梁世傑：從“因勢利導”談中醫病勢辨證的重要性

在浩瀚的醫學海洋中，中醫猶如一艘歷經千年的航船，承載着無數先賢的智慧與經驗，破浪前行。其中，中醫病勢理論，更是這艘航船上的璀璨明珠，它以其獨特的視角和深邃的洞察力，引領着我們探索疾病的奧祕。

中醫病勢理論，簡而言之，就是以疾病的發展趨勢爲核心，關注病情的動態變化、傳變規律及預後判斷。這不僅僅是一種理論，更是一種智慧，一種順應自然、因勢利導的哲學思想。正如古人云：“未病先防，既病防變。”中醫強調的，正是要警惕病勢的惡化趨勢，通過症狀的動態觀察來判斷病勢，從而做到未雨綢繆，防患於未然。

張景嶽，這位中醫史上的巨匠，在《類經》中深刻分析了“陰陽轉化”對病勢的影響。他告訴我們，陰陽的平衡與否，直接關係到病勢的吉凶。當陰陽失衡，病勢便如脫繮之馬，難以駕馭；而當陰陽調和，病勢則如春風化雨，潤物無聲。因此，動態觀察病程階段與預後判斷，對於中醫來說，至關重要。

辨病勢，就是預判疾病的發展趨勢與轉歸。這並非易事，需要綜合病因、病位、病性等多方面因素，推斷疾病的動態變化。病因，是疾病的起點，它決定了病位與病性。比如外感病因，多從表證開始，逐漸深入內臟；而病理產物，也可作爲病因，導致新的病位和病性出現。病位與病性，則互爲表裏。病位限定了病性的表現，比如同爲熱證，在心則口舌生瘡，在胃則牙齦腫痛；同爲虛證，在脾則乏力便溏，在腎則腰膝痠軟。病性，又影響着病位的傳變。比如肝陽上亢，可傳病位至腦，導致頭暈目眩；脾虛溼困，可傳病位至四肢，導致肢體困重。

而病勢，則是前三者的動態整合。它像是一條無形的線索，貫穿着疾病的始終，引領着我們探索疾病的演變規律。病因、病位、病性、病勢，四者相互關聯、層層遞進，構成一個動態立體的疾病分析框架。這個框架的整體性、動態性、層次性，讓我們能夠更加全面、深入地認識疾病，從而做到有的放矢、精準施治。

舉例來說，一位患者因外感風寒而發熱咳嗽，這是病因；病位在肺，表現爲咳嗽；病性爲寒，因爲發熱不高且惡寒明顯。根據這些信息，我們可以預判病勢：若及時治療，散寒解表，病勢將逐漸好轉；若延誤治療，寒邪入裏化熱，病勢將變得更加複雜。

中醫的魅力，在於它的整體觀和動態觀。它不僅僅關注疾病的當前狀態，更關注疾病的未來趨勢。這種因勢利導的思想，讓我們在面對疾病時更加從容不迫。我們不需要害怕疾病，因爲疾病並不是我們的敵人；我們需要害怕的，是對疾病的無知和盲目。

因此，作爲中醫的傳承者和發展者，我們更應該深入學習和理解中醫病勢理論，將這一理論運用到臨牀實踐中去。只有這樣，我們才能更好地爲患者服務，爲人類的健康事業貢獻自己的力量。讓我們攜手並進，共同探索中醫的奧祕，讓這一古老的醫學智慧在現代社會中煥發出更加璀璨的光芒！

作者簡介：梁世傑 中醫高年資主治醫師，本科學歷，從事中醫臨牀工作24年，積累了較豐富的臨牀經驗。師從首都醫科大學附屬北京中醫院肝病科主任醫師、著名老中醫陳勇，侍診多載，深得器重，盡得真傳！擅用“商湯經方分類療法”、專病專方結合“焦樹德學術思想”“關幼波十綱辨證”學術思想治療疑難雜症爲特色。現任北京樹德堂中醫研究院研究員，北京中醫藥薪火傳承新3+3工程—焦樹德門人（陳勇）傳承工作站研究員，國際易聯易學與養生專委會常務理事，中國中醫藥研究促進會焦樹德學術傳承專業委員會委員，中國藥文化研究會中醫藥慢病防治分會首批癌症領域入庫專家。榮獲2020年中國中醫藥研究促進會仲景醫學分會舉辦的第八屆醫聖仲景南陽論壇“經方名醫”榮譽稱號。2023年首屆京津冀“扁鵲杯”燕趙醫學研究主題徵文優秀獎獲得者。事蹟入選《當代科學家》雜誌、《中華英才》雜誌。

Liang Shijie: The Importance of Diagnosis of Diseases in Chinese Medicine From "Influence of Desire"

In the vast sea of medicine, Chinese medicine is like a ship that has lived for thousands of years, carrying the wisdom and experience of countless forefathers, breaking the waves. Among them, traditional Chinese medical theory of disease is the bright pearl of this ship, which leads us to explore the mysteries of disease with its unique perspective and deep insight.

In short, therapeutic disease theory is based on the development trends of the disease as the core, focusing on the dynamic changes of the disease, transmission patterns and prognosis. This is not just a theory, but a kind of wisdom, a philosophical thought that is consistent with nature and guided by forces. As the ancients said, "Before a disease occurs, before a disease becomes a disease." TCM emphasizes that it is precisely to be vigilant about the deteriorating trend of the disease, to judge the disease through the dynamic observation of symptoms, so as to prevent the disease before it occurs.

Zhang Jingyue, a giant in the history of traditional Chinese medicine, deeply analyzed the influence of "yin and yang transformation" on the condition of illness in the Traditional Chinese Medicine. He told us that the balance of yin and yang is directly related to the good and bad of a disease. When yin and yang are imbalanced, the disease is like a horse out of control and difficult to control. When yin and yang are reconciled, the illness is like the wind in spring, the rain in summer, and the moisture is silent. Therefore, dynamic observation of the pathological stage and prognosis is essential for traditional Chinese medicine.

Diagnosis of disease is to predict the development and regression of the disease. This is not an easy task, and it requires the integration of factors such as cause, location, and disease to infer the dynamics of the disease. The cause is the starting point of the disease, and it determines the location and nature of the disease. For example, the cause of external infections mostly begins with symptoms and gradually deepens into the internal organs. Pathological products can also act as causes, leading to the emergence of new conditions and pathologies. The location and the disease are related to each other. The location of the disease limits the performance of the disease, such as for the same heat, in the heart of the mouth and tongue sore, in the stomach of the swelling and aching of gum; Also false, in the spleen there is fatigue and diarrhea, in the kidney there is weakness in the waist and knees. The illness also affects the transmission of the disease site. For example, hyperthyroidism can be transmitted to the brain, causing dizziness; The weakness of the spleen can be transmitted to the limbs, causing the limbs to be heavy.

The disease is a dynamic integration of the three. It is like an invisible clue that runs through the entirety of a disease and leads us to explore the laws of its evolution. The cause, location, condition and condition are interrelated and step by step, forming a dynamic three-dimensional disease analysis framework. The holistic, dynamic and hierarchical nature of this framework allows us to gain a more comprehensive and in-depth understanding of the disease, so as to achieve targeted and precise treatment.

For example, a patient had a fever and cough due to a cold, which was the cause of the illness; The site is in the lungs and manifests as a cough; The illness is chilly because the fever is not high and the chill is obvious. Based on this information, we can predict the disease situation: if timely treatment is given and the cold is dissipated, the disease situation will gradually improve; If treatment is delayed and the cold becomes a foreign fever, the situation will become more complicated.

The charm of traditional Chinese medicine lies in its holistic and dynamic view. It focuses not only on the current state of the disease, but also on the future trends of the disease. This tendency-driven thinking makes us more relaxed in the face of illness. We do not need to be afraid of disease, because disease is not our enemy. What we need to fear is ignorance and blindness to disease.

Therefore, as inheritors and developers of TCM, we should more deeply study and understand TCM disease theory and apply this theory to clinical practice. Only in this way can we better serve our patients and contribute to the cause of human health. Let us join hands to explore the mysteries of traditional Chinese medicine, and let this ancient medical wisdom shine even brighter in modern society!

Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo''s ten-level diagnosis.He is currently a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation of Jiao Shude''s protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. His work was featured in the journal Current Scientist and the journal Chinese Talent.