叶天士“通痹治痿”医案解析

Analysis on medical records of Bi disease and flaccidity symptoms treated simultaneously by YE Tian-shi

文章从"体痹-热/寒-用痿"解析"因痹致痿"病机,指出阳虚和热盛是体痹向用痿转化的条件,强调热盛尤为关键。基于"因痹致痿"的认识,解析叶天士"通痹治痿"医案,分别归纳为清热利湿、凉血活血、流畅阳明气血和温养通补"通痹治痿"四法。清热利湿以木防己汤加味;凉血活血以凉血药为主,佐以清透和补益下焦真阴之品;流畅阳明气血主要由健脾药、风药和利湿药组成;温养通补以肉苁蓉、淫羊藿、狗脊等温养之品为主,佐以补益中焦之生白术、生黄芪等。

This article investigates the pathogenesis of Bi disease causing flaccidity symptoms from the view of ＇body arthralgia-heat/cold-function flaccidity＇. Yang deficiency and excessive heat are the conditions for the transformation of body arthralgia to function flaccidity, and heat is especially important. Based on the understanding of ＇Bi disease causing flaccidity symptoms＇, the paper analyses the medical record of Bi disease and flaccidity symptoms treated by YE Tian-shi. These treatment could be concluded four methods, that are clearing away heat and dampness, cooling and promoting blood, the method of regulating middle energizer, and the method of Wenyang Tongbu. Mufangji Decoction always be used to clear away heat and dampness, cool blood herbs be used to cool blood and promote blood circulation. It is necessary accompanied by clearing and expelling and nourishing zhenyin of lower jiao herbs. To regulate middle energizer, Jianpi herbs and wind-dispelling herbs and clearing away dampness herbs are also take into consideration. The method of Wenyang Tongbu is mainly based on the warming products such as Cistanche, Epimedium, and dog ridge, and is supplemented with Rhizoma Atractylodis Macrocephalae and Astragalusme mbranaceus.