吳謙婦科心法學術思想之研究

STUDY OF GYNECOLOGICAL THOUGHT BY WU QIAN'S FU-KE-XIN-FA

醫宗金鐘婦科心法鳥，青朝著名醫家其謙所編，其氏婦科學術思想，認為月經乃來自於先夭夭癸與後天精血的滋養，女于十四歲天癸呈，乃先天癸水中之動氣至於女子胞中所致。其氏婦科治病思想，五張月經忽期應從氣血虛實調治，崩漏治療宜用補虛消瘀清熱之法，帶下應著重于宮寒熱與肺脾腎虛之洽，好婊期間必須時時保護胎原為耍，產後疾病治療有血虛與血瘀之辨i澄。其氏婦科用藥的特色，調經辨證善用溫補之劑，血崩氣陷主用防脫升補之法，前陰病證講究內月且外治並用，溫補安胎童不削年腎氣血用辯，產後迴乳宜注意十全大補湯與兔懷散的應用不同，產後發熱需分血i恥、陰傷與亡陽的治療方式不同。此外，其氏對產後羊水或血搓搓塞所引起的產後「真心痛」、「氣喘」、「不語」、「妄言見鬼發狂」等危極重症之急救方，實值得臨床加叫研究。Fu-Ke-Xin-Fa in the book of Yi-Zong-Jin-Jian was compiled by Wu-Qian, a famous physician of the Qing Dynasty. In the field of gynecology, Wu believed that the menses was originated from congenital Tian-Gui and nourishment of acquired essence and blood. The arrival of Tian-Gui in the female at the age of fourteen was the result of qi moving in the congenital Tian-Gui to the uterus. In his approach to the treatment of women's disease, Wu treated menstrual irregularity by correcting vacuity and repletion of qi and blood. He treated abnormal uterine bleeding by the method of supplementing vacuity, dispersing stasis and clearing heat. In leukorrhea, he placed importance on uterine cold and heat patterns, as well as lung, spleen and kidney vacuity. During pregnancy, he considered protection of the fetus to be key point. He considered postpartum disease to be mainly caused by blood vacuity and blood stasis. The characteristics of Wu's use of medicinals in gynecological disease was his skill in using warming and supplementing recipes. To treat qi fall caused by massive uterine bleeding, he used the method of preventing shock and of raising and supplementation. In the treatment of pudendal disease, he combined oral and topical treatment. When warming and supplementing the fetus, he paid attention to using spleen, kidney, qi and blood medicinals. To promote weaning, he used ShiQuan- Da-Bu-Tan and Tu-Huai-San. In the treatment of postpartum fever, he had different prescriptions depending on whether the causes was blood stasis, damage to yin, or yang collapse. Wu's resuscitative decoctions for critical and severe postpartum diseases, for example, true heart pain, asthma, aphasia and delirious mania resulting from causes understood in modern medicine as postpartum amniotic fluid embolism or thrombus embolism, are worthy of clinical research.