张杰运用下瘀血汤治验4则

Four Medical Cases of ZHANG Jie's Clinical Experience in Using Xiayuxue Decoction

[目的]总结张杰教授临床运用下瘀血汤的经验,探讨其临证应用本方的思路。[方法]选取张杰教授运用下瘀血汤治疗肝硬化、输卵管堵塞、冠心病、颈总动脉斑块之验案4则,并结合历代医家的相关论述,从病因病机、治则治法、用药特点等方面对验案进行分析。[结果]张师认为,下瘀血汤中虫之咸寒走窜,桃仁之苦温推陈,大黄之苦寒荡涤,药专力宏,破血逐瘀之力颇强,只要抓住“瘀”这一主要病机,此方不仅可以治疗产妇瘀血内结之腹痛及妇人瘀阻胞宫之经水不利,灵活加减配伍后可广泛应用于多个部位的瘀血病证。张师运用此方治疗肝郁脾虚、痰毒瘀阻之肝积,胸阳不振、心脉瘀阻之胸痹,冲任虚寒、瘀阻胞宫之不孕,肝郁气滞、痰瘀内停之眩晕,疗效显著。[结论]张师辨证与辨病相结合,以下瘀血汤加减治疗多种瘀血病证,扩大了经方的应用范围,经验特色鲜明,值得学习和推广。

[Objective]To summarize Professor ZHANG Jie's experience in clinical application of Xiayuxue Decoction,and explore his clinical application of this prescription.[Methods]Four cases of liver cirrhosis,fallopian tube obstruction,coronary atherosclerotic heart disease and common carotid artery plaque treated by Professor ZHANG Jie with Xiayuxue Decoction were selected and analyzed from the aspects of etiology and pathogenesis,treatment principles and treatment methods,and medication characteristics,combined with the relevant discussions of doctors in previous dynasties.[Results]Professor ZHANG Jie believes that in the Xiayuxue Decoction,Eupolyphaga Seu Steleophaga is salty and cold,mobile and penetrating,Semen Persicae is bitter and warm,Rheum palmatum is bitter and cold,and it has strong ability to break blood and remove blood stasis.As long as the main pathogenesis of"blood stasis"is grasped,this prescription can not only treat the abdominal pain caused by blood stasis in puerpera,but also can be widely used in many parts of blood stasis syndrome after flexible addition and subtraction.Professor ZHANG Jie used this prescription to treat liver accumulation due to liver depression and spleen deficiency,phlegm toxin and blood stasis;chest obstruction due to hypofunction of Yang in the chest and blood stasis of heart vessels;infertility due to deficiency and cold of Chongren,blood stasis blocking the uterus;dizziness due to stagnation of Qi due to depression of the liver,stagnation of phlegm and blood stasis,all the cases achieved good results.[Conclusion]ZHANG Jie combines syndrome differentiation with disease differentiation,uses Xiayuxue Decoction to treat a variety of blood stasis syndrome,expanding the scope of application of classical prescriptions.His experience is distinctive,and worthy of learning and promoting.