基于叶天士医案探讨阳虚体质胃阳虚证的经方论治

Treatment of stomach yang deficiency pattern in yang-deficiency constitution with classical formulas based on Ye Tianshi’s medical records

阳虚体质是九种基本体质类型之一,脾胃阳虚是阳虚体质的一种主要证型,在临床多种脾胃病证治中广泛出现。历代医家或以中阳统称脾胃阳气,或重脾阳而略胃阳,但是脾、胃的生理病理和治法方药各不相同。叶天士倡导脾胃分治,且尤其注重体质。本文从阳虚体质角度,对叶天士以经方辨治胃阳虚不同汤证的病机、证候、治法、方药的差异进行分析探讨,并结合具体医案详细阐释了阳虚体质胃阳虚不同层次的治法,如"通补胃气"的大半夏汤法,"通补胃阳"的附子粳米汤法等。从辨体-辨病-辨证相结合的角度,对胃阳虚证辨治规律进行总结,以供脾胃病的临床诊疗借鉴。

Yang-deficiency constitution is one of the nine basic types of constitution in traditional Chinese medicine(TCM), with yang-deficiency of the spleen and stomach disorders as the main pattern that is frequently observed in clinical practices. The ancient practitioners usually used middle yang to refer to the spleen and stomach yang, or simply used spleen yang only while omitting the stomach yang. However, the physiological and pathological characteristics, and treatment methods of the spleen and stomach disorders are different. Ye Tianshi advocated differentiated treatment for spleen and stomach and paid particular attention to body constitution. This paper analyzed the pathogenesis, pattern, therapeutic methods and classical formulas of stomach yang deficiency used by Ye Tianshi for yang-deficiency constitution;and expounded on different levels of therapeutic methods with specific medical cases combined, such as activating and tonifying stomach qi using Da Banxia Tang(Major Pinellia Decoction) and activating and warming stomach yang using Fuzi Jingmi Tang(Aconite and Rice Fruit Decoction), etc. The rules of pattern differentiation and treatment for stomach yang deficiency was summarized with differentiation of constitution, disease, and pattern combined, which might provide reference for clinical diagnosis and treatment of the spleen and stomach diseases.