《临证指南医案》辛润通补法治疗噎膈思路探微  

Thought Analysis on Method of Moistening,Dispersing and Tonifying with Herbs Acrid in Flavor in Treatment of Dysphagia in Guide to Clinical Practice with Medical Records

作　　者：王茜 王俊涛[2] 尹怡[2] 王祥麒[2] WANG Xi;WANG Juntao;YIN Yi;WANG Xiangqi(Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China;The Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450003,China)

机构地区：[1]河南中医药大学,河南郑州450046 [2]河南中医药大学第三附属医院,河南郑州450003

出　　处：《山东中医药大学学报》2023年第6期735-739,共5页Journal of Shandong University of Traditional Chinese Medicine

基　　金：河南省中医药科学研究专项课题项目(编号:2019ZY2153)。

摘　　要：辛润通补法是叶天士基于胃的生理特性和噎膈的病机创立的治疗大法。系统分析《临证指南医案》所载噎膈医案33则,试总结叶天士“辛润通补”法治疗噎膈的规律。指出叶天士治噎膈遵张仲景缓攻,崇李东垣消补兼施,法胃以降为顺,在前人辛开苦降法基础上尤重顾护胃阴。叶师认为噎膈以阳结脘痹血瘀为机,以胃、肝、肺为要,总以辛润通补为法,主要有:辛开苦降,通阳开痞,养营疏胃;辛散郁结,酸甘润枯,柔肝和胃;辛凉轻降,润肺化燥,畅腑泻浊;苦降辛通,利痰清膈,静心宽中;辛窜通络,温润活血,止痛安胃。诸法以通补胃腑、和润血脉为旨。The method of moistening,dispersing and tonifying with herbs acrid in flavor is a great treatment method created by YE Tianshi based on the physiological characteristics of the stomach and the pathogenesis of dysphagia.A total of 33 dysphagia cases in Guide to Clinical Practice with Medical Records were systematically analyzed,this paper summarized the regularity of YE Tianshi’s method of moistening,dispersing and tonifying with herbs acrid in flavor in the treatment of dysphagia.YE Tianshi treated dysphagia with ZHANG Zhongjing’s mild purgation and LI Dongyuan’s treatment with both tonification and elimination.He followed the normal descending function of the stomach,emphasized protecting stomach yin on the basis of the predecessors’herbs acrid in flavor for dispersing and herbs bitter in flavor for descending.YE believed that dysphagia was caused by yang constipation,stomach impediment and blood staisis,involving stomach,liver and lung,and could be treated generally by method of moistening,dispersing and tonifying with herbs acrid in flavor,mainly including:herbs acrid in flavor for dispersing and herbs bitter in flavor for descending,activating yang and removing mass,nourishing nutrient and soothing stomach;resolving depression with acrid herbs,moistening dryness with herbs sour and sweet in flavor,softening liver and harmonizing stomach;descending with herbs acrid in flavor and cool in property,moistening lung and resolving dryness,relaxing bowels and purging turbidity;herbs bitter in flavor for descending and herbs acrid in flavor for dispersing,resolving phlegm and clear diaphragm,calming heart and smooth the middle;dissipating wind and dredging collaterals with herbs acrid in flavor,warming,moistening and activating blood,relieving pain and harmonizing stomach.Dispersing and Tonifying stomach,harmonizing and moistening blood and vessels are the general treatment methods.

关 键 词：《临证指南医案》 辛润通补 噎膈 通补胃腑 和润血脉 叶天士 

分 类 号：R249.1[医药卫生—中医临床基础] R256.32[医药卫生—中医学]