张锡纯治吐血六法探析

Analysis of Six Methods in Treating Hematemesis Proposed by Zhang Xichun

张锡纯在《医论·论吐血衄血之原因及治法》中认为吐血有寒热虚实等不同的诱因,但其根本在于胃气之上逆,组方重用代赭石,主张降胃为要。其将吐血的诱因分为因热、因凉、因肝胆之气上逆、因冲气上逆、因阴不潜阳及因气随血脱而胃气上逆六者,并根据临证经验,分别确立了“清热泻火,重镇降逆”“温中降逆,健脾消积”“凉肝泻火,重镇降逆”“平冲降逆,下气止呃”“滋阴清热,纳气平喘”“补气养血,纳气平喘”的治疗方法。

Zhang Xichun believes that hematemesis has different causes such as Cold,Heat,deficiency and excess,but the radical cause of hematemesis lies in the inversion of stomach Qi,so it is important to direct the Qi-stream downward and make the movement of Qi being regular.Zhang Xichun divides the causes of hematemesis into six aspects,which are dues to Heat,Cold,the inverse of the Qi of Liver and Gallbladder,the inverse of Chong-Qi,Yin doesn’t hide Yang,the inversion of stomach gas by Qi desertion due to blood depletion.According to the clinical experience,Zhang Xichun established different therapies when treating hematemesis caused by different pathogenesis,respectively summarized as“clearing Heat and purging Fire,inversing Qi by using tranquil drugs”“warming middle and inversing Qi,tonifying Spleen and eliminating indigestion”“cooling Liver and purging Fire,inversing Qi by using tranquil drugs”“calming and inversing Chong Qi,downing Qi and stopping hiccups”“nourishing Yin and clearing Heat,downing gas and calming asthma”“benefiting Qi and nourishing blood,downing gas and calming asthma”.