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  • 綜述

    葉天士運用經方加減治療生殖系統疾病研究

    堵吉

    [文章下載]

    【摘要】  溫病大家葉天士是研究傷寒的大家,李心機曾有“寒溫相承宗一脈,葉吳本是經方家”的說法。其擅長運用仲景的經方,經過化裁、變方治療各種疾病。筆者通過研讀其醫案,將其治療生殖系統疾病的經方總結,涉及月經病,包括閉止性月經病、疼痛性月經病、出血性月經病、月經先期、月經愆期、帶下病、妊娠病、產后病,婦科雜病如熱入血室及癥瘕,男性病,包括陰囊疾病、遺精、陽痿及男性不育癥。

    【關鍵字】  葉天士,經方,生殖系統疾病,研究

    中圖分類號:文獻標識碼:文章編號:

    [Abstract]Ye Tianshi is not only an outstanding warm pathogen diseases expert,but also an authentic masters of classical prescriptions. Li Xinji once said that "Cold pathogen diseases school and warm pathogen diseases school come down in one continuous line, Ye Tianshi and Wu Jutong are both master of classical prescriptions". He is good at using Zhongjing's classical prescriptions to treat various diseases through modification. Through studying his medical cases, the author summarized his classical prescriptions for treating reproductive system diseases, involving menstruation diseases, including amenorrhoea, dysmenorrhea, hemorrhagic menstrual disease, premenstruation, irregular menstruation, leukorrhagia, pregnancy disease, postpartum disease, miscellaneous diseases in women such as heat invasion of blood chambe and abdominal mass, male diseases, including scrotal diseases, spermatorrhea, impotence and male sterility.

    溫病大家葉天士是研究傷寒的大家,李心機曾有“寒溫相承宗一脈,葉吳本是經方家”的說法[1]。與眾不同的是,葉天士的《傷寒雜病論》的研究并不是通過理論進行闡述的,而是通過病案來剖析與應用的。他傾注畢生精力來實踐和發展仲景的經方,并通過化裁、變方最終有效的治療其同時代的疾病。筆者通過研讀相關醫案[2-12],將其治療生殖系統疾病的經方總結如下,不但有利于對葉天士學術思想的理解,同時可以提高對經方的理解和運用水平,更能對當前生殖系統的疑難雜癥的診療提供啟迪和思路。 1 月經病 1.1 閉止性月經病 1.1.1 婦人經閉 葉天士運用經方治療閉止性月經病的醫案較多。有停經兩月,兼見眩暈、心悸、鼻衄等,肝腎陰虛,肝陽化風,炙甘草湯加減(調經門某案)。若婦人伏暑月經不當期而來,熱氣逼迫營分,真陰大虛,月事不當期而來,選用炙甘草湯加減(調經門程案)。治木郁乘土,胃口漸敗,經閉半年,病成干血癆怯,葉氏選用安胃和肝法,選用烏梅丸加減(《種福堂公選醫案程案》)。對于營衛兩傷型閉經,《臨證指南醫案?調經》中載有王案,脈右虛,左虛弦數。腹痛兩月,胸痹咽阻,冷汗,周身刺痛,寒栗。葉氏認為這是內損經閉成勞,治宜溫經通陽,調和營衛,方用桂枝湯加減。對于奇經損傷經閉,在《臨證指南醫案?調經》中董案中有描述,該案癥見脈數色奪,久嗽經閉,寒從背起,熱過無汗。葉氏引用《黃帝內經》“陽維為病苦寒熱”立論,選方桂枝湯加減,去芍藥,加生鹿角、當歸、茯苓溫通奇經,調和營衛,另服回生丹活血通絡。這是葉天士變通使用“桂枝湯”,在桂枝湯的基礎上加入“鹿角、當歸、茯苓”通補奇經的藥物,開創了“通補陽維法”,對陽維病的治療開創了新的思路。對于肝陰虛型婦人經閉,葉氏指出“入肝必麻木,諸厥皆厥陰”,在《臨證指南醫案?調經》中石案中,癥見肢體麻木,心痛,便燥,乃氣閉血枯,“女子以肝為先天”,葉氏認為該病起因“勞怒情志不遂”,從肝論治,采用旋覆花湯變法,藥用桃仁、當歸、山楂、茺蔚子、澤蘭、柏子仁。其中桃仁、當歸辛潤通絡,山楂、茺蔚子、澤蘭、柏子仁活血止痛痛經。對于營陰虧虛型閉經,《葉氏醫案存真?卷一》記載,寒熱因經水不來而甚,此《內經》謂“二陽之病發心脾,女子不月”,肌肉日瘦,腹有動氣。
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