从国医大师周仲瑛教授病案探讨其证治特色及学术思想_史锁芳

·国医大师National Chinese Medical Science Master ·栏目主编：李俊德协办：中华中医药学会名医学术研究分会Column editor ：Li Jun-de

Cosponsor ：Great Physician Research Branch ，China Association of Chinese Medicine

*基金项目：江苏省优秀中青年中医临床人才高级研修项目

（］从国医大师周仲瑛教授病案探讨其证治特色及学术思想

Exploration on the Syndrome and Treatment Characteristics and Academic Thoughts of Professor Zhou Zhongying from His Medical Records

史锁芳Shi Suo-fang ，韩

旭Han Xu ，季建敏Ji Jian-min ，董

筠Dong Yun ，陈四清Chen Si-qing

南京中医药大学附属医院，江苏南京210029

Affiliated Hospital of Nanjing University of Traditional Chinese Medicine ，Nanjing ，Jiangsu ，China 210029

摘要：目的：总结国医大师周仲瑛教授的证治特色和学术思想。方法：通过临床跟师侍诊，研习、总结、归纳其病案书写风格。结果：周老病案具有如下特色：重视四诊信息收集，尤重望诊、问诊记载；辨证首重病机，尤重脏腑病机为核心的描述；体现辨证为主、

辨病为辅的病证结合思想；证治联系紧密、擅于揉合选方、疑难病善用复法大方；用药既重传承又重融入新知；重视病机动态变化，尊重事实善于修正。结论：国医大师周仲瑛教授临床辨治独具匠心，门诊病案颇具风格，对提高中医临证水平极具启迪作用。

Abstract ：Objective ：To summarize the syndrome and treatment characteristics and academic thinking of TCM master ，Professor Zhou

Zhong-ying．Methods ：To summarize and conclude his writing style by learning to diagnose and treat diseases with him in the clinic and studying medical records．Results ：The medical records of Professor Zhou Zhongying have the following features ：to emphasize on the gathering information obtained from the four diagnostic methods ，especially the records of inspection and inquiry ；to give priority to path-ogenesis when differentiating the syndromes ，

especially the description of the pathogenesis of zang －fu organs as the core ；to reflect the thinking of combination of the predominate disease differentiation with the supplementary syndrome differentiation ；to relate the syn-drome with the treatment closely with good integration and selection of formulae ；to be good at using great formulae ；to emphasize both on the transmission and reintegration into new knowledge ；to emphasize on the dynamic changes of pathogenesis and to respect the facts

with good amendment．Conclusion ：Professor Zhou has distinctive clinical diagnosis and treatment and unique medical records ，

which are very enlightening for the improvement of clinical practice of traditional Chinese medicine．关键词：国医大师；周仲瑛；病案；四诊；学术思想；证治经验

Key words ：TCM master ；Zhou Zhong-ying ；medical record ；four diagnostic methods ；academic thought ；syndrome and treatment experi-ence

中图分类号CLC number ：R222．19

文献标识码Document code ：A

文章编号Article ID ：1674－8999（2011）03－0409－04

门诊病案，又称医案、脉案，是记载医生诊疗过程和反映医疗质量的客观资料和原始凭证。因此，一份完整的病案能够反映出一名医生的诊疗水平、学术思想、独到经验。国医大师周仲瑛教授（以下简称周老）为全国名老中医，

学验俱丰，临床辨治独具匠心，门诊病案颇有特色，笔者有幸跟随周老侍诊，获益良多。在现今中医门诊病案书写蜕变严重的情况下，总结名老中医的门诊病案书写风格，对保持中医诊病特色，提高临证水平极具启迪和指导作用。现就其门诊病案的书写风格探讨其证治特色如下，以示其严谨治学、临证技巧之一斑。

1重视四诊信息收集，尤重望诊、问诊记载

“四诊”（望、闻、问、切）是搜集临床资料的主要方法，而

搜集临床资料则要求客观、

准确、系统、全面、突出重点，这就必须“四诊并用”、“四诊合参”。周老认为“四诊”的基本原理是建立在整体观念和恒动观念基础上的，是阴阳五行、藏象经络、

病因病机等基础理论的具体运用。周老认为一份好的病案应该具备完整的四诊信息资料，望诊是中医诊法中难以示人的重要技巧之一，是中医临证功夫日臻成熟时炉火纯青的重要标志之一。甚至古人有“望而知之谓之神”之说。周老曾讲，病人病情的轻重，病证的寒热虚实，病位的表里上下，有经验的中医一眼望过去往往就八九不离十。望诊虽有望全身、

望局部、望舌、望排泄物、望指纹等内容，但能否一望便知，关键是医生要有犀利的目光，“以神会神”，善于捕捉那些对辨证有价值的信息。因此，在周老的病案中经常可以看到对患者神态、面色及舌象的描写，特别对主诉症状较少的患者尤为突出，

这些资料对辨证论治极有启迪和帮助。如遇，