《伤寒杂病论》心下诸症浅析

An Analysis of Various Symptoms Under the Heart in Treatise on Cold Damage and Miscellaneous Diseases

心下是人体的运化中枢,脾胃为后天之本,百病之源,全身各脏腑经络之气的升降沉浮均围绕中土脾胃运转,机体任何一部位产生的病理变化均可能影响到心下。心下诸症变化多端,主要包括悸、满、濡、坚、硬、痞、闷、急、痛、呕、结等,病证本质是水停心下、胃家实、水结于胸腹、胃有邪热、邪留半表半里、胃中虚、气机失调冲逆、邪气结在胸中、妇人产后外感等,治疗上以利尿祛水解表、攻下祛实、攻实散水结、祛热下火除烦、补中和胃祛邪为原则,采用小青龙等解表散饮、承气汤等攻实泄下、陷胸汤等泄热逐水、泻心汤等清泄邪热、柴胡汤等和解少阳、五苓散等健脾利水。但处方用药不可单一而概括之,需要因时因人因地制宜,也需抓主症明病机,辨证施治。

The area under the heart is the transportation center of the human body.The spleen and stomach provide the material basis of the acquired constitution and the source of all diseases.The ascending, descending, floating and sinking of the qi in the viscera and meridians of the whole body revolve around the central spleen and stomach.Pathological changes in any part of the body may affect the area under the heart.Various diseases under the heart are changeable, mainly including palpitations, fullness, sogginess, hardness, stuffiness, urgency, pain, vomiting, stagnation, etc.The essence of the disease syndrome is water retention under the heart;stomach excess, water retention in chest and abdomen, the stomach having pathogenic heat, pathogen remaining half exterior and half interior, deficiency of stomach, disorder of qi movement, pathogenic qi stagnated in the chest, women′s postpartum external contraction, etc.The treatment is based on the principle of inducing diuresis and releasing exterior, purgation and removing excess, purging excess ad dispersing water retention, clearing heat and removing agitated vexation, supplementing the middle energizer, harmonizing the stomach and eliminating pathogens, etc.Therefore, Minor Green Dragon Decoction is often used to release the exterior and disperse retention;Major or Minor Purgative Decoction is often used to purge excess;Major or Minor Chest-Draining Decoction is often used to purge heat and expel water;Heart-Draining Decoction is often used to clear pathogenic heat;Bupleurum Decoction is often used to harmonize lesser yang meridian;Five Substances Powder with Poria is often used to invigorate the spleen and induce diuresis.However, drug use of a formula cannot be summarized in a single way.It is necessary to adjust according to exact time, people and local conditions, focus on the main symptoms, find out the pathogenesis, and achieve the satisfactory treatment based on combination of corresponding formula and syndrome.