论消化系统中的脾实证治及桂枝类方在其中的运用  

Clinical manifestations and therapeutic principles of the excessive spleen syndrome in digestive system diseases and the application of categoreal Guizhi formulas in its treatment

作　　者：周祎然 袁红霞[1] ZHOU Yiran;YUAN Hongxia(Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津中医药大学,天津301617

出　　处：《吉林中医药》2022年第4期389-393,共5页Jilin Journal of Chinese Medicine

基　　金：天津市科技计划项目慢性病防治科技重大专项(17ZXMFSY00110)。

摘　　要：脾实证作为脾胃病证的一个特殊类型,在既往的临床和理论研究中受到的关注较少。本文基于《伤寒论》原文,参考前人对脾实证的研究,结合导师袁红霞教授临床经验,探讨脾实证在消化系统的临床表现和证治,并认为脾实证实为太阴虚实夹杂证,以脾脏及脾经气滞热郁及痰瘀病理产物积聚为矛盾的主要方面,而以脾脏功能不健全为隐含的关键原因。在现代临床中脾实证可见于功能性消化不良、胃食管返流病、消化性溃疡、消化系统癌前病变及肿瘤的不同病程中。脾实证的论治可从太阴病角度入手,并充分考虑气血水的偏重。桂枝类方内蕴调和脾胃的思想,在特定的辨证范围内对脾实证的治疗具有较好的适应性。As a special syndrome type of spleen and stomach diseases,the excessive spleen syndrome has not been paid much attention to in the past clinical and theoretical research.Basing on the original text of Shanghan Lun(Treatise on Cold Pathogenic Diseases),referring to the clinical experience of Professor Yuan Hongxia’s as well as previous studies on it,this paper discusses its clinical manifestations and therapeutic principles in digestive system diseases,and believes that it is a Taiyin disease with the intermingled deficiency and excess syndrome,with the qi stagnation and heat depression and the accumulation of pathogenic products of phlegm and blood stasis in the spleen and spleen meridians as its major pathogenesis,and with the spleen dysfunction as the underlying key reason.In modern clinical practices,the excessive spleen syndrome can be found in functional dyspepsia,gastroesophageal reflux disease,peptic ulcer,different stages of precancerous lesions and tumors of the digestive system.The excessive spleen syndrome can be treated as a Taiyin disease,and the relationship among qi,blood and water should be fully taken into account.Categoreal Guizhi formulas contain the idea of reconciling the spleen and stomach,and they are proved to have a good adaptability to the treatment of the syndrome in a specific range of its syndrome differentiation.

关 键 词：脾实证 桂枝类方 消化系统疾病 虚实夹杂 气血水 

分 类 号：R222.2[医药卫生—中医基础理论] R256.3[医药卫生—中医学]