论“土郁夺之”在《小儿药证直诀》中的运用

On the application of “When the spleen gets stagnant,expel the damp pathogens” in Xiao’er Yaozheng Zhijue

"土郁夺之"始见于《素问·六元正纪大论篇》,为中焦壅滞不得畅达。后世诸家多以邪实困阻脾胃立论。《小儿药证直诀》中"土郁"病机不仅限于邪实,亦含虚滞,治疗上不拘于攻下、涌吐等狭义"夺"法,而随证以清化宣畅、温运和中、消积化癖、补运兼施立法并重视脏腑间的生克制化关系,恢复脾胃与其他脏腑间的动态平衡,皆为"土郁夺之"之发挥,体现了钱乙治病求本的思想。结合钱乙具体方药探析《小儿药证直诀》"夺之"诸法,拓展了《黄帝内经》"土郁夺之"治则,为临证提供参考。

The statement of “When the spleen gets stagnant,expel the damp pathogens” is first recorded in Suwen·Liuyuan Zhengji Dalun Pian,meaning that the spleen qi grows stagnated and jammed in middle jiao to be unable to move smoothly.Therefore,physicians of later generations mostly argue that the syndrome is manifested as excessive pathogens retaining in and disturbing the spleen and stomach.However,according to Xiao’er Yaozheng Zhijue,the spleen stagnation syndrome is not only caused by the excessive damp,but also the deficiency of the spleen itself.Consequently,its treatment is not limited to those “expelling” methods such as purgation and emesis in its narrow sense,whereas other effective methods should be adopted according to certain specific syndromes,such as clearing,resolving,dredging,warming,transporting,tonifying,etc.,to dissipate the damp pathogens in the spleen,promote the spleen qi movement and regulate the stomach.At the same time,attention should be given to the dialectic relationship of generation,restriction,governing and transformation between the visceral organs,so as to restore the dynamic balance between the spleen and stomach and other viscera.All of the above arguments are the extension of the original statement of “When the spleen gets stagnant,expel the damp pathogens”,reflecting Qian Yi’s idea of treating diseases by identifying and focusing on root causes.Combining Qian Yi’s specific prescriptions and medication,the paper explores the “expelling methods” collected in Xiao’er Yaozheng Zhijue,hoping to expand its original treatment rule proposed in Huangdi Neijing and to provide a reference for clinical practice.