基於《金匱要略》中「同病異治、異病同治」的二難推理與多難推理

Dilemma and Multilemma Based on “Same Disease, Different Treatments; Different Diseases, Same Treatment” in “Medical Synopsis of the Golden Chamber”

成書於東漢的《金匱要略》採取病—證相結合的方法來治療雜病，「同病異治、異病同治」在《金匱要略》中佔有極大份量，也是《金匱要略》對方證運用的一大特色。「同病異治」指同一種疾病，在不同的發展階段，反映出的病機、病性的不同，治法方藥就不同。「異病同治」指多種不同的疾病，在某一病變階段，如果反映出的病因、病位、病機和病性相同，就可以用同樣的治法與方藥。二難推理是人們在論辯過程中經常運用的一種推理，運用這種推理的一方常會提出具有兩種可能的選言前提，對方無論選擇哪一種的可能，結果都會陷入進退兩難的境地，故稱之為二難推理。基於《金匱要略》中的邏輯關係，除了二難推理以外，還有三難推理、四難推理、五難推理⋯⋯。因此，我們將二難推理做一個擴大，將具有三項或者更多充分條件假言前提和一個相應具有三項或者更多具有選言支的選言前提推出結論的推理定義為多難推理。《邏輯學》是被《大英百科全書》列為眾學科之首。希望不久的將來，能用《邏輯學》的科學方法，構建《金匱要略》的「方證論治系統」，讓中醫經典之一的《金匱要略》，其「方證論治系統」具有科學性與臨床實用價值。

The monograph “Medical Synopsis of the Golden Chamber” was written in the Eastern Han Dynasty. It combines diseases and syndromes together to treat miscellaneous diseases. “Same disease, different treatments; different diseases, same treatment” plays a significant role in the monograph. It is one of the best features for the usage of “prescriptions based upon syndromes” in the book.“Same disease, different treatments” means that the treatments are different for the same disease because the pathogenesis and syndromes presented are different at different stages. “Different diseases, same treatment” means that the treatment is the same for different diseases if the etiology, disease-bit, pathogenesis and syndrome presented are the same at a certain stage. Dilemma is widely employed as a process of reasoning during argument. One side using the method presents two predicates and the other side will be in a dilemma no matter which predicate is chosen. Base on the logic relationship in the book, there are trilemma, quadlemma, quintlemma and so on except dilemma. So we expand dilemma and define the following reasoning as multilemma: it has three or more sufficient condition hypothetical premise and a relevant disjunctive premise with three or more disjunctive branches. Logic is listed as the very first within all disciplines by “Encyclopaedia Britannica”. Hope we can build a “prescriptions based upon syndromes treatment system” from the logic perspective in the near future. The system in classic “Medical Synopsis of the Golden Chamber” will show its scientific and clinical value.