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漢方医学の診断について (2008.2.4)

漢方医学の診断について (2008.2.4 御茶ノ水東洋医学フォーラム)

Dr.三谷和男

・分かりにくいこと
 中医学
 日本漢方 
  -古法
  -後世方
 
 …少し前まで、それらがセクトで仲が悪かった
 「何をもって本当のことをつかもうか?」

 …一子相伝、師匠のことは金科玉条としなければならない、のが漢方
  →他の流派を批判していた
  西洋医がはいってから、ほんとうのこと、を掴むようになった


例: 人参
 …エネルギーを蓄える (滋養)
  のんでもらうと⇒ 元気になった・やる気がでてきた
 …循環血漿量↑
   沈んでいた脈が浮いてくる はず!
  →気をつけるべきは、血圧をあげること

 漢方医は自覚症状に重きをおいていたが、所見に徹底的に勝負すべき!
 西洋医学的に書き換える必要がある!
 体の中で何がおきているか掴め!

 「死法」で終らせないために…

例2: オウギ
 … エネルギーを巡らす
 

営(エイ) …脈管の気 …血液そのもの
衛(エ)  …脈外の気 … ??
 <不和!>

気??
 〇温 or ×冷
 〇巡 or ×止
  →ここにいれれば使用期限切れた血液、だいじょうぶ

●脈の取り方

脈状 …脈のΣ …全体像
  沈んでいる? 力は? 押しても触れる? などなど
脈証 …
  三部九候診
    上ショウ・中・下
    それを脈で診るのが、歴史的

肺経の気口で診る

脈で診るのは …totalとしての巡り & どこに問題?


 寸口・関上・尺中


吹き溜まり外来にならないために…
 必ず、紹介元に返す


ともあれ「比較しろ」
「どこに問題がある?」

●咳
通り道の問題・つかえ感なら 上・中証どちらも問題
   …ハンゲコウボクトウ 半夏厚朴湯
肺・中証の熱に問題あるなら …清肺湯
陰エキからのカラ咳・下証の問題あるなら …麦門冬湯

 西洋医学的症候医学では、難しい


●傷寒論  …紀元6年ごろにまとめられた本

・法 …法則
・方 …処方 100程度しかない

 法が大切!! 方をそのまま使うのは、バカ

●寒邪
 →皮 が梗塞(外に邪を出せなくなる) →邪がたまる →麻黄湯
かつ
 営が衛に犯されたところを整理

・表皮
・真皮  どれくらいどうなの?
  例: 浮腫
   pitting edema 皮膚はてかてかしていないもの

  表皮と真皮、なんで行き来がないの?

●五レイ散
「嘔気のない嘔吐に役に立つ」
 噴水用嘔吐
 さしてぐったりしていないのに
 下痢をしてコウカツ強くて水を飲んでもはく人に、いい
   歴史的
 なんでかわかった!
 視床下部・下垂体後葉・バソプレッシン →口渇
 で、なんではく?
 1999
 バソプレシンレセプターをゴレイサンが抑える
 

漢方でいちばんこわいのは…
 ええかげんに流してしまう癖をつけると時間があってもみれなくなる


「ちゃんと語れ!」
やりかたみてたって、やり方身につかない


望診(漢方) vs 視診(西洋)
 …遠くから望む
  細に分析するのではなく、「気配を感じてから診察」


例: HBVキャリア
  <紅>舌・舌苔・ジ苔(乳頭かくっついている)
  茸状乳頭のうったいが多い
 →イキ盛ん
     治ろうとする力が強い

  サイコザイ (ショウサイコトウ)でかなりなおる94%
   紅舌・茸状乳頭ないと、ショウサイコトウは使いにくい

 …数字がよくなったからいいわけではない!


例: AST・ALT 200前後の舌
 皮膚の弾力性
 おなかの所見
  →水を除いたら(ゴレイサン)、 中央に亀裂ができてきた
  →「なるほど、水の所見なんだな」
  インチンゴレイサン

例: HCV
 <紅舌なんてみたことない!> 戦いはそこそこあるはずなのに
 茸状乳頭のうったいなんてみたことない

 HCVにショウサイコトウはほとんど処方する機会はない
  …そうしていたら間質性肺炎の例

 水っぽいならブクリョウとか補剤的にいきたい

 で、HCV …「すごい調子いいです」「安定しています」
  そうしてみたら…
 苔が分厚くなる (交感神経過興奮でも苔は厚くなる)
  「中で何かが起こっている!!!」
 こうなってしまったら漢方医学では手は出せないので西洋医学で判断すべき


例: 感冒性腸炎の80歳女性
  黄苔がある時期から、
  ポンと瘡蓋が剥がれる時期がある
  そのあと、糸状乳頭が新しく出てくる

例: RA
 地図状舌
  表層性舌炎
   副交感神経が抑制・交感神経が亢進
   …なかなか治療効かない! 一筋縄じゃいかねぇ

例: なかなかタバコをやめない…
  すぱっと黄色苔ぬけるけれど…

例: 身体表現性障害
 紫色、舌先に赤い
 悲しみのありどころは?
 長年医者だった主人が50前半で倒れ
 上の息子が循環器・下が耳鼻科
 息子の嫁の話「とてもできた嫁」
 …すぐれた息子を持っているひとは嫁を褒めない?
 →往診してみた 隣の県まで
 →息子夫婦とは絶縁状態!

 …怒り・悲しみのエネルギー


例: 円形脱毛症
 なよっとした30代男性

  ちょこっとしか舌出していない
  気滞or気虚 ?


舌の先が赤い
 炎症または交感神経の過緊張

 …思いっきり出すとそうなることある


●舌 
 「ようなっていくのか、かわってないのか、かわるぅなってるかみる」
 神・色・形・動き
  『印象』 


・黒色舌
 「死証」
 嫌気性菌 が正体


●薬が効かないとき

 変わらない所見を「基本」と無視するのではなく
 診かたが間違えていると考え考察しなおすのがよい

●苔 厚い…
 陰きわまりて陽になる、
  のか
 いき盛ん、
  なのか

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