李花 刘旺华 何聪睿 凌智 周小青

〔摘要〕 基于《黄帝内经》以及后世医家关于生理上和病理上气机升降、病位上下、上下病证之诊断、上下分治、中药升降浮沉的论述，认为上下与阴阳、表里、寒热、虚实并列互补，提出增加上下为纲的辨证新思维，补八纲之阙。

〔关键词〕 上下为纲;八纲;辨证;中医思维

〔中图分类号〕R241       〔文獻标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.11.006

〔Abstract〕 Based on Huangdi's Internal Classic and the later doctors' opinions on the rise and fall of Qi in physiology and pathology， upper and lower position of disease，diagnosis of upper and lower diseases and syndromes，treatment according to the upper and lower location， ascending and descending， floating and sinking of Chinese materia medica， it is believed that the upper and lower parts are parallel and complementary to Yin and Yang， exterior and interior， cold and heat， and deficiency and excess， and a new thinking of adding the upper and lower principles as the principles of syndrome differentiation was put forward， and making up the deficiency of the eight principles.

〔Keywords〕 upper and lower as the principle; eight principles; syndrome differentiation; thinking of traditional Chinese medicine

八纲辨证起源于《黄帝内经》，《伤寒杂病论》已运用八纲进行辨证论治，《医林绳墨》云：“仲景治伤寒，……然究其大要，无出乎表里虚实阴阳寒热，八者而已。”《伤寒正脉》指出：“治病八字，虚实阴阳表里寒热，八字不分，杀人反掌。”《景岳全书》专设“《阴阳》”“《六变》”，以二纲统六变，近代祝味菊在《伤寒质难》中正式提出“八纲”概念[1]。八纲辨证是中医各种辨证方法的总纲。医者根据四诊取得的病情资料，综合分析，探求疾病性质、病变部位、病势轻重、正邪盛衰等情况，归纳为阴、阳、表、里、寒、热、虚、实八类证候，其中阴阳为总纲，表里辨部位，寒热辨性质，虚实辨邪正盛衰，是中医辨证的基本方法，也是从各种辨证方法的个性中总结出的共性。在中医病证诊断过程中，起到提纲挈领、执简驭繁作用[2]。八纲辨证的局限性在于结论略显抽象、笼统。八纲中阐释病位的纲领是表里，然而表里并不能涵盖上、下二纲，表里是横向的病位，上下是纵向的病位。《黄帝内经》及历代医家运用上、下病位阐释病机、指导辨证、指导治疗的论述较多，对临床辨证论治起了积极意义，笔者就上、下病位辨证略陈微见，以补八纲辨证之阙漏，以期更好指导临床。