从脾论治五更泻  

Discussion About the Treatment of Fifth-Watch Diarrhea from the Spleen

作　　者：张营营 符强[1] ZHANG Yingying;FU Qiang(Heilongjiang University of Chinese Medicine,Harbin,Heilongjiang,China,150040)

机构地区：[1]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《河南中医》2024年第2期193-196,共4页Henan Traditional Chinese Medicine

摘　　要：脾土载万物,诸病皆可及脾,对于肾阳亏虚不甚明显之五更泻,可从脾论治,益气健脾,升阳渗湿止泻,以升阳益胃汤为基础方。肾阳虚者合四神丸、附子、肉桂温补脾肾,涩肠止泻;完谷不化,形寒畏冷者合附子理中汤温中散寒;寒热错杂者合乌梅丸寒热平调;中气下陷者合补中益气汤益气升阳举陷;湿热者合葛根芩连汤清热利湿;滑泻不止者加乌梅、诃子;腹痛者加延胡索、乌药;腹胀者加木香;纳差者加山楂、麦芽。五更泻的发生也是阳气回复、驱邪外出的一种表现,不可见泻止泻,若病程短,不虚者可尝试因势利导,先其时而泻,去其积滞,肃清肠道,可用大黄附子汤加减,晚饭前服药,泻止用四君子汤加减培补正气。The spleen earth contains everything,and all diseases can relate to the spleen.For the patients with fifth-watch diarrhea whose kidney yang deficiency is not very obvious,it can be treated from the spleen,focusing on supplementing qi,activating the spleen,raising yang,draining dampness to stop diarrhea,so Yang-Raising and Stomach-Boosting Decoction can be adopted as the basic formula.For those with kidney yang deficiency,Four Spirits Pill,Fuzi(Radix Aconiti Lateralis Preparata)and Rougui(Cortex Cinnamomi)can be combined to warm the middle energizer and disperse cold.For cold and heat in complexity,Mume Pill can be combined to balance cold and heat.For sinking of the middle qi,Center-Supplementing and Qi-Boosting Decoction can be used to elevate yang to cure drooping.For dampness-heat,Pueraria and Scutellaria and Coptis Decoction can be used to clear heat and drain dampness.For efflux diarrhea,Wumei(Fructus Mume)and Hezi(Fructus Chebulae).For abdominal pain,Yanhusuo(Rhizoma Corydalis)and Wuyao(Radix Lin-derae)can be added.For abdominal distension,Muxiang(Radix Aucklandiae)can be added.For poor appetite,Shanzha(Fructus Cra-taegi)and Maiya(Fructus Hordei Germinatus)can be added.The occurrence of fifth-watch diarrhea is also a performance of yang-qi recovery and expelling pathogens out,so it is not good to stop diarrhea as long as diarrhea occurs.If the course of disease is short,with-out deficiency,it is possible to try to lead by the trend.First of all,making good use of diarrhea is to remove stagnation,clear the intes-tines,so Modified Rhubarb and Aconite Decoction can be used before supper.For diarrhea has stopped,Modified Four Gentlemen De-coction can be used to supplement the healthy qi.

关 键 词：五更泻 从脾论治 升阳益胃汤 四神丸 

分 类 号：R256.34[医药卫生—中医内科学]