国医大师张学文辨治胃痛经验
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摘要
张学文教授认为郁怒伤肝而致肝胃不和、脾胃虚弱而致阴阳两虚、久痛入络而致血瘀痰滞、寒热错杂而致升降失常和毒瘀交结而致湿热熏蒸为胃痛的主要病因病机。辨胃痛要从辨部位,辨气血,辨寒痛、热痛及寒热错杂痛和辨虚实及兼夹等方面入手。肝胃不和证应疏肝理气止痛,以柴胡疏肝散为基本方加减治疗;脾胃虚弱证应健脾益气,助阳养阴,若偏脾胃气虚者,用香砂六君子汤加减治疗,若偏阴虚者用一贯煎加减治疗;瘀阻胃络证应化瘀通络止痛,以丹参饮合失笑散加减治疗;寒热错杂证应辛开苦降,升清泄浊,以半夏泻心汤合左金丸加减治疗;毒瘀互结证应健脾和胃,解毒化瘀,以六君子汤加清热解毒类和活血化瘀类药味治疗。
Professor ZHANG Xue-wen thinks that the main pathogenesis of stomachache is including the indignant injury to liver and disharmony of the liver and stomach, deficiency of the spleen and stomach, causing deficiency of both yin and yang, stagnation of blood stasis and phlegm stagnation caused by long pain in the collaterals, intermingled cold and heat leading to abnormal rising and falling of vital energy, and toxic and stasis junction causing humid heat fumigation. It is necessary to differentiate stomachache from disease location. Qi and blood, cold pain, heat pain, intermingled cold and heat, and distinguish between deficiency and excess. The syndrome of incoordination between liver and stomach should be treated with dispersing liver and regulating qi to relieve pain, using Chaihu Shugan powder as the basic prescription. The syndrome of the deficiency spleen and stomach was given with strengthening the spleen and replenishing qi, and nourishing yang and yin, with a prescription of Xiangsha Liujunzi Decoction in case of the qi deficiency in spleen and stomach, or using a prescription of Yiguangjian Decoction in the event of yin deficiency.The syndrome of stasis obstructing stomach collaterals should remove stasis and dredge collaterals to relieve pain, and be treated with Danshen Drink combined with Shixiao Powder. The syndrome of intermingled heat and cold should be treated with Banxia Xiexin Decoction combined with Zuojin Pill. The syndrome of intermingling of toxic and static blood was treated with invigorating the spleen and stomach, removing toxicity substance and removing blood stasis, and treated with Liujunzi Decoction combined with Chinese materia medica of clearing heat and removing toxicity, activating blood and resolving stasis.
Professor ZHANG Xue-wen thinks that the main pathogenesis of stomachache is including the indignant injury to liver and disharmony of the liver and stomach, deficiency of the spleen and stomach, causing deficiency of both yin and yang, stagnation of blood stasis and phlegm stagnation caused by long pain in the collaterals, intermingled cold and heat leading to abnormal rising and falling of vital energy, and toxic and stasis junction causing humid heat fumigation. It is necessary to differentiate stomachache from disease location. Qi and blood, cold pain, heat pain, intermingled cold and heat, and distinguish between deficiency and excess. The syndrome of incoordination between liver and stomach should be treated with dispersing liver and regulating qi to relieve pain, using Chaihu Shugan powder as the basic prescription. The syndrome of the deficiency spleen and stomach was given with strengthening the spleen and replenishing qi, and nourishing yang and yin, with a prescription of Xiangsha Liujunzi Decoction in case of the qi deficiency in spleen and stomach, or using a prescription of Yiguangjian Decoction in the event of yin deficiency.The syndrome of stasis obstructing stomach collaterals should remove stasis and dredge collaterals to relieve pain, and be treated with Danshen Drink combined with Shixiao Powder. The syndrome of intermingled heat and cold should be treated with Banxia Xiexin Decoction combined with Zuojin Pill. The syndrome of intermingling of toxic and static blood was treated with invigorating the spleen and stomach, removing toxicity substance and removing blood stasis, and treated with Liujunzi Decoction combined with Chinese materia medica of clearing heat and removing toxicity, activating blood and resolving stasis.
引文
[1]周仲瑛.中医内科学.北京:中国中医药出版社,2007:186
[2]张声生,唐旭东.慢性胃炎中医诊疗专家共识意见(2017).中华中医药杂志,2017,32(7):3060-3064
[3]王永钧,陈洪宇,朱彩凤,等.余尚德自拟补充生肌汤治疗特殊类型溃疡病经验.世界中医药,2008,3(3):156-157
[4]张学文.疑难病证治.北京:人民卫生出版社,2005:240-251
[5]卢祥之.国医大师张学文经验良方赏析.北京:人民军医出版社,2013
[6]陈蓉,汤霞芬,朱根麟,等.胃炎冲剂的药理作用研究.中成药研究,1986(9):29-31
[2]张声生,唐旭东.慢性胃炎中医诊疗专家共识意见(2017).中华中医药杂志,2017,32(7):3060-3064
[3]王永钧,陈洪宇,朱彩凤,等.余尚德自拟补充生肌汤治疗特殊类型溃疡病经验.世界中医药,2008,3(3):156-157
[4]张学文.疑难病证治.北京:人民卫生出版社,2005:240-251
[5]卢祥之.国医大师张学文经验良方赏析.北京:人民军医出版社,2013
[6]陈蓉,汤霞芬,朱根麟,等.胃炎冲剂的药理作用研究.中成药研究,1986(9):29-31