傅青主女科鬱證學術思想之研究

Study on Thought of Depression Pattern by Fu Qing Zhu Nu Kie

傅青主為清朝著名的醫家，其所著《傅青主女科》一書，近代學者相當重視，並常於期刊雜誌討論傅氏對婦科疾病的治病思想。本文旨在探討傅氏治婦科鬱證的學術思想及分析其用藥特點。 結果顯示，血虛肝鬱為婦科鬱證的主要病機，而婦人血虛主要因於肝脾氣血虧損及肝腎精血虛損。肝鬱有情緒因素及體質因素所致，可分肝氣鬱、肝氣逆，肝鬱化火，但傅氏對婦科鬱證總以養血柔肝健脾與解鬱為主要治則，而四物湯、四君子湯、逍遙散為治療的重要方劑，方劑中常顯示白芍、當歸、熟地、白朮等藥物大劑量的使用特點，而疏肝解鬱的主要藥物柴胡卻小劑量的使用，香附的使用為小劑量至中等劑量。此說明傅氏對婦科鬱證的用藥方法，與前賢醫家不同，如薛己使用逍遙散，白芍、柴胡劑量比例均為1:1，病機著重於情志致鬱，而傅青主之定經湯白芍與柴胡劑量比例為20:1，病機則著重於血虛肝鬱。

Fu Qing Zhu Nu Kie was written by Fu Qing Zhu who was a famous physician in Qing Dynasty. Fu’s thought for gynecological disease was appreciated and usually discussed in Chinese medical journal by modern scholars. The purpose of this study was to discuss Fu’s thought for treatment of women depression patterns and analyze the character of medication. The results demonstrated that the blood vacuity and liver depression were main pathology in gynecological depression patterns. Women’s blood vacuity was caused by vacuity of liver-spleen qi and blood, and as well as liver and kidney essence-blood vacuity. Emotion and constitutional factors influenced liver depression which may be divided to liver qi stagnation, liver qi counterflow, and liver depression transforming into fire. Nourishing the blood, emolliating liver, regulating the spleen and resolving depression were Fu’s main principles for treating gynecological depression patterns. Four Agents Decoction (si wu tang), Four Gentlemen Decoction (si jun zi tang) and Free Wanderer Powder (xiao yao san) were important formulas for treatment. Among Fu’s formulas for treating women depression patterns usually presented a character of large doses of white peony, tangkuei, cooked rehmannia, ovate atractylodes. There were some herbs to course liver and resolve depression. Among them, bupleurum was used in small dose, and cyperus was used in small to moderate dose. It suggested that Fu’s medication for gynecological depression patterns was different from previous scholars like Xue Ji in Min Dynasty. The ratio of white peony and bupleurum used by Xue Ji was 1:1 in Free Wanderer Powder because of the patholoy caused by emotional depression. But the ratio was up to 20:1 in Ding Jing Tang by Fu due to the blood vacuity and liver depression.