須辨陰陽 塞流不(bu)可留(liu)瘀--蔡小蓀辨治血(xue)崩證的(de)經驗
上海(hai)蔡氏婦科以儒醫(yi)聞于世,至(zhi)吾師(shi)蔡小蓀(sun)已七代。其從醫(yi)50余載,臨床(chuang)經(jing)驗(yan)豐(feng)富,尤對血(xue)崩證的辨治(zhi)(zhi)獨具創見(jian),臨證屢獲卓效(xiao)。蔡師(shi)認為,本病(bing)的致病(bing)因(yin)素甚多,病(bing)情變(bian)化較為復(fu)雜,臨診時務必詳審病(bing)機,首辨陰陽(yang),即陰崩與陽(yang)崩之別。主張“求因(yin)為主,止血(xue)為輔”,補益不戀邪,止血(xue)勿留瘀(yu),以冀(ji)全效(xiao)。茲將(jiang)吾師(shi)治(zhi)(zhi)崩經(jing)驗(yan)略述(shu)鱗爪,以供參考。
陽盛崩證 善治其陰
《素(su)問·陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)陽(yang)(yang)別(bie)論》云(yun):“陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)虛陽(yang)(yang)搏(bo)謂之崩(beng)(beng)。”顯見(jian)陽(yang)(yang)崩(beng)(beng)之因乃(nai)(nai)(nai)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)虛陽(yang)(yang)盛所致(zhi)(zhi)。強調陽(yang)(yang)崩(beng)(beng)正(zheng)以(yi)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)虛為(wei)(wei)本,火熱(re)為(wei)(wei)標。蔡(cai)師認為(wei)(wei),女子(zi)曰陰(yin)(yin)(yin)(yin)(yin)(yin)(yin),以(yi)血為(wei)(wei)榮(rong)。由于(yu)(yu)經(jing)帶胎(tai)產等生理特(te)點(dian)(dian),陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)血易(yi)(yi)耗。女子(zi)以(yi)肝(gan)為(wei)(wei)先(xian)天,肝(gan)藏血,體(ti)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)而(er)(er)用(yong)陽(yang)(yang),陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)血不(bu)足,更易(yi)(yi)引起(qi)陽(yang)(yang)亢(kang)。此外又可因陽(yang)(yang)盛之體(ti),邪熱(re)易(yi)(yi)傷沖任,損及(ji)肝(gan)腎(shen)而(er)(er)致(zhi)(zhi)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)虛陽(yang)(yang)盛,迫血妄行。所以(yi),臨(lin)床(chuang)(chuang)上陽(yang)(yang)崩(beng)(beng)證(zheng)較(jiao)為(wei)(wei)多見(jian)。對(dui)于(yu)(yu)陽(yang)(yang)崩(beng)(beng)的(de)(de)治(zhi)療,蔡(cai)師常用(yong)養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)止(zhi)崩(beng)(beng)法取效。臨(lin)床(chuang)(chuang)上以(yi)經(jing)來(lai)先(xian)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin),量多如注(zhu),色(se)鮮或紫,質較(jiao)濃稠,脈(mo)細數,舌質紅或絳(jiang)等陽(yang)(yang)性征象,為(wei)(wei)運(yun)用(yong)養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)止(zhi)崩(beng)(beng)法的(de)(de)辨治(zhi)要點(dian)(dian)。蔡(cai)師曾治(zhi)療一位(wei)陽(yang)(yang)崩(beng)(beng)癥患者,年41歲,1993年5月29日(ri)初(chu)診。5月3日(ri)經(jing)來(lai)臨(lin),量多如注(zhu),將月不(bu)止(zhi),日(ri)來(lai)尤甚,色(se)鮮且稠,頭暈腰酸,肢軟(ruan)乏力,時(shi)有(you)腹疼,口干欲飲,屢注(zhu)催產素(su)及(ji)服中(zhong)西藥均不(bu)效。脈(mo)細數,苔薄質紅。此乃(nai)(nai)(nai)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)虛血熱(re),沖任失固。當擬(ni)養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)止(zhi)崩(beng)(beng)。選用(yong)自(zi)擬(ni)育(yu)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)止(zhi)崩(beng)(beng)湯(tang)加(jia)減(jian):當歸10克(ke),生地(di)炭(tan)30克(ke),炒(chao)蒲(pu)黃10克(ke),炙龜板10克(ke),白芍(shao)10克(ke),旱(han)蓮草12克(ke),熟女貞10克(ke),煅(duan)牡蠣(li)30克(ke),丹皮炭(tan)10克(ke)。藥后經(jing)量即減(jian),3劑而(er)(er)完全凈止(zhi)。本著(zhu)“熱(re)者清之,虛者補之”的(de)(de)原則,方(fang)中(zhong)炙龜板、生地(di)炭(tan)益(yi)腎(shen)滋陰(yin)(yin)(yin)(yin)(yin)(yin)(yin),牡蠣(li)滋陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)潛陽(yang)(yang),固澀止(zhi)血。鑒于(yu)(yu)時(shi)有(you)腹疼,防其(qi)尚(shang)有(you)殘瘀(yu),參當歸、蒲(pu)黃以(yi)祛瘀(yu)止(zhi)痛,旱(han)蓮草、白芍(shao)養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)柔肝(gan)育(yu)腎(shen)。方(fang)藥著(zhu)重于(yu)(yu)養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)止(zhi)崩(beng)(beng),養(yang)(yang)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)即所以(yi)抑(yi)陽(yang)(yang),陰(yin)(yin)(yin)(yin)(yin)(yin)(yin)陽(yang)(yang)平衡,沖任乃(nai)(nai)(nai)固,血崩(beng)(beng)自(zi)止(zhi)。這是蔡(cai)師治(zhi)療陽(yang)(yang)崩(beng)(beng)證(zheng)常用(yong)經(jing)驗方(fang),善(shan)治(zhi)其(qi)陰(yin)(yin)(yin)(yin)(yin)(yin)(yin),而(er)(er)取得(de)滿意效果。
陰盛崩證 善治其陽
《女科百問》齊仲甫說:“受(shou)冷而(er)(er)(er)色白(bai)者,謂之(zhi)(zhi)(zhi)陰(yin)(yin)(yin)(yin)(yin)崩(beng)(beng)。”蔡(cai)師認(ren)為(wei)(wei)(wei),陰(yin)(yin)(yin)(yin)(yin)崩(beng)(beng)證(zheng)多(duo)寒癥,大(da)多(duo)由(you)于素(su)體陽(yang)(yang)(yang)(yang)虛(xu)或(huo)崩(beng)(beng)久(jiu)(jiu)而(er)(er)(er)致陽(yang)(yang)(yang)(yang)虛(xu)。蓋(gai)血(xue)(xue)(xue)為(wei)(wei)(wei)氣(qi)的物質,陰(yin)(yin)(yin)(yin)(yin)血(xue)(xue)(xue)與陽(yang)(yang)(yang)(yang)氣(qi),陰(yin)(yin)(yin)(yin)(yin)血(xue)(xue)(xue)之(zhi)(zhi)(zhi)化(hua)全賴陽(yang)(yang)(yang)(yang)氣(qi)以(yi)溫(wen)運(yun)(yun)攝納,陽(yang)(yang)(yang)(yang)氣(qi)之(zhi)(zhi)(zhi)用(yong)全賴于陰(yin)(yin)(yin)(yin)(yin)血(xue)(xue)(xue)以(yi)營(ying)養(yang)。若陰(yin)(yin)(yin)(yin)(yin)血(xue)(xue)(xue)大(da)虧,氣(qi)無(wu)(wu)(wu)(wu)所附(fu)(fu)(fu)(fu),氣(qi)隨(sui)(sui)血(xue)(xue)(xue)衰,統攝無(wu)(wu)(wu)(wu)權(quan),以(yi)致久(jiu)(jiu)崩(beng)(beng)不(bu)止。故(gu)陽(yang)(yang)(yang)(yang)虛(xu)而(er)(er)(er)崩(beng)(beng)的病例以(yi)久(jiu)(jiu)崩(beng)(beng)引起較多(duo)。陽(yang)(yang)(yang)(yang)虛(xu)血(xue)(xue)(xue)崩(beng)(beng)雖為(wei)(wei)(wei)數較少,但(dan)亦不(bu)鮮見。臨(lin)(lin)床上多(duo)見經(jing)(jing)來似(si)崩(beng)(beng),色較淡而(er)(er)(er)稀為(wei)(wei)(wei)特點(dian),面色(白(bai)光)白(bai)少華,畏冷肢(zhi)清,出現陰(yin)(yin)(yin)(yin)(yin)亡而(er)(er)(er)陽(yang)(yang)(yang)(yang)亦隨(sui)(sui)之(zhi)(zhi)(zhi)虛(xu)脫的險(xian)(xian)證(zheng)。臨(lin)(lin)證(zheng)時(shi)當(dang)(dang)恪(ke)守(shou)“有(you)(you)形之(zhi)(zhi)(zhi)血(xue)(xue)(xue)不(bu)能(neng)速生,無(wu)(wu)(wu)(wu)形之(zhi)(zhi)(zhi)氣(qi)所當(dang)(dang)急固(gu)”之(zhi)(zhi)(zhi)訓(xun)。蔡(cai)師常喜投用(yong)參附(fu)(fu)(fu)(fu)湯,益氣(qi)溫(wen)陽(yang)(yang)(yang)(yang)攝血(xue)(xue)(xue),每(mei)能(neng)化(hua)險(xian)(xian)為(wei)(wei)(wei)夷。如蔡(cai)師曾治(zhi)療一位年(nian)(nian)逾半(ban)百的陰(yin)(yin)(yin)(yin)(yin)崩(beng)(beng)證(zheng)患者。1993年(nian)(nian)10月(yue)(yue)13日初診(zhen)。10月(yue)(yue)6日月(yue)(yue)經(jing)(jing)來臨(lin)(lin),始(shi)則(ze)淋漓(li),昨上午因勞(lao)累而(er)(er)(er)致狂行不(bu)止,色淡紅,質稀,順腿(tui)下(xia)(xia)流(liu),頭眩目花,肢(zhi)清心(xin)(xin)慌,血(xue)(xue)(xue)色素(su)65克,面色(白(bai)光)白(bai),注止血(xue)(xue)(xue)針未(wei)效。脈細數,苔淡薄質嫩紅,邊(bian)有(you)(you)齒印。顯見氣(qi)血(xue)(xue)(xue)大(da)虧,血(xue)(xue)(xue)去陰(yin)(yin)(yin)(yin)(yin)傷,陰(yin)(yin)(yin)(yin)(yin)損及陽(yang)(yang)(yang)(yang),沖(chong)(chong)任失固(gu)之(zhi)(zhi)(zhi)象(xiang),急當(dang)(dang)益氣(qi)溫(wen)陽(yang)(yang)(yang)(yang)止崩(beng)(beng)。處以(yi)炒黨(dang)參15克,炙黃芪15克,白(bai)芍10克,炒當(dang)(dang)歸10克,熟附(fu)(fu)(fu)(fu)片(pian)10克,生地炭(tan)30克,炮姜炭(tan)3克,仙鶴草30克,生蒲黃15克,阿膠珠(烊(yang)沖(chong)(chong))9克。投劑(ji)兩帖后,經(jing)(jing)即凈止。唯(wei)心(xin)(xin)悸寐差,神(shen)疲(pi)乏力,復(fu)診(zhen)擬益氣(qi)養(yang)血(xue)(xue)(xue),以(yi)杜反復(fu)。上方(fang)(fang)去附(fu)(fu)(fu)(fu)片(pian)、炮姜;增甘(gan)杞子(zi)(zi)(zi)15克、制黃精(jing)15克,以(yi)澄其源復(fu)其舊(jiu)。門診(zhen)隨(sui)(sui)訪3月(yue)(yue),血(xue)(xue)(xue)崩(beng)(beng)未(wei)見復(fu)發。蔡(cai)師指出,臨(lin)(lin)床上陰(yin)(yin)(yin)(yin)(yin)虛(xu)陽(yang)(yang)(yang)(yang)盛的血(xue)(xue)(xue)崩(beng)(beng),以(yi)龜板滋陰(yin)(yin)(yin)(yin)(yin)涼血(xue)(xue)(xue)之(zhi)(zhi)(zhi)劑(ji),顧忌較少。然對(dui)陽(yang)(yang)(yang)(yang)虛(xu)陰(yin)(yin)(yin)(yin)(yin)盛的崩(beng)(beng)癥,大(da)膽而(er)(er)(er)正確(que)使(shi)用(yong)附(fu)(fu)(fu)(fu)子(zi)(zi)(zi),溫(wen)陽(yang)(yang)(yang)(yang)止崩(beng)(beng),非常重要。因附(fu)(fu)(fu)(fu)子(zi)(zi)(zi)辛甘(gan)大(da)熱(re),且(qie)有(you)(you)毒,用(yong)于體虛(xu)崩(beng)(beng)癥,恐其動血(xue)(xue)(xue)劫陰(yin)(yin)(yin)(yin)(yin),故(gu)處方(fang)(fang)下(xia)(xia)藥時(shi)就不(bu)無(wu)(wu)(wu)(wu)顧忌。但(dan)若確(que)系陽(yang)(yang)(yang)(yang)虛(xu)血(xue)(xue)(xue)崩(beng)(beng),則(ze)又屬必用(yong)之(zhi)(zhi)(zhi)劑(ji)。《金(jin)匱》黃土湯治(zhi)療陽(yang)(yang)(yang)(yang)虛(xu)便血(xue)(xue)(xue),亦取附(fu)(fu)(fu)(fu)子(zi)(zi)(zi)溫(wen)陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)功。《校(xiao)注婦人良(liang)方(fang)(fang)》直接運(yun)(yun)用(yong)參附(fu)(fu)(fu)(fu)湯,治(zhi)婦女暴崩(beng)(beng)。然益氣(qi)溫(wen)陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)法,除(chu)確(que)診(zhen)陽(yang)(yang)(yang)(yang)虛(xu)血(xue)(xue)(xue)崩(beng)(beng)之(zhi)(zhi)(zhi)外(wai),不(bu)常輕(qing)用(yong)。溫(wen)燥之(zhi)(zhi)(zhi)劑(ji)畢竟有(you)(you)動血(xue)(xue)(xue)之(zhi)(zhi)(zhi)虞,一旦癥勢好轉,附(fu)(fu)(fu)(fu)子(zi)(zi)(zi)亦當(dang)(dang)減量或(huo)除(chu)去。故(gu)用(yong)附(fu)(fu)(fu)(fu)子(zi)(zi)(zi)治(zhi)陽(yang)(yang)(yang)(yang)虛(xu)血(xue)(xue)(xue)崩(beng)(beng)須膽大(da)心(xin)(xin)細,審證(zheng)明辨,正確(que)使(shi)用(yong),庶可無(wu)(wu)(wu)(wu)虞。
血瘀崩證 善治其因
在(zai)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)崩(beng)(beng)(beng)證(zheng)(zheng)中,血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)引起(qi)的(de)(de)崩(beng)(beng)(beng)證(zheng)(zheng)屢見不(bu)(bu)鮮(xian)。古人(ren)(ren)治(zhi)(zhi)崩(beng)(beng)(beng)有(you)塞(sai)(sai)流(liu)、澄源、復舊三(san)個步驟。先止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue),以(yi)塞(sai)(sai)其(qi)(qi)流(liu),這是應急的(de)(de)措施,在(zai)一般無瘀(yu)(yu)(yu)(yu)(yu)(yu)病(bing)例中誠可取(qu)效(xiao)(xiao)。但對于由血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)所引起(qi)的(de)(de)出血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue),常(chang)感效(xiao)(xiao)果(guo)不(bu)(bu)顯(xian)或(huo)無效(xiao)(xiao),甚至癥(zheng)(zheng)(zheng)勢(shi)反(fan)而(er)(er)增(zeng)劇。緣出血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)由于瘀(yu)(yu)(yu)(yu)(yu)(yu)滯(zhi)未(wei)清,瘀(yu)(yu)(yu)(yu)(yu)(yu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)去則新血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)生,血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)歸(gui)經,致出血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)止(zhi)(zhi)(zhi)(zhi)。如(ru)果(guo)不(bu)(bu)辨(bian)癥(zheng)(zheng)(zheng)因(yin)而(er)(er)單純止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue),往(wang)往(wang)愈(yu)(yu)塞(sai)(sai)流(liu)則出血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)愈(yu)(yu)甚。此(ci)(ci)外,在(zai)塞(sai)(sai)流(liu)止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)過程中,始終應該注(zhu)意止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)防瘀(yu)(yu)(yu)(yu)(yu)(yu),明察到單純止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)每(mei)(mei)易留瘀(yu)(yu)(yu)(yu)(yu)(yu)。誠如(ru)《血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)證(zheng)(zheng)論》云:“止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)之(zhi)(zhi)后(hou)(hou),其(qi)(qi)離(li)經之(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)而(er)(er)未(wei)吐出者(zhe),是為瘀(yu)(yu)(yu)(yu)(yu)(yu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)。”蔡師(shi)推(tui)崇此(ci)(ci)說,指出治(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)當以(yi)去蓄利瘀(yu)(yu)(yu)(yu)(yu)(yu),使血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)返故(gu)道(dao),不(bu)(bu)止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)而(er)(er)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)自止(zhi)(zhi)(zhi)(zhi),為治(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)崩(beng)(beng)(beng)證(zheng)(zheng)的(de)(de)大法(fa)。本著(zhu)“通(tong)因(yin)通(tong)用(yong)(yong)”的(de)(de)原則,自擬化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)止(zhi)(zhi)(zhi)(zhi)崩(beng)(beng)(beng)湯加減治(zhi)(zhi)療血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)崩(beng)(beng)(beng)證(zheng)(zheng)每(mei)(mei)獲(huo)佳效(xiao)(xiao)。如(ru)蔡師(shi)曾治(zhi)(zhi)療一位內膜異(yi)位癥(zheng)(zheng)(zheng)而(er)(er)致血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)崩(beng)(beng)(beng)。年40,初診(zhen)1992年1月(yue)14日(ri)。半年前婦科檢查,子宮(gong)后(hou)(hou)壁可觸及(ji)小結(jie)(jie)節,有(you)觸痛,B超提示左側(ce)附件4×3×1.5厘米腫(zhong)塊(kuai),診(zhen)斷為子宮(gong)內膜異(yi)位癥(zheng)(zheng)(zheng)。患者(zhe)每(mei)(mei)經臨兩少腹劇痛,昨臨經量多如(ru)涌,有(you)塊(kuai)且大,腰酸(suan)疲憊,頭暈目(mu)花(hua),脈細,苔薄(bo)有(you)紫斑(ban)。癥(zheng)(zheng)(zheng)屬(shu)宿(su)瘀(yu)(yu)(yu)(yu)(yu)(yu)內結(jie)(jie),血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)循經。治(zhi)(zhi)擬化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)。處以(yi)炒當歸(gui)10克(ke)(ke)(ke)(ke),丹(dan)參6克(ke)(ke)(ke)(ke),赤白(bai)芍(shao)各10克(ke)(ke)(ke)(ke),生蒲黃30克(ke)(ke)(ke)(ke),花(hua)蕊石(shi)15克(ke)(ke)(ke)(ke),血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)竭3克(ke)(ke)(ke)(ke),三(san)七末(mo)(吞)1.5克(ke)(ke)(ke)(ke),懷牛膝10克(ke)(ke)(ke)(ke),制香附10克(ke)(ke)(ke)(ke),震靈丹(dan)(包(bao))12克(ke)(ke)(ke)(ke)。3劑藥后(hou)(hou)痛減,經遂(sui)凈(jing)止(zhi)(zhi)(zhi)(zhi)。繼用(yong)(yong)桂(gui)枝茯(fu)苓法(fa)化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)散(san)結(jie)(jie),循環調(diao)治(zhi)(zhi)。三(san)月(yue)后(hou)(hou)門診(zhen)隨訪,血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)崩(beng)(beng)(beng)未(wei)見反(fan)復。蔡師(shi)分析,此(ci)(ci)病(bing)人(ren)(ren)瘀(yu)(yu)(yu)(yu)(yu)(yu)象顯(xian)然,惡血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)去,血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)不(bu)(bu)歸(gui)經,徒止(zhi)(zhi)(zhi)(zhi)何益?故(gu)予化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)止(zhi)(zhi)(zhi)(zhi)崩(beng)(beng)(beng)。方(fang)中血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)竭與三(san)七末(mo)配伍,取(qu)其(qi)(qi)既有(you)散(san)瘀(yu)(yu)(yu)(yu)(yu)(yu)行滯(zhi)之(zhi)(zhi)力,又有(you)止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)定(ding)痛之(zhi)(zhi)功,為血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)崩(beng)(beng)(beng)證(zheng)(zheng)必用(yong)(yong)之(zhi)(zhi)品。蔡老用(yong)(yong)藥每(mei)(mei)喜(xi)輕簡,唯(wei)蒲黃此(ci)(ci)藥常(chang)據(ju)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)崩(beng)(beng)(beng)證(zheng)(zheng)情況而(er)(er)定(ding),通(tong)常(chang)超量應用(yong)(yong),多則30克(ke)(ke)(ke)(ke),且喜(xi)用(yong)(yong)生蒲黃。因(yin)蒲黃具有(you)活血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)、收(shou)斂止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)之(zhi)(zhi)功,并能收(shou)縮子宮(gong)。震靈丹(dan)是蔡師(shi)治(zhi)(zhi)療血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)瘀(yu)(yu)(yu)(yu)(yu)(yu)崩(beng)(beng)(beng)證(zheng)(zheng)常(chang)用(yong)(yong)成藥之(zhi)(zhi)一,因(yin)其(qi)(qi)有(you)止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)行血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)之(zhi)(zhi)功,寓通(tong)于澀,既能固澀止(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue),又能化(hua)(hua)瘀(yu)(yu)(yu)(yu)(yu)(yu)、理氣、止(zhi)(zhi)(zhi)(zhi)痛。
血(xue)(xue)(xue)瘀(yu)崩證往往又(you)可(ke)因氣(qi)(qi)(qi)(qi)(qi)(qi)虛(xu)無力推動(dong)血(xue)(xue)(xue)液流行(xing)(xing)而(er)致(zhi),對于此(ci)(ci)(ci)型(xing)病(bing)(bing)癥(zheng),蔡師(shi)常注意(yi)補氣(qi)(qi)(qi)(qi)(qi)(qi)活(huo)血(xue)(xue)(xue)同用(yong)。他說:“元氣(qi)(qi)(qi)(qi)(qi)(qi)既(ji)虛(xu),必不能達(da)(da)于脈絡(luo),脈絡(luo)無氣(qi)(qi)(qi)(qi)(qi)(qi),必停(ting)留(liu)而(er)瘀(yu)。”在臨(lin)證時(shi)必須“審氣(qi)(qi)(qi)(qi)(qi)(qi)血(xue)(xue)(xue)之(zhi)榮(rong)枯,辨經絡(luo)之(zhi)通滯。”故(gu)在臨(lin)床上治(zhi)療氣(qi)(qi)(qi)(qi)(qi)(qi)虛(xu)兼有血(xue)(xue)(xue)瘀(yu)的崩證,常采用(yong)益(yi)(yi)氣(qi)(qi)(qi)(qi)(qi)(qi)化瘀(yu)止血(xue)(xue)(xue)法,療效顯(xian)著。在補氣(qi)(qi)(qi)(qi)(qi)(qi)止崩中不忘祛瘀(yu),他說:“有專用(yong)補氣(qi)(qi)(qi)(qi)(qi)(qi)者,氣(qi)(qi)(qi)(qi)(qi)(qi)愈補而(er)血(xue)(xue)(xue)愈瘀(yu),血(xue)(xue)(xue)瘀(yu)氣(qi)(qi)(qi)(qi)(qi)(qi)更不能外達(da)(da)。此(ci)(ci)(ci)時(shi)用(yong)補氣(qi)(qi)(qi)(qi)(qi)(qi)破血(xue)(xue)(xue)之(zhi)劑,通開(kai)血(xue)(xue)(xue)道(dao),氣(qi)(qi)(qi)(qi)(qi)(qi)直達(da)(da)于外,故(gu)兩者需時(shi)時(shi)兼顧。只(zhi)是在具體運用(yong)時(shi)需根(gen)據氣(qi)(qi)(qi)(qi)(qi)(qi)虛(xu)、血(xue)(xue)(xue)瘀(yu)的輕(qing)重緩(huan)急(ji)而(er)權(quan)衡側重。”如蔡師(shi)治(zhi)療一位(wei)農(nong)村(cun)婦女(nv),年(nian)43,1990年(nian)11月18日初診(zhen)(zhen)。兩年(nian)前因子(zi)宮內(nei)膜異位(wei)癥(zheng)手術(shu),近(jin)B超(chao)復(fu)查又(you)發現左側卵巢(chao)有7×6×5厘米不活(huo)動(dong)腫塊(kuai)。經期尚準(zhun),此(ci)(ci)(ci)次(ci)11日來潮,狂行(xing)(xing)如注,有塊(kuai)且大(da),色暗,已甫1周,面色(白(bai)光)白(bai),用(yong)中西藥均(jun)未效,故(gu)來本院就(jiu)診(zhen)(zhen)。癥(zheng)見苔薄質(zhi)偏(pian)暗,邊有齒(chi)印。蔡師(shi)認為,該(gai)病(bing)(bing)員突(tu)然大(da)量出(chu)血(xue)(xue)(xue),當(dang)屬暴(bao)崩急(ji)病(bing)(bing)。由(you)于農(nong)村(cun)工作辛勞過甚,難免氣(qi)(qi)(qi)(qi)(qi)(qi)虛(xu)不足,瘀(yu)血(xue)(xue)(xue)停(ting)留(liu)胞宮,而(er)致(zhi)大(da)下不止,間(jian)有血(xue)(xue)(xue)塊(kuai)。姑先益(yi)(yi)氣(qi)(qi)(qi)(qi)(qi)(qi)活(huo)血(xue)(xue)(xue)止崩。處以黨參15克,炙(zhi)黃芪(qi)15克,白(bai)芍10克,花蕊石12克,熟軍炭10克,炮姜炭3克,三七末(吞)3克。3劑后經血(xue)(xue)(xue)全止。二診(zhen)(zhen)再擬益(yi)(yi)氣(qi)(qi)(qi)(qi)(qi)(qi)養(yang)血(xue)(xue)(xue)之(zhi)品,復(fu)舊澄源,調理而(er)愈。方中熟軍炭與炮姜炭配伍,熟軍炭偏(pian)涼(liang),推陳致(zhi)新(xin),引血(xue)(xue)(xue)歸(gui)經,炮姜炭祛瘀(yu)生新(xin),溫經止血(xue)(xue)(xue),兩者相(xiang)伍行(xing)(xing)中有止,攻補兼施,相(xiang)得益(yi)(yi)彰(zhang),而(er)達(da)(da)止血(xue)(xue)(xue)消瘀(yu)之(zhi)效。
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