名老中医李鳌才辨治泄泻验案三则

Three tested cases of famous TCM doctor LI Aocai in differeation and treatment of diarrhea

目的:泄泻是中医临床常见病症,症状以排便频次增加、粪质稀溏或完谷不化甚至泻出如水样为主,可反复发作,迁延日久。文章总结李鳌才教授临证辨治泄泻的特色及经验。方法:通过跟诊学习的方法,收集整理李教授治疗泄泻的病案,选取三则典型临床诊疗验案,结合历代医家论述,分析并总结李教授辨治泄泻的学术思想及临床经验。结果:李教授认为泄泻具体病机可以分为两个方面:脾虚是泄泻之本,以脾阳虚为要,或兼脾肾阳虚;湿邪为主要病因,湿邪可外受亦可内生,可兼夹寒、热和食滞。临证时辨证重在辨虚实,虚者多见脾气虚、脾肾阳虚,实者多见里热、湿阻、食滞,多因素相兼、虚实夹杂者亦不少见。通过清热导滞、益气祛湿、健脾益肾、涩肠止泻等法合并诊疗的验案,因饮食积滞化热引起的热泄,李教授治以“食积泄”,拟推荡积滞,使食积去而泄自止法;因脾气虚引起的泄泻,拟以补脾益气法;因脾肾阳虚引起的泄泻,拟益肾健脾升阳法。李教授临证治疗泄泻遣方得体,配伍化裁,并酌情加以涩肠止泻之药治其标,疗效突出。结论:李教授融古贯今,辨治泄泻从虚实两端入手,随证施治,疗效确切,可以为临床提供更多的思路与方向。

Objective:Diarrhea is a common clinical disease in TCM,with symptoms such as increased frequency of defecation,loose stools or incomplete digestion,or even watery diarrhea,which can be recurrent and prolonged.The characteristics and experience of Professor LI Aocai in the clinical differeation and treatment of diarrhea is summarized.Methods:Through the method of follow-up study,the medical records of Professor LI in the treatment of diarrhea were collected and sorted out.Three typical clinical diagnosis and treatment cases were selected,and the academic thoughts and clinical experience of Professor LI in the treatment of diarrhea were analyzed and summarized in combination with the discussion of doctors in the past dynasties.Results:According to Professor LI,the specific pathogenesis of diarrhea can be divided into two aspects:deficiency of the spleen is the root cause of diarrhea,with spleen-Yang(阳)deficiency being the leading cause or it is accompanied with spleen-kidney-Yang deficiency;dampness is the main cause,which can be external or internal,and can be accompanied by cold,heat and food stagnation.Clinical syndrome differentiation focuses on the identification of the excess and the dificiency.In the case of deficiency,deficiency of the spleen and kidney Yang is the most common,while in the case of excess,internal heat,dampness and food stagnation are the most common,and it is not uncommon to see a combination of multiple factors and deficiency and excess.For diarrhea caused by heat and stagnation,Qi(气)and dampness,the treatment lies in strengthening the spleen and kidneys and relieving diarrhea with astringents to stop diarrhea,Professor LI treats“diarrhea caused by food stagnation”by removing the stagnation,so that the food stagnation can be removed and the diarrhea will stop;for diarrhea caused by spleen Qi deficiency,the professor proposes the method of tonifying the spleen and benefiting Qi;for diarrhea caused by spleen and kidney Yang deficiency,the Professor proposes the method of benefiting the kidneys and strengthening the spleen and kidney.Professor LI applies appropriate prescription which is modified and of high compatibility in the clinical treatment of diarrhea,and properly relieves diarrhea with astringents,the effect is outstanding.Conclusion:Professor LI’s approach in differentiation treatment of diarrhea is based on both deficiency and excess,which is with definite efficacy,and it can provide more ideas and directions for clinical practice.