唐千金婦人方與宋明溫補學家治療月經病溫補袪瘀用藥之研究

Comparism of Warm-supplementary and Stasis-dispelling Medications Between Gian Jin Fu Ren Fang and Warm-supplementary Scholars of Song-Ming Dynasty in Treating Menstrual Disease

孫思邈是唐朝著名醫家，所著《備急千金要方》，其中有〈婦人方〉分上、中、下三卷。孫氏學術思想深受仲景與巢氏《諸病源候論》的影響，治婦人病以溫補袪瘀為主，開宋、明溫補學派婦科調經思想之先河。本文旨在比較《千金‧婦人方》與、宋明溫補學家陳自明、薛己、張景岳治療月經病之學術思想及溫補袪瘀用藥的異同。 結果顯示，四位醫家調經思想，均以溫補為主。在用藥上，孫氏、陳氏均重溫經散寒，薛己與景岳則重溫補脾腎。惟薛己偏重調補肝脾；景岳則偏重溫補腎與命門，而辛溫散寒藥物已很少使用。至於袪瘀藥，孫氏常用破血攻堅藥，尤其善用蟲類藥，陳氏善施活血化瘀藥，尤其是對蟲類藥，已較孫氏減少許多；薛己與景岳則活血化瘀已甚少使用。此四位醫家治療月經病的方法，近代學者應用在痛經、不孕症、和子宮內膜異位症等，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，則各具有其特色。

Sun Si-Miao was a famous physician in Tang Dynasty. His great work, Bei Ji Gian Jin Yao Fang, included a part named Fu Ren Fang, which was divided into upper, middle, and lower volumes. Affected by Zhang Zhong-Jing in East-Han Dynasty and Chao’s Zhu Bing Yuan Hou Lun in Sui Dynasty, he treated gynecological diseases by mainly warm-supplementary and stasis-dispelling methods and enlightened warm-supplementary scholars in Song and Ming Dynasty in regulation of menses. The purpose of the study was to compare the thought of treating diseases of menses and variation of warm-supplementary and stasis respelling medication between Gain Jing Fu Ren Fang and warm-supplementary scholars including Chen Zi-Ming, Xue Ji, Zhang Jing-Yue in Song-Ming Dynasty. The results demonstrated the four physicians’ warm-supplementary thoughts of menses regulation were all the same. Sun and Chen appreciated warming the channels and dissipating cold whereas Xue Ji and Jing-Yue appreciated warming and supplementing the spleen and kidney. However, Xue Ji preferred to regulate and supplement the liver and spleen and Jing-Yue preferred to warm and supplement the kidney and the life gate. They both seldom used warm acrid and cold-dissipating herbs. As for the stasis-dispelling medicinal, Sun often used blood-breaking and hardness-attacking herbs, especially the warm medicinal. Blood-quickening and stasis-transforming medicinal, especially worm herbs, was used less by Chen than Sun and seldom applied by Xue Ji and Jing-Yue. The four physicians’ methods of treating menses diseases can be applied by scholars nowadays to treat dysmenorrhea, infertility, endometriosis and various gynecological diseases. There was significant effect to treat organic menstrual diseases by Sun’s method. There were individual characters in Chen’s, Xue’s and Jing-Yue’s principles for identifying patterns and administering treatment of functional menstrual diseases.