叶天士病证结合治痹证

Ye Tian-shi′s Method of Treating Impediment by Using Combination of Disease and Syndrome

叶天士对痹证的认识,承《黄帝内经》思想,循“风寒湿三气杂至,合而为痹”理论,并卓有创新。在辨证时宗病证结合思想,将痹证分为周痹、行痹、肢痹、筋痹进行论治。周痹主症为一身尽痛,病程较短者多属邪实,治以祛风散寒除湿为主;病程久者多虚或虚实夹杂,治以扶正为主,兼以祛邪,常选用虫类药搜剔经络。行痹主症为痛势流走,病性有寒热之分,治疗宗“热者寒之,寒者热之”平调之法。肢痹主症为疼痛以四肢为主,根据病变部位不同活用引经药,病在上肢者,予姜黄、羌活、桑枝引药至上肢;病在下肢者,予蚕沙、川萆薢、薏苡仁利下肢湿邪。筋痹主症为“筋纵痛甚”,治法为“补气血之中,必佐宣行通络”,在服用中药同时加用针刺治疗。叶天士根据痹证病因不同,将痹证分为寒湿痹证、风湿痹证、湿热痹证和痰血痹证,其中寒湿痹证分寒湿阻经与寒湿伤阳,分别治以温通经脉和斡旋其阳,使阳气宣通,经气流畅,痹痛自除。风湿痹证又分风湿痹阻与风湿化热,分别治以祛风除湿和宣通清解。湿热痹证治以分利湿邪,凉营清热。痰血痹证多为久病入络,以祛痰浊化败血为法,常用丸药缓缓图之。

Ye Tian-shi′s understanding of impediment inherits the thought of Huangdi′s Internal Classic and follows the theory of"wind-cold-dampness combination to form impediment",and has brought forth new ideas.In the course of syndrome differentiation,he puts forward the thought of combination of disease and syndrome,and divides impediment into whole body impediment,migratory impediment,limb impediment,and sinew impediment.The main symptom of whole body impediment is pain all over the body.The patients with short course of disease mostly have pathogenic excess,so the treatment is mainly to dispel wind,disperse cold and remove dampness.For those with a long course of disease,deficiency or deficiency-excess in complexity,the main treatment is to reinforce the healthy qi and remove pathogenic factors.Insect drugs are often used to completely remove pathogens from the meridians.The main symptom of migratory impediment is pain flowing.The nature of the disease can be divided into cold and heat,and the treatment is based on the method of"treating heat with cold,and treating cold with heat".The main symptom of limb impediment is pain focusing in the limbs.According to the different parts of the lesion,meridian-guiding drugs are used flexibly.If the disease is in the upper limbs,Jianghuang(Rhizoma Curcumae Longae),Qianghuo(Radix et Rhizoma Notopterygii)and Sangzhi(Ramulus Mori)are used to guide drugs to the upper limbs.If the disease is in the lower limbs,Cansha(Faeces Bombycis),Sichuan Bixie(Rhizoma Dioscoreae Hypoglaucae),Yiyiren(Semen Coicis)are used to remove dampness.The main symptom of sinew impediment is"severe tendon pain",and the treatment method is"tonifying qi and blood,supplemented by dredging meridians",and acupuncture and moxibustion are added besides taking decoction.According to the etiology of impediment,Ye Tian-shi divides impediment into cold-dampness impediment,rheumatism impediment,dampness-heat impediment and phlegm-blood impediment.Among them,cold-dampness impediment includes cold-dampness blocking meridians and cold-dampness hurting yang,which is treated with warming yang to dredging meridians,and moving yang respectively to unblock yang,make meridians′qi smooth and removing impediment pain.Rheumatism impediment includes rheumatism blocking and rheumatism transforming into heat,which is treated with removing wind and wind,and removing impediment and unblocking yang respectively.Dampness-heat impediment is treated with removing dampness pathogen,cooling nutrient qi and clearing heat.Phlegm-blood impediment is mostly a chronic disease into the collaterals,the treatment should be eliminating phlegm turbidity and resolving putrid blood,so pills are commonly used to treat the related symptoms step by step.