叶天士对张仲景脾胃思想的继承与发展  

Ye Tian-shi's Inheritance and Development of Zhang Zhong-jing's Spleen-Stomach Thought

作　　者：于磊[1] YU Lei(Tianjin University of TCM,Tianjin,China,300193)

机构地区：[1]天津中医药大学,天津300193

出　　处：《河南中医》2018年第9期1344-1346,共3页Henan Traditional Chinese Medicine

摘　　要：《临证指南医案》中直接应用《伤寒论》《金匮要略》之方近70首,明确提出循仲景法者上百处。叶天士在汲取仲景学术思想的基础上,进一步汲取了李东垣的学术思想,指出"太阴湿土,得阳始运,阳明燥土,得阴自安,以脾喜刚燥,胃喜柔润也",分治更加细化;叶天士认为,"胃为阳土,宜凉宜润",且"阳明阳土,非阴柔不肯协和",故叶天士反对妄用味苦性寒之品,而多施以甘平或甘凉濡润之品;通补阳明是叶天士重要的学术思想之一,是指通过顺达胃气,补中寓通的治胃之法,使胃气下行,达到通降胃气的目的,叶天士通补阳明的思想主要受张仲景大半夏汤影响;叶天士将仲景的理论进一步发挥,提出了"久痛入络""久积入络",治疗方面,在仲景活血化瘀通络的基础上,提出了"非辛香无以入络""病在脉络,为之辛香以开通"的观点,确立了以"辛香通络"为主的治疗大法;叶天士承仲景之说,知肝病易横传犯脾,指出"肝为起病之源,胃为传病之所""肝木横逆,胃土必伤",常肝脾同治。叶天士继承仲景的脾胃学说,并汲取后世医家的思想,在脾胃分治、固护胃阴、通补阳明、辛通胃络及调理肝木等方面均有所发展。There are nearly 70 prescriptions from Treatise on Cold Damage Diseases and Essentials from the Golden Cabinet directly used in Case Records as a Guide to Clinical Practice,and about 100 times which put forward Zhong-jing’s methods should be followed.On the basis of learning from Zhang Zhong-jing’s academic thought,Ye Tian-shi further drew on the academic thought of Li Dong-yuan,pointing out that ＂ The spleen is the zang-organ of Taiyin and dampness,which begins to work after obtaining yang.And the stomach is the fu-organ of Yangming and dryness,which begins to work after obtaining yin.Because the spleen prefers dryness while the stomach prefers dampness＂,treatment becomes more refined.Ye Tian-shi thought that he stomach is the yang earth,it can be either cool or moist,and Yang earth in Yangming cannot be harmonized without yin and moist,so he objected to use drugs with bitter taste and cold nature,and preferred to use the ones with sweet and mild or sweet and cool and moist.Dredging and nourishing Yangming Meridian is one of the important academic thoughts of Ye Tian-shi.It refers to the method of regulating stomach through smoothing stomach qi and nourishing the middle energizer to make the stomach qi descend,and reach the aim of reducing stomach qi.This thought is mainly influenced by Zhang Zhong-jing’s Pinellia Decoction.Ye Tian-shi further developed Zhang Zhong-jing’s theory,thought that long pain and accumulation attack meridians,so in terms of treatment,he established the principle of treating obstructed meridians with medicinals with pungent and fragrance.He followed Zhang Zhong-jing and thought liver diseases easily influence the spleen,so he often treated diseases in liver and spleen together.In a word,Ye Tianshi not only inherited Zhang Zhong-jing’s thoughts,but also developed it,such as treating the spleen and stomach respectively,protecting stomach yin,dredging and nourishing Yangming Meridian.

关 键 词：叶天士 张仲景 脾胃思想 《临证指南医案》 

分 类 号：R222.19[医药卫生—中医基础理论]