《伤寒论》脐旁动气的证治思路

The treatment of Dong qi beside the navel in Shanghan Lun

“动气”指以肚脐周围跳动为特征的病证,首见于《难经》。《伤寒论》中的“脐上筑”“脐下悸”“心下悸”皆属动气范畴。通过整理《伤寒论》对脐上悸、脐下悸的治疗思路,总结出动气的病机为心、脾、肾三脏阳气虚衰,气化不利,而致水饮内停。水饮是造成动气的关键因素。动气为病,即使有表证,亦不可发汗、攻下,若误治则会虚其阳、竭其阴、动其水,以致变证丛生;扶其阳气,利其水邪方为正治之法。茯苓、桂枝是张仲景治疗脐上动气和脐下动气的常用药对,体现了健脾通阳、化气行水的治疗方法。元代医家张璧师法张仲景,以崇土利水法治疗动气,补脾并兼顾肝、心、肺、肾四脏的气机升降出入,创保命四气散(枳壳散、茯苓散、防葵散、前胡散),分别主治动气在脐之上、下、左、右,对临床治疗具有启发意义。

Dong qi,referring to beating beside the navel,was proposed for the first time by Nan Jing."Beating above the navel""beating below the navel",and"beating below the heart"in Shanghan Lun all belong to the category of Dong qi.The pathogenesis of Dong qi can be learned from Shanghan Lun.Yang deficiency of the heart,spleen,and kidney,with qi failing to transform body fluids,results in fluid retention.Fluid retention is the key etiological factor of Dong qi.Although there is an exterior pattern with Dong qi,the exterior-releasing and purgative method cannot be used for treatment,or the patient will be impaired of yang and exhausted of yin,fluid circulation will be disturbed,and so on.Reinforcing yang qi to drain water retention is the treatment principle of Dong qi.The coupled medicines of Fuling and Guizhi were commonly used by ZHANG Zhongjing to treat Dong qi.This reflects the treatment principle of strengthening the spleen and warming yang for transforming qi to circulate body fluids.ZHANG Bi,a physician from the Yuan Dynasty who learned from ZHANG Zhongjing,thought that the treatment of Dong qi was based on the method of cultivating earth to restrain water and taking into account the ascending,descending,entering,and exiting of qi of the liver,heart,lung,and kidney while tonifying the spleen,and then created Baoming Siqi Powder(Zhiqiao,Fuling,Fangkui,and Qianhu Powder)for the treatment of Dong qi,which is of great significance to the clinic.