“治痿独取阳明”涵义解析及临床应用

Interpretation of“to treat wěi(atrophy,痿),select the yangming channel only”and its clinical application

近年来诸多医家对《黄帝内经》的“治痿独取阳明”的医理及临床应用进行了阐发,多认为“痿”即四肢痿废不用之意,多侧重于从“独取阳明”角度治疗重症肌无力等肢体病变。但作者认为,如此理解极大限制了此句经文的应用。本文基于“痿”字的文献涵义,结合现代疾病临床表现,提出“痿”与“萎”通,在微观层面凡是表现为器质性萎缩和功能退化性疾病,如萎缩性鼻炎、萎缩性胃炎、脏器下垂等,皆可以“独取阳明”立法诊治,且概括为补和泻2个方面的辨证治疗观,用药上以黄芪为主要药物,补气健脾兼通阳明之实滞。从而丰富了对理论的深层次认识,拓展本理论对临床的指导应用。

In recent years,many physicians have expounded the underlying theoretical foundation as well as clinical application of“to treat wěi(atrophy,痿),select the yangming channel only”in Huangdi Neijing(Huangdi's Internal Classic).Most of them think that“wěi(痿)”means that limbs are flaccid and not used.From the perspective of“selecting the yangming channel only”,they mostly focus on the treatment of limb diseases such as myasthenia gravis.However,we believe that the above-mentioned understanding greatly limits the application of this sentence.Based on the literary connotation of the word“wěi”and the clinical manifestations of modern diseases,this paper puts forward that both“flaccidity”and“atrophy”can be treated by selecting the yangming channel only at the micro level,which can be summarized as organic atrophy and functional degenerative diseases,such as atrophic rhinitis,atrophic gastritis,organ droopping,etc.In terms of syndrome differentiation and treatment of supplementation and purgation,Astragalus membranaceus is used as the main medicine to invigorate qi and spleen and eliminate the stagnation of Yangming.It enriches the deep understanding of the theory and expands the guiding application of the theory to clinical practice.