《伤寒论》痞证与心的相关性

Discussion on Epigastric Oppression Syndrome of Treatise on Febrile Diseases Related to the Heart

《伤寒论》痞证以心下痞为主症。临床上痞证可以分为热痞证、寒热错杂痞证和虚痞证3种,其病机均与心相关。热痞证与寒热错杂痞证皆由心中有热所致,治疗采用泻心汤类方,清泻心中热邪以消痞。热痞证如大黄黄连泻心汤证的病机为心火亢盛,附子泻心汤证则兼有肾阳虚衰;寒热错杂痞证如半夏泻心汤证的病机为心火上炎、脾胃虚弱,生姜泻心汤证的病机为心热脾虚、水气内停,甘草泻心汤证的病机为脾胃虚弱、心中有热。虚痞证的基本病机为心脾不足,治以温补心脾为主,旋覆代赭汤证属于心阳不足、脾虚有痰,桂枝人参汤证属于心脾两虚兼有表证。

The main symptom of epigastric oppression syndrome in Treatise on Febrile Diseases is feeling fullness and distension in the upper abdomen, whose position should be a part below the heart and above the stomach. Clinically, epigastric oppression syndrome can be divided into hot syndrome, cold and hot mixed syndrome and deficient syndrome, the pathogenesis of which is related to the heart. Hot epigastric oppression syndrome and cold and hot mixed epigastric oppression syndrome are caused by heat in the heart, treating with Xiexin decoction, clearing away heat evil to eliminate oppression. The pathogenesis of hot syndrome such as Dahuang Huanglian Xiexin decoction syndrome is heart-fire hyperactivity, and Fuzi Xiexin decoction syndrome with kidney yang deficiency;for example, the pathogenesis of Banxia Xiexin decoction syndrome is flaming up of the heart-fire and weakness of the spleen and stomach;the pathogenesis of ginger xiexin decoction syndrome is the heart heat and spleen deficiency, internal cessation of water and gas;the pathogenesis of licorice xiexin decoction syndrome is weakness of the spleen and stomach and heat in the heart. The basic pathogenesis of deficient epigastric oppression syndrome is weakness of heart and spleen, which is mainly treated by warming and strengthening the heart and spleen. Xuanfu Daizhe decoction belongs to deficiency of heart yang, spleen weakness with phlegm, and Guizhi Renshen decoction belongs to deficiency of heart and spleen with superficial symptoms.