中医杂志

辨证论治是中医诊疗体系的组成部分，其发展历程呈现出明显的阶段性特征。系统梳理辨证论治的演进脉络，从《黄帝内经》对症治疗到张仲景确立病-脉-证-治体系，从明清时期辨证论治的应用与发挥，再到近现代被确立为中医基本特点。但过度强调辨证论治，并淡化疾病观，使得基本特点逐渐异化为主要诊疗模式。提出辨证论治的异化主要表现为重证轻病的倾向，导致辨证论治概念泛化与应用局限，并造成辨证论治缺乏针对性。强调正确审视辨证论治是发展和完善中医诊疗体系的必要前提，通过现代医学诊断明确疾病靶点，运用中医思维提炼疾病共性规律，实现辨证论治与现代临床需求的精准对接，为解决辨证论治的当代困境提供参考。

Syndrome differentiation and treatment is an integral part of the traditional Chinese medicine(TCM) diagnostic and therapeutic system, whose development exhibits distinct stages. This paper systematically reviews the evolutionary trajectory of syndrome differentiation and treatment, from symptom-based treatment in Inner Canon of Yellow Emperor （《黄帝内经》）, to ZHANG Zhongjing's establishment of the disease-pulse-syndrome-treatment framework, through its application and development in the Ming and Qing dynasties, and finally to its recognition as a fundamental characteristic of TCM in modern times. However, the overemphasis on syndrome differentiation and treatment, coupled with a diminished focus on disease concepts, has led to its gradual alienation as the primary diagnostic and therapeutic model. The alienation mainly manifests as a tendency to prioritize syndrome over disease, resulting in the overgeneralization and limited application of the concept, and causing a lack of specificity in practice. This paper emphasizes that a correct understanding of syndrome differentiation and treatment is a necessary premise for the development and improvement of the TCM diagnostic and therapeutic system. By integrating modern medical diagnosis to clarify disease targets and applying TCM thinking to extract common patterns of diseases, precise alignment between syndrome differentiation and treatment and modern clinical demands can be achieved, providing a reference for addressing the contemporary challenges of syndrome differentiation and treatment.