《伤寒论》腹痛与腹中痛辨治  

Differentiation and Treatment of Abdominal Pain and Pain in the Abdomen in Shanghan Lun

作　　者：王桂彬 姜晓晨 刘福栋 庞博[2] 花宝金[1] WANG Guibin;JIANG Xiaochen;LIU Fudong;PANG Bo;HUA Baojin(Guang anmen Hospital,China Academy of Chinese Medical Seciences,Bejing China 100053;Intermaional Medical Department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing China 100053)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]中国中医科学院广安门医院国际医疗部,北京100053

出　　处：《中医学报》2022年第1期19-23,共5页Acta Chinese Medicine

基　　金：国家自然科学基金面上项目(81873399);全国中医药创新骨干人才培训项目{国中医药人教函[2019]128号};首都卫生发展科研专项青年优才项目(首发2018-4-4154)。

摘　　要：《伤寒论》之腹痛与腹中痛在病位、病因、病机、治法方面均有所差异。腹痛病位偏于脐下,病因多属寒中,乃阴寒之邪搏结肠胃,多为阳气不足之证,治疗当以温字立法。寒湿滞于下焦,充斥肠间所致腹痛,治宜温涩之桃花汤;阴寒之气内盛,水势泛滥所致腹痛,治宜温化之真武汤;阳气虚极,阴阳几近离绝所致腹痛,治宜温通之通脉四逆汤。腹中痛病位在腹痛之上,多在脐上,亦可攻于心下,病因多为气血津液失和所致,治疗应以和字立法。里虚脉急,虚劳不足所致腹中痛,治宜和阴阳之小建中汤;邪正相搏,结于胁下所致腹中痛,治宜和表里之小柴胡汤;寒热分踞胸胃上下,阴阳不交所致腹中痛,治宜和寒温之黄连汤;肝气郁结,阳郁湿阻所致腹中痛,治宜和气机之四逆散。There are differences betweenabdominal pain and pain in the abdomen in Shanghan Lun in disease location, etiology, pathogenesis and treatment.Abdominal pain is located under the umbilicus.The etiology mostly belongs to the cold, which is the pathogen of yin cold, beating the intestines and stomach, and the syndrome of insufficient yang qi.The treatment should be based on warming method.Cold dampness stagnates in the lower Jiao, which is full of abdominal pain caused by intestines.It is appropriate to treat with Taohua Decoction with the function of warming and astringent.The qi of yin cold is abundant, and the abdominal pain caused by the flood of water potential is treated with Zhenwu Decoction with the function of warming and resolving.Yang qi deficiency, yin and yang are almost separated, resulting in abdominal pain, which should be treated with Tongmai Sini Decoction with the function of warming and promoting circulation.Pain in the abdomen is located above abdominal pain, mostly on the umbilical cord, but also under the heart.The etiology is mostly caused by the loss of qi, blood and body fluid.The treatment should be based on the method of harmony.As for acute internal deficiency pulse and pain in the abdomen caused by insufficient fatigue, Xiaojianzhong Decoction with the function of regulating yin and yang is suitable.It is suitable to treat pain in the abdomen caused by the combination of pathogenic qi and vital qi, and Xiaochaihu Decoction with the function of regulating superficies and interior.Cold and heat are located in the upper and lower parts of the chest and stomach, and the pain in the abdomen caused by the non intersection of yin and yang should be treated with Huanglian Decoctionwith the function of regulating cold and warm.Abdominal pain caused by stagnation of liver qi and stagnation of yang and dampness should be treated with Sini Powder with the function of regulating qi movement.

关 键 词：腹痛 腹中痛 和法 桃花汤 真武汤 通脉四逆汤 小建中汤 小柴胡汤 黄连汤 四逆散 《伤寒论》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]