论《伤寒论》之“痞”(下)

Discussion About "Abdominal Mass" in Treatise on Cold Damage Diseases(Ⅱ)

"痞"病机为"阳气微弱,风冷入里",来源是少阳所传。张仲景对"心下痞"一证的治疗多从调理脾胃入手,代表处方有半夏泻心汤、甘草泻心汤、生姜泻心汤、大黄黄连泻心汤、附子泻心汤、桂枝人参汤。上焦和中焦脾胃的关系非常密切,上焦的疾病可以通过中焦来治疗,所以张仲景对于胸部的"痞"一证,不管是用"瓜蒂散"吐,还是用"人参汤"温,或是用"桂枝生姜枳实汤"散,其药物治在脾胃无疑。张仲景对于"痞"一证的治疗围绕着太阳、少阳(肝)、脾、肾这一主线,使用药物调解肝脾肾三脏之气机,治疗重点为调理脾胃。

The pathogenesis of ＂ abdominal mass＂ is due to weak yang and cold wind attacking the body,and the source comes from Shaoyang. In terms of ＂ epigastric fullness＂,Zhang Zhong-jing usually regulating the spleen and stomach,and the representing the prescriptions include Pinellia Heart-Draining Decoction,Rhubarb and Coptis Heart-Draining Decoction,Poria HeartDraining Decoction,Cinnamon Twig and Ginseng Decoction. The relationship between the upper-jiao and the the middle-jiao(spleen and stomach） is very close,the disease in the upper-jiao can be treated by middle-jiao,so Zhang Zhong-jing＇s focuses on regulating the spleen and stomach,whether using Melon Stalk Powder for vomiting,or Ginseng Decoction for treating,or Cinnamon Twig and Fresh Ginger and Immature Bitter Orange Decoction. For treating ＂ abdominal mass＂,Zhang Zhong-jing centers on Taiyang,Shaoyang(the liver）,spleen and kidney,uses drugs to regulate qi activities of the above three organs. In fact,the emphasis is on the spleen and stomach,which is his general treating principle.