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叶天士运用经方加减治疗生殖系统疾病研究

堵吉

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【摘要】  温病大家叶天士是研究伤寒的大家,李心机曾有“寒温相承宗一脉,叶吴本是经方家”的说法。其擅长运用仲景的经方,经过化裁、变方治疗各种疾病。笔者通过研读其医案,将其治疗生殖系统疾病的经方总结,涉及月经病,包括闭止性月经病、疼痛性月经病、出血性月经病、月经先期、月经愆期、带下病、妊娠病、产后病,妇科杂病如热入血室及癥瘕,男性病,包括阴囊疾病、遗精、阳痿及男性不育症。

【关键字】  叶天士,经方,生殖系统疾病,研究

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[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.

温病大家叶天士是研究伤寒的大家,李心机曾有“寒温相承宗一脉,叶吴本是经方家”的说法[1]。与众不同的是,叶天士的《伤寒杂病论》的研究并不是通过理论进行阐述的,而是通过病案来剖析与应用的。他倾注毕生精力来实践和发展仲景的经方,并通过化裁、变方最终有效的治疗其同时代的疾病。笔者通过研读相关医案[2-12],将其治疗生殖系统疾病的经方总结如下,不但有利于对叶天士学术思想的理解,同时可以提高对经方的理解和运用水平,更能对当前生殖系统的疑难杂症的诊疗提供启迪和思路。 1 月经病 1.1 闭止性月经病 1.1.1 妇人经闭 叶天士运用经方治疗闭止性月经病的医案较多。有停经两月,兼见眩晕、心悸、鼻衄等,肝肾阴虚,肝阳化风,炙甘草汤加减(调经门某案)。若妇人伏暑月经不当期而来,热气逼迫营分,真阴大虚,月事不当期而来,选用炙甘草汤加减(调经门程案)。治木郁乘土,胃口渐败,经闭半年,病成干血痨怯,叶氏选用安胃和肝法,选用乌梅丸加减(《种福堂公选医案程案》)。对于营卫两伤型闭经,《临证指南医案•调经》中载有王案,脉右虚,左虚弦数。腹痛两月,胸痹咽阻,冷汗,周身刺痛,寒栗。叶氏认为这是内损经闭成劳,治宜温经通阳,调和营卫,方用桂枝汤加减。对于奇经损伤经闭,在《临证指南医案•调经》中董案中有描述,该案症见脉数色夺,久嗽经闭,寒从背起,热过无汗。叶氏引用《黄帝内经》“阳维为病苦寒热”立论,选方桂枝汤加减,去芍药,加生鹿角、当归、茯苓温通奇经,调和营卫,另服回生丹活血通络。这是叶天士变通使用“桂枝汤”,在桂枝汤的基础上加入“鹿角、当归、茯苓”通补奇经的药物,开创了“通补阳维法”,对阳维病的治疗开创了新的思路。对于肝阴虚型妇人经闭,叶氏指出“入肝必麻木,诸厥皆厥阴”,在《临证指南医案•调经》中石案中,症见肢体麻木,心痛,便燥,乃气闭血枯,“女子以肝为先天”,叶氏认为该病起因“劳怒情志不遂”,从肝论治,采用旋覆花汤变法,药用桃仁、当归、山楂、茺蔚子、泽兰、柏子仁。其中桃仁、当归辛润通络,山楂、茺蔚子、泽兰、柏子仁活血止痛痛经。对于营阴亏虚型闭经,《叶氏医案存真•卷一》记载,寒热因经水不来而甚,此《内经》谓“二阳之病发心脾,女子不月”,肌肉日瘦,腹有动气。

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