肝病诊疗需重视补肝气与温肝阳
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摘要
[目的]分析肝气虚与肝阳虚客观存在的理论基础,探讨补肝气、温肝阳的理论依据,拓宽肝病诊疗思路,提高临床疗效。[方法]整理历代重要医籍中关于肝气虚与肝阳虚的论述,阐述肝气虚与肝阳虚客观存在的理论依据,归纳肝气虚与肝阳虚的病因病机,总结肝气虚与肝阳虚的临床症状、舌苔和脉象,概括补肝气与温肝阳的常用药物、代表方剂和中医外治疗法。[结果]肝病患者确实存在肝气虚与肝阳虚。早在《黄帝内经》就有相关论述。历代医家论著中不少关于肝气虚与肝阳虚的论述,是肝气虚与肝阳虚客观存在的理论基础。多种因素都可导致肝气虚与肝阳虚。正气亏虚、邪气侵犯,可消耗肝气、损伤肝阳。肝气虚与肝阳虚的关键发病因素为痰、湿、毒、瘀、虚。对于肝虚患者,不仅需重视滋肝阴、养肝血,还需重视补肝气、温肝阳。补肝气和温肝阳是中医治疗肝病的重要法则。[结论]通过对肝气虚及肝阳虚的历史渊源、病因病机、临床诊断及治疗方法进行总结归纳,可以看出,肝气虚与肝阳虚在肝病患者中客观存在,补肝气与温肝阳是中医理论体系中的重要内容。肝病诊疗过程中重视补肝气虚与温肝阳,可以丰富肝病中医诊疗理论,提高临床疗效。
[Objective] Firstly, to analyze the theoretical basis of the objective existence of the deficiency of liver Qi and liver Yang. Secondly, to make a discussion on the theoretical basis of nourishing liver Qi and warming liver Yang. Thirdly, to broaden the idea of liver disease diagnosis and treatment and then to improve the clinical efficacy. [Method] First, to collect and sort the discussion on the deficiency of liver Qi and liver Yang in the past dynasties medical books, and then to elaborate the objective existence of theoretical basis on deficiency of liver Qi and liver Yang. Third, to conclude the etiology and pathogenesis of deficiency of liver Qi and liver Yang. Finally, to summarize the clinical symptoms, coated tongue and pulse, and to sum up the commonly used medicine, representative prescription, external use of traditional Chinese medicine from their historical origin,and treatment methods and so on.[Result]Deficiency of liver Qi and liver Yang exists objectively in liver disease patients and it was discussed as early as in the Huangdi Neijing. The practitioners of later generations also have a lot of relevant discussions and those proved the truth of deficiency of liver Qi and liver Yang. In fact, various factors can lead to deficiency of liver Qi and liver Yang. For example, deficiency of vital qi and pathogens invasion, can consume liver Qi and injure liver Yang. The main pathogenic factors of deficiency of liver Qi and liver Yang are phlegm, damp-toxin, blood stasis, and deficiency. For these liver deficiency patients, they not only pay attention to nourishing the liver-Yin and liver blood, but also value nourishing the liver-Qi and warming liver Yang. So nourishing liver Qi and warming liver Yang is an important content in the theoretical system of traditional Chinese medicine.[Conclusion] By summarizing and inducing the historical origin, etiology and pathogenesis, clinical diagnosis and treatment method of the deficiency of liver Qi and liver Yang. As can be seen,nourishing liver Qi and warming liver Yang is an important principle in the treatment of liver diseases. In the diagnosis and treatment of liver disease, we should pay attention to nourishing liver Qi and warming liver Yang, which can improve the clinical efficacy and enrich the theory of traditional Chinese medicine diagnosis and treatment of liver disease.
[Objective] Firstly, to analyze the theoretical basis of the objective existence of the deficiency of liver Qi and liver Yang. Secondly, to make a discussion on the theoretical basis of nourishing liver Qi and warming liver Yang. Thirdly, to broaden the idea of liver disease diagnosis and treatment and then to improve the clinical efficacy. [Method] First, to collect and sort the discussion on the deficiency of liver Qi and liver Yang in the past dynasties medical books, and then to elaborate the objective existence of theoretical basis on deficiency of liver Qi and liver Yang. Third, to conclude the etiology and pathogenesis of deficiency of liver Qi and liver Yang. Finally, to summarize the clinical symptoms, coated tongue and pulse, and to sum up the commonly used medicine, representative prescription, external use of traditional Chinese medicine from their historical origin,and treatment methods and so on.[Result]Deficiency of liver Qi and liver Yang exists objectively in liver disease patients and it was discussed as early as in the Huangdi Neijing. The practitioners of later generations also have a lot of relevant discussions and those proved the truth of deficiency of liver Qi and liver Yang. In fact, various factors can lead to deficiency of liver Qi and liver Yang. For example, deficiency of vital qi and pathogens invasion, can consume liver Qi and injure liver Yang. The main pathogenic factors of deficiency of liver Qi and liver Yang are phlegm, damp-toxin, blood stasis, and deficiency. For these liver deficiency patients, they not only pay attention to nourishing the liver-Yin and liver blood, but also value nourishing the liver-Qi and warming liver Yang. So nourishing liver Qi and warming liver Yang is an important content in the theoretical system of traditional Chinese medicine.[Conclusion] By summarizing and inducing the historical origin, etiology and pathogenesis, clinical diagnosis and treatment method of the deficiency of liver Qi and liver Yang. As can be seen,nourishing liver Qi and warming liver Yang is an important principle in the treatment of liver diseases. In the diagnosis and treatment of liver disease, we should pay attention to nourishing liver Qi and warming liver Yang, which can improve the clinical efficacy and enrich the theory of traditional Chinese medicine diagnosis and treatment of liver disease.
引文
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[3]孙思邈.备急千金要方[M].长春:吉林人民出版社,1994:382-383.
[4]严用和.重订严氏济生方[M].北京:人民卫生出版社,1980:1.
[5]秦伯未.谦斋医学讲稿[M].上海:上海科学技术出版社,2009:83-84.
[6]王玉生.类经图翼·类经附翼评注[M].西安:陕西科学技术出版社,1996:402.
[7]孙星衍.华氏中藏经[M].北京:商务印书馆,1956:11-12.
[8]陈家旭.试述肝气虚证的诊断与鉴别[J].中医药研究,1993(6):11-12.
[9]王德伟,王喜周,陈力,等.张锡纯论肝气虚[J].浙江中医药大学学报,2012,36(8):869-870.
[10]史俊芳,刘建春.浅谈肝阳虚证[J].中国民间疗法,2006,14(10):3-4.
[11]乔蓉,李大军.张锡纯“肝气虚”理论初探[J].中国中医基础医学杂志,2003,9(9):69-70.
[12]张璐.千金方衍义[M].北京:中国中医药出版社,1995:245-246.
[13]张介宾.景岳全书[M].上海:第二军医大学出版社,2006:1548.
[14]李飞.方剂学[M].2版.北京:人民卫生出版社,2011:1155.
[15]杜丽英.赵学印教授治疗肝病经验[J].中国中医药现代远程教育,2015,13(17):30-31.
[16]鲁兆麟.中医各家学说[M].北京:中国中医药出版社,2000:192.
[17]张锡纯.医学衷中参西录[M].北京:中国医药科技出版社,2011:222-227.
[18]丁舸,娄雷涛.浅谈吴茱萸在方剂中的配伍意义[J].浙江中医药大学学报,2010,34(1):28-29.
[19]汪昂.全图本草备要[M].重庆:重庆大学出版社,1996:118.
[20]侯辰阳.“补气”、“养血”治法在肝系疾病治疗中的意义[J].山东医学高等专科学校学报,2013,35(2):158-159.
[21]苏卫东,袁学山.浅论肝气(阳)虚证[J].安徽中医学院学报,2005,24(5):1-3.
[22]窦材.扁鹊心书[M].北京:中医古籍出版社,1992:9.