基于五脏与津不足角度分析朱秉宜教授治疗便秘的临床经验

An analysis of Professor ZHU Bingyi’s clinical experience in treating constipation based on the insufficiency of the five internal organs and body fluid

便秘主要表现为大便排出受阻、大便次数少、大便干硬难解。便秘的原因较为复杂,发病机制尚不明确,目前临床中尚无根治的方法。朱秉宜教授为第一批国家级名老中医,在治疗便秘方面积累了丰富的经验。朱老认为,便秘的病机为“五脏不足”引起的“津不足,津不布”。“津不足”源于津液化生不足及消耗增多,与肾、肺相关;“津不布”源于脾气散精功能障碍。其观点是以“津亏”“燥结”为病理基础,以“五脏不足”为主要病机。临床治疗上朱老强调重视五脏虚,不可仅通六腑,应注意标本同治,虚实兼顾,以通肠道积滞。同时,朱老在“五脏不足”病机基础上重视阴阳双调。津液的输布与五脏的充盈与否关系密切,五脏不足可导致津液输布异常,进而导致结肠内津液不足,朱老的“通便汤”即以此为基础。基于津液代谢角度治疗便秘的“通便汤”药物组成主要有白术、苦杏仁、熟地黄、麦冬、玄参、南沙参、枳壳、厚朴、莱菔子、瓜蒌仁、火麻仁、郁李仁等。本方汇集了朱老治疗便秘的重要学术思想,补五脏重在调理肺、脾、肾之不足,符合肺、脾、肾参与体内津液代谢与输布的中医理论。朱老以“通便汤”来改善五脏不足、结肠津液不足,从而治疗便秘,取得了良好的疗效。

Constipation is mainly manifested by blocked stool discharge,less stool frequency,and hard stool.The causes of constipation are relatively complex,and the pathogenesis is still unclear.At present,there is no radical treatment in clinical practice.Professor ZHU Bingyi,one of the first batch of national famous TCM experts,has accumulated rich experience in the treatment of constipation.Professor ZHU believes that the pathogenesis of constipation is“insufficiency of body fluid”and“accumulation of body fluid”caused by“insufficiency of the five Zang organs”.“Insufficiency of body fluid”originates from insufficient production and increased consumption of body fluid,which is related to kidney and lung;“accumulation of body fluid”originates from the dysfunction of spleen Qi(气)dispersing essence.His viewpoint is that“body fluid”and“dryness knot”are the pathological basis,and“deficiency of the five Zang organs”is the main pathogenesis.In clinical treatment,Professor ZHU emphasizes that we should pay attention to the deficiency of the five Zang(脏)organs in addition to the six Fu(腑)organs and the treatment of symptoms and the root causes.At the same time,Professor ZHU emphasizes the regulation of Yin(阴)and Yang(阳)on the basis of the pathogenesis of“deficiency of the five internal organs”.The distribution of body fluid is closely related to the filling of the five Zang organs.The insufficiency of the five Zang organs can lead to abnormal body fluid distribution,leading to insufficient body fluid in the colon.The Professor ZHU’s Tongbian decoction(通便汤)is based on this.The drug composition of the Tongbian decoction,which is based on body fluid metabolism to treat constipation,mainly includes Baizhu(atractylodes macrocephala),Kuxingren(almonds),Shudihuang(rehmannia glutinosa),Maidong(ophiopogon japonicus),Xuanshen(scrophularia),Nanshashen(Adenophorae Radix),Zhike(orange peel),Houpo(magnolia officinalis),Laifuzi(radish seed),Gualouren(trichosanthes kernel),Huomaren(hemp seed),Yuliren(Yu plum kernel),etc.This prescription has collected Professor ZHU’s important academic thoughts on the treatment of constipation.The key point of tonifying the five Zang organs is to regulate the deficiency of the lung,spleen and kidney,which conforms to the TCM theory that the lung,spleen and kidney participate in the metabolism and distribution of body fluid.Professor ZHU applies the Tongbian decoction to ameliorate the deficiency of the five Zang organs and body fluid,thus treating constipation and achieving good results.