从肝胃体用分治探析叶天士治疗胃脘痛(肝胃不和型)之特色  

Exploring Characteristics of YE Tianshi Treating Epigastric Pain(Liver-Stomach Disharmony Type)from Perspective of Liver-Stomach Body and Function

作　　者：郭若涵 陈港金 李妍佳 汪红兵[2] GUO Ruohan;CHEN Gangjin;LI Yanjia;WANG Hongbing(School of Clinical Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Capital Medical University,Beijing 100069,China)

机构地区：[1]北京中医药大学临床医学院,北京100029 [2]首都医科大学附属北京中医医院,北京100010 [3]首都医科大学,北京100069

出　　处：《中华中医药学刊》2024年第10期181-184,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(8177150984);西藏自治区自然科学基金组团式医学援藏项目[XZ2022ZR-ZY23(Z)]。

摘　　要：清代名医叶天士对于肝气犯胃型胃脘痛的认识独到、治法井然,尤其重视肝木克犯胃土的因素,强调“夫肝风内扰,阳明最当其冲犯”“风木过动,致阳明日衰”等。已有医家对叶氏治疗肝气犯胃证或胃脘痛的策略进行探讨研究,但侧重于对用药数据的分析,理论方面的论述篇幅相对较短、内容涵盖不全面。故通过对叶氏胃脘痛、木乘土医案的研读,提出叶氏对于肝气犯胃型胃脘痛的治疗特色——强调从肝胃之体用分治。具体表现在:(1)胃之体用方面,强调脾胃分治,认为“胃腑以通为补”,反对芪术壅补,擅仿大半夏汤之法通降阳明;他提出肝气裹挟阴浊上逆,是导致胃脘痛急性发作的关键,即急则治其标;而当胃体不足时,宜用味薄药物清养胃阴,以平肝木之侮,最忌辛香温燥耗散胃体。(2)肝之体用方面,叶氏擅用金铃子散清泄肝经气血分郁火;擅用桑叶、丹皮清透肝经风火、两和气血;若下焦肝肾阴亏影响胃腑,则重在填补下焦,甚则应用血肉有情之品补益精髓;若久病入络,叶氏则强调运用辛润入血通络之品疏通络脉郁滞。总之,叶氏擅长应用养肝体以平郁逆、和胃降痰、扶土制肝、寒热并用等方法,临证经验丰富、见解老道,针对其治疗特色进行阐述,以期对指导现今临床有所裨益。YE Tianshi,a famous doctor in the Qing Dynasty,had a unique understanding and effective treatment of epigastric pain caused by liver Qi invading stomach,with a particular emphasis on the factors of liver wood restraining the stomach earth.He emphasized that“if the liver wind is disturbed internally,Yangming should be most suitably for its invasion”and“if the wind wood is too active,it will cause Yangming to decline day by day”.Medical experts have explored and studied the strategies of YE Tianshi's treatment for liver Qi invasion of the stomach syndrome or epigastric pain,but the focus is on the analysis of medication data,and the theoretical discussion is relatively short and the content is not comprehensive.Therefore,based on the study of YE Tianshi's epigastric pain and the medical case of wood over-restricting earth,the author proposed YE Tianshi's treatment characteristics for liver Qi invading stomach type of epigastric pain,emphasizing the syndrome differentiation of treatment based on the body and function of liver and stomach.In the aspect of body and function of stomach,he emphasized the syndrome differentiation of spleen and stomach and thought that“stomach should be treated by dredging”,opposed blocking and tonifying function of Huangqi(Astragali Radix)and Baizhu(Atractylodis Macrocephalae Rhizoma),and was good at imitating Dabanxia Decoction(大半夏汤)method of dredging Yangming,when the stomach body is insufficient,it is appropriate to use thin-flavor drugs to clear and nourish stomach Yin,to calm the liver counter-restriction,mostly avoiding dissipating stomach body with spicy,warm and dry drugs.In terms of the body and function of liver,YE Tianshi is good at using Jinlingzi Powder(金铃子散)to clear liver meridian Qi and blood and fire depression,Sangpi(Mori Folium)and Danpi(Moutan Cortex)to clear liver meridian wind and fire and harmonize Qi and blood.If the disease goes into the collaterals for a long time,YE Tianshi emphasizes the use of the products of flesh and blood to dred

关 键 词：叶天士 胃脘痛 体用关系 肝气犯胃 

分 类 号：R256.3[医药卫生—中医内科学]