王孟英论治老年便秘特色

Wang Mengying's Characteristics of Treating Elderly Constipation

“调愆”为王孟英治疗内伤杂病的法则,也是其治疗老年便秘的指导思想,具体为宣肺降气、疏肝平肝、燮理中焦三法。肺主一身之气,肺气宣发肃降则腑气通顺;肺为水上之源,肺叶布津则肠腑濡润,故王孟英常从肺论治便秘,对于他脏气机愆滞所致之便秘,王孟英仍以宣降肺气法治疗。肝气在左,其性升发;肺气在右,其性敛降,两脏气机一升一降,相互制约,称为“龙虎回环”,肺肝升降之环共司大肠的传导糟粕功能,故王孟英治疗老年便秘亦多从疏肝平肝论治。脾胃同居中焦,为气机运行之中轴,脾气不足,推动无力,胃不降浊,腑气不通,皆可导致便秘,故调理脾胃也是治疗老年便秘的重要途径。王孟英遣方用药注重气机的调畅,强调药贵流通、浊药轻投,与“调愆”思想相呼应。由于老年人年高体弱,王孟英虽用峻下药,只以丸药缓投,且临证寻察病因,兼顾体质。

"Regulating excess"is Wang Mengying's treatment concept for internal injuries and miscellaneous diseases,and it is also his guiding ideology for treating elderly constipation.Specifically,there are three methods:Ventilating the lung and directing qi downward,soothing and pacifying the liver,and harmonizing the middle energizer.The lungs control the qi of the whole body,and when the lung qi is released and descended,the visceral qi will become smooth.The lungs are the source of water,and the distribution of fluid in the lungs nourishes the intestines.Therefore,Wang Mengying often treats constipation from the lungs.For constipation caused by the stagnation of qi other organs,Wang Mengying always applies the method of ventilating and lowering lung qi.Liver qi is on the left,and its nature is ascending.The lung qi is on the right side,and its nature is converging and descending,and the two organs'qi mechanisms:ascending and descending,mutually constrain each other,known as the"Dragon-Tiger Returning Ring".The ascending and descending ring of the lung and liver jointly serve as the dross-conducting function of the large intestine.Therefore,Wang Mengying's treatment of elderly constipation is often based on soothing and pacifying the liver.The spleen and stomach coexist in the middle energizer,serving as the central axis for the movement of qi.Insufficient spleen qi,weakness in propulsion,inability to lower turbidity in the stomach,and obstruction of internal qi can all lead to constipation.Therefore,regulating the spleen and stomach is also an important way to treat elderly constipation.When choosing medicines and formulas,Wang Mengying emphasizes the smooth regulation of qi and circulation,and light administration of turbid medicines,which is in line with the idea of"regulating excess".Due to their elderly and weak physique,al-though Wang Mengying uses severe medication,he only takes pills carefully.There are also many excess syndromes of elderly constipation,and it is necessary to investigate the cause and take into account the physical condition in clinical practice.