摘要
关于“胃家实”的讨论,现今大多数观点更类似于讨论“胃家实”为“证”与“症”。以六经辨证阳明经为立足点,从另一角度对“胃家实”与便秘的相关性进行探讨,通过对《伤寒论》中阳明病篇“阳明之为病,胃家实是也”的一个侧面剖析,认为《伤寒论》中的“燥屎、大便难”等描述为便秘的症,是便秘的雏形;结合六经的思想,足阳明胃经、手阳明大肠经是便秘功能性经属,从“燥、湿、瘀、虚、郁、和”等方面推演便秘并概要基础治法。其基础治法表现:(1)燥与“胃家实”,热多存于血,截流源头清血热后调气血,热退血畅,燥可得解;(2)湿与“胃家实”“引湿入海”,运脾尤为重要;(3)瘀与“胃家实”,则气血同调;(4)虚与“胃家实”,阳明以胃气为本,调升降,济阴阳;(5)郁与“胃家实”,则要顺气;(6)和与“胃家实”,以平为期;(7)“胃家实”欲解时,为7月、8月、9月,19日至26日,15―21时。此欲解时对于治疗有一定价值,但此欲解时只能看作特征性的本经病,即“津枯燥屎结”,津因阳过而损,阳气降,症得缓。基于此,比阳明经“燥屎”更复杂的是“胃家实”便秘。笔者临床观察体会到,功能性便秘的“欲解时”可考虑为晨起、三餐后、压力减轻后、情绪舒缓后。基于阳明经“胃家实”观点,气与血是胃肠生理功能、病理的表现,是辨治便秘的基础。而从经典出发,探索错综复杂的便秘网,有利于进一步深入阐释“肠神”的临床及实验研究,也从一定角度为研究经典提供了方法论基础。
As for discussion about“stomach excess”,most of the current views are more similar to the discussion of“stomach excess”as“syndrome”and“disease”.Based on the syndrome differentiation of the six meridian Yangming(阴明)meridian,discusses the correlation between“stomach excess”and constipation from another perspective.Through a side analysis of“Yangming disease is due to stomach excess”in Shanghan Lun(《伤寒论》),it is considered that“dry excrement and difficulty in defecating”in Shanghan Lun are described as constipation,which is the prototype of constipation.Combined with the thought of the six meridians differentiation,the stomach meridian of foot Yangming and the large intestine meridians of hand Yangming are functional meridians of constipation,and the basic treatment of constipation are deduced from the aspects of“dryness,dampness,blood stasis,deficiency,depression and harmony”.The basic treatment is manifested as:①Dryness and“stomach excess”,if heat is in the blood,cut off the source of blood heat after regulating Qi(气)and blood,the heat and dryness can be solved.②Wet and“stomach excess”,‘Draining the moisture into the sea’,spleen regulation is particularly important.③Blood stasis and“stomach excess”,regulating Qi and blood simutaneously;④Deficiency and“stomach excess”,Yangming is based on stomach Qi,adjusting the ascending and descending of stomach Qi and harmonizing Yin(阴)and Yang(阳).⑤Depression and“stomach excess”,it is necessary to ease Qi.⑥Harmony and“stomach excess”,harmony is the goal.⑦The time of remission of such diseases of“stomach excess”is from July,August,September,from the 15th to the 21st,and from 15:00 to 21:00.This solution has certain value for treatment,but this solution can only be seen as a characteristic of the classic disease,that is,“dry excrement knot”due to Yang damage,when Yangqi(阳气)is regulated,the disease is slow.Based on this,compared with Yangming meridian“dry excrement”,“stomach excess”constipation is more complex.The author’s clinical observation experience shows that the time of remission of functional constipation can be considered at time points of morning,after three meals,after pressure relief,after emotional relief.Based on the view of“stomach excess”,Qi and blood are the physiological functions of gastrointestinal tract and the pathological manifestations,and are the basis for the diagnosis and treatment of constipation.Starting from the classics,the exploration of the complex constipation network is conducive to further interpret the clinical and experimental studies of“intestinal God”,and also provides a methodological basis for the study of classics from a certain perspective.
出处
《中医临床研究》
2023年第3期39-42,共4页
Clinical Journal Of Chinese Medicine
基金
云南省省中医肛肠病区域中心建设项目
云南省科技厅-云南中医药大学应用基础联合专项面上项目[2018FF001(-071)]
云南省中医肛肠临床医学分中心建设项目
关键词
胃家实
功能性便秘
六经辨证
六经便秘
Stomach excess
Functional constipation
Syndrome differentiation of the six meridians
Six meridians constipation
