《临证指南医案•目病篇》初探

A Preliminary Study of Ophthalmopathy Chapter in Medical Records for Clinical Guidance

《临证指南医案•目病篇》所载医案记录了叶天士对目病的认识以及其针对目病所采用的特色辨证和治疗方法。叶天士目病辨证的特色主要包括“必伏其所主,先其所因”“体质辨证,精准施治疗目疾”“平脉辨证,目病见肝脉弦者多”“温病的辨证理论应用于目病”“五轮辨证,目之特色”“抓主症,目赤、脉弦辨从肝肺”。叶天士目病治疗特色以“重视王道、疗目病以扶正祛邪”“目病多郁火,火郁当发之”“三因制宜,治疗目病个性化”为主。本文从辨证方法和治疗特色方面初步探讨《临证指南医案•目病篇》中叶天士治疗目病的思想,以期指导中医眼科临床,解专科固有思维,探眼体辨治之旨。同时为眼底病现代科技结合中医传统理论的未来辨治方向提供初步理论探索。

The medical records in The Ophthalmopathy Chapter of Medical Records for Clinical Guidance recorded YE Tianshi's understanding of eye diseases and his characteristic syndrome differentiation and treatment methods for eye diseases.The characteristics of YE Tianshi's syndrome differentiation of eye diseases mainly include:"subduing the main cause,prioritizing the cause""identifying TCM constitution differentiation and treating eye diseases accurately""identifying symptoms through TCM pulse diagnosis for eye diseases are usually manifested as taut pulse""applying the theory of syndrome differentiation of warm diseases to eye diseases""distinguishing symptoms through five-wheel pattern differentiation,which is the characteristic of ophthalmology""grasping the main symptoms,considering red eyes and taut pulse as liver and lung disorder through syndrome differentiation".The treatment features of YE Tianshi while treating eye diseases mainly focus on"paying attention to the benevolent government,and treating eye diseases from the perspective of strengthening the body resistance to eliminate pathogenic factors""eye diseases are often accompanied by fire depression syndrome,and fire stagnation should be dispersed""treating disease according to three categories of etiologic factors,and applying personalized treatment methods while treating eye diseases".This paper mainly explores YE Tianshi's thoughts on treating eye diseases in Medical Records for The Ophthalmopathy Chapter of Medical Records for Clinical Guidance from the aspects of syndrome differentiation and treatment characteristics,in order to guide the clinical practice of Ophthalmology of TCM,dispel the inherent thinking of ophthalmology,and explore the essence of eye-body differentiation and treatment.At the same time,it provides preliminary theoretical exploration for the future syndrome differentiation and treatment direction of fundus diseases by combining modern technology with TCM theory.