新安医家程原仲辨治郁证经验探析

Analysis of CHENG Yuanzhong's Experience in Treating Depression Syndrome

[目的]探析新安医家程原仲辨治郁证的经验。[方法]以《程原仲医案》为主要研究内容,结合《内经》、丹溪、河间等名家论著,整理、分析程原仲郁证验案,归纳、总结其辨治思路及特色。[结果]程氏认为,凡人身之滞而不通,皆为之郁。诊法上,程氏四诊合参,重视脉诊,擅于凭脉辨证。辨证论治方面,程氏认为,诸因皆可生郁,当各求其属,随证治之。虚可致郁,郁久易虚,解郁补虚须审察标本,谨守病机,同时重视脾胃中土的枢机作用。治疗时,若情志不舒、气机郁滞,治以开郁养心;若误用寒凉、血郁邪伏,治以开郁逐邪;若误用温补、气血郁滞,治以行气开郁。程氏临证善用古法而不泥古,常有独创之见,脾胃中土,畏其壅淤,郁则夺之,有硝黄下之,有桂附温之,亦有平胃散燥之,皆为“土郁夺之”之发挥。对于儿科患者的辨治,程氏重视气的生理作用,提出“幼无七情,惟气滞则诸病生焉”,治疗则重在调畅气机。[结论]程氏临床诊治郁证,善从脉证入手,治疗上注重调和脾胃中土和全身气机。整理分析程原仲郁证验案及其辨治特色,可为现代临床中此类疾病的治疗提供更广阔的思路。

[Objective]To explore CHENG Yuanzhong's experience in treating depression syndrome.[Methods]With the“CHENG Yuanzhong Medical Cases”as the main research content,combined with“Neijing”,the works of ZHU Danxi,LIU Hejian and other famous scholars,the author sorted out and analyzed the cases of depression syndrome treated by CHENG Yuanzhong,summarized his ideas and characteristics of syndrome differentiation and treatment.[Results]CHENG Yuanzhong thought that all the stagnation of human body was depression.In terms of diagnosis,based on synthesis of the four diagnostic methods,CHENG Yuanzhong paid more attention to the pulse diagnosis,and was good at distinguishing syndrome differentiation based on the pulse.In terms of syndrome differentiation and treatment,CHENG Yuanzhong considered all causes can lead to depression,which should be treated according to the syndrome.Weakness can result in depression,and depression also contributes to weakness easily,in order to relieve the depression or benefit the weakness,doctors needed to distinguish between superficial and fundamental causes,carefully guarded the pathogenesis.What's more,CHENG Yuanzhong attached importance to the role of middle-Jiao as a pivot.If there was emotional disorder,Qi circulation stagnation,relieving the depression and nourishing the heart should adopted.If the cold method was used wrongly,leading to blood stagnation and the pathogenic factors hidden,treatment should be relieve the depression and dispel the pathogenic factors.If the nourishing method was misused,leading to Qi and blood stagnation,expelling stagnation and relieving depression should be adopted.CHENG Yuanzhong was good at using ancient methods in clinical practice,but didn't follow them blindly.What's more,he got his own unique views that the spleen and stomach was afraid of stagnation,depression should be treated with dispelling,including purging with Natrii Sulfas and Rheum palmatum,warming interior with Cinnamomum cassia Presl and AconitiLateralis Radix,and drying with Pingwei powder,all of above was development of expelling therapy of gastro-stagnation.For differentiation and treatment of pediatric patients,CHENG Yuanzhong paid attention to the physiological role of Qi,and put forward that children had no emotional factors,all the reasons were the stagnation of Qi,so treatment should be focused on regulating Qi activities.[Conclusion]When treating depression syndrome,CHENG Yuanzhong was good at starting with pulse diagnosis and symptoms,and paid more attention to the harmony of spleen and stomach,and Qi activities.Sorting out and analyzing CHENG's cases of depression syndrome and its characteristics of syndrome differentiation and treatment can provide broader idea for the treatment of such diseases in modern clinical practice.