中医内科学:脾系病证概要  

Traditional Chinese Internal Medicine:Summary of Diseases and Syndromes Differentiation of the Spleen System

作　　者：周仲瑛[1] ZHOU Zhong-ying(Inheritance Studio of TCM Master Zhou Zhongying, Nanjing University of Chinese Medicine, Nanjing, 210023, China)

机构地区：[1]南京中医药大学国医大师周仲瑛传承工作室,江苏南京210023

出　　处：《南京中医药大学学报》2020年第6期783-787,共5页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：国家中医药管理局“国医大师周仲瑛传承工作室”建设项目;国医大师学术经验传承研究室二期建设项目;全国和省名老中医药专家传承工作室基层工作站建设项目——周仲瑛传承工作室;江苏省社会发展重点研发计划(BE2019723)。

摘　　要：介绍了中医内科学脾系病证概要,包括脾系的概念、病因病机、辨治要点、病证举要、治法方药和临证要点。脾系病证的病因病机,实为湿盛而阳微,湿困脾运;虚则脾不化湿,阳微湿盛。辨证分气、血、虚、实、寒、热,治疗要点不在补而在运。病证常见有胃痛(胃痞)、腹痛、呕吐、呃逆、噎膈、反胃、泄泻、便秘、吐血、便血、痰饮、脾瘅等。治法有温中燥湿、清热化湿、攻逐水湿、补中益气、健脾运中、益胃养阴、健脾温中、化瘀通络等,兼证治法有健脾舒肝、健脾和胃、疏肝和胃、抑肝扶脾、培土生金等法。临证要点包括虚实寒热常易并见;治脾当祛湿为主;治胃以调气为先;胃腑热证,注意养阴;脾胃与他脏的关系。This paper summarized the diseases and syndrome differentiation of the spleen diseases in traditional Chinese medicine(TCM),including the concept of the spleen,the etiology and pathogenesis,key points of syndromes and symptoms differentiation,therapeutic methods,prescription,and clinical application.The etiology and pathogenesis of spleen diseases could be categorized as excess and deficiency,which were represented as excessive dampness and weak yang,as well as dampness encumbering the spleen for the former,while spleen failure to remove dampness,weak yang and excessive dampness for the later.The syndrome differentiation was based on qi,blood,deficiency,excess,cold,and heat.The therapeutic principle was focused on transporting rather than tonifying.Such clinical manifestations were common as stomachache,abdominal pain,vomiting,hiccup,dysphagia,regurgitation,diarrhea,constipation,hematemesis,hemafecia,phlegm retention,and the spleen-warm syndrome.The therapeutic methods could be to warm the center and dry dampness,clear heat and remove dampness,expel water by purgation,supplement the center and boost qi,fortify the spleen and activate the center,boost the stomach and tonify yin,fortify the spleen and warm the center,as well as dissolve stasis and unblock the collaterals.The combined methods were like fortifying the spleen and soothing the liver,fortifying the spleen and harmonizing the stomach,soothing the liver and harmonizing the stomach,inhibiting the liver and reinforcing the spleen together with banking up earth to generate metal.As for the significant points of clinical application,it contains the common deficiency,excess,cold and heat combined syndrome,removing dampness to regulating the spleen,harmonizing qi to treat the stomach,tonifying yin to clearing stomach heat,along with focusing on the relation between the spleen,stomach,and other Zang-organs.

关 键 词：中医内科学 脾系 病因病机 辨治要点 治法 方药 

分 类 号：R256.3[医药卫生—中医内科学]