从《两都医案》探析明代医家倪士奇脉诊特色

Analysis of the Characteristics of Pulse Diagnosis of NI Shiqi in Ming Dynasty from“Liangdu Medical Records”

[目的]通过对《两都医案》的整理分析,探析明代医家倪士奇的辨证思维及脉诊特色。[方法]运用文献学方法,将《两都医案》中涉及到脉象及脉理阐释的部分进行分类整理,从病因、病机、病位、病性等方面分析倪士奇脉诊特色。[结果]《两都医案》共载医案69则,均有详细的脉象描述及脉理分析,其脉诊特色为:以脉定病因,通过人迎脉辨别内伤外感,并且将人迎脉的变化作为疾病痊愈的标准;以寸、关、尺脉象局部脉判断患者五脏生克关系,从而确定疾病的内在机制;以脉定病性,对于厥症阴阳之气不相顺接者,多舍症从脉;治内痈,皮色不变难以辨证者,以脉诊确定病位,左手沉数则内痈在左,右手沉数则痈在右,中央沉数则痈在中。[结论]《两都医案》内容丰富,阐理详尽,反映了倪士奇的系统辨证思维及诊脉特色,具有独特的临床价值,值得后世进一步研读、总结及传承。

[Objective]Through the collation and analysis of"Liangdu Medical Cases",the thinking of syndrome differentiation and pulse diagnosis characteristics of Ming Dynasty physician NI Shiqi are explored.[Methods]Using the method of philology,classify the parts of the"Liangdu Medical Records"that involve pulse status and pulse interpretation,and analyze the characteristics of NI Shiqi's pulse diagnosis from the etiology,pathogenesis,disease location and nature of disease.[Results]“Liangdu Medical Records”contained 69 medical records,all with detailed pulse description and pulse analysis.Its pulse diagnosis features included:The cause of the disease was determined by pulse,and the exogenous and internal injuries were identified by Renying pulse,the change of Renying pulse was regarded as the standard of disease recovery;the internal mechanism of the disease could be determined based on the relationship among the five viscera according to the local pulse conditions of Cun,Guan,and Chi;the nature of the disease could be determined by pulse,for the patient of syncope whose Yin and Yang Qi was not in accordance with each other,diagnosis and treatment should be based on pulse condition rather than syndrome type;for the treatment of internal carbuncle,if the skin color remained unchanged and it was difficult to differentiate the symptoms and signs,pulse diagnosis should be used to locate the internal carbuncle.If the left hand sank,the internal carbuncle should be on the left,the right hand should be on the right,and the central one should be in the middle.[Conclusion]“Liangdu Medical Records”is rich in content and detailed in analysis,reflecting NI Shiqi's systematic thinking of syndrome differentiation and pulse diagnosis characteristics.It has unique clinical value and is worthy of further study,summary and inheritance.