口苦症的病机探析

Discussion on the Pathogenesis of Bitter Taste in Mouth

[目的]分析中医经典和历代医家中对后世影响较大的口苦病机相关论述,以冀为口苦的中医研究和治疗开拓思路。[方法]运用分析、对比、总结等方法,系统回顾《黄帝内经》《伤寒论》《素问玄机原病式》《景岳全书》等医著中口苦病机相关论述,分析其中的共同点和差异点,总结出口苦病机,并附验案一则。[结果]《黄帝内经》《伤寒论》《景岳全书》中认为的口苦病机都与肝胆邪溢有关,只是在病因角度有所不同,《内经》偏向于情志失畅而《伤寒论》偏向于外邪侵袭,《景岳全书》则强调心脾两虚和肝肾阴虚等阴血虚证影响肝胆气机,导致“肝胆邪溢”而口苦。《素问玄机原病式》中“心热则口苦”的说法虽然影响广泛,但其论证过程似有瑕疵。所举医案中张光霁教授亦用清利肝胆法治疗口苦,取得满意疗效。[结论]针对口苦病机,历代医家虽然众说纷纭,但口苦病位在肝胆、病机关键为“肝胆邪溢”是其大体共识,疏肝利胆法应当贯穿治疗口苦症的始终。整理、分析、总结对后世影响较大的口苦病机相关论述,可为口苦的中医研究和临床治疗提供思路。

[Objective]To analyze the pathogenesis of bitter taste in mouth and provide clinicians with diagnosis and treatment ideas.[Methods]We systematically reviewed the theories about bitter taste in mouth in Inner Canon of Huangdi,Treatise on Febrile Disease,Jingyue Encyclopedia and Etiology Based on Plain Questions.[Result]Inner Canon of Huangdi,Treatise on Febrile Disease,Jingyue Encyclopedia all discuss the bitterness from the theory of liver and gallbladder,but they differ in the cause of the disease.,Inner Canon of Huangdi is biased towards emotional loss and the Treatise on Febrile Disease is biased towards exogenous evils.Jingyue Encyclopedia emphasizes that the spleen and blood deficiency syndrome such as heart and spleen deficiency and liver and kidney Yin deficiency affect the liver and gallbladder Qi function,leading to"hepatobiliary evil"and bitter taste.Although the saying"heart hot leads to bitter taste"in Etiology Based on Plain Questions is widely affected,but its argumentation process seems to be flawed.[Conclusion]For the bitter disease mechanism,although the doctors of the past generations had different opinions,it is a general consensus that the bitter disease is located in the liver and gallbladder and the pathogenesis is"hepatobiliary".Organizing,analyzing and summarizing the relevant discussions on the bitter and pathological mechanism has a great influence on later generations,and can provide ideas for TCM research and clinical treatment.