桂枝加龙骨牡蛎汤分层论治妇人失血证的临床运用  

Clinical Application of Guizhi Decoction with Longgu Muli Added in Treating Gynecological Diseases with Blood Loss Based on Stratified Differentiation and Treatment

作　　者：赵慧君 孙娟[1] 骆美成 曹立幸[2] ZHAO Hui-Jun;SUN Juan;LUO Mei-Cheng;CAO Li-Xing(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广东省中医院,广东广州510120

出　　处：《广州中医药大学学报》2020年第10期2022-2026,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医院中医药科学技术研究专项课题(编号:YN2016ML05)。

摘　　要：桂枝加龙骨牡蛎汤(桂枝、白芍、大枣、生姜、甘草、龙骨、牡蛎)为《金匮要略》中的经典名方。妇人失血证病机特点之一为伤血耗精、精血亏虚,而此特点正契合桂枝加龙骨牡蛎汤调和阴阳精血的作用机理。故提出临床诊治妇人失血证可着眼于"失精家",采用桂枝加龙骨牡蛎汤加减分层论治妇人失血证:先排除器质性病变引起的失血,再根据妇人失血之早期、中期、后期的气血虚损情况采用桂枝加龙骨牡蛎汤加减治疗。失血早期重在固冲任及止经血,可辅以桂枝加龙骨牡蛎汤调和阴阳;失血中期重在调阴阳及养阴血,先予桂枝加龙骨牡蛎汤调和阴阳,再予补益气血之品养阴血;失血后期重在重镇潜阳及滋阴养血,主要采用桂枝加龙骨牡蛎汤,且需重用桂枝、龙骨、牡蛎。运用此方异病同治,治疗妇科失血证可以取得较好的疗效。Guizhi Decoction with Longgu Muli Added is one of the famous classical formulae recorded in Synopsis of the Golden Chamber,which is composed of Ramulus Cinnamomi,Radix Paeoniae Alba,Fructus Jujubae,Rhizoma Zingiberis Recens,Radix Glycyrrhizae,Os Draconis,and Concha Ostrea. Gynecological diseases with blood loss have the pathogenesis of consumption of blood and essence resulting into the insufficiency of blood and essence,and the pathogenesis is exactly the action target of Guizhi Decoction with Longgu Muli Added which has the effects of regulating yin,yang,essence and blood. Therefore,the diagnosis and treatment of gynecological diseases with blood loss can be focused on the loss of essence,and the stratified differentiation and treatment with modified Guizhi Decoction with Longgu Muli Added are suitable for gynecological diseases with blood loss. During the diagnosis and treatment of gynecological diseases with blood loss,the loss of blood induced by organic diseases should be firstly excluded,and then the application of modified Guizhi Decoction with Longgu Muli Added should be based on the degree of insufficiency of qi and blood in the early, middle, and late stage of gynecological diseases with blood loss. In the early stage of gynecological diseases with blood loss, the treatment should be focused on consolidating thoroughfare vessel and conception vessel,and on arresting menstruation,which can be assisted by Guizhi Decoction with Longgu Muli Added to regulate yin and yang;in the middle stage of gynecological diseases with blood loss, the treatment should be focused on regulating yin and yang, and on nourishing yin and blood,which can be achieved by Guizhi Decoction with Longgu Muli Added to regulate yin and yang firstly,and then treated by the herbs with the actions of tonifying qi and blood to nourish yin and blood;in the late stage of gynecological diseases with blood loss,the treatment should be focused on subsiding yang with heavy herbs and on nourishing yin and blood,which can be achieved mainly by Gui

关 键 词：桂枝加龙骨牡蛎汤 失精家 中医药治疗 经方 妇人失血证 

分 类 号：R271.11[医药卫生—中医妇科学]