「經方」新議──兼論辨證與論治間的空白

An Insight into ''Jing Fang'': to Fill in the Blank between Differential Diagnosis of Syndromes and Therapeutic Treatment

多數中醫學文本皆強調診治過程必須辨證論治、方證相應，然而在臨床實際應用時，若僅將經由四診蒐集到的資料照本宣科轉換成簡化的「證型」，再套用對應的處方論治，卻可能得到有限的療效，並流於處方種類龐雜之弊。這是因為在臨證思考時生理機轉與病理現象（病因病機）兩類理論被粗糙而簡化的連結，使辨證與論治間產生了隱藏的斷層所導致。 本文將先重新闡述「經方」二字之意義，以引導出古典醫學診治疾病時的原生意識；並試圖藉由思辨經典內涵填補臨床診治思維空白之範例，呈現中醫師必須熟稔歷史沿革與經典內容的重要性。目的乃為了呼籲在臨床操練過程當中，必須重視中醫學法則與技術，以避免過度簡化的辨證論治所可能帶來的風險。

To prescribe treatment based on the differential diagnosis of syndromes has been highly emphasized in the traditional Chinese medical (TCM) texts. However, when practicing four diagnostic techniques, a TCM practitioner may fail to produce the desired therapeutic effect or may produce a random assortment of prescriptions if he or she interprets the clinical evidence entirely according to the classification of syndromes specified in the texts. This is because the interrelationship of etiological agents and pathological manifestations are oversimplified in the process of examining a patient. A breach is therefore created and concealed between the differentiation of syndromes and therapeutic treatment. In this article, “Jing Fang” as the dominant medical discourse is elaborated from a historical perspective, in which the prototypical reasoning behind the clinical application of classical Chinese medicine theory is approached. Critical analysis of the meanings inherent in the classical medical texts is demonstrated to highlight a fact that a TCM doctor is required to be acquainted with historical background of the medical theory, with the significance of medical canons. To do so is to fill the gap between theory and practice. The essay aims to remind that there exists a clinical risk for those who perform differential diagnosis of syndromes and prescribe corresponding treatment if they overlook the depth and complexity of such medical practice.