从《黄帝内经》脏腑辨证论“五脏皆令人秘”  

Analysis on idea of‘all five zang-organs leading to occurrence of constipation'from syndrome differentiation of zang-fu organs in Huangdi Neijing

作　　者：方国栋 朱君华[2] FANG Guodong;ZHU Junhua(The Second Affliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,China;Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学附属第二医院,杭州310005 [2]浙江中医药大学,杭州310053

出　　处：《中华中医药杂志》2025年第3期1353-1356,共4页China Journal of Traditional Chinese Medicine and Pharmacy

摘　　要：便秘病主脏在脾,病位在肠,且与其他脏腑关系密切,有“五脏六腑皆令人秘”之说。“六腑宜通”,现代医家多以此论治便秘,忽视从五脏辨治之重要性。文章通过整理《黄帝内经》中关于五脏与便秘的相关论述,从脏腑辨证角度探讨五脏便秘的中医诊治方法,分别从肝秘、心秘、脾秘、肺秘、肾秘进行论述,认为肝秘有肝郁、实热、血虚之别,治疗上可选六磨汤、泻肝柴胡散、四物汤等,且临证用药宜柔润不可刚硬;心秘有血瘀、阴虚、火旺之分,临证可选桃仁承气汤、天王补心丹、四黄汤等;脾秘有虚实之分,虚证多见,宜补之,实证则宜清泻;肺秘有气虚秘、燥秘、热秘、痰秘、风秘之分,临证可据证用方,如黄芪汤、清燥救肺汤等,并应注重宣通上焦肺气;肾秘多虚证,有阴虚、气虚、阳虚之别,临证治疗以滋肾阴、补肾气、温肾阳为主,辅以通腑导滞。五脏便秘,虚实各异,临证当辨病辨证相结合。The constipation,whose main related zang-organ is the spleen and whose disease location is in the intestine,is also closely related to other zang-fu organs,which can be refected in an idea of'all the five zang-organs and six fu-organs leading to the occurrence of constipation'.Chinese medicine practitioners nowadays treat constipation with the thought of'six fuorgans should be dredging',but they overlook the importance of the five zang-organs.By sorting out and analyzing the relevant discussions on five zang-organs and constipation in Huangdi Neijing,this paper discusses the diagnosis and treatment of this disease related to five zang-organs in Chinese medicine from the perspective of syndrome differentiation of zang-fu organs,and respectively discusses from the constipation related to the liver,the heart,the spleen,the lung,and the kidney.This paper holds the following viewpoints.The constipation related to the liver has different types,such as liver depression,sthenic heat and blood deficiency,and this kind of constipation should be treated with Liumo Decoction,Xiegan Chaihu Powder and Siwu Decoction,etc.,and clinical medication should be used with soft but no rigid.The constipation related to the heart consists of the types of blood stasis,yin deficiency,hyperactivity of fire,which should be treated with Taoren Chengqi Decoction,Tianwang Buxin Pill,Sihuang Decoction,etc..The constipation related to the spleen includes deficiency and excess.That deficient syndromes are common and shoud be treated by reinforcing,and the excess syndromes should be treated with clear purgation.The constipation related to the lung has different types of qi deficiency constipation,dry constipation,heat constipation,phlegmatic constipation,wind constipation,and prescriptions,such as Huangqi Decoction,Qingzao Jiufei Decoction,etc.,should be applied according to different syndromes in clinical treatment.And the ventilating pulmonary qi of the upper energizer should be paid more attention in the treatment of this constipation.The consti

关 键 词：《黄帝内经》 脏腑辩证 便秘 五脏 六腑 

分 类 号：R256.3[医药卫生—中医内科学]