杨荣超 温瞿华 敖永衡 姜瑞麟 张春和

【摘 要】 《医林改错》为清代著名医学家王清任所著，笔者认为，书中至少从三点表达了王氏的辨证论治思想。首先，诊病应首重脏腑，因脏腑为一身之本，本源一错，万虑皆失。其次，倡导气血理论，明晰初病先伤气血，最终病理转归为气虚血瘀。其三，基于气血理论主张“诸病之因，皆由血瘀”，对怪病难辨之证从“血瘀”而辨治。王氏的上述思想对男科疾病的辨证论治多有启迪，其一，临证时要熟知男科生理病理与脏腑的联系，针对不同疾病特点着重对某脏进行脏腑论治探讨。其二，重视气血损伤对男科病症临床结局的影响，以恢复局部及全身气血平衡。其三，针对男科疾病临证特点，善于运用“血瘀”作为病机进行辨治，活用“活血化瘀法”。

【关键词】 《医林改错》;王清任;论治思想;男科疾病

【中图分类号】R22 【文献标志码】 A 【文章编号】1007-8517（2021）15-0004-04

Abstract：“Yilin gaicuo” was written by Wang Qingren， a famous medical scientist in the Qing Dynasty. The author believes that the book expresses Wangs thought of syndrome differentiation and treatment from at least three points. First of all， the diagnosis should focus on the internal organs， because the internal organs are the basis of one body， the origin is wrong， and everything is lost. Secondly， advocate the theory of qi and blood， clarify that the first illness first hurts qi and blood， and finally the pathology turns to qi deficiency and blood stasis. Third， based on the theory of qi and blood， it is advocated that “the causes of all diseases are all caused by blood stasis.” The above-mentioned thoughts of Wangs have many enlightenments on the differentiation and treatment of andrological diseases. First， when they are in the syndrome， they should be familiar with the relationship between andrology and pathology and viscera. Second， pay attention to the impact of qi and blood injury on the clinical outcome of andrology to restore local and systemic qi and blood balance. Thirdly， according to the clinical features of male diseases， he is good at using “blood stasis” as the pathogenesis for diagnosis and treatment， and making use of the “blood stasis method”.

Keywords：Yilin Gaicuo;Wang Qingren;Discussed and Treated of Thought;Andrology Diseases

隨着当今社会和经济的快速发展，男性的工作、生活压力与日俱增，加之移动互联网的普及给人们带来的便利和不良生活习惯，罹患男科疾病的人数迅速增长[1]。男科疾病以其复杂多变的症状、缠绵难愈的病程，给患者身心健康造成极大的危害，也令男科医师颇感棘手。《医林改错》[2]为清代著名医学家王清任所著，首创“血瘀”病机辨治疑难杂症，王氏认为诊病应首重脏腑，因脏腑为一身之本，本源一错，万虑皆失;其次，倡导气血理论，明晰初病先伤气血，最终病理转归为气虚血瘀;最后，基于气血理论主张“诸病之因，皆由血瘀”，对怪病难辨之证从“血瘀”而辨治。……