基于“肝为罢极之本”诊治心脾疾病验案四则  

Four Cases of Clinical Diagnosis and Treatment of Heart and Spleen Diseases Based on“Liver Being Root of Tolerance to Fatigue”

作　　者：李晨[1] 张庆祥[1] 蒋馨莹 陆柯 褚翘 LI Chen;ZHANG Qingxiang;JIANG Xinying;LU Ke;CHU Qiao(Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学,山东济南250355

出　　处：《山东中医杂志》2024年第2期193-196,共4页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:81774169);国家自然科学基金青年科学基金项目(编号:82004233);山东省研究生教育质量提升计划项目(编号:SDYKC18037)。

摘　　要：“肝为罢极之本”是指通过肝脏的调节,人体各脏腑组织及精气血津液运行皆弛张有度,无太过或不及,以维持中和的状态。若肝脏功能失调,影响全身气机枢转,可导致病理表现截然相反的五脏病变。如肝气疏泄不及,气滞肠腑,或肝血不足,阴津匮乏,会导致大便干结、秘而不通;肝气疏泄太过,横乘脾土,又可导致腹痛泄泻、大便稀溏。肝郁乘脾,脾虚生痰,会出现乏力懒言、多寐等症状;肝火亢盛,影响心神,可导致少寐、不寐。文章列举分析基于“肝为罢极之本”诊治的脾胃病泄泻案、便秘案和心系疾病不寐案、多寐案,旨在说明临床治疗心脾疾病时可以调肝为主,调整阴阳,补虚泻实,双向调节,使肝气无太过亦无不及,全身气血不急不怠,脏腑经络等恢复和合状态。“Liver being the root of tolerance to fatigue”refers to the role of the liver in regulating the zang-fu organs,tissues,and the movement of essence,qi,blood and body fluid to maintain a neutral state.If the liver dysfunction affects the pivotal movement of qi throughout the body,it can lead to the opposite pathological manifestations of the five zang organs.For example,insufficient flowing of liver qi can cause qi stagnation in the intestines,or insufficient liver blood can lead to deficiency of yin fluid,resulting in constipation or blocked bowel movement.Overactive flowing of liver qi can overwhelm the spleen,leading to abdominal pain and diarrhea.Liver depression over-restricting the spleen,and spleen deficiency producing phlegm can manifest as symptoms of fatigue,reluctance to speak,and excessive sleep,while excessive liver fire affecting the mind can lead to less sleep and insomnia.The article analyzes four cases(stomach diseases:a case of diarrhea,a case of constipation;heart-related diseases:a case of insomnia,a case of excessive sleep)diagnosed and treated according to“liver being the root of tolerance to fatigue”,in order to demonstrate that treating heart and spleen diseases can focus on regulating the liver,adjusting yin and yang,replenishing deficiency and reducing excess,and achieving a bidirectional regulation so that the liver qi is neither excessive nor deficient,and the overall qi and blood flow smoothly,restoring harmony to the zang-fu organs and meridians.

关 键 词：肝为罢极之本 泄泻 便秘 不寐 多寐 心脾疾病 

分 类 号：R249[医药卫生—中医临床基础]