陈士铎辨治痿症临证经验和特色探析  

CHEN Shiduo's Experience and Characteristic in Treating Flaccidity Syndrome by Syndrome Differentiation

作　　者：袁宇芳 吴浩祥[2] YUAN Yufang;WU Haoxiang(The First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学第一临床医学院,广州510405 [2]广州中医药大学第一附属医院

出　　处：《浙江中医药大学学报》2023年第10期1162-1165,共4页Journal of Zhejiang Chinese Medical University

摘　　要：[目的]探析陈士铎治痿经验及用药特色,以期为痿症的临床辨治提供新思路。[方法]通过研习《辨证录》痿症门的八则医案,并借助《石室秘录》及《本草新编》中有关痿症的方药论述加以理解分析,从而总结归纳陈士铎对痿症的分类、病因病机、治则治法及方药配伍等方面的经验特色。[结果]陈士铎将痿症分为五痿,分属五脏,医案详症略脉,重视从症状入手定位病脏。病因首推阳明胃火,五脏痿症因脏腑相关及五行生克特点而病机各异,但本质皆为肾水不足,骨空无髓。临床治疗上,陈氏主张从胃肾出发,遵循泻胃火、滋肾水,兼顾他脏的原则,强调忌大寒泻火,宜微寒散火,同时大补肾阴、和调脏腑。用药上,陈氏重用玄参、麦冬为君,配以熟地黄,并善用甘菊花清退胃火。[结论]陈士铎诊治痿症多有效验,并极具个人特色,在汲取前人思想精华的基础上,常有自己的新见解,值得后世借鉴与参考。[Objective] To analyze CHEN Shiduo's experience in treating flaccidity syndrome and the characteristics of medication,in order to provide new ideas for the clinical differentiation and treatment of flaccidity syndrome. [Methods] Through the understanding and analysis of the eight medical records of flaccidity syndrome and the discussion on the medication treatment of flaccidity syndrome in Shishi Milu and Bencao Xinbian,so as to sum up CHEN Shiduo's experience on the classification of flaccidity syndrome,etiology and pathogenesis,treatment rules and methods and prescription compatibility. [Results] CHEN Shiduo divided flaccidity syndrome into five categories,belonging to the five Zang organs,medical records described the symptoms in detail and less described the pulse condition,attached flaccidity syndrome to the location of the diseased viscera from the symptom. Yangming stomach fire was the first cause,and the pathological mechanism of each flaccidity syndrome was slightly different,but the essence was kidney water insufficiency and bone empty without marrow. In clinical treatment,CHEN advocated starting from the stomach and kidney,following the principles of clearing the stomach fire,nourishing the kidney water,and taking into account other viscera. The treatment should not use heavy cold drugs to clear fire,should be slightly cold scattering fire,while tonifying the kidney Yin and regulating viscera. In the application of drugs,CHEN's used heavy amounts of Scrophulariae Radix and Ophiopogonis Radix as the king,with ripe Rehmanniae Radix Praeparata,and made good use of Chrysanthemi Flos to clear Yangming stomach fire. [Conclusion] CHEN Shiduo's treatment of flaccidity syndrome was very effective,and had very individual characteristics,on the basis of absorbing the essence of predecessors' thoughts,often had his own new opinions,worthy of reference for later generations.

关 键 词：陈士铎 痿症 辨证录 临证经验 用药特色 脏腑相关 五行生克 

分 类 号：R658[医药卫生—外科学]