试从肝胆角度研究《脾胃论》及治疗脾胃病的用药特点

Study on Treatise on the spleen and stomach and the rules of treating spleen and stomach disease from the liver and gallbladder

目的:从五脏六腑的关系中探索《脾胃论》的深刻内涵,加深对经典的认知,进一步完善、指导临床实践。方法:通过:①对比的方法,找出李东垣治疗脾胃病的思路与用药特点。②文献梳理找到肝胆与脾胃病之间的关系,并进一步挖掘其中的规律;③从临床入手,以药证对应的方法,分析补泄肝胆与健脾胃之间的关系。结果:脾为死阴,没有肝胆的升发功能则无法发挥运化作用。脾胃病与肝胆的升清功能有着密切的关系,李东垣虽然强调补脾胃,但是绝大多数的情况下都会用升阳、祛风的思路,着重在肝胆升发上做文章,其中常用的黄芪、升麻、柴胡、防风等药就是具体的抓手,治疗脾胃病时肝胆与脾胃是一体的,你中有我,我中有你,相辅相成。结论:《脾胃论》是一部非常实用的经典,其所论的脾胃是所有与脾胃有关的脏腑关系的总和,而不是狭义的脾胃。脾胃病治疗中,要考虑“凡十一脏,皆取决于胆”中肝胆的决定作用。

Objective:To explore the profound connotation of Treatise on the spleen and stomach from the relationship between the five zang-six fu-organs, to deepen the cognition of classics, and further improve and guide clinical practice. Methods: 1. Comparative method was used to find out Li Dongyuan’s treatment of spleen and stomach disease and drug characteristics.2.The relationship between liver and gallbladder and spleen and stomach diseases was found through literature review, and the rules were further explored;3.The relationship between supplementing and relieving liver and gallbladder and strengthening spleen and stomach was analyzed from the clinical perspective and with the corresponding method of drug syndrome. Results: The spleen is dead Yin, and without the ascending function of liver and gallbladder, it cannot play the function of transportation and chemical transformation. Spleen and stomach disease have close relations with the liver and gallbladder’s function of raising and clearing, Li Dongyuan emphasized spleen and stomach, but in the vast majority of cases, invigorating Yang and dispelling the wind was applied, the commonly used astragalus, cohosh, radix bupleuri, divaricate saposhnikovia root and other medicine are the grippers, in the treatment of spleen and stomach disease, liver and spleen and stomach is an organic whole. Conclusion: Treatise on the spleen and stomach is a very practical classic. The theory of spleen and stomach is the sum of all the zang-fu relations related to spleen and stomach, rather than the narrow sense of spleen and stomach. In the treatment of spleen and stomach disease, consideration should be given to the decisive action of liver and gallbladder.