李东垣《兰室秘藏》外科学术思想及证治规律探析

An Analysis of Li Dong-yuan's Academic Thought of Surgery and the Law of Treatment Based on Syndrome Differentiation in Secrets from the Orchid Chamber

《兰室秘藏》是李东垣的代表著作之一,贯穿了李东垣的内伤脾胃学说论点,其中《疮疡门》章节记载了外科疮疡的方药。李东垣认为,在临床治疗中应以脾胃为本,首当顾护脾胃元气。李东垣重视脾胃与营卫关系,和营通经,故化瘀消滞是必不可少的治法。元气亏虚与湿热内蕴同时存在,是李东垣阴火论的一个重要病机,也是阴火证的一个类型。湿邪易阻滞气机,故湿邪内蕴,易蕴而成火,故当在补益脾胃,顾护元气基础上,辅以泻火燥湿解毒。李东垣认为,阴火为患,应升阳开郁发散阴火。痈疽疮疡为有形之病,为邪气结聚所成,消肿软坚散结为重要治疗方法。李东垣辨病而治,将连翘作为治疗疮疡的一味专药,并根据疮疡发生的部位、分属经络,采用分经论治。李东垣运用风药,既用其升阳散火之功,也作为引经报使之用,进而设立了针对不同病位疮疡的方剂:散肿溃坚汤、升阳调经汤、连翘散坚汤、内托羌活汤、内托黄芪汤、白芷升麻汤等。

Secrets from the Orchid Chamber is one of the representative works of Li Dong-yuan,which runs through his theory of internal injury to the spleen and stomach.The chapter Sores records the prescription of surgical sores.According to Li Dong-yuan,spleen and stomach should be taken as the foundation in clinical treatment,and primary qi of spleen and stomach should be considered first.Li Dong-yuan attached great importance to the relationship between spleen and stomach,harmonizing ying and dredging meridians,so removing blood stasis and eliminating stagnation is an essential therapy.Coexistence of deficiency of primary qi and damp heat is an important pathogenesis of Li Dong-yuan's yin fire theory and a type of yin fire syndrome.Dampness easily blocks qi movement,then transforms into fire.Therefore,on the basis of tonifying spleen and stomach,and protecting primary qi,purging fire and drying dampness and removing toxicity should be supplemented.Li Dong-yuan believed that yin fire is a disease which should be dispersed by lifting yang and relieving depression.Carbuncle and sores are visible diseases,which are formed by stagnated qi.Swelling reduction,softening mass and are important treatment methods.Li Dong-yuan used Lianqiao(Fructus Forsythiae)as a kind of medicinal for treating sores based on location and meridian.He used wind medicinals to lift yang and remove fire,and guide medicinals into the related meridian.He further adopted different prescriptions based on location of sores,such as Swelling-Subduing Decoction,Yang-Raising and Menstruation-Regulating Decoction,Coptis Mass-Resolving Decoction,Notopterygium Interior-Supporting Decoction,Astragalus Interior-Supporting Decoction,Radix Angelicae Dahuricae and Rhizoma Cimicifugae Decoction,etc.