张锡纯辨治吐衄血证思想及经验探析

Discussion on ZHANG Xichun’s thought and experience in treating hematemesis and epistaxis

张锡纯,中国晚清著名中西汇通医学家。他一生深研经典古籍,遵古参西,被誉为晚清三贤之一,著有医学名著《医学衷中参西录》。张锡纯在治疗吐衄血证上,立方新颖,指出“胃气上逆”是其基本病机。吐血是阳明胃气逆冲而上;衄血是胃气沿经络上行,探究其根本原因,二者皆因胃气上逆而导致。在治疗上,张锡纯反对单纯止血,他主张应以降胃气为主,以理气药加减配伍,形成了独特的治疗吐衄血证的思想体系。文章从吐衄责之阳明、止血活血、收敛开通畅达内外、治血不忘理肝等方面对其治疗吐衄血证的学术思想进行总结,并通过案例,一诊治以养肝阴滋肾水为主,辅以理气清热,进而达到标本同治之效,畅达全身气机,降逆上行之气血,气血和调,血止病安。二诊拟方酸枣仁汤、生脉饮合百合地黄汤加减养心除烦,安神和胃。探析张锡纯思想及谴方经验,希望为临床治疗吐衄血证提供参考。

ZHANG Xichun,a famous Chinese medical expert who was proficient in TCM and Western medicine in the late Qing dynasty.He studied classical Chinese traditional medical works and referred to Western medicine all his life.He was honored as one of the three sages in the late Qing dynasty,and wrote the medical work Yixue Zhongzhong Canxi Lu(《医学衷中参西录》).ZHANG Xichun pointed out that the basic pathogenesis of hematemesis and epistaxis was stomach Qi(气)upwardness.Hematemesis is the stomach Qi of Yangming(阳明)rushing upward.Epistaxis is stomach Qi ascending along meridians.To explore the root cause,both are caused by the inversion of stomach Qi.In terms of treatment,ZHANG Xichun opposes simple hemostasis.He advocates that stomach Qi should be mainly lowered,and the combination of Qi regulating drugs should be used,forming a unique ideological system for the treatment of hematemesis and epistaxis.This paper summarizes its academic ideas on the treatment of vomiting blood and bleeding from the aspects of Yangming,stopping bleeding and activating blood,convergence and opening up unobstructed internal and external,treating blood without forgetting to take care of the liver,and through cases,the first diagnosis and treatment is mainly to nourish the liver and nourish the kidney water,supplemented by rationalizing Qi and clearing heat,and then achieve the effect of treating the symptoms and the root cause,unblocking the whole body Qi machine,reducing the upward Qi and blood,Qi and blood and regulation,and blood stopping the disease.The second diagnosis is the work of the Suanzaoren decoction(酸枣仁汤),Shengmai Yin(生脉饮)plus the Baihe Dihuang decoction(百合地黄汤)to reduce and rejuvenate the mind and eliminating troubles,calming the mind and stomach.This paper analyzes ZHANG Xichun’s thoughts and experience in remedy,hoping to provide reference for the clinical treatment of vomiting blood and hemorrhage.