刘华一基于“虚、滞”治疗痞满经验

Liu Hua-yi′s Experience of Treating Stuffiness and Fullness Based on"Deficiency and Stagnation"

刘华一教授认为,气血运行阻滞是痞满关键病机,因滞致虚,虚滞夹邪致脾胃升降失和,气机阻结于中焦,治疗应着眼于通,行气化瘀,燮理升降,同时酌情益气和胃,消补兼施,无问何证,均应稍加行气化瘀药物,如桔梗、枳壳、厚朴、枳实、柴胡、升麻、荷叶等。脾胃虚弱是本病的根本病机,治疗时应重视补虚健脾复运。脾虚主要包括脾气虚、脾阳虚、胃阴虚,脾气虚以人参、白术、黄芪等益气健脾;脾阳虚以黄芪建中汤、理中丸等温中补虚,建中焦阳气的同时合用苍术、豆蔻、砂仁等化湿;胃阴虚予女贞子、墨旱莲、麦冬、沙参、玉竹、石斛等甘凉濡润之品,或荷叶、淡豆豉等清养悦胃之品,使胃津得复,虚痞自消。寒热不调者,以和理之,以半夏泻心汤为主方;肝胃气滞者,理气为要,以四逆散为主方;脾虚湿阻者,消补兼施,用独活、乌药、半夏、炒鸡内金、陈皮等运脾祛湿。

Professor Liu Hua-yi believes that the obstruction of qi and blood circulation is the key pathogenesis of stuffiness and fullness of the spleen and stomach,which is caused by stagnation and leads to deficiency.The deficiency and stagnation of pathogenic factors lead to disharmony in the ascending and descending of the spleen and stomach,and the obstruction of qi movement is concentrated in the middle energizer.The treatment should focus on dredging,promoting qi circulation,resolving blood stasis,regulating ascending and descending,as well as supplementing qi and harmonizing the stomach appropriately,removing and tonifying simultaneously.No matter what syndrome,it is necessary to add some herbs for promoting qi and resolving blood stasis according to the situation,such as Jiegeng(Radix Platycodonis),Zhiqiao(Fructus Aurantii),Houpo(Cortex Magnoliae Officinalis),Zhishi(Fructus Aurantii Immaturus),Chaihu(Radix Bupleuri),Shengma(Rhizoma Cimicifugae),Heye(Folium Nelumbinis),etc.Spleen and stomach weakness is the fundamental pathogenesis of this disease,and attention should be paid to tonifying deficiency,strengthening the spleen and restoring circulation during treatment.Spleen deficiency mainly includes spleen qi deficiency,spleen yang deficiency,and stomach yin deficiency.For those with qi deficiency,Renshen(Radix Ginseng),Baizhu(Rhizoma Atractylodis Macrocephalae),Huangqi(Radix Scutellariae),etc.can be used to replenish qi and strengthen the spleen.For spleen yang deficiency,Astragalus Center-Fortifying Decoction,Center-Regulating Pill,etc.can be used to warm the middle and tonify the deficiency;At the same time,Canzhu(Rhizoma Atractylodis),Doukou(Fructus Amomi Rotundus)and Sharen(Fructus Amomi),etc.can be used to remove dampness.For stomach yin deficiency,Nvzhenzi(Fructus Ligustri Lucidi),Mohanlian(Herba Ecliptae),Maidong(Radix Ophiopogonis),Sharen(Fructus Amomi),Yuzhu(Rhizoma Polygonati Odorati),Shihu(Caulis Dendrobii),etc.which are sweet,cool and moistening products,or Heye(Folium Nelumbinis),Dandouchi(Semen Sojae Praeparatum),etc.which are can clear heat and nourish the stomach can be used to restore stomach fluid and eliminate deficiency stuffiness and fullness.For disharmony of cold and heat,the main formula is Pinellia Heart-Draining Decoction for harmony.For liver and stomach qi stagnation,regulating qi is essential,and the main formula is Frigid Extremities Powder.For spleen deficiency and dampness obstruction,removing and tonification should be focused together,so Duhuo(Radix Angelicae Pubescentis),Wuyao(),Banxia(Rhizoma Pinelliae),fried Jineijin(Endothelium Corneum Gigeriae Galli),Chenpi(Pericarpium Citri Reticulatae),etc.can be used.Patients are required to pay attention to a balanced diet,live regularly,nourish their essence and mind,in order to achieve such a state that"if one keeps yin even and yang firm,one′s spirit will be sound."