叶天士辨治痿证学术思想特色探微

On the characteristics of Ye Tianshi’s academic thought on differentiating and treating a flaccidity syndrome

叶天士在继承前人辨治痿证的经验之上,提出了富有创见的学术观点,认为痿证的病因、病机虚实错杂,本虚标实,初病以湿热为患,络热则痿,久病则以脏腑虚损,奇脉空虚为主要病理机制;痿证的论治以虚、实为纲,虚者治以补益脾肾,通摄奇经,实者治以辛开苦降,利湿泄浊;痿证的用药注重血肉有情之品、虫蚁搜剔之类、辛散宣布之药的运用。叶氏的辨治经验对当下痿证的临床仍具有重要指导意义。

On the basis ofinheriting the experience of his predecessors’in differentiating and treating a flaccidity syndrome,Ye Tianshi puts forward an innovative academic point of view that its etiology and pathogenesis are characterized by the intermingled deficiency in manifestations and excess in the root cause.According to him,the onset of the disease is caused by dampness and heat,and afterwards heat in collaterals leads to the syndrome.Over a period of time,its main pathological mechanisms turn into deficient viscera and feeble paradoxical pulses.Its treatment should focus on both the deficiency syndrome and the excess syndrome.For its deficiency syndrome,the disease should be treated by tonifying the spleen and kidney,regulating extra meridians,while for its excess syndrome,it should be treated by inducing resuscitation with pungent natured drugs and promoting purgation with bitter natured drugs,to eliminate dampness and resolve turbidity.Drugs with the pungent nature for the disease should be performed mainly for warmly invigorating kidney yang,promoting blood circulation for removing blood stasis,dispersing dampness and ventilating qi.Ye Tianshi’s experience in the differentiation and treatment of the syndrome still has his important guiding significance in clinic.