从“引火归元”论治更年期综合征

The treatment of climacteric syndrome from the theory of Yinhuo Guiyuan

更年期综合征主要是指女性在绝经前后的这段时间出现的一系列心理和生理方面的病证。由于患者性激素逐渐减少,导致一系列精神及躯体表现,如植物神经功能紊乱、生殖系统萎缩等,还可能出现一系列生理和心理方面的变化,如焦虑、抑郁和睡眠障碍等。古代医籍中并未对更年期综合征单独命名,其症状描述多散在“不寐”“脏躁”“郁证”“百合病”“崩漏”之中,卓雨农先生提出了“绝经前后诸症”的病名。历代医家对其病因病机的认识基本一致,皆认为当责之于肾,女性进入更年期后,肾中精气渐衰,天癸将竭是更年期综合征发生的根本病机。女子一生经、带、胎、产数伤于血,常年处于“阴血不足”的状态,血为精之属,精藏之于肾,阴血依赖肾中阴精的滋养与补充,故而更年期综合征的病机以偏于肾阴虚为主,临床所见也是肾阴虚证为多。因相火藏于肾水之中,更年期前后,阴虚水亏,相火无处潜藏,相火离位上冲,不归命门,引起一系列火不归元的病理现象。“引火归元”就是引上越之虚火回归命门的治疗方法,起源于《黄帝内经》,以相火理论为基础,适用于肾阳浮越、虚火上升、火不归元之证。随着理论研究的深入,其治疗范围不断扩大,许多医家以此理论指导更年期综合征的辨证论治,效果颇佳。文章结合案例,从“引火归元”理论的角度来论述更年期综合征的病因病机和辨证论治,以期为临床提供参考。

Menopause syndrome mainly refers to a series of psychological and physiological symptoms of women during the period before and after menopause.There are a series of mental and physical manifestations caused by the gradual decrease of sexual hormones in patients,such as autonomic nervous dysfunction and reproductive system atrophy,and there are also a series of physiological and psychological changes,such as anxiety,depression and sleep disorders.The ancient medical texts did not name the menopausal syndrome alone,and its symptom descriptions were scattered in sleeplessness,dirty irritability,depression,lily disease and leakage,and Mr.ZHUO Yunong proposed the name of pre-and post-menopausal diseases.Successive generations of doctors have basically the same understanding of its etiology and pathogenesis,and they all believe that the kidney is responsible,and after women enter menopause,the essence in the kidney gradually declines,and the exhaustion of heavenly decoction is the fundamental pathogenesis of menopausal syndrome.A woman's life menstruation,belt,fetus,and childbirth are injured by blood,and she is in a state of Yin(阴)blood deficiency all year round,blood is the genus of essence,essence is stored in the kidney,and Yin blood depends on the nourishment and supplement of the Yin essence in the kidney,so the pathogenesis of menopausal syndrome is mainly biased towards renal Yin deficiency,and clinical evidence of renal Yin deficiency is more.Because the Xianghuo(相火)is hidden in the kidney water,before and after menopause,the Yin deficiency water loss,the Xianghuo has nowhere to hide,the Xianghuo rushes up from the position,and does not return to the door,causing a series of pathological phenomena of Huobu Guiyuan(火不归元).Yinhuo Guiyuan(引火归元)is a therapeutic method that leads deficiency fire back to the gate of life.It originates from the Huangdi Neijing(《黄帝内经》),and is based on the theory of ministerial fire,which is applicable to kidney deficiency.With the deepening of theoretical research,the scope of treatment continues to expand.Many doctors use this theory to guide the syndrome differentiation and treatment of menopausal syndrome,and the effect is quite good.This paper discusses the etiology,pathogenesis and syndrome differentiation and treatment of menopausal syndrome from the perspective of the theory of Yinhuo Guiyuan,in order to provide a reference for clinical practice.