疏肝理气治胃病 疏肝理气.docx

疏肝理气治胃病 疏肝理气 摘 要：阐述疏肝理气在胃病治疗中的作用，探讨8种胃证的遣方用药方法。 关键词：胃病；中医治疗；疏肝理气 中图分类号：R259.73 文献标识码：A 文章编号：1673-7717(2008)03-0627-03 1 依照传统的中医理论，胃是水谷之海、多气多血之腑，生理上胃主受纳而不藏，喜条畅而恶抑郁，病理上由于各种病因侵扰胃腑，如：寒热不均、饮食失节、心情紊乱，或因脾胃自身失调而产生气血瘀滞，则胃病易生。肝主疏泄而藏血，因而肝与气血运行亲密相关，气血瘀滞时亦应责之于肝。此外，肝气犯胃是胃病产生的常见因素(木乘土依据五行学说)。因此，疏肝理气是治疗胃病的特别重要的一个方面。临床实践也证明：治疗有些胃证时假如处方中未包含疏肝理气之药，就难以奏效。 1 临床应用 临床上常选用气薄质清，能有效疏理肝胃不和之气的中药，如：柴胡、香附、佛手、木香、枳壳和陈皮。常用处方如：四逆散、柴胡疏肝散和金铃子散。胃脘疾病可归纳为以下8种证型。 1.1 脾胃气虚 证见：胃脘隐痛日久，饥则痛甚，食后痛缓，或痛势绵绵休无止时，纳减，便溏，头晕乏力，苔白薄腻，脉弦缓。证以痛势缓、病程长为特点。常用方药：党参、茯苓、焦冬术、炙甘草、广木香、陈皮、炒扁豆、焦谷麦芽、玫瑰花、苏梗、佛手、杭白芍。 加减：(1)若泛吐清水，可加代赭石、旋复花以镇降肝胃之逆气。(2)若腹痛肠鸣，便溏明显者，乃肝气乘脾为主，可加防风炭而成痛泻要方，另加车前草利小便以实大便。 1.2 肝胃寒凝 证见：胃痛暴作或隐隐，喜暖喜按，口不渴，喜热饮，苔薄白，脉弦紧。常用方药：吴茱萸、炮姜、党参、炙甘草、杭白芍、制香附，娑罗子、玫瑰花、广木香、佛手。 1.3 肝胃郁热 证见：胃脘胀痛，有灼热感，嘈杂不舒，嗳气泛酸，口干味苦，或见口舌糜烂，牙龈肿痛，大便燥结，苔薄黄，舌质红，脉弦数。常用方药：黄连、吴茱萸、红藤、蒲公英、绿萼梅、川楝子、香附、八月扎。 加减：(1)胃酸过多，可用乌贼骨、象贝以抑酸和胃。(2)胃酸过少，则用乌梅以促进胃酸分泌。(3)若口干甚，舌干少津，苔光，脉细者乃热伤胃阴，当酌加北沙参、麦冬、川石斛、天花粉以滋养胃阴。(4)大便干结，则用火麻仁、炙瓜蒌仁以润肠通便。 1.4 食结胃腑 证见：脘腹胀甚而痛，不思饮食，嗳腐吞酸或呕吐不消化食物，便溏不爽，苔白腻或黄腻，脉弦滑。常用方药：广木香、杭白芍、生甘草、川朴、焦冬术、茯苓、陈皮、枳壳、焦谷麦芽、鸡内金。 加减：若食积湿滞化热则加用黄芩、川连以清热化湿。 1.5 胆胃不和 证见：右胁难受牵及胃脘甚或肩背，嗳气，口苦，纳减，苔黄薄腻，脉弦。患者多有胆囊炎、胆结石病史。常用方药：柴胡、炒枳壳、杭白芍、生甘草、川楝子、鸡内金、金钱草、广郁金、忍冬藤、蒲公英、黄芩、制军。 1.6 肝血不足所致肝胃不和 证见：胃脘难受，胸闷嗳气，纳减，头晕乏力，寐劣心悸，面色不华，唇甲色淡，舌淡脉细。常用方药：当归、白芍、炙甘草、茯苓、柴胡、大枣、淮小麦、枸杞子、佛手、玫瑰花、绿萼梅、焦麦芽。 加减：若兼见头昏胀痛，恶心，烦躁，则属阴虚阳亢，可用生地、麦冬、川石斛、钩藤、石决明、代赭石、白蒺藜以平肝潜阳。 1.7 肺胃痰滞 证见：胃痛脘痞，痰多，胸闷，泛恶，纳食呆钝，苔白腻，脉滑。常用方药：制半夏、茯苓、陈皮、生甘草，杏仁、旋复花、淡竹茹、 代赭石、炒枳壳、川朴、苏梗、玫瑰花。 1.8 瘀血阻胃 证见：胃脘刺痛，痛处固定，舌见瘀斑或泛紫，脉弦涩。常用方药：当归、赤芍、白芍、炙甘草、玫瑰花、延胡索、橘络、郁金、旋复花、女贞子、墨旱莲。 加减：若胃痛继见呕血便血，用墨旱莲、仙鹤草收敛止血，藕节、参三七止血而不留瘀，加党参、黄芪以益气调血。 2 结 语 鉴于疏肝理气在胃病治疗中的重要性，临床上需留意选择味薄、气清之品，所用计量亦轻。盖气机郁滞变换不定，唯轻清灵动而不重浊滋腻之品调理气机最佳。且肝胃性刚而脾性柔，过刚易伤肝胃，过柔则易伤脾。故切记用药清轻，点到即止，以平为期。 Treatment of Stomach Disorder Through Liver Qi Regulation ZHANG Shu-yan (Zhejiang Province Hospital of TCM，Hangzhou 310006，Zhejiang，China) Abstract：This paper emphasizes the regulation of liver Qi in the treatment of stomach disorders and discussed recipes for the eight types of stomach problems. Keywords：stomach disorder；treatment of TCM；regulating liver Qi According to Traditional Chinese Medical theory，the stomach is the sea of food and water.When uninhibited，there is a natural free flow and the stomach is full of Qi and blood.However，in an unhealthy state with stagnation of Qi and blood，a pathological condition may easily occur due to various pathogenic factors：heat or cold attacking the body，irregular food intake，emotional disturbances and/or disorders originating in the stomach or spleen itself.The liver function is to maintain the Qi equilibrium and to store blood.Hence，the liver has a close relationship with Qi and blood circulation and is partially responsible when stagnation of Qi and blood occurs.Furthermore，liver Qi attacking the stomach is a common cause of stomach disorders(wood overacting earth according to the theory of five elements).Thus，regulation of the liver Qi is very important aspect in the treatment of stomach problems.It has also been proven in clinical practice that some stomach syndromes are difficult to cure if no herbs are included in the prescription to disperse and rectify the liver Qi. 1 Clinical application Herbs with a light，clearing nature that are effective to disperse and requlate unbalanced Qi of both the liver and stomach are usually selected，like：Chai Hu，Xiang Fu，Fuo Shou，Mu Xiang，Zhi Ke，and Chen Pi，for example.The common formulas are SiNi power，ChaiHu ShuGan power，and JingLingZi power. Stomach disorders can be classified in the 8 following types with different syndromes. 1.1 Deficiency of stomach and spleen Qi Manifestations chronic and dull stomach pain which is aggravated by hunger and alleviated after a meal，poor appetite，loose stool，dizziness，lassitude，a white，thin，sticky tongue coating with a wiry and slow pulse.Recipe：Dang Shen，Fu Ling，Bai Shu(burnt)，honey fried Gan Cao，Mu Xiang，Chen Pi，fried Bian Dou，Gu Ya(burnt)，Mai Ya(burnt)，Mei Gui Hua，Su Geng，Fuo Shou and Bai Shao. Supplementation： For watery regurgitation add Dai Zhe Shi and Xuan Fu Hua to reverse the adverse rising Qi of the liver and stomach. Abdominal pain，borborygmus and loose stool，which are indications of liver Qi attacking the spleen，maybe treated with TongXieYao reeipe which is Fang Feng(roasted)combined with the above listed herbs.To improve diuretion and to dry the stool，Che Qian Cao may also be added. 1.2 Accumulation of cold pathogenic factors in the stomach and liver Manifestations：sudden stomach pain which is relieved by warmth and pressure，no signs of thirst，preference for warm food，a thin white tonguecoating and a wiry tight pulse. Recipe：Wu Zhu Yu，dry-fried Jing Jiang，Dang Shen，honey-fried Gan Cao，Bai Shao，prepared Xiang Fu，Suo Luo Zi，Mei Gui Hua，Mu Xiang and Fuo Shou. 1.3 Accumulation of heat in the stomach and liver Manifestations：stomach distention and pain mixed with a burning sensation，thirst，a bitter taste in the mouth，dry stool sometimes with constipation，a thin yellow tongue coating，with a wiry and rapid pulse.Recipe：Huang Lian，Wu Zhu Yu，Hong Teng，Pu Gong Ying，Lu Mei Hua，Chuan Lian Zi，Xiang Fu and Ba Yue Za. Supplementation： Hyperc Lorhydria：Wu Zei Gu and Zhe Bei Mu added to control stomach acidity. Hypochlorhydria：Wu Mei can be added to promote stomach acidity. Thirst，a red dry tongue with no coating and thready pulse can be relieved by using Bei Sha Shen，Mai Dong，Shi Hu and Tian Hua Fen to nourish the Yin and strengthen the stomach fluids. Dry stool or constipation：utilization of Huo Ma Ren and honey-fried Gua Lou Ren to moisten the stool. 1.4 Food stagnation in stomach Manifestations：stomach distention and pain，lack of appetite，belching with fetid odour，sometimes vomiting of undigested food，loose stool but difficult to discharge，greasy white or yellow tongue coating and a wiry or slipperypulse. Recipe：Mu Xiang，Bai Shao，raw Gan Cao，Hou Pu，burned Bai Shu，Fu Ling，Chen Pi，Zhi Ke，burned Gu Ya，Burned Mai Ya and Ji Nei Jing. Supplementation：when stagnant food and the accumulated dampness rises to the heat，add Huang Qin and Huang Lian to resolve the dampness and to clear the heat. 1.5 Dishanmony between the gall bladder and stomach Manifestations：right hyperchondriac pain radiating to the stomach or right shoulder and back，belching，bitter taste in the mouth，loss of appetite，a thin yellow sticky tongue coating and wiry pulse.Usually the patient has a histoty of cholecystitis and cholelithiasis. Recipe：Chai Hu，fried Zhi Ke，Bai Shao，raw Gan Cao，Chuan Lian zi，Ji Nei Jing，Jing Qian Cao，Yu Jing，Ren Dong Teng，Huang Qin and prepared Da Huang. 1.6 Dishatmony between the liver and stomach caused by deficiency of liver blood Manifestations：stomach pain，congested chest，belching，loss of appetite，dizziness，lassitude，poor sleep，palpitation，pale complexion，pale tongue，pale eyelids and nails with a thready pulse. Recipe：Dang Gui，Bai Shao，honey-fried Gan Cao，Fu Ling，Chai Hu，Hong Zao，Huai Xiao Mai，Gou Ji Zi，Fuo Shou，Mei Gui Hua，Lu Mei Hua and Mai Ya(burnt). Supplementation：when headache，head distention，nausea or irritability are present，they signify Yin deficiency and hyperactivity of the Yang，raw Di Huang，Mai Dong，Shi Hu，Gou Teng，Shi Jue Ming，Dai Zhe Shi and Bai Ji Li are used to support the Yin and to eliminate excess Yang. 1.7 Phlegm stagnation in the stomach and lung Manifestations：sensation of fullness and/or pain in the stomach，excess sputum，congested chest，nausea，lack of appetite，white and greasy tongue coating with a slippery pulse. Recipe：Zhi Ban Xia，Fu Ling，Chen Pi，rao Gan Cao，Xing Ren，Xuan Fu Hua，Dan Ru，Dai Zhe Shi，fried Zhi ke，Hou pu，Su Gen and Mei Gui Hua. 1.8 Blood stasis causing obstruction in the stomach Manifestations：stabbing and fixed stomach pain，purplish tongue with a wiry and choppy pulse. Recipe：Dang Gui，Chi Shao，Bai Shao，honey-fried Gan Cao，Mei Gui Hua，Yan Hu Suo，Ju Luo，Yu Jing，Xuan Fu Hua，Nu Zhen Zi and Han Lian Cao. Supplementation：when stomach pain is followed by hematemesis and bloody stool，add astringent herbs such as Han Lian Cao，and Xian He Cao，Ou Jie and San Qi to stop bleeding and to avoid the side effect of blood stasis，add Dang Shen plus Huang Qi to tonify the spleen Qi in order to regulae the blood circulation. 2 Comment Since the regulation of liver and stomach Qi is so important in the treatment of stomach disorders，attention should be paid to select those herbs whose nature is light and clear with limitation on the quantity utilized.Because Qi stagnation fluctuates easily.Herbs of a slightly exciting nature and that are not heavy or sticky，are the best to promote the free-flow of Qi.Furthermore，since both the liver and stomach are strong organs whiIe the spleen is sensitive，utilization of herbs with a dry nature can easilv damage the liver and stomach，while herbs which are moist can hurt the spleen.The most important factor to be remembered in the treatment of stomach disorders is that balance restoration is the overall objective.