「傅青主」致婦科病症：病因與肝鬱病理機轉

目的：鬱症是中醫辨證理論相當重要的課題，本文主旨在探討《傅青主女科》中肝鬱病機所致婦科的相關病症。方法：本文以人民衛生出版社2006年出版之《傅青主女科》為研究資料藍本，以關鍵字「肝」、「鬱」、「肝氣」做全文搜尋，將傅青主於帶下、調經及血崩各門婦科病症條文，彼此做交叉比對分析，探求傅青主對肝鬱病機致婦科病症的觀點。結果：《傅青主女科》中，婦科病症四門28條條文中，其中帶下門5條中有4條，調經門14條中有8條，血崩門7條中有1條，分別是白帶下、青帶下、黃帶下、赤帶下、鬱結血崩、經水先後無定期、年老經水復行、經水忽來忽斷時疼時止、經水未來腹先疼、行經後少腹疼痛、經前腹疼吐血、經前大便下血及年未老經水斷。結論：傅青主對於肝鬱病機導致婦科病症的思想及辨證，多著重在肝經氣血以及脾、腎三臟之間的關係，並特別重視調經，將月經時間之準與不準、量之多寡、痛之有無三者歸類為肝鬱造成月經不調的辨證準則；帶下病在病理機轉的發展過程，首先是任、督脈病，進而影響導致帶脈的病症，提出了肝、脾、腎與經絡及奇恆之府間的中醫病理機轉，中醫婦科醫師若能精通帶下門及調經門之肝鬱病理辨證及機轉，則於診治現今生活型態下婦女的諸多病症，不難入手，傅青主於肝鬱致病的論點，實具有臨床婦科診病很高的參考價值。結論：《傅青主女科》一書中，每論一病一症，必探其病因，靈活運用《內經》之理，妙解各症病因病機，對病因病機分析，都能提綱挈領，扼要得當，傅青主使後世醫家能見病知源，便於臨床掌握，其推演論理的獨到功夫，可以成為後世習醫者一個很好遵循的模式。

關鍵字

肝鬱體質；鬱症；傅青主

並列摘要

Objective: Stagnation syndrome is a very important topic in the concept and proof of Traditional Chinese Medicine (TCM). This article aims to explore the discourse of ”Fu Qing Zhu Gynecology” on stagnation syndrome and the etiology and pathogenesis related to woman diseases. Methods: This study was based on the ”Fu Qing Zhu Gynecology” published in 2006 by People's Medical Publishing House. Full text search showed four gynecology related chapters in Fu Qing Zhu Gynecology with 28 syndrome clauses and among there, 13 clauses were related to stagnation syndrome. Result: More than half of the clauses pertain to the pathogenesis of stagnation syndrome in the chapter of Leucorrhea and Regulation of Menses. Fu Qing Zhu put special emphasis on regulating menses, and considered punctuality and quantity of menses and presence of dysmenorrhea as crucial guidelines in differentiating the pattern of abnormal menstruation resulting from liver stagnation. For the pathogenesis of leucorrhea, the Dai meridian pathology is induced by dysfunction of Ren meridian and Du meridian in advance. He suggested a pathological mechanism involving liver, spleen, and kidney organs, meridians and extraordinary organs. Should TCM gynecologists become well-versed with the pathology, pattern differentiation and mechanism of liver stagnation in the chapters of Leucorrhea and Regulation of Menses, it would be easy to master the treatment principles in other chapters of the book. Conclusion: In addition to pursuing the causes of symptom and disease, ”Fu Qing Zhu Gynecology” also draws ”Huangdi Neijing” to interpret the etiology and pathogenesis of each symptom. In doing so, Fu Qing Zhu helps future physicians to identify and grasp the true cause of diseases. The uniqueness of Fu Qing Zhu's in inferring the pathogenesis serves a good TCM learning model for future physicians.