文章摘要
徐凤凯,陈晓.《内经》消瘅证治探[J].浙江中医药大学学报,2021,(2):139-141, 149.
《内经》消瘅证治探
Exploration and Analysis of the Pattern Differentiation and Treatment of Xiaodan Disorder in “Inner Canon of the Yellow Emperor”
投稿时间:2020-06-09  
DOI:10.16466/j.issn1005-5509.2021.02.007
中文关键词: 消瘅  黄帝内经  肾沥汤  虚劳病  外台秘要方  胸痹心痛病  腹满寒疝病  医案
英文关键词: Xiaodan Disorder  Inner Canon of the Yellow Emperor  Shenli Decoction  deficiency and consumption disease  Arcane Essentials from the Imperial Library(Waitai Miyao)  chest pain  ventral cold hernia  medical record
基金项目:上海市进一步加快中医药事业发展三年行动计划(2018—2020年)(ZY[2018-2020]-CCCX-2001-01)
作者单位E-mail
徐凤凯 上海中医药大学 上海 201203  
陈晓 上海中医药大学 上海 201203 121@126.com 
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中文摘要:
      [目的]探究《内经》消瘅之病的证治特点。[方法]以精究病源、深探方论、解析药说的方法并结合相关原文,从消瘅的病名机释、证治分型、病变机联等三个方面进行探析,并作医案举例。[结果]消瘅之病,是因五脏气血衰少、津液消灼而成,易现喘息短气、手足清冷、皮肤消薄、肌肉消瘦等象。在治疗上,偏元阴不足,虚阳外发外走,而见性情刚强、烦躁多怒、胸闷不舒、高横眉瞪眼等证者,可与《外台秘要方》肾沥汤,以补肺益肾、健脾养肝、宁心定志、强阴益精、养血止痛、清热生气;偏肥甘太过,内热炽生,消灼津液,而见喜冷肤热、消谷易饥、便黄如糜、善食而瘦等证者,可与《外台秘要方》宣补丸,以宣泄肠胃之内热、补益五脏之津气。所举案例属肺消瘅,乃精血衰少、形气不足所致,当以甘药调之,但因误治而脉道损伤、经络厥绝而死。[结论]消瘅之病,因气血衰少、津液消灼而成,病变日久,可现胸痹心痛病、腹满寒疝病、奔豚上气病、虚劳结气病、脚气冲心病等,可根据气血虚损之不同部位,津液消灼之不同程度,辨证选用丸、散、膏、汤,以消气血衰少、津液消灼之态。
英文摘要:
      [Objective] To explore and analyze the characteristics of the pattern differentiation and treatment of Xiaodan Disorder in “Inner Canon of the Yellow Emperor”(Huangdi Neijing).[Methods] By means of precise investigation into the disease causes, deep probation into the prescription commentaries and analysis of the herbs, this paper analyzes the three aspects of the explanation of disease name, syndrome differentiation, pathological mechanism, and makes a medical case as example. [Results] Xiaodan Disorder is caused by deficiency of Qi and blood in the five viscera and consumption of fluids, marked by panting, shortness of breath, cold hands and feet, thin skin and emaciation. For treatment, those with insufficiency of primordial Yin and outward movement of deficient Yang, marked by hard personality, irascibility, chest stuffiness and angry looks, can be treated with Shenli Decoction recorded in “Arcane Essentials from the Imperial Library”(“Waitai Miyao”) to tonify the lung and kidney, strengthen the spleen and nourish the liver, tranquilize the mind, replenish Yin and benefit essence, nourish blood, relive pain, clear heat and produce Qi; those with abundant internal heat and consumption of fluids due to excessive intake of sweet and greasy food, marked by preference for cold, hot skin, insatiable hunger, yellowish and loose stool, excessive food intake and emaciation, can be treated with Xuanbu Pill recorded in “Arcane Essentials from the Imperial Library” to disperse heat in the stomach and intestines and replenish fluid inside the five viscera. The case presented was Xiaodan Disorder of the lung, caused by a lack of renal essence, as well as essential blood and Qi. It should be corrected by Chinese medicine with a sweet taste. However, due to mistreatment, the patient died of damage to the meridians.[Conclusion] Xiaodan Disorder is caused by deficiency of Qi and blood and consumption of fluids. Eventually, it will lead to chest impediment and heartache, abdominal distension and cold hernia, sensation of Qi rushing upward(Bentun Qi), stagnated Qi due to deficiency consumption and cardiac beriberi. Clinically, according to the locations of Qi and blood deficiency and degrees of fluid consumption, different forms of prescription, such as pill, powder, ointment and decoction can be used to replenish Qi, blood and fluid.
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