些论述与临床不符。论述面太窄,容易误导学习者。如寒热往来一症,《教材》中只言其见于少阳证、疟疾和妇女热入血室,而临床上湿热蕴肾证(急性肾盂肾炎),某些悬饮(结核性胸膜炎)皆可见寒热交作。若按《教材》中所言,湿热蕴肾证和某些悬饮所出现的寒热往来就会被误诊为少阳证或疟疾。低热一症,《教材》中只言其由阴虚、气虚、气阴两虚及郁热所致。而湿热蕴胆证(慢性胆囊炎)、下焦湿热证、膀胱湿热证(慢性肾盂肾炎、慢性膀胱炎)及各种慢性炎症如慢性乳娥、慢性脓耳、鼻渊等皆可出现低热。若按《教材》所言病因辨证,则容易对上述病证产生误诊。《教材》中对某些症状体征的表述也多有与临床不符之处。根据自己的临床观察与体会,并结合中医理论对上述问题提出自己的看法。

Problems in the 9th Version of Traditional Chinese Diagnostics

The author found there are some issues need to be further explored in learning the 9th version of Traditional Chinese Diagnostics. Firstly,some issues of the four diagnostic methods for some symptoms and signs are too narrow. Secondly,some issues in the book are not consistent with the clinical observations. The discussion is too narrow,so it is easy to mislead the learners to make misdiagnosis. For example,chills and fever in the textbook are only explained to be seen in Shaoyang syndrome,malaria,and women's heat into the blood chamber,but also seen in dampness and heat accumulating the kidney syndrome(acute pyelonephritis) and Xuanyin(tuberculous pleurisy) which may be mistaken for Shaoyang syndrome or malaria according to the textbook. As for low-grade fever,the textbook explains it only be caused by Yin deficiency,Qi deficiency,Qi and Yin deficiency and stagnated heat. But dampness and heat accumulating gallbladder syndrome(chronic cholecystitis),syndrome of dampness and heat in lower energizer,dampness and heat in bladder syndrome(chronic pyelonephritis and chronic cystitis) and a variety of chronic inflammation,such as chronic tonsillitis,chronic pyotorrhea,nasosinusitis all can cause low-grade fever. If the learners only diagnose the diseases according to the cause of the textbook,the above diseases are easy to be misdiagnosed. Some of the symptoms and signs in the textbook do not conform to the clinical practice,so it should be modified by the clinical observations to avoid misleading learners. According to own clinical observations and experiences,the author put forward some new viewpoints combined with the theory in traditional Chinese medicine,hoping to contribute to traditional Chinese diagnostics.