《类证治裁》痛证辨治特色浅析

Characteristics of Syndrome Differentiation and Treatment on Pain Syndrome in Categorized Patterns with Clear-cut Treatments

目的:全面整理和总结清代医家林珮琴治疗痛证的论述与方药,认真研究和挖掘林氏的学术思想与辨治特色。方法:运用文献学研究方法,认真研读《类证治裁》书中卷六"头痛论治""胸痹论治""心痛论治""胃脘痛论治""胁痛论治""腹痛论治""肩背手臂痛论治""腰脊腿足痛论治""身痛论治"等章节,对林氏学术思想、论治理念、方药特色进行了较为深入的阐发。结果:林珮琴祖述经典,旁及众家,撷其精英,灼有定见。在痛证的论治中,博采众长,但不人云亦云,每有真知卓见;细审病因,详陈辨证,勘验轻重缓急;五脏通调,重在治肝,谙熟清疏泻润诸法;力倡温通,综合调治,以除寒瘀虚滞之弊;独爱金石,沉降荡涤,以收效专力宏之功。结论:林氏集百家之言,汇众医之长,既有虔诚笃定的沿袭继承,又有匠心独运的神来之笔。本文以痛证的治疗为切入点,窥一斑而知全豹,深刻领略大师风范,以期尽取精华,更好地在临床论治该病。

Objective： To summarize the ideas and formulas in treatment of pain syndrome of LIN Pei-qin in the Qing Dynasty,and to explore Lin’s academic thought and treatment characteristics. Methods： By literature research methods,carefully read chapters in Categorized Patterns with Clear-cut Treatments ： Syndrome Differentiation and Treatment on Headache,on Pectoral Stuffiness Pain,on Heartache,on Epigastric Pain,on Hypochondriac Pain,on Abdominal Pain,on Shoulder,Back and Upper Limbs Pain,on Lumbar Vertebrae and Lower Limbs Pain,and on Body Pain,so as to elaborate Lin’s academic thoughts,ideas of syndrome differentiation and treatment,and characteristics of medication. Results： LIN Pei-qin followed the classic,absorbed advantages of different sides,and formed his own ideas. In the treatment of pain syndrome,he learned widely from others,but did not repeat others; he examined carefully the causes,detailed the differentiation,and identified the order of priority; he regulated the five zang organs,focused on treating the liver,and was proficient in the various methods of clearing,dredging,purging and moistening; he advocated warming and dredging methods,and comprehensive treatment,in order to remove cold stasis and deficiency stagnation; he preferred mineral medicine,purging and clearing methods in order to get the concentrated and forceful effect. Conclusion： Lin collected all schools of thoughts,and compiled the strengths of many skilled doctors,combining the sincere inheritance and the great originality. This paper started from the treatment of pain syndrome to appreciate deeply the master’s style so as to absorb the essence for the better treatment of the disease in clinical practice.