Clinical thinking is a TCM doctor of traditional Chinese medicine in the whole medical process, using the tool of thinking to patients sick certificate or related things and phenomena in a series of investigation, analysis, judgement, decision, implementation and verification, to explore the nature of disease and treatment law of thinking activity process. "Based on the overall concept for understanding, based on the treatment of disease, treatment based on syndrome differentiation for core, the company outside with inside as the main form" is the main characteristics of TCM clinical thinking mode, in under the guidance of the basic theories of TCM, TCM doctor is gradually formed in the process of clinical practice. Clinical thinking is the key to clinical efficacy, throughout the diagnosis and treatment in the process of concrete can be divided into four diagnosis and differentiation diagnosis of thinking, the establishment of and the measures of treatment of thinking, as well as clinical verification and confirmed feedback thinking. Relative to clinical thinking in terms of modern medicine, Chinese medicine clinical thinking basically has the following five aspects, the characteristics of a type of the process of data collection of universality, thinking orientation, the dialectical thinking mode, the three debates of the individuality as well as the results of qualitative and fuzzy thinking.

This article will talk about the clinical thinking of TCM in the treatment of skin diseases.

1. Comparison of clinical thinking of combination of traditional Chinese medicine, western medicine and traditional Chinese medicine

At present, there are three modes of medicine, namely the combination of traditional Chinese medicine, western medicine and Chinese and western medicine. Due to the different cultural background and development environment, there are great differences among them in many aspects. Cultural differences create different ways of thinking. Thinking is the process of processing information. Therefore, different ways of thinking will make different decisions on the same information in the face of collected information. For example, when receiving patients, doctors of western medicine should first judge the disease by auxiliary examination and treat the disease. The treatment of TCM doctors will be based on the patient's physical condition, comprehensive etiology, pathogenesis, diagnosis and treatment, syndrome differentiation. The following is a comparative analysis of the three types of clinical thinking from the perspectives of generation times, thinking methods, medical models, research contents, research methods and characteristics:

Chinese medicine is a treasure of the Chinese nation. It has been proved to be effective and advantageous after thousands of years of verification. The formation of TCM theoretical system, which is produced in experience medicine era, is the early scattered, self-consciousness, local and spread in folk medicine practice experience, through clinical exploration step by step in the accumulation and development, gradually formed have guiding significance of medical theory knowledge, the system of medical knowledge. Represented by "the book of changes" in the development of Chinese traditional culture is the soil, in the process of the occurrence, development and evolution of traditional Chinese medicine, the time is not under the influence of ancient philosophy of traditional Chinese medicine and the enlightenment, thus formed is given priority to with natural philosophy mode of medical model. Its special way of thinking also decides the paradigm of the doctor in the process of diagnosis and treatment of traditional Chinese medicine using image thinking to judgment of disease, is a TCM doctor, on the basis of the original perceptual knowledge with the help of specific image to think of a way of thinking, can be summarized as observation method, directly grasp take analogy, etc. The research contents include five elements of Yin and Yang, qi and blood of Tibetan elephant, eight principles of four diagnosis and eight principles of meridian, etc.

Background of western medicine and the development of the environment and the traditional Chinese medicine is very different, the recognition method is derived from the ancient Greek civilization and reductionism of the Renaissance era, western heroes of that, the world is made up of elements particles, research object can be constantly were analyzed, and eventually restore its original state, complex to simple. So its use is based on anatomy, based on the analysis of the concept of boundary clear and strict logical thinking and form, attaches great importance to the local and micro research, from the system to organs, to cells, molecules, quantum, at present has research to the genetic level. Its understanding of disease is based on the study of anatomy, physiology, pathology and etiology. Clinical diagnosis and treatment thought mainly through the complaints of the patient, the information collected by visual touch knock at listening to the patient carries on the preliminary judgment, again through the diagnosis and treatment technology to determine the disease, the occurrence, development rules, prognosis of disease, complications, such as has its special regularity, each disease has the corresponding diagnosis and treatment procedures. Compared with traditional Chinese medicine, it is more objective, direct and has its limitations.

Combine traditional Chinese and western medicine is the inevitable trend under the new era, with the modern Zhang Xichun "recorded in medical applications and the west" as the beginning, from 60-70 - s of the 20th century in the early period clinical and experimental research, basic research to the clinical research of the 1980 s and deepen the development stage, to combine traditional Chinese and western medicine discipline construction stage of the 90 s after, combine traditional Chinese and western medicine was founded in holistic medicine era, based on logical thinking mode of thinking, to "biological - nature - society - psychology - individual" mode for medical model, USES the method of analysis and comprehensive research, understanding of the human body and diseases, It is characterized by the combination of macroscopic wholeness and microscopic molecular level [3].

Ii. Three stages of clinical thinking of TCM

The process of TCM clinical differentiation and treatment is a complete and complex process of thinking, with its unique way of thinking. Famous doctor in qing dynasty Ye Tianshi once said, "be a certificate, legislation, with the knowledge, this is three key", this is the essence of TCM clinical thinking, throughout the diagnosis and treatment in the process of TCM clinical thinking is roughly can be divided into three phases: diagnosis, analysis and treatment [4].

The diagnosis stage is the first step for TCM to obtain disease information and make correct judgment. Rely mainly on inspection, auscultation and olfaction, inquiry, and pulse-taking and palpation of TCM four diagnostic disease information collection, TCM four diagnosis was collected by senses of doctor and master the appearance of information to determine patient, in the main use is in the process of thinking in images. In this process, it is necessary to fully analyze the relationship between the external environment and human activities, and the relationship between local diseases and the whole body. Only in this way can clinical diagnosis and treatment activities be carried out effectively.

Analysis phase based on syndrome differentiation as the core, the han, zhang zhongjing "typhoid miscellaneous disease theory" pioneering treatment based on syndrome differentiation, differentiation is through listening, asking and four diagnostic information collected, analyzed and derived inductive, clear etiology, disease, disease resistance, evil is relations, the specimen successively and so on, the final judgment for a "certificate", according to the card to further determine the therapeutic principle and treatment, namely "view its pulse card, know how to make, in the rule". Syndrome differentiation and treatment is the core theory and method of TCM diagnosis and treatment of diseases.

After examination and analysis phase, you have to have a clear rational knowledge of the patient, clinical thinking activities are transferred to the intervention by the diagnosis at this time, namely the establishment of, prescription drugs. Treatment part treatment and external treatment, doctors mainly rely on his own experience, in view of the core mechanism to choose, and according to the associated with symptoms or signs, specimen successively, master-slave good or poor to add and subtract drugs.

3. Clinical thinking of dermatology in traditional Chinese medicine

Skin diseases in TCM belongs to the category of surgery, ancient literature of skin disease is extremely rich, in the 14th century BC in the oracle with scabies, 疕, disease such as the emergence of pictograms, these are skin disease, especially in huangdi neijing have sores, ulcers, skin disease of disease such as Cuo records, in addition to that, "on larger questions. To really" "pathogenesis article 19" recorded in the paper about etiology and pathogenesis, including "the little sore, heart all belongs to" "the wet swelling full, all belong to the spleen" on clinical has important guiding significance to the future generations. In the modern concept of medical dermatology general occurred in human skin, mucous membrane and skin adnexal a major types of disease, can now be named skin and adnexal diseases with different clinical characteristics as many as more than 2000 kinds of varieties, high incidence worldwide, such as global psoriasis incidence of about 3%, the incidence of about 0.47% in our country, and has the trend of increased year by year, and because of its complex causes, repeated attacks, seriously affect the patient's quality of life, also caused a certain burden to the society. Traditional Chinese medicine has a long history and many methods to treat skin diseases. It has the advantages of overall adjustment, improvement of symptoms, less side effects and low recurrence rate. TCM holds that the occurrence of skin diseases cause points of human body internal cause and external cause of disease cause, is due to the six evils of the seven emotions, diet, disease cause the body work or partial tide of Yin and Yang, qi and blood, make the viscera caused by disorders of the activities and functions. Himself after years of clinical experience, in the skin of clinical thinking aware, summarizes its characteristics mainly include the following: (1) supported by the basic theory of TCM, the overall view to know basis; (2) combination of "disease-syndrome-disease"; (3) integration of the whole and the part, and integration of macro and micro; (4) control the dynamics of the system, three factors are appropriate; (5) combination of classics and experience; (6) combination of internal and external treatment. It is discussed in detail below.

1. Based on the basic theory of traditional Chinese medicine and the holistic view

The human body is a harmonious and unified organic whole, any disease and inner is closely related to the dysfunction of qi and blood, organs, skin also is such, although it develops in the body surface locally, but local lesion is often viscera internal pathological changes in the reaction of the local. For example, the surgeon, whose tumors are not included, is named after the surgeon. But surgery must be inward, and inward, and outward, as it were, according to the hands. In the world of extermination, we have no idea of its origin. Therefore, the diagnosis and treatment of skin diseases should be the same as other diseases, based on the basic theory of traditional Chinese medicine, and based on the overall view, explore its origin and focus on internal treatment.

Overall treatment based on syndrome differentiation of traditional Chinese medicine (TCM) is the key to clinical thinking, is also an important part of disease by dermatologists, Chinese medicine syndrome differentiation is collected by listening, asking and abstraction of information comprehensive analysis and induction, a clear etiology, disease, disease resistance, evil is relations, the specimen successively and so on, finally judged as a "pass" of some kind, then according to the result of syndrome differentiation, determine the therapeutic principle and treatment, treatment of implementation. Chronic disease, complicated complex diseases, in particular, the overall majority belongs to the syndrome differentiation, the status of local differentiation more true, must be based on the whole, evidence-based medicine, from the inner modulation, including overall adjustment to improve the local conditions, external treatment to the disease so improve local symptoms.

Pathogenesis of the syndrome differentiation and treatment is the key, is the mechanism of disease occurrence, development and change, is to use careful card beg for TCM clinical thinking methods of induction, by analyzing the clinical syndrome, to generalize the norms and the corresponding therapeutic treatment, and the formulas, is the basis principle of France, is the core of TCM clinical thinking. Skin disease pathogenesis mainly wind, dampness, heat, toxin, worm and other external causes and medicial, diet weary, liver and kidney loss under the action of internal cause, the imbalance, estrangement and zang-fu organs evil poison knot together, and gave birth to wind, wet, dry, weak, blood stasis, heat, tianjin, etc. When discussing the etiology and pathogenesis of skin diseases, we should also combine the relevant dialectic ideas of Yin and Yang, surface, cold and heat, false and solid, sanjiao, qi yingxue, qi and blood fluid, meridian, viscera and so on. I personally think that the most representative of traditional Chinese medicine physicians in their etiology and pathogenesis of psoriasis and to investigate from the "blood differentiation", the dialectical qi-blood and wei qi camp blood organic unifies in together, such as Zhao Bingna think, according to clinical manifestations can be mainly classified into XieReXing, psoriasis and blood stasis type and XieSaoXing, blood heat certificate for medicial, long the fire, cause thermal FuYing blood; Or because of eating the thing that scarlet hair, bring about spleen and stomach to be out of tune, yu long changes heat; Or due to the external evil guest in the skin, inside and outside the confluence and illness; Blood stasis is often caused by chronic qi and blood loss, blockage of meridians and veins, coagulation of qi and blood, and dermatitis. Patients with blood dryness are often caused by chronic Yin and blood consumption injury, dampness and wind, and dermatitis [5].