《张氏医通》辨治血证机理

张璐辨治血证以脏腑为本,用药顾及其间的生克顺逆,提出"证有虚中挟实,治有补中寓泻,从少从多之治法,贵于临病处裁",治以标本兼治,首重其本,如治疗吐血,提出宜补肝,不宜伐肝,以平肝气而令血有所归,伐肝则肝虚不能藏血,血愈不止矣。同时以各脏腑功能的不同,所发生血证的特点也不尽相同,来辨证施治。治疗时,张氏尤重胃气,因血证伤及人身正气,虚劳百伤,不管见何样血证,治先量胃气虚实用药。如对吐血血暴涌如潮者,若脉见虚大,此火势未敛,不可便与汤药,急以热童便,或藕汁灌之滋阴降火,俟半日许,脉势稍缓,方可进调养之剂。而对见吐血一吐则倾盆盈碗,或鲜血中兼紫黑大块,吐后不即凝结的,盖吐血出于胃,胃为水谷之海,多气多血,所以吐多而不即凝,以中杂水谷之气也,皆劳力内伤中气而得(亦有醉饱伤内而致者),治不可骤止,止则使败血留积,为瘀血之根,不时举发,为害非轻,亦不宜峻攻,复伤其血,只宜调治胃气以安其血。

Syndrome Differentiation and Treatment Mechanism of Blood Syndrome in Comprehensive Medicine According to Master Zhang

For the syndrome differentiation and treatment of blood syndrome,Master Zhang takes the zang-fu organs as the root and gives considerations to the generation,restriction,sequential or adverse transmission,occurrence of blood syndrome and the involved viscera.He proposed "the syndrome is deficiency complicated with excess,the treatment is tonification mixed with purgation,and the flexible option of the therapy lies in the clinical symptoms".The treatment should be treating both the manifestations and the root cause of the disease and the root cause is put as the priority.For example,in treating hematemesis,he suggests tonifying the liver rather than suppressing the sthenic liver qi in order to sooth liver qi and restore the blood.If suppress the sthenic liver qi,the liver would become too deficient to store blood.At the meanwhile,due to the various visceral function,the characteristics of blood syndromes are not the same and neither are the differentiation and treatment.During treatment,Master Zhang especially values the stomach qi.Since blood syndrome impairs healthy qi,consumptive disease regardless of which kind of blood syndrome is treated from the distinguishing of the deficiency and excess of stomach qi.For patients with flooding hematemesis and feeble and big pulse,the hot tendency hasn't astringed and decoction cannot be given instantly.For urgent cases,hot child urine or lotus root juice can be used to nourish yin and purge fire;after half a day and when the pulse recovers to certain degree,decoctions for regulation and nourishment can be applied.While for patients with hematemesis and once spitting,he would spit a whole bowl of blood or purple-black blood clots which wouldn't coagulate after being spit.This is because the hematemesis originates from the stomach which is the sea of water and grain and full of qi and blood.It fails to coagulate since there is qi of food essence in the blood.It is caused by impairment of the middle energizer qi by overstrain or overdrinking or overeating.The treatment shouldn't be stopped immediately because sudden stop may lead to accumulation of deteriorated blood which is the origin of blood stasis,and the unknown sudden attack of it would cause serious results.But it shouldn't be purged for the reason that it may impair the blood again.It is advisable to regulate stomach qi to tranquilize the blood.