| 摘要: | 傅青主為清初著名的醫家，其著作《傅青主女科》僅6萬餘言，卻為臨床醫家與學者所重視，有大量相關論文於期刊發表，但是多數研究為短篇文章，無法全面分析《女科》整體內容及其價值，對其學術思想傳承也缺乏深入論述。為了更了解《女科》的學術内涵與臨床應用價值，本文使用考證學方法探察文獻的真偽，用計量法以歸類病機、治法、方藥，用統一的研究標準來檢示《女科》內容，以探討傅氏《女科》的學術理論，治病思想及處方用藥特點。
傅氏的學術思想主要受到內經、金元醫家與明朝溫補學派如薛己、張景岳的影響。於婦科治病思想方面，以「不損天然之氣血」為調經原則，經病調治重肝腎脾，以肝腎精血、肝脾氣血虧損為主要病機。提出經水先期量多為腎中水火太旺，量少為腎中水虧火旺；肝腎為母子相關，肝鬱則腎鬱會造成月經周期失調，當治以肝腎同治之法。所以慎用理氣、活血化瘀及辛熱助陽之品。女子以陰血為主，又多氣鬱，因此闡述鬱證經病，治以補虛稍佐舒肝。提出「帶下俱是濕證」，白帶下病機為肝鬱脾虛，濕熱下注所致，當大補脾胃之氣，稍佐疏肝之品；血崩多與房勞造成虛火的妄動有關，當補氣清熱滋陰；不孕多為脾腎陽虛所致，所以種子之法要在脾腎雙補，溫補填精。
產科治病思想方面，重視調補肝脾與氣血，尤重補氣，於治妊娠病以補氣養血安胎為主；產後氣血虛弱，注重補中行瘀。《產後編》為後人所附，並非傅氏所著，指出產後多虛多瘀，當養血活血，化瘀生新，論治和《女科》也不同，所以不宜混為一談。
傅氏《女科》處方用藥特點，處方多以補養之品如四物湯、四君子湯和逍遙散化裁，若挾鬱者酌與輕劑疏肝解鬱。用藥特點偏於溫補，其中當歸、熟地、白芍、川芎，人參、茯苓、白朮、甘草的藥物頻次共佔《女科》總藥物次數的42.18%。其最常重用的藥物依次為當歸、人參、白朮、熟地、白芍，而柴胡疏肝解鬱之品僅用數分至一錢劑量；《產後編》對產後諸症的治療則以生化湯為主。
傅氏《女科》影響近代學者對於肝鬱、肝腎氣鬱的不孕證型以及生化湯有深入的研究，這些都是《女科》的學術運用發揮。
Fu Qing Zhu Nu Kie written by Fu Qing Zhu who was a famous physician in early Qing Dynasty. It was a brief book with sixty thousand words，but its content was appreciated and usually discussed in Chinese medical journal by modern scholars. Most studies were short papers which could not analyze whole book in depth. The purpose of this study was to research Fu，s thought for treatment of gynecological disease and analyze the character of his medication. In order to realize his thought and for clinical use, we researched on the text, generalized pathologies, treatment principles, formulas, drugs and inspected them identically.
Fu’s thought mainly affected by Nei Jin, physicians of Jin-Yuan Dynasty and Ming Dynasty, like Xue Ji, Chang Jing-Yue. On thought of gynecological treatment, do not hurt nature qi and blood was the main principle of treating menstrual problems. In though of diagnosis, Fu focused on liver, kidney and spleen. Liver kidney essence-blood vacuity and liver spleen qi-blood vacuity were main pathologies in gynecological disease. He mentioned that too much kidney water and kidney fire would lead to advanced menstruation with large blood loss, and excess kidney fire with less kidney water would lead to advanced menstruation with little blood loss. Liver and kidney being of same origin, liver qi stagnation would cause kidney qi stagnation and lead to menstruation at irregular intervals. In this situation, simultaneous treatment of liver and kidney was the best choice. Qi rectifying drugs, blood rectifying drugs, blood-quickening stasis-spelling drugs and interior-warming drugs should be used carefully. Women were governed by blood, and usually being with liver qi depression. It should be treated with supplementing qi-blood and coursing liver. Vaginal discharge was a pattern of damp. White Vaginal discharge was caused by liver depression, spleen deficient and damp-heat pouring downward. Patient should be treated with supplementing stomach and spleen and also regulating liver qi. Flooding often caused by deficiency fire which resulted from causal sex and should be treated with supplementing qi ,yin and cleaning heat. The most pattern of infertility was spleen-kidney yang deficiency, therapeutic method of fertility should warm the kidney and fortify the spleen and tonify kidney essence.
In Obstetric disease, Fu emphasized on harmonizing liver and spleen, and supplementing qi-blood, especially qi. Treating pregnancy disorder should be supplementing qi-blood to prevent abortion. After procreation, the pathologies were qi and blood vacuity . Patient should be treated by supplementing, quickening the blood and transforming stasis. Chan hou bian was not written by Fu, therefore added by someone else. It focused on weakness and blood stasis, therapeutic method were supplementing blood and transforming stasis. Theory between Nu Kie and Chan hou bian were deferent that could not be mixed.
The character of prescription and drugs were as follows: Four Agents Decoction (si wu tang), Four Gentlemen Decoction (si jun zi tang) and Free Wanderer Powder (xiao yao san) were important formulas for treatment. The amount of Four Agents Decoction (si wu tang) and Four Gentlemen Decoction (si jun zi tang) was up to 42.18% of the herb used. It usually presented a character of large doses of tangkuei, ginseng ,ovate atractylodes, cooked rehmannia, white peony, and small dose of bupleurum. The common use after procreation in Chan hou bian was sheng hua Decoction.
Fu’s Nu Kie had great effects on infertility researches in some patterns such as liver qi stagnation, liver-kidney qi stagnation. Scholars also had advanced studies on sheng hua Decoction, these were furthermore application of Nu Kie. |
