仲景对腹痛证治规律的探讨
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摘要
腹痛是临床常见病证之一,主要表现为胃脘以下耻骨以上部位发生疼痛。腹痛轻者,隐隐作痛,时痛时止,按之痛缓,得温痛减。腹痛重者,剧痛、满痛、绞痛、痛不可触,甚至伴随剧烈呕吐、头晕、恶心。
腹痛发生率很高,外感、内伤、饮食、情志及虫积等因素都会造成腹痛。腹痛病因病机复杂多样,许多腹痛在西医的治疗下不易取得良好成效。中医治疗从整体观念出发,辨证论治,具有综合作用的优势,因而受到广泛关注。
目的：《伤寒论》以六经辨证,主要为外感病辨证论治而设。《金匮要略》为脏腑经络辨证,主要用于内伤杂病的辨证论治。本文将在仲景论治基础上,结合《伤寒论》与《金匮要略》两书,针对腹痛条文进行病因病机与治则归纳分析,期望找出仲景对腹痛的证治规律。
方法：以《伤寒论讲义》与《金匮要略讲义》为资料来源,选取症状出现“痛”与部位于“腹”(或“小腹”、“少腹”、“心下”、“胁下”)的条文,按八纲进行病因病机分类,再以八法完成治则归类。
结果：分析条文后选出《伤寒论》腹痛条文26条,《金匮要略》腹痛条文39条。按八纲辨证,将腹痛病因病机分为寒、热、虚、实四大类,分别为寒：肾虚寒盛、表里俱寒、寒实结胸、寒实内结、寒饮逆满、寒热夹杂、脏寒虫扰；热：阳明热实、热实结胸、热瘀互结、胆胃热实、肝郁气逆、里实兼表；虚：肝脾不和、脾阳不振、血虚内寒、血虚气滞、冲任虚寒；实：水气内停、水饮壅盛、瘀血内结。治则归为下、和、温、消、补五大法,分别为下法：通腑泻实、泻热逐瘀、泻热逐水、泻热排脓、攻泻水饮、温寒开结、破血逐瘀；和法：和解少阳、和解通里、疏肝理脾、解表攻里、解表和脾、解表通滞、清热散寒、平肝降逆；温法：温阳散寒、温阳利水、温中降逆、温阳通便、温中涩肠；消法：清热散饮、行气散结、安蛔止痛；补法：温中健脾、补血散寒、温补冲任。
结论：仲景学说至今近二千年,通过条文分析,可知仲景虽有专立腹痛篇章,但此章篇外仍有许多遗漏的腹痛条文。此次结合《伤寒论》与《金匮要略》各篇腹痛条文共65条进行整理归纳,归纳腹痛病因病机多为寒、热、虚、实,治则上对食、痰、血、湿、水结聚内实证用以下法,半表半里、肝脾失调用以和法,脏腑虚寒用以温法,症瘕痞块用以消法,血气虚弱用以补法。这些腹痛辨证论治思想与处方用药,对中医临床仍具有重要的指导意义,值得深入探讨与研究。
Abdominal pain is a common disease pattern. The main symptom is distention in between stomach duct and pubis. Patients with mild abdominal pain can experience slight and paroxysmal pain which can be relieved when the abdominal is being pressed or warmed. Patients with severe abdominal pain can experience gripping pain. The abdominal can be too painful to be touched and accompanied by severe vomiting, dizziness and nausea.
There is a high incidence of abdominal pain which can be caused by external contraction, internal damage, diet, the seven emotions, worm accumulation syndrome and so on. The causes and mechanisms of which can be complicated and diverse. Many of the abdominal pain cases under the treatment of western medicine did not come out satisfying. However, traditional Chinese medicine treats disease with holism which takes pattern identification and treatment into account. It has the advantage of combined effects and is therefore attracting much attention.
The Objective:Shanghanlun indentifies disease with six-meridian pattern identification which is set for pattern identification and treatment for external contractions. Jinguiyaolue indentifies disease with visceral pattern which is set for pattern identification and treatment for internal damage and miscellaneous disease. The objectives of this study is to sum up the mechanisms and causes of abdominal pain based on the pattern identification and treatment of Zhang Zhongjing and by combining the theory of Shanghanlun and Jinguiyaolue.
Results:In the analysis of these abdominal-related articles,26articles from Shanghanlun and39from Jinguiyaolue were selected. According to causes and mechanisms of disease, these articles were further classified into four groups which are:cold pattern, heat pattern, deficiency pattern and excess pattern. For therapeutic principles, they can be divided into five methods which are:purgation, harmonizing method, warming method, disperse and tonifying methods.
Conclusion:The Zhang Zhongjing theory has been known for nearly two millennia. Through the article analysis, we know there is one chapters specifically about abdominal pain. However, there are still many related articles that were not included in this study which also have great influences for posterity. In summary, the pattern identification and treatment of Zhang Zhongjing for abdominal pain can be classified into four groups (cold pattern, heat pattern, deficiency pattern and excess pattern) according to causes and mechanism of disease. For therapeutic principles, they can be divided into five methods (purgation, harmonizing method, warming method, disperse and tonifying methods). Based on the results, these patterns can be used as references for clinical pattern identification and treatments for abdominal pain.
腹痛发生率很高,外感、内伤、饮食、情志及虫积等因素都会造成腹痛。腹痛病因病机复杂多样,许多腹痛在西医的治疗下不易取得良好成效。中医治疗从整体观念出发,辨证论治,具有综合作用的优势,因而受到广泛关注。
目的：《伤寒论》以六经辨证,主要为外感病辨证论治而设。《金匮要略》为脏腑经络辨证,主要用于内伤杂病的辨证论治。本文将在仲景论治基础上,结合《伤寒论》与《金匮要略》两书,针对腹痛条文进行病因病机与治则归纳分析,期望找出仲景对腹痛的证治规律。
方法：以《伤寒论讲义》与《金匮要略讲义》为资料来源,选取症状出现“痛”与部位于“腹”(或“小腹”、“少腹”、“心下”、“胁下”)的条文,按八纲进行病因病机分类,再以八法完成治则归类。
结果：分析条文后选出《伤寒论》腹痛条文26条,《金匮要略》腹痛条文39条。按八纲辨证,将腹痛病因病机分为寒、热、虚、实四大类,分别为寒：肾虚寒盛、表里俱寒、寒实结胸、寒实内结、寒饮逆满、寒热夹杂、脏寒虫扰；热：阳明热实、热实结胸、热瘀互结、胆胃热实、肝郁气逆、里实兼表；虚：肝脾不和、脾阳不振、血虚内寒、血虚气滞、冲任虚寒；实：水气内停、水饮壅盛、瘀血内结。治则归为下、和、温、消、补五大法,分别为下法：通腑泻实、泻热逐瘀、泻热逐水、泻热排脓、攻泻水饮、温寒开结、破血逐瘀；和法：和解少阳、和解通里、疏肝理脾、解表攻里、解表和脾、解表通滞、清热散寒、平肝降逆；温法：温阳散寒、温阳利水、温中降逆、温阳通便、温中涩肠；消法：清热散饮、行气散结、安蛔止痛；补法：温中健脾、补血散寒、温补冲任。
结论：仲景学说至今近二千年,通过条文分析,可知仲景虽有专立腹痛篇章,但此章篇外仍有许多遗漏的腹痛条文。此次结合《伤寒论》与《金匮要略》各篇腹痛条文共65条进行整理归纳,归纳腹痛病因病机多为寒、热、虚、实,治则上对食、痰、血、湿、水结聚内实证用以下法,半表半里、肝脾失调用以和法,脏腑虚寒用以温法,症瘕痞块用以消法,血气虚弱用以补法。这些腹痛辨证论治思想与处方用药,对中医临床仍具有重要的指导意义,值得深入探讨与研究。
Abdominal pain is a common disease pattern. The main symptom is distention in between stomach duct and pubis. Patients with mild abdominal pain can experience slight and paroxysmal pain which can be relieved when the abdominal is being pressed or warmed. Patients with severe abdominal pain can experience gripping pain. The abdominal can be too painful to be touched and accompanied by severe vomiting, dizziness and nausea.
There is a high incidence of abdominal pain which can be caused by external contraction, internal damage, diet, the seven emotions, worm accumulation syndrome and so on. The causes and mechanisms of which can be complicated and diverse. Many of the abdominal pain cases under the treatment of western medicine did not come out satisfying. However, traditional Chinese medicine treats disease with holism which takes pattern identification and treatment into account. It has the advantage of combined effects and is therefore attracting much attention.
The Objective:Shanghanlun indentifies disease with six-meridian pattern identification which is set for pattern identification and treatment for external contractions. Jinguiyaolue indentifies disease with visceral pattern which is set for pattern identification and treatment for internal damage and miscellaneous disease. The objectives of this study is to sum up the mechanisms and causes of abdominal pain based on the pattern identification and treatment of Zhang Zhongjing and by combining the theory of Shanghanlun and Jinguiyaolue.
Results:In the analysis of these abdominal-related articles,26articles from Shanghanlun and39from Jinguiyaolue were selected. According to causes and mechanisms of disease, these articles were further classified into four groups which are:cold pattern, heat pattern, deficiency pattern and excess pattern. For therapeutic principles, they can be divided into five methods which are:purgation, harmonizing method, warming method, disperse and tonifying methods.
Conclusion:The Zhang Zhongjing theory has been known for nearly two millennia. Through the article analysis, we know there is one chapters specifically about abdominal pain. However, there are still many related articles that were not included in this study which also have great influences for posterity. In summary, the pattern identification and treatment of Zhang Zhongjing for abdominal pain can be classified into four groups (cold pattern, heat pattern, deficiency pattern and excess pattern) according to causes and mechanism of disease. For therapeutic principles, they can be divided into five methods (purgation, harmonizing method, warming method, disperse and tonifying methods). Based on the results, these patterns can be used as references for clinical pattern identification and treatments for abdominal pain.
引文
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[3]尤亚贤.中西医结合治疗隐匿性抑郁症100例[J].陕西中医,1985,6(6)：247-248
[4]韩毳,李晓泓.抑郁症与中医肝脏关系探讨[J].山东中医杂志,2001,20(5)：326-329
[5]邵文虎.解郁合欢汤治疗抑郁症举隅[J].河北中医,1996,18(5)：33-34
[6]刚岫清.中西医结合治疗隐匿性抑郁症初步体会[J].内蒙古中医药,1986,7(3)：29-30
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