喻昌辨治虚劳病思想探析

Analysis on YU Chang’s thought of distinguishing and treating deficiency disease

通过对清代名医喻昌代表作《医门法律》中“虚劳门”篇章进行整理、分析,总结喻老辨治虚劳病的思想。其在“五劳七伤”论的基础上,又细化出“病损”和“药损”2个虚劳病因。辨诊喻老遵经典、重脏腑,提出虚损有别;承仲景、重脉法,强调虚实当辨;同时喻老将所创“大气论”“秋燥论”用于辨治本病;并于篇后设禁律,以防后人失治误治。临证治疗喻老注重缓调,而不专补,尤重脾肾,多先调后天脾胃以滋生化,渐补先天肾本以固真元,分别从精血、阳气、阴津、瘀血等4个方面入手。用药喻老博采众方,善膏丸并重,渐服数日后结合食养,以缓复正气。喻老辨治虚劳病谨遵先贤,力求创新,强调证治规范,对现代临床有高度的参考价值。

This paper provides a comprehensive overview of YU Chang's treatment of deficiency disease,a prevalent chronic illness in ancient China,as outlined in the“Xulao Men”of YU's classical work,Principles for Medicine.In addition to the traditional“five kinds of consumptive disease and seven kinds of damage”,YU Chang further categorized the causes of deficiency into“disease damage”and“drug damage”.Regarding diagnosis,YU Chang adhered to classical principles,placing significant emphasis on internal organ assessment and differentiation between various types of exhaustion.He also followed ZHANG Zhongjing's approach by highlighting the importance of pulse diagnosis and stressing the need to distinguish between deficiency and excess.Furthermore,YU Chang introduced the“Daqi Theory”and the“Autumn Dryness Theory”,applying them to disease treatment.Additionally,he established a set of prohibitions at the conclusion of his chapter to prevent future misdiagnosis and mistreatment.In terms of clinical treatment,YU Chang emphasized gradual adjustment rather than relying solely on supplementation.He paid special attention to regulating spleen and kidney function by initially focusing on stomach and spleen regulation to support metabolic processes before gradually supplementing kidney for consolidating the basis.His treatment approach encompassed addressing qi,blood,yang,and body fluids.With regards to medication usage,YU Chang drew from an extensive range of prescriptions while emphasizing pill and ointment administration with gradual dosage increments over several days before integrating dietary therapy for gradual restoration of normal qi.YU Chang strictly adhered to his predecessors'teachings while seeking innovation;he emphasized standardized diagnosis and treatment methods that hold significant reference value for modern clinical practice.