浅论明清时期医家对“热入血室”的理论探讨

Discussions on the theory of"heat invading the blood chamber"by doctors in the Ming and Qing Dynasties

“热入血室”是常见的妇人温病,明清时期医家在结合前代医家理论的基础上,对热入血室证进行了深刻而广泛的挖掘。其认为血室的位置可能是肝、冲脉、子宫或冲任二脉;热入血室的病因是外感温邪,而不同于《伤寒论》中的外感风寒之邪;病机是“经来之时,血室新虚”,故病邪直入血室。在治疗方法上也不拘泥于“小柴胡”一法,而是根据病邪的轻重、血室的盈亏及具体症状,或从卫气营血辨证治疗。同时对热入血室、蓄血证、血结胸三证进行了阐发,其认为从病位而言,热入血室证属于蓄血证;从病机而言,二者是并列关系。并提出血结胸是热入血室证进一步发展的结果。还认为男子亦有热入血室证,并将男子血室定位为“直肠膀胱陷凹”,提出男子热入血室证的治法是凉血、解毒。上述认识丰富了温病学、中医妇科学、中医男科学的理论。

"Heat invading the blood chamber"is a common warm disease in women.In the Ming and Qing dynasties,doctors had deeply and extensively explored this syndrome on the basis of the theories of previous generations.It is believed that it may be located in the liver,thoroughfare channel,uterus,or the thoroughfare and conception channels,and is caused by an exogenous heat pathogen,which is different from the exogenous windcold pathogen described in the Shanghan Lun(Treatise on the Cold Pathogenic Diseases),while its pathogenesis is that the pathogen invades the blood chamber directly as"it happens to be weak during menstruation".It is held that its treatment should not be limited to the Xiaochaihu Decoction,but rather based on the severity of the disease,the waxing and waning of the blood chamber and its specific symptoms,or the syndrome differentiation of weifen,qife,yingfen and xuefen.At the same time,the paper expounds on the syndrome of heat invading the blood chamber,the stagnated blood syndrome,and the chest binding syndrome,believing that the syndrome of heat invading the blood chamber is subordinate to the category of the stagnated blood syndrome with regard to its location,yet is in a parallel relationship with the latter with respect to their pathogenesis.And it is proposed that the chest binding syndrome is the result of its further development and that men can develop the syndrome as well,which is defined as"rectovesical pouch"and should be treated by cooling blood and removing toxins.The above discussions are expected to be able to enrich the theories of science of epidemic febrile disease of traditional Chinese medicine,gynecology of traditional Chinese medicine,and andrology of traditional Chinese medicine.