叶天士从络病论治痹证研究

Study on treatment of arthralgia syndrome by YE Tian-shi based on ‘collateral disease' theory

"络病"是广泛存在于内伤疑难杂病和外感重症中的病理状态。叶天士极大程度地发展了"络病"理论,建立完善的"络病"诊疗体系,尤其在内伤杂病痹证中得到充分体现。认为从"络病"的视角辨治痹证,须以虚、实为纲,治疗则在攻邪和荣养的基础上,需遵循其"络以通为用"的治"络病"原则。文章通过数则医案,从虚实两个方面,对叶天士治疗痹证的分型、治法、用药规律进行探讨。络实,包括风湿阻络、寒湿阻络、湿热阻络、痰瘀阻络4种证型,由外邪袭络或痰瘀阻络而为痹,治以攻邪通络,选取其常用的相应祛除外邪和通络之药;络虚,包括阴虚,阳虚,肝肾亏虚,气血虚衰4种证型,由络虚不充而为痹,治以扶助正气,荣养脉络兼以通络,除选用补充正气,荣养脉络之药外,加以其常用通络之药。

‘Collateral disease＇ was a pathological condition that was widely found in difficult and complicated cases due to internal injuries as well as serious exopathic diseases. YE Tian-shi developed the ‘collateral disease＇ theory greatly and established a perfect diagnosis and treatment system based on the theory, which was fully reflected in the application of arthralgia syndrome. From the prespective of ‘collateral disease theory＇, YE Tian-shi proposed that the diagnosis and treatment of arthralgia syndrome should be focused on the deficiency and excess. Therefore, on the basis of eliminating evils or strengthening body resistance, the treatment principle of arthralgia syndrome should be in accordance with a standard that the collateral functions well when unobstructed. In this paper, we concluded rules from some medical records of YE Tian-shi, and the syndrome types, principles of treatment and medication in terms of deficiency and excess were also discussed. The excessive collateral diseases, including the syndrome of wind-dampness blocking the superficial venules, the syndrome of cold-dampness blocking the superficial venules, the syndrome of damp-heat blocking the superficial venules and the syndrome of phlegm and blood stasis blocking the superficial venules, were usually caused by exogenous pathogenic factors or stagnation of phlegm and blood stasis in superficial venules. The excessive collateral diseases should be dealt with principles and commonly used medicines of eliminating evils and activating channels. The deficient collateral diseases, including the syndrome of deficiency of yin, the syndrome of deficiency of yang, the syndrome of deficiency of the liver and the kidney and the syndrome of deficiency of both qi and blood, were usually caused by deficiency of superficial venules. It should be dealt with strengthening body resistance or nourishing the superficial venules combined with activating channels. Besides medicine of replenishing vital qi, nourish superficial venules, the commonly used medicine of activating channels were added also.