浅谈不同中医医案研究方法对临床思维建立的重要性
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摘要
临床思维是指医者在临床诊疗过程中,应用掌握的理论知识和实践经验,在判断分析疾病本质、发病规律、制定治疗原则及处方用药中所表现的思维活动。每一次具体临床思维过程都是一次科学假说,而这是临床医疗实践中最有价值的思维方法,经验思维、取象思维、辨证思维、系统思维、直觉和灵感思维等为典型特点的中医思维方式深藏在浩瀚的历代医案典籍中,通过对典籍的阅读研习才能揣摩领悟其内在思维本质。故而在新的学科体系取代"经典学习"的今天,"读经典、做临床"重新唤起对中医临床思维的培养和研究有一定的深远意义。
Clinical thinking refers to the theoretical knowledge and practical experience that doctors grasp in the process of clinical diagnosis and treatment. They are thinking activities in judging and analyzing the nature of disease, rule of onset, formulating therapeutic principles and prescribing medication. Every specific clinical thinking process is a scientific hypothesis.And this is the most valuable way of thinking in clinical practice. Experience thinking, image thinking, dialectical thinking, systems thinking, intuition and inspiration, typical of Chinese way of thinking is deep in the vast ancient medical record books.Reading the TCM medicine cases is the best way to comprehend the essence of its inner thinking. Although, the new discipline system has replaced the ‘classical learning' today. ‘Reading classics, doing clinical' is of great significance to the training and research of clinical thinking of traditional Chinese medicine.
Clinical thinking refers to the theoretical knowledge and practical experience that doctors grasp in the process of clinical diagnosis and treatment. They are thinking activities in judging and analyzing the nature of disease, rule of onset, formulating therapeutic principles and prescribing medication. Every specific clinical thinking process is a scientific hypothesis.And this is the most valuable way of thinking in clinical practice. Experience thinking, image thinking, dialectical thinking, systems thinking, intuition and inspiration, typical of Chinese way of thinking is deep in the vast ancient medical record books.Reading the TCM medicine cases is the best way to comprehend the essence of its inner thinking. Although, the new discipline system has replaced the ‘classical learning' today. ‘Reading classics, doing clinical' is of great significance to the training and research of clinical thinking of traditional Chinese medicine.
引文
[1]余占海,段淑琴,姜化侯.把握临床思维的特点.临床误诊误治,1997,1(3):131-132
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[4]邢玉瑞.中医临床思维特点探讨.湖南中医药大学学报,2009,29(4):3-4
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[14]孙岸弢,王永炎,谢雁鸣.中医意象思维理念刍议.中医杂志,2011,52(2):89-91
[15]王永炎,郭蕾,张俊龙,等.论诠释学与中医学创新.中医杂志,2010,51(7):587-589
[16]潘超,杨良怀,龚卫华,等.模式匹配研究进展.计算机系统应用,2010,19(11):265-275
[17]U M Fayyad,G Piatetsky-Shpiro,P Smyth,et al.Advances in Discovery Knowledge and Data Mining.MIT Press,1996:2
[18]刘建平,张柯欣,杨钧.数据挖掘技术及其在中医药领域中的应用.辽宁中医药大学学报,2007,9(6):203-204
[19]陈擎文.数据挖掘技术在古代名中医中风医案之应用研究.中华中医药学刊,2008,26(10):2254-2257
[20]李晓红.中文文本分类技术研究.兰州:兰州理工大学,2009
[21]程斌.邓铁涛医案研究及交互式网站的构建.广州:广州中医药大学,2006
[22]张启明,王永炎,张志斌,等.中医历代医案数据库的建立与统计方法.山东中医药大学学报,2005,29(4):298-299
[23]郑红.明清医家论治骨痹(骨关节炎)用药规律研究.山东中医药大学学报,2003,27(2):95-97
[24]林景亮.关联规则挖掘算法及其应用研究.厦门:厦门大学,2007
[25]杨洪军,赵亚丽,唐仕欢,等.基于熵方法分析中风病方剂中药物之间的关联度.中国中医基础医学杂志,2005,11(9):706-709
[26]唐仕欢,陈建新,杨洪军,等.基于复杂系统聚类方法的中药新药处方发现研究思路.世界科学技术-中医药现代化,2009,11(2):225-228
[27]陈建新.中医证候的复杂系统建模及其与疾病的相关性研究.北京:中国科学院,2008
[28]Yang Hongjun,Chen Jianxin,Tang Shihuan,et al.New drugR&D of traditional Chinese medicine-role of data mining approaches.Journal of Biological Systems,2009,17(3):1-4
[29]朱蕾蕾,孙继佳,金采映,等.基于数据库及数据挖掘的中医医案方法学研究——蒋健教授治疗胃痛的临床经验总结.中华中医药杂志,2013,28(10):2888-2893
[30]刘贤亮,黎创,毛炜.近十年中医医案研究进展.中华中医药杂志,2012,27(8):2132-2134
[2]姜兆侯,姜立.少见疑难病的临床思维特点.医学与哲学,1997,18(6):320-322
[3]蒋永光,潘娟,金桂花,等.中医临床思维及其特点.辽宁中医杂志,2001,28(8):463-464
[4]邢玉瑞.中医临床思维特点探讨.湖南中医药大学学报,2009,29(4):3-4
[5]鲁兆麟.近代名老中医临床思维方法.北京:人民卫生出版社,1997
[6]李春昌,李春昇.点击临床思维——误诊60病例分析.北京:人民军医出版社,2006
[7]周同甫.临床思维与临床决策.成都:四川大学出版社,2011
[8]刘虹.临床哲学思维.南京:东南大学出版社,2011
[9]俞麟森,杨森昌,施汉范,等.临床思维偏差与误诊.临床误诊误治杂志,1999,1(12):11-12
[10]邢玉瑞.中医思维方法.北京:人民卫生出版社,2010
[11]畅达.中医临床思维要略.北京:中国中医药出版社,2011
[12]王伯章.中医临床思维导学.上海:上海中医药大学出版社,2009
[13]贾春华.张仲景方证理论体系研究.北京:人民卫生出版社,2011
[14]孙岸弢,王永炎,谢雁鸣.中医意象思维理念刍议.中医杂志,2011,52(2):89-91
[15]王永炎,郭蕾,张俊龙,等.论诠释学与中医学创新.中医杂志,2010,51(7):587-589
[16]潘超,杨良怀,龚卫华,等.模式匹配研究进展.计算机系统应用,2010,19(11):265-275
[17]U M Fayyad,G Piatetsky-Shpiro,P Smyth,et al.Advances in Discovery Knowledge and Data Mining.MIT Press,1996:2
[18]刘建平,张柯欣,杨钧.数据挖掘技术及其在中医药领域中的应用.辽宁中医药大学学报,2007,9(6):203-204
[19]陈擎文.数据挖掘技术在古代名中医中风医案之应用研究.中华中医药学刊,2008,26(10):2254-2257
[20]李晓红.中文文本分类技术研究.兰州:兰州理工大学,2009
[21]程斌.邓铁涛医案研究及交互式网站的构建.广州:广州中医药大学,2006
[22]张启明,王永炎,张志斌,等.中医历代医案数据库的建立与统计方法.山东中医药大学学报,2005,29(4):298-299
[23]郑红.明清医家论治骨痹(骨关节炎)用药规律研究.山东中医药大学学报,2003,27(2):95-97
[24]林景亮.关联规则挖掘算法及其应用研究.厦门:厦门大学,2007
[25]杨洪军,赵亚丽,唐仕欢,等.基于熵方法分析中风病方剂中药物之间的关联度.中国中医基础医学杂志,2005,11(9):706-709
[26]唐仕欢,陈建新,杨洪军,等.基于复杂系统聚类方法的中药新药处方发现研究思路.世界科学技术-中医药现代化,2009,11(2):225-228
[27]陈建新.中医证候的复杂系统建模及其与疾病的相关性研究.北京:中国科学院,2008
[28]Yang Hongjun,Chen Jianxin,Tang Shihuan,et al.New drugR&D of traditional Chinese medicine-role of data mining approaches.Journal of Biological Systems,2009,17(3):1-4
[29]朱蕾蕾,孙继佳,金采映,等.基于数据库及数据挖掘的中医医案方法学研究——蒋健教授治疗胃痛的临床经验总结.中华中医药杂志,2013,28(10):2888-2893
[30]刘贤亮,黎创,毛炜.近十年中医医案研究进展.中华中医药杂志,2012,27(8):2132-2134