从薛己医案辩证分析疗效与更方的关系

Dialectical analysis of the relationship between the therapeutic effect and changing the prescription based on XUE Ji medical records

临床实践中经常需要复诊,首诊易,复诊难,这是医务工作者的切身感受。复诊之难在于要不要更方,当更而不更,不当更而更,或当更而更之不当,这些都是临证的失误。著名中医心血管病专家周次清教授曾撰写《从"效不更方"谈起》一文,读之获益匪浅,但是周教授的论文未有医案作证未免有些空洞。明代医家薛己精通临床各科,他对于这一问题的处理也许会给当代中医临床一些启示。通过对薛氏的一些医案进行解析,辩证分析疗效与更方的关系。

Clinical practice requires further consultation. It is a common feeling for all the medical workers that preliminary diagnosis is easy while return-visits are difficult. The core difficulty of further consultation lies in the doctors＇ decision--whether or not to adjust prescriptions. There are several mistakes during clinical practice, including no adjustment for the patients who need new prescriptions, newly prescriptions for ones who need the primary curing and unappropriate adjustment for ones who need newly prescriptions. The outstanding Chinese cardiovascular disease expert, professor ZHOU Ci-qing wrote one paper called Talking from No Adjustment for Effects which is directive but empty without medical cases. Physician XUE Ji in Ming Dynasty is proficient in clinical subjects and his handling of this issue may give some inspiration to contemporary clinical practice of traditional Chinese medicine. Through the analysis of Xue＇s medical cases, we can dialectically know the relationship between efficacy and prescription adjustment.