清代医家叶天士、张锡纯论治女子癥瘕之剖玄析微

Anatomy and Analysis of the Treatment of Women’s Obstruction of the Abdomen by Ye Tianshi and Zhang Xichun in the Qing Dynasty

摘要: 女子癥瘕是指妇女小腹内的结块，伴有胀满闭塞，并常致月经或带下异常，甚至影响生育的疾病，发生多与正气不足、脏腑功能失调有关。清代医家叶天士和张锡纯各抒己见，分别对其进行不同的阐发。叶天士作为络病学说的集大成者，在女子癥瘕的发生上认为“络瘀成瘕”是其主要病机，在传统癥瘕经病层次深入到络病深层，提出“络脉以通为用”的总治则，并创立辛润通络等治法，治则宜缓宜曲，施补忌涩忌呆。而张锡纯则认为女子癥瘕病变在经，即“冲任之间”，强调了冲任二脉病变在女子癥瘕发病过程起主导地位，治疗上以消癥瘕之专药开破，以补气血之药辅之，攻补兼施，攻而不伤气化，达到徐徐消磨癥瘕之目的。

Abstract: Women’s obstruction in the abdomen refers to women’s lumps, accompanied by fullness and occlusion. It often leads to menstruation or abnormalities and even affects fertility. Its occurrence is mostly associated with insufficiency of healthy Qi and dysfunction of Zang-Fu organs. Qing Dynasty physicians Ye Tianshi and Zhang Xichun expressed their views, respectively, on its different interpretations. Ye Tianshi, as a master of the theory of complex disease, believed that “complex stasis becomes obstruction” is the main mechanism in the occurrence of women’s obstruction, and in the traditional level of obstruction in the meridian, he went deeper into the deeper level of complex disease, put forward the general rule of “the complex veins should be used to pass”, and created the method of Xinrun to pass the complexes and so on; the rule should be slow and curved, and the treatment method should be slow and curved, and the method should be different. The treatment should be slow and curved, and the application of tonic should not be astringent or dull. Zhang Xichun, on the other hand, believed that women’s impediments were in the meridians, “between Chong Ren”, and emphasized the dominant role of Chong Ren in the pathogenesis of women’s impediments, and that the treatment of impediments should be based on the use of special medicines for eliminating impediments, supplemented by medicines for replenishing qi and blood, and the use of a combination of both attack and replenishment, which could achieve the purpose of eliminating impediments in the meridians slowly without harming qi.