从《临证指南医案》论叶天士“辨治胃阳”思想及特色

Discussion on YE Tianshi’s Academic Thought and Characteristics of “Differentiating and Treating Stomach Yang” Based on Guide to Clinical Practice with Medical Records(《临证指南医案》)

叶天士在《临证指南医案》中对脾胃病进行了详细的论述,以阴阳为纲,创立了"胃阴学说",受到后世医家的关注。同时,叶天士亦重视胃腑之阳气,诊治胃阳虚医案众多,病因病机多有阳明不运、中焦失司,胃土失用、脏腑失和,胃络失守、气血失调等方面;在证治上提出通补阳明、调和脏腑、补虚通络等要法;用药则善刚柔相济,喜以薄味之品相通,对诊治脾胃系统疾病有一定指导意义。

YE Tianshi discussed the spleen and stomach diseases in detail in Guide to Clinical Practice with Medical Records(《临证指南医案》),taking yin and yang as the principle,he established the "theory of stomach yin",which was focused and studied by later physicians. Meanwhile,it is believed that YE Tianshi attaches importance to yang qi in the stomach fu organs,and has many medical cases for the diagnosis and treatment of stomach yang deficiency. The etiology and pathogenesis are mainly yangming’s failure to transport,loss control of middle jiao,malfunction of stomach earth,disharmony of zang organs and fu organs,loss defense of stomach collaterals,imbalance of qi and blood,etc. In the treatment of syndrome,he puts forward some important methods,such as dredging yangming,harmonizing zang organs and fu organs,tonifying deficiency and dredging collaterals. The drugs are good at combining hardness with softness,preferring to be combined with drugs of thin flavor,which has a certain guiding significance to the diagnosis and treatment of the spleen and stomach system diseases.