杨喆，刘琴，黎亚，李定祥*

（湖南中医药大学，湖南长沙410208）

·血瘀证治·

朱丹溪“左瘀右痰”论治中风浅析

杨喆，刘琴，黎亚，李定祥*

（湖南中医药大学，湖南长沙410208）

金元医家朱丹溪认为瘀和痰为中风的重要致病因素，通过对阴阳、左右、气血、肝肺的属性特点分析，结合其“阴升阳降”、“左肝右肺”、“左血右气”理论，并根据朱氏治疗中风对于病位在左者以行血补血治瘀为主，常用四物汤加减；病位在右者以化痰行气为主，多以二陈汤化裁的诊疗思路，笔者总结出丹溪论治中风“左瘀右痰”的观点，临床运用，效如桴鼓。

瘀；痰；中风；气；血；朱丹溪

〔Abstract〕Zhu Danxi，one of the Jin and Yuan dynasty's famous traditional Chinese medicine doctors，thought that stasis and phlegm were the important causes of stroke.The properties and characteristics of the Yin-Yang，left-right，Qiblood，liver-lung were analyzed and the theory of"ascending of Yin and descending of Yang"，"liver belongs to the left and lung belongs to the right"，"blood belongs to the left and Qi belongs to the right"were combined.Finally，we summarize the point of"stasis belongs to the left and phlegm belongs to the right"from Zhu Danxi on diagnosis and treatment of stroke.The diseases in left location were mainly treated to remove stasis，such as the often use of Siwu decoction，while the diseases in leftmainly were reduced phlegm，such as Erchen decoction，which show a good effect.

〔Keywords〕stasis；phlegm；stroke；Qi；blood；Zhu Danxi

朱震亨，字彦修，早年崇理学，后改学医。然理学思想对其影响深远，丹溪将《易经》的阴阳、卦象与藏象理论结合，认为痰瘀互结可致百病，创立了“阴升阳降”理论与“左血右气”理论，为“滋阴派”的奠基人。杂病宗丹溪，丹溪在临床上对于气、血、痰的论治独具匠心，本文将对朱丹溪从“左瘀右痰”理论治疗中风进行深入研究。

1　瘀、痰是导致中风的直接病因

《灵枢·九宫八风》认为中风之人多为风邪所伤，“其有三虚而偏中于邪风，则为击仆偏枯矣。”《素问·风论》亦有“风之伤人也，或为寒热，或为热中，或为寒中，或为疠风，或为偏枯”的记载。不同于《内经》中外中风的观点，丹溪认为中风多为内中风，即内因所致。丹溪虽未明确指出中风因“左瘀右痰”所致，但在《丹溪心法·中风》曰：“半身不遂，大率多痰，在左属死血瘀血，在右属痰有热，并气虚。”并且在用药上左侧半身不遂者以行血补血为主，用四物汤加减；……