摘要
[目的]探析张杰教授运用全真一气汤的临床经验。[方法]通过临床侍诊学习,选取张师运用全真一气汤治疗腋窝淋巴结炎术后、畏寒泄泻、早泄之验案3则,从方剂源流与方剂应用特色角度对《冯氏锦囊秘录·杂证大小合参》所载全真一气汤进行解读,并结合张师"虚、毒、瘀"理论、"脾阳为本"理论和现代药理研究成果,对验案进行研讨,以便进一步探析张杰教授运用全真一气汤的经验。[结果]全真一气汤由人参、制附子、熟地、麦冬、白术、牛膝、五味子组成,药少效宏。张杰教授继承并发展了冯氏重视"补气""滋阴""敛纳"三法的思想,强调人体阳气的主导作用,讲究药物剂量和炮制。并与时俱进,结合现代药理研究将全真一气汤古方今用,善抓"阳虚阴损"所致的临床指征与"虚、毒、瘀""久病多虚,久必及肾"这些核心病机,因证施治。案一患者行腋窝肿物切除术后,呈气阴两虚、浊毒内蕴、痰瘀互结证,治以益阴和阳、解毒散瘀、清化痰结;案二患者极度怕冷伴泄泻,为中阳极亏、营卫不足证,治以补脾助阳、温养营卫;案三患者早泄日久,属肾元不固证,治以固本培元。[结论]张师临床上辨证与辨病相结合,以"通利上焦""健运中焦""缓资下焦"三法,灵活化裁全真一气汤,治疗三焦之疾等各种疑难杂症,更加扩大了全真一气汤的应用范围,对当今临床有较好的指导作用。
[Objective] To explore Professor ZHANG Jie’s clinical experience in using Quanzhen Yiqi Decoction. [Methods] Through clinical study, this paper selected 3 cases of axillary lymphadenitis, chilly diarrhea and premature ejaculation treated by Professor ZHANG with Quanzhen Yiqi Decoction,and interpreted Secret Record of FENG’s Brocade Bag·Combination of Large and Small Syndromes from the perspective of the origin and application characteristics of the prescription in order to further explore Professor ZHANG’s experience in using Quanzhen Yiqi Decoction, through discussion of the theory of "deficiency, toxin and blood stasis" and "spleen Yang based" and modern pharmacological achievements. [Results] Quanzhen Yiqi Decoction was composed of Panax ginseng, Pripremljen akon, Rehmanija, Ophiopogon japonicus, Atraktilodi makrokefala, Achyranthes bidentata, Schisandra chinensis. Professor ZHANG inherits and develops FENG’s thought of "tonifying Qi" "nourishing Yin" and "absorbing", emphasizes the leading role of Yang Qi in human body, and emphasizes the dosage and processing of drugs. Professor ZHANG is good at grasping the clinical indications caused by"Yang deficiency and Yin damage" and the core pathogenesis of "deficiency, toxin, blood stasis" and "chronic disease with multiple deficiency, long time will reach the kidney", and treats according to the syndrome. In case one, after axillary tumor resection, the patient presented the syndrome of Qi and Yin deficiency, turbid toxin accumulation and phlegm and blood stasis, the treatment was to benefit Yin and harmonize Yang, detoxify and dissipate blood stasis, and clear phlegm and blood stasis. In case two, the patient was extremely afraid of cold with diarrhea, which was the syndrome of central Yang deficiency and lack of Ying and Wei, the treatment was to supplement the spleen, invigorate Yang, warming and nourishing Ying and Wei. In case three, the patient had premature ejaculation for a long time, which belonged to the syndrome of kidney essence deficiency, the treatment was to consolidate the foundation and cultivate the essence. [Conclusion] Professor ZHANG combines syndrome differentiation with disease differentiation in clinical practice, and flexibly use Quanzhen Yiqi Decoction to treat various difficult and miscellaneous diseases, such as diseases of tri-Jiao, with three methods of "making the upper-Jiao unobstructed" "strengthening the middle-Jiao"and "slowly nourishing the lower-Jiao", which further expands the application scope of Quanzhen Yiqi Decoction and has a better guiding role in today’s clinical practice.
作者
赵建根
李凯
杨佳
柳星
张杰
ZHAO Jiangen;LI Kai;YANG Jia(Anhui University of Chinese Medicine,Hefei(230012),China;Anhui Acupuncture and Moxibustion Hospital)
出处
《浙江中医药大学学报》
CAS
2021年第12期1301-1306,共6页
Journal of Zhejiang Chinese Medical University
基金
国家中医药管理局全国名老中医药专家张杰传承工作室建设项目(国中医药人教发[2012]149号)
安徽省省级师承培养项目(OP2000000511)
安徽中医药大学校级自然科学基金项目(2020zryb02)
国家级大学生创新创业训练计划项目(202010369098)。
关键词
全真一气汤
阳虚阴损
三焦
疑难杂症
冯兆张
张杰
名医经验
Quanzhen Yiqi Decoction
Yang deficiency and Yin damage
tri-Jiao
difficult and miscellaneous diseases
FENG Zhaozhang
ZHANG Jie
experience of famous doctors
