叶天士分消走泄法临床应用探讨

Clinical Application of YE Tian-shi's Method of Dispersing and Eliminating to Discharge or Depart Evils

分消走泄法是叶天士《温热论》中治疗湿热病的主要方法。分消是因势利导应用开上、畅中、渗下的方法祛除湿邪,通过祛湿使阳气通达;走泄是指用行气之品,宣通气机,使气行湿去。湿热病常以脾胃为中心,脾胃纳运结合,升降相因,燥湿相济共同完成着饮食物的消化、吸收、转输。湿热最易损伤脾胃,而脾胃功能失调也最易内生湿热。湿为有形之邪,湿热相合,热蒸湿动,就会弥散三焦,湿性黏腻,又很少传变,难以清除,必然导致三焦气机不畅,气化不行,水道不通,水液代谢障碍等变化而出现相应症状,治疗当从祛除湿邪,通利三焦水道入手。所以叶天士提出"分消上下之势"的治法。临床凡是内伤杂病属痰、饮、水、湿类疾患,都可以此法变通应用。三仁汤、甘露消毒丹、黄芩滑石汤、温胆汤等临床应用即其实例。

Dispersing and eliminating to discharge or depart evils is the main principle while treating humid-heat diseases in Humid-heat Discussion written by YE Tian-shi.′Dispersing′ means opening upper energizer,cheering middle energizer and leaking lower energizer to clear dampness evil out in the light of its general tendency so as to uncage yang.′Eliminating′ means making the dampness evil move about so as to eliminate it,id est,using the herbal of promoting qi circulation to remove dampness,and unblockened qi pushing about dampness evil to go out.Humid-heat diseases often take spleen and stomach as centre.Spleen and stomach have the relationship of combination of receiving food and transportation and transformation,mutual causality of ascending and descending,and coordination between dryness and dampness,together to fulfil the duty of digestion,absorption,transportation and transformation.Humid heat is easy to injure spleen and stomach,and the dysfunction of spleen and stomach is easy to generate humid-heat interiorly.Dampness evil is a kind of material evil.When dampness evil and heat evil combined together,heat evaporates dampness to move about,and wetness would diffuse among triple warmer.The nature of dampness is sticking and greasy,so dampness seldom could cause progress of disease and is difficult to be cleared out.So functional activity of qi in triple warmer would not be smooth,pneumatolysis would not work,and water course would be impassable.Dysbolism of body fluid can lead to various symptoms.Treatment should begin with clearing dampness evil out to unblock triple warmer.So YE Tian-shi raised the treatment method of dispersing and eliminating in upper and lower.In clinic such endogenous miscellaneous diseases as phlegm,fluid,water and dampness diseases,endogeny humid-heat syndrome,and endogeny cold-damp syndrome all can be treated according to it.And the author cited examples of Three-seeds Decoction,Detoxification Pill,Scutellaria and Talcum Decoction and Decoction for Clearing Away Gallbladder Heat by way of explanation.