《素圃医案》阴证似阳证辨识

郑重光认为三阳证的诊治显明易见,而对于亢害危殆的三阴证,在他看来,其似是而非的临床表现决定了诊断是关键的一环。在各类疾病中,阴证似阳证的阴阳病机最不易判断,常常表现出表、里、寒、热、虚、实错杂繁复的特点,向来最易造成误诊误治。郑重光认为的阴证似阳证的脉象普遍特点是脉必沉细而疾,或沉迟无力,脉沉紧或散大。在表象都是热症的情况下,郑重光注重病人的脉诊结果,在脉证不吻合时,郑重光进一步指出要"凭脉不凭证",以脉象来揭开繁杂的表象,探求疾病的本质,达拨乱反正之功,可见这种脉辨病机的思想是郑重光辨识阴证的重要特点。郑重光独尊脉诊,强调凭脉不凭证,但并不是说他忽视了其他诊断方式,脉证合参是其临证的基础。郑重光辨识错综复杂的阴证似阳证疾病有丰富的经验,他以脉证合参为辨证基础,同时又以脉诊为直接判识病机的依据,为后世医家提供了可靠详尽的参考,堪为后世所珍。

Identification of Yin Syndrome Which is Like Yang Syndrome in Su Pu Medical Cases

According to Zheng Chong-guang,diagnosis and treatment of three-yang syndromes are obvious,but in terms of threeyang syndromes which are very dangerous,he thinks that their paradoxical clinical manifestations make the diagnosis become the key link.In all kinds of diseases,the pathogenesis of yin and yang of yin syndrome which is like yang syndrome is the most difficult to judge,often show characteristics of exterior,interior,cold,heat,deficiency,excess,and easily leads to misdiagnosis and mistreatment.Zheng Chong-guang thinks that the general characteristics of pulse condition of yin syndrome which is like yang syndrome are as follows:the pulse is sinking,thin and rapid,or sinking,slow and weak,or sinking,tight or dispersing.In the case of appearance with heat syndrome,Zheng Chong-guang pays attention to the patient's pulse diagnosis result.In the case of pulse which does not coincide with syndrome,he depends on pulse diagnosis rather than syndrome in order to reveal the complex representation,probe into the essence of the disease,and bring order out of chaos.This thought is his important feature of identifying yin syndrome,but it does not mean that he ignores the other diagnosis methods,in fact,using pulse and syndrome diagnosis together is his clinical base.In terms of identifying yin syndrome which is like yang syndrome,he has rich experiences:Based on using pulse and syndrome diagnosis together,he regards pulse diagnosis as basis to directly identify pathogenesis,which provides reliable detailed reference for following physicians and is worth valuing.