从痰饮病证治探仲景顾护脾胃思想

Discussion About Zhang Zhong-jing′s Thought of Protecting Spleen and Stomach in Synopsis of the Golden Chamber:Pulse Syndrome of Phlegm-Fluid Retention and Cough

《金匮要略·痰饮咳嗽病脉证》认为,痰饮病病机为脾阳不足,运化失司,水液代谢障碍,致水液停聚,生成痰饮;痰饮又作为新的致病因素,引起悬饮、溢饮、支饮。治疗原则为“病痰饮者,当以温药和之”,常用甘草、大枣、蜂蜜等甘温之品补脾护脾,苦温之品燥湿化痰,同时加入酸敛之品,与行气、消饮、通阳之品配合使用。该篇共选方20首,用药33味,分为5大类:(1)温阳化饮类,如苓桂术甘汤、肾气丸、五苓散、泽泻汤、小半夏汤等;(2)表里双解类,如大青龙汤、小青龙汤等;(3)疏导肠胃类,如己椒苈黄丸、厚朴大黄汤等;(4)泻水逐饮类,如葶苈大枣泻肺汤、甘遂半夏汤、十枣汤等;(5)扶正祛饮类,如木防己汤、木防己去石膏加茯苓芒硝汤等。组方时多以甘草、大枣、蜂蜜、饴糖等甘味药培补中气,使邪祛而脾胃不伤。本虚为主时,选苓桂术甘汤、泽泻汤、大青龙汤、己椒苈黄丸等,以甘草、生姜、大枣、白术等护脾胃而固本;标实为主时,选甘遂半夏汤,剂型用汤剂,以甘草、白蜜以及顿服法等顾护脾胃。并且在煎药、服药注意事项当中亦不忘顾护脾胃。

According to Synopsis of the Golden Chamber:Pulse Syndrome of Phlegm-Fluid Retention and Cough,the pathogenesis of phlegm-fluid retention and cough is the deficiency of spleen yang,the dysfunction of transportation and transformation,the disorder of water and fluid metabolism,resulting in the stagnation of water and fluid and the formation of phlegm-fluid retention;As a new pathogenic factor,phlegm-fluid retention causes pleural fluid retention,subcutaneous fluid retention and thoracic fluid retention.The treatment principle is that"those who suffer from phlegm-fluid retention should be regulated with warm medicine".Sweet and warm products such as Gancao(Radix Glycyrrhizae),Dazao(Fructus Jujubae),Fengmi(Mel),etc.are often used to supplement and protect the spleen,while bitter and warm products are used to dry dampness and dissipate phlegm.At the same time,acid and astringent products are added,which can be used in combination with products that promote qi,eliminate fluid retention and dredge yang.In this chapter,20 formulas are selected and 33 kinds of medicines are used,which can be divided into five categories:(1)The ones for warming yang and resolving fluid retention,such as Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction,Kidney Qi Pill,Five Substances Powder with Poria,Rhizoma Alismatis Decoction,Minor Pinellia Decoction,etc.(2)The ones for releasing both the exterior and interior,such as Major Green Dragon Decoction,Minor Green Dragon Decoction,etc.(3)The ones for dredging the intestines and stomach,such as Radix Stephaniae Tetrandrae and Semen Zanthoxyli andSemen Descurainiae seu Lepidii and Rhubarb Pill,Officinal Magnolia and Rhubarb Decoction,etc.(4)The ones for purging water and removing fluid retention,such as Lepidium and Jujube Lung-Draining Decoction,Radix Kansui and Pinellia Decoction,Ten Jujubes Decoction,etc.(5)The ones for reinforcing healthy qi and removing fluid retention,such as Cocculus Root Decoction,Cocculus Root Decoction Removing Shigao(Gypsum Fibrosum)plus Poria and Natrii Sulfas Decoction.When formulating formulas,sweet drugs such as Gancao(Radix Glycyrrhizae),Dazao(Fructus Jujubae),Fengmi(Mel),Yitang(Saccharum Granorum),etc.are often used to nourish the middle energizer qi,so as to dispel pathogens without damaging the spleen and stomach.In case of root deficiency,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction,Rhizoma Alismatis Decoction,Major Green Dragon Decoction,Radix Stephaniae Tetrandrae and Semen Zanthoxyli andSemen Descurainiae seu Lepidii and Rhubarb Pill,etc.are selected;Gancao(Radix Glycyrrhizae),Shengjiang(Rhizoma Zingiveris Recens),Dazao(Fructus Jujubae),Baizhu(Rhizoma Atractylodis Macrocephalae),etc.are often used to protect the spleen and stomach and consolidate the foundation.In case of excess of manifestations,Radix Kansui and Pinellia Decoction is selected,and the dosage form is the decoction.Gancao(Radix Glycyrrhizae)and white Fengmi(Mel)should be taken at each meal to protect the spleen and stomach.Besides,in decocting medicine and taking medicine,it is necessary to pay attention to protecting the spleen and stomach.