摘要
经行发热是以每月行经前后出现周期性发热为特征的病症,属经前期综合征范畴。当前社会女性精神压力增大,或先天禀赋不足,或因工作劳累久坐,体质虚弱,使本病发病率呈上升趋势。“热入血室”出自《伤寒论》,经过历代医家解读,形成了以冲脉、胞宫、肝论病位,外感为主、内伤为辅论病因,柴胡类方结合活血化瘀法为治则的理论基础,在现代医学中广泛应用。赵宏利教授受《傅青主女科》调经篇“经水忽来忽断时疼时止”一节启发,将《傅青主女科》加味四物汤证列为热入血室前驱期,将热入血室按病邪由浅入深的顺序分为前驱期、中期、极期三阶段,并分别提出病因病机及治法。前驱期血海空虚、风邪外袭,治以补益血海,兼以疏散,方用加味四物汤;中期邪入少阳化热,治以和解少阳、引邪外出,用以小柴胡汤为基础的柴胡类方,兼有血热者可加凉血药清血分热;极期血瘀津伤、瘀热于里,治以活血化瘀、养营清热,须加桃核承气汤、抵挡汤、桂枝茯苓丸等化血瘀。所附验案为经行发热,辨为热入血室前驱期,选用《傅青主女科》加味四物汤为主方,临证注重散风邪及固护脾胃,加减治疗1个月后患者经前经期诸证明显改善,疗效满意。赵宏利教授分期辨治热入血室经验独到而有效,体现既病防变的治则,为经行发热的治疗提供了新的诊疗思路。
Menstrual fever is characterized by periodic fever occurring around the time of menstruation,which falls into the category of premenstrual syndrome.In today’s society,increased mental stress for women,along with insufficient congenital endowment or fatigue from prolonged sitting and work,has led to a rising incidence of this condition.The term“heat entering the blood chamber”originates from Shanghan Lun(《伤寒论》),and through interpretations by generations of physicians,a theoretical framework has developed that classifies disease location through the perspectives of the Chong meridian,uterus,and liver,and considers external pathogens as primary and internal injuries as secondary for etiology.Chaihu-related formula combined with the method of activating blood circulation and removing blood stasis is the theoretical basis of the treatment principle,which is widely used in modern medicine.Professor ZHAO Hongli,inspired by the section on menstrual regulation in FU Qingzhu Nvke(《傅青主女科》)that discusses“menstrual flow suddenly coming and stopping,with pain and relief”,categorized the Jiawei Siwu decoction(加味四物汤)from gynecology as the prodromal phase of heat entering the blood chamber.The professor further divided the stages of heat entering the blood chamber by the depth of the pathogenic factors into three phases:the prodromal stage,the mid-stage,and the extreme stage,while outlining etiologies,pathogenesis,and methods of treatment for each phase.In the prodromal stage,with vacuity of the blood sea and external invasion of wind,the treatment involves nourishing the blood sea while also dispersing the pathogen,using the jiawei Siwu decoction.In the mid-stage,when the pathogen enters the Shaoyang(少阳)causing heat transformation,treatment is aimed at harmonizing the Shaoyang and expelling the pathogen outwards,utilizing Chaihu-based formulas,and for those with blood heat,cooling blood medications can be added.In the extreme stage,with blood stasis and damage to body fluids,characterized by stasis-heat internally,the treatment involves invigorating blood and resolving stasis while nourishing the nutritive aspect and clearing heat,necessitating the addition of the Taohe Chengqi decoction(桃核承气汤),the Didang decoction(抵挡汤),and Guizhi Fuling Wan(桂枝茯苓丸)for resolving blood stasis.The attached empirical case showed menstrual fever,which was recognized as heat entering the blood chamber in its prodromal phase,where the Jiawei Siwu decoction was employed as the main formula.In clinical practice,attention was paid to dispersing wind pathogen and protecting the spleen and stomach.After one month of adjusted treatment,the patient’s menstrual symptoms were ameliorated significantly,achieving satisfactory results.Professor ZHAO’s staged differentiation approach to treating heat entering the blood chamber is unique and effective,reflecting the principle of preventing disease progression,providing new diagnostic and therapeutic insights for menstrual fever.
出处
《中医临床研究》
2025年第30期84-88,共5页
Clinical Journal Of Chinese Medicine
基金
先兆流产辅助决策平台的开发与运用(GZY-ZJ-KJ-24042)。
关键词
热入血室
经行发热
经前期综合征
加味四物汤
Heat entering the blood chamber
Menstrual fever
Premenstrual syndrome
The Jiawei Siwu decoction
