叶天士辨治脾胃病思想  

Ye Tian-shi′s Thought of Differentiation and Treatment of Spleen-Stomach Diseases

作　　者：于世坤 张丽艳[1] YU Shi-kun;ZHANG Li-yan(Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning,China,110847)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847

出　　处：《河南中医》2022年第9期1349-1351,共3页Henan Traditional Chinese Medicine

基　　金：辽宁中医药大学2020年度教学改革研究项目立项教学课题项目(LNZYJG2020048);辽宁中医药大学2019年度一流本科课程培育项目(LNZYBK201932)。

摘　　要：叶天士强调脾胃分治,治脾以理阳通阳,治胃以和降通顺。其在历代医家养胃阴的基础上,提出了“甘凉生津滋胃阴”理论,认为“初为气结在经,久则血伤入络”,胃病日久,必入于络,应治以辛香理气,辛柔和血之法。肝胆属木,脾胃属土,肝有实病会乘脾胃之土,脾胃有病也会反侮肝木,故治疗脾胃病时要兼顾肝胆。叶天士在治疗脾胃虚所致腹满时,常加入黄芩、菊花、桑叶、旋覆花等药物清肝疏肝。其治疗痰饮病时,常用苓桂剂分消利导,再佐以生姜、半夏、黄连、生姜汁等开通气机,并提出“外饮治脾,内饮治肾”,常用理中丸、建中汤等建立中阳,化痰散饮,配伍薤白、瓜蒌、枳实等温阳化痰开痹,藿香、佩兰等芳香醒脾。Ye Tian-shi emphasizes the differentiation and treatment of the spleen and stomach diseases,that is,regulating yang and activating yang in the treatment of the spleen,while harmonizing and descending in the treatment of the stomach.On the basis of"nourishing stomach yin"of doctors in previous dynasties,he puts forward the theory of"nourishing stomach yin with sweet and cool drugs for generating body fluid",and believes that"qi stagnation is in the meridian at the beginning,then long-time blood in-jury is into the collaterals",so stomach disease should be treated with the method of regulating qi with pungent fragrance,harmoni-zing blood with pungent and softening drugs.The liver and gall belong to wood,while the spleen and stomach belong to earth.If the liver has excess diseases,it will affect spleen-stomach earth.On the contrary,spleen-stomach diseases also affect liver wood,so when treating spleen and stomach diseases,we should give consideration to the liver and gall.When Ye Tian-shi treats abdominal fullness caused by spleen-stomach deficiency,he often adds drugs such as Huangqin(Radix Scutellariae),Juhua(Flos Chrysan-themi),Sangye(Folium Mori),Xuanfuhua(Flos Inulae),etc.to clear the liver and soothe the liver.In the treatment of phlegm retention disease,the formulas containging Fuling(Poria)and Guizhi(Ramulus Cinnamomi)are often used to eliminate and guide,and then Shengjiang(Rhizoma Zingiveris Recens),Banxia(Rhizoma Pinelliae),Huanglian(Rhizoma Coptidis),Jiangzhi(Succus Rhizomatis Zingiberis),etc.are supplemented to dredge qi movement.He proposes that"the spleen should be treated for external retention,and the kidney should be treated for internal retention.Center-Regulating Pill,Center-Fortifying Pill Decoction,etc.are often used to strengthen middle yang,dissipate phlegm retention.Xiebai(Bulbus Allii Macrostemi),Gualou(Fructus Tri-chosanthis),Zhishi(Fructus Aurantii Immaturus),etc.are often combined to warm yang and dissolve phlegm and dredge arthral-gia.Huoxiang(Herba PogoStemonis),Peilan(Herba Eupatorii)

关 键 词：脾胃病 叶天士 通补胃阳 甘凉滋胃 辛润通络 木土同治 

分 类 号：R256.3[医药卫生—中医内科学]