谢晶日以土木升降相因理论治疗胆石症经验

XIE Jingri's Experience in Treating Cholelithiasis with the Theory of the Rise and Fall of Soil and Wood Depend on Each Other

[目的]探究谢晶日教授治疗胆石症的临床经验。[方法]通过门诊跟师学习,收集整理医案,对谢师治疗胆石症的理论基础、辨证特点和用药经验的独特之处进行总结,并附验案一则加以佐证。[结果]谢师认为,胆石症的病机以肝郁脾虚为本,湿热互结为因,胆腑瘀阻为标,并首次提出了“土木升降相因”理论,主张升发肝脾之气,和降胆胃之气,脾胃肝胆升降有序,则气机运转通畅,中焦生机不息,结石无由以生。临证时以升发肝脾、和降胆胃为纲,标本兼治,以复土木之升降;针对兼症,灵活采用利湿、化瘀等法。所举医案患者症状反复发作,为胆胀肝郁气滞兼相火炽盛证,治以疏肝行气、利胆通腑之法,临床症状好转,复查超声结石基本消失。[结论]谢师治疗胆石症注重肝脾同调,遣方用药灵活多变,疗效显著,其经验值得学习和推广。

[Objective]To explore the experience of Professor XIE Jingri in treating cholelithiasis.[Methods]By following out-patient study,collecting and sorting out records,this paper summarized the unique experience of Professor XIE in the treatment of cholelithiasis,which was based on the theoretical basis,syndrome differentiation characteristics,medication experience.And a medical case was presented to prove it.[Results]Professor XIE believes that the pathogenesis of cholelithiasis is based on liver depression and spleen deficiency,the mutual cause of dampness and heat is a reason,and the obstruction of cholecyst is appearance.Professor XIE puts forward the theory of“the rise and fall of soil and wood depend on each other”for the first time and advocates promoting Qi of the liver and spleen,and reducing the Qi of the gallbladder and stomach.The rise and fall of the spleen,stomach,liver and gallbladder are orderly,and the Qi circulates unobstructedly,the middle-Jiao is active that the stones do not occur.In the treatment of diseases,promoting the liver and spleen,and reducing the gallbladder and stomach should be taken as the principle,treating both symptoms and root so as to restore the rise and fall of the soil and wood.At the same time,the method of invigorating dampness and removing blood stasis should be flexibly adopted for complications.The patient's condition of the cited medical case recurred repeatedly,which was the syndrome of liver depression and hyperactivity of fire.After treated with soothing the liver and promoting Qi circulation,stimulating bile excretion and dredging intestines,the clinical symptoms were relieved,and ultrasound B showed that the calculi were almost gone.[Conclusion]In the treatment of cholelithiasis,Professor XIE pays attention to the harmonization of the liver and spleen,and the use of the prescription is flexible and effective.His experience is worth learning and popularizing.