吴志洲运用经方辨治便秘经验  

Wu Zhizhou′s Experience of Treating Constipation with Classical Formulas

作　　者：李严生[1] 建晓珂[1] LI Yansheng;JIAN Xiaoke(Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450008)

机构地区：[1]河南中医药大学第三附属医院,河南郑州450008

出　　处：《河南中医》2024年第12期1845-1850,共6页Henan Traditional Chinese Medicine

基　　金：国家中医药管理局科研基金项目{国中医药人教函〔2022〕76号}。

摘　　要：吴志洲教授认为,便秘主要病因病机为气机失调,脾胃失和,宿食留滞,发为便秘,可因素体阳盛,嗜食辛辣厚味,而致肠胃积热,或因气血亏虚,津液不足,热气留结肠道致病。吴教授临床治疗便秘善用经方,对不同体质及证型灵活施以“温下法、润下法、清下法、寒下法”等中医疗法。便秘胃肠积热证,应清热消积,对于火热症状较轻者施以小承气汤,为“轻下法”,主治阳明腑实轻证;对于症轻体弱者,应施以调胃承气汤,可缓下热结,为“缓下法”;对于火热症状较严重者,则应施以“寒下法”,主张用大承气汤治疗;对于伴有恶心的阳明腑实证者,需施以大柴胡汤以兼清里热、和解少阳、调畅气机;另基于小承气汤,酌麻子仁、芍药、杏仁等,炼制为丸,制成麻仁丸,可适用于肠燥严重的多种慢性疾病的继发便秘、老年人便秘或妇女产后津枯引起的便秘,为“清下法”。便秘寒积内结证,应散寒消积,可施以大黄附子汤、温脾汤等。便秘太阴失运证,应健脾祛湿,枳术丸、厚朴生姜半夏甘草人参汤、桂枝加芍药汤等为临床常用方。便秘气滞血燥证,应理气养血,对于肝郁气机不畅引起的便秘,临证多用四逆散加减;对于气滞较甚,伴腹胀、腹痛者,用厚朴三物汤以行气消积祛瘀;虚弱、妊娠及产妇多因津血不足,无以滋润荣养肠道而致肠燥津枯,大便坚涩,发为便秘,治疗以润下为主,方用济川煎、当归贝母苦参丸及当归补血汤等;气为血之帅,血为气之母,血虚日久多兼气虚,临证多用当归补血汤加减。Professor Wu Zhizhou believes the main etiology and pathogenesis of constipation lies in qi movement disorder,disharmony of the spleen and stomach,and retained food causing obstruction.This condition may arise from excessive yang constitution with a preference for spicy and rich foods,leading to intestinal heat accumulation,or from qi and blood deficiency and lack of body fluids,resulting in heat retention in the intestines.In clinical practice,Professor Wu skillfully applies classical formulas and employs various TCM approaches,such as"warming purgation,""moistening purgation,""clearing purgation,"and"cold purgation,"tailored to different constitutions and syndromes.For constipation due to gastrointestinal heat accumulation,clearing heat and removing masses is necessary;mild symptoms of yang brightness excess are treated with Minor Purgative Decoction,which is called"mild purgation method".For milder symptoms with weakness,Stomach-Regulating and Purgative Decoction is used for relieving heat accumulation gently,which is called"moderate purgation".For severe heat symptoms,"cold purgation"should be used,so Major Purgative Decoction can be adopted.For yang brightness excess with nausea,Major Bupleurum Decoction is employed to clear interior heat,harmonize lesser yang,and regulate qi movement.Based on Minor Purgative Decoction,Maziren(Fructus Cannabis),Shaoyao(Radix Paeoniae Alba seu Rubra),Xingren(Semen Armeniacae Amarum),etc.are prepared to Cannabis Fruit Pill.It can be used for the secondary constipation caused by chronic diseases with severe intestinal dryness,constipation in the elderly or postpartum constipation caused by dehydration in women.This is called"moistening purgation method."For cold accumulation in the intestines,it is necessary to disperse cold and resolve accumulation using Rhubarb and Aconite Decoction or Spleen-Warming Decoction.For constipation with syndrome of greater yin dysfunction,it is necessary to invigorate the spleen and dispel dampness using Immature Bitter Orange and Atractylodes Mac

关 键 词：便秘 经方 胃肠积热证 寒积内结证 太阴失运证 气滞血燥证 《伤寒论》 张仲景 吴志洲 

分 类 号：R256.35[医药卫生—中医内科学]