张珍玉从肝论治脾胃病经验探析

ZHANG Zhenyu′s Experience on Treating Spleen and Stomach Diseases from Liver

张珍玉教授基础理论深厚,临证经验丰富,他强调中医基础理论,尤其是藏象学说对临床实践的指导作用。他亦强调辨证论治,重视脏腑辨证。肝与脾胃关系密切,二者同位膈下,共居中焦,位置相邻,经络相系。在生理上相互为用,病理上亦相互影响。临床上,当肝气逆乱,横逆乘脾犯胃,木土相克;或肝气郁结,木不疏土。或脾气虚弱,土虚木乘等都是导致脾胃病发生的常见发病途径。因此张老提出:肝失疏泄包括“太过”和“不及”两端,辨证就有“肝气郁”与“肝气逆”两证,辨证施治应有“舒肝”和“疏肝”二法。他认为柴胡疏肝散以疏肝理气为主,逍遥散偏于疏肝解郁;肝气逆证首选柴胡疏肝散,肝气郁证则先用逍遥散。肝主疏泄,调畅全身气机,张老擅长从肝入手,立足于气机失调,以调肝为基础进而调节全身脏腑气机,从根本上恢复人体肝与脾胃气机为要。肝复疏泄之职,则气机调畅,有助于脾胃之气的正常运行,从而保证了脾胃功能的正常发挥。因此深化肝与脾胃藏象理论,对临床临证具有重要意义。

Professor ZHANG Zhenyu has profound basic theory of TCM and rich clinical experience.He emphasizes the guiding role of the basic theory of TCM,especially theory of visceral manifestation in clinical practice.He also emphasized treatments based on syndrome differentiation and visceral differentiation.The liver is closely related to the spleen and stomach.The two are in the same position under the diaphragm,co-living in the middle coke,adjacent in position,and the meridians are in the system.They are physiologically useful and pathologically influencing each other.Clinically,when the liver Qi is disordered,the spleen invades the stomach,and the wood and earth overcome each other.Or the liver Qi is stagnant,and the liver wood can not soothe the spleen earth;or the spleen and stomach Qi is deficient and the deficient earth can by subjugated by wood.Therefore,Professor ZHANG has proposed that liver failing to soothe includes“soothing too much”and“soothing not enough”.There are“stagnation of liver Qi”syndrome and“inversion of liver Qi”syndrome based on syndrome differentiation.There should be two methods of“making liver comfortable”and“soothing liver”in syndrome differentiation and treatment.He believes that Chaihu Shugan Powder(柴胡疏肝散)is mainly used to soothe liver and regulate Qi,while Xiaoyao Powder(逍遥散)is used to soothe liver and relieve depression.Chaihu Shugan Powder is the first choice for liver Qi inversion syndrome,while Xiaoyao Powder is the first choice for liver Qi depression syndrome.The liver controls the release of Qi and regulates the Qi movement of the whole body.Professor ZHANG is good at starting from liver,based on the imbalance of Qi movement,regulating Zang-Fu organs Qi of the whole body on the basis of regulating liver,and fundamentally restoring the Qi movement of liver,spleen and stomach.The function of liver restoring and relieving is to soothe the Qi movement,which is conducive to the normal operation of spleen and stomach Qi,and thus ensuring the normal play of the function of spleen and stomach.Therefore,it is of great significance to deepen the viscera manifestation theory of liver,spleen and stomach.