| 摘要: | 婦人大全良方婦科學術思想研究
研究生：施慧瑄
指導教授：陳立德博士
中國醫藥大學 中國醫學研究所
摘要
陳自明，字良甫，宋朝臨川人，出身醫學世家，是當時有名的婦產科專家。於西元1237年撰成《婦人大全良方》24卷，為集宋以前之大成的綜合性婦產科專著，共分八門依次為調經、眾疾、求嗣、胎教、妊娠、坐月、產難、產後。其學術思想主要稟承於巢元方《諸病源候論》、孫思邈《千金方》，以風冷致瘀、勞傷氣血、情志失節三大病因病機貫串全書。治療宜以溫經散寒、活血化瘀、補養衝任氣血、調暢情志為主。
以調經思想為例，因風冷外襲，導致血凝而月經不調，甚至血結成癥而月經不通。對於風冷外邪，陳氏主張用辛散風寒之品，而寒邪久傷必生陽虛內寒，因此又加溫經散寒之品，並以活血化瘀藥治療血凝血癥。室女經閉成勞說明情志失當使心脾損傷，造成經閉，必須要先「改易心志」，再「用藥扶接」。而勞傷氣血是致使風冷外邪容易侵襲的潛在病因，因此在方中多有益氣養血之品。
陳氏的思想以及用藥，具有前瞻性，並影響後世深遠。室女經閉成勞的症狀，類似於神經性厭食症，而西方醫學在1868年才出現anorexia nervosa的描述，較陳氏提出時間晚了631年，且治療婦科疾病重視情志的思想，影響後世婦科學家甚鉅；陳氏用《內經》四烏鰂骨一藘茹丸治療血枯經閉，開展金元明清醫家如劉河間、張景岳、武之望、葉天士，吳鞠通等，使用腥臭脂膏以補下焦肝腎精血的治療方法；陳氏使用袪風散寒、溫經散寒、活血化瘀藥治療月經病的思想，承自孫思邈。到明朝雖因氣候、環境變遷，薛己、張景岳已甚少使用辛溫散寒、活血化瘀藥，但就現代應用治療月經病言之，孫氏用藥對器質性月經病具有顯著效果；而陳氏、薛氏、與張氏的用藥，在功能性月經病的辨證施治上，則各具特色。
Research of Gynecological Medical Thoughts of Fu Ren DA Quan Liang Fang
Leih-Der Chen, Jung-Chou Chen and Hui-Hsuan Shih
Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan.
Abstract
Chen Zi-Ming was a famous obstetric-gynecological doctor in Song Dynasty. He wrote “Fu Ren Da Guan Liang Fang” in A.D. 1237. This great work contains 24 volumes and was divided into eight themes which are menstrual regulation, all kinds of diseases, sterility, pregnancy, parturient time, difficult labor, and postpartum. His gynecological medical thoughts was affected by Chao Yuan-fang’s Zhu Bing Yuan Hou Lun and Sun Si-Miao’s Gian Jin Fang. Blood stasis made by wind-cold, taxation damage of qi and blood, and affect-mind disharmony were there most important medical toughts in the book. Therefore, Chen treat gynecological diseases by warming the channels and dissipating cold, supplementing qi-blood, and regulating affect-mind.
Let’s take menstrual regualtion for example. Because wind-cold assailing the outer body made blood stasis, mestrual irregularities or even absense of menses happened. Chen used dissipating acridity wind-cold medicine to treat external evil of wind-cold and channel-warming and cold-dissipating medicine to treat internal cold. Chen also used blood-quickening and stasis transfoming medicine to treat blood stasis and blood concretion. Absense of menses of maiden leading to taxation was made by affect-mind disharmony, which damage heart and spleen. To treat the disease, the paitient should change her affect-mind and then supplemented by medicine. Taxation damage of qi and blood was potentail foctor which made patients vulnerable to wind-cold external evil. Therefore, many formulas contain qi and blood-supplementing medicine.
Chen’s thoughts and treatment were sagacious and affected posterity very much. Symptoms of absense of menses of maiden leading to taxation were similar with those of anorexia nervosa, which was proposed by a British doctor in A.D. 1868, later than Chen by 631 years. Chen treated blood desiccation menstrual block by Four Cattlefish Bone with one Rubiae Radix Pill in Inner Canon, which enlightened doctors in later dynasties to use Fishy-smell Fat Paste to supplement liver and kidny essense and blood of lower burnner. Chen’s thoghts of treating mestrual diseases by dissipating acridity wind-cold medicine, channel-warming and cold-dissipating medicine, blood-quickening and stasis transfoming medicine was in accordance with Sun Si-Miao. With change of climate and enviornment in Ming Dynasty, Xue Ji and Zhang Jing-Yue used few dissipating acridity wind-cold and blood-quickening and stasis transfoming medicine. But to treat menstral diseases nowadays, there was significant effect ot treat organic menstrual diseases by Sun’s method. There were individual characters in Chen’s, Xue’s and Zhang’s principles of identifying patterns and administering treatment of functional menstrual diseases. |
