指迷茯苓丸证治内涵探析  

Analysis on the syndrome and strategy of Zhimi Fuling Pill

作　　者：张楚欣 王坦[1] 唐博杰 高琳[1] ZHANG Chu-xin;WANG Tan;TANG Bo-jie;GAO Lin(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029

出　　处：《中华中医药杂志》2023年第3期1070-1073,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京高等教育“本科教学改革创新项目”《方药学》整合课程建设(2020);北京中医药大学教育教学课题(No.XJY21002);全国名老中医王绵之传承工作室;北京中医药薪火传承“3+3”工程王绵之名家研究室;北京中医药薪火传承“3+3”工程李庆业名老中医学术思想传承室。

摘　　要：指迷茯苓丸是治疗痰湿型肩臂疼痛的经典名方。其用药偏入中焦,作用以燥湿化痰、破结通滞为主,与现代临床治肩臂痛常见的活血通络思路有较大差异。从中医理论、临床现象、生理病理机制三方面分析可发现,肩臂痛既能见于肩周炎,在肠易激综合征、胆囊炎等多种消化系统疾病中亦为常见症状。但因肩臂部疼痛与消化系统疾病的发病机制并无直接联系,这一现象往往被人们忽视。而基于会聚投射学说与会聚易化学说的“内脏-体表牵涉痛”原理,可以对此做出很好的解释。从配伍用药可知,本方对痰湿中阻型的中焦病证有很好疗效,其所治疗的肩臂疼痛当与中焦病证引起的牵涉痛有密切关系。厘清这一证治思路,为拓展指迷茯苓丸的临床运用提供了理论支持。Zhimi Fuling Pill is a famous classical formula for treating shoulder-arm pain caused by phlegm-dampness.The herbs of the formula mainly act on the middle-jiao,and show the effects of drying dampness,eliminating phlegm and breaking through stagnation.This strategy is quite different from the common ideas of treating shoulder-arm pain by promoting blood circulation to remove meridian obstruction.From the views of TCM theory,clinical phenomena and physiological and pathological mechanism,it could be found that shoulder-arm pain is not only seen in scapulohumeral periarthritis,but also common in irritable bowel syndrome,cholecystitis and other digestive system diseases.However,this phenomenon is often overlooked,since there is no direct link in pathogenesis between shoulder-arm pain and digestive system diseases.But it can be well explained by the principle of visceral-surface referred pain,which involves convergence-projection theory and convergence-facilitation theory.The herbs in the formula of Zhimi Fuling Pill show good therapeutic effect on the middle-jiao disease syndrome induced by phlegmdampness.Therefore,it suggests that there is a close relationship between shoulder-arm pain and the referred pain caused by the middle-jiao disorders.It is meaningful to clarify the idea,which could provide the theoretical support for expanding the clinical application of Zhimi Fuling Pill.

关 键 词：指迷茯苓丸 肩臂痛 消化系统疾病 牵涉痛 

分 类 号：R289.5[医药卫生—方剂学]