叶天士“肝病主治三法”理论的运用规律探析

Study on the Application of"Three Therapeutic Methods of Liver Diseases"of YE Tianshi

叶天士将《黄帝内经》中肝之苦欲补泻气味治法--甘缓、辛散、酸泄,总结归纳为"《内经》肝病主治三法",指出此治法的本质乃是调肝之体用:辛以理用,酸以治体,甘以缓急。通过全面分析叶天士著述中相关医案,系统探求其中变化运用规律:苦降、辛泄、微酸配伍之意,最合经旨,但需依病机变化以化裁。若营络虚损者,忌酸宜以辛甘润补;淋疝体虚者,忌酸宜以辛香甘润;肝胆相火亢盛者,则加苦寒之品以泄之;下焦肝肾精血不足者,则去辛散,取咸寒滋水以涵木等;并指出此种治法的禁忌病症情况,若其腑络壅结,则不宜用辛酸甘法,又当另辟咸苦配伍等其他治法。

Huangdi Neijing recorded the therapeutic methods of nature and flavor about Kuyu Buxie of liver,such as gan-huan,xin-san and suan-xie,which YE Tianshi named"three therapeutic methods of liver diseases of Huangdi Neijing",and pointed out the essence was regulating the liver being substantial yin and functional yang,namely pungent taste promotes the function of liver-yong,sour taste promotes the function of liver-ti,and sweet taste alleviates liver-qi.The paper study the various rules of its application,through analyzing the related medical cases of YE Tianshi.The compatibility between bitter down bearing,and pungent taste divergence with some sour taste,is accord with the meaning of Huangdi Neijing.But need to use flexibility on the basis of the pathogenesis.If the collateral is deficiency,the xin-run and gan-bu are needed,and sour taste is avoided.If the constitution is fragile,and have gonorrhoea or hernia,the xin-run with aromatic and gan-bu are needed,and sour taste is inappropriate.If the liver and gall-fire hyperactivity,bitter-cold is needed.If it is yin deficiency of liver and kidney,salty-cold is added,the methods of xin-san is avoided.And pointed out the contraindication of"three therapeutic methods of liver diseases of Huangdi Neijing".For example,if it is stagnation in collateral of intestines,the compatibility of sour-pungent-sweet taste is improper,the compatibility of salt-bitter taste is suitable.