“治之以兰,除陈气也”新解  

New interpretation of‘treat with Lan to remove Chen qi’

作　　者：刘旭菲 倪青[1] LIU Xufei;NI Qing(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中华中医药杂志》2025年第2期718-722,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82174354)。

摘　　要：《黄帝内经》中“治之以兰,除陈气也”描述了脾瘅的治疗方法。脾瘅属现代医学糖尿病前期范畴,其核心病机是脾虚湿蕴,主要症状是倦怠、口中甜和口渴引饮,体征是形体肥胖。临床上此类患者以胰岛素抵抗为中心环节,常见多系统代谢紊乱,涉及高血压、高血糖、高脂血症、高尿酸血症、脂肪肝、多囊卵巢综合征等多种病证,病情进一步发展可见多种并发症。“治之以兰,除陈气也”中“兰”可以理解为芳香化浊、健脾祛湿等治疗原则,“除陈气”可以理解为治疗目的;其包含对于这类疾病需“补不足,损有余”、早期截断扭转、既病防变、谨守病机、各司其属的思想。在此原则指导下衍生出理气醒脾、芳香化浊、健脾祛湿等多种治法,对肥胖型糖尿病前期或糖尿病等代谢类疾病的疗效显著。笔者自拟藿朴夏苓汤加减方是其代表方之一。Huangdi Neijing describes the treatment of Pidan as'treat with Lan to remove Chen qi'.Pidan belongs to the category of pre-diabetes in modern medicine,and its core pathology is spleen deficiency and dampness,with the main symptom is tiredness,sweetness in the mouth and thirst,and physical signs of obesity.Clinically,these patients have insulin resistance as the central link,multi-system metabolic disorders are common,involving hypertension,hyperglycemia,hyperlipidemia,hyperuricemia,fatty liver,polycystic ovary syndrome and other diseases,and further development of the diseases result a variety of complications.The‘Lan'in‘treat with Lan to remove Chen qi'can be understood as the therapeutic principles of aromatizing and removing turbidity,strengthening the spleen and dispelling dampness,and'removing Chen qi'can be understood as the therapeutic purpose.It contains the idea that for this kind of disease,it is necessary to make up for the deficiency,damage superfluous',cut off and reverse the disease at an early stage,prevent disease progression,and capture the core disease mechanism.Under the guidance of this principle,a variety of treatments have been derived,such as regulating qi and awakening the spleen,aromatizing and removing turbidity,strengthening the spleen and dispelling dampness,etc.,which are effective in metabolic disorders such as obese pre-diabetes or diabetes mellitus.The author's self-formulated Huopo Xialing Decoction is one of the representativeformulas.

关 键 词：兰 陈气 脾瘅 糖尿病 内分泌代谢病 《黄帝内经》 

分 类 号：R259[医药卫生—中西医结合]