金元明清医家辨治燥证思想探析

摘要

[目的]探讨金元明清医家辨治燥证的学术思想。[方法]通过学习古代医著，分析医家对燥证病因病机、理法方药的阐述，总结医家辨治燥证的特点。[结果]刘完素总结燥的病理为血枯、津亏，症候为内在脏腑组织干燥及外在皮肤干燥的紧敛燥涩之象，列治燥十一方；喻嘉言提出了秋燥病名，总结出“燥病必渴”的临床特点，提出治疗燥证多从肝肺入手，并自制清燥救肺汤用治温燥伤肺；费伯雄提出温燥和凉燥之分，并以五脏分证论治秋燥，强调“和法缓治”；叶天士指出燥证有内伤、外感之分，以卫气营血及三焦辨证为核心，提出上燥治气、下燥治血，并制定了具体的治疗方法；吴鞠通将秋燥按上、中、下三焦辨治，指出秋燥可沿三焦次第相传，并创立杏苏散、桑杏汤、沙参麦冬汤。[结论]金元明清医家在辨治燥证的理法方药方面都有不同程度的发挥和创新，对后世医家研究和诊治燥证具有指导意义。%Objective To investigate academic thoughts of physicians in the treatment of dryness syndrome in Jin, Yuan, Ming and Qing Dynasties. [Methods] With learning the ancient medical works, etiology-pathogenesis and principle-method-recipe-medicines of dryness syndrome were analyzed, and characteristic of the treatment of dryness syndrome was summarized. [Results] Liu Wansu summarized that blood exhaustion and body fluid deficiency were the pathology of dryness syndrome, and zang and fu organs and skin dry manifestation were the clinical symptoms, and he proposed 11 prescriptions. Yu Jiayan put forward the name of autumn-dryness disease, summarized clinical characteristics was thirsty. He proposed the rule to treat the dryness syndrome from lung and liver, and also created Qingzao Jiufei decoction to treat the warm and dryness pathogen attacking lung syndrome. Fei Boxiong raised dryness syndrome could be divided into warm dryness and cool dryness, treated from five zang organs, and emphasized the application of harmonization method to mild treatment. Ye Tianshi raised dryness syndrome could be divided into internal injury and exogenous disease, to treat upper dryness from QI and lower from blood based on Wei qi camp blood and Sanjiao syndrome differentiation . Wu Jutong treated autumn-dryness in Sanjiao syndrome differentiation, and pointed out the progression of autumn-dryness could be along upper jiao, middle jiao and lower jiao. He created Xingsu powder, Sangxing decoction and Shashen Maidong decoction. [Conclusion] There were al kinds of innovation of syndrome differentiation and treatment of dryness syndrome in Jin, Yuan, Ming and Qing Dynasties, and it is instructive to diagnosis and treatment for later physician.