基于一气周流理论探讨苓蔻人参汤在溃疡性结肠炎治疗中的应用

Application of Lingkou Renshen decoction in the treatment of ulcerative colitis based on the theory of “one Qi circumference”

溃疡性结肠炎(Ulcerative Colitis,UC)是消化系统的常见病和多发病,病情容易反复发作、迁延难愈,严重影响患者的生活和健康,成为临床上难治性疾病之一。清代著名医家黄元御在《四圣心源》中提出“一气周流”理论,以“人体心、肝、肺、肾皆由脾胃所化生,人体气机以中土为轴,肝肾之气左升,心肺之气右降,循环周流”为主要内容。根据黄元御“一气周流”的学术思想探讨UC的病机和治法,认为UC的病机关键为水寒土湿,肝郁脾陷。基于以上的病机认识,本病的治疗应从整体把握脾、肝、肾等多脏气机的全局变化,在以温阳健脾,斡旋中气为临床治疗和遣方用药原则的同时,结合具体情况灵活施治,治理源头的同时兼及四维,以求达到土干、木达、水暖,帮助恢复人体一气的流通,使人体阴阳气血随着“周流之气”按部就班地各司其职,以求阴阳相济、气血归和,从而达到人即安和的状态。苓蔻人参汤出自《四圣心源》,为治疗泄利的经典方剂,其依理立方基于“木郁、土湿、水寒”的基本病机,通过条达肝气,益气补中,燥化水湿,以恢复人体的“一气周流”,在一定程度上能缓解甚至治愈疾病,为临床治疗UC提供了新的思路,值得后世医者的进一步研悟借鉴。

Ulcerative colitis is a common and frequently-occurring disease of the digestive system,which is easy to reoccur,prolonged and difficult to cure,seriously affecting the patient's life and health,and it is one of the clinically difficult diseases.HUANG Yuanyu,a famous doctor in the Qing Dynasty,put forward the theory of “one Qi(气) circumference” in Sisheng Xinyuan(四圣心源) which is based on the theory that “the heart,liver,lungs and kidneys of the human body are all produced by the spleen and stomach,and the human body's Qi is based on the axis of the middle earth,with the Qi of the liver and kidneys ascending to the left,and the Qi of the heart and lungs descending to the right,and the cycle of circumference” as the main content.According to HUANG Yuanyu's academic idea of “one Qi circumference”,the pathogenesis and treatment of ulcerative colitis are explored,and it is believed that the key to the pathogenesis of ulcerative colitis is water-cold and earth-dampness,and liver-depressing and spleen-depressing.Based on the above understanding of the disease mechanism,the treatment of this disease should be based on the overall grasp of the spleen,liver,kidney and other viscera Qi in the overall situation.While taking warming Yang(阳) and invigorating spleen and mediating Qi as the principle of clinical treatment and prescription medication,flexible treatment should be given according to specific conditions.At the same time,the treatment targets the source and the four dimensions,in order to achieve the goal of drying earth,stretching wood,and warming water to restore the flow of the body's Qi.It helps to restore the circulation of one Qi circumference in the human body,so that Yin(阴) and Yang(阳),Qi and blood of the human body can fulfill their responsibilities step by step with the “circulating Qi”,so as to achieve a state of peace.Lingkou Renshen decoction(苓蔻人参汤) is from Sisheng Xinyuan,and it is a classic formula for the treatment of diarrhoea.Its rationale is based on the basic pathogenesis of “wood depression,earth dampness and water coldness”,and it restores the “one Qi circumference” of the human body by organising the liver Qi,benefiting Qi and tonifying the middle,and drying up and transforming the water-dampness,which can alleviate or even cure the disease to a certain extent,providing a new way of thinking for the clinical treatment of ulcerative colitis,which is worthy of further study and reference for post-medical practitioners.