从《金匮要略》虚劳论治复发性流产

Discussion About Treating Recurrent Abortion from Consumptive Disease

复发性流产(recurrent spontaneous abortion,RSA)病机为脾肾两虚,《金匮要略》虚劳病机为气血阴阳俱虚,虚实寒热错杂,二者病机相似,故RSA可从虚劳论治。虚劳以虚为本,故补益脾肾为其基本治则,但虚劳又有夹瘀、夹痰、虚寒、虚热的不同,治疗时张仲景遵循"补不足,损有余"的原则,采用薯蓣丸补益气血,大黄■虫丸活血祛瘀,瘀祛生新,则胞宫得养;酸枣仁汤清热养血,热清血和胎自安;辅以祛风邪之品治疗虚劳风气百疾。正虚为主者扶正为主,佐以祛邪,正复邪自祛;以邪实为主者以祛邪为主,佐以扶正,邪祛则正自复。

The pathogenesis of recurrent spontaneous abortion(RSA)is deficiency of both spleen and kidney,while that of consumptive disease is deficiency of both qi and blood,yin and yang,deficiency and excess and cold and heat in complexity.Their pathogenesis is similar,so RSA can be treated from consumptive disease.Consumptive disease is based on deficiency,so tonifying the spleen and kidney is the basic treatment principle.However,consumptive disease includes different types such as deficiency combined with blood stasis,or phlegm,cold or heat,so Zhang Zhong-jing followed the principle of"treating deficiency with supplementation method and excess with draining method".Rhizoma Dioscoreae Pill is often used to nourish and blood;Rhubarb and Eupolyphaga Pill is used to activate blood circulation,remove blood stasis and regenerate the uterus.Sour Jujube Decoction is used to clear heat and nourish blood,and prevent abortion.The medicinals for removing wind pathogen can also be combined to treat all kinds of diseases due to consumptive disease and wind pathogen.For deficient healthy qi,reinforcing healthy qi is mainly adopted,combined with dispelling pathogens.For excessive pathogens,dispelling pathogens is mainly adopted,combined with reinforcing healthy qi.In this way,healthy qi can be recovered.