基于唐宗海《血证论》探讨妊娠合并肺结核的中医论治

Discuss the Treatment of Pregnancy with Pulmonary Tuberculosis in Traditional Chinese Medicine Based on the Blood Syndrome Theory of TANG Zonghai

[目的]研究晚清名医唐宗海《血证论》中的治痨思想,进而探讨妊娠合并肺结核一病的中医药治疗方案。[方法]以《血证论》中'痨瘵篇'和'抱儿痨篇'为研究对象,结合《红炉点雪》《十药神书》《诸病源候论》及《医学正传》等相关著作中对痨病的认识,探讨妊娠合并肺结核一病的中医论治思路。[结果]妊娠合并肺结核相当于中医抱儿痨病,因痰、水饮、相火在上逆胎气的带动下上攻肺部而引发,病机复杂,当从五脏论治。痰为病,当'滋脾肾之阴,清肺豁痰';水饮为病,当'温脾肾之阳,泻肺除饮';相火为病,当'交通心肾,培土生金';痨虫为病,当'凉血泄瘀,杀虫伐肝'。同时,'纳肾气,降肺胃之气'及'补养气血'贯穿以上诸法之中。产母困惫者又当下胎保母,并注重早期预防和产后调护。[结论]唐宗海《血证论》在痨病的治疗上,理法清晰,见解独到,从而为妊娠合并肺结核的治疗提供了较为系统的理论指导,有助于提高临床辨治此病的水平。

[Objective]To study the ideas of treating tuberculosis in Blood Syndrome Theory by TANG Zonghai,a famous doctor in the late Qing dynasty,and to explore the treatment scheme of TCM for pregnancy with pulmonary tuberculosis.[Methods]Taking the contents of Lao Zhai and Bao Erlao of Blood Syndrome Theory as the research objects,and combining the other relevant knowledge of Red Furnace Little Snow,Miraculous Book of Ten Prescriptions,Various Pathogenic Designate Theory and Formal Medical Biography,discussing the thinking of treatments in TCM of pregnancy with pulmonary tuberculosis.[Results]Pregnancy with pulmonary tuberculosis is same as Bao Erlao of TCM,caused by phlegm,water,and ministerial fire attack on the lung,which driven by the fetal air,the pathogenesis is complicated,and should treat the five internal organs.Phlegm disease,should'nourish Yin of spleen and kidney,clear the phlegm of lung';Water drink for disease,should'warm the Yang of spleen and kidney,clear the drink of lung';Ministerial fire for disease,should'connect heart and kidney,reinforcing the earth to generate the metal';Tuberculosis worm for disease,should'cool blood and clear blood stasis,kill the worm and attack on liver'.And let the ways of'lower the Qi of kidney,lung and stomach'and'supplement Qi and blood'run through the ways discussed above.When the pregnant woman is tired extremely,we should protect the mother by aborting,and pay attention to early prevention and postpartum care.[Conclusion]The treatment of tuberculosis in the Blood Syndrome Theory of TANG Zonghai is relatively clear of the theory and method,and has unique insights,which provides systematic theoretical guidance for the treatment of pregnancy with pulmonary tuberculosis,and that is helpful to improve the level of clinical diagnosis and treatment of this disease.