劉完素治療婦科疾病運用四物湯加減法探析

Si-Wu Decoction for Gynecological Disease Used by Liu Wan-Su

金元醫家劉完素在婦科靈活運用四物湯的治療思想，對後世醫家啟發甚多。本文旨在透過劉完素運用四物湯之藥物加減法，瞭解劉完素的婦科學治療思想。本文歸納及分析劉完素《黃帝素問宣明論方》、《素問玄機原病式》、及《素問病機氣宜保命集》三書中含有四物湯組成之加減藥物頻率、性味及歸經，並探討劉完素運用四物湯之加減法及其婦科學術思想。以四物湯為底的方劑共計24個方、45味加減藥物。出現頻率為最高的加減藥物為白朮、甘草、黃芩、茯苓；藥物以溫性偏多，佔44.4%，寒性藥則佔37.8%。加減藥物中苦、辛、甘味分佔64.4%、57.8%、及35.6%；藥物歸經則是以脾（51.1%）、肺（48.9%）、肝經（48.1%）為最多。劉完素運用四物湯加減方治療婦科疾病不僅重視女子以脾為後天的學術思想，亦重視女子情志化火的特點，多選擇補脾養血、疏肝解鬱藥來治療婦女諸疾病。此外，劉完素雖被後人尊崇為「寒涼派」的始袓，但選擇四物湯加減藥時，不唯以寒涼藥攻邪為論。

Liu Wan-Su, a famous physician in Jin-Yuan Dynasty, treated postpartum and menstrual disease with modified Si-Wu Decoction, and inspired physicians of generations. Aim of this study is to realize the gynecological thought of Liu Wan-Su through his modified formula of Si-Wu Decoction. Liu Wan-Su wrote three book named “Prescriptions and Expositions of Huangdi’s Plain Questions”, “Exploration to Mysterious Pathogenesis and Etiology Based on the Plain Questions”, and “Su Wen Bing Ji Qi Yi Bao Ming Ji”. We summarized and analyzed the frequency, natures, flavors, and meridian entry of addition medicines of modified Si-Wu Decoction in these books to discover Liu Wan-Su’s ideas in gynecology. There were totally 24 decoctions with 45 addition ingredients which derived from modified Si-Wu Decoction. The most frequently medicine added on Si-Wu Decoction was Atractylodes, followed by Liquorice, Baikal Skullcap, and Poria. Among these formulas, 44.4% of add-on medicines were warm and 37.8% were cold. The bitterness, pungency, and sweetness were counted for 64.4%, 57.8%, and 35.6% of addition medicines, respectively. 51.1% of these medicines belonged to Spleen meridian and 48.9% to Lung meridian. Through this study, we found Liu Wan-Su frequently chose spleen-tonifying and liver qi-soothing medicines added in Si-Wu Decoction, which implied Liu attached importance to acquired Qi and moodiness transforming into fire while treating gynecological disease. In addition, although Liu the first proposed “fire-heat mechanism”, he did not always add cold ingredients on Si-Wu Decoction.