蒋啸 郑旭锐

摘要  目的：寻求优化与整合精准临证策略与方法，以求提高临床辨证、治疗精度。方法：通过对“方证对应”概念源流的梳理与评析，结合叶天士临证经验与降维升阶思想，求取优化策略。结果：结合方证对应目前存在的空白，提出结合数据回顾性研究的叶氏“机法相参”模式。结论：叶天士遥承仲景法证思想，结合大量临证经验，以病机与治法为更高阶辨证标准，以证素与经方为低纬因子，能够更好地解决提高临证效果与辨证精度的问题。

关键词  方证对应;机法相参;叶氏法证;思维模式;循证数据;中医思维;精准医疗

A Brief Discussion on the Construction of Machine Method Reference of YE Tianshi in Precision Medicine

JIANG Xiao，ZHENG Xurui

（Shaanxi University of Chinese Medicine，Xianyang 712046，China）

Abstract Objective： To optimize and integrate precise clinical syndrome strategies and methods to improve clinical differentiation and treatment accuracy. Methods： Through combing and analyzing the source flow of the concept of “prescriptions corresponding to syndromes”，combining with YE Tianshi′s experience of clinical evidence and the idea of dimension reduction and promotion，the optimization strategy was obtained. Results： Combining with the existing gaps of prescriptions corresponding to syndromes，this paper put forward a retrospective study of YE′s model of “ machine method reference”. Conclusion： YE Tianshi inherited Zhongjing′s forensic thought，combining a large number of clinical experience，taking pathogenesis and treatment as higher-order syndrome differentiation standard，and taking syndrome element and meridian prescription as low latitude factor，which could better solve the problems of improving the therapeutic effects and accuracy of clinical syndrome differentiation.

Keywords  Prescriptions corresponding to syndromes; Pathogenesis corresponding to therapeutic method; Ye Tianshi′s treatment methods and clinical experience; Thinking model; Evidence-based data; Chinese medicine thinking; Precision medicine

中圖分类号：R242;R249 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.031

目前，医学越发地重视各系统间的“整合”与治疗方案的“精准”。在此标准下回顾性地评述“方证对应”的沿革和发展与现阶段所面临的困局和问题。通过梳理叶氏医案而取法于临证大家叶天士，提出机法相参的解决策略。用于进一步提高临证的准确性。并引入循证医学的思维和数据挖掘的方法。进一步寻找临床最佳证据，为提高“诊断与临床效能”提供思路与方法。

1 方证对应思维模型

方证对应是一种指导中医临床应用的认知思维模型，体现了面对复杂临床问题时古人的思索与应答。体现了从散在零碎的点知识向体系性知识的建构过程，在历代医家将自己的临床心得与经验注入后，最终发展为相对完备的与复杂的诊疗思维模型指导着临床应用，哺育着中医习者。

1.1 方证对应沿革