《张氏医通》肢体痹证治述要

Synopsis of syndrome differentiation and treatment for bi-syndrome of limbs in ZHANG’s Comprehensive Medical Book

通过整理与分析清代医家张璐所著的《张氏医通》中与肢体痹有关的论述,探讨张璐肢体痹理论的主要观点、证治要点和特点。其治痹理论主要源于《黄帝内经》《金匮要略》,认为风邪是痹证发生的重要原因,明确提出了“三焦痹”的概念,认为《金匮要略》中的桂枝芍药知母汤“总治三焦痹”,并指出后世医家提出的“痛风”就是《黄帝内经》中的“痹”、《金匮要略》中的“历节”、朱丹溪的“白虎历节”,其实质是痛痹;在肢体痹的证治方面,其不仅能博采众家之长,还自创了新的方剂,强调不能盲目使用寒凉药,临证善用温阳药、风药、除湿药,且重视脉诊和外治法,其内治方药剂型多样,并灵活调整服药时间、煎服方法。

By sorting out and analyzing the arguments related to bi-syndrome of limbs in ZHANG’s Comprehensive Medical Book written by ZHANG Lu,a doctor in the Qing Dynasty,this paper discusses the main viewpoints,syndrome differentiation and treatment points and characteristics of ZHANG Lu’s bi-syndrome of limbs theory.His theory of treatment for bi-syndrome mainly originates from Huangdi’s Internal Classic and Synopsis of Prescriptions of the Golden Chamber.He holds that pathogenic wind is the important causation of the occurrence of bi-syndrome and clearly puts forward the concept of“triple energizer bi-syndrome”,considering that Guizhi Shaoyao Zhimu Tang(桂枝芍药知母汤)in Synopsis of Prescriptions of the Golden Chamber can“overall treat triple energizer bi-syndrome”,points out that“gout”put forward by doctors in later generations is the“bi-syndrome”of Huangdi’s Internal Classic,the“acute arthritis”in Synopsis of Prescriptions of the Golden Chamber,and acute migratory arthritis of ZHU Danxi,whose essence is painful bi-syndrome.In the aspect of syndrome differentiation and treatment of bi-syndrome of limbs,he can not only extracts piths from others,but also create new prescriptions,emphasizing that cold and cool natured medicinals can not be used blindly,warming yang medicinals,wind medicinals and eliminating dampness medicinals can be used well in clinical syndrome,and paying attention to pulse diagnosis and external treatment,whose internal treatment prescriptions and forms have various types,and the medication time and decoction method can be adjusted flexibly.