中医中药治疗头痛之浅谈 - Discussion on Shi Pei-qing’s Treatment of Headaches

中医中药治疗头痛之浅谈 -Discussion on Shi Pei-qing’s treatment of headaches

史培卿 张 锦

Translated by: Xu Zhi-jun & J. Heaverlo

摘要:目的:自拟中药方剂治疗头痛的有效性。方法:临床辨证论治,实际运用。结果:治疗患者159例,外感头痛一号方应用患者73例,无效 者 0 例 , 有 效 7 3 例 , 治愈 7 1 例 , 有 效 率 1 0 0 % , 治愈率 : 9 7 . 2 6 %。 内 伤 头 痛 一 号 方 应 用 患 者 8 6 例 , 无 效 者 0 例 , 有 效 8 6 例 , 治愈 8 5 例 , 有 效 率 为100 % ,治愈 率 98 . 83 % ,两则方剂总体治愈率为 98 . 05 % 以 上 。 结 论 :两 则 方 剂 均 为 治 疗头痛的 有 效 方 剂 。

Abstract: This article introduces two custom herbal formulations for the treatment of headaches: one formulation for the treatment of externally contracted headaches and one formulation for the treatment of headaches due to internal damage. Clinically, 73 patients were treated with the herbal formula for externally contracted headaches. 71 patients made a full recovery. The efficacy rate is 100% and the cure rate is 97.26%.  86 patients were treated with the herbal formula for headaches due to internal damage. 85 patients made a full recovery. The efficacy rate is 100% and the cure rate is 98.83%.  The cure rate of the two formulations is 98.05%.  Both formulations have proved to be effective within clinical practice.

关键词:中医中药 治疗头痛
Key words: Chinese medicine, Headache treatment

头痛是临床常见的症状之一。 头痛病因多端,分为外感和内伤两大 类。 头为诸阳之会,清阳之府,凡五脏精华之血,六腑清阳之气,皆上注 于 头 , 故 六 淫 之 邪 外 袭 , 上 犯 巅 顶 邪 气 稽 留 , 阻 抑 清 阳 , 或 内 伤 诸 疾 , 导 致 气 血 逆 乱 , 瘀 阻 经 络 , 脑 失 所 养 , 均 可 致 头 痛 。

Clinically, headaches are one of the most commonly seen symptoms. There are various causes for headaches. Generally, it is divided into external contraction and internal damage. The head is the confluence of  Yang Qi and the house of the clear Yang.  Essence and blood, which are derived from the five viscera, and the clear Yang Qi, which is derived from the six bowels,  ascend upward to the head. Therefore, various factors may lead to headaches. It may be due to an external evil attack of the six excesses, which invade the vertex, store the evil Qi, and obstruct the clear Yang. Or, it may be due to disease caused by internal damage, which leads to the chaotic counterflow of Qi and blood, stasis and obstruction of the channels and vessels, and therefore, causing the brain to be deprived of nourishment.

外感六淫:六淫外袭起居不慎,均可致头痛,《素问· 太阴阳明论》云:“伤于风者,上先受之,故头痛以风邪所致者最为多见。”且风为百病 之长,多夹时气为患,若风寒袭表,寒凝血涩,则头痛而恶寒战栗,风热上犯清空,则头痛而身热烦心,风湿袭表,上蒙清阳,则头痛而重,若湿邪中阻,清阳不升,浊阴不降,亦可引起头痛。

Headaches due to external contraction of the six excesses: In “Plain Questions · Treatise on Greater Yin and Yang Brightness” states, “If a person is attacked by wind, the head is the first place to be affected; therefore, most headaches are due to wind evil.” In addition, wind is the chief of the one hundred diseases, and often combines with seasonal Qi. If wind-cold assails the exterior, there will be congealed cold and inhibited blood.  This will lead to headaches and aversion to cold with shivering. If wind-heat invades the brain, headaches will present with body heat and heart vexation. If wind-damp assails the exterior and clouds the clear Yang, there will be headaches and sensations of heaviness. If damp evil obstructs the center, the clear Yang will fail to bear upward and the turbid Yin will fail to bear downward. This may also lead to headaches.

内伤不足:“脑为髓海”,主要依赖肝肾精血及脾胃运化水谷精微濡养,气血不足,失却濡养可见头痛,三脏邪盛亦可引发头痛,故其发病与 肝、脾、肾三脏有密切关系。

Headaches due to internal damage: “The brain is the sea of marrow”, which is mainly nourished by the essence blood from the liver and kidney and the essence of grain and water transformed from the spleen and stomach. If the Qi and blood is insufficient, the brain will lack nourishment and headaches will follow. Exuberant evil of the three viscera may also lead to headaches. Therefore, the pathomechanisms of headaches are closely related to the liver, spleen and kidney.

头痛的辩证,要详问病史,根据各种症状不同表现,辨别致病之因以外,尤其注意头痛之久暂,疼痛之性质,特点及部位之不同,辨别外感和内伤,以便进行论治。

While identifying the patterns for headaches, the doctor should inquire about the patient’s medical history in detail.  After doing so, the doctor can make a differential diagnosis according to the various symptoms. What is more important, in order to determine the appropriate treatment, the doctor should clearly identify if the headache is: enduring or temporary; what type of pain is present; where the pain is located; and if the headache is due to external contraction or internal damage.

另外,头痛还应根据发病部位之异,参照经络循行路线加以判断-大抵太阳经头痛多在头后部,下连于颈,阳明经头痛多在眉棱骨等处,少 阳经头痛多在头之两侧,并连接耳部;厥阴经头痛多在巅顶部位,或连于目系。 临床辨证既应注意头痛的不同特点,同时还应结合整体情况及其有关兼症全面分析以便处方用药。

In addition, headache patterns should be diagnosed according to the channel pathways. The varying types of headaches can be located within the different regions of the head: generally, the greater Yang channel headache is located at the back of the head and connects with the nape of the neck. The Yang brightness channel headache is located at or around the orbital bone. The lesser Yang channel headache is located at the parietal sides of the head and connects to the ears. The reverting Yin channel headache is located at the vertex, and/or connects with the eye. Clinically, attention should be paid not only to the different types of headaches, but also to the condition of the whole body and other concurrent patterns.

本人行医30多年,对治疗头痛有很好的经验,根据外感、内伤两大类来自拟头痛外感一号方,内伤头痛一号方,应用于临床两年来,治疗患者97例,取得了良好的效果。

Based on 30 years of medical practice,  Shi Pei-qing has acquired outstanding clinical experience in the treatment of  headaches. He has devised herbal formulations for the treatment of externally contracted headaches, and headaches due to internal damage. They have been applied clinically for two years and have achieved great results.

1 资料与方法 外感头痛一号方

1. Formula for the treatment of externally contracted headaches

组 成 : 菊花一包 (10g), 川穹一包 (6g), 羌活一包 (10g), 白芷一包 (6g), 蔓荆子一包 (10g), 甘草一 包 (3g)。
Ingredients: chrysanthemum (ju hua) 10g, chuan xiong rhizoma (chuan xiong) 6g, notopterygium (qiang huo) 10g, dahurian angelica (bai zhi) 6 g, vitex (man jin zi) 10g, licorice (gan cao) 3g

功效: 祛风,散寒,止痛。

Function: dispel wind, dissipate cold, and relieve pain

主治: 外感头痛:头痛,恶寒恶风,肢体困重,脉浮。

Indications for externally contracted headaches: headache, aversion to cold and wind, heavy and cumbersome limbs, and a floating pulse

用法:一日一剂,温开水冲服。

Directions: one dose per day, decoct in boiling water and administer warm.

方义分析:菊花散风清热, 川穹、白芷祛风止痛,羌活除湿散寒,蔓荆子清头目止痛,甘草调和诸药。

Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) relieve pain. Notopterygium (qiang huo) eliminates dampness and dissipates cold. Vitex (man jing zi)  clears the head and eyes and relieves pain. Licorice (gan cao) harmonizes the formula.

加减:头痛而胀,发热而加石膏一包以助清热泻火之功。

Additions and subtractions: If there is pain, distention in the head and fever , add gypsum to help clear heat and drain fire.

内伤头痛一号方

Formula for the treatment of headaches due to internal damage

组 成 : 天 麻 一 包 (10g), 钩 藤 一 包 (10g), 石 决 明 一 包 (20g), 川 穹 一 包 (6g), 菊 花 一 包 (10g), 藁本 一 包 (10g), 当 归 一 包 (10g), 茯神 一 包 (10g), 蔓荆子一包(10g),甘草一包(3g)。

Ingredients: gastrodia (tian ma) 10g, uncariae (gou teng) 10g, abalone shell (shi jue ming) 20g, chuan xiong rhizoma (chuan xiong) 6g, chrysanthemum (ju hua) 10g, Chinese lovage (gao ben) 10g, Chinese angelica (dang gui) 10g, root poria (fu shen) 10g, vitex (man jing zi) 10g, licorice (gan cao) 3g.

功效:平肝养血,祛瘀止痛。

Function: Calm the liver, nourish the blood, dispel stasis, and relieve pain.

主治:内伤头痛势弱,时发时止,倦怠乏力,舌质红,苔薄黄,脉弦细。

Indications: Intermittent headaches that are due to internal damage, fatigue and lack of strength, red tongue, thin and yellow coating, fine and stringlike pulse.

方药:石决明潜镇以定肝阳上亢。 天麻、钩藤平肝熄风,菊花、蔓荆子、藁本、川穹清头目,祛风止痛。当归养阴补血, 茯神宁心安神,甘草调和诸药,共奏平肝养血祛瘀止痛之功。

Explanation: Abalone shell (shi jue ming) subdues and settles to calm ascendant hyperactivity of the liver Yang. Gastrodia (tian ma) and uncariae (gou teng) calm the liver and extinguish wind. Chrysanthemum, vitex, Chinese lovage and Chuan xiong rhizoma clear the head and eyes, dispel wind and relieve pain. Chinese angelica (dang gui) nourishes the Yin and supplements the blood. Root poria (fu shen) quiets the mind and spirit. Licorice harmonizes the formula.  Used together, this formula can calm the liver, nourish the blood, dispel stasis and relieve pain.

加减:气虚头痛甚者加人参一包(5g), 黄芪一包(10g),血虚者加熟 地养阴补血,痰浊甚者加半夏一包,健脾化痰,瘀血甚者加红花桃仁,增强活血化瘀。

Additions and subtractions: If the patient has Qi vacuity with severe headaches, add Ginseng (ren shen) 5g, astragalus (huang qi) 10g. If the patient has blood vacuity, add cooked rehmannia (shu di) to nourish the Yin and supplement the blood. If the patient has severe phlegm turbidity, add pinellia (ban xia) to fortify the spleen and transform phlegm. If the patient has severe blood stasis, add safflower (hong hua) and peach kernel (tao ren) to quicken the blood and transform stasis.

典型病例

Exemplar case

姓名:某某 性别:男 年龄:50岁 职业:务农

Male, 50 years old

就诊时间:2011年8月2日 发病季节:立秋

First visit: August 2, 2011. Onset of the disease: the beginning of Autumn

地址:山西襄垣
主诉:头痛如裹,肢体困重,恶风,面红目赤,渴喜热饮。

Complaints: the head is heavy as if wrapped, the limbs are heavy and cumbersome.  Patient has aversion to wind, red face and eyes, and a thirst with a desire for hot drinks.

四诊得之:面色少华,精神一般,舌质红,苔薄黄,脉浮。

Symptoms:  a lusterless complexion, a moderate essence-spirit, a red tongue, thin and yellow coating, and a floating pulse.

辩证:由于气候炎热,雨水连绵,致湿热之邪较盛,湿为阴邪,其性重浊,热为阳邪,其性炎上,湿热之邪外袭,上蒙清窍,故头痛如裹,肢体困重,舌红而赤,口渴喜饮。 脾主运化,主四肢,脾为湿困,故肢体困重。 苔薄黄,脉浮,为风热之邪炽盛之象。

Pattern identification: Hot weather and continuous rain bring about exuberant damp-heat evils. Dampness is a Yin evil. By nature it is heavy and turbid. Heat is a Yang evil. By nature it flames upward. If damp-heat evils attack the outer body, it will ascend upward to cloud the clear orifices. This is why the head feels heavy, as if it was wrapped; while, the limbs are heavy and cumbersome, the tongue is red, and the patient feels thirsty with a desire for fluids. The spleen governs movement, transformation, and the limbs. When the spleen is encumbered by dampness, the limbs will become heavy and cumbersome. When there is wind-heat evils present, the tongue will have a thin and yellow coating and the pulse will be floating .

中医诊断:外感头痛。

Diagnosis by Chinese medicine: headache due to external contraction (of evils).

治法:清热,祛湿,止痛。

Method of treatment: clear heat, dispel dampness and relieve pain.

方药:外感头痛一号方。

Formula: Formula for the treatment of externally contracted headaches

用法:,开水冲服,五剂,一日一剂。

Directions: Decoct in boiling water and administer warm. Five doses altogether. One dose per day.

分析:菊花祛风清热,羌活祛风胜湿,川穹, 白芷祛风止痛,蔓荆子清头目止痛,甘草调和诸药,口服五剂后症状好转,无其他不适症状。
Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Notopterygium (qiang huo) dispels wind and overcomes dampness. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) dispel wind and relieve pain. Vitex (man jing zi) clears the head and eyes, and relieves pain. Licorice root harmonizes the formula. After taking five doses, the condition improved and the patient had no other abnormal symptoms.

3. 讨论
依治疗原则看,外感头痛多属实证,治疗应以驱邪为主,因风者疏之,因寒者散之,因湿者化之,因热者清之。 内伤头痛,多属虚证,治疗以扶正为主。风阳侵袭则熄风潜阳,气虚则益气升清,血虚则养阴补血,肾虚则益肾填精,至于痰浊,淤血所致头痛,本虚标实,或先祛其实,或扶正驱邪兼顾。 但本人通过多年临床经验,简化了诊疗过程,把外感,内伤头痛进行综合分析,制出了外感头痛一号方、内伤头痛一号方, 以便更加方便的应用于临床实践,并且取得了良好的效果。 凡前来就诊的头痛的患者,需辨清外感,内伤,方可用上方。 请各位同仁辩证用之,有不妥之处, 请指正。

3. Discussion
Most externally contracted headaches belong to repletion patterns; therefore, the treatment should focus on expelling evils. Wind-evil should be coursed, cold-evil should be dissipated, damp-evil should be transformed, heat-evil should be cleared. Most headaches due to internal damage belong to vacuity patterns. The treatment should focus on supporting the upright Qi. If it is due to the invasion of wind Yang, extinguish the wind and subdue the Yang; if it is due to Qi vacuity, boost the Qi and upbear the clear; if it is due to blood vacuity, nourish Yin and supplement blood; if it is due to kidney vacuity, boost the kidneys and replenish the essence.  Headaches caused by phlegm turbidity and blood stasis are due to a vacuity at the root and a repletion at the branch. In treatment, the repletion should be expelled first, or simultaneously support the upright Qi and expel evil. After many years of clinical practice,  Shi Peiqing simplified the diagnostic and treatment process and created the two above-mentioned formulas. Clinically, he has achieved great results.  Before using these formulations, it is important to identify whether the headache is due to external contraction or internal damage .

中医中药与针灸治疗脱发150 例 – Fu Mei-hua’s Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

中医中药与针灸治疗脱发150 例 – Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

富梅华
Translated by Xu Zhi-jun & J. Heaverlo

关键词: 中医中药;针灸;脱发
Key words: Chinese medicine; herbs; acupuncture; hair loss

现代医学将脱发分为斑秃、脂溢性脱发、症状性脱发等多种。中医学也有很多记载,如隋代《诸病源候论》称为“鬼舔头”;明代《外科正宗》有油风记载。症状性脱发从中医理论来看,也属于油风范畴,其病因不同,但治疗上有相同的地方。笔者用中医药、针灸治疗脱发150例,疗效显著,现报告如下。

Modern medicine classifies hair loss into many various types; such as alopecia areata, seborrheic alopecia, and symptomatic alopecia. There are also numerous accounts of hair loss in the Chinese medicine classics. For examples, hair loss is called “demon-licked head” in “The Origin and Indicators of Diseases” of the Sui Dynasty. It is recorded as “oil wind hair loss” in “Orthodox Manual of External Medicine” of the Ming Dynasty. According to Chinese medicine theory, symptomatic alopecia should be categorized into “oil wind hair loss”. Although the disease pathomechanisms may vary, there are commonalities within the treatments. The author has treated 150 cases of hair loss with herbs and acupuncture, and achieved notable results. The following is a report of his findings.

•    一般资料

150例患者中男性80例,女性70例,年龄11-46岁。

1. General information
Among the 150 cases, there are 80 males and 70 females. The age ranges from 11 to 46.

•    治疗方法

2.1 中药治疗:健脾祛湿、清利湿热、养血生发为主:白术12g、茯苓12g、泽泻12g、生薏米30g、 升麻12g、丹皮12g、当归12g、川芎12g、鸡血藤15g、干生地12g、熟地12g、柴胡12g、首乌12g、焦三仙45g. 每日一剂,每日二次。湿服;如皮脂溢出过多者加赤石脂12g、侧柏叶12g、猪苓12g;如腰腿酸软、遗精盗汗、夜寐不安,加龙骨12g(先煎) 、牡蛎12g(先煎) 、乌梅12g;气虚加黄芪20g;如突然大把脱落,急躁易怒,加女贞子12g、旱莲草12g、钩藤12g等进行辩证论治。

2. Treatment

2.1 Herbs-  The therapy focuses on the following treatment methods: fortify the spleen, dispel dampness, clear heat, nourish the blood and promote hair growth.
White atractylodes (bai zhu) 12g,  poria (fu ling) 12g,  alisma (ze xie) 12g, coix (yi mi ren) 30g, cimicifuga (sheng ma) 12g, moutan (mu dan pi) 12g, Chinese angelica (dang gui) 12g, chuanxiong rhizoma (chuan xiong) 12g, spatholobus (ji xue teng) 15g, dried rehmannia (sheng di huang) 12g, cooked rehmannia (shu di huang) 12g, bupleurum (chai hu) 12g, flowery knotweed (shou wu) 12g, scorch-fried three immortals (jiao san xian) 45 g.   Cook one dose a day and take twice while it is warm.

If there is too much seborrheic production, add happoysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g, and polyporus (zhu ling) 12g.

If the patient has lumbar soreness and/or leg achiness, seminal emissions, night sweating, and restless sleep, add dragon bone (long gu) (predecocted) 12g, oyster shell (mu li): 12g (predecocted), and mume fruit (wu mei) 12g.

If the patient has Qi vacuity, add astragalus (huang qi) 20 g.

If there is great hair loss with irritability add ligustrum (nu zhen zi) 12g, eclipta (han lian cao) 12g, and uncaria (gou teng) 12g.

•    针灸法:以养血活血祛风、健脾祛湿生发为主:选穴:百会、风池、足三里、血海、
神门、内关。操作方法:以虚补实泻法针刺,除肝俞、肾俞针刺用补法外,其余配穴按实泄法针刺。

2.2    Acupuncture treatment principles are: quicken the blood, dispel wind, fortify the spleen, dispel dampness, and promote hair growth.

Selection of acupuncture points: GV-20 (one-hundred convergences), GB-20 (wind pool), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass).

Manual needling methods should be used to supplement vacuity and drain repletion. Use supplementation method on BL-18 (liver transport) and BL-23 (kidney transport). Use draining method on all other points.

•    疗效标准

痊愈:脱发症状消失,脱发试验阴性;好转:脱发症状减轻,脱发试验阳性;无效:
脱发症状未减,脱发试验阳性。

•    Standard of Curative Effect

Full recovery: the symptom of hair loss disappears, and the test result is negative;
Improvement: the symptom of hair loss is alleviated, and the test result is positive;
No effect: the symptom of hair loss remains the same, and the test result is positive.

•    治疗结果

痊愈140例,好转9例,无效1例。

•    Therapeutic effect:

Full recovery: 140 cases;
Improvement: 9 cases;
No effect: 1 case.

•    病例

王某,男,37岁,脱发2个月,患者自述平素工作紧张,平时皮脂溢出过多。 查:脱
发试验阳性,头皮瘙痒,毛发稀疏,头油多,精神欠佳,神疲乏力,夜寐不安,二便正常,舌淡苔白,脉眩滑。诊断:中医:油风(脾虚蕴湿,湿热互结);西医:脂溢性脱发。治疗以健脾祛湿,清利湿热,养血生发为主。处方:生白术12g、茯苓12g、生薏米30g、川皮解15g、车前子15g、泽泻15g、当归12g、首乌12g、川芎12g、黄芪20g、乌梅20g、羌活12g、升麻12g、黄芩10g、黄连12g、龙骨12g先煎、牡蛎12g、枳壳12g、丹皮12g、焦山楂15g、炒麦芽15g。水煎400ml,每次200ml,早晚两次湿服。配合针灸选穴:百会、风池、三阴交、足三里、血海、神门、内关、肝俞、肾俞、按虚补实泻法针刺,每日一次,治疗3d,症状有所减轻;患者腰酸,头晕,故原方加赤石脂12g、侧柏叶12g、枳壳12g、灸山芋12g,以助除湿行气、补益肝肾。按以上方法治疗22d,症状全部消失,随访三个月,未复发,告痊愈。

5. Case Study

Examination:  Mr. Wang is 37 years old. He has been experiencing hair loss for two months. His work is very stressful. He has a considerable amount of seborrheic production. The test for hair loss is positive. His symptoms include itchy scalp, scant hair, and excessively oily hair. He appears listless, has a lack of strength, and restless sleep. His stool and urine are normal. His tongue is pale with a white tongue fur. His pulse is stringlike and slippery.

Chinese medicine diagnosis: :  “Oil wind hair loss” due to spleen vacuity and damp-heat binding.

Western medicine diagnosis: seborrheic alopecia.  TCM treatment principles should be: fortify the spleen, dispel dampness, clear heat, disinhibit dampness, nourish the blood, and promote hair growth.

Therapy: fresh white atractylodes (sheng bai zhu) 12g, poria (fu ling) 12g, coix (yi mi ren) 30g, rhizoma dioscorea (bi xie) 15g, plantago seed (che qian zi) 15g, alisma (ze xie) 15g, Chinese angelica (dang gui) 12g, flowery knotweed (shou wu) 12g, chuanxiong rhizoma (chuan xiong) 12g, astragalus (huang qi) 20g, mume fruit (wu me) 20g, notopterygium (qiang huo) 12g, cimicifuga (sheng ma) 12g, scutellaria (huang qin) 10g, coptis (huang lian) 12g,  dragon bone (long gu) (predecocted) 12g oyster shell (mu li) 12g, bitter orange (zhi ke) 12g,  moutan (mu dan pi) 12g, scorch-fried hawthorne fruit (jiao shan zha) 15g, stir-fried barley sprout (chao mai ya) 15g.

(Combine herbs and 1200 ml of water).  Decoct in water until 400 ml. remain. Drink 200 ml twice per day.  Drink once in the morning and once in the evening.  Should be consumed warm.

Acupuncture treatment was used in combination. Selections of acupuncture points: GV-20 (hundred convergences), GB-20 (wind pool), ST6 (three Yin intersection), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass), BL-18 (liver transport) and BL-23 (kidney transport). Manual needling methods used should be supplement vacuity and drain repletion. Acpuncture is performed once a day.

After 3 days of treatment, the symptoms were alleviated to some extent. The patient also had sore and aching low back and dizziness.  Therefore additional herbs were utilized.  Additions include: halloysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g,  mix-fried dioscorea (zhi shan yu) 12g.  These additions may help dispel dampness, move the Qi, supplement the liver and kidney.

The symptom completely disappeared after 22 days of treatment.   After 3 months, the symptoms had not returned.

•    讨论

皮肤病虽发于皮肤,但常是和内脏有密切的联系,有诸内必形于外,运用中医理论,
对疾病进行综合分析、归纳、总结,找出皮肤病与肌体内脏的关系,正确的辩证施治,是治疗皮肤病的关键。方中白术、茯苓、生薏米、生侧柏、赤石脂、枳壳、川皮解、车前子、泽泻,健脾行气除湿;升麻、龙骨、牡蛎、乌梅、以收敛固涩、升阳安神、益精开胃;当归、川芎、鸡血藤、首乌、黄芪、丹皮益气养血活血,祛瘀生新;黄芩、黄连清热燥湿,清上焦头目之热;灸山芋补益肝肾;山楂、炒麦芽调理脾胃功能,使枢机功能得以改善;配合针灸针刺,疏通经络,调理脾胃肝肾功能。综观,使气血大和,毛发得以精血充养,则诸症消失。可见中药,针灸联合治疗脱发,疗效快,复发率低。

•    Discussion:

Although skin diseases manifest on the skin, they are often closely related with the viscera. According to Chinese medicine theory, the key to treating skin diseases is to find the relationship between the disease and the viscera, and then to administer treatment according to the pattern. In the therapy, atractylodes (bai zhu), poria (fu ling), coix (yi mi ren), arborvitae leaf (ce bai ye), halloysite (chi shi zhi), bitter orange (zhi ke), rhizoma dioscorea (bi xie), plantago seed (che qian zi), and alisma (ze xie) can fortify the spleen, move the Qi and dispel dampness. Cimicifuga (sheng ma), dragon bone (long gu), oyster shell (mu li), and mume fruit (wu mei) can astringe and secure, upbear the Yang, quiet the spirit, boost the essence and increase the appetite. Chinese angelica (dang gui), rhizome chuanxiong (chuan xiong)  spatholobus (ji xue teng), flowery knotweed (shou wu), astragalus (huang qi), and moutan (mu dan pi) can boost the Qi, nourish and quicken the blood, dispel stasis, and engender the new. Scutellaria (huang qin) and coptis (huang lian) can clear heat, dry dampness, and clear  heat on the head and eyes. Mix-fried dioscorea (zhi shan yu) can supplement the liver and kidney. Hawthorne fruit (shan zha) and stir-fried barley sprout (chao mai ya) can regulate the stomach.   Acupuncture can free the channels, and regulate the spleen, stomach, liver and kidney. The overall effect is to greatly harmonize the Qi and blood so that the hair can be nourished by the essence and blood.

施今墨的降血压十法 - SHI Jin-mo’s 10 methods for reducing blood pressure

Translated by XU Zhi-jun & J. Heaverlo

高血压是以特续性动脉压增高为主要表现,久而久之,可导致心,脑,肾等重要器官损害,其临床病状归于祖国医学“眩晕”,“头痛”病的范畴。其病因复杂,尤其与精神因素(忧思,恼怒等)关系密切,此外,禀赋不足,脏腑虚损,饮食劳卷等诸多因素均可引起阴阳失调,气血紊乱,络道不畅,血脉瘀滞。为了提高生活质量,健康长寿,务必降低血压,使其维持在一定的水平甚为重要。施今墨将降压之法概括为十法,分述如下.

The chief manifestation of high blood pressure is a continued elevation of arterial blood pressure.  Over time, this can lead to damage of the heart, brain, and kidneys, as well as other vital organs.  Its clinical symptoms belong to the Chinese medicine category of “dizziness” and “headache”.  The disease etiology is complex, especially when psychological factors (such as anxiety and anger) are intimately related.  In addition, natural endowment insufficiency, zàng fǔ organ vacuity and damage, exhaustion of food and drink, plus many other factors can lead to yīn yáng imbalance, qì and blood disorder, and blood stasis of the luò pathways.
In order to enhance the quality of life, health and longevity, it is necessary to lower the blood pressure and important to maintain a certain level.  Below is a summary of  SHĪ Jīnmò’s ten methods for reducing (blood) pressure.

(一)苦寒降压法
肝胆火旺,炎至于上,气血沸腾,并走于脑,遂有头疼如裂,青筋怒张,面红耳赤,烦热易怒,大便硬结,小便短赤,舌红,苔黄腻。治宜清肝泻火,苦寒折逆。方用三黄石膏汤,龙胆泻肝汤。药用黄芩,黄连,知母,生石膏,槐花, 蔚子,夏枯草,知母,黄柏等。

(1) Method of using bitter and cold medicinals to reduce pressure

Use bitter and cold medicinals when there is liver and gall bladder effulgent fire, upward flaring fire, qì and blood seething upward towards the brain.  Hence, there will be splitting headaches, sudden distention of veins, red complexion and ears, easy to anger, heat vexation, bowels which are hard and bound, urination that is short and dark colored, tongue that is red with a thin, yellow coating.
The appropriate treatment is to the drain liver and gall bladder with bitter and cold medicinals.  The exemplar formulas are sān huáng shí gāo tāng, and lóng dǎn xiè gān tāng.  The medicinals used are huáng qín, huáng lián, zhī mǔ, shēng shí gāo, huái huā, wèi zi, xià kū cǎo, zhī mǔ, huáng bǎi.

(二)调气降压法
按“气为血之师,血随气行,行有一息之不运,血有一息之不行”之理,运用降气,顺气之法亦是降压有效治法。方用旋覆花,代赭石,桔梗,枳壳,杏仁,薤白,佛手,香橼等。

(2)  Regulate the qì to reduce blood pressure

It is said that “qì is the commander of the blood, when qì moves blood moves, when qì stops  blood stops”.  To regulate the qì is an effective method for treatment.  Medicinals used are xuán fù huā, dài zhě shí, jié gěng, zhǐ ké, xìng rén, xiè bái, fó shǒu, xiāng yuán.

(三)息风降压法
适用于肝风内动,眩晕面赤,烦躁不宁,夜卧不安。治宜熄风降压。方用天麻够腾饮。药用够腾,天麻,槐花,菊花,羚羊角,水牛角等。

(3)     Extinquish wind to reduce blood pressure

This method is appropriate for use with liver wind internally stirring, with dizziness and a red complexion, vexation and agitation, restlessness, and inability to rest in the evening.
The appropriate treatment is to extinguish wind to reduce the blood pressure.  The exemplar formula is tiān má gòu téng yǐn.  Medicinals used include gòu téng, tiān má, huái huā, jú huā, líng yáng jiǎo, shuǐ niú jiǎo.

(四)镇逆降压法
适用于肝阳亢盛,血压甚高,头脑血管过于充盈诸症。治宜贝石重镇之品,以引血下行。方用镇肝熄风汤等。药用紫贝齿,紫石英,青龙齿,石决明,磁石,铁落,珍珠母,磁朱丸等。

(4) Settle counterflow to reduce blood pressure

This method is appropriate to use when there is liver yáng exuberance.  The blood pressure will be exceedingly high and the blood vessels of the head are excessively full.  The correct method of treatment is to select stones and heavy substances to settle, thereby, leading the blood downward.
The exemplar formula is zhèn gān xí fēng tāng.  Medicinals used are zǐ bèi chǐ, zǐ shí yīng, qīng lóng chǐ, shí jué míng, cí shí, tiě luò, zhēn zhū mǔ, cí zhū wán.

(五)化痰降压法
痰浊中阻,升降失常,眩晕头痛,头胀如裹,胸膈满闷,肢体麻木,言语不利,呕吐痰涎,苔白腻,脉弦滑。治宜和胃降浊,化痰降压。方用半夏白术天麻汤,十味温胆汤。药用半夏,竹茹,茯苓,白术,橘皮,远志,菖蒲,枳实,胆南星等。

(5)    Transform phlegm to reduce blood pressure

Transform phlegm to reduce blood pressure when there is turbidity obstructing the center causing abnormal upbearing and downbearing, dizziness, headaches, distention headaches as if bound, chest and diaphragm fullness and oppression, numbness of the limbs, inhibited speech, and vomiting of phlegm.  The tongue coating will be white and greasy.  The pulse will be bowstring and slippery.
The appropriate treatment is to harmonize the stomach, descend turbidity, and transform phlegm to reduce the blood pressure.  The exemplar formulas are bàn xià bái zhú tiān má tāng, and shí wèi wēn dǎn tāng.  Medicinals used are bàn xià, zhú rú, fú líng, bái zhú, jú pí, yuǎn zhì, chāng pú, zhǐ shí, dǎn nán xīng.

(六)滋阴降压法
肝肾阴虚,水不涵木,肝阳上扰,血随气升,血压增高。治宜滋阴降压。方用知柏地黄汤,杞菊地黄汤。药用枸杞子,菊花,白蒺藜,沙苑子,女贞子,旱莲草,知母,黄柏,生熟地,砂仁,杜仲,怀牛膝等。

(6) Enrich the yīn to lower blood pressure

When there is liver and kidney yīn vacuity, water will not be able to moisten wood and liver yáng will rise to harass the upper body.  The blood will follow the ascension of the qì thereby causing the blood pressure to increase.  The appropriate treatment is to enrich the yīn to decrease the blood pressure.  The exemplar formulas are zhī bǎi dì huáng tāng and qǐ jú dì huáng tāng.  Medicinals used would be gǒu qǐ zi, jú huā, bái jí lí, shā yuàn zi, nǚ zhēn zi, hàn lián cǎo, zhī mǔ, huáng bǎi, shēng shú dì, shā rén, dù zhòng, huái niú xī.

(七)通便降压法
适用于实热内积,升降失常(清阳不升,浊阴不降),腑行不畅。治宜通调腑气,泻热降压。方用承气汤。药用生川军,芒硝,瓜蒌,风化硝,枳实,厚朴,晚蚕砂,炒皂角子等。

(7) Open the bowels to reduce blood pressure

This method is appropriate for replete heat internally accumulating with abnormal upbearing and downbearing (the clear yáng will be unable to ascend while the turbid yīn will not be able to descend)  the bowels, therefore, will become blocked.
The appropriate treatment would be to open and regulate the bowel qì, drain heat to descend the blood pressure.  The exemplar formula would be chéng qì tāng.  Medicinals used are shēng chuān jūn, máng xiāo, guā lóu, fēng huà xiāo, zhǐ shí, hòu pǔ, wǎn cán shā, chǎo zào jiǎo zi.

(八)利水降压法
适用于气血紊乱,久久不愈,以致水液代谢障碍,兼见下肢水肿。治宜利水降压。方用真武汤,五苓散,二草丹。药用猪苓,冬瓜皮,冬瓜字,车前子,车前草,旱莲草,赤茯苓,赤小豆等。

(8) Disinhibit water to reduce blood pressure

This method is appropriate when the qì and blood have become chaotic with prolonged recovery.  Therefore, the water and fluids will become obstructed.  There will be concurrent lower limb swelling.  It is appropriate to disinhibit water to reduce blood pressure.  The exemplar formula is zhēn wǔ tāng, wǔ líng sàn, or èr cǎo dān.  Medicinals used are zhū líng, dōng guā pí, dōng guā zì, chē qián zi, chē qián cǎo, hàn lián cǎo, chì fú líng, and chì xiǎo dòu.

(九)通络降压法
络脉以通为顺,高血压之人,多有络脉不活之征,俗云:“久病入络”即是明证。治宜通络降压。方用六藤煎等。药用够藤,忍冬藤,海风藤,络石藤,青风藤,鸡血藤,桑寄生,桑枝,丝瓜络,炮甲珠等。

(9) Open the luò vessels to decrease blood pressure

The luò vessels can flow smoothly when they are unobstrcuted .  Among high blood pressure patients, many have improper circulation of the luò vessels.  It is said: “chronic disease enters the luò vessels”, (here) this is evident.  The appropriate treatment is to open the luò vessels to descend the (blood) pressure.  The exemplar formula is Six Vine Decoction (liù téng jiān).  The medicinals used are gòu téng, rěn dōng téng, hǎi fēng téng, luò shí téng, qīng fēng téng, jī xuè téng, sāng jì shēng, sāng zhī, sī guā luò, and pào jiǎ zhū.

(十)活血祛瘀降压法
高血压晚期多有血脉瘀滞征象,治宜活血祛瘀降压。方用血府逐淤汤等。药用桃仁,红花,当归,川芎,丹参,葛根,茺蔚子,夏枯草等。

(10) Quicken the blood and expel stasis to decrease blood pressure

In the later stages of high blood pressure many (patients) will exhibit signs of stasis in the blood vessels.  The appropriate treatment is to quicken the blood and expel stasis to reduce the blood pressure.  The exemplar formula is xuè fǔ zhú yū tāng.  The medicinals used are táo rén, hóng huā, dāng guī, chuān xiōng, dān shēn, gé gēn, chōng wèi zi, and xià kū cǎo.

加减法:眩晕加白薇汤(当归,党参,白薇,甘草);欲作中风者,加天麻,够藤,菊花,地龙;失眠,证属心肾不交者,加远志,菖蒲,酸枣仁,液交藤;心悸,心动过速者,加朱砂,琥珀,珍珠母,紫石英,仙鹤草,卧蛋草;心前区疼痛者,加檀香,降香,丹参,三七,蒲黄,五灵脂,蜈蚣,全蝎,乳香,没药等。

Methods for additions and subtractions:  If there is dizziness add bái wēi tāng (dāng guī, dǎng shēn, bái wēi, gān cǎo); if treating wind stroke add tiān má, gōu téng, jú huā, dì lóng; if there is insomnia and the pattern belongs to heart and kidney not communicating add yuǎn zhì, chāng pú, suān zǎo rén, yè jiāo téng; if there is palpitations or tachycardia, add zhū shā, hǔ pò, zhēn zhū mǔ, zǐ shí yīng, xiān hè cǎo, wò dàn cǎo; if there is precordial pain add tán xiāng, jiàng xiāng, dān shēn, sān qī, pú huáng, wǔ líng zhī, wú gōng, quán xiē, rǔ xiāng, mò yào.

古代医家对不孕症的认识 – The Ancient Chinese Doctors Understanding and Treatment of Infertility

古代医家对不孕症的认识

许淑怡’,叶骞’,叶平2壤 2009年4月第29卷第4期 JiLin Journey of Traditional Chinese Medicine 2009.v01.29.No.4

Translated by XU Zhi-jun & J. Heaverlo

[摘要]

中医对不孕症的认识源远流长,在中医古籍中,不孕症的病名有不孕、无子、绝产、断 绪、全不产等称谓。概括其对病因病机的认识有肾虚、瘀血、痰湿、经络为病、月经不 调、外感内伤等。辨证论治包括从肾论治、从气血论治、从瘀论治、从痰论治、从郁论 治,还有针灸疗法、外治法。在预防调护方面,有“男养精,女养血”“合男女必当其年” 的记载,并提倡调情志、节嗜欲。

The Ancient Chinese Doctors Understanding and Treatment of Infertility

Abstract:

Chinese medicine has a long history of understanding and treating infertility. In the ancient books of Chinese medicine, infertility syndrome is also referred to as “infertility”, “without offspring”, “breaking lineage”, and “complete infertility”. The causes of infertility and it’s pathomechanisms are summarized as: kidney vacuity, static blood, phlegm-damp, disease of the channel and network vessels, menstrual irregularities, and external contraction with internal damage. Pattern identification for determining treatment includes treating the kidneys, qi and blood, stasis, phlegm, and depression. Besides acupuncture and moxibustion, additional external treatments may also be applied. In regards to prevention and regulation, it is written that “a man should nourish his essence and a woman should nourish her blood”, as well as, “both men and women should begin sexual activity at an appropriate age.” It is also advocated to regulate one’s affect-mind and control one’s sensual desires. Key Words: infertility; pathomechanism; kidney vacuity; static blood; phlegm-damp; external contraction ________________________________________________________________________________________________ 不孕症是妇科的常见病,近年来全世界的不孕人数有增加的趋势。进入2l世纪的人类,更加关注自身的生殖健康和生育的权利,使不孕症的研究亟待深入。中医对不孕的认识源远流长,早在公元前11世纪《易经·爻辞》中即有“妇孕不育” “妇三岁不孕”等关于不孕不育的最早记载。现就古代医家对不孕的认识论述如下。

In gynecological medicine, infertility is a commonly seen disease. In recent years, the number of infertility cases globally has continued to increase. As we enter into the 21st century, men and women are increasingly paying more attention to their reproductive health, as well as, their right to pro-create. Therefore, infertility research has begun to search for a deeper understanding of this syndrome. Chinese medicine has a long history of understanding and treating infertility. The earliest writings about infertility and sterility can be found in the Yì Jīng·Yáo Cí 《易经·爻辞》(“Book of Changes-Trigrams”) from the 11th century B.C, where it describes: “the woman who carries a child but does not bring it forth” and “for three years the woman cannot carry a child”. This paper is intended to explore how ancient Chinese doctors understood and treated infertility.

1。病名追溯

《周易》最早提出不孕病名及不孕年限的界定。在中医古籍中,不孕的病名有不 孕、无子、绝产、断绪、全不产等称谓。如《素问·骨空论》云:“督脉者⋯⋯此为病⋯⋯其女子不孕”⋯。《素问·上古天真论》云:“七七,任脉虚,太冲脉衰少,天癸 竭,地道不通,故形坏而无子”。《脉经》云:“妇人少腹冷,恶寒久,年少者得 之,此为无子,年大者得之,绝产。”《诸病源候论》专列“无子”一条,对本病之病因加以探讨。《千金方》记载“妇人立身已来全不产,及断绪久不产三十年者”,将不孕分为全不产和断绪,前者即“原发性不孕”,后者相当于“继发性不孕”。

1. The evolvement of the disease name

The Yì Jīng《易经》(“Book of Changes”) was the first text to employ the name “infertility” and the first to define the age limit of infertility. In the ancient books of Chinese medicine, infertility is also referred to as “childless”, “without offspring”, “breaking lineage”, and “complete infertility”. For example, the Sù Wèn-Gú Kōng Lùn《素问·骨空论》(“Plain Questions· Treatise on Bone Hollow”) states, “When there is disease in the Governing Vessel…the woman cannot carry a child”. The Sù Wèn·Shàng Gǔ Tiān Zhēn Lùn 《素问·上古天真论》(“Plain Questions-Treatise of Heavenly Truth from Remote Antiquity”), states, “At the age of 49, the controlling vessel becomes vacuous, the great thoroughfare vessel starts to debilitate, the menstruation becomes exhausted, and the pathway becomes obstructed. Therefore, the body declines and cannot bear children”. The Mài Jīng《脉经》(“The Pulse Canon”) states, “If a woman has cold in the abdomen, feels aversion to cold for a long time, and is still in her youth, this will result in infertility. If she is older it will result in complete infertility.” In Zhū Bìng Yuán Hòu Lùn《诸病源候论》(“The Origin and Indicators of Disease”), the author recorded “infertility” as an entry and further explored the causes of this disease. The Qiān Jīn Fāng《千金方》(“Thousand Gold Pieces Formulary”) describes “a woman who physically is incapable of pregnancy”, and “a woman whom for more than thirty years has been unable to conceive”. Here it is divided into “complete infertility” and “breaking lineage”. The former is “primary infertility” and the latter is “secondary infertility”.

2 病因病机

2.1 肾虚

自《素问·上古天真论》提出“女子七岁,肾气盛,齿更发长,二七而天癸至,任脉 通,太冲脉盛,月事以时下,故有子”以来,肾为生殖之本的论点就为历代医家所认同。《圣济总录》云:“妇人所以无子者,冲任不足,肾气虚寒故也”,说明胞宫失于温煦,宫寒不能摄精成孕而成本病。傅青主也认为不孕之本在肾口,种子门载有不孕病因十条:“身瘦不孕、胸闷不思食不孕、下身冰冷不孕、胸满少食不孕、少腹急迫不孕、嫉妒不孕、肥胖不孕、骨蒸夜热不孕、腰酸腹胀不孕、便涩腹胀足浮肿不孕”,其中有6条论及肾,如“妇人有下身冰冷,非火不暖⋯⋯胞宫既寒,何能受孕⋯⋯胞胎之寒凉,乃心肾二火之衰微也。”指出肾火不足、胞宫寒冷致不孕。又有云:“况瘦人多火⋯⋯此阴虚火旺,不能受孕。”指出肾阴虚所致不孕;及肾气不足、膀胱气化不利致“便涩腹胀浮肿不 孕”等。

2. The Disease Causes and Pathomechanisms

2.1 Kidney Vacuity

As the Sù Wèn 《素问·上古天真论》(“Plain Questions· Treatise of Heavenly Truth from Remote Antiquity”) points out, “When a female reaches the age of seven, her kidney qì becomes exuberant, her teeth change and her hair grows. At the age of 14, her reproductive ability arrives, the controlling vessel opens, the great thoroughfare vessel becomes exuberant, the menstruation comes regularly, and she is able to bear children.” Since the time of the Sù Wèn《素问》(“Plain Questions”), the theory that the kidneys act as the root of reproduction has been widely accepted by the ancient physicians. The Shèng Jì Zǒng Lù《圣济总录》 (“Sages’ Salvation Records”), states, “A woman is childless because her thoroughfare and controlling vessels are insufficient and her kidney qì is vacuous and cold”. This seeks to explain that infertility is due to the uterus’s lack of warmth, and therefore, uterine cold leads to infertility. Fù Qīngzhǔ (傅青主) also agreed the root cause of infertility lies within the kidneys. Zhǒng Zǐmén (种子门) listed ten causes for infertility: “A woman can’t become pregnant if her body is thin; if she feels oppressed in the chest and does not want to eat; if her lower body is icy-cold; if she feels full in the chest and eats too little; if her lesser abdomen is distressed; if she is envious; if she is obese; if she has steaming bone syndrome and night fevers; if she has an aching lumbar and abdominal distention; or if she has difficult urination, abdominal distention and floating edema of the feet”. Among these, six causes have a relationship with kidneys. For example, “If the woman’s lower body is icy-cold and can’t become warm without fire…how can she become pregnant with uterine cold… uterine cold results from the debilitation of heart and kidney fire”. This clearly states that kidney fire insufficiency and uterine cold lead to infertility. It further reads “thin people have more fire. This is yīn vacuity with fire effulgence, which creates the inability to conceive.” This further points out kidney yīn vacuity leads to infertility; and insufficient kidney qì and inhibited bladder qì transformation leads to “infertility because of difficult urination, abdominal distention and floating edema”.

2.2 瘀血

《针灸甲乙经》提出瘀血是不孕之因,“女子绝子,坏血在内不下”。《医宗金鉴》云:“不子之故伤冲任⋯⋯或因积血胞寒热。”说明气血失和导致瘀血内阻,胞脉受 阻,冲任不通不能成孕口。《傅青主女科》云:“疝瘕碍胞胎而外障,则胞胎必缩于疝瘕之内,往往精施而不能受。”《石室秘录》云:“任督之间倘有瘕瘕之症,则精不能施,因外有所障也”,明确指出瘀血等有形之物可以阻碍精子通过胞络而影 响受孕。《张氏医通·妇人门》云:“因瘀积胞门,子宫不净,或经闭不通,成崩中不止,寒热体虚而不孕者。”又云:“妇人立身以来全不产。⋯⋯此胞门不净,中有瘀积结滞也。”亦持瘕瘕积聚可致不孕之观点。王清任善用活血化瘀之法,其从瘀论治不孕获奇效,从而论证瘀血确为不孕致病之因。

2.2 Blood stasis

Zhēn Jiū Jiǎ Yǐ Jīng 《针灸甲乙经》 (“The Systematized Canon of Acupuncture and Moxibustion”) proposes that blood stasis is the cause of infertility. “Female infertility results from the internal retention of spoiled blood”. Yī Zōng Jīn Jiàn《医宗金鉴》(“The Golden Mirror of Medicine”) states, “Infertility is because the thoroughfare and controlling vessels are injured… or because the uterus is both cold and hot due to accumulated blood.” This explains that infertility results from a disharmony of qì and blood, which leads to internal static blood obstruction of the uterine vessels, and of the thoroughfare and controlling vessels.  Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “Mounting-conglomeration impedes the uterus, which leads to external obstruction, and thus the uterus must retract into the mounting-conglomeration. More often than not, even though the semen is without defect, the uterus cannot be fertilized.” The Shí Shì Mì Lù 《石室秘 录》(“Secret Record in the Stone Chamber”) states, “If conglomerations exist between the controlling vessel and the governing vessel, the semen will be inhibited due to the external obstruction.” It is explained clearly that the tangible matter, such as blood stasis, is likely to impede the semen from passing through the uterine network vessels and thus affect the fertility. Zhāng Shì Yī Tōng·Fù Rén Mén 《张氏医通·妇人门》 (“Zhang’s Clear View of Medicine·On Women”), also supports the viewpoint that conglomerations can lead to infertility. “Some women can’t become pregnant because stasis accumulates at the uterine gate, the uterus is not clear, or because the menstruation is blocked and incessant flooding happens, furthermore, the constitution is weak due to cold and heat.” It again states, “A woman cannot be pregnant at all …because the uterine gate is not clear, and there is blood stasis accumulation within.” Wáng Qīngrèn (王清任) used the method of blood-quickening, stasis-transforming to treat infertility from blood stasis. Using this method he was able to obtain miraculous results. This exemplifies that blood stasis is indeed one of the main causes of infertility.

2。3 痰湿

朱丹溪首先提出痰湿可致不孕,《丹溪心法》指出:“若是肥盛妇人,禀受甚厚,恣于酒食之人,经水不调,不能成胎,谓之躯脂满溢,闭塞子宫”,他认为“肥盛妇 人,主脂膜塞胞”和“冲任伏热”都是导致不孕的原因。《济阴纲目》提出“痰饮不孕”和“胸中有实痰”的证治。傅青主亦有云:“妇人有身体肥胖,痰涎甚多,不能受孕者⋯⋯乃脾土之内病也⋯⋯不知湿盛者多肥胖,肥胖者多气虚,气虚者多痰涎⋯⋯夫脾本湿土,又因痰多,愈加其湿,脾不能受,必浸润于胞胎,日积月累且肥胖之妇,内肉必满,遮隔子宫,不能受精,此必然之势也。”

2.3 Phlegm-damp

Zhū Dānxī (朱丹溪) was the first to point out that phlegm-damp is likely to cause infertility. In the Dān Xī Xīn Fǎ《丹溪心法》(“Dān Xī’s Heart-Methods”) Zhū Dānxī (朱丹溪) points out, “Women who are overweight and thick, and those who indulge in wine and food, suffer from menstrual irregularities and cannot establish a pregnancy. This is because too much body fat will overflow and block the uterus.” According to Zhū Dānxī (朱丹溪) , “The fat layer of overweight women can congest the uterus”, as well as,“latent heat lies in their thoroughfare and controlling vessels”, both of which are causes of infertility. The Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn ”) put forward the patterns and treatments of “phlegm-rheum leading to infertility” and “replete phlegm in the chest”. The Fù Qīngzhǔ Nǚ Kē《傅青主女科》(“Fù Qīng Zhǔ: Gynecology”) also states, “If a woman cannot become pregnant, it is due to obesity and too much phlegm-drool, which originates from the internal disease of spleen-earth. Most of those with damp encumbrance are overweight, most of those who are overweight have qì -vacuity, and most of those who have qì vacuity have too much phlegm-drool. The spleen itself is damp, and too much phlegm will intensify this dampness. This will be too much for the spleen to bear and the fetus will be infiltrated. If occurring over a long period of time, the internal flesh will certainly become full; the uterus will be blocked and will not be able to become fertilized. This is an inevitable outcome.”

2.4 经络为病

《素问》云:“督脉生病,女子不孕。”提出不孕与经络的联系。《格致余论》主“血海太热。”《女科经纶》引朱丹溪言“妇人久无子者,冲任脉中伏热也⋯⋯内热则荣血枯。”经络之中,尤以冲任二脉最为重要,“冲为血海”“冲为十二经脉之海”。 能调节十二经的气血,“任主胞胎”,冲任损伤必然导致妇科诸疾。

2.4 Diseases of the channels and network vessels

The Sù Wèn《素问》(“Plain Questions”) states, “A female with the disease of the governing vessel cannot become pregnant.” This points out the relationship between infertility and the channels and network vessels. The Gé Zhì Yú Lùn《格致余论》 (“Further Treatises on the Properties of Things”) states, “The sea of blood is too hot.” The Nǚ Kē Jīng Lún《 女科经纶》(“The Classics of Gynecology”) quoted Zhū Dānxī (朱丹溪), “A woman will suffer from chronic infertility due to latent heat in the thoroughfare and controlling vessel, while internal heat leads to the desiccation of the luxuriant blood.” The thoroughfare and controlling vessels are the most important among the channels and network vessels. “The thoroughfare vessel is the sea of blood”, and “the thoroughfare vessel is the sea of the twelve channels, which can regulate the qì and blood of the twelve channels.” “The controlling vessel governs the uterus”. Damage to the thoroughfare and controlling vessels will inevitably result in gynecological diseases.

2.5 月经不调

不孕与月经不调关系密切,朱丹溪有言:“妇人无子者,多由血少不能摄精,经水不调,不能成胎”。《济阴纲目》较具体地论述了不孕与月经不调的表现:“每见妇人之无子者,其经必或前或后,或多或少,或将行作痛,或行后作痛,或紫或黑或 淡,或凝而不调,不调则血气乖争,不能成孕矣。”《景岳全书·妇人规》突出了月经与孕育的关系,提出“妇人所重在血,血能构精,胎孕乃成”及“妇人之病,当以经血为先”“经调则子嗣”的理论。清代医家王宏翰”1认为:“阴失其道而不能受胎者,乃气胜血衰故也,衰则寒热乘之,气凝血滞,营卫不和,则月水先后不调。”对女性不孕指出是“气盛血衰”所致,女性属阴,以血为主,血虚则不孕。

2.5 Menstrual irregularities

Infertility is closely related to menstrual irregularities. Zhū Dānxī (朱丹溪) once said, “In many cases, females cannot become pregnant because they suffer from blood scantiness and thus cannot receive essence, the menstrual flow becomes irregular and the woman is unable to conceive”. The Jì Yīn Gāng Mù 《济阴纲目》 (“Compendium of Helping Yīn”) gives a relatively specific exposition on the symptoms of infertility and menstrual irregularities, “Each time we see a female who is unable to conceive, it will be likely her menstruation is too early or too late, too heavy or too light, or there is pain before or after menstruation. The menstrual blood will be purple, black or pale, or congealed with clotting and irregular. Irregularity leads to the disharmony of blood and qì therefore leading to infertility.” The Jǐng Yuè Quán Shū·Fǔ Rěn Guī《景岳全书 ·妇人规》(“Jǐng Yuè’s Complete Compendium· Discourses on Women”), emphasizes the relationship of menstruation and pregnancy. It sates, “What is important to women is blood. Blood has the ability to create essence, henceforth pregnancy,” and “gynecological diseases are derived, firstly from menstrual blood”, “when there is regular menstruation, this will produce offspring.” According to Wáng Hónghàn (王宏翰), physician of the Qīng Dynasty, “When yīn loses its path, conception cannot occur. This is because qì is exuberant and the blood is depleted. Once debilitated, cold and heat break through, the qì will congeal and the blood will become stagnant, leading to the construction and defensive to become disharmonious. This leads to irregular menstrual flow.” This quotation illustrates how infertility results from “exuberant qì and debilitated blood”. Women are of yīn and are governed mainly by blood. Therefore, blood vacuity may lead to infertility.

2.6 外感内伤

不孕亦与外感六淫、内伤七情、房劳相关。明代薛己在《薛氏医案》中提出“妇女之不孕,亦有因六淫七情之邪,有伤冲任”的观点。《济阴纲目》云:“婢妾多郁,情不宣畅,经多不调,故难成孕”。《景岳全书》则阐述了情志致病的机理:“产育 由于气血,气血由于情怀,情怀不畅则冲任不充,冲任不充则胎孕不受”。清代陈修园《女科要旨》谓:“妇人无子,皆由内有七情之伤,外有六淫之感。或气血偏盛,阴阳相乘所致。”《冯氏锦囊秘录·女科精要》论述“妇人不孕亦有六淫七情之邪伤冲任,子宫虚冷,⋯⋯或血中伏热,⋯⋯或有积血积痰凝滞胞络”,指出情志可致本病,胞络受阻乃是不孕的一个主要成因。此外,生活失度亦可致不孕。《济阴纲目》指出“合男子多则沥枯虚人,产乳众则血枯杀人”。

2.6 External contraction and internal damage

Infertility is also related to external contraction of the six excesses, internal damage by the seven affects, and sexual taxation. During the Míng Dynasty, Xuē Jǐ(薛己) in his text Xuē Shì Yī Àn《薛氏医案》(“Xuè’s Case Histories”) points out, “In some cases, women’s infertility results from the evil of the six excesses and the seven affects, which injure the thoroughfare and controlling vessels. The Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn”) states, “The concubines have excessive depression, their affect-minds are blocked, they have excessive menstruation which cannot be regulated, hence it is difficult to become pregnant”. Jǐng Yuè Quán Shū《景岳全书》(” Jǐng Yuè’s Complete Compendium”) expounds the mechanism that the affect-mind can cause disease, “Childbirth depends on qì and blood, qì and blood depend on the affect-mind. If the affect-mind is not smooth this leads to insufficiency of the thoroughfare and controlling vessels, which leads to infertility.” During the Qīng Dynasty, Chén Xiū Yuán (陈修园), in Nǚ Kē Yào Zhǐ《女科要旨》(“The Main Points of Gynecology”) he states, “All infertility results from the internal damage of the seven affects and the external contraction of the six excesses, or from abnormal exuberance of qì and blood, and overwhelming of yīn and yáng.” In Féng Shì Jǐn Náng Mì Lù ·Nǚ Kē Jīng Yào《冯氏锦囊秘录·女科精要》(“Féng’s Embroidered Bag of Secret Records- Essentials of Gynecology”) expounds, “In some cases, infertility results from the damage of the thoroughfare and controlling vessels by the six excesses and the seven affects, the uterus is cold and vacuous, or there is latent heat in the blood, or accumulated blood and phlegm stagnating the uterine network vessels”. This points out that the affect-mind can bring about disease. Blockage of the uterine network vessels is one of the main causes of infertility. Furthermore, an intemperate lifestyle is also likely to cause infertility. Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn”) points out, “Excessive sexual activity exhausts the blood and weakens the body, excessive breastfeeding withers the blood and can lead to death”.

3 辨证论治

3.1 从肾论治

肾主生殖,从肾论治不孕者,如《千金翼方》云:“夫求子者⋯⋯并服紫石门冬丸,则无不得效矣。”《太平圣惠方》云:“治妇人血海久积虚冷,无子,阳起石丸方。” 紫石门冬丸、阳起石丸均为温肾暖宫之方,适宜肾阳虚衰,宫寒不孕者。傅青主则从。肾阴阳水火出发,提出补血生精、益气生精、温润添精、气中补阳、固摄肾精及阴阳并顾等治疗法则,《傅青主女科》云:“治法必须大补。肾水而平肝木,木旺则血旺,⋯⋯不特补血而纯于填精,精满则子宫易于摄精,血足则子宫易于容物,皆有子之道也。”又云有一类小孕妇人“饮食少思,胸膈满闷,终日倦怠思睡,一经房事,呻吟不已,人以为脾胃之气虚也,谁知是肾气不足乎⋯⋯治法必以补肾气为主,但补肾而不兼以补脾胃之品,则肾之水火二气,不能提于至阳之上也。”

3. Pattern Identification As The Basis For Determining Treatment

3.1 Determining treatment according to kidney patterns

The Kidneys govern reproduction. Some doctors put forward the viewpoint of treating infertility according to the kidneys. For example, the Qiān Jīn Yì Fāng《千 金翼方》(“Wings of the Thousand Gold Pieces Formulary”) states, “Those who want children have no reason to fail if taking together Zǐ Shí Mén Dōng Wán (紫石门冬丸).” While the Tài Píng Shèng Huì Fāng 《太平圣惠方》(“The Great Peace Sagacious Benevolence Formulary”) states, “Yáng Qǐ Shí Wán (阳起石丸) should be adopted to treat women’s enduring accumulated vacuity cold in the sea of blood causing childlessness.” Both Zǐ Shí Mén Dōng Wán (紫石门冬丸) and Yáng Qǐ Shí Wán (阳起石丸) are formulas that warm the kidneys and uterus. This is a suitable treatment for those who suffer from infertility due to debilitation of kidney yáng and uterine cold. Fù Qīngzhǔ (傅青主) from the perspective of kidney yīn and yáng, water and fire, put forward the principles of treatment of supplementing the blood to engender the essence, boosting qì to engender the essence, warming and moistening to replenish the essence, center the qì to supplement yáng, secure and contain the kidney’s essence, as well as yīn and yáng. Fù Qīngzhǔ Nǚ Kē《傅 青主女科》(“Fù Qīng Zhǔ: Gynecology”) states, “Infertility must be treated by greatly supplementing the kidney water and calming the liver-wood. Effulgent wood makes effulgent blood. This is not only for supplementing blood but also for replenishing essence. Sufficient essence and blood make it easier for the uterus to become fertilized. All of these are ways to aid conception.” The text further explains, some women who suffer from infertility “have little thought of food and drink, a sensation of fullness, oppression of the chest, fatigued and drowsy all day long, and groan incessantly after having sexual intercourse. This has been ascribed to qì vacuity in the spleen and stomach, when in fact it is actually due to kidney qì insufficiency and must be treated by supplementing the kidney qì. However, if you do not simultaneously supplement the spleen and stomach, the qì of the water and fire within the kidneys cannot rise up to the top of zhì yáng (阳之) (GV 9-extremity of yáng).”

3.2  从气血论治

从气血论治,调经为先者,如朱丹溪云:“求子之道,莫如调经。”《万氏妇人科》亦云“女子无子,多因经候不调⋯⋯调经为女子种子紧要。”《景岳全书》立“育麟珠”用于补气血调经,极效。《宋氏妇科秘书》立“百子建中丸”治“妇人久冷,赤白 带下,肚腹疼痛,经水不调”,方以“温中暖脐、调经开郁、开胃”为法,“服至半 月,必有孕矣”。王肯堂论不孕亦强调气血平和,调经种子,谓“滞者香附、缩砂、 木香、槟榔、桃仁、延胡。滞久而沉痼者吐之下之。脉证热者四物加芩连⋯⋯值至积去滞行虚回,然后血气平和能孕子也。”《沈氏女科辑要》也说:“求子全赖气血充足,虚衰则无子”。《妇科玉尺》认为“求嗣之术,不越男养精、女养血两大关键”,而“养血之法,莫先调经”,可用香附末醋丸、琥珀调经丸等治疗。傅青主疗不孕,亦重调护气血”,认为“不损天然之气血”“妊娠一门总以补养气血为主”。

3.2 Determining treatment according to qì and blood

Some doctors place regulation of the menses as the primary objective when determining treatment according to qì and blood diagnosis. For examples, Zhū Dānxī (朱丹溪) says, “No other method is better than regulating menstruation in order to become fertile.” Wàn Shì Fù Rén Kē《万氏妇人科》(“Wàn’s Gynecology”) also states, “In most cases, a woman cannot conceive because of irregular menses. Regulating menstruation is the vital point for a woman to become pregnant.” Jǐng Yuè Quán Shū《景岳全书》(“Jǐng Yuè’s Complete Compendium”) uses ” Yù Lín Zhū ” (育麟珠) to supplement qì and blood in order to regulate the menses, thereby achieving optimal results. The Sòng Shì Fù Kē Mì Shū《宋氏妇科秘书》(“Sòng’s Secret Book of Gynecology”) treats “women’s enduring cold, red and white vaginal discharge, abdominal pain, and irregular menstrual flow” with Bǎi ZǐJiàn Zhōng Wán (百子建中丸) (“Bǎi ZǐStrengthen the Center Pill”). The text suggests using the method of warming the center and navel, regulating menstruation and opening depression, as well as regulating the stomach in order to increase the appetite”. The text further states, “After taking for this prescription for half a month, pregnancy must occur”. Wáng Kěntáng (王肯堂), on the topic of infertility, also places emphasis on calming and harmonizing qì and blood and regulating menstruation. He says, “If qì and blood are stagnant, use xiāng fǔ (相府), suō shā (縮砂), mù xiāng(木香), bīn láng (槟榔), táo rén (桃仁), and yán hú (延胡). If the stagnation is enduring and chronic, let it vomited and precipitated. If the pulses and symptoms indicate heat then use these four agents with qín lián (芩连), then qì and blood will be calm and harmonious allowing for conception.” Shěn Shì Nǚ Kē Jí Yào《沈氏女科辑要》(“The Summary of Shěn’s Gynecology”) also states, “Pregnancy all depends on sufficient qì and blood. Debilitation leads to infertility”. According to the Nǚ Kē Yù Chǐ《妇科玉尺》(“The Jade Ruler of Gynecology”), “The methods to become pregnant do not contain more than two points: the male nourishes his essence and the female nourishes her blood.” “The first thing to do in order to nourish blood is to regulate menstruation”, xiāng fú mò cù wán (香附末醋丸) (Cyperus Rotundus Vinegar Pills) and hǔ pò diào jīng wán (琥珀调经丸) (“Amber Regulate the Menses Pill”) can be used for treatment. Fù Qīngzhǔ (傅青主) also attaches great importance to regulating and protecting the qì and blood. He warns, “Do not injure qì and blood”, “The first objective for fertility is to supplement and nourish qì and blood”.

3.3  从瘀论治

从瘀论治者,如《千金方》云:“女服紫石门冬丸及坐浴、荡胞汤,无不有子”“二三十年全不产育者,胞中必有积血,主以荡胞汤”,荡胞汤乃祛瘀血下积聚之药,在《千金方》为妇人求子第一方,“主妇人断绪二、三十年,及生来无子,并数数失 子”。王清任善用活血化瘀之法治疗诸多疾病,其论治不孕亦获奇效。

3.3 Determining treatment according to blood stasis

The Qiān Jīn Fang《千金方》(“Thousand Gold Pieces Formulary”) states, “No woman will fail to become pregnant if she takes zǐ shí mén dōng wán (紫石门冬丸) (Flourite and Ophiopogon Pill) along with the medicinal soak dàng bāo tāng,(荡胞汤) (Uterus Sweeping Decoction)”. The text continues to state, “those who have been infertile for 20 or 30 years…their uterus must have accumulated blood…which should be primarily treated with dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction)”, dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction) is for dispelling blood stasis and precipitating accumulation, which is taken as the first method for infertility according to the Qiān Jīn Fāng《千金方》(“Thousand Gold Pieces Formulary”). This formula is used for “treating those women who break lineage for 20 or 30 years, or who cannot become pregnant from birth, or who have miscarriages again and again”. Wáng Qīngrèn (王清任) was adept at treating many forms of diseases by using the method of quickening the blood and transforming stasis. He also gained extraordinary efficacy on treating infertility with this approach.

3.4 从痰论治

从痰湿论治者,朱丹溪首倡“躯脂满溢,闭塞子宫,宜行湿燥痰”。《冯氏锦囊秘录》立“启官丸”治“妇人肥盛,子宫脂满壅塞,不能孕育”,指出痰湿型应以启宫丸为主方,药简而效佳。《傅青主女科》云:“治法必须以泄水化痰为主。然徒泄水化 痰,而不急补脾胃之气,则阳气不旺,湿痰不去,人先病矣”,提出补脾化痰治不孕之法。

3.4 Determining treatment according to phlegm accumulation

Zhū Dānxī (朱丹溪) was the first to advocate “When the body is exuberant with fat, the uterus will be blocked. In this case, the method of moving dampness and drying phlegm should be adopted”. Féng Shì Jǐn Náng Mì Lù《冯氏锦囊秘录》(“ Féng’s Embroidered Bag of Secret Records”) lists qǐgōng wán (启官丸) (Uterus-Opening Pill) to treat “the infertile woman whose uterus is exuberant with fat and congestion”. It further points out that phlegm-damp infertility should be treated chiefly with qǐgōng wán (启官丸) (Uterus-Opening Pill), which is a simple but effective medicine. Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “this must be treated with the method of discharging water and transforming phlegm”.

3.5 从郁论治

情志不畅亦可致不孕,《济生方》提出疏肝解郁,养血理脾治女子不孕,云“妇女血衰而气旺,是谓夫病妇疹,皆使人无子。治疗之法,女子当养血抑气,以减喜怒。”《傅青主女科》云:“肝木不舒,必下客脾土而致塞”,使“胞胎之门必闭”而不能受 孕,“解肝气之郁,宣脾气之困,而心肾之气亦因之俱舒,所以腰脐利而任带通达,不必启胞脉之门,而胞脉自启”,并立“开郁种子汤”治疗嫉妒不孕。

3.5 Determining treatment according to depression

If the affect-mind is unsmooth, this can also lead to infertility. The text Jì Shēng Fāng《济生方》(“Life-Saving Formulas”) put forward the method of coursing the liver and resolving depression, nourishing the blood and rectifying the spleen to treat infertility. It states, “That when a women’s blood is debilitated and her qì is exuberant. This is referred to as “Fū Bìng Fù Zhěn” (夫病妇疹) (see foot note). This will certainly lead to infertility. As to the method of treatment, the female should nourish her blood and repress her qì, so as to reduce excess joy and anger.” Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “If the liver-wood is constrained, it will descend to invade the spleen-earth, leading to congestion”, thus “closing the uterine gate” making it unable to achieve pregnancy. If the depression of the liver qì is resolved and the encumbrance of the spleen qì is diffused, consequently, the qì of the heart and the kidney will also be soothed. Therefore, the waist and navel will become uninhibited, freeing the controlling vessel. The uterine vessel will then effortlessly open by itself”. The book also lists Kāi Yù Zhǒng Zǐ Tāng (开郁种子汤) (Depression-Opening Seed-Planting Decoction) for treating infertility due to jealousy.

4 其他疗法

4.1 针灸疗法

针灸能治疗部分功能性不孕症,如《医心方》载“治无子法:灸中极穴”。《千金要方》云:“妇人绝嗣不生,胞门闭塞,灸关元三十壮”。《针灸甲乙经》云:“绝子,灸脐中,令有子”。《针灸大成》云:“子宫二穴,在中极两旁各开三寸,针二寸,灸二七壮,治妇人久无子嗣”。《医学入门》载三阴交主“妇人月水不调,久不成孕”。《类经图翼》语:“阴廉:若经不调未有孕者,灸三壮即有子”。古人用针灸治疗的不孕证,以寒证为多,热证为少。对于寒证和虚证,则有使用灸法的倾向。《类经图翼》载:“神阙:妇人血冷不受胎者,灸此永不脱胎”。采用隔物灸者, 《医学入门》所隔之物为“彭祖固阳固蒂长生延寿丹”,用以治疗“久无生育,子宫极冷”之证,其组成药物具有温阳益气,行气走窜,活血壮肾,散寒祛风等作用,加上大剂量的灸疗,直至“遍身大汗”,故能取得一定疗效。

4. Other Methods of Treatment

4.1 Acupuncture and moxatherapy

Acupuncture can treat various situations of functional infertility. As Yī Xīn Fāng《医心方》(“Heart-Treating Formula”) states, “Method for treating infertility: moxa zhōng jí xué (中极穴)(CV 3-Central Pole Point)”. The Qiān Jīn Yào Fāng 《千金要方》(“A Thousand Gold Pieces Prescriptions”) states, “The reason a woman cannot give birth is because her uterine gate is blocked. Burn 30 cones of moxa at guān yuán (关元) (CV 4-Pass Head)”. Zhēn Jiū Jiǎ Yǐ Jīng《针灸甲乙经》(“The Systematized Canon of Acupuncture and Moxibustion”) states, “As to infertility, moxa qí zhōng (脐中) (CV 8-Center of the Navel) to allow for pregnancy”. Zhēn Jiū Dà Chéng《针灸大成》 (“The Great Compendium of Acupuncture and Moxibustion”) states, “Locate the two acupuncture points of the uterus, three inches beside zhōng jí (脐中) (CV 3-Central pole). Needle the two inch-point, and burn 27 cones of moxa. This method can treat a woman who has had no offspring for a long period of time”. According to the record of Yī Xué Rù Mén《医学入门》(“The Gateway to Medicine”), sān yīn jiāo (三阴交) (SP 6-Three Yīn Intersection) is in charge of “women’s chronic menstrual irregularities and infertility”. The Lèi Jīng Tú Yì 《类经图翼》(“The Illustrated Wings of the Classified Canon”) says, “If one cannot become pregnant because of irregular menstruation, burn 3 cones of moxa at yīn jí (壮即) (LV 11-Yīn Corner) and one will surely conceive”. Ancient Chinese practitioners more often treated cases of infertility due to cold patterns than those of heat patterns. They did so by administering acumoxatherapy. It is therefore intended to administer moxa to treat patterns of cold and vacuity. Lèi Jīng Tú Yì 《类经图翼》(“The Illustrated Wings of the Classified Canon”) records, “If the woman cannot become pregnant because of blood cold, moxa shén quē (神阙) (CV 8, Spirit Gate Tower) and then miscarriage won’t happen at all”. In Yī Xué Rù Mén 《医学入门》(“The Gateway to Medicine”), the formulation used is péng zǔ gù yáng gù dì chǎng shēng yán shòu dān (彭祖固阳固蒂长生延寿丹) (“stalk securing and life-extending elixir”), which can treat the symptoms of chronic infertility and extreme uterine cold. This formula has the effect of warming yáng and boosting qì, moving qì and penetrating, quickening blood and invigorating the kidneys, dissipating cold and dispelling wind. In addition, apply a great amount of moxa. The patient will “sweat profusely”. This is precisely why it is so effective.

4.2 外治法

《干金翼方》的记载说明当时已有阴道用药治疗不孕,“女服荡胞汤,及坐药,并服紫石门冬丸,则无不得效矣。”书中还详细记载了坐导药方的组成,使用方法。《外台秘要·求子法及方》所引《经心录》茱萸丸、《女科要旨》所载“广嗣方”,均为 阴道用药治疗不孕。古代还有“兜肚方”治疗不孕的记载,出自《医学入门》与《古今医统》两书,分别日:“久不受孕者,惟有孕者忌之”“兼丹田、神阙,令人有 子”。《古今医统》载有“保真种子膏”,将此膏“贴。肾俞,暖丹田,子午既济,百病自除,一膏能贴六十日,金水生时,用功即孕,大有奇效”,“贴六十日揭去,入房即孕”。

4.2 External method of treatment

The recording in Qiān Jīn Yì Fāng《干金翼方》(“Wings of the Thousand Gold Pieces Formulary”) illustrates that during this period, applications of external medicinal baths had been used to treat infertility. “The female won’t fail once taking dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction), together with zǐshí mén dōng wán (紫石门冬丸) (Flourite and Ophiopogon Pill). The book also records in detail the formula composition and instructions. Wài Tái Mì Yào·Qiú Zǐ Fǎ Jí Fāng 《外台秘要·求子法及方》(“Essential Secrets from Outside the Metropolis·The Methods and Formulas for Seeking Offspring”) quotes zhū yú wán (茱萸丸) (Evodiac Fructus Pill) from Jīng Xīn Lù《经心录》(“Records of Managing Heart”) to be used for cases of infertility. guǎng sì fāng (广嗣方) (Formula for Extending Descendants) is recorded in Nǚ Kē Yào Zhǐ 《女科要旨》 (“The Main Points of Gynecology”). Both of these treat infertility with the method of using external medicinal baths. In addition, dōu dǔ fāng (兜肚方) (Abdomen-Covering Formula) is also recorded to treat infertility. The formula can be found in Yī Xué Rù Mén 《医学入门》(“The Gateway to Medicine”) and Gǔ Jīn Yī Tǒng《古今医统》(“The Complete Compendium of Medical Works; Ancient and Modern”). They state respectively, “Those who cannot become pregnant for a long time will surely conceive”. They further project, “Treating dān tián (丹田) (Cinnabar Field) and shén quē (神阙) (Spirit Gate Tower) makes people pregnant”. The Gǔ Jīn Yī Tǒng《古今医统》(“The Complete Compendium of Medical Works; Ancient and Modern”), also records bǎo zhēn zhǒng zǐ gāo (保真种子膏) (True-Safeguarding Seed-Planting Paste) for external application. “Attach this paste on shèn shù (肾俞) (BL-23-Kidney Transport) to warm dān tián (丹田) (Cinnabar Field). Since selection of the zǐ wǔ (子午) (Midday-Midnight/Stem and Branch points) will have mutual benefits, once utilized, the hundreds of diseases will all be eliminated naturally”. One application can remain for up to sixty days. Once metal and water engenders, pregnancy will take place with little effort, thus proving to be extraordinarily effective.

5预防调护

《妇科玉尺》云:“求嗣之术,不越男养精、女养血两大关键。盖男精女血,因感而会,精成其子”,提出蓄精养血以利受孕。《褚氏遗书》提出男女双方应适龄而婚:“合男女必当其年。男虽十六而精通,必三十而后娶;女虽十四而天癸至,必二十而嫁”,其道理在于“皆欲阴阳完实,然后交合,则交而孕,孕而育,育而为子,坚壮强寿”,若“未笄之女,天癸始至,”就过早交合,则“交而不孕,孕而不育,育而子脆不寿”,指出了早婚对生育的危害性,提倡男女适龄而婚,为后世医家所认同。但婚育又要及时,不可过晚,《济生方》言:“男女婚姻,贵乎及时,夫妇贵乎强壮,则易于受形也”,并提倡调情志,节嗜欲,言:“女子应养血抑气,以减喜怒,男子益肾生精,以节嗜欲⋯⋯阴阳和平,则妇人乐有子矣。”《万氏妇人科》提出节欲以养 精:“故种子者,男则清心寡欲以养其精,女则平心定气以养其血。”《女科准绳》引袁了凡言:“天地生物,必有氤氲之时,万物化生,必有孕育之时⋯⋯凡妇女一月经行一度,必有一日氤氲之候,于一时晨间⋯⋯此的候也⋯⋯顺而施之则成胎矣。”指出欲受孕者,当交合有时。《性原广嗣》云【4 J:“凡夫妇交会之际,勿嗔怒而骄傲,勿醉饱,勿用房术,勿动邪恶之心。”告诫世人交合时要选择好时间、地点,要有好心情,男女融洽,自然而然,尤其强调不用房术,在四季、阴阳、寒暑、雷霆风雨变化时,对男女双方的心理和生理上产生影响,情绪受到干扰导致脏腑功能紊乱,对受胎不利。

5. Prevention and Regulation

Fù Kē Yù Chǐ 《妇科玉尺》(“The Jade Ruler of Gynecology”) states, “The way to seek descendants does not require more than two key points: men need to nourish their essence and women need to nourish their blood. Males’ essence and females’ blood will come together because of this interaction. It is the essence that makes the child”. The book puts forward the opinion that essence-amassment and blood-nourishment is primary to pregnancy. Chǔ Shì Yí Shū 《褚氏遗书》 (“Chǔ’s Collected Writings”) puts forward the idea that a man and a woman should marry at the correct age. “The male and the female must start sexual intercourse at the correct time. Although, starting to produce essence at the age of sixteen, a man must wait to marry until the age of thirty; even though the first menstruation arrives at the age of fourteen, a woman must wait to marry until the age of twenty”. This is because “if waiting to begin sexual intercourse until after both yīn and yáng are completely mature, the intercourse will be able to lead to pregnancy, the pregnancy can lead to childbearing, and the child will be strong and long-lived”. If “the under age female begins to have sexual intercourse at the time of the first menstruation”, “the intercourse cannot lead to pregnancy, the pregnancy cannot lead to childbearing, and if it does, the child will be fragile and short-lived”. The book points out the perniciousness of marrying too early in regards to childbearing, and advocates that both males and females should marry at the appropriate age. This idea has been widely accepted by physicians of later generations. Although marriage and childbearing should occur within an appropriate amount of time, it should also not occur too late. Jì Shēng Fāng《济生方》(“Life-Saving Formula”) states, “Marriage is valued for its timeliness, husbands and wives are valued for their robustness, which allows for ease in obtaining pregnancy”. The book also advocates to regulate one’s affect-mind and to control one’s sensual desires, “Females should nourish blood and repress qì in order to reduce excess joy and anger; males should boost the kidneys and engender essence in order to control sensual desires. If yīn and yáng are calm and harmonious, a woman will happily conceive.” Wàn Shì Fù Rén Kē 《万氏妇人科》(“Wàn’s Gynecology”) holds that essence should be nourished by controlling one’s desires: “the male should be pure of heart and have few desires in order to nourish his essence, the female should keep the heart and mind calm in order to stabilize her qì and nourish her blood.” Nǚ Kē Zhǔn Shéng《女科准绳》(“The Level-Line of Gynecology”) quotes from Yuán Liǎowán (袁了凡), “There must be a time of yīn-yáng interaction for the generation of heaven and earth. There must be a time of pregnancy for the transformation of the ten thousand things of creation. All women, who have regular monthly menstruation, must have one day of ovulation, which happens within a two-hour period. This is the period of ovulation. Taking advantage of this period of time for sexual intercourse leads to pregnancy.” This quotation points out that those who desire to conceive should have sexual intercourse at a very distinct and appropriate time. Xìng Yuán Guáng Sì《性原广嗣》(“The Principle of Sex and Descendants Extention”) states, “While having sexual intercourse, the husband and wife should refrain from anger and conceit. They should not be drunken and full. They should refrain from the use of fáng shù (房术) (intercourse techniques). They should also take care as to not have evil thoughts.” This exhorts couples to have intercourse at a good time and a good location. Both individuals should be in a happy mood, be on good terms, and maintain a natural approach, and absolutely refrain from using fáng shù (房术) methods. Also, sexual intercourse, in relation to the changing of the four seasons, yīn and yáng, cold and heat, thunder and lightening, wind and rain, are likely to affect the psychology and physiology of both men and women. Disturbed emotions are likely to result in the dysfunction of the bowels and viscera, which is unfavorable for pregnancy.

6 结语

不孕症涉及到每个婚姻、家庭的幸福,也同样是世界性的生殖健康问题。不孕症的发病原因多且复杂,古代先贤们对此形成了各家独到的认识,为我们积累了诸多宝贵的经验。临床对不孕症的治疗,除先天生理缺陷者以纠正缺陷为主要治疗外,多以辨证为本,借鉴古代医家的经验,综合考虑多方面的因素,改善全身状况,内外调适,身心同治,以达到助孕成胎目的。

6. Conclusion

Fertility is directly related to the happiness of every marriage and every family. It can be furthered considered a worldwide health issue. The causes of infertility are various and complicated. The ancient physicians, with their accumulated experience, established and put forth their original theories. Clinically, excluding those with genetic physiological defects, the treatment of infertility is mainly based on pattern identification. The best approach is to utilize the experience of the ancient physicians as a reference and comprehensively consider various factors. Treatment should be aimed to improve the state of the whole body, regulate both the internal and external, and treat both the body and mind, so as to attain the goal of conception and maintain a healthy pregnancy.

慢性阻塞肺病急性发作期的辨治要点 – The Treatment of Acute Phases of Chronic Obstructive Pulmonary Disorder

慢性阻塞肺病急性发作期的辨治要点
作者:周仲瑛

译者:何安杰  (美国谦益翻译公司)

The Treatment of Acute Phases of Chronic Obstructive Pulmonary Disorder

Author:  ZHŌU Zhòngyīng
      Translated by XU Zhi-jun & J. Heaverlo

慢性阻塞性肺疾病 (COPD, 简称慢阻肺)是具有气流阻塞特征的慢性支气管炎和(或)肺气肿。气流阻塞进行性发展,但部分有可逆性, 可伴有气道高反应性。慢性支气管炎,某些支气管哮喘患者, 在疾病进程中发展为不可逆性气流阻塞, 当支气管哮喘与慢性支气管炎和(或)肺 气肿重叠存在或难以鉴别时,也列入慢性阻塞性肺疾病范围。在慢性阻塞性肺疾病发展过程中,根据病情可分为急性加重期和稳定期。急性加重期,患者在短期内咳 嗽,喘息加重,痰呈脓性或黏液脓性,量明显增加,可伴发热等炎性表现。稳定期,患者咳嗽,咳痰,气短等症状稳定或症状轻微。

Chronic Obstructive Pulmonary Disorder (C.O.P.D) is a condition that is characterized by an obstruction of the pulmonary airflow. It is commonly seen with chronic bronchitis or emphysema.  Obstruction of the airflow is typically a progressive development, however some cases may be reversible. It is possible that an obstruction may accompanied by a hyperreactive airway.  Chronic bronchitis and some bronchial asthma patients, during the course of their illness, will develop irreversible pulmonary obstruction.  With bronchial asthma and chronic bronchitis patients, there may be some overlapping occurrences of emphysema, as well as the development of Chronic Obstructive Pulmonary Disorder.  This makes for difficulty in differentiating the separate diseases.  During the development process of COPD, it is possible to divide each case into one of three stages: acute stage, mid-term stage, and a stable stage.  In the acute and mid-term stage, the patient within a short period of time will develop coughing, panting, and gasping for breath that becomes increasingly severe.  There will be phlegm and pus, or sticky mucus with pus.  Symptoms will become increasingly obvious and possibly accompanied by fever and other inflammatory conditions.  During the stable stage, the patient will experience coughing, coughing with phlegm, and shortness of breath.  Symptoms will not increase in severity and will be relatively light in nature.

中医学把慢阻肺归于慢性咳嗽,喘证,肺胀等疾病。外邪侵袭,饮食不当,情志刺激,体虚劳卷等都可以导致慢性阻塞性肺疾病。急性期以实证邪盛为主,如风寒犯 肺,谈热,痰湿等蕴肺,缓解期以肺脾肾虚为主,兼有痰浊与瘀血阻肺。发作期治疗,主要集中在清热化痰,清热活血,化痰祛瘀,通腑泄热等方面,也有并用益气 活血,补肾健脾,温阳扶正者。对于缓解期治疗,基本以补肺,健脾,益肾为主,兼以祛邪。总之,通过临床观察证候规律大致为发作期多伴有热象,治以清热化痰 活血;迁延期多以痰,瘀,虚为主,治从化痰活血,兼加补益,或益气,或益气养阴,或助阳;缓解期以虚为主,兼有痰瘀,治疗在益肺健脾补肾基础上化痰,活 血。

Chinese Medicine categorizes COPD as chronic cough, panting, and lung distention.  In addition, external evil attack, improper diet, irritability, weak constitution, and fatigue can all lead to the development of COPD.  An acute-stage of COPD is governed by replete exuberant evils.  Such as, wind-cold invading the lungs, phlegm-heat, and phlegm-damp collecting in the lungs.

During the non-acute stages, , the organs governed by vacuity are lungs, spleen, and kidney.  Simultaneously, there will be phlegm turbidity and blood stasis obstructing the lungs.  In an acute stage, the chief concentration of the treatment should be to clear heat and transform phlegm, clear heat and quicken the blood, transform phlegm and expel stasis, open the  organs and drain heat.  In addition, boost the and quicken the blood, supplement the kidneys, strengthen the spleen, warm the yáng, and support the upright .
During a stable-stage, the treatment principles are to supplement the lungs, strengthen the spleen, and boost the kidneys while simultaneously expelling evil.

Furthermore, during an acute-stage, after completing an examination to determine the patterns for treatment, it is possible to find various overlapping signs of heat.  The treatment method is to clear heat, transform phlegm, and quicken the blood.  Periods of long delays between symptoms are governed by phlegm, stasis, and vacuity.  Therefore, the treatment principles are to transform phlegm, quicken the blood, while simultaneously supplementing and boosting, or boosting the , or boosting the  and nourishing the yīn, or assisting the yáng.

The stable-stage is governed by vacuity.  Additionally, there will be phlegm and stasis.  The treatment principles are to boost the lungs, strengthen the spleen, and supplement kidneys while employing a foundational treatment to transform phlegm and quicken the blood.

周民认为,慢性阻塞性肺病的临床表现主要为咳嗽,咳痰,气喘,属于中医学肺胀,痰饮,咳喘等病症范畴。主病之脏在肺,可累及脾,肾和心,病理性质多属标实本虚,寒热错杂,病机特点为肺虚痰瘀。  由于本病多为发作与缓解交替,发作期偏于标实,多属感受外邪诱发;缓解期偏 于本虚,多属脏气不足。本着急则治标,缓则治本的原则,应矛分别处理。慢性阻塞性肺病急性发作期以邪实为主,治疗重在缓解标急,外解表邪,内祛痰瘀,且应杂合。

ZHŌU Zhòngyīng believes the chief clinical manifestations of chronic obstructive pulmonary disorder are coughing, coughing with phlegm, and asthma.  He believes it belongs in the Chinese medicine disease category of lung distention, phlegm-rheum, coughing and panting.  The primary organs involved in this disorder are the lungs, exhaustion reaching the spleen, the kidneys, and the heart.  The main pathological nature is; repletion in the branch, vacuity at the root, cold and heat combined, lung  vacuity with phlegm, and stasis.

With COPD there will be an alternating between acute stages and periods of symptom relief.  During the acute-stage the branch becomes replete, mostly due to externally contracted evils.  During stable periods where there is relief from symptoms, there is a tendency towards the root being vacuous, which is largely categorized as organ insufficiency.  In the acute-stage treat the branch.  In the stable-stage treat the root.  There should be a clear distinction between the two methods of treatment.  Acute stages of COPD are governed by replete evils.  The chief objective of the treatment is to settle the acute branch by releasing the exterior and resolving external evils, while simultaneously expelling phlegm and stasis internally.

1。祛邪
久病咳喘,肺虚卫外不固,外邪每易反复侵袭,诱使急性发作。对外邪的班证,既应区别其寒热属性,分风寒,风热治疗,更要重视其内外合邪,同气相召,互为关联影响。如寒痰(饮)蕴 肺者易为风寒所乘,表现外寒内饮证,治当解表散寒,温肺化饮,方如小青龙汤;痰热郁肺者,易为风热所伤,治当解表清理,清肺化痰,方如越脾加半夏汤,麻杏 石甘汤;若外寒束表,肺热内郁,客寒包火,又当加重辛散解表药的药味和用量,如小青龙加石膏汤;若寒邪入里化痰,则当清肺化痰,入桑白皮汤。必须注意外邪 的病理性质,每与内在宿邪及体质有关, 阳虚寒痰蕴肺者,外邪易从寒化而表现为内外皆寒,甚至因机体外邪的反应能力低下,虽为感受邪热,仍可见邪从寒化者;阴虚痰热郁肺者,外邪又易从热化,表现 为表里皆热。基于反复感邪的病理根由是正虚,或耗气,或伤阴,若气虚可配党参,黄芪,太子参,阴虚可配沙参,麦冬,知母。治疗时要做到祛邪不忘扶正,但又 忌恋邪。

1.  Expel Evil
In chronic diseases of coughing and panting the lungs will become vacuous allowing for the defensive  and exterior to become insecure.  This insecurity will make it possible for wind evil to easily attack, thereby causing an acute episode.  When diagnosing the nature of the exterior evil pattern, one should clearly differentiate between either a hot condition or a cold condition.  Thereby, separating the treatment into either wind-cold or wind-heat.  Equally important, one must carefully inspect to determine whether the internal and external evils have mutually combined or if they are conjointly influencing one another.

For example, cold phlegm collecting in the lungs is easy to be taken advantage by cold evil.  It will manifest as a pattern of exterior cold with internal phlegm.  The treatment principles are to release the exterior and disperse cold, warm the lungs and transform rheum.  The exemplar formula is xiǎo qīng lóng tāng.

In cases of phlegm heat depressing the lungs it is easy for wind and heat to cause damage.  The treatment principles are to release the exterior and clear interior, clear the lungs and transform phlegm.  The exemplar formula is yuè pí jiā bàn xià tāng, and má xìng shí gān tāng.

With the diagnosis of external cold evil binding the exterior, lung heat internal depression, and guest cold binding heat, use acrid, dispersing, exterior resolving medicinals.  The exemplar formula is xiǎo qīng lóng tāng jiā shí gān tāng.

With cold evil entering the interior and transforming heat the treatment methods are to clear the lungs and transform phlegm.  The exemplar formula is sāng bái pí tāng.

It is very important to pay close attention to the pathological nature of the exterior evil. Each external evil has a particular relationship with evils currently lodged within the interior of the body.  In yáng vacuity with cold phlegm collecting in the lungs, an external cold evil readily transforms in to an interior-exterior cold pattern.  Even though the body’s ability to react is lowered and it has contracted an exterior heat evil, it is still possible to see the evil transforming from cold; In yīn vacuity with phlegm heat depressing the lungs, an externally contracted evil easily transforms into heat.  It will manifest as both internal and external heat.  When there is repeated contraction of external evils it will lead to a vacuity of the upright  or will eventually damage the yīn.  If there is  vacuity use dǎng shēn, huáng qí, and tài zǐ shēn.  If there is  yīn vacuity use shā shēn, mài dōng, zhī mǔ.  When treating, one should not only expel evil without forgetting to support the upright  but also separate from evil.

麻黄辛温解表散寒,宣肺止咳平喘,故为久病咳喘,感邪诱发之首先药,历来用治咳喘的麻黄类方甚多,且可根据辩证配药,较广泛地应用多种证候。如麻黄配石膏 辛凉宣泄,外解在表之风寒,内清肺经之郁热,适用于表寒里热证;配黄芩清宣肺热,适用于痰热郁肺,肺失宣降之证;配葶苈子泻肺祛饮,宣泄肺气,适用痰饮壅 肺,肺气上逆之证; 配大黄宣上导下,适用于肺胃热盛,痰饮壅肺,肺气不通之证;配五味子,散敛相合,适用肺虚气逆,寒饮内停,肺失宣降之证;配熟地滋肾平喘,适用于肺实痰 壅,肾阴亏耗,肺气上逆,肾虚不纳之证;配黄芪一散一固,宣肺平喘,益气固表,适用于寒痰阻肺,气虚卫弱之证。

Má huáng is acrid and warm.  It releases the exterior and disperses cold, diffuses the lungs, stops coughing, and arrests wheezing.  Therefore, it is appropriate to select this herb in chronic diseases of cough and panting or externally contracted evils. According to the individual diagnosis, má huáng may also be paired with other herbs and has a relatively wide range of suggested usage for many types of patterns.  For example, má huáng may be paired with shí gāo.  Where one herb is acrid, the other is cold.  Where one herb diffuses, the other drains.  Together, they release the exterior and expel wind-cold, while at the same time internally clear depressed heat in the lung channel.  It is suitable to use in cases of exterior cold with internal heat.  When combined with huáng qín, the pairs herbs are capable of diffusing lung heat and can be used with patterns of phlegm heat depressing the lungs, or lungs failing to diffuse and down-bear.  The combination of má huáng and tíng lì zi can drain lungs and expel phlegm-rheum, as well as diffuse and descend lung qi.  This combination of herbs is suitable for use with phlegm-rheum obstructing the lungs or lung qi counter-flowing upwards.  When combined with dà huáng, the combination can diffuse the upper and simultaneously guide downward.  It is appropriate to use with lung and stomach heat exuberance, phlegm-rheum obstruction and binding, and blocked organ Má huáng with wǔ wèi zi, where one herb disperses, the other astringes.  It is suitable to use with lung  vacuity with counter-flow, cold rheum internally collecting, and lungs failing to diffuse and descend.  Má huáng with shú dì enriches the kidneys and calms panting.  It is suitable in cases of lung repletion with phlegm stagnation, kidney yīn depleted and consumed, lung  counter-flow, and kidney vacuity not receiving.  Má huáng paired with huáng qí, where one herb disperses and the other herb secures.  Together they can diffuse the lungs and calm panting, boost the and secure the exterior.  This combination is appropriate for cold phlegm obstructing the lungs, and  vacuity with weakened defensive 

另一方面,特别要注意掌握麻黄治喘的禁忌证,如额头汗出清冷,心悸喘促,气短息弱,有喘脱征象者;痰少而黏,不易咯出,咽干,手足心热,舌红苔少或光剥,脉细数等肺肾阴液亏竭者;平素肝阳上亢,头痛眩晕者,均不宣用。

In addition, it is especially important to have a firm understanding of the contra-indications for má huáng in regards to its application of treating cough patterns.  For example, it is contra-indicated when there is sweating of the forehead with chills, heart palpitations, rapid panting, shortness of breath with weak inhalations,panting leading to desertion, small amounts of phlegm or sticky phlegm that is difficult to expectorate, dry throat, five palm heat, a red tongue with little coating or peeled; a rapid, thin pulse, or lung and kidney yīn fluid depletion and exhaustion.  Commonly, these patients will also have liver yáng overbearing with headaches and dizziness.  The use of má huáng is contra-indicated for use with all the above conditions.

2。涤痰
感受外邪诱致本病急性发作时,每因外邪引触肺中伏痰而致痰浊壅阻气道,肺气不 利,痰涌气闭,导致窒息危候,此时痰黏稠浊腻,难化难消,已属顽痰,老痰一类,故涤痰利肺最为当务之急。如能及时祛除气道的胶痰,通过吐利荡涤排出,则窒 息之势自可逆转,方如六安煎,三子养亲汤,葶苈泻肺汤,药如半夏,白芥子,桔梗,莱菔子,葶苈子,海浮石,礞石,泽漆,皂荚等,并伍沉香,苏子,陈皮,厚 朴顺气导痰。寒痰可加干姜,细辛,热痰加知母,黄芩,竹沥,肺热腑实加大黄,风化硝。

2。 Flush Phlegm
When the contraction of an external evil occurs it is possible for it to cause an acute episode of COPD.  No matter which external evil it is, it can lead to the lungs being overcome by phlegm or phlegm turbidity obstructing the air passages, which in turn causes the lung  to become inhibited.  The phlegm bubbles upward to obstruct the air circulation leading to choking sensations and other critical signs.  At this time the phlegm will be sticky, thick, turbid, greasy, difficult to transform, and difficult to eliminate.  This type of phlegm belongs to the category of “stubborn” phlegm.  Phlegm that has been retained for a long period of time is another example.  Therefore, the treatment must flush the phlegm and disinhibit the lungs.  It is important to promptly expel and eliminate the glue-like phlegm from the airways by means of vomiting or disinhibiting.  It is likely, once the phlegm has been expelled and cleaned up, that the sensation of choking will naturally resolve.  The exemplar formula is liù ān jiān, sān zi yǎng qīn tāng, tíng lì xiè fèi tāng, with medicinals such as bàn xià, bái jiè zǐ, jié gěng, lái fú zi, tíng lì zi, hǎi fú shí, méng shí, zé qī, zào jiá, together with chén xiāng, sū zi, chén pí, hòu po to assist in smoothing the  to help guide out the phlegmIn the case of cold phlegm add gān jiāng and xì xīn.  In the case of hot phlegm add zhī mǔ, huáng qín, and zhú lì.  When there is lung heat organ repletion add dà huáng or fēng huà xiā.

猪牙皂与皂荚同功而祛痰开闭尤佳,历来用于痰喘气闭,顽痰壅塞气道,黏稠难咯,胸满,气逆,闷塞绝之急症。虽属劫夺之品,劫有开上导下,利肺通腑之神功,周民用于咳喘壅气闭之实证,屡获奇效。每次用量2-3g,可入煎剂,或配入丸散中。入属痰热闭肺,喘促气粗,胸满胁胀,痰涎壅盛,甚则动风痉厥者,可用猴枣散(药物组成:猴枣,羚羊角,天竺黄,川贝,礞石,沉香,麝香,硼砂),清热豁痰,息风开窍。用法:每次服0。3-0。6g, 每日2次。验之临床,中药祛痰药颇具尤势,其疗效机理多端,轻者可化,可豁,进而可祛,可涤,甚者予以吐利攻逐。若能辩证选药,根据治痰药的性味,功用特点组方配药,合理使用,更能提高疗效。

Other herbs that are particularly effective in expelling phlegm and opening obstruction are zhū yá zào and zào jiá.  Historically these herbs are used with cases of; phlegm panting and  obstruction, stubborn phlegm obstructing the airways, sticky, dense and difficult to expectorate phlegm, chest fullness,  reversal, plus oppression and congestion that is inconsolable.  Even though these herbs belong to the category of “expelling” nevertheless they can miraculously open the upper and guide downward, disinhibit the lungs and open the zàng organs.  ZHŌU Zhòngyīng is able to repeatedly receive wonderful results when administering these herbs for repletion patterns such as coughing and panting, phlegm obstruction, and  blockage.  With phlegm heat obstructing the lungs with hasty panting, rough breathing, chest fullness, rib-side distention, phlegm-drool encumberance and congestion leading to stirring wind and tetanic reversal use hóu zǎo sàn (hóu zǎo, líng yáng jiǎo, tiān zhú huáng, chuān bèi, méng shí, chén xiāng, shè xiāng, péng shā) to clear heat, sweep phlegm, extinguish wind and open the orifices.  Directions: each dose administer 0.3g-0.6g, twice per day.
Through clinical examinations, Chinese herbal medicines have displayed outstanding potential for expelling phlegm.  The mechanisms by which its curative effects are attained are multi-fold.  They can gently gently transform phlegm, clear phlegm, even penetrate deeper to expel lodged phlegm.  Chinese herbal medicines are commonly used to expel phlegm and re-open air passages.  When selecting herbs according to the identified patterns, selections will be based on the herb’s nature, flavor and special characteristics. When used appropriately,they can increase the efficacy of treatment.

3。化痰
久病咳喘,痰浊潴留,肺气不利,治节失司,心血营运不畅,而致肺病及心,瘀血阻碍肺气,瘀滞心脉,表现久病入络,痰瘀互结同病的病理变化。不仅要痰瘀同治,且应重在治瘀。
若痰饮壅阻肺气,喘而气逆痰涌,胸部憋闷,胁肋胀痛,面黯,唇甲青紫,舌苔浊,质紫,脉细滑者,当化痰祛瘀,选用杏苏二陈汤合加味旋覆花汤,药如苏子,白芥子,葶苈子,法半夏,杏仁,桃仁,当归,旋覆花,茜草根,降香等。
如痰瘀壅肺,肺失吸清呼浊之职,浊邪害清,上蒙神机,以致神志淡漠,恍惚,烦 躁,昏昧,面黯,唇紫,喘促气逆,痰黏难咯,舌苔浊腻,质紫,脉细滑数,治当涤痰泄浊,化瘀开窍,选用涤痰汤合通窍活血汤,药如半夏,南星,天竺黄,炙远 志,陈皮,茯苓,菖蒲,郁金,丹参,赤芍,川芎,桃仁,红花,麝香等。

3. Transform Phlegm
In chronic illnesses of coughing and panting phlegm turbidity pools and lodges, therefore causing the lung  to become inhibited and lose its management and regulation. Cardiovascular transportation will become impeded as the lung disease reaches the heart.  Static blood will in turn obstruct the lung, as well as stagnate the heart channel.  Chronic disease manifests in the luò channels.  Phlegm and blood stasis will eventually combine and transform into one disease. In this situation it is not sufficient to merely treat the phlegm stagnation but it is equally necessary to treat blood stasis.
If phlegm-rheum obstructs the lung  there will be panting,  counterflow with phlegm regurgitation, chest oppression and stifling, rib-side distention and pain, and a dark complexion.  The lips and nails will be greenish purple.  The tongue coating will show turbidity and the tongue body will be purple in color.  The pulse will be thin and slippery.  The treatment principle is to transform phlegm and expel stasis.  The exemplar formula is xìng sū èr chén tāng with xuán fù huā tāng, with such medicinals as sū zi, bái jiè zǐ, tíng lì zi, fǎ bàn xià, xìng rén, táo rén, dāngg uī, xuán fù huā, qiàn cǎo gēn, jiàng xiāng. 

如痰瘀壅阻气机,脉络不通,气化失宣,津液失于输化,则可导致血瘀水停,身肿 足浮,腹满,喘急咳逆,心慌动悸,颈脉动甚,面唇,爪甲,舌质暗紫,脉来三五不调,表现肺心同病之候,治疗当重在瘀利水,药用苏木,泽兰,路路通,当归, 丹参,桃仁,茯苓,泽泻,汉防己,泽漆,万年青根,蟾皮,茶树根等。苏木咸能入血,辛能走络,功能活血祛痰消肿。参苏饮,取人参,苏木二味,一补肺气,一 降瘀血。周民常用苏木以治肺心喘满,咳逆胸胀,面浮色紫之症。泽漆辛苦而凉,功能行水消肿,祛痰散结,主药,用治喘咳痰多,身肿。周民曾用治肺心病房颤, 喘咳面浮,手臂肿胀之患者。而苏木与泽漆合用,祛痰散结以行水,相得益彰。

If there is phlegm-stasis obstructing the  dynamic, the vessels and network channels will become blocked causing the  transformation to lose its ability to diffuse.  Hence, there will be a loss of fluids and fluid transformation, which, in turn can lead to blood stasis with water collecting.  The entire body will be swollen and the feet will have floating edema. There will be abdominal fullness, rapid panting, cough with counterflow, flustered emotions, palpitations and stirring of the neck vessels.  The face, lips, fingernails, and tongue body will all be dark purple.  The pulse will be irregular.  In addition, there will be clinical manifestations of a lung and heart combined illness. It is important for the treatment to transform phlegm and disinhibit water.  Use medicinals such as sū mù, zé lán, lù lù tōng, dāng guī, dān shēn, táo rén, fú líng, zé xiè, hàn fáng jǐ, zé qī, wàn nián qīng gēn, chán pí, chá shù gēn.

Sū mù is salty and therefore capable of entering the blood.  Its acrid nature allows it to reach the luò vessels.  Its functions include quickening the blood, expelling stasis, and dispersing swelling.  The formula  shēn sū yǐn combines rén shēn and sū mù.  One herb boosts the lung  while the other descends bloods stasis.  ZHŌU Zhòngyīng often uses sū mù to treat lung and heart patterns characterized with panting and fullness, cough with counterflow, chest distention,and a facial complexion that is transient purple.
Zé qī  is acrid, bitter, and cool.  Its functions are to move water and disperse swelling, expel phlegm, and disperse binding.  It is mainly used to treat water swelling with lower abdominal fullness, phlegm-rheum, panting and coughing, plus scrofula patterns. Zé qī tāng utilizes zé qī as the chief ingredient to treat panting and coughing with copious amounts of phlegm and swelling of the entire body.  ZHŌU Zhòngyīng uses this formulation to treat lung and heart illnesses characterized by atrial fibrillation, panting and coughing, facial edema with hand and arm swelling, plus distention.  Furthermore, su mu and ze qi can be combined together to expel phlegm, disperse binding and move water.  As a pair herb combination they achieve a synergistic effect to maximize efficacy.

[周仲瑛。慢性阻塞肺病急性发作期的辨治要点。江苏中医药2006;27(7):5]