从“肝主筋”理论辨治慢性疲劳
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摘要
肝阴、肝血滋养不足可致筋膜失养、肝用的相对不及而出现慢性疲劳,而肝气、肝阳升发调达功能的绝对不足更可直接导致慢性疲劳。气血、水湿、邪气常因物候、地理、体质等因素夹寒化热,导致气机紊乱,肝不得疏,气血、经络运行不畅,最终导致筋脉失于濡养而出现痿软乏力。可见,慢性疲劳的病机核心在于肝用不及,不能发挥"罢极之本"的功能。因此,临证辨治慢性疲劳不可先入为主、漫谈虚劳、以方套病,须当条析诸症、四诊合参,方能见病之源,收到良好的临床效果。
Liver Yin,Liver blood nourishment shortage can cause fascia dystrophy.The relative deficiency of Liver function can cause chronic fatigue,and the absolute deficiency of liver Qi and liver Yang function can lead to chronic fatigue more directly.Qi and blood,Dampness and Evil factors would cause Heat or Cold symptoms and result in Qi movement disorder based on different phenology,geography and human physical constitution as well as other factors.When Liver Qi cannot act normally,Qi and blood operation in meridians would not be smooth,and eventually lead to the loss of nutrients and weakness in tendons and meridians.It can be seen that the core pathogenesis of the chronic fatigue is the dysfunction of Liver,which cannot play the function of "being the source of endurance".Therefore,in clinical syndrome differentiation and treatment,chronic fatigue cannot be considered only as a disease itself.Only by comprehensive diagnosis,can the source of the disease be treated correctly and effectively.
Liver Yin,Liver blood nourishment shortage can cause fascia dystrophy.The relative deficiency of Liver function can cause chronic fatigue,and the absolute deficiency of liver Qi and liver Yang function can lead to chronic fatigue more directly.Qi and blood,Dampness and Evil factors would cause Heat or Cold symptoms and result in Qi movement disorder based on different phenology,geography and human physical constitution as well as other factors.When Liver Qi cannot act normally,Qi and blood operation in meridians would not be smooth,and eventually lead to the loss of nutrients and weakness in tendons and meridians.It can be seen that the core pathogenesis of the chronic fatigue is the dysfunction of Liver,which cannot play the function of "being the source of endurance".Therefore,in clinical syndrome differentiation and treatment,chronic fatigue cannot be considered only as a disease itself.Only by comprehensive diagnosis,can the source of the disease be treated correctly and effectively.
引文
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[2]胡国臣,张年顺.李东垣医学全书·脾胃论[M].北京:中国中医药出版社,2006:56.
[3]尤怡.医学读书记[M].南京:江苏科学技术出版社,1983:18.
[4]段玉裁.说文解字注[M].台北:艺文印书馆,2005:107.
[5]李今庸.读古医书随笔[M].北京:人民卫生出版社,1984:31.
[6]姚荷生,潘佛岩.脏象学说与诊断应用的文献探讨——脾脏·肝脏·肺脏[M].北京:人民卫生出版社,2014:103.
[7]王冰.重广补注黄帝内经素问[M].北京:学苑出版社,2009:207.
[8]张锡纯.医学衷中参西录[M].太原:山西科学技术出版社,2009:178.
[9]秦伯未.谦斋医学讲稿[M].上海:上海科学技术出版社,2009:83-84.
[10]伍建光.伍炳彩教授从湿论治内伤杂病的学术经验和临床研究[D].南京:南京中医药大学,2012.
[11]林佩琴.类证治裁[M].北京:人民卫生出版社,1988:157-158.
[12]姚国美.姚国美医学讲义合编[M].北京:人民卫生出版社,2009:31.
[13]姚荷生.中医内科学评讲[M].北京:人民卫生出版社,2013:287-289.
[14]姚荷生,万友生,邵功厚,等.杏林医选江西省名老中医经验选编[M].南昌:江西科学技术出版社,1987:67-68.
[15]胡翘武.橘井一勺四时常见感症求径[M].北京:学苑出版社,2015:63-64.
[16]赵敏,刘英锋,万松.刘英锋从中焦湿热论治慢性疲劳综合征[J].江西中医药,2016,66(4):22-23.
[17]陈瑶,章文春.从少阳论治慢性疲劳综合征[J].江西中医药,2016,66(7):28-29.