李用粹《旧德堂医案》证治经验探析  

Analysis on the Syndrome Treatment Experience of Jiudetang Yi’an by LI Yongcui

作　　者：范佳美 李冉 王泽颖[1] FAN Jiamei;LI Ran;WANG Zeying(Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China)

机构地区：[1]潍坊市中医院,山东潍坊261041

出　　处：《浙江中医药大学学报》2024年第10期1301-1304,共4页Journal of Zhejiang Chinese Medical University

基　　金：齐鲁医派中医学流派传承项目(鲁卫函﹝2021﹞45号);山东省中医药科技项目(M-2023246T)。

摘　　要：[目的]探析清代名医李用粹所著《旧德堂医案》的学术特色,从而拓宽临床诊疗思路。[方法]以《旧德堂医案》所载67则医案为主要研究对象,通过提炼、分析医案中主症、病位、证型、治则及用药遣方,并参证其他相关典籍,总结李氏学术思想及证治经验。[结果]李氏幼传家学,广撷各家思想之精华,补前人所未发。学术上以《内经》之基,并深受东垣学说影响,对“阴火”见解独到。临证谨遵整体,用药择时;上病下取,巧妙辨施;提倡调脾为本,并重肝和之要,顾护脾肾;色脉为先,精于脉诊,脉症为逆,因脉施治;用药平和,慎用攻伐,善用报经引使药物,巧用代赭。[结论]《旧德堂医案》选案精要,理法方药完备,其蕴含的李氏鲜明的诊疗特色对开拓辨证思维,指导临床诊疗皆具有参考价值,值得后世研习与继承。[Objective]To analyse the academic characteristics of Jiudetang Yi’an by the famed Qing Dynasty physician LI Yongcui,so as to braoden the schemes of the clinical diagnosis and treatment.[Methods]Using the 67 medical cases recorded in the Jiudetang Yi’an as the primary research subjects,this paper extracted and analyzed the main symptoms,disease locations,syndrome types,treatment principles and prescriptions from these cases.Additionally,this paper referenced other relevant classical texts to summarize LI’s academic thoughts and clinical experiences.[Results]LI inherited family medical teachings from a young age and extensively absorbed the essence of various schools of thought,supplementing areas unexplored by his predecessors.Academically,he was grounded in the Huangdi Neijing and was profoundly influenced by Dongyuan’s theories,developing unique insights into“Yin fire”.In clinical practice,LI strictly adhered to holistic principles,selecting medications based on timing;treating upper body ailments by addressing lower body issues with skillful differentiation;advocating spleen regulation as fundamental while emphasizing the liver harmony and protecting the spleen and kidney functions.LI prioritized complexion and pulse diagnosis,excelling particularly in pulse diagnosis,and basing treatments on pulse-symptom discrepancies.His approach favored mild medications,cautiously employing aggressive treatments,effectively utilizing channel-guiding and envoy drugs,and skillfully incorporating hematite in prescriptions.[Conclusion]Jiudetang Yi’an presents a collection of meticulously selected cases,comprehensive in theory,methodology,prescription,and medication.The distinctive diagnostic and therapeutic features of LI’s practice,as encapsulated in these records,offer valuable insights for expanding syndrome differentiation thinking and guiding clinical diagnosis and treatment.This work merits in-depth study and inheritance by future generations of practitioners.

关 键 词：《旧德堂医案》 李用粹 学术思想 《黄帝内经》 整体观念 脾胃 脉诊 诊疗特色 

分 类 号：R221[医药卫生—中医基础理论]