基于系统辨证脉学探讨大气下陷理论的临床应用  

Clinical Application of Sinking of Great Qi Theory Based on Systematic Sphygmology for Syndrome Differentiation

作　　者：王柯尔 齐向华[2] 王浩 WANG Ke’er;QI Xianghua;WANG Hao(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011,China;Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China)

机构地区：[1]山东中医药大学,山东济南250355 [2]山东中医药大学附属医院,山东济南250011 [3]潍坊市中医院,山东潍坊261041

出　　处：《山东中医药大学学报》2023年第3期275-278,共4页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(编号:2018YFC1707500);山东省重点研发计划(重大科技创新工程)项目(编号:2021LCZX06)。

摘　　要：梳理大气下陷的理论渊源发现,自《黄帝内经》首见“大气”之名后,在医家张仲景、喻嘉言创新发展的基础上,张锡纯结合自己的临证经验,创立了大气下陷理论。结合现代理论,系统探讨大气下陷证的病因病机,认为除张锡纯所述的力小任重、病后失养、泄泻日久等病因导致大气虚衰而下陷外,精神萎靡、郁闷不舒、思虑过度三种心理紊乱状态亦会引起大气下陷。阐述临床应用升陷汤治疗大气下陷证相关疾病,以“系统辨证脉学”为工具,以脉象要素为切入点,归纳大气下陷的主要脉象要素特征为:沉、迟、弱、下、细、寒、进少退多,且不同病因病机所表现出的脉象要素不同。探讨两则临床病案,使大气下陷的脉象特征更加清晰易了,便于临证运用。By analyzing the theoretical source of sinking of great qi,it is found that“great qi”was first seen in Inner Canon of Huangdi,based on the basis of the innovation and development of ZHANG Zhongjing and YU Jiayan,ZHANG Xichun established the theory of sinking of great qi by combining his clinical experience.Combined with modern theory,the etiology and pathogenesis of sinking of great qi syndrome were systematically analyzed.In addition to the factors mentioned by ZHANG Xichun,such as slight strength with heavy task,malnutrition after illness and prolonged diarrhea,which led to great qi deficiency and sinking,three mental disorders,such as low-spiritedness,depression and excessive thinking,can also cause sinking of great qi.This paper described the clinical application of Shengxian Decoction(升陷汤)in treating diseases related to sinking of great qi syndrome,taking“systematic sphygmology for syndrome differentiation”as the tool,and taking pulse elements as the starting point,the main pulse elements of sinking of great qi were summarized as follows:deep,slow,weak,down,fine,cold,less forward and more backward,and the pulse elements were different in different etiology and pathogenesis.Two clinical cases were discussed,so as to make the pulse characteristics of sinking of great qi more clear,which was convenient for clinical application.

关 键 词：系统辨证脉学 大气下陷 张锡纯 宗气 大气虚衰 精神萎靡 郁闷不舒 思虑过度 升陷汤 脉象要素 

分 类 号：R241.1[医药卫生—中医诊断学] R228[医药卫生—中医临床基础]