中医经典文献中的医案因子传承与源流辨证新论

中医经典文献中的医案因子传承与源流辨证新论

中醫经典文献中的医案意指医者在诊察患者过程中经由临床辨证思维与诊疗时作追踪的具体记录。历代文献中均有代表性的医案著作，不同时期的医案著作有其不同编纂方式与书写体例，在中国医学史上也各有其代表性意义。本文挖掘探源中医医案的因子传承与源流辨证，即《史记》是最早的中医医案记录，《普济本事方》则以医案作为临证经验的论述佐证，《伤寒九十论》是中医学首部记述性医案的著述，《小儿药证直诀》是最早的儿科系统性病案汇编，《洗冤集录》是世界最早的法医学专书，《名医类案》搜罗诸子百家医案而成为最早的中医病案著作，《临证指南医案》是温病学重要的医案著述，《古今医案按》开创了全面评述古今医案的先河，《经方实验录》则是近代最具代表性的《伤寒论》经方医案。

Abstract：Medical records in TCM classics refer to specific records that doctors follow in the process of clinical diagnosis of patients through clinical dialectical thinking and diagnosis and treatment. In ancient times，there are representative works of medical records，and different periods of medical writings have different ways of compiling and writing，with representative significance in the history of China. This article summarized the knowledge route and dialectical map of TCM clinical medical cases，and summed up the following conclusions：Shi Ji is the earliest record of TCM records；Pu Ji Ben Shi Fang uses medical case as evidence of clinical experience；Shang Han Jiu Shi Lun is the world’s first book of narratives of medical records；Xiao Er Yao Zheng Zhi Jue is the world’s first systematic case compile for pediatrics；Xi Yuan Ji Lu is the world’s first book of forensic medicine；Ming Yi Lei An is the world’s first TCM medical case book with medical cases of different schools；Lin Zheng Zhi Nan Yi An is an important medical book of epidemiology；Gu Jin Yi An An creates comprehensive review of ancient and modern medical cases；Jing Fang Shi Yan Lu is the most representative formula records in Shang Han Lun.

Keywords：TCM classics；medical records；knowledge route；dialectical map

医案又称脉案、方案、诊籍，内容包括患者症状舌象脉象、病因病机、诊断治则与药物，同时含有治疗后的病情变化。医案是医者临床辨证思维与临证理法方药诊疗心得的具体记录。研读医案等于间接向历代名医学习其宝贵的临床经验，有助于提升开拓医者的临床辨证与用药思考能力。兹通过探源传统典籍中的重要档案著作，将其成书编纂过程、书中病案记录格式，以及全书在医案发展史上的代表性意义进行知识路径分析，以追溯与呈现中医临床医案的脉络图谱。

1 医案的因子传承

1.1 《史记》