六经血证辨治探析

Analysis of differentiation and treatment of blood syndrome of the six meridians

血证辨证论治始于《伤寒论》,散见于六经篇章之中。以六经为序对血证进行梳理,总结仲景治疗血证的经验。仲景对血证的论述有出血、瘀血之分,而其病机、治法、方药各有不同。其中出血的部位广泛,在上可从口鼻而出,在下可从大小便而出;其病机有火热迫血妄行(火热亦有虚实之分)以及气(阳)虚不摄之别;治法上实热者清热泻火,虚热者滋阴清热,阳虚不摄者温涩固脱。瘀血病机有寒热之不同,治法虽以活血化瘀为主,亦要随病机之寒热而加以变化,寒者热之,热者寒之。此外,在活血药的使用上要根据瘀血之轻重缓急酌情选用植物药或动物药。

Blood syndrome differentiation and treatment began with ＂Treatise on Febrile Diseases＂, scatteredly recorded in pages and chapters conceming ＂six meridians＂. In this paper, blood syndrome was rearranged according to the order of＂six meridians＂, aimed to summarize relevant experience of ZHANG Zhongjing in treating this syndrome pattern. ZHANG＇s discussion and statement about blood syndrome included bleeding and blood stasis, and the corresponding pathogenesis, treating methods as well as prescriptions varied. On bleeding pattern, there exist different bleeding parts of the body from nose and mouth at the superior position to urination and stool at the inferior position, and the pathogenesis has the differences of heat （ including both excessive heat and deficient heat ） forcing blood to flow irregularly and being unable to govern blood due to qi Orang） deficiency and the specific treating methods consist of eliminating heat aimed at excess pattem, moisting yin aimed at deficiency pattern and warming yang and enhancing defense at yang deficiency pattern. On blood stasis, the pathogenesis refers to types of both cold and heat and the main treating way is to invigorate the blood circulation but the final method differs and changes in accordance with cold or heat in the pathogenesis, which means using cold medicine in heat pattern and hot medicine in cold pattern. In addition, on the use of medicine improving the blood circulation, the herbs and animal medicine should be selected appropriately according to the priorities of blood stasis.