温经汤“下利”原意考辨及临证应用拓展

Textual investigation into the original meaning of “Xiali” in Wenjing Decoction and expansion of its clinical applications

关键词:  金匮要略  下利  温经汤  原意考证  应用拓展

Key words:  Jin Gui Yao Lüe  xiali  Wenjing Decoction  investigation of original meaning  expansion of clinical applications

摘要:

《金匮要略》温经汤作为妇科调经之常用方，具有温经散寒、养血化瘀之功，张仲景对该方主治的描述为“病下利数十日不止”，其中“下利”的含义后世医家有不同的见解，大致可分为“前阴下血”“后阴下利”“下阴产物总称”3类。文章将结合“下利”称谓的流变过程及后世医家对其病机、方证之论述，结合温经汤的现代临床应用及机制研究，明晰原文所指，并拓展该方在围绝经期综合征及内科杂病方面的应用，为传统中医药的临床实践提供参考。

Abstract:

Wenjing decoction，recorded in Jin Gui Yao Lüe，is a commonly used formula for regulating menstruation in gynecology and is known for its effects of warming the meridians，dispelling cold，nourishing blood，and removing blood stasis. ZHANG Zhongjing described its indication as “xiali persisting for dozens of days”. However，the meaning of “xiali” has been interpreted differently by later physicians and can generally be categorized into three types：“bleeding from the anterior yin”，“diarrhea from the posterior yin” and “a general term for pathological discharges from the lower orifices.” By examining the historical evolution of the term “xiali”， together with later physicians’ discussions on its pathogenesis，formula indications，as well as modern clinical applications and mechanistic studies of Wenjing decoction，this article aims to clarify the original meaning of the term in the source text and further expand the application of this formula in perimenopausal syndrome and internal miscellaneous diseases，thereby providing a reference for the clinical practice of traditional Chinese medicine.