基于中医“相火动静观”论治异常子宫出血

Treating Abnormal Uterine Bleeding Based on the Theory of “Concept of Ministerial Fire Stirring and Stillness” in Traditional Chinese Medicine

摘要: 异常子宫出血(中医属“崩漏”范畴)是妇科常见难治性疾病，以月经紊乱、经量异常为特征，病因复杂，治疗常陷入“止血易、调经难”的困境。本文基于朱震亨“相火动静观”，结合崩漏核心病机，阐释相火失衡在发病中的关键作用及辨证治疗价值。崩漏核心病机分为“动型”与“静型”：“动型”以肾阴虚、肝失疏泄为根基，诱因引动相火亢越，灼伤冲任胞脉，表现为崩中突发或漏下伴热象；“静型”以精血亏虚为根本，相火失养“静怯”，无力温煦化血、推动气血，表现为漏下量少伴虚衰之象。治疗以“调畅相火、固护冲任”为总则，动型治以滋阴降火、疏肝敛火、益气摄血，静型治以补益精血、温养肝肾、养血宁心。本研究构建相火动静观指导下的崩漏辨治体系，为临床“标本兼顾、精准止血调经”提供新依据与路径。

Abstract: Abnormal uterine bleeding (which belongs to the category of “metrorrhagia and metrorrhagia” in traditional Chinese medicine) is a common and intractable gynecological disease, characterized by menstrual disorder and abnormal menstrual flow, with complicated causes. The treatment often falls into the dilemma of “easy hemostasis and difficult menstruation regulation”. Based on Zhu Zhenheng’s “concept of ministerial fire stirring and stillness” and combined with the core pathogenesis of metrorrhagia, this paper explains the key role of phase fire imbalance in the pathogenesis and the value of syndrome differentiation and treatment. The core pathogenesis of metrorrhagia and metrorrhagia is divided into “dynamic type” and “static type”. The “dynamic type” is based on kidney yin deficiency and liver failure to disperse and drain, which leads to excessive fire and burns the pulse, showing sudden or leaking heat-accompanying images during metrorrhagia; The “static type” is based on the deficiency of essence and blood, and it is “quiet and timid” because of the lack of nourishment, and it is unable to warm and melt blood and promote qi and blood, which is manifested as the image of less leakage accompanied by weakness. The general principle of treatment is “regulating smooth fire, protecting chong and ren”, while the dynamic treatment is nourishing yin to reduce fire, soothing the liver and astringing fire, benefiting qi and absorbing blood, while the static treatment is nourishing essence and blood, warming liver and kidney, nourishing blood and calming the heart. In this study, a syndrome differentiation and treatment system for metrorrhagia and metrorrhagia under the guidance of the concept of dynamic and static fire is constructed, which provides a new basis and path for clinical “treating both symptoms and root causes, accurately stopping bleeding and regulating menstruation”.