辨析经方之“里急”

Concept of"Li Ji"in Classical Formula

“里急”是经方中较为常见的症状之一,通过分析与张仲景生活时代相近的著作《说文解字》中“急”的字义,结合《伤寒论》《金匮要略》中“里急”条文的证治,研究经方中关于“里急”腹证的论述。经方中的“里急”与现今中医学“里急”的概念非常不同,其临床表现、治疗方法、方剂也完全不同。经方中的“里急”应主要表现为腹部消瘦、腹部肌肉紧张、自觉腹部拘挛不适,治当以小建中汤、黄芪建中汤等温中补虚缓急之剂;现今之“里急”主要表现为腹痛窘迫、时时欲便,常与“后重”相伴出现,治当以白头翁汤、芍药汤等清热祛湿之剂,对两者的进行明确区分不仅有助于理解张仲景原文,也可避免临床使用经方时出现“虚虚实实”之误。

"Li Ji"is one of the common symptoms in Jing Fang.By analyzing the meaning of"Ji"in Shuo Wen Jie Zi,which is similar to ZHANG Zhong-jing's life,combined with"Treatise on Cold Damage Disease"and"Synopsis of the Golden Chamber"for the treatment of the"Li Ji"provisions,study the Jingfang's exposition on the"Li Ji"abdominal evidence.The concept of"Li Ji"in Jing Fang is very different from the concept of"Li Ji"in modern Chinese medicine,and its clinical manifestations,treatment methods,and prescriptions are completely different.The"emergency"in Jingfang should mainly be manifested as abdominal wasting,abdominal muscle tension,and conscious abdominal cramping discomfort.The treatment should be Xiaojianzhong Decoction,Huangqi Jianzhong Decoction,etc.;"Li Ji"in modern Chinese medicine is mainly manifested as abdominal pain,distress,and frequent loosening.It is often accompanied by"Houzhong",and it should be used to remove heat and dampness such as Baitouweng Decoction and Shaoyao Decoction.A clear distinction between the two will not only help to understand Zhong-jing's original text,but also avoid mistake in clinical use of Jing Fang.