《临证指南医案·湿》辨治特色探微

Study on the differentiation and treatment characteristics of Guide to Clinical Practice with Medical Records·Dampness

《临证指南医案·湿》共载医案52例,集中展现了叶天士论治湿病的学术思想。叶氏遵《内经》将湿分为外受与内生,秉承刘完素三焦理论并有所发挥,用以辨治湿病。其重视体质,治湿先辨体质阴阳而知其寒热,湿热者治以祛湿清热,尤重祛湿;寒湿者治以温化寒湿,然寒湿阴邪,更易伤阳,重在温阳;病久阳衰,常法难治,求变于奇经以获良效。叶氏治疗湿病,方法周详,极具特色,对现代临床具有指导意义。

Guide to Clinical Practice with Medical Records ? Dampness contains a total of 52 medical records,which intensively displays Ye Tianshi’s academic thoughts on treating dampness diseases.In accordance with Huangdi Neijing,he classifies dampness into external and endogenous pathogens,and differentiates and treats dampness diseases by following and improving Liu Wansu’s sanjiao theory.He attaches great importance to individuals’ constitutions,and in the treatment of damp diseases,he first of all distinguishes the nature of yin or yang of one’s constitution,and then to know whether it belongs to a cold-damp syndrome or a damp-heat syndrome.For patients with a damp-heat syndrome,he administers a treatment by dispelling the dampness and clearing the heat,while especially emphasizing dispelling the dampness.For those with a cold-damp syndrome,he gives a treatment by warming the cold and eliminating the dampness.As the cold-damp pathogen belongs to yin and more easily hurts yang,he lays more emphasis on warming yang.While in patients with a dampness disease for a long time,yang usually gets deficient and it is often difficult to cure the disease with a common method,so he resorts to idiosyncratic methods in order to obtain a magical effect.Ye Tianshi’s treatment methods for dampness diseases are comprehensive and very distinctive,and they are believed to have a guiding significance for modern clinical practice.