《医宗金鉴》中黄疸证辨治选方浅析

An analysis of treating jaundice syndrome by differeatiation in Yizong Jinjian

《医宗金鉴》刊于清代乾隆七年,为清代官修医学丛书之代表作,是300多年来影响最大的国家医学教材之一。该书分为“一论二要旨,两注十要诀”,共15分册,内容从对《伤寒论》《金匮要略》的注解,到对中医临床各类疾病的临床表现及病证、治则、治法、方药进行分科论述,博采众书,萃其精华,强调辨证论治,选方用药精练实用,对临床各科的诊断治疗具有极大的指导意义。黄疸病名首见于《黄帝内经》,以“面目身黄”为主要特点。各个时期的医家对其病因、病机、辨证、治则、方药都提出过独到见解,对黄疸的认识不断丰富与完善。此书设立专门章节总结了清代以前治疗黄疸病的经验精华。其将寒湿热理论、阴阳论、六经辨证、表里分治理论结合在一起,开创性地完善了黄疸病的六经传变。其辨证注重表、里、寒、热,以气血为本,祛湿为要,采用汗、下、利、渗四法,重视对脾胃阳气的保护。治疗在选用麻黄连翘赤小豆汤、桂枝加黄芪汤、茵陈五苓散等经典方剂的基础上灵活加减用药。本研究试从理、法、方、药等方面系统讨论总结《医宗金鉴》中黄疸疾病的辨证论治选方特点,以期为临床提供治疗黄疸的理论依据与思路。

Published in the seventh year of Emperor Qianlong’s reign in the Qing Dynasty,Yizong Jinjian(《医宗金鉴》)is the representative work of the official medical series in the Qing Dynasty,and it is also one of the most influential national medical textbook for more than 300 years.The book is divided into 15 sub volumes,“One summary of famous doctors’prescriptions,two medical monographs,two annotations of ancient books,and ten pithy formulas for treating diseases”.The content of this book has been written separately from the annotation of Shanghan Lun(《伤寒论》)and Jingui Yaolue(《金匮要略》)to the clinical manifestations of various diseases in TCM,as well as the disease syndromes,treatment principles,treatment methods and prescriptions.This book draws on the strengths of others and emphasizes the treatment based on syndrome differentiation.The prescription selection and medication are concise and practical,which has great guiding significance for clinical practice.Jaundice,the name of this disease is first seen in Huangdi Neijing(《黄帝内经》),with“Yellow face and body”as the main symptom.Physicians in various periods have put forward unique opinions on its etiology,pathogenesis,symptoms,treatment principles and prescriptions,which has promoted the continuous enrichment and improvement of TCM understanding of jaundice.This book sets up a special chapter to summarize the essence of the experience of treating jaundice before the Qing Dynasty.It combines cold damp heat theory,theory of Yin(阴)and Yang(阳),six meridians syndrome differentiation,exterior and interior differentiation theory,and creatively improves the six meridians transmission theory of jaundice.Its syndrome differentiation theory pays attention to the exterior,interior,cold and heat,takes Qi(气)and blood as the foundation,dispels dampness as the key,adopts the four methods of perspiration and diuresis,and attaches importance to the protection of Yang Qi in the spleen and stomach.In terms of treatment,it is recommended to use the Mahuang Lianqiao Chixiaodou decoction(麻黄连翘赤小豆汤),the Guizhi Huangqi decoction(桂枝加黄芪汤),Yinchen Wuling San(茵陈五苓散)and other classic prescriptions on the basis of flexible and modified medication.This paper systematically discusses and summarizes the characteristics of the dialectical treatment of jaundice disease in Yizong Jinjian from the aspects of theory,method,formula,medicine,etc.,in order to provide the theoretical basis and clinical ideas for the treatment of jaundice.