叶松从气论治肝胃郁热型膈肌痉挛

Professor YE Song Treating Phrenic Muscle Spasm of Liver-Stomach Stagnation-Heat Type from Qi Theory

文章主要介绍叶松教授运用中医药治疗肝胃郁热型膈肌痉挛的临床经验,叶松教授从事中医临床工作20余载,擅长消化性溃疡、慢性胃炎、慢性腹泻、功能性消化不良等脾胃病的诊治与研究,其中对膈肌痉挛的中医各证候特点及其治疗也有独到的见解。叶松教授认为呃逆的病位虽然在膈,但主要责之于脾、胃、肝、肺,其中脾的升清和胃的降浊气功能失调,导致中焦气机升降失调,浊气不降反升,则会出现呃声连连,发为呃逆;因此提出:"呃之要在于升降,治呃必先疏肝"的独到见解,重在通降,佐以升提,首重条达肝气,在其自拟方剂中以《伤寒论》经方旋覆代赭汤为基本方进行加减,保留了其核心组成旋复花、代赭石、半夏三味药物,从疏肝的立意出发,加入柴胡疏肝理气,加入竹茹可清热又可降逆,防止其郁而生热,特别是兼有便秘的患者,还要酌量加入杏仁以调节肺气的宣发与肃降,伸其治节;组方配伍时,善用药对,如使用升降药对时,使用檀香与降香,一升一降,升降相因,有助其脾胃气机的恢复,亦有使用性味功能相近之药对,如佛手与香橼皮,增强疏肝理气之功,郁热轻者,郁解热去,郁热显者,可加入丹皮、栀子仿丹栀逍遥散之意,而经方旋覆代赭汤经过不同医家化裁之后,可与西药、针灸等合使用治疗诸如顽固性呃逆、顽固性咳嗽等病,亦可单用治疗儿童抽动症等疑难杂症,其临床用途值得进一步挖掘。

This article mainly introduced professor YE Song’s clinical experience on treating diaphragmatic spasm of liver-stomach stagnation-heat type.Professor YE Song has been engaged in clinical work of traditional Chinese medicine for over 20 years.He is good at the diagnosis,treatment and research of spleen and stomach diseases such as peptic ulcer,chronic gastritis,chronic diarrhea,functional dyspepsia and so on.Professor YE Song believes that although the site of hiccup is the diaphragm,it is mainly responsible for spleen,stomach,liver and lung,among which the ascending and clearing of the spleen and the lowering of the turbid Qi function of the stomach are maladjusted,resulting in the ascending and descending of Qi in the middle Jiao,and the ascending of the turbid Qi,and then it would cause hiccup.Therefore,it is proposed that " the key point of diaphragmatic spasm is to ascend and descend,and the first step for treating diaphragmatic spasm is to soothe the liver".Its self-made formula is based on Xuanfu Daizhe Decoction(旋覆代赭汤) in Treatise on Febrile Disease,maintaining the three core drugs which were Xuanfuhua(Inulae Flos),Daizheshi(Ochre) and Banxia(Pinelliae Rhizoma).Starting from the purpose of soothing the liver,Chaihu(Bupleuri Radix) is added to soothe the liver and regulate Qi,and Zhuru(Bambusae Caulis In Taenias) is added to clear the heat and reduce its reversion,so as to prevent heat from the depression,especially in patients with constipation,the proper amount of Xingren(Armeniacae Semen Amarum) should be added to regulate lung Qi.The proper use of drug pairs,such as Tanxiang(Santali Albi Lignum) and Jiangxiang(Dalbergiae Odoriferae Lignum) is helpful for the recovery of Qi movement of spleen and stomach.There is also the use of drugs with similar natures and tastes,such as Foshou(Citri Sarcodactylis Fructus) and Xiangyuan(Citri Fructus) to enhance the liver and Qi-soothing effect.If the stagnated heat is light,it will relieve heat by itself.If the stagnated heat is heavy,Danpi(Moutan Cortex) and Zhizi(Gardeniae Fructus) can be added.After being treated by different doctors,Xuanfu Daizhe Decoction can be used in combination with Western medicine,acupuncture and moxibustion to treat diseases such as intractable hiccup and intractable cough,and can also be used solely to treat difficult and complicated diseases such as tic disorder in children,and its clinical use is worthy of further exploration.