从"辨"与"治"谈针灸临床中辨证方法的择宜而用

针灸临床上,要在明辨病位、病因、病性、病机、证候等基础上,才能依据近部选穴、远部选穴、辨证选穴、对症选穴的原则确定腧穴;要在辨明表里虚实寒热等病性的基础上才能确定相应的针灸方法和刺灸技术。而各种不同的辨证方法对这些辨证要素的辨别具有相对的特异性,因此从"治"谈"辨",各种辨证方法均适宜于针灸临床。在各种辨证方法中,经络辨证至关重要,辨病位是核心,并可以兼辨病性。经络辨证适合于几乎所有的病症甚至是一些疑难病、复杂病的辨治,尤其对肢节、官窍、皮外科病等病位较明显、局限的疾患最为适宜。脏腑辨证不可或缺,在确定脏腑病位基础上辨证候是关键,脏腑辨证适合于以全身症状为主要表现的脏腑病、无明显局限病变部位的疑难病,以及一些官窍病等。八纲辨证执简驭繁,辨病性是根本,对于表里、寒热、虚实证错综复杂者,有提纲挈领的指导作用,使用范围较广。另外,病因辨证在针灸临床中对于辨病位、辨病性、选穴和选择刺灸法方面发挥着积极的指导作用,气血津液辨证常与辨经络结合使用,能够有效地指导针灸辨证施治的各个环节。因此,从"辨"谈"治",诸种辨证方法各有所长,针灸临床要择宜而用,针灸临床中虽然以经络辨证为基本辨证施治的方法,但应与其他多种辨证方法相互补充、相互结合使用。

Eligible selection of syndrome differentiation methods based on discrimination and treatment in acupuncture clinic

Acupoints can be determined on the foundation of distinguishing disease location,cause,pathogenesis and syndromes,and principles of selecting local acupoints and distant acupoints and selecting acupoints according to syndrome differentiation and symptoms and signs.The methods and techniques of acupuncture and moxibustion can be decided after differentiating the disease nature of exterior,interior,deficiency,excess,cold and heat,so different methods of syndrome differentiation are suitable acupuncture clinic with relative specificity.Among all identifying location and nature of disease.The meridian differentiation is suited to the differentiation and treatment of almost all diseases including some difficult and complicated ones,especially for those of limbs,orifices and skin with apparent locations.Visceral syndrome differentiation is also important,which is the key of symptom distinguishing after determining disease location in viscera and bowels,and is suited to the diseases with general manifestations,difficult ones without marked local pathological changes and some orifice diseases.The base of eight-principles syndrome differentiation is to distinguish disease nature with guiding significance to the differentiation of complicated diseases loading exterior-interior,cold-heat and deficiency-excess complex.Disease cause syndrome differentiation plays a role in the differentiation of disease location and nature and selection of acupoints and acupuncture methods.Qi-blood syndrome differentiation and fluid-humor syndrome differentiation are commonly combined with meridian differentiation and used for syndrome differentiation and treatment in acupuncture clinic.Each method of syndrome differentiation,therefore,has its strengths or advantages and should be selected eligibly in clinic.Although meridian differentiation is a basic method in acupuncture clinic,other methods can be used for complementation.