湿秘刍议

Discussion on Damp Constipation

湿秘在古代典籍中多有提及,且在临床中常见,但在目前的教材及指南中论述较少,故明确湿秘的概念、常见类型、证候、治法、方药等,有助于拓宽便秘的诊治思路,提高临床疗效。该文结合古今文献及临床实践认为,湿秘是一种因湿邪阻滞气机而致大肠传化失司的特殊类型便秘。其基本病机为湿阻气滞,病位虽在大肠,但五脏的功能失调均可在其发病过程中起着一定的作用,尤需关注脾胃、肺、肾、肝等脏腑通过津液代谢与气机运动,对该病发生、发展及临床治疗所产生的重要影响。湿秘的治疗原则为祛邪扶正,以祛邪为先导,辅以扶正。临证时谨守"湿阻气滞"病机,确立祛湿理气为该病的基本治法。祛湿应根据湿邪性质及阻滞部位,湿困中焦者治以苦芳燥化,湿停下焦时治以甘淡渗利,阳虚湿滞者当温阳化湿,湿热滞中者治以清热祛湿,湿热弥漫三焦则需分清化浊;理气应立足于和中、调理肝肺气机。如兼夹邪气郁滞,需重视疏导邪滞。伴脾肾虚损时,则佐以运脾、温肾方药,以求标本兼治。

Damp constipation has been mentioned in ancient books,and it is a common disease in the clinic.But there are few consensus discussants in the current textbooks and guidelines.Therefore,clarifying the concept,common types,symptoms,treatment methods,prescriptions and so on of damp constipation will help to broaden the diagnosis and treatment of constipation and improve the clinical efficacy.Combining ancient and modern literature and clinical,damp constipation is a special type of constipation in which the conduction function of the large intestine fail due to the blockage of dampness.The basic pathogenesis of damp constipation is considered to be the damp obstruction and Qi stagnation,and the location of the disease is the large intestine.However,the dysfunction of the five Zang-organs system can also play a certain role in its pathogenesis.Particular attention should be paid to the important influence of the spleen,stomach,lung,kidney,liver and other organs on the occurrence,development and clinical treatment of this disease through body fluid metabolism and Qi movement.The treatment principle of damp constipation is to eliminate pathogen and strengthen vital Qi,with the principle of eliminating pathogen as the guide,and supplemented by the strengthening vital Qi.In the treatment,we should strictly observe the pathogenesis of“damp-obstruction and Qi-stagnation”,take expelling damp and Qi-regulating as the basic treatment.Eliminating dampness should be based on the nature of dampness and the obstruction location.When the dampness is obstructed in middle Jiao,we should dispell dampness with bitter warm-natured drugs and aromatics.When the dampness is in lower Jiao,the treatment is to promote diuresis with sweet drugs of tasteless flavor and sweet taste.Those with Yang deficiency and dampness should be warmed to reduce dampness.Treatment of dampness-heat obstructed in middle Jiao is to clear away dampness-heat.The treatment is to distinguish and resolve turbidity while dampness-heat pervades three Jiao.Regulating qi-flowing should be based on harmonizing spleen and stomach and regulating Qi of liver and lung.If accompanied by pathogenic Qi stagnation,the attention should be paid to easing the stagnation.When accompanied by spleen and kidney deficiency,do not forget to promote the spleen and warm the kidney in order to treat both manifestation and root cause of damp constipation.