《脾胃论》辨治迟脉症探幽  

The syndrome differentiation and treatment of delayed pulse syndrome in Piwei Lun

作　　者：马英明[1] 田静峰[1] MA Yingming

机构地区：[1]中国中医科学院望京医院,北京100102

出　　处：《中医临床研究》2023年第29期34-38,共5页Clinical Journal Of Chinese Medicine

基　　金：国家中医药管理局第四批全国中医(西学中)临床优秀人才研修项目(国中医药人教发[2019]13号)。

摘　　要：文章首先从《黄帝内经》中总结寸口脉与脾胃的生理机制关系,进而从《脾胃论》中摘取相关内容,阐述李杲(号东坦)认为脾胃病是迟脉症病因的观念。脉象在临床上确立了脾胃不足型、心火亢盛型、肝木妄行型、肺金受邪型以及肾水反来侮土型等五种类型,脉象分别为迟缓脉、兼洪大、兼弦、兼浮涩、兼沉细。文章着重体现其在证候归纳、病机分析、选方用药等方面的理论,介绍其纳入运气理论来总结脾胃病与其他四脏盛衰的规律,依据升降浮沉的机制进行分类选药的思想,形成从脾胃论治迟脉症的理论体系,并列表加以说明。通过列举一例肾水反侮证型迟脉症病例进行探讨,用干姜为君,白术、附子配合,从脾胃以壮中阳,上可温补心肺以增御外之力,下可坚肝肾以治寒湿痿厥,故新病久病俱适用,从实践阐述其理论精要,并在选方用药上与麻黄附子细辛汤相比较以说明其优势。This article first summarizes the physiological mechanism relationship between Cunkou(寸口)pulse and the spleen and stomach from Huangdi Neijing(《黄帝内经》).Furthermore,relevant content was extracted from Piwei Lun(《脾胃论》)to elaborate on LI Gao’s concept that spleen and stomach disease is the cause of delayed pulse syndrome.Clinically,five types of pulsesT were established,namely spleen and stomach insufficiency,heart fire hyperactive,hepatic delirium,external evil invades the lungs type,and renal water insulting type,and the veins were slow pulse,combined powerful,combined taut,combined Fuse(浮涩)and combined fine,respectiuely.Emphasis is placed on its theoretical aspects of symptom induction,pathogenesis analysis,and selection of prescription and medication.The theory of Yunqi(运气)introduced by the TCM master is given to summarize the relationship between spleen and stomach diseases and the rise and fall of other organs.The TCM master also classified and selected drugs based on the mechanism of rise and fall,and formed a theoretical system for treating delayed pulse syndrome from the spleen and stomach.There is one list for explanation.One case of delayed pulse syndrome of kidney water reflux syndrome is given for discussion,with Ganjiang(Rhizoma Zingiberis)as monarch medicine,Baizhu(Rhizoma Atractylodis Macrocephalae)and Fuzi(Radix Aconiti Lateralis Preparata)as cooperation,from the spleen and stomach to strengthen Yang(阳),the upper can warm the heart and lungs to increase the external strength,the lower can strengthen the liver and kidney to cure cold and wet hemorrhoids,so the new diseases and long-term diseases are applicable.Its theoretical essence is explained from practice,and it is compared with the Mahuang Fuzi Xixin decoction(麻黄附子细辛汤)from selecting prescription and medication to show its advantages.

关 键 词：迟脉症 脾胃病 升降浮沉 脾病脉迟 

分 类 号：R241.1[医药卫生—中医诊断学]