择时“扶阳抑阴”治疗腹泻型肠易激综合征理论探讨

Timing to Strengthen Yang and Suppress Yin in Treating Diarrhea Type Irritable Bowel Syndrome

黄元御在《四圣心源》中提出"一气周流,土枢四象"的学术思想,注重左升右降之圆圈理论。以此理论分析腹泻型肠易激综合征(IBS-D)基本病机为"阳衰土湿木郁",简而言之为清阳不升于左,故其治疗上主张升达左阳,使一气周流复常,清升浊自降,临证灵活运用"扶阳抑阴"学术思想对泄泻疗效显著。文章从针灸学子午流注时辰规律、《伤寒论》六经病欲解时辰规律,阐述了择时治疗疾病的重要性,为遵循时辰规律用药提供可靠的依据。结合相关文献资料进一步探讨"扶阳抑阴"学术思想辨证施治IBS-D的优势和有效性。

HUANG Yuanyu proposed the academic thought ＂Qi circulates into four directions with the earth as the pivot＂ in Sisheng Xinyuan,focused on lifting the left or descending the right of the circle theory.From the theoretical analysis,the basic pathogenesis of diarrhea type irritable bowel syndrome（IBS-D） was＂Yang deficiency,dampness in the earth and wood Qi stagnation＂,in a word,failure of lucid Yang to lift to the left,so the advocated treatment was to lift the left Yang to circulate Qi and lift the lucid Qi and descend the turbid. ＂Strengthening Yang and suppressing Yin＂ used in the clinical flexibility had remarkable curative effect on diarrhea. The time rule of midnight-noon ebb-flow in acupuncture and moxibustion as well as the time rule of disease recovery from six meridians were discussed to explain the importance of timing in the treatment of diseases and supply the reliable basis for the treatment according to time rules. The advantage and efficiency of ＂strengthening Yang and suppressing Yin＂ were discussed to treat IBS-D based on syndrome differentiation.