孙冰运用寒热并用法治疗脾胃病经验
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摘要
寒热并用的组方策略首见于《黄帝内经》,主要应用于寒热错杂的复杂病证。孙冰认为脾胃病的重要病机是寒热错杂,核心病机为脾寒胃热。脾为太阴,其气易虚,虚则有寒;胃为阳明,受邪易实,实则易热,因而治疗以寒热并用为基本大法,选方宜以半夏泻心汤、生姜泻心汤、乌梅丸等具有寒热平调作用的方剂为基本方,药物多以黄连、黄芩配伍干姜、吴茱萸、附子,同时强调治疗时应注意脾胃的生理特点,配合健脾益气、疏肝行气、养阴生津的党参、白术、柴胡、玉竹、麦冬、沙参、生地黄等药物,从而达到寒热并用以调阴阳,辛降并进以顺其升降的目的,无论是指导脾胃病的临床治疗,还是阐述方剂的组方原则,都具有一定的实践意义。
The cooling and heating methods was first found in Huangdi Neiing and used in the complicated symptoms of intermingling of cold and heat.SUN Bing believed that the important pathogenesis of diseases of the spleen and stomach was intermingling of cold and heat with cold in spleen and heat in stomach as the core pathogenesis.The spleen belongs to taiyin and the spleen qi is easy to be deficient which has a clinical symptom of cold,while the stomach belongs to yangming and is easy to be excess which has a clinical symptom of heat.So the cooling and heating methods were the basic methods in treating the diseases of the spleen and stomach.The appropriate formulas includs Banxia Xiexin decoction,Shengjiang Xiexin decoction,Wumei pills,etc.with the functions of regulating cold and heat.The common herbs are:huang lian(coptis rhizome),huang qin(radix scutellaria)combined with gan jiang(rhizoma zingiberis),wu zhu yu(evodia rutaecarpa)and fu zi(Radix Aconiti Lateralis Praeparata).Prof.SUN Bing also paid attention to the physiological characteristics of the spleen and stomach and applied dang shen(pilose asiabell root),bai zhu(rhizoma atractylodes macrocephalae),chai hu(radix bupleurum),yu zhu(radix polygonati officinalis),mai dong(tuber of dwarf lilyturf),sha shen(radix adenophorae)and sheng di huang(dried rehmannia root)etc.with the functions of invigorating the spleen qi,soothing the liver qi and nourishing yin and body fluid so as to regulate yin and yang by using cooling and heating methods,promote the upward and downward flowing of qi by using pungent and descending herbs which had practical significance in guiding not only the clinical treatment but also the prescribing principles.
The cooling and heating methods was first found in Huangdi Neiing and used in the complicated symptoms of intermingling of cold and heat.SUN Bing believed that the important pathogenesis of diseases of the spleen and stomach was intermingling of cold and heat with cold in spleen and heat in stomach as the core pathogenesis.The spleen belongs to taiyin and the spleen qi is easy to be deficient which has a clinical symptom of cold,while the stomach belongs to yangming and is easy to be excess which has a clinical symptom of heat.So the cooling and heating methods were the basic methods in treating the diseases of the spleen and stomach.The appropriate formulas includs Banxia Xiexin decoction,Shengjiang Xiexin decoction,Wumei pills,etc.with the functions of regulating cold and heat.The common herbs are:huang lian(coptis rhizome),huang qin(radix scutellaria)combined with gan jiang(rhizoma zingiberis),wu zhu yu(evodia rutaecarpa)and fu zi(Radix Aconiti Lateralis Praeparata).Prof.SUN Bing also paid attention to the physiological characteristics of the spleen and stomach and applied dang shen(pilose asiabell root),bai zhu(rhizoma atractylodes macrocephalae),chai hu(radix bupleurum),yu zhu(radix polygonati officinalis),mai dong(tuber of dwarf lilyturf),sha shen(radix adenophorae)and sheng di huang(dried rehmannia root)etc.with the functions of invigorating the spleen qi,soothing the liver qi and nourishing yin and body fluid so as to regulate yin and yang by using cooling and heating methods,promote the upward and downward flowing of qi by using pungent and descending herbs which had practical significance in guiding not only the clinical treatment but also the prescribing principles.
引文
[1]周永学.中药寒热并用在方剂配伍中的应用[J].中华中医药杂志,2010,25(10):1543-1545.
[2]刘绍能,张秋云.脾胃病寒热错杂证辨治体会[J].北京中医药,2011,30(4):282-283.
[3]王江,周永学,谢勇波.基于寒热并用配伍原则探讨慢性消化性溃疡的辨证施治[J].陕西中医学院学报,2013,36(1):75-77.
[4]马祥雪,王凤云,唐旭东.从寒热并用理论探讨慢性胃肠疾病的辨治[J].中医杂志,2015,56(24):2125-2132.
[5]王江,周永学,谢勇波.半夏泻心汤拆方对胃溃疡大鼠胃黏膜修复因子EGF、VEGF表达的影响及方中寒热并用配伍意义的研究[J].中华中医药学刊,2015,33(11):2700-2702.
[6]胡庆昌,张凤敏.柴胡桂枝干姜汤治疗腹泻型肠易激综合征疗效观察[J].新中医,2014,46(1):62-63.
[7]李赛美.《伤寒论》寒热并用法临床应用[J].北京中医药大学学报,2008,31(12):797-799.
[8]赵健,严季澜,李柳骥.中医药治疗肠易激综合征用药规律分析[J].中医学报,2015,30(4):586-589.
[9]王捷虹,靳光荣,卞立群,等.唐旭东教授对功能性胃肠病症状重叠现象的学术观点及其中医治疗经验[J].四川中医,2016,34(3):8-9.
[2]刘绍能,张秋云.脾胃病寒热错杂证辨治体会[J].北京中医药,2011,30(4):282-283.
[3]王江,周永学,谢勇波.基于寒热并用配伍原则探讨慢性消化性溃疡的辨证施治[J].陕西中医学院学报,2013,36(1):75-77.
[4]马祥雪,王凤云,唐旭东.从寒热并用理论探讨慢性胃肠疾病的辨治[J].中医杂志,2015,56(24):2125-2132.
[5]王江,周永学,谢勇波.半夏泻心汤拆方对胃溃疡大鼠胃黏膜修复因子EGF、VEGF表达的影响及方中寒热并用配伍意义的研究[J].中华中医药学刊,2015,33(11):2700-2702.
[6]胡庆昌,张凤敏.柴胡桂枝干姜汤治疗腹泻型肠易激综合征疗效观察[J].新中医,2014,46(1):62-63.
[7]李赛美.《伤寒论》寒热并用法临床应用[J].北京中医药大学学报,2008,31(12):797-799.
[8]赵健,严季澜,李柳骥.中医药治疗肠易激综合征用药规律分析[J].中医学报,2015,30(4):586-589.
[9]王捷虹,靳光荣,卞立群,等.唐旭东教授对功能性胃肠病症状重叠现象的学术观点及其中医治疗经验[J].四川中医,2016,34(3):8-9.