The so-called diagnosis and treatment mode is a high generalization of the leading thought of a medicine in diagnosis and treatment, a concise expression of the medical clinical thinking in refined language, and can reflect its academic characteristics. Since ancient times, there have been many views on the diagnosis and treatment mode of traditional Chinese medicine, such as seeking the root, differentiating diseases, treating according to syndrome differentiation, examining quality and treating symptoms. Among all the diagnosis and treatment modes, the most important and commonly used one can dominate or contain other diagnosis and treatment modes to a great extent, which is called subject diagnosis and treatment mode.
The diagnosis and treatment model is different from the medical model. The latter refers to a basic viewpoint or starting point of medical understanding and treatment of diseases, which is more abstract and rational, such as "biology, psychology and society", and is considered as a modern medical model, while the former is a concentrated expression of medical diagnosis and treatment laws and clinical thinking, which is more concrete and practical, such as the aforementioned "treatment based on disease differentiation".
1.2 is the main diagnosis and treatment mode in Neijing.
Neijing has laid a solid foundation for the theoretical system of traditional Chinese medicine, and its diagnosis and treatment mode is no exception. Among many principles of diagnosis and treatment discussed in Neijing, the most important one is that "treatment must be based on this" (Su Wen. Yin and Yang should be like a big theory). "Treatment" here has two meanings: diagnosis and treatment, and "root" refers to the essence and root of the disease, especially the pathogenesis of yin-yang imbalance here. When talking about the diagnosis and treatment of false cases, Su Wenzhi's On the Truth points out: "Take the master first, then take the cause." Don't be confused by the illusion of the disease, first make clear its real etiology and pathogenesis, and then treat it according to the pathogenesis. The article also takes "fever patients are hot because of cold, and cold patients are hot because of cold" as an example to show that if we only see the phenomenon of heat and cold on the surface of the disease, we can't grasp the internal essence of yin deficiency and yang deficiency, and we will be mistreated. It is based on the understanding that pathogenesis is the "root" of seeking disease, this article repeatedly emphasizes that "it is appropriate to examine the disease without losing qi" and "it is necessary to do one's duty to examine the pathogenesis carefully." In this regard, Zhu Zhenheng, a famous doctor in the Yuan Dynasty, once asserted: "The Internal Classic says that' treatment must be based on its origin', and the herbal medicine says that' if you want to treat its disease, you should first examine its pathogenesis', which means that the pathogenesis should also be examined." "It is reasonable to seek the pathogenesis of this disease and seek its source with the husband." [1] For Chinese medicine, the pathogenesis is a high generalization of the nature of the disease. And "observing pathogenesis" is to explore the essence of the disease-pathogenesis through the symptoms and signs of the disease. It can be seen that the idea of treating diseases in Neijing can be simply expressed by the word "judging the machine and treating it"
The clinical work of TCM based on Neijing can be divided into five links or steps, namely, four diagnosis, syndrome differentiation, machine recognition, legislation and prescription. In the process of TCM diagnosis, the four diagnoses are to collect necessary clinical information for syndrome differentiation (that is, syndromes with symptoms and signs as the main symptoms), and syndrome differentiation is to process syndromes by using TCM theory, and finally determine the pathogenesis and disease name. In the diagnosis conclusion of traditional Chinese medicine, pathogenesis is the main body, and disease name is secondary. Because the main basis of establishing therapeutic principles is pathogenesis rather than disease name, understanding pathogenesis has become the purpose and destination of syndrome differentiation. Although there is no word "syndrome differentiation" in Neijing, the basic means to examine pathogenesis (examination mechanism) is syndrome differentiation, and "examination mechanism" has actually summarized the connotation and cognitive mechanism of syndrome differentiation. Although there are many factors that determine the treatment principle in the clinical practice of traditional Chinese medicine, the primary and fundamental basis is the pathogenesis conclusion drawn from the diagnosis, and the prescription is only the specific methods and measures to implement the treatment principle. From this point of view, the diagnosis of traditional Chinese medicine is mainly based on the diagnosis of pathogenesis, and the treatment of traditional Chinese medicine is first based on the treatment of pathogenesis. The word "judge the machine and determine the treatment" summarizes the basic law of TCM diagnosis and treatment and the essence of clinical thinking. To this end, Zhang Jiebin, a great doctor in Ming Dynasty, spoke highly of the "Nineteen Pathogenesis Articles" described in Neijing: "This is the transmission of sage's heart, the subtle place, the tightest program ... the pathogenesis of husband, the way to get started, and the step-by-step method." [2] Lingshu Benjing emphasizes: "The five zang-organs are uneasy, so it is necessary to examine the pathological morphology of the five zang-organs to know the deficiency and excess of their qi, so it is appropriate to adjust them." The so-called "shape of differentiating diseases" and knowing "excess and deficiency" are just the differentiation of symptoms and signs, referred to as "differentiation of signs"; "Cautious regulation" means taking corresponding reinforcing and reducing and regulating rules according to the pathogenesis of deficiency and excess of five internal organs. This is an example of Neijing attaching importance to and expounding the diagnosis and treatment mode of "judging the machine and fixing the treatment".
Other diagnosis and treatment modes are also discussed in Neijing. For example, Lingshu carbuncle treats "senility" with "Lingqiao drink", which belongs to one side of a disease and is an example of "differentiation of diseases and treatment"; The so-called "spiritual pivot root knot" that "those who stab the cloth are deeply sorry, but those who stab the adults are slightly slow, all because of the fierce and slippery qi" is an example of "checking the quality (constitution type) and treating it". However, these two modes of diagnosis and treatment are only in a secondary position in Neijing, and to a certain extent, they are subordinate to "judging the machine and determining the treatment". It can be asserted that there is no doubt that "judging the machine and determining the treatment" is regarded as the main diagnosis and treatment mode advocated by Neijing.
2. The far-reaching influence of "judging the machine and determining the treatment" on Chinese medicine.
2. 1 established the dominant idea of TCM diagnosis and treatment of diseases.
Due to the diagnosis and treatment mode of "judging the machine and determining the treatment" proposed and advocated by Neijing, the essence of clinical thinking of TCM is summarized, and the basic diagnosis and treatment rules of TCM are revealed, which can effectively guide clinical practice. In the past two thousand years, it has been regarded as the standard by doctors of past dynasties and has become the guiding ideology and the first principle of TCM diagnosis and treatment of diseases, that is, the main diagnosis and treatment mode of TCM. Give a few examples as proof. Zhang Ji, a medical sage in the Eastern Han Dynasty, said in Introduction to Treatise on Febrile Diseases: "Although all diseases have not been cured, we can know the source of all diseases." Here, "knowing the source according to the disease" refers to the mechanism identification of syndrome differentiation and treatment. "Treatise on Febrile Diseases" (126) said: "Fever, less abdominal distension, is not conducive to urination, and those who go against it are blood today. There is no medicine at present, it should be pills. " The first four sentences belong to syndrome differentiation, "blood stasis" is the recognition mechanism, "health" is the legislation, and "reaching for pills" is the prescription. The overall principle of syndrome, mechanism, method and prescription is achieved in one go, which fully embodies the judgment mechanism and the purpose of determining treatment. Sun Simiao, a great doctor in the Tang Dynasty, pointed out: "If a husband wants to treat a disease, he should first examine its source and wait for its pathogenesis." [3] It is emphasized that observing symptoms and pathogenesis is the primary task of doctors in clinical treatment of diseases. Liu Ye, a famous doctor in the Jin Dynasty, said: "Therefore, we should examine the essence of pathogenesis, take taste as sexual use, and then clarify the source of the disease. Therefore, if you are not ill, don't seek its roots. " [4] It emphasizes the causal relationship between trial and treatment. Zhou Zigan, a resident doctor in the Ming Dynasty, said: "Seeing a doctor is a taboo for doctors ... When you see a certificate, you will definitely lose it; If you see that you can only get a certificate, you can know. " [5] From both positive and negative aspects, this paper expounds the extreme importance of "finding the proven reason", that is, judging the machine. Yue Meizhong, a late contemporary famous doctor, also pointed out: "When you see symptoms, you should further pursue the essence of the disease, not just stay on the surface of cold and heat, but ... the business period is meticulous to suit the disease." [6] Doctors are required to carefully and accurately examine the pathogenesis, so that it is completely consistent with the actual condition, and satisfactory curative effect can be achieved.
2.2 laid the main academic characteristics and advantages of traditional Chinese medicine.
People talk a lot about the characteristics of traditional Chinese medicine, that is, "treating different diseases with the same disease" and "treating different diseases with the same treatment". However, this is determined by the principle of trial and error. Because the same disease is treated differently because of different pathogenesis, the same disease is treated together because of the same pathogenesis. The overall unbalanced view of disease and the overall adjusted view of treatment are another feature and advantage of TCM. The so-called "holistic disorder" means that human diseases are the result of the destruction of the internal and external balance and coordination of the human body under the action of some reasons, that is, holistic disorder or "yin-yang imbalance". It can be manifested in many types, such as the rise and fall of cold and heat, the deficiency and excess of pathogenic factors, the imbalance of qi, blood and body fluid, etc., all of which belong to the category of pathogenesis. Therefore, understanding the specific content of patients' overall imbalance at this stage is to clarify their current pathogenesis. The so-called "overall adjustment" is to apply appropriate treatment rules and corresponding prescriptions according to the specific pathogenesis conclusions of patients, such as reinforcing or purging, warming or clearing, consolidating or dispersing, so as to achieve new overall balance and coordination of patients' bodies and restore their health. It can be seen that the implementation of the overall concept of Chinese medicine in clinical practice also depends on the implementation of the diagnosis and treatment model of judgment machine.
Treating people and treating diseases at the same time is another feature and advantage of Chinese medicine, which is mainly reflected in two aspects. First, TCM not only treats diseases based on syndrome differentiation (including diseases and the names of diseases in Chinese and Western medicine), but also knows how to treat people. Although each disease has its specific clinical manifestations, course of disease and rules of diagnosis and treatment, doctors are not facing abstract or conceptual diseases in clinic, but a sick individual. Every patient is an organism with essence, qi and spirit that can move independently, so patients are far more complicated and changeable than diseases. Therefore, saving lives is more important than treating diseases. This is implied in Su Wen's Shu Wu Guo Lun and Ling Shu Shi Zhuan. The focus of "governing people" is to adjust the mentality again. For example, "Su Wen. "On Tang Yu" warns: "If the spirit does not advance, the will will will not heal, so the disease cannot be cured." Because the pathogenesis conclusion obtained through diagnosis can reflect the state and changes of patients' essence, qi and spirit, which is an important way and a good form to save lives. Secondly, the core of people-oriented treatment is the principle of "different from person to person", which requires full consideration of the influence of patients' age, gender, physique type, occupation, hobbies, diet and living habits on the disease, and these influences are also included in their pathogenesis conclusions to varying degrees. For example, children are prone to deficiency and excess, the elderly are weak, blood and blood are stagnant, and women's blood is more than qi. People of different physique types have different susceptibility to evil spirits and convergence to diseases. These pathological factors all participate in the formation of pathogenesis in some form. It can be asserted that judging the machine and determining the treatment is an indispensable cornerstone for constructing the people-oriented characteristic thought of traditional Chinese medicine.
2.3 to create conditions for the standardization of TCM theory.
In view of the fact that the dissemination and education of Chinese medicine have long followed the way of private giving and receiving, there are confusion and differences in the interpretation and use of many terms and concepts in Chinese medicine theory, which is extremely unfavorable to the modern development of Chinese medicine and its going to the world. Judging the diagnosis and treatment mode of the machine can help to clarify some important words. For example, the "syndrome" or "syndrome" commonly used in TCM, that is, the "symptoms" and "symptoms" mentioned in Neijing, all refer to the phenomenon of diseases and are evidence of TCM diagnosis. The "root" of treatment-pathogenesis is the essence of disease. Therefore, some textbooks interpret "syndrome" as a "pathological summary" that integrates pathogenic factors, disease nature, disease location and other factors, which is equivalent to the concept of pathogenesis and obviously confuses the phenomenon and essence of disease, which is not desirable. For another example, the so-called "syndrome differentiation and treatment" is regarded as the basic law and characteristics of TCM, but as mentioned above, in the clinical process of TCM, syndrome differentiation serves the cognitive mechanism, and pathogenesis is the main body of TCM diagnosis and the primary basis of TCM treatment. Without the key word "pathogenesis" in the word "syndrome differentiation and treatment", the diagnosis will not be implemented, the treatment will lose its basis, and the basic laws and clinical thoughts of traditional Chinese medicine will not be expressed. Therefore, there is a big gap between its text composition and the content it wants to express, but "judging the machine and setting the rules" is competent for this task.
2.4 pointed out the direction for the modernization of traditional Chinese medicine.
The history and present situation of TCM prove that as the main diagnosis and treatment mode of TCM, it is a powerful driving force to promote the continuous progress and development of TCM, and pathogenesis has become a well-deserved core in the theoretical system of TCM. [7] At present, Chinese medicine is on the eve of modernization and internationalization, and its development breakthrough has become the focus of Chinese medicine academic circles and the field of integrated traditional Chinese and western medicine. The academic development history of traditional Chinese medicine shows that the achievements of famous doctors and the formation of various academic schools all come from the establishment of new pathogenesis viewpoints or the deepening of the original pathogenesis viewpoints. Looking at the present situation of clinical, teaching and scientific research of traditional Chinese medicine, the slow progress of pathogenesis research and the lag of pathogenesis theory have become the "bottleneck" restricting the rapid development of these fields. Most people of insight who use modern scientific and technological means to study Chinese medicine think that the modern research of Chinese medicine should start with the essence of "syndrome". The so-called "syndrome" here refers to the syndrome type caused by a certain pathogenesis and is named after it. For example, "spleen deficiency syndrome" is the syndrome type caused by the pathogenesis of "spleen deficiency". In other words, a group of syndromes, such as anorexia, abdominal distension, diarrhea and fatigue, are only the external manifestations of "spleen deficiency syndrome (type)", and the pathogenesis of "spleen deficiency" is its internal essence. Therefore, starting from the essence of syndrome, we should focus on the formation, change mechanism and material basis of various pathogenesis. In a word, grasping the breakthrough of pathogenesis research can promote the all-round and in-depth development of the whole cause of Chinese medicine.