基于张锡纯吐血证治探析老年呕血辨治思路

Probe into the Syndrome Differentiation Treatment Thought of Hematemesis in the Elderly Based on Zhang Xichun's Hematemesis Syndrome

老年人体质多虚实夹杂,多脏虚损,对于老年呕血患者,若但止血,恐在止血过程中由于瘀血骤然形成,发生危急重症;若但消瘀,又恐正虚难复,再次引发出血,故止血与消瘀当同时进行。但若为急性吐血,吐血量较大,则以止血为第一要务;若吐血量少,反复发作,缠绵难愈,应加用水蛭、土鳖虫、地龙等辛咸之品,此类药物需合用健脾补肾、益气养血之剂,免伤正气。再者,老年患者应尽早扶正,谨防变证。张锡纯治吐血诸方,将消瘀、宁血及补血法寓于止血一法之中,一方多用,止血而不留瘀,补虚而不壅滞,冲、胃、肝、脾、肾往往多向兼顾,药用全面而重点突出,更适用于老年患者。但张锡纯止血之后,无补血专方,应宗唐宗海之意,血止之后予人参养荣汤、大补阴丸等补血方药以善后,同时配合脏腑辨证,补其不足,泻其有余,方可避免反复发作。

The elderly physique is characterized by deficiency-excess in complexity with multiple viscera asthenic diseases.For the eld-erly patients with hematemesis,if the purpose of treatment is only for hemostasis,there is fear of sudden formation of blood stasis in the process of hemostasis,resulting in severe emergencies.If the blood stasis is eliminated,there will be fear that the deficiency of healthy qi is difficult to recover,causing bleeding again.Therefore,hemostasis and stasis should be treated at the same time.But if the patient real-ly has acute hematemesis with a large amount of hematemesis,hemostasis is the first priority;If the amount of hematemesis is small with lingering recurrent atacks,some pungent and salty drugs,such as Shuizhi(Hirudo),Tubiechong(Eupolyphaga seu Steleophaga),Dilong(Pheretima),etc.can be added.However,such drugs need to be combined with drugs that invigorate the spleen and nourish the kidney,replenish qi and nourish blood,so as to avoid damaging the healthy qi.Furthermore,elderly patients should reinforce healthy qi as soon as possible and be cautious of deteriorated syndromes.Zhang Xichun's various formulas for treating hematemesis include the methods of eliminating blood stasis,calming blood,and tonifying blood in one method of hemostasis.One method can be used for multi-ple syndromes to stop bleeding without leaving blood stasis,and to supplement deficiency without stagnation,consider thoroughfare ves-sel,stomach,liver,spleen,and kidney in multiple aspects,with comprehensive and prominent medicinal effects,making it more suitable for elderly patients.But afer Zhang Xichun stopped bleeding,there was no specific formula for tonifying blood.According to Tang Zong-hai,some formulas for tonifying blood,such as Ginseng Supporting and Nourishing Decoction,Major Yin-Supplementing Pill,etc.can be adopted to improve the aftermath.At the same time,in conjunction with visceral syndrome differentiation,he supplemented the deficien-cy and purged the excess to avoid recurrent attacks of haematemesis.