李东垣从肾论治脾胃病探究  

Research on Li Dong-yuan′s Treatment of Spleen and Stomach Diseases from the Kidney

作　　者：雷婷 王建坤 魏凤琴[1] LEI Ting;WANG Jian-kun;WEI Feng-qin(Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250355;Jiarui Sports Rehabilitation Traditional Chinese Medicine Clinic of Lixia District of Jinan,Jinan,Shandong,China,250355)

机构地区：[1]山东中医药大学,山东济南250355 [2]济南市历下区嘉瑞运动康复中医门诊,山东济南250355

出　　处：《河南中医》2022年第12期1834-1837,共4页Henan Traditional Chinese Medicine

基　　金：国家中医药管理局张珍玉名老中医传承工作室建设项目(2020-112);山东省重点研发计划项目(2016GSP202024)。

摘　　要：李东垣认为,治疗脾胃病不能拘泥于脾胃本身,须从五脏整体考虑。肾与脾分主先后天,肾为人身之根本,肾不封藏,则水中之精不足,则无精以行升浮之令,百病乃生;肾阳为脾胃阳气的根本,肾阳充足,温暖中土,则土不致寒冷,脾胃之阳充足则能腐熟、运化水谷,且制水而水不泛滥,故不病;肾阳虚则水土不温,脾胃一派寒象,名“寒中”;肾精滋润濡养脾胃,开窍于二阴,胃主降,体阳用阴,若肾精亏虚,则脾胃、大小肠失润而不能向下传化糟粕,可引发便秘;肾之阴火可伤及脾胃元气,加重脾胃虚损程度。因此临证治疗脾胃病时,李东垣除补益脾胃外,还注重从肾论治脾胃病。肾阳不足、寒水侮土者,李东垣善用辛热,佐以甘药,辛热泻寒水,甘热补脾肾阳气,常用理中丸、四逆汤等加减;水来侮土、阴寒不盛者,用理中丸;阴寒甚者,用四逆辈,方如四逆汤、姜附御寒汤、神圣复气汤、附子理中丸等;肾之水虚阴火上僭者,用生地黄、黄柏、知母等滋水泻火。其还善用风药升散阴火,散寒胜湿升阳,并强调要因时用药,肾元不足者,慎用发表药。Li Dong-yuan believesthat the treatment of spleen and stomach diseases should not be confined to the spleen and stomach themselves,but should consider the five internal organs as a whole.The kidney and spleen are in charge of innate essence and acquired essence respectively.The kidney is the foundation of the human body.If the kidney fails to seal,the essence in the water is insufficient,and there is no way to ascend,which results in various diseases.The kidney yang is the root of the yang qi of the spleen and stomach.The kidney yang is sufficient to warm the middlemen energizer.The yang of the spleen and stomach can decompose and transport food and drink.If the kidney yang is deficient,the water and earth will not be warm,and it will lead to"cold middle energizer".Kidney essence can nourish the spleen and stomach,and the kidney opens into the two private parts.The stomach is in charge of descending,with easy yang excess and yin deficiency.If kidney essence is deficient,the spleen and stomach,the large and small intestines lose their moisture and fail to transfer the dross downward,constipation will occur.The yin fire of the kidney can damage the original qi of the spleen and stomach,and aggravate the deficiency of the spleen and stomach.Therefore,in the clinical treatment of spleen and stomach disease,Li Dong-yuan not only supplements the spleen and stomach,but also focuses on the treatment from the kidney.For deficient kidney yang and cold water attacking earth,Li Dong-yuan is good at using pungent and hot drugs,supplemented with sweet drugs.Pungent and hot water is used to purge cold water,while sweet and heat is used to replenish spleen and kidney yang qi,so Middle-Regulating Pills and Frigid Extremities Decoction are often modified for use.For water attacking earth with not excessive yin cold,Center-Regulating Pill is often used.For For water attacking earth with excessive yin cold,Frigid Extremities types are often used,such as Frigid Extremities Decoction,Rhizoma Zingiberis and Aconite Cold-Resisting Decoc

关 键 词：脾胃病 从肾论治 李东垣 《脾胃论》 《内外伤辨惑论》 

分 类 号：R256.3[医药卫生—中医内科学]