童天昊 周小青 李金霞

摘要 构建诊断与理法方药紧密契合的诊疗体系，从而实现诊断与治疗的精准化，是中医药领域发展的必然趋势。以主诉诊疗学作为切入点，从四诊合参、关联分析等方面展开论述，提出主证精细深入分析、主证横/纵向分析等研究思路与对策，以期优化中医临床诊断思路，为临床路径提供决策参考。

关键词 中医诊断;中医主诉诊疗;四诊合参;关联分析;临床诊疗路径;症对;精准诊断;精准施治

Abstract It is an inevitable trend in the development of traditional Chinese medicine（TCM）to build a diagnosis and treatment system that closely accords with the principle-method-recipe-medicines in order to achieve precise diagnosis and treatment.This paper takes the chief complaint diagnosis and treatment as the entry point and discusses the synthesis of the 5 diagnostic methods and association analysis.It proposes research ideas and measures such as precise-depth analysis of the main symptoms and horizontal/vertical analysis of the main symptoms to optimize the clinical diagnosis of TCM paths and to provide decision-making reference for the clinical pathway.

Keywords Diagnosis of traditional Chinese medicine; Chief complaint diagnosis and treatment; Synthesis of the 4 diagnostic methods; Association analysis; Clinical diagnosis and treatment path; Coupled symptoms; Accurate diagnosis; Precise treatment

中圖分类号：R241;R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.07.024

中医诊疗是一个疾病、症状、证型相互结合，理、法、方、药俱备的系统医疗工程。中医学在医学领域具有丰富的实践经验、技术和理论，其中医诊断的基本原则——四诊合参、整体审查、病证结合，使中医学在现代诊疗路径研究中更具特色和可行性。中医临床诊疗的核心是辨证论治，也是中医学有别于现代医学诊疗体系的独特优势，其理论体系经过上千年临床实践的检验，充分体现了中医学理论的有效性与科学性[1]。传统中医主要通过整体、动态、个性化了解身体状态来诊断疾病的理念超前，然而方法却依赖于经验，使其巨大潜力未能充分发挥[2]。主诉是对病情的高度提炼，是中医临床诊疗的核心，抓住主诉并结合四诊、确定病因、病性、病位，对其进行关联分析和定量诊断，是提高辨病辨证准确性的关键环节，只有辨病辨证精准、客观，才能保证理、法、方、药各个步骤的准确性，以确保临床疗效。因此探讨以主诉为切入点的四诊合参、关联分析的治疗思路研究具有贴近临床的实际意义。……