中醫病因病機理論的源流與臨床案例分析推演

Analyzing and Deducting the Theoretical Origin and Clinical Case of Chinese Medical Etiopathogenesis and Pathogenesis

中醫病因病機學，是中醫研究疾病發生、發展及其傳變、轉歸的機制和規律的學科，是中醫辨證論治的基礎。《黃帝內經》是中醫病因病機理論的源頭，張仲景以六經辨證的手法將中醫病因病機學與辨證論治進行結合。《諸病源候論》是最早最完備的中醫病因病機學專著。《小兒藥證直訣》是中醫兒科病機學的始祖。《溫疫論》對傳染病的病因、傳染與流行作了明確的描述，充實了外感熱病的病機。近代學者則引用微觀辨證方法來研究中醫的「證」。經過了幾千年的經驗累積，中醫病因病機學的內涵逐漸充實豐富。 掌握好疾病的病因病機分析，是學習中醫也是悠關臨床療效的重要關鍵。衛生署於2008年4月25日公告「中醫醫療基構負責醫師訓練課程基準」，其中「病因病機分析推演」被明列為中醫內科學的學習目標與訓練內容。本文參考多位資深中醫師的經驗，將臨床病因病機分析推演的過程分解成五個基本步驟，包括（1）完整的病史與四診診察資料蒐集、（2）主要症候與伴隨症狀的鑑別分析、（3）發病原因與致病機理的歸納推演、（4）整體病因病機架構的建立及（5）依病機設定治則與處方佈局。並舉一臨床實際案例說明其運用與推演方法，希望能提供未來中醫內科臨床技能一個較明確的訓練與學習方法。

The Chinese medical etiology and pathogenesis (CMEP) theory contains the courses covering disease occurrence, development, transmission, and prognosis mechanisms and regularities, is the base of the differential diagnosis and treatment (DDT): “Yellow Emperor's Internal Classic” created the CMEP theory which was Zhang Zhongjing-united with DDT via six-meridian syndrome differentiation theory. “General Treatise on the Etiology and Symptomology of Diseases” is the initial consummate CMEP theory monograph. “Key to Therapeutics of Children's Diseases” is the primary pediatric pathogenesis book. “Treatise on Pestilence states” specifically the etiopathogenesis, infection and epidemic and elaborates externally contracted febrile disease pathogenesis. Modern scholars manipulate micro syndrome differentiation to investigate the differentiation in Chinese medicine. Since the CMEP theory for thousands of years, it has been exposited stepwise.\ Well analyzing and deducting the Chinese medical etiology and pathogenesis is the key to successfully study Chinese medicine or obtain the clinical effect. The health department declared the training standard of appointed doctors of Chinese medicine institution on April 25, 2008. For the trainings about the Chinese medicine internal medicine learning goal and training content, the CMEP analysis and deduction were listed. After many senior Chinese medicine doctor’s experiences explored, analyzing and deducting the CMEP were divided into: (1) collecting the data via thorough patient history and Four Diagnostic Methods; (2) differentially analyzing the main and concomitant symptom; (3) inducting and deducting the CMEP; (4) launching the complete theory framework; (5) founding pathogenesis-based treatment principles and prescriptions. Additionally, the clinical case was exemplified for explicating the application and deduction to provide Chinese medicine internal medicine clinical attainments with more explicit education and acquisition approaches.