《黄帝内经》“胆瘅”探析

Analysis of“Dandan”in Huangdi’s Canon of Internal Medicine

梳理《黄帝内经》中关于“瘅”的论述及古代医家的阐释,认为《黄帝内经》中“瘅”总不离“劳”“热”“黄”三义。分析胆瘅内涵,认为原文胆瘅是多虑劳胆致胆气郁而化热所出现的以口苦为主要临床表现的病证,后世分别从脏腑气血津液辨证、经络辨证及六经辨证等角度予以解读发挥。其治疗宜调整阴阳、疏胆降浊;针刺治疗实证宜选阳陵泉,虚郁宜选胆之募俞;药物治疗单药常选柴胡、兰叶(佩兰),复方常选刘完素之益胆汤和罗天益之龙胆泻肝汤。

By reviewing the analysis of“Dan”in the Huangdi’s Canon of Internal Medicine and the interpretations of ancient physicians,it is believed that the“Dan”in the Huangdi’s Canon of Internal Medicine always refers to three meanings:“overstrain”“heat”and“jaundice”.Analyzing the connotation of Dandan,it is believed in the original text that Dandan refers to a disease characterized by bitter taste in mouth caused by excessive anxiety straining gallbladder,gallbladder depression transforming into heat,which was interpreted and developed in later generations from the perspectives of syndrome differentiation based on zangfu-organs,qi,blood,body fluids,meridians,and six meridians.The treatment should regulate yin and yang,soothe gallbladder and reduce turbidity.Acupuncture treatment for excess syndrome should choose Yanglingquan(GB34),and for deficiency and depression syndrome should choose the Mu and Shu acupoints of the gallbladder meridian.Chaihu(Bupleuri Radix)and Lanye(Eupatorii Herba)are commonly used in the medication,while the most commonly used compound formulas are LIU Wansu’s Yidan Decoction(益胆汤)and LUO Tianyi’s Longdan Xiegan Decoction(龙胆泻肝汤).