《名医类案》中补中益气汤误治医案研究

Study on the Mistreatment of Medical Cases of Buzhong Yiqi Decoction in “Mingyi Leian”

[目的]探析《名医类案》中补中益气汤误治医案的临床价值。[方法]采用人工筛选的方法,纳入8则治疗过程记录翔实的医案,按照误治原因进行分类,从病因、病机、治法、用药各方面进行深入剖析,并总结医案中内寓的临床经验。[结果]8则医案的主要误治原因分两大类,一为辨证不明:虚实不分,表里不明,即没有充分进行四诊合参,只依赖单一的症状而没有抓住核心病机,导致辨证失误,用药方向错误;二为用药不当:补益过度或病重药轻,虽方向正确,但没有把握好药物剂量,病仍不除,甚至损伤正气。[结论]误治医案从反面警示临床医者需谨守辨证论治、治病求本、以平为期的论治思想,在重视经典传承的同时,不应忽略总结误治经验,用以指导临床治疗。

[Objective]To investigate the clinical value of the mistreatment of medical cases of Buzhong Yiqi decoction in"Mingyi Leian".[Methods]Eight medical cases,which recorded the course of treatment in detail,were selected out.These cases were classified according to the reason of clinical mistreatment and discussed deeply in etiology,pathogenesis,therapies and medications.The clinical experience and lessons in the cases was summarized and analyzed.[Results]The reasons of the mistreatment included two primary points.Firstly,syndromes were not differentiated accurately,like asthenia syndromes and sthenia syndromes,internal syndromes and external syndromes,all these were messed up.It led to wrong syndromes differentiation and improper use of drugs without comprehensive analysis of four methods of diagnosis or just relying on single syndrome.Secondly,improper dosage of drug was used.Though the direction of diagnosis was right,the disease wouldn’t be cured and healthy Qi would be damaged,if body was invigorated excessively or inappropriate dosage of drugs led to the inadequate efficacy.[Conclusion]These cases of mistreatment remind clinical doctors to comply with the thoughts of treatment based on syndrome differentiation and searching for the primary cause of disease in order to achieve the balance of Yin and Yang.Experiential inheritance and experience of mistreatment are both necessary in guiding clinical treatment.