《连建伟手书医案》临证特色探赜

Exploring the Clinical Features in “LIAN Jianwei’s Handwritten Medical Cases”

[目的]探讨《连建伟手书医案》所选医案体现的临证特色。[方法]在研读全书116则医案的基础上,总体把握连建伟教授的临证特色,并选择其中的14则典型医案加以探讨,据其脉证,析其方药,明其理法。[结果]连建伟教授的临证特色包括诊察辨证与立法处方两个方面。诊察辨证主要体现在"四诊合参,尤重舌脉",如参附汤证案、苓桂术甘汤证案(二)、大黄牡丹汤证案(二)所述。立法处方包括"病有标本,治有先后",如平胃散证案、八正散证案、猪苓汤证案所述";天人相应,三因制宜",如苏子降气汤证案、蒿芩清胆汤证案、血府逐瘀汤证案所述";病达其机,药尽其性",如温脾汤证案、茵陈蒿汤证案所述";随证施治,中病即止",如小青龙汤证案、真武汤证案、地黄饮子证案所述。[结论]连老临证并无标新立异之法,疗效却可靠卓著,这既得益于他诊察辨证中的四诊合参、见微得过,亦离不开立法处方中的方证相应,故连老的临证特色可进一步概括为"司常达变,守正出奇"。

[Objective] To explore the clinical features of the selected medical cases in the "LIAN Jianwei’s Handwritten Medical Cases". [Methods]Through analyzing and comparing of typical medical cases in the book, the clinical features of Professor LIAN Jianwei were summarized, and 14 typical medical cases were selected for discussion to research the pulse and syndromes, analyze the prescriptions and medicines, and clarify its rationale.[Results] Professor LIAN Jianwei’s clinical features include two aspects: Diagnosis and syndrome differentiation of prescriptions and legislative prescriptions. The diagnosis and syndrome differentiation mainly refers to "synthesis of the four diagnostic methods and especially taking tongues and pulse as important", as mentioned in the Shenfu decoction syndrome case, the second Linggui Zhugan decoction syndrome case and the second Dahuang Mudan decoction syndrome case. The legislative prescriptions include four points, the first is "diseases have manifestation and root cause, and treatment has priority and secondary", as mentioned in the Pingwei powder syndrome case, the Bazheng powder syndrome case, and the Zhuling decoction syndrome case. The second is"relevant adaptation of the human body to natural environment and suit measures according to three categories of etiological factors ",as mentioned in the Suzi Jiangqi decoction syndrome case, the Haoqin Qingdan decoction syndrome case, and the Xuefu Zhuyu decoction syndrome case.The third is"understanding the real pathogenesis and making full use of drugs", as mentioned in the Wenpi decoction syndrome case and the Yinchenhao decoction syndrome case. The last is "treating according to syndrome and stopping treatment in time", as mentioned in the Xiaoqinglong decoction syndrome case, the Zhenwu decoction syndrome case, and the Dihuang drink syndrome case. [Conclusion] Even though there is no new and innovative method in the clinical works of Professor LIAN Jianwei, the curative effect is reliable and remarkable. This is not only due to the combination of the four diagnostic methods and insight into the changes of diseases from little things, but also due to the corresponding prescriptions and syndromes in the legislative prescriptions. Professor LIAN Jianwei’s clinical features can be furtherly summarized as "mastering both permanence and change, keeping integrity and achieving good results in a surprising way".