从五脏郁论治心系病证方药及验案举隅

Prescriptions and Clinical Experienceof Heart System Syndromes Treatment from Five Zang-Fu Organs Depression Syndrome

“五脏郁”是孙一奎继《内经》五郁发展而来,融《内经》五运、情志之郁论,易水学派之六郁论于其中,阐释五脏失调而出现的“郁”象,从而提出相应的治法方药。心系病证病位主要在心,且临床往往病程较长,常有多脏腑功能失调,其病理主要表现为血脉运行不利和情志思维活动的异常。文章以“心郁、肝郁、脾郁、肺郁、肾郁”之五脏郁为切入点,理论梳理与临证实践相结合,总结出“心郁发之,双心同治;肝郁达之,调气为先;脾郁夺之,坤静乾运;肺郁泄之,气清治节;肾郁折之,制水守蛰”的治疗思路,提出在恢复心主血脉与藏神功能的总治则下注重五脏郁的辨治,使五脏生理功能归于调顺;且进一步归纳出五脏郁的辨证要点及遣方用药规律,附以典型验案举例说明,以期加深对心系病证病因病机的理解,并为临床组方用药提供参考,同时亦丰富了中医学关于“郁”理论的研讨。

The theory of five Zang-Fu organs depression syndromes was developed by SUN Yikui which is based on the notion of “five depression syndromes” in Huangdi Neijing,combining with the depression from the five evolutive phases and emotion in Huangdi Neijing and six kinds of depression of Yishui School.This theory elaborates on the depression syndromes resulting from Zang-Fu organs dysfunction, thereby forming the corresponding “theory, principle, prescription and medicine”.The main location of heart system syndromes lies in heart, and its clinical course is often long, with multiple Zang-Fu organs dysfunction, and its pathology is mainly manifested by unfavorable operation of blood in the vessels and abnormal emotional thinking activities.This article takes the five Zang-Fu organs depression including “heart depression, liver depression, spleen depression, lung depression and kidney depression” as breakthrough point, and combining theoretical analysis with clinical practice, which concludes the therapy that the treatment of heart depression with the therapy of relieving can treat the psychosomatic diseases of heart system syndromes;the treatment of liver depression with soothing should pay attention to the treatment of Qi movement;the treatment of spleen depression with strengthening can make the functions of transportation and transformation of spleen harmoniously;the treatment of lung depression with dispersing can make lung Qi clear and govern management regularly;the treatment of tonifying to treat kidney depression can make Qi of kidney govern the storge and body fluid.This paper puts forward that the attention should be paid to the analysis of the five Zang-Fu organs depression under the general treatment principle of restoring the function of heart, governing blood vessels and storing spirit, so as to restore the physiological function of the five Zang-Fu organs.It further sums up the main points of syndrome differentiations and medication rules of the five Zang-Fu organs depression, together with an example of typical case, so as to deepen the understanding of the etiology and pathogenesis of heart system diseases, and provide a reference for clinical prescription with the usage of medicine.At the same time, it also enriches the research on the theory of “depression” in TCM.