基于汤液经法图从肝分期论治心理性阳痿浅述

Discuss on the treatment of psychic impotence from liver staging based on the atlas of Tang Ye Jing Fa

汤液经法图相传是伊尹所撰《汤液经法》的关键配伍原理图,对历代医家临床用药都具有重要的指导作用。肝郁作为心理性阳痿的主要病机,在其疾病的发生演变各个阶段的表现又有所不同。本文以汤液经法图五脏虚实辨证理论和五味补泻用药理论为主,结合团队从肝分期治疗心理性阳痿的临证经验,认为心理性阳痿早期典型临床表现符合“肝实证”的病证特点,由于“肝德在散”,故应采用以“以辛补之,以酸泻之”为主的组方治疗,临床用药上可采用柴胡、蒺藜、芍药等一系类辛酸之品;心理性阳痿中期典型临床表现符合“肝实脾虚证”的病证特点,就其虚实夹杂的病机特点,联合“脾德在缓”的特性,治疗上当在肝实证治法的基础上合以“以甘缓之,以甘补之”,用药方面除了使用辛味药、酸味药,还可加入人参、炙甘草等;心理性阳痿后期典型临床表现符合“肝虚及肾证”的病证特点,又因“肾德在坚”的特性,故采用“以辛酸补之,以甘苦润之”为主的组方思路,得坚闭肾阴,辛酸化阳,酸甘化阴,阴阳并补之效,辨证处方上可主用生地、芍药、干姜之品。

The atlas of Tang Ye Jing Fa is the key principle diagram of Tang Ye Jing Fa written by Yi Yin,which has an important guiding role for clinical medicine in past dynasties.As the main pathogenesis of psychological impotence,liver depression has different manifestations in different stages of the disease.Based on the theory of syndrome differentiation of deficiency and excess of five zang-organs in the atlas of Tang Ye Jing Fa and the theory of reinforcing and reducing drugs,combined with the clinical experience of treating psychological impotence from liver staging,it is believed that the typical clinical manifestations of psychological impotence in the early stage are in accordance with the characteristics of“liver excess syndrome”,and that because“Gan De Zai San”should be treated with the prescription of“Reinforcing with pungent herbs and reducing with acid”.The typical clinical manifestation in the middle stage of psychological impotence accords with the characteristics of the syndrome of“deficiency of liver-excess and spleen-deficiency”,according to the characteristics of the pathogenesis of the syndrome of deficiency and excess,combined with the characteristic of“the spleen morality is slow”;the treatment should be based on the treatment of liver excess syndrome combined with“to slow it down and to fill it up with Gan”;in addition to the use of acrid drugs,sour drugs can be added to ginseng,baked licorice,etc.The typical clinical manifestations of late stage of psychological impotence accord with the characteristics of"liver deficiency and kidney syndrome";and because of the characteristic of“kidney virtue is firm”,we adopt the method of“nourishing the kidney with the pungent and acid,and moistening it with sweetness and bitterness”,to strengthen and close the kidney Yin,transform Yang by the pungent and acid,transform Yin by acid and sweet,Yin and Yang complement effect;the prescription of syndrome differentiation can be mainly used raw soil,peony,dry ginger.