《临证指南医案·噎膈反胃》辨治浅析

Analysis on Diagnosis and Treatment of Clinical Guide Medical Case·Dysphagia and Regurgitation

反胃、噎膈、关格为三种不同的病症,综合历代医家对三者的描述,认为三者可出现于食管癌的不同发展阶段。《临证指南医案·噎膈反胃》篇记载反胃、噎膈、关格三种病证,较为集中地反映了叶天士的学术思想。文章以医案为依托,治法为主线,总结反胃治则:益火之源、温暖脾胃;噎膈治则:噎证-甘寒以救阴,膈证-化痰降逆、通络祛瘀、通补胃阳;关格治则:交通阴阳。同时叶天士注重顾护肺胃之津液,善用辛开苦降之法,用药多选用苦辛甘之品,为后世医家治疗食管癌提供思路。

There are three different symptoms:regurgitation,dysphagia,obstruction and rejection.Based on the descriptions of doctors in the past dynasties,it is concluded that regurgitation,dysphagia,obstruction and rejection can appear in different stages of esophageal cancer.The article“Clinical Guide Medical Case Dysphagia and Regurgitation”records this three disease syndromes,and mainly reflects ye Tianshi s academic thought.This paper is based on medical cases and the main line of treatment,summarizes the principles of regurgitation:beneficial to the source of fire,warm the spleen and stomach;Principles of dysphagia:Choking syndrome-Gan Han to save Yin,Diaphragmatic syndrome-eliminating phlegm,dispelling blood stasis,tonifying stomach Yang;Principles of Obstruction and Rejection:Bring Yin and Yang together.At the same time,Ye Tianshi paid attention to the body fluid of lung and stomach,made good use of the method of acid to diffuse and bitter descend,and Ye Tianshi's thought has provided the thought for the treatment of esophageal cancer for later generations.