程志清教授从脏腑气化论治高脂血症临床经验荟萃

Professor CHENG Zhiqing's Clinical Experience in the Treatment of Hyperlipidemia from Qi Transformation of Viscera

[目的]介绍与总结程志清教授从脏腑气化论治高脂血症的经验。[方法]通过跟随程志清教授抄方侍诊,总结程志清教授运用辨证思维从脏腑气化论治高脂血症的病因病机、临床诊疗思路及用药经验,并列举一则典型医案加以佐证。[结果]程志清教授认为脏腑气化失司是高脂血症形成发生的核心病机,有肝胆失疏、脾胃失和、心脉受损、肾气亏虚、三焦气化失常诸端,故临证时固本清源并施、标本兼顾,尤重疏肝理气、健脾和胃、化湿祛痰、活血化瘀、畅达三焦,恢复脏腑气化功能。所选医案患者确诊为高脂血症,该患者性情急躁,头晕纳差,更衣时干时稀,舌红苔腻,舌下络脉瘀紫,脉细弦,故辨证为肝郁脾虚、肝胆失疏、湿郁化热、血凝成瘀,治以调肝理气、健脾利湿、清化湿热、和畅三焦,获满意疗效。[结论]程志清教授从脏腑气化论治高脂血症,病因病机常见脾胃失和、肝胆失疏、心脉受损、肾气亏虚、三焦不畅等,治疗上从恢复脏腑气化入手,精准合理选择药物,疗效确切,其治疗经验具有较高的临床参考价值,值得深入学习和推广运用。

[Objective]To introduce and summarize the experience of Professor CHENG Zhiqing in the treatment of hyperlipidemia from Qi transformation of viscera.[Methods]Through following Professor CHENG’s clinical work and copying prescriptions,Professor CHENG’s etiology and pathogenesis,clinical diagnosis and treatment ideas and medication experience in treating hyperlipidemia from the perspective of Qi transformation of viscera were summarized and a typical medical case was listed as proof.[Results]Professor CHENG believes that failure of Qi transformation of viscera is the core pathogenesis of hyperlipidemia.Therefore,in clinical practice,doctors should pay attention to consolidate the source and clear the source and take into account both the manifestations and the root causes.There are liver and gallbladder disorders,spleen and stomach disorders,damage of heart channel,kidney Qi deficiency,and Tri-Jiao disorders.The emphasis should be put on soothing the liver and regulating Qi,invigorating the spleen and harmonizing the stomach,eliminating dampness and removing phlegm,promoting blood circulation and removing blood stasis,making tri-Jiao work smoothly,and restoring the function of Qi transformation of viscera.The medical case was diagnosed as hyperlipidemia,and the patient had an impetuous temper,dizziness,poor appetite,dry or diarrhea when defecating,red tongue and greasy coating,blood stasis under the tongue,and narrow pulse.Therefore the syndrome differentiation was liver depression and spleen deficiency,liver and gallbladder dysfunction,dampness stagnation transforming to heat,blood coagulation leading to stasis,so the treatment was to regulate the liver and regulate Qi,invigorate the spleen and eliminate dampness,and clear dampheat,harmonize and make tri-Jiao work smoothly,which eventually achieved a satisfactory effect.[Conclusion]Professor CHENG Zhiqing treats hyperlipidemia from the theory of visceral Qi transformation.Etiology and pathogenesis such as disharmony of the spleen and stomach,dysfunction of the liver and gallbladder,damage of heart channel,deficiency of the kidney Qi,and failure of tri-Jiao to work smoothly are common.With the treatment of restoring the function of Qi transformation of viscera,Professor CHENG chooses drugs accurately and reasonably,and has a definite effect.The experience and ideas have high clinical reference value and are worthy of in-depth study and popularization.