首页|秦伯未与《清代名医医案精华》诊治咳嗽的经验挖掘与对比研究

秦伯未与《清代名医医案精华》诊治咳嗽的经验挖掘与对比研究

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目的 探析中医名家秦伯未与其所编著的《清代名医医案精华》中诊治咳嗽的经验,通过对比尝试寻求其学术渊源及特点,并为现代临床提供参考.方法 查阅、筛选并录入现存于东直门医院病案室的秦伯未查房记录、出版书籍及《清代名医医案精华》中的咳嗽医案,统计医案与处方数量、临床表现与药物出现频次、频率等信息,并进行关联规则分析、聚类分析及复杂网络分析,再结合清代名医医案文本内容及秦伯未著作中对咳嗽的认识,与挖掘结果互参、互证、互补,从而总结秦伯未与清代名医诊治咳嗽的思路与经验.结果 共获得秦伯未治疗咳嗽的医案51份,处方81首以及《清代名医医案精华》中7位医家治疗咳嗽的医案73份,处方91首.通过挖掘分析结合内容分析,可将秦伯未诊治咳嗽的主要思路总结为:咳分外内脏腑,治需标本兼顾;标在痰阻气逆,宣肺降气化痰;本于外感内伤,尚应审因论治.清代名医诊治咳嗽则亦重顺气化痰,多用培土生金;亦分外内脏腑,重视五行生克.结论 秦伯未与清代名医诊治咳嗽均重视外邪、内伤、脏腑咳的分类以及顺气化痰法的使用,秦伯未以理气化痰止咳为核心,并细分病因而治;清代名医则多用培土生金之法,并重视五行生克.二者的诊疗经验对现代临床较少关注的伤暑、伤湿及外寒内热等外感咳嗽,食积、瘀血、心火、肝气、胃寒、肾虚等内伤咳嗽以及脏腑咳的辨治可提供有益启发.
Qin Bowei and The Essence of Medical Records of Famous Doctors in Qing Dynasty in Diagnosis and Treatment of Coughs:Experience Mining and Comparative Re-search
Objective To explore the experience of renowned traditional Chinese medicine(TCM)physician Qin Bowei in treating coughs,as documented in The Essence of Medical Records of Famous Doctors in Qing Dynasty,and to seek the academic sources and characteristics of his approach through comparison,aiming to provide references for modern clinical practice.Methods Case records from Qin Bowei's ward rounds,published books,and The Essence of Medical Re-cords of Famous Doctors in Qing Dynasty,housed in the medical records office of Dongzhimen Hospital,were reviewed,se-lected,and entered into a database.Data on the number of cases,prescriptions,clinical manifestations,and frequency and number of times of drug usage were collected.Association rule analysis,cluster analysis,and complex network analysis were performed.These findings were then cross-referenced and complemented with an analysis of the Qing Dynasty physicians'case records and Qin Bowei's understanding of cough treatment,as documented in his writings,to summarize the thought process and experience of both Qin Bowei and the Qing Dynasty physicians in treating coughs.Results A total of 51 case records and 81 prescriptions for cough treatment by Qin Bowei were obtained,along with 73 case records and 91 prescrip-tions for coughs from seven physicians in The Essence of Medical Records of Famous Doctors in Qing Dynasty.Through mining and content analysis,Qin Bowei's primary approach to treating coughs can be summarized as differentiating coughs caused by internal and external factors and treating both the symptoms and the root cause.Phlegm obstruction and reversed flow of qi serve as manifestation,and treatment should focus on ventilating the lung,lowering qi,and resolving phlegm.Ex-ternal invasion and internal injury serve as the root causes,and treatment should be adjusted according to the cause.Qing Dynasty physicians similarly emphasized regulating qi and resolving phlegm,often using methods to"bank up earth to gen-erate metal",while also distinguishing between internal and external factors affecting the organs,with attention to the inter-actions of the Five Elements.Conclusion Both Qin Bowei and the Qing Dynasty physicians emphasized the classification of coughs caused by external pathogens,internal injuries,and organ imbalances,and the use of methods to regulate qi and resolve phlegm.Qin Bowei focused on stopping coughs by regulating qi and resolving phlegm,with a detailed differentiation of causes,while the Qing Dynasty physicians often employed the method of"bake up the earth to generate metal"and paid close attention to the interactions of the Five Elements.Their diagnostic and treatment experiences can provide valuable in-sights into the treatment of externally contracted coughs such as those caused by summer heat,dampness,or a combination of external cold and internal heat which receive relatively less attention in modern clinical practice,and internally generated coughs caused by factors like food stagnation,blood stasis,heart fire,liver qi,stomach cold,and kidney deficiency,as well as coughs induced by internal organs.

CoughMedical RecordsQin BoweiThe Essence of Medical Records of Famous Doctors in Qing Dy-nasty

陈一凡、李雁

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北京中医药大学国学院,北京 102488

北京中医药大学东直门医院,北京 100700

咳嗽 医案 秦伯未 《清代名医医案精华》

国家重点研发计划项目国家重点研发计划项目北京中医药薪火传承"3+3"工程项目

2018YFC17041002018YFC17041012020-SZ-A-47

2024

世界中西医结合杂志
中华中医药学会

世界中西医结合杂志

CSTPCD
影响因子:1.053
ISSN:1673-6613
年,卷(期):2024.19(9)
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