张伯礼教授临床治疗虚痹经验

Professor ZHANG Boli’s clinical experience in the treatment of deficiency Bi syndrome

关键词:  虚痹  中医药  名医经验  张伯礼

Key words:  Deficiency Bi syndrome  traditional Chinese medicine  famous physician experience  ZHANG Boli

摘要:

虚痹之病多由阴阳失调、气血亏虚而致寒湿痹阻、络脉不通，病势缠绵反复。张伯礼教授临证经验丰厚，于虚痹辨治尤具特色。文章整理张教授辨治虚痹经验，张教授认为其核心病机在于肾精不足、冲任虚损所致之阴阳两虚，复因虚致寒、寒湿痹阻、瘀痰互结，形成“不通则痛、不荣则痛”之候。治疗上以温阳为纲、扶正为本、通络为用，兼顾滋阴潜阳与祛风除湿，使补通相济、标本兼施。临证注重附子与姜类“走守相合”以温阳散寒，配伍二至丸等滋阴填精以燮理阴阳；善用八珍汤以气血双补；巧用藤类药与祛风除湿之品通络达邪，以期为复杂虚痹证候辨治提供参考。

Abstract:

Deficiency Bi syndrome is primarily caused by imbalance of yin and yang and deficiency of qi and blood，which lead to the obstruction of the meridians by cold and dampness and impaired circulation in the channels and collaterals. The condition is often chronic，lingering，and recurrent. ZHANG Boli has accumulated extensive clinical experience and has developed distinctive insights into the differentiation and treatment of deficiency Bi syndrome. This paper summarizes his clinical experience. Professor Zhang believes that the core pathogenesis lies in the insufficiency of kidney essence and deficiency of the Chong and Ren meridians，resulting in a dual deficiency of yin and yang. Subsequently，deficiency gives rise to cold，with cold-dampness obstructing the meridians and the interweaving with blood stasis and phlegm，thereby forming a pathological pattern characterized by “pain due to obstruction” and “pain due to malnourishment”.In treatment，warming yang is taken as the guiding principle，reinforcing vital qi as the foundation，and unblocking the collaterals as the therapeutic approach. Meanwhile，nourishing yin and subduing yang are combined with dispelling wind and eliminating dampness，thereby achieving a balance between tonification and dredging while addressing both the root and the manifestation. In clinical practice，special attention is paid to the combined use of Fuzi（Aconiti Lateralis Radix Praeparata） and ginger to integrate dispersing and consolidating actions for warming yang and dispelling cold. This is complemented by formulas such as Er Zhi Wan to nourish yin and replenish essence for harmonizing yin and yang. Bazhen Decoction is frequently used for dual tonification of qi and blood. In addition，vine-type herbs and wind-dampness dispelling medicinals are skillfully applied to unblock the collaterals and eliminate pathogenic factors. This study aims to provide a reference for the differentiation and treatment of complex deficiency-type Bi syndromes.