基于《名医类案》探讨补中益气汤治疗崩漏

Based on the"Famous Medical Case",the Treatment of Collapse and Leakage of Buzhong Yiqi Decoction is Discussed

目的:梳理总结《名医类案》中补中益气汤治疗崩漏医案的辨证施治要点,辨析其所治医案的病因病机,对医案中补中益气汤的运用规律及其化裁规范进行探讨。方法:以文献整理为基础,结合医案分析,探讨不同医案病因病机。结果:《名医类案》中应用补中益气汤治疗的崩漏案及其类方共计5案,围绕中气亏虚、气虚不摄崩漏案;脾气、脾阳虚崩漏案;脾虚兼夹湿热案;元气下陷,虚寒内生崩漏案;脾阳下陷崩漏案;以补中益气汤为基础方,灵活化裁理论与临床实践相结合,重视温补治病求本,有别与现代繁杂的加减变化。结论:补中益气汤为《名医类案》治疗崩漏最为常用方剂,疗效肯定,化裁灵活有度,总体以元气亏损,脾胃虚弱,气虚下陷为核心病机,在药物方面中重视黄芪、人参加量应用,符合“气为血之帅”“补气生血”的理论,蕴含后世血症治疗“塞流”理论的基础。

Objective:To sort out and summarize the key points of syndrome differentiation and treatment of Buzhong Yiqi Decoction in the treatment of metrorrhagia in“Famous Doctors Records”,to analyze the etiology and pathogenesis of the medical records,and to analyze the application rules of Buzhong Yiqi Decoction in the medical records.and its tailoring specifications will be discussed.Methods:Based on literature review and medical case analysis,the etiology and pathogenesis of different medical cases were explored.Results:There were a total of 5 cases of metrorrhagia and metrorrhagia treated with Buzhong Yiqi Decoction and similar prescriptions in“Famous Doctors’Cases”,focusing on cases of metrorrhagia due to deficiency of central qi and failure to absorb Qi;cases of metrorrhagia due to deficiency of spleen and spleen yang;cases of metrorrhagia due to deficiency of spleen and stomach;Cases involving both dampness and heat;cases of subsidence of vitality and endogenous metrorrhagia caused by deficiency and cold;cases of subsidence of spleen yang and metrorrhagia;based on the Buzhong Yiqi Decoction,flexible tailoring theory and clinical practice are combined,emphasizing warming and tonic to treat the disease and seek root causes.Which is different from modern complicated additions and subtractions.Conclusion:Buzhong Yiqi Decoction is the most commonly used prescription for treating metrorrhagia in the“Famous Doctors”.It has positive efficacy and flexible treatment.Overall,the core pathogenesis is loss of vitality,weakness of the spleen and stomach,and Qi deficiency and subsidence.In terms of medicine,astragalus is emphasized.The dosage of ginseng is applied in line with the theory of“Qi is the leader of blood”and“replenishing Qi and generating blood”,and contains the basis of the“blocking flow”theory of treating later-term hemorrhage.