叶天士医案消渴病辨治特色述要

Summary of the characteristics of the diagnosis and treatment of diabetes in Ye Tianshi’s medical records

叶天士《临证指南医案·三消》认为消渴病病因是七情内伤,房劳耗精,病机关键为内热烁津。叶氏基于三消学说,加入卫气营血辨证,充实了消渴病诊疗体系。善用石膏剂与地黄类方,以甘露饮、清暑益气汤、白虎汤、白虎加芍药汤、白虎加地黄汤等方清气分热盛;用清营汤合益胃汤、玉女煎等清营凉血;用加减复脉汤、济生肾气丸、六味地黄丸治疗消渴血分证。

According to Ye Tianshi’s Guide to Clinical Practice with Medical Records·Three Consumption,the main cause of diabetes is the internal damage of the seven emotions and essence consumption due to sexual intemperance,while the key to its pathogenesis is“the endogenous heat evaporating the clear fl uid”.Basing on the theory of three consumption and dryness-heat,combining the syndrome diff erentiation of weifen,qifen,yingfen and xuefen,Ye Tianshi improves the diagnosis and treatment of diabetes.He is good at using the preparation of gypsum and the associated prescriptions of rehmannia root to treat the disease:using Ganlu Yin,Qingshu Yiqi Decoction,Baihu Decoction,Baihu and Shaoyao Decoction,Baihu and Dihuang Decoction to clear the heat excess in qifen;using Qingying Decoction,in combination with Yiwei Decoction,Yunu Decoction,to cool blood in yingfen;using Fumai Decoction,Jisheng Shenqi Pills and Liuwei Dihuang Pills,with the proper addition or subtraction of dosage,to treat the syndrome of xuefen in diabetes.